RESUMEN
PURPOSE: Screening school students for refractive errors is a component of many primary eye care programs. In 2004 a trial of two approaches of spectacle-delivery to Tanzanian secondary school students found that only one third of students were using their spectacles at three months. Barriers to spectacle use were investigated using questionnaires and focus group discussions. METHODS: At the three months follow-up survey a questionnaire explored satisfaction with spectacles and the attitudes of trial participants (median age 15 years). Attitudes and reactions of friends, teachers and families were also explored. Students also discussed their experience with spectacle use and reasons for non-use in 8 focus groups divided by intervention, sex and spectacle use. RESULTS: In general, students seemed happy with the appearance of their spectacles and the beneficial impact on their vision. Peer pressure and parental concerns about safety of spectacle use, cost of purchasing spectacles and difficulties in accessing good local optical services were identified as the main barriers. Students criticized prescribing practices of local opticians and favored alternative and traditional treatments for visual impairment. CONCLUSION: To increase the effectiveness of school vision screening in Tanzania, barriers such as peer pressure or concerns about safety need to be addressed, in addition to provision of affordable, good quality spectacles. Barriers to spectacle use in children are likely to exist in all populations, but may vary in their nature and importance and therefore should be investigated in existing and new screening programs.
Asunto(s)
Anteojos/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Errores de Refracción/terapia , Adolescente , Femenino , Estudios de Seguimiento , Humanos , Masculino , Cooperación del Paciente , Educación del Paciente como Asunto , Prevalencia , Errores de Refracción/fisiopatología , Estudios Retrospectivos , Tanzanía/epidemiología , Selección Visual , Agudeza VisualRESUMEN
OBJECTIVE: Male circumcision reduces risk of HIV among heterosexual men by about 60%. Modelling the impact of circumcision on HIV transmission, and planning service expansion, relies on self-reported circumcision status. We investigated the validity of self-reported status. METHODS: Survey and in-depth interview (IDI) data from adolescents enrolled in a community randomized sexual health intervention trial in rural Mwanza, Tanzania were analysed. RESULTS: The 5354 male school attenders (median age 15.5 years) were recruited in 1998 and followed for 3 years. At baseline, circumcision prevalence was 13.7% by self-report and 11.8% by clinical examination, rising to 17.3% by clinical examination at final survey. Only 61.5% of Muslim males were circumcised at the final survey. Of 506 participants who reported being circumcised at baseline, only 78.9% reported this at interim. Similarly, only 84.2% of participants clinically assessed as circumcised at baseline were also assessed as circumcised at interim. At both baseline and interim surveys, about 80% of participants who reported being circumcised were also found to be so at clinical examination. There was a high tolerance and respect for circumcision among male IDI respondents, with widespread belief that it was beneficial for penile hygiene and disease prevention. The majority of female IDI respondents said that they did not know what male circumcision was. DISCUSSION: Attitudes to male circumcision were positive in this population despite its low prevalence. There were substantial inconsistencies in both self-reported and clinically assessed circumcision status. Methods are needed to improve self-report and training of clinicians in this setting.
Asunto(s)
Circuncisión Masculina/estadística & datos numéricos , Infecciones por VIH/prevención & control , Enfermedades de Transmisión Sexual/prevención & control , Adolescente , Adulto , Circuncisión Masculina/psicología , Estudios de Cohortes , Conocimientos, Actitudes y Práctica en Salud , Heterosexualidad , Humanos , Masculino , Análisis de Regresión , Encuestas y Cuestionarios , Tanzanía/epidemiologíaRESUMEN
The World Health Organization estimates that 3.1 percent of East African women aged 15-44 have undergone unsafe abortions. This study presents findings regarding abortion practices and beliefs among adolescents and young adults in Tanzania, where abortion is illegal. From 1999 to 2002, six researchers carried out participant observation in nine villages and conducted group discussions and interviews in three others. Most informants opposed abortion as illegal, immoral, dangerous, or unacceptable without the man's consent, and many reported that ancestral spirits killed women who aborted clan descendants. Nonetheless, abortion was widely, if infrequently, attempted, by ingestion of laundry detergent, chloroquine, ashes, and specific herbs. Most women who attempted abortion were young, single, and desperate. Some succeeded, but they experienced opposition from sexual partners, sexual exploitation by practitioners, serious health problems, social ostracism, and quasi-legal sanctions. Many informants reported the belief that inopportune pregnancies could be suspended for months or years using traditional medicine. We conclude that improved reproductive health education and services are urgently needed in rural Tanzania.
Asunto(s)
Aborto Criminal/etnología , Aborto Criminal/psicología , Conducta Sexual/etnología , Conducta Sexual/psicología , Aborto Criminal/estadística & datos numéricos , Adolescente , Adulto , Antropología Cultural , Toma de Decisiones , Femenino , Humanos , Relaciones Interpersonales , Magia , Embarazo , Tanzanía/epidemiología , Resultado del TratamientoRESUMEN
Most people living with AIDS in sub-Saharan Africa have had neither a biomedical diagnosis nor antiretroviral medication, leading to the question of how individuals understand and treat AIDS. This study examined general illness, sexually-transmitted infection (STI) and AIDS treatment-seeking behaviour in rural Mwanza, Tanzania. From 1999-2002, participant observation was carried out in nine villages for a total of 158 person-weeks. Treatments were pluralistic and opportunistic, usually beginning with home remedies (western or traditional), followed by visits to traditional healers (THs) and/or health facilities (HFs). THs were sometimes preferred over HFs because of familiarity, trust, accessibility, expense, payment plans, and the perceived cause, nature and severity of the illness, e.g. only THs were believed to successfully treat bewitchment. Some people, particularly young girls, delayed or avoided seeking treatment for STIs for fear of stigma. Most STIs were attributed to natural causes, but AIDS was sometimes attributed to witchcraft. Locally available biomedical care of people with AIDS-like symptoms consisted of basic treatment of opportunistic infections. Most such individuals repeatedly visited THs and HFs, but many stopped attending HFs because they came to believe they could not be cured there. Some THs claimed to cure witchcraft-induced, AIDS-like illnesses. There is an urgent need for improved biomedical services, and TH interventions could be important in future HIV/AIDS education and care.
Asunto(s)
Aceptación de la Atención de Salud/estadística & datos numéricos , Enfermedades de Transmisión Sexual/terapia , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/psicología , Síndrome de Inmunodeficiencia Adquirida/terapia , Adulto , Femenino , Humanos , Masculino , Cuerpo Médico de Hospitales/normas , Medicinas Tradicionales Africanas , Salud Rural , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/psicología , Estereotipo , Tanzanía/epidemiologíaRESUMEN
HIV/AIDS programmes and interventions are more likely to succeed if they engage with local people's beliefs about AIDS causation. This study examined beliefs about general illness, sexually-transmitted infection (STI) and AIDS aetiology in rural Mwanza, Tanzania. From 1999-2002, participant observation was carried out in nine villages for a total of 158 person-weeks. Beliefs about general illness causation included God's will, chance, natural/biological, ancestral spirits, and witchcraft. STIs were generally attributed to natural causes, but beliefs about AIDS causation were more complex. Few villagers had heard of HIV, but most had heard of AIDS and understood that AIDS could be contracted through sex. A small proportion of villagers knew that such an infected person might appear healthy, but they generally believed the asymptomatic period to last only a few months after exposure; if healthy beyond that, the person was not believed to have been infected. Many people in all villages reported belief in both a 'real' (natural) AIDS, which leads to certain death, and a similar illness caused by witchcraft, which can be cured using traditional medicine. Punishment of accused witches occurs officially and informally, and this may increase with increasing AIDS deaths. There is an urgent need for culturally appropriate interventions to address HIV/AIDS causation beliefs in the region.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/etnología , Características Culturales , Conocimientos, Actitudes y Práctica en Salud , Población Rural , Supersticiones , Actitud Frente a la Salud/etnología , Femenino , Humanos , Masculino , Tanzanía , Salud de la MujerRESUMEN
There has been a long-running debate as to whether sexual cultures in sub-Saharan Africa are permissive or characterised by restrictive rules, rituals and self-restraint. This paper, based on participant observation data, outlines the main features of sexual culture in rural northern Tanzania and highlights both permissive and restrictive norms and expectations for young people. It also illustrates how sexual beliefs are socially constructed and subject to social change. Sexual activity is constrained by clear norms of school pupil abstinence, female sexual respectability and taboos around the discussion of sex. However, these norms are incompatible with several widely held expectations: that sexual activity is inevitable unless prevented, sex is a female resource to be exploited, restrictions on sexual activity are relaxed at festivals, and masculine esteem is boosted through sexual experience. Differential commitment to these norms and expectations reflects conflicts between generations and genders. Young people appear to manage the contradictions in these norms by concealing their sexual relationships. This almost certainly contributes to their short duration and the high levels of partner change, since relationships are not reinforced through social recognition and there is little scope to develop intimacy through non-sexual contacts.