Mark NICHTER, Global Health: Why Cultural Perceptions, Social Representations, and Biopolitics Matter

Le nouveau livre de Mark Nichter, portant sur la santé globale, est issu d'un rapport commandité par le programme spécial OMS-UNICEF-PNUD-Banque mondiale de recherche et de formation concernant les maladies tropicales (TDR). Il passe en revue l'état des recherches en sciences sociales sur la compréhension culturelle des maladies tropicales et la santé des enfants et des femmes. Son objectif principal est d'explorer les perceptions et représentations des populations locales des pays en dévelop..

Stigma and Therapy Completion for Latent Tuberculosis among Haitian-origin Patients

A prospective cohort study of LTBI treatment conducted within the Haitian population of South Florida investigated the predictive association between illness-related stigma among patients near the beginning of treatment and completion of preventive therapy. Factors associated with perceived stigma were also investigated. Ninety patients from Broward and Palm Beach counties were administered a questionnaire that included items related to illness history, perceptions and understanding of latent tuberculosis, and a 25-item stigma scale adapted from previously developed measures of tuberculosis-related stigma. Therapy completion was determined through a follow-up chart review. Data analyses compared patients who completed therapy with those who defaulted on a number of variables including perceived stigma. No association was found between perceived stigma or demographic characteristics and adherence to preventive therapy. Perceived stigma was associated with patient report of illness-related distress and was higher among patients who were lost to follow up. Some evidence suggested that stigma was higher among contacts of cases, patients with limited understanding of the condition, and patients who were more closely monitored during treatment. Case management should focus on patient-centered approaches to education and counseling about LTBI that address patient understanding of the condition and concerns about its physical and psychosocial effects

Factors Associated with Institutionalization for Treatment of Active Tuberculosis: A Synopsis from In-depth Patient Interviews

To increase the effectiveness of therapeutic regimens for tuberculosis (TB) and to reduce the societal risks for both infected and uninfected individuals, it is beneficial to be able to predict factors associated with non-adherence to treatment. The purpose of this study was to acquire detailed case histories of TB patients admitted to a hospital setting and to gain a better understanding of how patients explain the life events leading up to their admission for treatment. Twenty-one patients with active TB were interviewed concerning their knowledge of TB, diagnosis and treatment history, recent history prior to hospitalization, reactions to and life changes associated with having TB, and future life intentions following treatment. Three situations were identified that contributed to institutionalization: inability to carry out self-care; need for specialized care to address conditions beyond the patient’s control; and failure to follow the therapeutic regimen. Results confirmed known risk factors for acquisition of TB, situations that delay diagnosis and treatment, and variables that influence adherence and defaulting. Coordinated case management of multiple problems co-occurring with TB treatment may contribute to improved adherence. Consideration of psychosocial and economic needs is important to patient care. Improved communication between health care personnel and patients may enhance the likelihood of successful directly observed therapy (DOT) outside of an institutionalized setting. Some circumstances may preclude non- institutionalized care. These findings bring a dimensional richness to understanding of the patient’s view of the disease and institutionalized care

Allocation of family resources for health care in rural Haiti

A household survey of 230 episodes of infant and child illness in rural Haiti was analyzed to identify sociocultural and environmental factors that determine allocation of family resources for health care. The analysis tested the hypothesis that expenditures of time and money would vary according to expectations about the prognosis for the disease in question, the age and sex of the child, the household composition and family structure, and seasonal fluctuations in weather and financial resources. The results show that these factors are significant predictors of resource allocation, although they do not always produce the kind of influence that was hypothesized. The findings emphasize the importance of cultural and ecological variables, as well as of purely medical and economic factors, in understanding family response to illness. The importance of nonmometary resources (such as the free time available to adult family members) in that response is also indicated. The study has methodological and practical implications for Haiti and other areas.

Adoption of oral rehydration therapy among Haitian mothers

The paper reports findings from a study of mothers' knowledge and use of oral rehydration therapy (ORT) for childhood diarrhea in a mixed urban and rural population in Haiti. From the perspectives of the adoption of a medical innovation and the decision to use it in various situations, we assessed the differential exposure to information about the treatment and identified sociocultural factors which predict ORT knowledge, utilization, and choice between alternative methods of preparation (packaged mix versus home recipe). Three hundred and twenty mothers and caretakers of preschool children were given a questionnaire to compare respondent characteristics and attributes of recent episodes of child diarrhea in relation to knowledge and use of ORT. The data were analyzed with multiple regression techniques to determine which factors had independent effects on 6 outcome variables. Significant effects were found for urban/rural residence; literacy; economic position; use of medical services; conjugal status; and the explanatory model of the effect of ORT. No characteristics of diarrheal episodes had predictive effects in the multivariate analyses.oral rehydration therapy innovation adoption Haiti

'New age' healing in the U.S.

This paper provides a conceptual overview of the 'New Age' phenomenon and of 'New age healing' concepts which have gone virtually unaddressed in social science research, health-related or otherwise. First, drawing upon diverse sources, the authors attempt to define 'New age', after which they discuss those medical, spiritual, and sociocultural developments which help account for the rise of new age healing in the U.S. Next, a comprehensive review of over a dozen schemata of healing, healers, and medical systems fails to provide a satisfactory classification of new age healing. Finally, by analyzing data derived from primary and secondary source materials on 81 healing systems or techniques identifying themselves with the new age, a typology of new age healing itself is inductively generated. Three general modes are found: mental or physical self-betterment, esoteric teachings, and comtemplative practice. These types of new age healing place primary emphasis, respectively, on body, mind and soul.new age holistic health religion and medicine parapsychology

Social and psychological costs of preventive child health services in Haiti

Much of the research on determinants of health service utilization has focused on economic and cognitive variables which influence preventative health behavior. Our ethnographic study of maternal perceptions of the barriers and incentives to immunization use in Haiti underscores the importance of 'hidden' social and psychological costs of utilization, such as embarrassment, fear, child care difficulties, and competing demands on maternal time. Findings from focus group interviews with mothers, individual interviews with health care providers, and observation at health posts identified five categories of maternal factors (competing priorities, low motivation, socioeconomic constraints, fears about health or social consequences, knowledge and folk beliefs) and five categories of system factors (accessibility, acceptability, availability, accomodation, affordability) which can deter immunization completion. The discussion focuses on how these factors influence maternal decision-making regarding use of preventive child health services. More attention is needed on the psychosocial costs of health behavior in developing country settings.utilization of services child health psychosocial costs Haiti