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PubMed2000

Public reform and the privatisation of poverty: some institutional determinants of health seeking behaviour in southern Tanzania.

This paper explores the changing institutional context of health service delivery in rural Tanzania through an anthropological analysis of the kinds of healing strategies pursued by men and women when they are ill. In some rural districts popular dissatisfaction with state medical provision is not manifested in a rejection of the allopathic medicine with which it is associated, but in increased reliance on an emerging informal sector of private medical provision. Although this sector provides a valued and accessible service to certain categories of clients it delivers poor quality treatment, serving to reinforce the cyclical relationship between poverty and ill health. Despite the best intentions of major public sector reforms neither government nor other agencies are able to meet rural demand for health services. Reliance on the parallel market for medical provision is likely to continue, at least in the short term, with negative consequences for health.

Adult↗
PubMed2001

Aging in a tiger welfare regime: the single elderly in Hong Kong.

This paper explores the coping strategies of the low income single elderly in Hong Kong, which are divided into several broad types: government-orientated (public services); market-orientated; community-orientated; and individually-orientated (practically speaking self restraint and denial). It highlights this group's reliance on the government, which not only provides housing, medical care and other services, but is also a major source of income support, although support levels are seriously inadequate. Yet the highly differentiated nature of Hong Kong's market economy provides single elders with ways to supplement inadequate public provision, by entering into low paid, menial work, and purchasing consumption necessities and accessing affordable housing in the informal sector--notably those segments of Hong Kong's increasingly sophisticated economy that are a throwback to leaner, meaner times. This case study also highlights the extent to which the community sector is undeveloped in Hong Kong. In spite of Hong Kong's wealth and level of economic development the prognosis for this group is not good.

Journal Article↗
PubMed1998

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↗
PubMed2001

Assistance with personal care activities among the old-old in Israel: a national epidemiological study.

OBJECTIVES: The objectives of this study were to (1) estimate rates of difficulty, need for assistance, and receipt of assistance with activities of daily living (ADLs) among the old-old in Israel; (2) describe the living arrangements of the dependent old-old; and (3) gain insight into the caregiving provided to the disabled members of this population. DESIGN: A random stratified sample of 1,820 subjects age 75 to 94 selected from the National Population Register (NPR), a complete listing of the Israeli population maintained by the Ministry of the Interior. The study sample consisted of Jews living in Israel on January 1, 1989, stratified by age (four 5-year age groups: 75-79, 80-84, 85-89, 90-94), sex, and place of birth (Europe-America, Middle East/North Africa, Israel). SETTING: National sample of old-old Jewish Israelis. PARTICIPANTS: One thousand eight hundred twenty Israelis age 75 to 94 who were living in the community or in institutions at the time of the baseline interview. MEASUREMENTS: Participants' disability status was classified in terms of difficulty with, needing help with, and receiving help with any of five ADLs (washing/bathing, dressing, transferring, toileting, and eating). Only those receiving assistance from a person (as opposed to a device) were considered to be receiving help. The independent variables used included sociodemographic, health, and social network characteristics of the participants. RESULTS: Twenty-one percent of those age 75 to 94 were found to be receiving personal assistance with at least one ADL. The most dependent were those age 90 to 94, women, those born in the Middle East or North Africa, and those living in an institution. Among those dependent in one or more ADLs, the overall community:institutionalized ratio was 2.4:1. Those who were dependent in three to five ADLs were about twice as likely to live in an institution as were those who were dependent in one or two ADLs. The Middle Eastern/North African born were more likely to be dependent, and at any given level of disability were more likely to be living in the community with a child and receiving the majority of their caretaking from the informal sector, primarily their family. CONCLUSION: We conclude that the families of disabled older people, particularly the Middle Eastern/North African born, provide a great deal of care for their older relatives despite the availability of a full range of services, providing no evidence of withdrawal of family care when state home and institutional care are available. This finding may imply underutilization of services, which should be investigated further to determine if it is caused by barriers to utilization or by the free choice of the disabled old-old and their families.

Activities of Daily Living↗
PubMed2003

Empowered women, social networks and the contribution of qualitative research: broadening our understanding of underlying causes for food and nutrition insecurity.

OBJECTIVE: To investigate underlying causes for food and nutrition insecurity in black South African households and to gain understanding of the factors contributing to better nutrition security, with emphasis on household organisation, gender and intra-household dynamics and social networks. DESIGN, SETTING AND SUBJECTS: Within a larger cross-sectional survey that investigated the impact of urbanisation on the health of black South Africans, 166 people, mostly women, were interviewed on household food security. Methods used were structured face-to-face interviews, in-depth interviews, observation, interviews with key informants and a sociodemographic questionnaire. Information was collected from 1998 to 2000 in 15 rural and urban areas of the North West Province, South Africa. RESULTS: Three-quarters of households in this sample are chronically food-insecure. Families are disrupted, due to migrant work, poverty and increasing societal violence, and half of households are female-headed. Certain categories of female-headed households and households based on partnership relationships, despite more limited resources, achieve a better or an equal economic status and better nutrition security than those households led by men, with the latter often being considered an economic liability. The reliance on and fostering of social ties and networks appear to be of central significance. CONCLUSION: Gender and intra-household relations, as well as social networks and income from informal sector activities, are often not uncovered by conventional statistical methods. Qualitative research can reveal the unexpected and furthermore empowers people, as their voices are heard.

Adult↗
PubMed1989

The impact of circular migration on a village economy.

The author examines the economy of a rural village in Indonesia in which a high proportion of households rely on remittances from urban informal sector earnings. Household income and per capita income are analyzed according to whether or not households have at least one temporary migrant, and by the sex and age of the household head. Findings indicate that "remittances from short-term circular migration push many households into the middle and upper income ranges. However, the wealthiest households continue to rely on traditional high earning activities and do not depend on remittances. The poorest households are scattered among those who rely on remittances and those still totally dependent upon traditional low earning village activities, regardless of the sex and age of the household head."

Age Factors↗
PubMed2004

Widening the cervical cancer screening net in a South African township: who are the underserved?

Cervical cancer screening services in South Africa have failed to reach the majority of the population and to significantly reduce mortality. A household survey in a predominantly Black African population living in a low-income township on the outskirts of Cape Town was undertaken to ascertain the characteristics of women reporting never having been screened. In our group of 664 representatively sampled women. 45% of women reported having had a cervical screening test. However, in what at first glance appears to be a fairly homogeneous population, there were significant differences in the types of women who access and who do not access cervical smear services. The underserved tend to be the older, poorer, less educated, and unemployed (or working in the informal sector) women. They tend to live in nonpermanent dwellings without a partner, they do not know anyone else who has had a cervical smear, and they have not recently sought care for other ailments, or used contraception. Cervical cancer is a slow-to-develop, eminently preventable disease, and yet opportunistic screening through antenatal and family planning services has failed to reach the women most at risk. Efforts in the future must include targeting older women in health centres where they present for other curative services (diabetes, hypertension). Most importantly, areas of the community with the greatest concentration of marginalized women need to be targeted through peer education and other innovative programs. As the underserved tend to be the poorer and less educated women in the community, we must ensure that messages are culturally relevant and appropriate and have a holistic focus on women's physical, mental, and emotional health.

Adult↗
PubMed1980

Formal and informal care: discontinuities in a continuum.

Informal caregiving by family, friends, neighbors, and self-help groups is being given greater attention as human-service policy seeks to establish a continuum of care knitting together professional efforts and informal helping. However, there are many contradictions in assumptions and perspectives about who should handle problems and in what way. Alternative modes of interaction are outlined to indicate the variety of relationships that have developed in response to differences in assumptions about care. Collaboration between formal and informal helping efforts requires that the informal sector be able to influence professional and organizational expectations regarding responsibility, authority, and credibility.

Continuity of Patient Care↗
PubMed2000

The costs of HIV/AIDS care at government hospitals in Zimbabwe.

According to official figures, HIV infection in Zimbabwe stood at 700 000-1 000 000 in 1995, representing 7-10% of the population, with even higher expected numbers in 2000. Such high numbers will have far reaching effects on the economy and the health care sector. Information on costs of treatment and care of HIV/AIDS patients in health facilities is necessary in order to have an idea of the likely costs of the increasing number of HIV/AIDS patients. Therefore, the present study estimated the costs per in-patient day as well as per in-patient stay for patients in government health facilities in Zimbabwe with special emphasis on HIV/AIDS patients. Data collection and costing was done in seven hospitals representing various levels of the referral system. The costs per in-patient day and per in-patient stay were estimated through a combination of two methods: bottom-up costing methodology (through an in-patient note review) to identify the direct treatment and diagnostic costs such as medication, laboratory tests and X-rays, and the standard step-down costing methodology to capture all the remaining resources used such as hospital administration, meals, housekeeping, laundry, etc. The findings of the study indicate that hospital care for HIV/AIDS patients was considerably higher than for non-HIV/AIDS patients. In five of the seven hospitals visited, the average costs of an in-patient stay for an HIV/AIDS patient were found to be as much as twice as high as a non-HIV/AIDS patient. This difference could be attributed to higher direct costs per in-patient day (medication, laboratory tests and X-rays) as well as longer average lengths of stay in hospital for HIV/AIDS patients compared with non-infected patients. Therefore, the impact on hospital services of increasing number of HIV/AIDS patients will be enormous.

Cost Allocation↗
PubMed2003

Social context for workplace health promotion: feasibility considerations in Costa Rica, Finland, Germany, Spain and Sweden.

We constructed a simple, flexible procedure that facilitates the pre-assessment of feasibility of workplace health promotion (WHP) programmes. It evaluates cancer hazards, workers' need for hazard reduction, acceptability of WHP, and social context. It was tested and applied in 16 workplace communities and among 1085 employees in industry, construction, transport, services, teaching and municipal works in Costa Rica, Finland, Germany, Spain and Sweden. Social context is inseparable from WHP. It covers workers' organizations and representatives, management, safety committees, occupational health services, health and safety enforcement agencies, general health services, non-government organizations, insurance systems, academic and other institutions, regulatory stipulations pertaining WHP, and material resources. Priorities, risk definitions, attitudes, hazard profiles, motivations and assessment methods were highly contextual. Management preferred passive interventions, helping cover expert costs, participating in planning and granting time. Trade unions, workers' representatives, safety committees and occupational health services appeared to be important operational partners. Occupational health services may however be loaded with curative and screening functions or be non-existent. We advocate participatory, multifaceted WHP based on the needs and empowerment of the workers themselves, integrating occupational and lifestyle hazards. Workforce in irregular and shift work, in agriculture, in small enterprises, in the informal sector, and immigrant, seasonal and temporary workers represent groups in need of particular strategies such as community health promotion. In a more general framework, social context itself may become a target for intervention.

Attitude to Health↗
PubMed1992

The street children of Recife: a study of their background.

A classification of street children as those 'on' the street and 'of' the street is offered. In a study of children 'on' the street, economic need of the family was the main cause (82 per cent). The children were 14 times more likely to come from families who have recently moved into a neighbourhood; 3 and 3.7 times, respectively, to come from households headed by the mother or her male companion; nine times more likely to be living in homes without running water, and four times more likely to be without toilet facilities. The family income was a third less than average. Some families had sent their children out to work as early as the age of 5 years. Ninety-four per cent of the children were contributing between half to all of their earning to the home, although this was less so with older children. Exploitation at work was common. More than three-quarters earned less than the minimum wage, and half of them earned less than half the minimum wage. More than a third were not attending school and, among them, 87 per cent had left school after going 'on' the street. Those attending school were a grade or two behind that expected for their age. After working on the street for several years (mode = 4 years; longest = 12 years) most could see themselves as continuing to work in the informal sector. They ways in which MCH services can respond to the needs of street children are discussed.

Adolescent↗
PubMed2001

Mother's working status and nutritional status of children under the age of 5 in urban low-income community, Surabaya, Indonesia.

A cross-sectional anthropometrics survey was carried out in a low-income community of Surabaya, Indonesia, to examine the association between mother's employment and the child's nutritional status for identifying a group at risk of having malnourished children. Subjects were 274 children under the age of 5. The children of non-working mothers had significantly higher height-for-age z-score (HAZ) (p < 0.05) than those of working mothers. When mother's work was divided into 'formal' and 'informal', HAZ and weight-for-age z-score (WAZ) of children of the informal worker's group were significantly lower than those of the non-working mother and the formal worker's group (p < 0.05). Mother's education and income of the formal worker's group were significantly higher than those of the informal worker's group (p < 0.01). Our study identified a group at risk of malnutrition, i.e., children of mothers working in informal sectors. The programs to provide childcare for working mothers should target this particular group of poor households.

Adult↗
PubMed1993

Rural-urban migration in economic development.

"This paper provides a review of the theoretical literature on rural-urban migration in contemporary LDCs [less developed countries]. The paper begins with a brief discussion of the Lewis model before going on to discuss the Todaro and the Harris-Todaro models and the large literature which these models have spawned. The question of job search in the context of migration and the role of family members in migration decisions are considered next. The paper then takes a closer look at the Informal sector and also sets out alternative migration functions to the ones usually employed in the literature."

Demography↗
PubMed1986

Class structure and spatial polarization: an assessment of recent urban trends in Latin America.

"In this paper, we review those major trends characteristic of peripheral urbanization as they are reflected in the recent Latin American experience. Such trends include: urban primacy and the relative absence of secondary city systems, the character and dynamics of the informal sector, housing deficiencies and state housing policy, and the recent rise of popular organizations oriented toward self-sufficiency or militant demand-making. These trends are important because they represent the form in which continuity and change of peripheral class structures are reflected in space, both at the national and local levels....[The authors conclude that] the political economy of Latin American cities is one where the resolution to the plight of underdevelopment promised by accelerated capitalist industrialization has not materialized. Instead, the process has produced a more complex and more contradictory social fabric."

Americas↗
PubMed2005

A case-control study of risk factors for male infertility in Nigeria.

AIM: To evaluate the association between selected potential socio-demographic and behavioral risk factors and infertility in Nigerian men. METHODS: There were two groups in this study. One group consisted of 150 men with proven male infertility, and the other consisted of 150 fertile men with normal semen parameters. Both were matched for age, place of residence and key socio-demographic variables. They were compared for sexual history, past medical and surgical history, past exposures to sexually transmitted infections and treatment, past and current use of drugs as well as smoking and alcohol intake history. RESULTS: Infertile men were significantly more likely than fertile men to report having experienced penile discharge, painful micturition and genital ulcers, less likely to seek treatment for these symptoms and more likely to seek treatment with informal sector providers. Multivariate analysis showed that male infertility was significantly associated with bacteria in semen cultures, self-reporting of previous use of traditional medications and moderate to heavy alcohol intake, but not with smoking and occupational types. CONCLUSION: INFERTILITY is associated with various proxies of sexually transmitted infections (STIs) and poor healthcare-seeking behavior for STIs in Nigerian men.

Adult↗
PubMed2004

Sexual patterning and condom use among a group of HIV vulnerable men in Thika, Kenya.

BACKGROUND/AIM: A composite sample of 37 peer educators and 215 members of self help groups of male informal sector workers in Thika, Kenya, targeting HIV/AIDS prevention, were interviewed about their sexual behaviour, using a customised template, as part of a broader survey on gender attitudes and peer pressure. METHOD: Details on each sexual partner reported by each man over a 12 month recall period included type of partner, months during which sexual relations took place, and condom use. RESULTS: The men reported 471 sexual partners over the recall period, with a range of 0-16 partners, and an average of just under two partners. 8% of men had had no sexual partner, half were monogamous, and 3% had multiple partners with whom they used condoms exclusively, leaving 39% at varying degrees of risk. Condom use increased significantly with reduced intimacy of partner. 16% of men reported having at least one liaison with a female sex worker and two thirds of such liaisons were exclusively protected by condom use. Younger, single men had significantly more partners, but were more likely to use condoms. Duration of membership in self help groups was strongly associated with exclusive use of condoms with casual or FSW partners. Recorded attitudes corresponded somewhat with practice, but the data showed large gaps between the two, and low levels of gender sensitivity. CONCLUSION: There is some evidence that group membership has resulted in increased condom use and partner reduction, but there are doubts as to the extent to which the "ABC" strategy can be successful in stemming the HIV/AIDS epidemic. It may be necessary for interventions to target contextual issues, particularly gender relations, if the approach is to be more successful.

Adult↗
PubMed2001

Where do sex workers go for health care? A community based study in Abidjan, Côte d'Ivoire.

OBJECTIVES: To describe health seeking behaviour of female sex workers in Abidjan, Côte d'Ivoire. METHODS: A population based survey among a representative sample of 500 female sex workers and six focus group discussions. RESULTS: The sites of first encounter for care for the last STI episode included a public hospital or health centre (28%), a private clinic (16%), a confidential clinic (13%), a pharmacy (13%), and the informal sector (23%). The agreement between preferred and actual services used was weak (kappa 0.16). CONCLUSIONS: Sex workers expressed interest in seeking STI care in a wide range of public and private healthcare facilities. Those services should be upgraded to better respond to their sexual health needs.

Adult↗
PubMed2002

Part time female sex workers in a suburban community in Kenya: a vulnerable hidden population.

BACKGROUND: In sub-Saharan Africa, female sex workers (FSWs) are a vulnerable high risk group for the acquisition and transmission of sexually transmitted infections (STI) and HIV. OBJECTIVES: To study parameters of sexual behaviour and knowledge of STI and HIV, to describe health seeking behaviour related to STI, and to measure the prevalence of gonorrhoea, chlamydia, syphilis, and HIV-1, to provide baseline data for targeted STI and HIV prevention interventions. METHODS: In a cross sectional survey with snowballing recruitment, between February and March 2000, 503 self identified FSWs in a suburb in Mombasa, Kenya, were interviewed with a structured questionnaire and screened for gonorrhoea, chlamydia, syphilis, and HIV-1. RESULTS: The mean number of sexual partners in the previous week was 2.8 (SD 1.6). The mean number of non-regular clients and regular clients in the previous week was 1.5 (1.0) and 1.0 (0.9) respectively. The median weekly income from sex work was $US15. A total of 337 (67%) women had an alternative income in the informal sector. 146 (29%) and 145 (45%) never used a condom with a client and non-paying partner respectively. The prevalence of gonorrhoea, chlamydia, and syphilis was 1.8%, 4.2%, and 2.0% respectively. The overall HIV-1 seroprevalence was 30.6%. CONCLUSIONS: There is a large need for intensive STI and HIV prevention interventions in part time FSW.

Acquired Immunodeficiency Syndrome↗