Sex, social institutions, and social structure: anthropological contributions to the study of sexuality.
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Anthropology↗
Biomedical subjects
L Manderson
Publications and source records attributed to L Manderson.
Patterns of treatment for malaria in Tayabas, The Philippines: implications for control.
This paper describes local understandings of illness and documents treatment-seeking behaviour in Tayabas, Quezon, The Philippines. Data were collected using focus group discussions and narrative interviews with adults and with mothers of children, who had had confirmed malaria during a two-month surveillance period. Signs and symptoms of malaria are important in directing individual diagnosis, treatment-seeking and therapy. Household therapy with antimalarials, and more commonly antipyretics and herbs, as used before seeking care from either the formal or informal sector. Care outside the home was sought where symptoms continued and/or worsened, with an average period of time from onset of symptoms to presentation to a clinic of six days. Accessibility to clinics is not a problem in the study area and hence the primary reason for delay was propensity to self-treat first and to discontinue medication when feeling better. These factors affect the control of malaria and the potential to reduce transmission. Better advice to the community regarding the importance of diagnosis and compliance with antimalarial therapy is indicated.
Adult↗
Applying medical anthropology in the control of infectious disease.
This paper focuses on two roles of anthropology in the control of infectious disease. The first is in identifying and describing concerns and understandings of disease, including local knowledge of cause and treatment relevant to disease control. The second is in translating these local concerns into appropriate health interventions, for example, by providing information to be incorporated in education and communication strategies for disease control. Problems arise in control programmes with competing knowledge and value systems. Anthropology's role conventionally has been in the translation of local concepts of illness and treatment, and the adaptation of biomedical knowledge to fit local aetiologies. Medical anthropology plays an important role in examining the local context of disease diagnosis, treatment and prevention, and the structural as well as conceptual barriers to improved health status. National (and international) public health goals which respect local priorities are uncommon, and generic health goals rarely coincide with specific country and community needs. The success of interventions and control programmes is moderated by local priorities and conditions, and sustainable interventions need to acknowledge and address country-specific social, economic and political circumstances.
Anthropology↗
Perceptions of HIV/AIDS and caring for people with terminal AIDS in southern Thailand.
This study presents data collected from village-based ethnographic research conducted in southern Thailand in 1995-1996, and focuses on perceptions of HIV/AIDS infection, patients with AIDS and their provision of care. Individual interviews were conducted with 300 village women. These data were supplemented by data from 14 focus group discussions involving 100 participants, both men and women, randomly selected from six villages in Hatyai district, Songkla Province, Thailand. In addition, 23 people with HIV/AIDS and their caregivers participated in subsequent in-depth interviews. Participants generally obtained their information about HIV/AIDS from television and radio, and the information they obtained was generally negative. AIDS was perceived as a disease associated with dirt, danger and death, although it was also considered to be a disease of karma (rok khong khon mee kam) and a 'woman's disease' (rok phu ying) associated with prostitution. Few women perceived themselves to be at risk of infection because they 'trusted' their husbands to be faithful. There were some differences in attitudes towards caring for AIDS patients among people who lived in semi-urban and rural areas, and with areas which had not yet experienced AIDS among community members. Focus group discussions clarified issues related to the illness and patterns of caregiving among men and women. Areas of misperception and confusion were identified and will be used for interventions.
Attitude to Health↗
Community perceptions of health, illness and care: identifying issues for indigenous communities.
Community meetings, interviews with key informants, and focus groups were used to document major health concerns and problems among Indigenous women in Queensland, as part of the Australian Longitudinal Study on Women's Health. In this article, we analyze understandings of "community" as used in Australian health research and among Indigenous women. We then examine health issues as identified and experienced by women and explore the gaps that exist between community concerns, individual health status, and service delivery.
Adolescent↗
Security and safe havens: health issues among women in mobile homes.
This paper is based on a small study of women resident in caravan parks. The study, undertaken in the context of the Australian Longitudinal Study on Women's Health, explored the health status and the health seeking behavior of women living in mobile homes in two townships in north coast New South Wales, Australia. Older women had moved to park accommodation, some with husbands, to escape the financial strains of maintaining larger homes on fixed incomes. Younger women, in contrast, typically moved to the parks alone or with children but without an adult partner, and were motivated to move from more permanent housing as a result of financial hardship, domestic violence, and their own or partners' drug and alcohol abuse. We had hypothesized some differences in women's health status and health related behavior according to place of residence, because of the differences in the two townships with respect to infrastructure and social characteristics. However, women's health status varied primarily according to age. Women believed they were physically healthy, although with some dental, sexual and particularly mental health problems.
Adult↗
"Nerves" and tranquilizer use in rural Brazil.
Drawing on data from a morbidity survey of sampled households in 25 small villages in Espirito Santo, Brazil, this article is concerned with reports of "nerves" (nervos) or nerve problems (problema de nervos). Reported cases of nervos (30 percent of all reports of illness) included a variety of symptoms: insomnia, body pains, dizziness, trembling, weakness, and emotional states ranging from feelings of sadness to anger. In one-third of the accounts, "overwork" was mentioned as the main cause, due both to its direct physical effect and to stress related to economic hardship and responsibility. In 88 percent of the cases, the afflicted person regularly used at least one psychotropic drug to relieve symptoms. Daily use of drugs occurred in 68 percent of the cases, and in 47 percent of cases people were reported as "dependent" on the drugs. The extensive use of psychotropic drugs suggests medicalization of nervos, creating a sick role for patients and keeping at an individual level the problems resulting in nervos.
Adult↗
Incorporating gender in the anthropology of infectious diseases.
The paper focuses on key issues in research and control of infectious diseases and demonstrates the utility of combining a gender perspective with anthropological investigation both for understanding disease and for designing and evaluating interventions for its control. Based on a definition of gender as opposed to sex, it illustrates, with the help of a gender framework for tropical diseases, how this concept is applied. It argues that gender-sensitive research is essential to the understanding of the nature of the disease, its prevalence, distribution, determinants and consequences. Examples are taken from anthropological studies on infectious diseases, including research on urinary schistosomiasis, malaria, leprosy, leishmaniasis and onchocerciasis. How gender-sensitive qualitative research can guide the design and evaluation of appropriate interventions for the prevention and control of infectious diseases is also discussed.
Anthropology↗
Perceptions of malaria in a low endemic area in the Philippines: transmission and prevention of disease.
Qualitative methods were used to gather data on community perceptions of malaria in Morong, Bataan. People recognised an illness which they called "malarya' through a discrete set of symptoms: high fever and intense chills, with or without a severe headache. Self-medication was common. Enquiry into perceptions of cause and prevention of the disease revealed a complex mixture of beliefs involving environmental conditions, the mosquito vector and parasites, but included also various ideas about dirty water, diet, hunger and conditions of hygiene. The implications of these findings for disease control, and the relationship between knowledge and practices, are discussed.
Adolescent↗
Social aspects of malaria in Heping, Hainan.
This paper presents findings from a study conducted in Heping Town, Qiongzhong County, Hainan Province, China. The study, conducted in 1992, used qualitative as well as quantitative methods to gather social, cultural and behavioural data associated with the acquisition, transmission and prevention of malaria, and the diagnosis and treatment of disease. These methods included focus groups, key informant and other in-depth interviews, and observations, a household survey and tests of school children of knowledge of malaria. The study is among the first to our knowledge that has utilized this broad mix of methods for tropical disease research in China.
Adolescent↗
Responding to cough: Boholano illness classification and resort to care in response to childhood ARI.
A qualitative study into the health seeking behaviour of caretakers in response to ARI in children under five years of age was conducted in the province of Bohol, the Philippines. The study was designed to compliment survey data generated from a long running ARI intervention project, specifically to explain behaviours identified as problematic by the project. Results indicate the importance of folk diagnosis as a basis for selection of first resort for care in the management of childhood ARI. A cultural category, piang, was identified as a major factor influencing health seeking behaviour and delay in consulting the biomedical system where serious ARI exists. In addition, caretakers' financial situation and social contacts are important in their decision to seek biomedical assistance and are often implicated in delay in presentation and acting upon referral to hospital.
Acute Disease↗
The social life of bonding theory.
'Bonding' as a crucial factor of the early post-partum entered obstetric and paediatric practice after the publication of Maternal and Infant Bonding in 1976 by Klaus and Kennell. The concept has held its place since, as witnessed by medical textbook accounts of it, and the perception of 'instantaneous bonding' as a vital component of the ideal birth experience has dominated media representations of childbirth and, until very recently, feminist writing. Only during the last few years has this literature taken into account research findings concerning the guilt and anxiety experienced by women whose expectations regarding 'bonding' are not realised. While it is now generally acknowledged that maternal attachment develops over an extended period of time, 'bonding' as used extensively in both popular and scientific literature conflates a wide range of meanings and blurs the boundaries between process and outcome. This facilitates the entry of ideological elements into a field which is, by its very nature, deeply significant for human experience. We therefore argue for a continuing critical appraisal of the role of 'bonding' in both general and scientific research.
Anxiety↗
Health at the margins: providing services in remote areas and for marginal populations.
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Australia↗
Contact tracing and sexually transmitted disease among aboriginal men on the Anangu Pitjantjatjara lands.
Sexually transmitted diseases (STDs) are a major health problem for Pitjantjatjara Aboriginal people, causing considerable morbidity and being implicated in the potential rapid transmission of human immunodeficiency virus (HIV) infection. This paper presents data in relation to STD contact tracing on the Anangu Pitjantjatjara lands. In-depth interviews were conducted with Aboriginal men and non-Aboriginal clinic staff to ascertain their attitudes to and perceptions of contact tracing. The interviews with Aboriginal men also sought more general information in relation to health-seeking behaviour and knowledge of STDs. While contact tracing has proven an effective method of case detection on the Anangu Pitjantjatjara lands (most named contacts are able to be located and a high proportion are found to be infected), the data suggest that important constraining issues are the reluctance of Aboriginal men to consult with particular health workers because of moiety group considerations, concerns about confidentiality, and the low level of knowledge of STDs, particularly of largely asymptomatic infections such as chlamydia, syphilis and HIV.
Adolescent↗
Cultural factors in dialysis and renal transplantation among aborigines and Torres Strait Islanders in north Queensland.
Australian Aborigines experience end-stage renal disease at 10 times the national average. Although contributing physiological factors have been widely discussed, there has been little research into cultural factors affecting treatment and outcomes. This paper discusses folk and lay understandings of renal physiology and disease aetiology, and social and cultural factors in dialysis and transplantation, in a group of Aboriginal and Torres Strait Island renal transplant recipients. The implications for service delivery include the need for improved and clear information regarding renal disease and treatment and for culturally appropriate and acceptable support systems. Beliefs that continued alcohol consumption and poor nutrition were major reasons for kidney failure and separation from kin and country emerged as significant factors affecting treatment and leading to poor outcomes.
Cultural Characteristics↗
Social science research in tropical disease.
Awareness of the importance of social science research in health education and the control of tropical diseases is increasing. This article outlines the current status of social science research, highlighting ways in which an understanding of indigenous beliefs and perceptions about illnesses can facilitate their treatment in tropical regions.
Diagnosis↗
Incorporating social sciences into health research.
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Humans↗
Evaluating agency initiatives: building social science capability in tropical disease research.
In recent years, in an endeavour to increase social and economic research in tropical diseases, WHO/TDR has used a number of alternative models to develop social science research capability in countries endemic for the designated tropical diseases. These have included small grants schemes to encourage junior researchers to gain familiarity with the subject area and methods, and protocol development and methodology workshops, either for specific research topics (e.g. adolescent women's health; community perceptions of schistosomiasis) or for any topic of interest to the participants. Participants have included medical researchers, social science researchers, and interdisciplinary teams (e.g. a medical researcher and a collaborating social scientist). This paper develops a typology and critically analyses these alternative approaches to developing research capability, and assesses their effectiveness in terms of cost, short-term effectiveness, and sustainability of the initiative.
Evaluation Studies as Topic↗