Hiding or hospitalising? On dilemmas of pregnancy management in East Cameroon

Current international debates and policies on safe motherhood mainly propose biomedical interventions to reduce the risks during pregnancy and delivery. Yet, the conceptualisations of risk that underlie this framework may not correspond with local perceptions of reproductive dangers; consequently, hospital services may remain underutilised. Inspired by a growing body of anthropological literature exploring local fertility-related fears, and drawing on 15 months of fieldwork, this paper describes ideas about risky reproduction and practices of pregnancy protection in a Cameroonian village. It shows that social and supernatural threats to fertility are deemed more significant than the physical threats of fertility stressed at the (inter)national level. To protect their pregnancies from those social and supernatural influences, however, women take very physical measures. It is in this respect that biomedical interventions, physical in their very nature, do connect to local methods of pregnancy management. Furthermore, some pregnant women purposefully deploy hospital care in an attempt to reduce relational uncertainties. Explicit attention to the intersections of the social and the physical, and of the supernatural and the biomedical, furthers anthropological knowledge on fertility management and offers a starting point for more culturally sensitive safe motherhood interventions

Financial barriers to HIV treatment in Yaoundé, Cameroon: first results of a national cross-sectional survey

Objective To assess the extent to which user fees for antiretroviral therapy (ART) represent a financial barrier to access to ART among HIV-positive patients in Yaounde, Cameroon. Methods Sociodemographic, economic and clinical data were collected from a random sample of 707 HIV-positive patients followed up in six public hospitals of the capital city (Yaounde) and its surroundings through face-to-face interviews carried out by trained interviewers independently from medical staff and medical questionnaires filled out by prescribing physicians. Logistic regression models were used to identify factors associated with self-reported financial difficulties in purchasing ART during the previous 3 months. Findings Of the 532 patients treated with ART at the time of the survey, 20% reported financial difficulty in purchasing their antiretroviral drugs during the previous 3 months. After adjustment for socioeconomic and clinical factors, reports of financial difficulties were significantly associated with lower adherence to ART (odds ratio, OR: 0.24; 95% confidence interval, CI: 0.15-0.40; P < 0.0001) and with lower CD4+ lymphocyte (CD4) counts after 6 months of treatment (OR: 2.14; 95% CI: 1.15-3.96 for CD4 counts < 200 cells/mu l; P= 0.04). Conclusion Removing a financial barrier to treatment with ART by eliminating user fees at the point of care delivery, as recommended by WHO, could lead to increased adherence to ART and to improved clinical results. New health financing mechanisms based on the public resources of national governments and international donors are needed to attain universal access to drugs and treatment for HIV infection

Understandings and Responses to Domestic Violence in the African Great Lakes Communities of Western Sydney

The project is a partnership between the Sexualities and Genders Research initiative of Western Sydney University (WSU) and the Great Lakes Agency for Peace and Development (GLAPD). The project is guided by three research questions: what are the views and attitudes of Great Lakes community members in Australia on domestic violence within their communities?; what are the views and experiences of health professionals on domestic violence in the Great Lakes community?; and how can health and welfare responses to domestic violence in the Great Lakes community be improved? We found five overlapping themes to be core to understandings and responses to domestic violence. These were cultural dissonance resulting from migration and displacement; responsibility within and outside of communities; trust; cultural codes of shame and respect; and broader social and structural factors such as racism and socio-economic disadvantage arising from unemployment. Our recommendations were for education within the Great Lakes communities, and of service providers; building trust within Great Lakes communities and between service providers and these communities; and legal sanctions as a last resort