Suchergebnisse

Many scholars claim that open access due to the effective absence of state control is the major reason for the overuse of common-pool resources such as fisheries. Based on data from the Kafue Flats fisheries in Zambia, we argue that the main problem in open-access situations is the paradox of a state that is simultaneously absent and present: present in actions that dismantle local fishery institutions but absent when it comes to the ability to enforce the laws that might protect the resources. Thus, the state is present in the voice of immigrants from other parts of the country who use their Zambian citizenship to legitimize free access to the fisheries. But it is absent when the Department of Fisheries is not able to enforce its own formal rules or control these immigrants' activities. Local groups are unable to act collectively to reinstall new institutions due to the absence of formal law enforcement. This paper analyses this historic process of institutional change within the theoretical framework of New Institutionalism. We test the hypothesis that the main reason for the lack of local collective action in the Kafue Flats is ideology (the notion of citizenship) strengthening the bargaining power of external actors, who profit most from open access constellations.

AbstractThis article describes the reproductive governance deployed in Burundi, which promotes fertility control through uptake of modern contraceptives as a solution to the economic hardship and land pressure of individuals and communities. Using a qualitative approach, we explore how women and couples in rural Burundi set their preferences, choices and practices of family planning, and how they relate with the government discourse. We describe how reproductive practices are complex and modulated by social and material factors and power dynamics. We argue that the current hegemonic discourse—largely supported by external donors—adopts a depoliticised and technocratic approach to family planning that aligns with neoliberal development frameworks, leaving existing power dynamics and resources distribution issues unexamined and unaddressed. By situating reproductive navigation in context, we show how medicalisation of reproduction is not fully enacted, and partly resisted by women and other actors.

IntroductionDespite the relatively effective roll‐out of free life‐prolonging antiretroviral therapy (ART) in public sector clinics in Zambia since 2005, and the proven efficacy of ART, some people living with HIV (PLHIV) are abandoning the treatment. Drawing on a wider ethnographic study in a predominantly low‐income, high‐density residential area of Lusaka, this paper reports the reasons why PLHIV opted to discontinue their HIV treatment.MethodsOpened‐ended, in‐depth interviews were held with PLHIV who had stopped ART (n = 25), ART clinic staff (n = 5), religious leaders (n = 5), herbal medicine providers (n = 5) and lay home‐based caregivers (n = 5). In addition, participant observations were conducted in the study setting for 18 months. Interview data were analysed using open coding first, and then interpreted using latent content analysis. The presentation of the results is guided by a social‐ecological framework.FindingsPatient attrition from ART care is influenced by an interplay of personal, social, health system and structural‐level factors. While improved corporeal health, side effects and need for normalcy diminished motivation to continue with treatment, individuals also weighed the social and economic costs of continued uptake of treatment. Long waiting times for medical care and placing "defaulters" on intensive adherence counselling in the context of insecure labour conditions and livelihood constraints not only imposed opportunity costs which patients were not willing to forego, but also forced individuals to balance physical health with social integrity, which sometimes forced them to opt for faith healing and traditional medicine.ConclusionsComplex and dynamic interplay of personal, social, health system and structural‐level factors coalesces to influence patient attrition from ART care. Consequently, while patient‐centred interventions are required, efforts should be made to improve ART care by extending and establishing flexible ART clinic hours, improving patient‐provider dialogue about treatment experiences and being mindful of the way intensive adherence counselling is being enforced. In the context of insecure labour conditions and fragile livelihoods, this would enable individuals to more easily balance time for treatment and their livelihoods. As a corollary, the perceived efficacy of alternative treatment and faith healing needs to be challenged through sensitizations targeting patients, religious leaders/faith healers and herbal medicine providers.

Abstract

Background
The Democratic Republic of the Congo is among the poorest countries in the world with a low gender development index. To help households improve their economic levels and address gender-based violence, the Mawe Tatu programme was created to combine women's empowerment through village savings and loans associations (VSLA) with engaging men in changing their attitudes and adopting positive masculinities.


Methods
This study explores the impact of women's empowerment through VSLA while their husbands participate in a men's reflection group pursuing a gender equity curriculum. Data were collected over three years through focus group discussions and in-depth interviews with both men and women. Data were analysed using an inductive approach, building themes based on respondents' narratives.


Results
Household welfare was described as 'improved' when both partners participated in the intervention. More cash was available in the household, cohesion within the couple increased, and men were more likely to involve their wives in decision-making processes. Men were also more involved in childcare and more concerned about their partner's health, especially during pregnancy.


Conclusion
Combining women's economic empowerment through VSLA while raising awareness of gender equity among their husbands is a promising approach. However, it is necessary to develop positive femininities in parallel to positive masculinities, as women to avoid being judged, may fear changes preserving empirical gender norms. Creating more 'friendly' and inclusive spaces in health centers will make it easier for men to accompany their wives for maternal health services.

OBJECTIVES: Vaccine clinical trials in low‐resource settings have unique challenges due to structural and financial inequities. Specifically, protecting participant and caregiver autonomy to participate in the research study can be a major challenge, so understanding the setting and contextual factors which influence the decision process is necessary. This study investigates the experience of caregivers consenting on behalf of paediatric participants in a malaria vaccine clinical trial where participation enables access to free, high‐quality medical care. METHODS: We interviewed a total of 78 caregivers of paediatric participants previously enrolled in a phase II or III malaria vaccine clinical trial in Uganda, Tanzania and Kenya. Interviews were qualitative and analysed using a thematic framework analysis focusing on the embodied caregiver in the political, economic and social reality. RESULTS: Caregivers of participants in this study made the decision to enrol their child based on economic, social and political factors that extended beyond the trial into the community and the home. The provision of health care was the dominant reason for participation. Respondents reported how social networks, rumours, hierarchal structures, financial constraints and family dynamics affected their experience with research. CONCLUSIONS: The provision of medical care was a powerful motivator for participation. Caregiver choice was limited by structural constraints and scarce financial resources. The decision to participate in research extended beyond individual consent and was embedded in community and domestic hierarchies. Future research should assess other contexts to determine how the choice to participate in research is affected when free medical care is offered.

Rotavirus and oral cholera vaccines have the potential to reduce diarrhea-related child mortality in low-income settings and are recommended by the World Health Organization. Uptake of vaccination depends on community support, and is based on local priorities. This study investigates local perceptions of acute watery diarrhea in childhood and anticipated vaccine acceptance in two sites in the Democratic Republic of Congo. In 2010, 360 randomly selected non-affected adults were interviewed by using a semi-structured questionnaire. Witchcraft and breastfeeding were perceived as potential cause of acute watery diarrhea by 51% and 48% of respondents. Despite misperceptions, anticipated vaccine acceptance at no cost was 99%. The strongest predictor of anticipated vaccine acceptance if costs were assumed was the educational level of the respondents. Results suggest that the introduction of vaccines is a local priority and local (mis)perceptions of illness do not compromise vaccine acceptability if the vaccine is affordable.

Objectives: This study aims to compare obstetric outcomes between Eritrean and Swiss women in Switzerland, focusing on instrumental or surgical interventions and analgesia use.Methods: The study included data from 45,412 Swiss and 1,132 Eritrean women who gave birth in Swiss hospitals (2019–2022). Mixed-effects logistic regression was used to assess the effect of nationality on mode of delivery and analgesia use and multinomial mixed-effects logistic regression to assess the effect of nationality on mode of delivery in women intended for spontaneous vaginal delivery.Results: Compared with Swiss, Eritrean women had a lower rate of primary C-section (Adj. OR 0.73, 95% CI [0.60, 0.89]) but a higher risk of initially planned vaginal deliveries ending in emergency C-section (RRR 1.31, 95% CI [1.05, 1.63]). Eritrean women were less likely to receive epidural analgesia (Adj. OR 0.53, 95% CI [0.45, 0.62]) and more likely to not receive any analgesia (Adj. OR 1.73, 95% CI [1.52, 1.96]).Conclusion: This study reveals disparities in obstetric care, notably in higher emergency C-section rates and lower analgesia use among Eritrean women. For promoting equitable healthcare practices deeper understanding of obstetrics decision-making is needed.

When clinical trials enter human communities, two complex systems merge—creating challenges for the clinical trial team and the local human community. This is of particular relevance for clinical trials in low-resource settings where the resource scarcity can intensify existing inequities. Here we present a case study of a phase III malaria vaccine clinical trial. Through qualitative interviews with researchers and caregivers of pediatric participants we elucidate themes that shape the clinical trial system. These themes can be a useful complementary planning tool to existing research guidelines for clinical trial researchers. Respondents from both groups reported financial and social contextual realities to be major drivers in the system. We found a strong historical path dependency in the community that was closely tied to the relationships with researchers and indicative of the structural inequities. We elaborate on these findings and offer recommendations to improve trial design.

Abstract Background In regions where access to clean water and the provision of a sanitary infrastructure has not been sustainable, cholera continues to pose an important public health burden. Although oral cholera vaccines (OCV) are effective means to complement classical cholera control efforts, still relatively little is known about their acceptability in targeted communities. Clarification of vaccine acceptability prior to the introduction of a new vaccine provides important information for future policy and planning. Methods In a cross-sectional study in Katanga province, Democratic Republic of Congo (DRC), local perceptions of cholera and anticipated acceptance of an OCV were investigated. A random sample of 360 unaffected adults from a rural town and a remote fishing island was interviewed in 2010. In-depth interviews with a purposive sample of key informants and focus-group discussions provided contextual information. Socio-cultural determinants of anticipated OCV acceptance were assessed with logistic regression. Results Most respondents perceived contaminated water (63%) and food (61%) as main causes of cholera. Vaccines (28%), health education (18%) and the provision of clean water (15%) were considered the most effective measures of cholera control. Anticipated vaccine acceptance reached 97% if an OCV would be provided for free. Cholera-specific knowledge of hygiene and self-help in form of praying for healing were positively associated with anticipated OCV acceptance if costs of USD 5 were assumed. Conversely, respondents who feared negative social implications of cholera were less likely to anticipate acceptance of OCVs. These fears were especially prominent among respondents who generated their income through fishing. With an increase of assumed costs to USD 10.5, fear of financial constraints was negatively associated with anticipated vaccine acceptance as well. Conclusions Results suggest a high motivation to use an OCV as long as it seems affordable. The needs of socially marginalized groups such as fishermen may have to be explicitly addressed when preparing for a mass vaccination campaign.