The social diagnostics of stroke-like symptoms: healers, doctors and prophets in Agincourt Limpopo Province, South Africa

This paper focuses on the clinical and social diagnostics of stroke-like symptoms in Limpopo Province, South Africa. The research questions addressed here are: what are the lay understandings of strokelike symptoms and what are the health-seeking behaviours of Tsongan Mozambican refugees and South Africans in this area? The study site is ten villages in the Agincourt sub-district of Limpopo Province which are within the health surveillance area of the Agincourt Health and Population Unit (AHPU) of the University of Witwatersrand. The population are Tsongan who speak Shangaan and comprise self-settled Mozambican refugees who fled to this area during the 1980s across the nearby border and displaced South African citizens. The latter were forcibly displaced from their villages to make way for game reserves or agricultural development and moved to this area when it was the former ‘homeland’ of Gazankulu. The team collected data using rapid ethnographic assessment and household interviews as part of the Southern Africa Stroke Prevention Initiative (SASPI). The main findings are that stroke-like symptoms are considered to be both a physical and social condition, and in consequence plural healing using clinical and social diagnostics is sought to address both these dimensions. People with stroke-like symptoms maintain their physical, mental and social well-being and deal with this affliction and misfortune by visiting doctors, healers, prophets and churches

Assessing the effectiveness of a longitudinal knowledge dissemination intervention: Sharing research findings in rural South Africa

Knowledge dissemination interventions (KDIs) are integral to knowledge brokerage activities in research as part of the ethics of practice, but are seldom evaluated. In this case study, we critically reflect on an annual KDI as part of knowledge brokerage activities in the MRC/Wits-Agincourt Unit health and demographic surveillance system (HDSS) in rural South Africa from 2001 to 2015. The HDSS findings on births, deaths and migrations, as well as nested research project results, were shared with villagers, village leaders and service providers. The data used for this case study comprised secondary analysis of 13 reports and 762 evaluation forms of annual village-based meetings; records of requests for data from stakeholders; and qualitative analysis of 15 individual and five focus group interviews with local leaders and service providers involving 60 people. Over time, the KDI evolved from taking place over one week a year to being extended over six months, and to include briefings with service providers and local leaders. Attendance at village-level meetings remained low at an average of 3 per cent of the total adult population. Since 2011, the KDI village-based meetings have developed into an embedded community forum for discussion of topical village issues. There has been a decrease in requests for health-care and other services from the research unit, with a concurrent increase in research-related questions and requests for data from service providers, village leaders and political representatives. We conclude that, in this setting, the dissemination of research findings is not a linear exchange of information from the researchers to village residents and their leadership, but is increasingly multi-directional. KDIs are a key component of knowledge brokerage activities and involve, influence and are influenced by other aspects of knowledge brokerage, such as identifying, engaging and connecting with stakeholders and supporting sustainability

Issues of gender, reflexivity and positionality in the field of disability : researching visual impairment in an Arab society

This article examines how the social and cultural context influence the way in which field research methods are utilized. Research methods need to be modified to meet the sensibilities and sensitivities of particular social groups and settings. Through a reflexive analysis of a research study on the lives of visually impaired young people and adults in Bahrain, this article discusses how gender, religion and culture need to be taken account of. It also discusses how the research process needed to take account of the participants’ disabilities. It examines the issues of research access, informed consent, researcher’s dress, confidentiality, research location, and time. It highlights how the gender of the researcher was constraining in some gender segregated educational settings in a Muslim society. The article engages with the researcher’s positionality through reflexive discussion

Sites for health rights: Local, national, regional and global

This Part-Special Issue seeks to capitalize on emerging work at the intersection of studies of global health, the right to health and ‘the spatial turn’ in the social sciences. The articles included address globally applicable research from a range of disciplines. The relevance of the right to health cuts across traditional disciplinary boundaries. The Part-Special Issue contributes to debates by presenting empirical and theoretical work from public health, social policy, political science, geography, anthropology and socio-legal studies. Attention to the right to health has increased in the last three decades mainly due to HIV/AIDS. Nevertheless, the spatial component of how to implement the right to health has been neglected by researchers, policy makers and practitioners compared to other, legal aspects of the right to health

Advocating multi-disciplinarity in studying complex emergencies : the limitations of a psychological approach to understanding how young people cope with prolonged conflict in Gaza

The paper looks at the limitations and strengths of using the A-cope questionnaire for measuring strategies for coping with prolonged conflict by Palestinian young people in Gaza. The scale was administered to young people between the ages of 8 and 17. The results show some gender differences in coping strategies. However, some items on the subscales are not relevant for Muslim societies or societies in situations of prolonged conflict. The authors suggest that combining an anthropological contextual perspective and qualitative data with psychological instruments is an effective way of addressing the limitations of using a single quantitative method of assessment in non-Western complex social and cultural settings

The rise of injecting drug use in east Africa: a case study from Kenya

Studies on injecting drug use in East Africa are reviewed. The existingstudies document the spread of heroin injection in Kenya and Tanzania, both countries where HIV rates are high. No data from Uganda on injecting drug use was found by the authors. A case study of the growth of heroin injection in a Kenyan coastal town is presented. The need for needle-exchange programmes and other prevention services is discussed

Dilemmas of Ethics in Practice in Longitudinal Health Research: Identifying Opportunities for Widening Participation of Residents

Background: Mechanisms for widening participation of local participants in research studies can improve governance of public health research. Research conducted in longitudinal health study areas depends on there being mutual trust and respect over time between the local residents and researchers. Ethics in practice needs consideration alongside procedural ethics. By widening participation of the experimental public—local residents and resident service providers—ethics in practice and accountability are strengthened.Methods: The study was undertaken in a longitudinal health study area in rural South Africa using multiple qualitative methods. The sample included 35 individual and five group interviews with resident local leaders and service providers, 24 individual and eight group interviews with residents of the study area, and ten researchers' reflections on two critical incidents from ethnographic field notes on dilemmas of ethics in practice. The interviews were all audio-recorded (besides one where consent to record was not given) and then transcribed verbatim and translated from Shangaan into English. Thematic analysis was conducted.Results: Residents requested the reporting back of personal screening test results from research studies, and raised informed consent issues. Researchers recognized the importance of mechanisms to increase their accountability to residents throughout the research process, and the complexity of informed consent and fieldwork procedures within research studies.Conclusion: This study elicited the views of residents and researchers in a longitudinal health study area to seek guidance on how to strengthen participation in research governance. Three strategies were identified by participants to widen participation of the experimental public. Firstly, increasing study budgets so that individual screening test results could be personally delivered back to participants. Secondly, more rigorous field staff training in informed consent and study procedures with ongoing monitoring and supervision from researchers. Thirdly, increased earlier involvement of residents in research protocol development through study advisory groups. Additional strategies include deeper involvement of Community Advisory Groups and more focused dissemination of research results to specific audiences. In general, there is a need to identify strategies for increased accountability of researchers and participatory governance through involvement of the experimental public in all aspects of longitudinal public health research as part of the ethics in practice and democratization of science

Use of applied theatre in health research dissemination and data validation: a pilot study from South Africa

This article reports on a pilot study of the use of applied theatre in the dissemination of health research findings and validation of data. The study took place in South Africa, as part of the Southern Africa Stroke Prevention Initiative (SASPI) and was based at the University/Medical Research Council Rural Public Health and Health Transitions Research Unit (also known as the Agincourt Unit). The aim of SASPI was to investigate the prevalence of stroke and understand the social context of stroke. It was decided to use an applied theatre approach for validating the data and disseminating findings from the anthropological component of the study. The pilot study found that applied theatre worked better in smaller community groups. It allowed data validation and it elicited ideas for future interventions resulting from the health research findings. Evaluation methods of the impact of applied theatre as a vehicle for the dissemination and communication of research findings require further development

The Emergence of the Arms Trade Treaty as a Global Norm Cluster

The Arms Trade Treaty brings together a number of small arms control norms into one instrument and is a new initiative, which was instigated by state and NGO norm entrepreneurs. This thesis attempts to understand what has led to the emergence of these norms in the Arms Trade Treaty, in what will be termed a ‘cluster’ of small arms norms. Examining the small arms norms associated with the Arms Trade Treaty will explain their development and their likelihood of successfully being incorporated into this instrument. Analysis of the development of the norms related to the Arms Trade Treaty will explore the relationship between norms, their promoters and their opponents. This thesis will do this by providing detailed analysis of the development of specific norms in a series of case studies: control over arms brokering, transfers to non-state actors and civilian possession. It will place this development within the broader context of the ATT instrument and the international society in which it is emerging into. This thesis finds that power and powerful states have a significant role to play in the emergence of norms, in some cases despite the efforts of norm promoters. Norms were not able to emerge in their original form due to the influence of powerful states, which resulted in norms evolving in different directions or not emerging at all

Formative evaluation of a training intervention for community health workers in South Africa : a before and after study

Background Community Health Workers (CHWs) have a crucial role in improving health in their communities and their role is being expanded in many parts of the world. However, the effectiveness of CHWs is limited by poor training and the education of CHWs has received little scientific attention. Methods Our study was carried out in two districts of KwaZulu-Natal, South Africa. We developed and piloted an inexpensive (two day) training intervention covering national government priorities: HIV/AIDS, sexually transmitted disease and Tuberculosis; and Women’s Sexual and Reproductive Health and Rights. Sixty-four CHWs consented to participate in the main study which measured knowledge gains using a modified Solomon design of four different testing schedules to distinguish between the effects of the intervention, testing and any interaction between intervention and testing. We also measured confidence, satisfaction and costs. Results Following the training intervention, improvements in knowledge scores were seen across topics and across districts. These changes in knowledge were statistically significant (p<0.001) and of large magnitude (over 45 percentage points or four standard deviations). However, the CHWs assigned to the test-test-train schedule in one district showed high gains in knowledge prior to receiving the training. All CHWs reported high levels of satisfaction with the training and marked improvements in their confidence in advising clients. The training cost around US$48 per CHW per day and has the potential to be cost-effective if the large gains in knowledge are translated into improved field-based performance and thus health outcomes. Conclusion Training CHWs can result in large improvements in knowledge with a short intervention. However, improvements seen in other studies could be due to test ‘reactivity’. Further work is needed to measure the generalisability of our results, retention of knowledge and the extent to which improved knowledge is translated into improved practice