The construction of gender in times of change : a case study of school-based HIV/AIDS education in Kilimanjaro

This case study utilized qualitative and quantitative methods to examine how gender, power and HIV/AIDS merge to create situations of risk and vulnerability for young people in the Kilimanjaro region, Tanzania. Questionnaires were collected from 160 secondary school students, while qualitative data came from 3 focus group discussions (one mixed and two single sex), interviews with one male and one female parent, one male and one female teacher, and an educational representative, in addition to observation. By looking at the socially constructed and multifaceted nature of gender and its inherent connection to power, this study highlights the contradictory and confusing state young people find themselves in nowadays. Particularly in regards to gender norms, roles and expectations, this study found that the school appears to be a modernizing influence, more overtly oriented towards gender equality in comparison to other facets of society such as the home and the work place, where inequality is still pervasive. Yet even there, it becomes obvious that changing long held beliefs concerning the roles, abilities, and characteristics of girls and boys takes considerable amounts of time. Gender inequality and entrenched power structures creep insidiously even into schools, which are supposed to be the levelers of difference. The push and pull factors at work in Kilimanjaro are also evident considering the plethora of sources of information concerning sexuality, gender, condoms and HIV/AIDS that shape young people’s attitudes, beliefs and behavior. Competing “moral regimes” and the subsequent incongruence and ambiguity of messages emanating from the mass media, religious institutions, parents, peers and teachers undermine any prevention program and have clear implications for HIV/AIDS program planners attempting to design and implement contextually sensitive school-based programs based on a coherent, unified stance. Thus, the importance of context and change were recurring themes in the study as having relevance for HIV/AIDS programming. Most strikingly, the need for a forum where young people can openly articulate their concerns, fears, questions and desires as well as address the ambiguities and contradictions in their lives emerged as having importance for programming

Access and utilization of water and sanitation facilities and their determinants among pastoralists in the rural areas of northern Tanzania

Introduction: Lack of safe water, sanitation and hygiene remains one of the most pressing global health issues of our time. Water and sanitation-related improvements are crucial in meeting the Global Sustainable Development Goals. This study was conducted to determine the access, utilization, and determinants of access to sanitation facilities among pastoral communities in rural areas of northern Tanzania.Methods: This cross-sectional study was carried out in Ngorongoro Conservation Area of Ngorongoro District in northern Tanzania. The survey included key measures adapted from the Joint WHO/UNICEF Core Questions on drinking-water and sanitation for Household Surveys. An observation checklist was also completed at each household. Geographical positions of the households were recorded using a Global Positioning System.Results: A total of 175 households participated in the study. More than half (61.7%, n=108) of the participants reported access to an improved water source throughout the year. The majority (50.3%, n=88) of the households reportedly practised open defecation. The multivariate analysis identified that the key determinants to access a sanitation facility at a household were socio-economic status, family size, the presence of under-five years of age in the household, history of diarrhoeal diseases – self-reported of an adult, having ever received education on sanitation and motivation for improvement in defecation place.Conclusion: There is limited access to water and sanitation facilities in communities in the Ngorongoro Conservation Area. Individual and community factors are key determinants for a household to own a sanitation facility. Findings from this study indicate a need for interventions to improve access to water and sanitation facilities in the area.

COMPARE Forum: The idea of North-South and South-South collaboration

The idea of having a Compare Forum focusing on the above title was first discussed with one of the Editors of Compare during a PhD defence in Oslo in 2011. The PhD dissertation itself was linked to a larger project in which researchers from the North (Norway) and the South (South Africa) had been collaborating in educational research for over 10 years. Despite the fact that North-South collaboration is not a new issue on the agenda (King 1985) it is still a timely topic to explore, particularly given the recent growth and moves towards North-South-South collaboration or even South-South Cooperation in Education and Development (Chisholm and Steiner-Khamsi 2009). Thus, any discussion of research collaboration, whether North-South or South-South, is seen as an ideal topic for comparative education, particularly when exploring why there should be collaboration at all and if so what are some of the challenges. While it may be argued that the difference between North-South and South-South collaboration may simply be a question of geography, King (1985) reminds us that collaboration is not necessarily between equals and that collaboration at times ‘appears to be a process initiated in the North, and in which the South participates, as a counterpart’ (184). Ultimately, the differences go beyond simple geographic location to issues of funding and power, something that each of the contributions will touch upon in their own way. While cooperation may mean working with someone, it does suggest that one partner provides information or resources to the other, while collaboration suggests a more equal partnership in which researchers work alongside each other. For the majority of our contributors, we use collaboration as opposed to cooperation, although the literature is not always so clear on this distinction.Web of Scienc

Research priorities to reduce the impact of COVID-19 in low- and middle-income countries

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Research priorities to reduce the impact of COVID-19 in low- and middle-income countries.

BackgroundThe COVID-19 pandemic has caused disruptions to the functioning of societies and their health systems. Prior to the pandemic, health systems in low- and middle-income countries (LMIC) were particularly stretched and vulnerable. The International Society of Global Health (ISoGH) sought to systematically identify priorities for health research that would have the potential to reduce the impact of the COVID-19 pandemic in LMICs.MethodsThe Child Health and Nutrition Research Initiative (CHNRI) method was used to identify COVID-19-related research priorities. All ISoGH members were invited to participate. Seventy-nine experts in clinical, translational, and population research contributed 192 research questions for consideration. Fifty-two experts then scored those questions based on five pre-defined criteria that were selected for this exercise: 1) feasibility and answerability; 2) potential for burden reduction; 3) potential for a paradigm shift; 4) potential for translation and implementation; and 5) impact on equity.ResultsAmong the top 10 research priorities, research questions related to vaccination were prominent: health care system access barriers to equitable uptake of COVID-19 vaccination (ranked 1st), determinants of vaccine hesitancy (4th), development and evaluation of effective interventions to decrease vaccine hesitancy (5th), and vaccination impacts on vulnerable population/s (6th). Health care delivery questions also ranked highly, including: effective strategies to manage COVID-19 globally and in LMICs (2nd) and integrating health care for COVID-19 with other essential health services in LMICs (3rd). Additionally, the assessment of COVID-19 patients' needs in rural areas of LMICs was ranked 7th, and studying the leading socioeconomic determinants and consequences of the COVID-19 pandemic in LMICs using multi-faceted approaches was ranked 8th. The remaining questions in the top 10 were: clarifying paediatric case-fatality rates (CFR) in LMICs and identifying effective strategies for community engagement against COVID-19 in different LMIC contexts.InterpretationHealth policy and systems research to inform COVID-19 vaccine uptake and equitable access to care are urgently needed, especially for rural, vulnerable, and/or marginalised populations. This research should occur in parallel with studies that will identify approaches to minimise vaccine hesitancy and effectively integrate care for COVID-19 with other essential health services in LMICs. ISoGH calls on the funders of health research in LMICs to consider the urgency and priority of this research during the COVID-19 pandemic and support studies that could make a positive difference for the populations of LMICs

Reflecting and shaping the discourse: The role of music in AIDS communication in Tanzania

Failure to recognize the importance of oral traditions in Africa and the potential of music and song for stimulating social and behavior change would represent a missed opportunity in HIV prevention strategies. Local narratives concerning AIDS are often utilized in popular songs and constitute rich sources of contextual information about the epidemic that have thus far been un- or underutilized in HIV prevention strategies. Endogenously conceived messages delivered via a channel such as music increase the likelihood of messages being contextually appropriate and culturally engaging. This form of media also presents the greatest opportunity for wide dissemination. Drawing on field work conducted in the Kilimanjaro region, this paper presents examples of how music and musicians in Tanzania reflect and potentially shape AIDS discourse. Three broad recurrent themes addressed in songs are discussed: AIDS metaphors, stigma and broader HIV prevention messages. By tapping into the wealth of information about AIDS discourse contained within popular songs, and by recognizing musicians as potential opinion leaders and agents of social change, the effectiveness of prevention strategies may be increased.Tanzania HIV prevention Music HIV/AIDS

Understanding Adolescents' Perceptions of Diarrhea: A Formative Research Study of a Visual Scale to Measure Self-Reported Diarrhea in Low-Resource Settings

Introduction: Although water, sanitation, and hygiene interventions are effective in reducing diarrhea, there are methodological issues regarding the research tools used to evaluate their health impact. Moreover, there is limited research on individuals' subjective interpretations of diarrheal illness which may introduce further limitations in relying on self-reported data. Therefore, we conducted a study that aims to understand adolescents' perceptions of diarrheal illness in rural Tamil Nadu, India. Next, we wish to explore the acceptability of the Bristol Stool Form Scale to assess self-reported diarrhea in water, sanitation, and hygiene interventions involving adolescent participants in low-resource settings.Materials and Methods: The study was conducted as part of the formative research phase in the cultural adaptation of Project SHINE, a school-based educational water, sanitation, and hygiene intervention in Thirumalaikodi, Tamil Nadu, India. A convergent parallel mixed-methods study design with a purposive sampling strategy was used. Qualitative data included 10 in-depth interviews with student participants aged 13–14. Quantitative data were collected through interviewer-administered face-to-face surveys (n = 14) and one-week stool diaries (n = 14). Each data set was analyzed separately and compiled during the interpretation of the findings.Results: Across all data sets, diarrhea was reported to be perceived as unhealthy and an irregular occurrence among participants. Participants also reported diarrheal-taboos, local methods to cure or control diarrhea, and discussed how diarrheal illness can lead to absenteeism or withdrawal from school and social activities. Moreover, participants were able to understand and answer questions about their stool using the Bristol Stool Form Scale, suggesting that is an acceptable tool.Discussion: Visual tools demonstrate promise in improving self-reported diarrheal illness among adolescents in low-resource settings in India. However, until we address diarrhea-related taboos it will be difficult to address methodological issues in the assessment and reporting of diarrheal illness among adolescents

Socio-ecological Factors Associated with Snacking Behaviors of Basic School Students in Nepal

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An integrated human behavioral model for mosquito-borne disease control: A scoping review of behavior change theories used to identify key behavioral determinants

Mosquito-borne disease (MBD) control depends largely on a range of public health measures aimed at reducing the spread of infected mosquitoes and human-mosquito contact. These public health measures are generally driven by voluntary, though in few occasions obligatory (e.g., indoor residual spraying), self-protective behaviors by individuals and communities. To develop effective interventions that promote public health measures, the underlying mechanisms that contribute to self-protective behaviors should be well understood. The present scoping review aims to provide a timely overview of how behavior change theories have been applied in the context of MBD control. In addition, the review proposes an integrated model that includes identified key determinants in MBD control behavior, and identifies knowledge gaps to inform future research. A comprehensive search was performed in several databases: MEDLINE, PsycINFO, Embase (Ovid), Web of Science Core Collection, CINAHL, ERIC, and Econ.Lit (EBSCO), as well as registered trials and reviews in CENTRAL and PROSPERO to identify ongoing or unpublished studies. References of included studies and literature reviews were screened, as well as citation tracking in Web of Science, Google Scholar and the malaria database of Behavior Change Impact. This scoping review identified a total of 28 studies. Most studies targeted personal-protective behavioral measures such as adopting, using, or maintaining insecticide-treated bed nets, and were most frequently informed by risk-related behavioral theories. Knowledge and perceived susceptibility of the risk, and related perceived efficacy were identified as key behavioral determinants in the conceptual, integrated human behavior model for MBD control. Numerous studies related to MBD control behavior, especially those focusing on knowledge-attitudes-practices (KAP), often lack a solid theoretical framework, which risks depicting an incomplete understanding of behaviors. In addition, by incorporating various behavioral disciplines into the domain of MBD control, a more comprehensive understanding of key behavioral determinants may be developed and applied in future research and MBD control efforts