A qualitative investigation into knowledge, beliefs, and practices surrounding mastitis in sub-Saharan Africa: what implications for vertical transmission of HIV?

BACKGROUND: Mastitis constitutes an important risk factor in HIV vertical transmission. Very little, however, is known on how women in sub-Saharan Africa conceptualise health problems related to breastfeeding, such as mastitis, and how they act when sick. We aimed at filling this gap in knowledge, by documenting the indigenous nosography of mastitis, health seeking behaviour, and remedies for prophylaxis and treatment in rural sub-Saharan Africa. METHODS: The study was conducted in the Nouna Health District, rural Burkina Faso. We employed a combination of in-depth individual interviews and focus group discussions reaching both women and guérisseuers. All material was transcribed, translated, and analysed inductively, applying data and analyst triangulation. RESULTS: Respondents perceived breast problems related to lactation to be highly prevalent and described a sequence of symptoms which resembles the biomedical understanding of pathologies related to breastfeeding, ranging from breast engorgement (stasis) to inflammation (mastitis) and infection (breast abscess). The aetiology of disease, however, differed from biomedical notions as both women and guerisseurs distinguished between "natural" and "unnatural" causes of health problems related to breastfeeding. To prevent and treat such pathologies, women used a combination of traditional and biomedical therapies, depending on the perceived cause of illness. In general, however, a marked preference for traditional systems of care was observed. CONCLUSION: Health problems related to breastfeeding are perceived to be very common in rural Burkina Faso. Further epidemiological research to assess the actual prevalence of such pathologies is urgently needed to inform the design of adequate control measures, especially given the impact of mastitis on HIV vertical transmission. Our investigation into local illness concepts and health care seeking behaviour is useful to ensure that such measures be culturally sensitive. Further research into the efficacy of local customs and traditional healing methods and their effect on viral load in breast milk is also urgently needed

Barriers and facilitators to extended working lives in Europe : a gender focus

Background: There is a global imperative to respond to the challenge of a growing ‘old-age dependency ratio’ by ensuring the workforce is healthy enough to remain in work for longer. Currently more than half of older workers leave before the default retirement age, and in some countries (e.g. the United Kingdom) the time spent in retirement is increasing. At the same time across Europe there is a gender employment gap, with 14.5% fewer female workers between 55-64 years old, and a large variation in the participation of older women in the workforce (ranging from 30%-75%). As older women are under-represented in the workforce, increasing employment in this group has the propensity to go some way towards reducing the old-age dependency ratio to ensure continued economic growth. Objectives: This review explores the barriers and facilitators to extended working lives in Europe, particularly those than impact on women. Methods: A systematic mapping review process was undertaken using four electronic databases, Medline, PsychoInfo, Psych Extra via Ovid and Age Line via EBSCO, using the terms, ‘work’, ‘ageing’, ‘retirement’, ‘pension’, ‘old’, ‘barrier’, ‘extended working life’, ‘gender’, ‘health and wellbeing’. Hand searching was also carried out in the Journal of Aging and Human Development and the Journal of Ageing and Society. Results: The search resulted in 15 English language studies published from 1st January 2005 to the current date that met the inclusion criteria. Key findings: The key factors that influenced decisions to retire or extend working lives in Europe, were health; social factors; workplace factors; and financial security and pension arrangements. Conclusions and implications of key findings: Health was found to be the most commonly cited barrier to extended working lives in Europe, and a number of social inequalities to work exist by gender. Structural factors exist, such as the gender pay gap, which disadvantage women, while the nature of work itself differs by gender and can have a negative impact on health. Currently women tend to exit the labour market earlier than men, however, changes in the state pension age are resulting in women being required to work for as long as men, in most countries. For women to remain healthy at work, workplaces need to consider a range of interventions, including flexible arrangements to both work and retirement to enable women to balance the demands of work with domestic and caring responsibilities that particularly impact on them