The acceptability of intermittent preventive treatment of malaria in infants (IPTi) delivered through the expanded programme of immunization in southern Tanzania

BACKGROUND\ud \ud Intermittent preventive treatment of malaria in infants (IPTi) reduces the incidence of clinical malaria. However, before making decisions about implementation, it is essential to ensure that IPTi is acceptable, that it does not adversely affect attitudes to immunization or existing health seeking behaviour. This paper reports on the reception of IPTi during the first implementation study of IPTi in southern Tanzania.\ud \ud METHODS\ud \ud Data were collected through in-depth interviews, focus group discussions and participant observation carried out by a central team of social scientists and a network of key informants/interviewers who resided permanently in the study sites.\ud \ud RESULTS\ud \ud IPTi was generally acceptable. This was related to routinization of immunization and resonance with traditional practices. Promoting "health" was considered more important than preventing specific diseases. Many women thought that immunization was obligatory and that health staff might be unwilling to assist in the future if they were non-adherent. Weighing and socialising were important reasons for clinic attendance. Non-adherence was due largely to practical, social and structural factors, many of which could be overcome. Reasons for non-adherence were sometimes interlinked. Health staff and "road to child health" cards were the main source of information on the intervention, rather than the specially designed posters. Women did not generally discuss child health matters outside the clinic, and information about the intervention percolated slowly through the community. Although there were some rumours about sulphadoxine pyrimethamine (SP), it was generally acceptable as a drug for IPTi, although mothers did not like the way tablets were administered. There is no evidence that IPTi had a negative effect on attitudes or adherence to the expanded programme on immunisation (EPI) or treatment seeking or existing malaria prevention.\ud \ud CONCLUSION\ud \ud In order to improve adherence to both EPI and IPTi local priorities should be taken into account. For example, local women are often more interested in weighing than in immunization, and they view vaccination and IPTi as vaguely "healthy" rather preventing specific diseases. There should be more emphasis on these factors and more critical consideration by policy makers of how much local knowledge and understanding is minimally necessary in order to make interventions successful

Fear and rumours regarding placental biopsies in a malaria-in-pregnancy trial in Benin.

BACKGROUND: A multi-country, community-based trial on scheduled screening and treatment for malaria in pregnancy was conducted in Benin, The Gambia and Burkina Faso. Despite standardized procedures and outcomes, the study became subject to rumours and accusations of placenta being sold for mystical and financial gain by trial staff, leading to drop-out rates of 30% and the consequent halting of placental biopsy sampling in Benin. This paper explores the role of socio-cultural beliefs related to placenta and identified additional factors contributing these rumours. METHODS: A qualitative comparative emergent-theory design was used to assess social factors related to trial implementation and uptake in the three countries. Data from participant observation, informal conversations, group discussions and interviews were triangulated and analysed with NVivo Qualitative Analysis software. RESULTS: Despite similar sociocultural beliefs about the sacred nature of the placenta in all three study countries, these beliefs did not affect participation rates in Burkina Faso and The Gambia and placenta-related rumours only emerged in Benin. Therefore, the presence of beliefs is not a sufficient condition to have generated placenta-selling fears. The rumours in Benin reflected the confluence of placenta-related beliefs and factors related to the implementation of the trial (including a catalysing adverse event and miscommunication during the informed consent procedure). Furthermore, distinct socio-political factors contributed to the emergence of rumours, including the historical distrust in governmental organizations and the tense relationship between some of the actors involved in the trial. CONCLUSION: Transdisciplinary social science research designs should accompany the implementation of the trial. The integration of multiple stakeholders' knowledge and involvement is required to define and solve upcoming barriers

Labour of love: Secrecy and kinship among Ghanaian-Dutch and Somali-Dutch in The Netherlands

This paper examines the productive role of secrecy in the nexus of transnational mobility, kinship, and intimate relations among Ghanaian-Dutch and Somali-Dutch in the Netherlands. Whereas secrecy is typically understood as one person concealing knowledge from another, implying the latter’s passivity, we argue that secrecy depends on mutually constitutive interactions. Secrecy is explored as the result of an interaction between those who obscure knowledge in creative ways and those who maintain a not-knowing. The paper analyzes how people negotiate moral expectations regarding sexuality, respect, and loyalty, while also manoeuvring to fulfil their personal aspirations. Especially in kinship relations, when people are bound to each other by moral and social obligations, the management of secrecy often makes people mutually dependent. Secrecy is revealed as skillfully choreographing relations by the ebb and flow of information where kinship, respect, or love and (not-) knowing reinforce another.ASC – Publicaties niet-programma gebonde

Condoms become the norm in the sexual culture of college students in Durban, South Africa.

The aim of this study was to examine the factors contributing to the increase in condom use among college students in Durban, KwaZulu-Natal, South Africa, and some of the barriers to consistent condom use. The data were drawn from six focus group discussions with male and female students aged 18-24 in three public tertiary education institutions, supplemented by a survey of 3,000 students aged 17-24. Condoms had become "part of sex" and highly acceptable to the great majority, and were easily accessible. They were primarily being used for preventing pregnancy; many students liked not having to go to a health facility for supplies. Less than half of male and only a third of female students thought male partners had greater influence over the decision whether a condom was used. If a woman requested condoms, men and women agreed the man must comply. Some men were suspicious of women who agreed to have unprotected sex. Almost 75% of sexually active students surveyed reported condom use at last sexual intercourse, but consistent condom use, reported by only a quarter, remains the main challenge. It may be more effective to promote condoms for contraception among sexually active young people than for HIV prevention. Condoms have become the most commonly used contraceptive method among students, and this trend should be reinforced

The Unfortunate Sufferer: Discursive Dynamics around Pregnancy Loss in Cameroon

Pregnancy losses are ambiguous affairs in East Cameroon. Childbearing is not always people's primary aim within their fragile sexual and marital relationships, and it is often unclear to outsiders whether a pregnancy interruption is intended or unintended. Drawing on 15 months of fieldwork, I explore the discursive strategies Gbigbil women deploy while navigating such ambiguities. Suffering is central to their defensive discourses. Depending on the stakes in their relationships, women foreground the notion of suffering either to portray themselves as moral and innocent - and maintain social status or raise support - or to allude to or acknowledge their intention to terminate a pregnancy. This dynamic deployment of a suffering discourse reveals the interconnections of unintended and intended pregnancy losses, and of suffering (associated especially with the former) and agency (often associated with the latter)