Nonbiomedical stroke practitioners in Aceh

This is the accepted version of the following article: Norris, M., Allotey, P. and Barrett, G. (2011), Nonbiomedical stroke practitioners in Aceh. International Journal of Stroke, 6: 152–154. doi: 10.1111/j.1747- 4949.2010.00575.x, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2010.00575.x/abstract.Stroke resources in Indonesia are limited; however, there has been demand to include nonbiomedical practitioners in stroke care. This paper will present a snapshot of available nonbiomedical stroke ‘services’ used by stroke survivors in two subdistricts of Aceh, Indonesia. Data were collected through interviews, observations, focus groups and vignettes with stroke survivors, their carers, biomedical and nonbiomedical stroke practitioners. Two categories of nonbiomedical practitioners were identified, all of whom discussed and demonstrated an understanding and approach to stroke treatment with multiple layers of influence, predominantly, education, religion and culture. There were a number of areas of overlap between the two categories; some of these influences were also evident in the biomedical practitioners

Structure, (governance) and health: An unsolicited response

Background: In a recently published article, it was suggested that governance was the significant structural factor affecting the epidemiology of HIV. This suggestion was made notwithstanding the observed weak correlation between governance and HIV prevalence (r = .2). Unfortunately, the paper raised but left unexamined the potentially more important questions about the relationship between the broader health of populations and structural factors such as the national economy and physical infrastructure. Methods: Utilizing substantially the same data sources as the original article, the relationship between population health (healthy life expectancy) and three structural factors (access to improved water, GDP per capita, and governance) were examined in each of 176 countries. Results: Governance was found to be significantly correlated with population health, as were GDP per capita, and access to improved water. They were also found to be significantly correlated with each other. Conclusion: The findings are discussed with reference to the growing interest in structural factors as an explanation for population health outcomes, and the relatively weak relationship between governance and HIV prevalence

'It burdens me': The impact of stroke in central Aceh, Indonesia

This is the accepted version of the following article: Norris, M., Allotey, P. and Barrett, G. (2012), ‘It burdens me’: the impact of stroke in central Aceh, Indonesia. Sociology of Health & Illness, 34: 826–840. doi: 10.1111/j.1467-9566.2011.01431.x, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/j.1467-9566.2011.01431.x/abstract.The complex primary and secondary consequences of stroke have often been equated with the concept of biographical disruption, although a number of mediating factors have been identified. However, the research to date is almost exclusively based in western contexts, despite the fact that stroke is increasing most rapidly in low-income and middle-income countries. This research explores the experience of stroke in the rural community of central Aceh, Indonesia. The participants included 11 stroke survivors and 18 carers, with data collected through in-depth interviews and photographic facilitated interviews, supported with participant observation over a nine month period. The participants discussed and illustrated the disruptive result of their stroke, but for most, their ability to maintain religious duties and contribute to their family resulted in a form of biographical continuity. Their strategies and challenges are discussed alongside the implications for care in this context

Socioeconomic inequalities in access to health care: Examining the case of Burkina Faso

Copyright @ 2011 Johns Hopkins University PressThe past decade has recorded remarkable interest in socioeconomic inequalities in health care. A multivariate analysis of the World Health Survey data for Burkina Faso was conducted using STATA. This included questions on household economic factors, perceived need, and access to health care. Poverty was defined using Principal Components Analysis. There was no significant difference in perceived need on the basis of poverty or gender. The less poor accessed health care more than the poor, but this difference was significant only among males. Respondents who lived in urban areas accessed health care more than those in rural areas, but this difference was significant only among females. We argue that health care financing arrangements affect self-reported need and access to health care. Even when they perceive need, the poor do not access care, probably because of cost, exacerbated by non-availability of readily accessible health care facilities

"Social Medication" and the control of children: A qualitative study of over-the-counter medication among Australian children

Objective. The aim of the study was to identify the patterns of use of over-the-counter (OTC) medications among children. Methods. The study used a qualitative design, with in-depth interviews of 40 parents with children <5 years of age. Results. There were 3 striking and readily apparent themes in the use of OTC medications among children. One was the administration of OTC medications as a form of “social medication,” to give parents control over children’s behavior that they perceived as fractious and irritating. A related theme was the use of OTC medications to reduce the inconvenience to the parents of having a sick child, again giving parents greater control and better time-management abilities. Finally, acetaminophen was considered by many parents to have almost miraculous properties in calming, sedating, and lifting the mood of children. Conclusions. The use of OTC medications for the treatment of minor ailments among children is widespread, despite the lack of evidence of efficacy of the most commonly used medications and the potential for toxicity. With the increasing propensity to look to medication as a means of supporting changing lifestyles, there is an urgent need to review the prevalence and effects of social medication. Pediatrics 2004; 114:e378 –e383. URL: http://www.pediatrics.org/cgi/ content/full/114/3/e378; parental stress, parental perception, child behavior, drug safety, over-the-counter

"I feel like half my body is clogged up": Lay models of stroke in Central Aceh, Indonesia

This is the post-print version of the final paper published in Social Science and Medicine. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2010 Elsevier B.V.Stroke in low and middle income countries is an increasing cause of death and disability, with rates and the estimated burden considerably higher than that of high income countries. Lay explanatory models are believed to be one of the major influences on health seeking behaviour and essential to understand for appropriate education strategies. Despite stroke being a considerable health concern in Indonesia and particularly in Aceh, no studies to date have explored lay stroke models in that context. This paper presents the findings of a qualitative study informed by both hermeneutic phenomenology and ethnography. Based in rural communities in Bener Meriah and Aceh Tengah in Central Aceh, Indonesia, data were gathered through interviews, photographs and observations with 11 persons with stroke (aged 32–69 years) and 18 of their carers. Fieldwork was conducted over nine months between 2007 and 2008. The study examined lay concepts of stroke, described as a condition resulting from a local blockage in blood from multiple causes, many of which are not recognised within the biomedical frame. The blockage is understood to be reversible and therefore the condition curable. This understanding is embedded and sustained in the specific political, cultural, religious and social context. The results illustrate similarities and differences with other cross-cultural studies and suggest areas of future research and points of consideration for stroke education strategies

Health systems performance in sub-Saharan Africa: Governance, outcome and equity

Copyright @ 2011 Olafsdottir et al.BACKGROUND: The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. METHODS: Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. RESULTS: Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. CONCLUSION: This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalizability beyond U5MR as a health outcome measure, as well as the geographical generalizability of the results

Behaviour Change in Public Health: Evidence and Implications

Article ID 598672The evidence on the role of particular lifestyles, smoking, binge drinking, lack of physical activity, and poor health care seeking, in increased risks for mortality and morbidity is compelling [1]. Understanding the pathways through which these various “unhealthy” behaviours affect health is complicated by the broader ecological context in which they occur. The complexity is further enhanced because behaviours do not occur in isolation and there is often a convergence of associations. Interventions to achieve changes in either single or multiple behaviours have therefore often been limited in their effectiveness and longer term sustainability. In order to develop and implement a meaningful behaviour change agenda we need to establish innovative ways of operationalizing and understanding the complexity of behavioural factors and their dynamic interrelationships and how these collectively affect health. The Behaviour Change Research Cycle (BCRC) (Figure 1) provides a simple illustration of the life cycle of evidence required