Rural East Africa Research Articles

Disempowerment of Men in Rural and Urban East Africa: Implications for Male Identity and Sexual Behavior

Patriarchal structures and stereotyped notions of gender hide the increasing disempowerment of many men in rural and urban East Africa. Socioeconomic change has left men with a patriarchal ideology bereft of its legitimizing activities. Unemployment or low incomes prevent men from fulfilling their male roles as head of household and breadwinner. Women's roles and responsibilities have increased. This affects men's social value, identity and self-esteem. Multi-partnered sexual relationships and sexually aggressive behavior seem to strengthen male identity and sense of masculinity. Strategies to improve sexual and reproductive health must take into account how socioeconomic changes have affected traditional gender roles and male sexual behavior.

Rotating Saving and Credit Associations in Rural East Africa

Theoretical arguments suggest that rotating savings and credit associations (ROSCAs) improve welfare by reducing the utility cost of saving for a consumer durable. Data from two communities in East Africa reveal major differences in the incidence of ROSCAs participation arising, conjecturally, from differences in the relative depths of market penetration and perceptions about the efficacy of alternative strategies for compensating for failures in the financial markets. Participation in ROSCAs in these communities is partly driven by the need to raise school fees, meet medical expenses and buy food. ROSCAs funds are also used to start or promote small businesses and acquire assets, including livestock. Households owning smaller landholdings and those enjoying higher expenditures are more likely to participate in ROSCAs. The number of schemes in which a household participates is closely related to the main uses of ROSCAs funds while contributions and value of receipts are determined by total expenditures and frequency of turns respectively.

Dermatologic Diseases of Eastern Africa

The countries of eastern Africa are deprived of the most basic of care for their skin disease. Diagnostic tools and treatment modalities that are commonplace in developed countries are at a bare minimum in these third world nations. In addition, there is a dearth of trained dermatologic specialists, especially in the arid areas of Kenya and Tanzania. The International Foundation for Dermatology was founded in 1987 in an attempt to address this vacuity in medical care. During the last 6 years, they have launched a campaign concentrated on the activation of Regional Training Centers in Africa, where students will enter a 2-year training program and graduate with the title of "Dermatology Officer" possessing those skills required to treat 80% of common skin diseases. It is hoped that this will lead to an increased awareness of skin pathology in general and the specific need for trained specialists in underserved areas. However, a lack of health care specialists is only part of the problem. Better nutrition, clean water, and the education of tribal communities are impending future goals, difficult to attain in a nation burdened with economic and political strife.

Maternal recall of symptoms associated with childhood deaths in rural east Africa.

Verbal autopsies (VA) are frequently used to determine causes of death for individuals for whom there is no reliable clinical information regarding the terminal illness. VA interviews are used to note key symptoms and signs recalled by relatives of the deceased and diagnoses ascribed according to the symptom complexes. The VA technique assumes that individual disease entities have discrete symptom complexes and that these can be accurately recognized and recalled by the interviewees. We have examined the accuracy with which specific symptoms are recalled over time by mothers or normal guardians of 491 children who died on the paediatric wards of two district hospitals in East Africa. Kwashiorkor, measles, trauma, generalized convulsions and neonatal tetanus were all reported with a high degree of accuracy for children who died of these conditions and had low false positive rates for children without these conditions. Recall was similar within 1 month of death compared to recall after 6 months for most symptoms and signs except neonatal tetanus where false positive reports by mothers increased with time since death. Symptoms and signs commonly used to describe malaria, respiratory tract and diarrhoea-related deaths were reported by mothers to have been present during the terminal illness in 43% of cases where these features were absent. Recall abilities differed between the two communities studied for some symptoms and signs highlighting the importance of such studies in every setting where VA are applied.

Ethnic Factors in Health and Disease

Part 1 Background issues: migration, ethnicity, health and disease the changing nature of populations - the British example general approaches to migrant studies - the relation between disease, social class and ethnic origin genetic versus environmental influences on disease - perspectives on obesity in particular populations molecular markers of ethnic groups. Part 2 Epidemiology: the health of migrants in England and Wales - causes of death epidemiological and clinical comparison of cardiovascular disease in blacks and whites in the USA blood pressure in urban and rural East Africa - the Kenyan Luo migrant study. Part 3 Sociology: Sociology of race and health. Part 4 Specific medical aspects: pregnancy and antenatal care viral infections of pregnancy and childhood haematological and clinical aspects of sickle cell disease in Britain thalassaemia screening ethics and practice running a sickle cell centre community counselling sickle cell screening and its value in Jamaica rheumatic disorders and SLE cancer in migrant populations - a study in Singapore the human retroviruses - human T-leukemia/lymphoma virus and human disease HTLV-I associated lymphomas/leukemias - the Jamaican experience psychiatric practice and ethnic minorities ethnic factors in psychoses - a picture from Birmingham UK a perspective from Nottingham UK psychiatric hospital admissions in North London tuberculosis sarcodosis nutritional patterns and deficiencies features of Gujarati, Punjab and Muslim diets in the UK diets and food habits in the Indian subcontinent nutrition of Asian children - fetus and newborn nutrition of Asian children - infants and toddlers food type and preference among Afro-Caribbeans in Britain high blood pressure/stroke ischaemic heart disease ethnicity, lipoproteins and haemostatic factors diabetes management of hypertension in the Caribbean - the Jamaican perspective diabetes mellitus and its management in the Caribbean.

Points: Elective surgery in rural east Africa

Points: Elective surgery in rural east Africa

Surgical safaris with the East Africa Flying Doctor Service.

A few hundred small mission and government hospitals serve the 20 million people who live in rural East Africa. The physician-patient ratio is 1:25,000. Surgical support to many of these hospitals is provided through the East Africa Flying Doctor Service of the African Medical and Research Foundation. Small aircraft that are coordinated by a wide radio network bring surgical capability to a maximum number of patients in this area of 1,300,000 sq km (500,00 sq miles). The clinical problems, differential diagnoses, operative decisions, risk, and complications of surgical care all have a distinctly African quality. The working conditions and variety and magnitude of problems provide a stimulating challenge. Surgical safaris are a catalyst for gaining acceptance of modern scientific methods by Africa's tradition-oriented tribesmen.

Experimental malaria control and demography in a rural East African community: A retrospect

The aftermath of the Pare-Taveta Malaria Scheme, an experiment to control malaria in rural East Africa, provided opportunities to study the recovery of malaria vectors after the suspension of the dieldrin spraying programme. The vector status of A. gambiae did not return until some 6 years after the final round of spraying; similarly, there was a delay of almost 8 years before A. funestus was able to re-establish itself in the Mkomazi valley of South Pare. These findings are tentatively attributed to recurrent potentiation of dieldrin remaining in the mud walls of huts treated during the Scheme, which seemed to take place each year at the onset of the wet season. The opportunity was taken to examine the effects of the resurgence of malaria on local vital rates. Through the generosity of the Nuffield Foundation, a 5-year programme for the collection of vital statistics was initiated in 1961 in two communities where these rates had recently improved, coincidentally with protection from malaria transmission. A parallel series of observations were made in a neighbouring upland community, that was malaria-free. The improvements in vital rates that occurred during the Malaria Scheme in the lowland communities have been well maintained among most age-groups, at least until the end of 1966, despite the progressive return of malaria. However, there was evidence of a rising death rate during this period among young children and infants, that could be confidently connected with malaria infections. No evidence has been found to indicate that the resumption of malaria transmission was interfering with fertility in these communities.