Social and cultural dimensions of hygiene in Cambodian health care facilities

<p>Abstract</p> <p>Background</p> <p>The frequency of bloodborne pathogen healthcare-associated infections is thought to be high in developing Southeast Asian Countries. The underlying social-cultural logics contributing to the risks of transmission are rarely studied. This report provides some insights on the social and cultural factors that shape hygiene practices in Cambodian health care settings.</p> <p>Methods</p> <p>We conducted qualitative surveys in various public and private health facilities in Phnom Penh, the capital city and in provinces. We observed and interviewed 319 participants, health care workers and patients, regarding hygiene practices and social relationships amongst the health care staff and with patients. We also examined the local perceptions of hygiene, their impact on the relationships between the health care staff and patients, and perceptions of transmission risks. Data collection stem from face to face semi-structured and open-ended interviews and focus group discussions with various health care staffs (i.e. cleaners, nurses, midwives and medical doctors) and with patients who attended the study health facilities.</p> <p>Results</p> <p>Overall responses and observations indicated that hygiene practices were burdened by the lack of adequate materials and equipements. In addition, many other factors were identified to influence and distort hygiene practices which include (1) informal and formal social rapports in hospitals, (2) major infection control roles played by the cleaners in absence of professional acknowledgment. Moreover, hygiene practices are commonly seen as an unessential matter to be devoted to low-ranking staff.</p> <p>Conclusion</p> <p>Our anthropological findings illustrate the importance of comprehensive understanding of hygiene practices; they need to be considered when designing interventions to improve infection control practices in a Cambodian medical setting.</p

Jovens e associações em Moçambique: motivações e dinâmicas actuais

O presente artigo é uma reflexão sobre dinâmicas associativas de jovens no Moçambique pós colonial. O objectivo desta reflexão foi identificar e analisar as motivações de engajamento dos jovens nesses agrupamentos. Baseando-se em aproximações empíricas feitas a duas associações de jovens - Associação Aro Juvenil e Associação Positiva Juvenil - a análise demonstra que dinamica associativa de jovens mete em evidência relações complexas entre identidade, contexto, o privado, o público e o afectivo. Embora haja múltiplas motivações, a adesão dos jovens em associações associa trajectórias e expectativas individualizadas. A nível discursivo, a entrada na vida associativa representa uma forma de legitimação sóciopolítica em resposta a um discurso que considera os jovens passivos e pouco intervenientes na solução dos problemas que lhes afecta em particular e à sociedade no geral. A nível das práticas associativas quotidianas, os jovens reintrepretam e dão outro sentido às motivações do seu engajamento: para lá dos objectivos formais, pretensamente desenvolvimentistas, altruistas e humanitários, o associativismo é uma estratégia de vida e de realização de projectos individuais. Criar uma associação e/ou nela aderir pode significar maiores possibilidades de aceder e controlar recursos e capitais diversificados como emprego/profissão, dinheiro, trabalho, poder, reconhecimento e prestigio, formações entre outros que de outra forma não seria possível.This article reflects on youth associations dynamics in Postcolonial Mozambique. The aim is to identify and analyze motivations for young people's involvement in such groups. Based on empirical work with two youth associations - namely "Associação Aro Juvenil" and "Associação Positiva Juvenil" - the assessment finds that youth associations dynamics highlights intricate relationships involving identity, context, private, public and affective milieus. Although there are multiple motivations, young people's adherence to associations is combined with individual life stories and expectations. At the discourse level, entrance to the associative life represents a form of socio-political legitimation in response to other narratives that consider young people very passive and less intervening in finding solutions to their own problems, and society's in general. At the level of day-to-day practices, young people re-interpret and give a different sense to their motivations and commitment: beyond formal objectives - arguably development-oriented, altruistic and humanistic - associations are a life strategy for the accomplishment of individual achievements. To create an association and/or take part in one may imply greater possibilities of accessing and controlling diversified resources and capitals, such as a job/occupation, money, work, power, recognition, prestige, and training, among others, which would be otherwise impossible

A process evaluation of user fees abolition for pregnant women and children under five years in two districts in Niger (West Africa)

<p>Abstract</p> <p>Background</p> <p>African policy-makers are increasingly considering abolishing user fees as a solution to improve access to health care systems. There is little evidence on this subject in West Africa, and particularly in countries that have organized their healthcare system on the basis of the Bamako Initiative. This article presents a process evaluation of an NGO intervention to abolish user fees in Niger for children under five years and pregnant women.</p> <p>Methods</p> <p>The intervention was launched in 2006 in two health districts and 43 health centres. The intervention consisted of abolishing user fees and improving the quality of services (drugs, ambulance, etc.). We carried out a process evaluation in April 2007 using qualitative and quantitative data. Three data collection methods were used: i) individual in-depth interviews (n = 85) and focus groups (n = 8); ii) participant observation in 12 health centres; and iii) self-administered structured questionnaires (n = 51 health staff).</p> <p>Results</p> <p>The population favoured abolition; health officials and local decision-makers were in favour, but they worried about its sustainability. Among health workers, opposition to providing free services was more widespread. The strengths of the process were: a top-down phase of information and raising community awareness; appropriate incentive measures; a good drug supply system; and the organization of a medical evacuation system. The major weaknesses of the process were: the perverse effects of incentive bonuses; the lack of community-based management committees' involvement in the management; the creation of a system running in parallel with the BI system; the lack of action to support the service offer; and the poor coordination of the availability of free services at different levels of the health pyramid. Some unintended outcomes are also documented.</p> <p>Conclusion</p> <p>The linkages between systems in which some patients pay (Bamako Initiative) and some do not should be carefully considered and organized in accordance with the local reality. For the poorest patients to really benefit, it is essential that, at the same time, the quality of services be improved and mechanisms be put in place to prevent abuses. Much remains to be done to generate knowledge on the processes for abolishing fees in West Africa.</p

Determinants of Refusal of A/H1N1 Pandemic Vaccination in a High Risk Population: A Qualitative Approach

International audienceBackground: Our study analyses the main determinants of refusal or acceptance of the 2009 A/H1N1 vaccine in patients with cystic fibrosis, a high-risk population for severe flu infection, usually very compliant for seasonal flu vaccine.Methodology/Principal Findings: We conducted a qualitative study based on semi-structured interviews in 3 cystic fibrosis referral centres in Paris, France. The study included 42 patients with cystic fibrosis: 24 who refused the vaccine and 18 who were vaccinated. The two groups differed quite substantially in their perceptions of vaccine- and disease-related risks. Those who refused the vaccine were motivated mainly by the fears it aroused and did not explicitly consider the 2009 A/H1N1 flu a potentially severe disease. People who were vaccinated explained their choice, first and foremost, as intended to prevent the flu’s potential consequences on respiratory cystic fibrosis disease. Moreover, they considered vaccination to be an indirect collective prevention tool. Patients who refused the vaccine mentioned multiple, contradictory information sources and did not appear to consider the recommendation of their local health care provider as predominant. On the contrary, those who were vaccinated stated that they had based their decision solely on the clear and unequivocal advice of their health care provider.Conclusions/Significance: These results of our survey led us to formulate three main recommendations for improving adhesion to new pandemic vaccines. (1) it appears necessary to reinforce patient education about the disease and its specific risks, but also general population information about community immunity. (2) it is essential to disseminate a clear and effective message about the safety of novel vaccines. (3) this message should be conveyed by local health care providers, who should be involved in implementing immunization

Norms, Networks, Power, and Control: Understanding Informal Payments and Brokerage in Cross-Border Trade in Sierra Leone

Recent research has cast light on the variety of informal payments and practices that govern the day-to-day interactions between traders and customs agents at border posts in low-income countries. Building on this literature, this paper draws on survey and qualitative evidence in an effort to explore which groups are most advantaged and disadvantaged by the largely informal processes and norms governing cross-border trade. We find that understanding variation in strategies and outcomes across traders can only be effectively understood with reference to the importance of norms, networks, power, and the logic of control.Department for International DevelopmentBill and Melinda Gates Foundatio

P192: Comparisons Of Procedure Specific Surgical Site Infection Rates Of A Turkish University Hospital With Turkish National Surveillance Data

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