El paludismo y otras penurias. Salud y desigualdades de género en Tanzania

A pesar de todos los esfuerzos realizados para controlar la malaria, esta enfermedad protozoaria sigue siendo uno de los principales azotes del continente africano. En los grupos más vulnerables a la enfermedad, particularmente los niños menores de cinco años, el tratamiento rápido con medicación adecuada es la única manera de prevenir la muerte u otras graves consecuencias de la enfermedad. Los datos de este artículo proceden de una etnografía médica realizada en Lipangalala, una comunidad tanzana que basa su economía en el cultivo del arroz, y donde la malaria es holoendémica. Lipangalala se distingue del panorama médico africano general por una larga historia de presencia biomédica. En la actualidad cuentan con un hospital bien equipado, la biomedicina es la primera opción para el tratamiento de la malaria, existe un buen conocimiento del problema fruto de numerosas campañas de salud y, sin embargo, el paludismo sigue siendo la primera causa de mortalidad infantil, con unas cifras muy por encima de lo que cabría esperar en estas condiciones. En Lipangalala, más que con las ‘creencias’ o la disponibilidad de recursos, la terapia antipalúdica tropezaba con la falta de dinero y las dificultades para conseguirlo. En este artículo nos enfocamos en la búsqueda de recursos para pagar el tratamiento,un proceso clave, aunque a menudo olvidado por los investigadores, para comprender el problema del acceso a la terapia en toda su dimensión. Concretamente presentamos los procesos de toma de decisiones, los itinerarios sociales – normativos y reales – que las madres de niños enfermos siguen para conseguir dinero del padre u otros parientes, las estrategias activadas para hacer frente a los costes del tratamiento, el contexto socio-económico y ecológico que condiciona estos procesos, y el papel determinante de las desigualdades de género. Contrariamente al objetivo dominante en las investigaciones actuales en salud pública, orientadas a dilucidar los factores determinantes del retraso terapéutico, aquí proponemos una perspectiva a la vez procesual y estructural, que permite articular y contextualizar los elementos en juego, así como reconstruir las espirales de vulnerabilidad en las que están inmersas las personas de Lipangalala

Malaria in pregnancy: what can the social sciences contribute?

Building on existing knowledge from social science work on malaria, the authors propose two models for studying social science aspects of malaria in pregnancy

Пойменные ценокомплексы Красноярского водохранилища в районе залива реки Убей

Текст работы публикуется с изъятиям

Per una reflexió crítica sobre la noció de mestissatge

A través d'una anàlisi històrica i transcultural de l'Europa cristiana, el món jueu, àrab-musulmà, subsaharià, indígena americà i crioll, el projecte actual busca explicar l'origen, el procés, els sentits, les justificacions socials i culturals i els usos contemporanis del concepte de "mestissatge", l'espai social de les barreges i els ponts culturals, per desenvolupar una proposta des de l'antropologia històrica d'anàlisi dels mestissatges com a categories i com a fenòmens socioculturals.Through a transcultural and historical analysis of Christian Europe, Jewish, Arabic- Muslim, Subsaharian, American Indigenous and Creole Worlds, the current project is intended to explain the origin, process, meanings, social and cultural justifications and the current uses of "hybridation" concept. Also, the project tries to understand the social space and the barriers and cultural bridges for developing a proposal from the Historic Anthropology for these categories and those sociocultural phenomena

Low perception of malaria risk among the Ra-glai ethnic minority in south-central Vietnam: implications for forest malaria control

BACKGROUND: Despite Vietnam's success in reducing malaria mortality and morbidity over the last decade, malaria persists in the forested and mountainous areas of the central and southern provinces, where more than 50% of the clinical cases and 90% of severe cases and malaria deaths occur. METHODS: Between July 2005 and September 2006, a multi-method study, triangulating a malariometric cross-sectional survey and qualitative data from focused ethnography, was carried out among the Ra-glai ethnic minority in the hilly forested areas of south-central Vietnam. RESULTS: Despite the relatively high malaria burden among the Ra-glai and their general awareness that mosquitoes can transmit an unspecific kind of fever (84.2%), the use of bed nets, distributed free of charge by the national malaria control programme, remains low at the farmers' forest fields where the malaria risk is the highest. However, to meet work requirements during the labour intensive malaria transmission and rainy season, Ra-glai farmers combine living in government supported villages along the road with a second home or shelter at their slash and burn fields located in the forest. Bed net use was 84.6% in the villages but only 52.9% at the forest fields; 20.6% of the respondents slept unprotected in both places. Such low use may be explained by the low perception of the risk for malaria, decreasing the perceived need to sleep protected. Several reasons may account for this: (1) only 15.6% acknowledged the higher risk of contracting malaria in the forest than in the village; (2) perceived mosquito biting times only partially coincided with Anopheles dirus ss and Anopheles minimus A true biting times; (3) the disease locally identified as 'malaria' was hardly perceived as having an impact on forest farmers' daily lives as they were unaware of the specific kind of fevers from which they had suffered even after being diagnosed with malaria at the health centre (20.9%). CONCLUSIONS: The progressive confinement of malaria to minority groups and settings in the Greater Mekong sub-region implies that further success in malaria control will be linked to research into these specific socio-cultural contexts. Findings highlight the need for context sensitive malaria control policies; not only to reduce the local malaria burden but also to minimize the risk of malaria spreading to other areas where transmission has virtually ceased

What Role Do Traditional Beliefs Play in Treatment Seeking and Delay for Buruli Ulcer Disease?–Insights from a Mixed Methods Study in Cameroon

Victims of Buruli ulcer disease (BUD) frequently report to specialized units at a late stage of the disease. This delay has been associated with local beliefs and a preference for traditional healing linked to a reportedly mystical origin of the disease. We assessed the role beliefs play in determining BUD sufferers' choice between traditional and biomedical treatments.Anthropological fieldwork was conducted in community and clinical settings in the region of Ayos and Akonolinga in Central Cameroon. The research design consisted of a mixed methods study, triangulating a qualitative strand based on ethnographic research and quantitative data obtained through a survey presented to all patients at the Ayos and Akonolinga hospitals (N = 79) at the time of study and in four endemic communities (N = 73) belonging to the hospitals' catchment area.The analysis of BUD sufferers' health-seeking behaviour showed extremely complex therapeutic itineraries, including various attempts and failures both in the biomedical and traditional fields. Contrary to expectations, nearly half of all hospital patients attributed their illness to mystical causes, while traditional healers admitted patients they perceived to be infected by natural causes. Moreover, both patients in hospitals and in communities often combined elements of both types of treatments. Ultimately, perceptions regarding the effectiveness of the treatment, the option for local treatment as a cost prevention strategy and the characteristics of the doctor-patient relationship were more determinant for treatment choice than beliefs.The ascription of delay and treatment choice to beliefs constitutes an over-simplification of BUD health-seeking behaviour and places the responsibility directly on the shoulders of BUD sufferers while potentially neglecting other structural elements. While more efficacious treatment in the biomedical sector is likely to reduce perceived mystical involvement in the disease, additional decentralization could constitute a key element to reduce delay and increase adherence to biomedical treatment