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McCollum R, Barrett C, Zawolo G, Johnstone R, Godwin-Akpan TG, Berrian H, Chowdhury S, Kollie J, Kollie K, Rogers E, Parker C, Phillip M, Sempe L, Seekles M, Smith JS, Seekey W, Wickenden A, Zaizay Z, Theobald S, Dean L. 'The Lost Peace': Evidencing the Syndemic Relationship between Neglected Tropical Diseases and Mental Distress in Liberia. Trop Med Infect Dis 2024; 9:183. [PMID: 39195621 PMCID: PMC11359536 DOI: 10.3390/tropicalmed9080183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/12/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024] Open
Abstract
Neglected Tropical Diseases (NTDs) are a group of chronic infectious diseases of poverty affecting over one billion people globally. Intersections of NTDs, disability, and mental ill-health are increasingly evidenced but are rarely studied from a mixed-methods perspective. Here, we advance syndemic understandings by further assessing and contextualising the syndemic relationship between NTDs (particularly their associated disability) and mental distress in Liberia. Participatory qualitative methods, including body mapping (56 participants), social mapping (28 participants), and in-depth interviews (12) provided space for persons affected by NTDs to narrate their experiences. Simultaneously, 201 surveys explored experiences of common mental health conditions among persons affected by skin NTDs. An intersectionality approach was applied within the analysis for both qualitative and quantitative methods informed by Meyer's minority stress model, adapted for NTDs. Qualitative data was analysed thematically and gender-disaggregated, univariable and multivariable analyses were applied to survey data for the outcome measures depression (PHQ-9) and anxiety (GAD-7). Disability was associated with higher levels of depression and anxiety (p < 0.001). An interaction between disability and being a women increased incidence risk ratio of depression (p < 0.001). In alignment with qualitative findings, persons affected experienced additional generalised (financial concerns), external (experience of stigma) and internal (experience of pain and physical symptoms) minority stressors, to varying degrees, which contributed towards their mental distress, and mental health conditions. These findings were used to co-develop a syndemic-informed person-centred health system response to address the suffering associated with NTDs and mental distress, including a focus on strengthening relationships between formal and informal community health actors and the broader health system.
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Affiliation(s)
- Rosalind McCollum
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Carrie Barrett
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Georgina Zawolo
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia 1000, Liberia
| | - Rachel Johnstone
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | | | - Hannah Berrian
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia 1000, Liberia
| | - Shahreen Chowdhury
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Jerry Kollie
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia 1000, Liberia
| | - Karsor Kollie
- Department of Health Services, Ministry of Health-Liberia, Congo Town Back Road, Monrovia 1000, Liberia
| | - Emerson Rogers
- Department of Health Services, Ministry of Health-Liberia, Congo Town Back Road, Monrovia 1000, Liberia
| | - Colleen Parker
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia 1000, Liberia
| | - Maneesh Phillip
- International Programs Department, Effect Hope, 200-90 Allstate Pkwy, Markham, ON L3R 6H3, Canada
| | - Lucas Sempe
- The Institute for Global Health and Development Division, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Maaike Seekles
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - John Solunta Smith
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia 1000, Liberia
| | - Wede Seekey
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia 1000, Liberia
| | - Anna Wickenden
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
- International Programs Department, Effect Hope, 200-90 Allstate Pkwy, Markham, ON L3R 6H3, Canada
| | - Zeela Zaizay
- Action Transforming Lives, Congo Town Backroad, Monrovia 1000, Liberia
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
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Barrett C, Chiphwanya J, Matipula DE, Douglass J, Kelly-Hope LA, Dean L. Addressing the Syndemic Relationship between Lymphatic Filariasis and Mental Distress in Malawi: The Potential of Enhanced Self-Care. Trop Med Infect Dis 2024; 9:172. [PMID: 39195610 PMCID: PMC11360657 DOI: 10.3390/tropicalmed9080172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
Lymphatic filariasis (LF) causes disfiguring and disabling lymphoedema, which can lead to mental distress and requires life-long self-care treatment. This study applies syndemic theory to understand the biosocial relationship between LF and mental distress in Malawi. Using in-depth qualitative methods, we critically evaluate experiences of mental distress and LF through 21 life-history interviews, to narrate experiences from the perspective of persons affected by LF, and to understand how enhanced self-care (ESC) for lymphoedema management disrupts the syndemic relationship. Complementary key informant interviews with Ministry of Health LF programme staff were conducted to further understand intervention and health system delivery. All interviews were recorded, transcribed, and translated, and then subject to thematic analysis. Our findings suggest that for persons affected by LF in Malawi, before being trained in ESC, absent referral pathways, inequalities in healthcare provision or available treatment, and limited knowledge of the condition (LF) drove the syndemic of LF and mental distress. Distress was often exacerbated by stigma and social exclusion, and shaped by intersections of gender, generation, poverty, and extreme climate conditions. We argue that addressing the syndemic suffering associated with LF and mental distress through interventions which center the needs of persons affected is critical in effective and equitable LF care delivery.
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Affiliation(s)
- Carrie Barrett
- Centre for Neglected Tropical Disease, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - John Chiphwanya
- National Lymphatic Filariasis Elimination Programme, Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi
| | - Dorothy E. Matipula
- National Lymphatic Filariasis Elimination Programme, Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi
| | - Janet Douglass
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, 1 James Cook Drive, Douglas, QLD 4811, Australia
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Disease, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, 146 Brownlow Hill, Liverpool L3 5RF, UK
| | - Laura Dean
- Centre for Neglected Tropical Disease, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Chweya RN, Onyango CA, Saigilu S, Mwangi C, Gachohi JM. Spatial and network mapping of comorbidity with trachoma and visual-impairing NCDs in a pastoralist community in Kenya: implications for SDGs and UHC. Int Health 2024; 16:35-44. [PMID: 37528750 PMCID: PMC10759297 DOI: 10.1093/inthealth/ihad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/19/2023] [Accepted: 07/14/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND We explore the spatial distribution of comorbidity with trachoma and potentially visual-impairing non-communicable diseases (NCDs) and their risk factors among Kenyan pastoralists. METHODS Using a cross-sectional study design, we recruited and clinically examined 262 study participants for NCDs (hypertension or diabetes) and trachoma using the World Health Organization grading system. Network models estimated interactions and risks linked with trachoma and NCDs while the Poisson point process determined their spatial distribution. RESULTS Of the 262 participants, 140 (53%) had trachoma, with >71% of these cases identified among females and those >60 y of age. A total of 36 trachoma cases co-occurred with hypertension (26%) and diabetes (0.01%). NCDs were frequent among those with recurring trachoma (21%) and trachomatous trichiasis (14.3%). Trachoma and NCDs clustered together in <1 km distances (R=0.18, p=0.02). In network analysis, age was strongly associated with trachoma and NCDs. Trachoma was linked with geographic location while diabetes was linked with water source distances. Education level became the central risk factor. CONCLUSIONS We demonstrate a twin trachoma-NCD burden that is higher among elderly pastoralists in southern Kenya. Attenuating adverse population-level visual impairment, including integrating the trachoma SAFE strategy with NCD comprehensive care, amplifies the benefits from economies of scale, accelerating realization of Sustainable Development Goal 3 and universal health coverage in hard-to-reach areas.
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Affiliation(s)
- R N Chweya
- Airbel Labs, International Rescue Committee, P.O. Box 62727-00200 Nairobi, Kenya
| | - C A Onyango
- Airbel Labs, International Rescue Committee, P.O. Box 62727-00200 Nairobi, Kenya
| | - S Saigilu
- Public Health Service, Kajiado County Government, P.O. Box 11-01100, Kajiado, Kenya
| | - C Mwangi
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200 Nairobi, Kenya
| | - J M Gachohi
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200 Nairobi, Kenya
- Global Health Program, Washington State University, P.O. Box 62000-00200, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University, P.O. Box 62000-00200 Nairobi, Kenya
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Workman CL, Stoler J, Harris A, Ercumen A, Kearns J, Mapunda KM. Food, water, and sanitation insecurities: Complex linkages and implications for achieving WASH security. Glob Public Health 2022; 17:3060-3075. [PMID: 34506263 DOI: 10.1080/17441692.2021.1971735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Food, water and sanitation insecurities are complex, multi-dimensional phenomena that entail more than availability and access; food, water, and sanitation resources must be safe and culturally appropriate. Researchers and implementers concerned with these insecurities have demonstrated that there are notable interactions between them resulting in significant psychological and biological outcomes. Recent randomised controlled trials (RCTs) in Bangladesh, Kenya (WASH Benefits) and Zimbabwe (SHINE) demonstrated no effect from water, sanitation and hygiene (WASH) interventions on linear growth, and mixed evidence on enteropathogen burden and risk of diarrhoea in young children. These data suggest a need for a more comprehensive understanding of WASH security. The risks posed by multiple resource insecurities shift depending on the individual, their movement throughout their day, their economically and socially prescribed roles, and ecological features such as seasonality and precipitation. By more fully integrating food, water and sanitation security in interventions and subsequent impact evaluations, we can achieve WASH security-one that addresses myriad transmission pathways and co-occurring diseases-that ultimately would improve health outcomes throughout the world. In this critical review, we outline the complexity of combined resource insecurities as a step towards transformative WASH.
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Affiliation(s)
| | | | - Angela Harris
- North Carolina State University, Raleigh, North Carolina
| | - Ayse Ercumen
- North Carolina State University, Raleigh, North Carolina
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Wenning B, Price H, Nuwangi H, Reda KT, Walters B, Ehsanullah R, Viana G, Andras A, Dikomitis L. Exploring the cultural effects of gender on perceptions of cutaneous leishmaniasis: a systematic literature review. Glob Health Res Policy 2022; 7:34. [PMID: 36163191 PMCID: PMC9511709 DOI: 10.1186/s41256-022-00266-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/12/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND More than one million people each year become infected by parasites that cause the disease cutaneous leishmaniasis (CL). This disease manifests as one or more skin lesions or ulcers that are slow to heal with variable response rates to drug treatments. Thus far, little attention has been paid to how the cultural effects of gender shape perceptions and experiences of CL. This review aims to bring together and analyse existing studies which use qualitative data to explore these differences. These studies offered insights into our specific research questions. METHODS We conducted a systematic review of the literature pertaining to either CL or muco-cutaneous leishmaniasis (MCL) through EBSCO, EMBASE, Medline, Scopus and Web of Science databases. To meet inclusion criteria, articles had to be either qualitative or mixed-method with a qualitative component. They also had to include a reflection on how the gender of participants impacted the findings and addressed the lived experiences of CL. We did not exclude articles based on the language they were published in or in which country the study took place. RESULTS From a total of 1589 potential articles, we found that thirteen met the inclusion criteria. These articles were published in English, Spanish or Portuguese and reported on studies carried out in various countries in Africa, Asia and South America. After using the principles of a meta-ethnography to analyse these studies, we generated several key themes. We found that health-seeking behaviours, treatment choices, stigma and the impact of scarring are shaped by gender in a variety of contexts. CONCLUSIONS Gender impacts on an individual's experience of CL. In particular, women are more constricted in their health-seeking behaviours and experience more stigma both from the active lesions and from scarring than men. In many contexts, however, men are more at risk of becoming infected by the parasite that causes CL and may turn to more harmful or aggressive self-treatments. We recommend that future research on CL should consider the impact of gender as this can create very different experiences for individuals.
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Affiliation(s)
- Brianne Wenning
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, CT2 7FS, UK
| | - Helen Price
- School of Life Sciences, Keele University, Newcastle-under-Lyme, UK
| | - Hasara Nuwangi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | | | - Ben Walters
- Royal Stoke University Hospital, Stoke-on-Trent, UK
| | | | - Greice Viana
- State University of Rio de Janeiro (UERJ) and Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Alina Andras
- School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Lisa Dikomitis
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, CT2 7FS, UK.
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Montiel Ishino FA, Rowan C, Talham C, Villalobos K, Poudel D, Rajbhandari-Thapa J, Ambikile JS, Williams F. Household profiles of neglected tropical disease symptoms among children: A latent class analysis of built-environment features of Tanzanian households using the Demographic and Health Survey. J Glob Health 2022; 12:04067. [PMID: 36057837 PMCID: PMC9441010 DOI: 10.7189/jogh.12.04067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background While malaria and neglected tropical disease (NTD) morbidity and mortality rates among children <5 years old have decreased through public health efforts in the United Republic of Tanzania, associations between household environments and disease outcomes are relatively unknown. Methods We conducted latent class analysis (LCA) on 2015-2016 Tanzania Demographic Health Survey data from mothers with children <5 years old (N = 10 233) to identify NTD household risk profiles. The outcome of child NTD was assessed by mothers’ reports of recent diarrhoea, cough, treatment for enteric parasites, and fever symptoms. Household-built environment indicators included urban/rural designation, electricity access, water source, cooking fuel, flooring, wall, and roofing materials. External environmental covariates were considered to further differentiate profiles. Results Five profiles were identified in the sample: rural finished walls households (40.2%) with the lowest NTD risk; rural rudimentary households (20.9%) with intermediate-low NTD risk; finished material households (22.5%) with intermediate NTD risk; urban households (14.4%) with intermediate-high NTD risk and high likelihood of enteric parasites; rural finished roof/walls households (2.1%) with the highest overall NTD risk. Conclusions This study is among the first to use LCA to examine household environment characteristics to assess child NTD risk in Tanzania. This paper serves as a framework for community-level rapid NTD risk assessment for targeted health promotion interventions.
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Affiliation(s)
- Francisco A Montiel Ishino
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Claire Rowan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Charlotte Talham
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Kevin Villalobos
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Dikshit Poudel
- Department of Agricultural and Applied Economics, College of Agricultural and Environmental Science, University of Georgia, Athens, Georgia, USA
| | - Janani Rajbhandari-Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Joel Seme Ambikile
- Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Singer M, Bulled N, Ostrach B, Lerman Ginzburg S. Syndemics: A Cross-Disciplinary Approach to Complex Epidemic Events Like COVID-19. ANNUAL REVIEW OF ANTHROPOLOGY 2021. [DOI: 10.1146/annurev-anthro-100919-121009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this review, we trace the origins and dissemination of syndemics, a concept developed within critical medical anthropology that rapidly diffused to other fields. The goal is to provide a review of the literature, with a focus on key debates. After a brief discussion of the nature and significance of syndemic theory and its applications, we trace the history and development of the syndemic framework within anthropology and the contributions of anthropologists who use it. We also look beyond anthropology to the adoption and use of syndemics in other health-related disciplines, including biomedicine, nursing, public health, and psychology, and discuss controversies in syndemics, particularly the perception that existing syndemics research focuses on methodologies at the individual level rather than at the population level and fails to provide evidence of synergistic interactions. Finally, we discuss emerging syndemics research on COVID-19 and provide an overview of the application of syndemics research.
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Affiliation(s)
- Merrill Singer
- Department of Anthropology, University of Connecticut, Storrs, Connecticut 06269-1248, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut 06269-1248, USA
| | - Nicola Bulled
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut 06269-1248, USA
| | - Bayla Ostrach
- Family Medicine Department, Boston University School of Medicine, Boston, Massachusetts 02118, USA
| | - Shir Lerman Ginzburg
- Department of Public Health Sciences, The University of Connecticut Health Center, Manchester, Connecticut 06042, USA
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Singer M, Rylko-Bauer B. The Syndemics and Structural Violence of the COVID Pandemic: Anthropological Insights on a Crisis. ACTA ACUST UNITED AC 2020. [DOI: 10.1515/opan-2020-0100] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Abstract
This paper examines the COVID-19 pandemic in light of two key concepts in medical anthropology: syndemics and structural violence. Following a discussion of the nature of these two concepts, the paper addresses the direct and associated literatures on the syndemic and structural violence features of the COVID pandemic, with a specific focus on: 1) the importance of local socioenvironmental conditions/demographics and disease configurations in creating varying local syndemic expressions; 2) the ways that the pandemic has exposed the grave weaknesses in global health care investment; and 3) how the syndemic nature of the pandemic reveals the rising rate of noncommunicable diseases and their potential for interaction with current and future infectious disease. The paper concludes with a discussion on the role of anthropology in responding to COVID-19 from a syndemics perspective.
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Affiliation(s)
- Merrill Singer
- University of Connecticut , Department of Anthropology , 354 Mansfield Road, Unit 1176, Storrs, CT 06269-1176, United States
| | - Barbara Rylko-Bauer
- Michigan State University , Department of Anthropology , 655 Auditorium Drive – East Lansing, MI 48824, United States
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Heckert C. Syndemics in Symbiotic Cities: Pathogenic Policy and the Production of Health Inequity across Borders. JOURNAL OF BORDERLANDS STUDIES 2019; 37:37-55. [PMID: 35321446 PMCID: PMC8937002 DOI: 10.1080/08865655.2019.1700823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Carina Heckert
- Department of Sociology and Anthropology, The University of Texas at El Paso
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10
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Franklinos LHV, Jones KE, Redding DW, Abubakar I. The effect of global change on mosquito-borne disease. THE LANCET. INFECTIOUS DISEASES 2019; 19:e302-e312. [PMID: 31227327 DOI: 10.1016/s1473-3099(19)30161-6] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/19/2019] [Accepted: 03/21/2019] [Indexed: 01/01/2023]
Abstract
More than 80% of the global population is at risk of a vector-borne disease, with mosquito-borne diseases being the largest contributor to human vector-borne disease burden. Although many global processes, such as land-use and socioeconomic change, are thought to affect mosquito-borne disease dynamics, research to date has strongly focused on the role of climate change. Here, we show, through a review of contemporary modelling studies, that no consensus on how future changes in climatic conditions will impact mosquito-borne diseases exists, possibly due to interacting effects of other global change processes, which are often excluded from analyses. We conclude that research should not focus solely on the role of climate change but instead consider growing evidence for additional factors that modulate disease risk. Furthermore, future research should adopt new technologies, including developments in remote sensing and system dynamics modelling techniques, to enable a better understanding and mitigation of mosquito-borne diseases in a changing world.
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Affiliation(s)
- Lydia H V Franklinos
- Centre for Biodiversity and Environment Research, Division of Biosciences, University College London, London, UK; Institute for Global Health, University College London, London, UK.
| | - Kate E Jones
- Centre for Biodiversity and Environment Research, Division of Biosciences, University College London, London, UK; Institute of Zoology, Zoological Society of London, London, UK
| | - David W Redding
- Centre for Biodiversity and Environment Research, Division of Biosciences, University College London, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
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11
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Maju M, Sharma A, Beeram A, Ostrach B. A colonial legacy of HIV/AIDS, NTD, and STI super-syndemics: Eugenicist foreign aid and intertwined health burdens in Nigeria. Glob Public Health 2019; 14:1221-1240. [PMID: 30829113 DOI: 10.1080/17441692.2019.1582683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Syndemics theory has been applied to the structurally shaped, biologically facilitated co-occurrence of HIV/AIDS with Neglected Tropical Diseases (NTDs) and with sexually transmitted infections (STIs). The biological and social pathways of interaction between all three ailments have not yet been analysed together. The effects of these diseases are often exacerbated by structural factors including access to care and socioeconomic status. We explore the interrelated biological pathways and structural factors that have further heightened the risk for HIV/AIDS, NTDs, and STIs. Furthermore, we argue women in rural areas are at an increased risk for all three diseases due to biological and social factors including increased distance to quality care and lower reproductive autonomy. This paper integrates the established syndemics of HIV/NTDs and HIV/STIs within the historical and modern contexts of colonisation and neo-colonisation in Nigeria. We explore the effects of colonisation on women's health by evaluating the influence of foreign aid policies, structural programmes, and shifting gender norms. Applying a syndemic approach, juxtaposed by historical contextualisation, offers important implications for the prevention and treatment of HIV/AIDS, STIs, and NTDs. Our analysis suggests a perspective through which to view health of regions with a history of colonisation.
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Affiliation(s)
- Mehar Maju
- a Department of Community Health Sciences, UCLA Fielding School of Public Health , Los Angeles, CA , USA.,b Department of Anthropology , Boston University , Boston, MA , USA
| | - Andria Sharma
- c Department of Biology , Boston University , Boston, MA , USA.,d Rutgers New Jersey Medical School, School of Medicine, Newark , New Jersey , USA
| | - Archana Beeram
- c Department of Biology , Boston University , Boston, MA , USA.,e Imperial College London, School of Public Health , London , UK
| | - Bayla Ostrach
- f Family Medicine, and Affiliated Faculty, Medical Anthropology , Boston University School of Medicine , Boston, MA.,g Sociology and Anthropology , University of North Carolina Asheville , NC , USA
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12
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Bardosh KL, Ryan SJ, Ebi K, Welburn S, Singer B. Addressing vulnerability, building resilience: community-based adaptation to vector-borne diseases in the context of global change. Infect Dis Poverty 2017; 6:166. [PMID: 29228986 PMCID: PMC5725972 DOI: 10.1186/s40249-017-0375-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/15/2017] [Indexed: 11/14/2022] Open
Abstract
Background The threat of a rapidly changing planet – of coupled social, environmental and climatic change – pose new conceptual and practical challenges in responding to vector-borne diseases. These include non-linear and uncertain spatial-temporal change dynamics associated with climate, animals, land, water, food, settlement, conflict, ecology and human socio-cultural, economic and political-institutional systems. To date, research efforts have been dominated by disease modeling, which has provided limited practical advice to policymakers and practitioners in developing policies and programmes on the ground. Main body In this paper, we provide an alternative biosocial perspective grounded in social science insights, drawing upon concepts of vulnerability, resilience, participation and community-based adaptation. Our analysis was informed by a realist review (provided in the Additional file 2) focused on seven major climate-sensitive vector-borne diseases: malaria, schistosomiasis, dengue, leishmaniasis, sleeping sickness, chagas disease, and rift valley fever. Here, we situate our analysis of existing community-based interventions within the context of global change processes and the wider social science literature. We identify and discuss best practices and conceptual principles that should guide future community-based efforts to mitigate human vulnerability to vector-borne diseases. We argue that more focused attention and investments are needed in meaningful public participation, appropriate technologies, the strengthening of health systems, sustainable development, wider institutional changes and attention to the social determinants of health, including the drivers of co-infection. Conclusion In order to respond effectively to uncertain future scenarios for vector-borne disease in a changing world, more attention needs to be given to building resilient and equitable systems in the present. Electronic supplementary material The online version of this article (doi: 10.1186/s40249-017-0375-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kevin Louis Bardosh
- Department of Anthropology, University of Florida, Gainesville, USA. .,Emerging Pathogens Institute, University of Florida, Gainesville, USA.
| | - Sadie J Ryan
- Emerging Pathogens Institute, University of Florida, Gainesville, USA.,Department of Geography, University of Florida, Gainesville, USA
| | - Kris Ebi
- Department of Global Health, University of Washington, Seattle, USA
| | - Susan Welburn
- Centre of Infectious Disease, University of Edinburgh, Edinburgh, UK
| | - Burton Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, USA
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DILEMMAS OF COMMUNITY-DIRECTED MASS DRUG ADMINISTRATION FOR LYMPHATIC FILARIASIS CONTROL: A QUALITATIVE STUDY FROM URBAN AND RURAL TANZANIA. J Biosoc Sci 2016; 49:447-462. [PMID: 27470198 DOI: 10.1017/s0021932016000365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There has in recent years been a growing interest in the social significance of global health policy and associated interventions. This paper is concerned with neglected tropical disease control, which prescribes annual mass drug administration to interrupt transmission of, among others, lymphatic filariasis. In Tanzania, this intervention is conducted through community-directed distribution, which aims to improve drug uptake by promoting community participation and local ownership in the intervention. However, the average uptake of drugs often remains too low to achieve the intended interruption of transmission. The qualitative research presented here followed the implementation of mass drug administration in Lindi and Morogoro Regions, Tanzania, in 2011 to understand the different forms of involvement in the campaign and the experiences of stakeholders of their part in community-directed distribution. Some health care workers, community leaders and drug distributors were generally positive about the intervention, emphasizing that the drugs were welcome. Other stakeholders, including the drug-receiving population, reported facing a number of dilemmas of uncertainty, authority and exclusion pertaining to their roles in the intervention. These dilemmas should be of interest to donors, policymakers and implementers. Community-directed distribution relies on social relations between the many different stakeholders. Successful and justifiable interventions for lymphatic filariasis require implementers to recognize the central role of sociality and that the voices and priorities of people count.
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Armah FA, Quansah R, Luginaah I, Chuenpagdee R, Hambati H, Campbell G. Historical Perspective and Risk of Multiple Neglected Tropical Diseases in Coastal Tanzania: Compositional and Contextual Determinants of Disease Risk. PLoS Negl Trop Dis 2015; 9:e0003939. [PMID: 26241050 PMCID: PMC4524715 DOI: 10.1371/journal.pntd.0003939] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 06/29/2015] [Indexed: 11/06/2022] Open
Abstract
Background In the past decade, research on neglected tropical diseases (NTDs) has intensified in response to the need to enhance community participation in health delivery, establish monitoring and surveillance systems, and integrate existing disease-specific treatment programs to control overlapping NTD burdens and detrimental effects. In this paper, we evaluated the geographical distribution of NTDs in coastal Tanzania. Methods and Findings We also assessed the collective (compositional and contextual) factors that currently determine risks to multiple NTDs using a cross sectional survey of 1253 individuals in coastal Tanzania. The results show that the effect size in decreasing order of magnitude for non-binary predictors of NTD risks is as follows: NTD comorbidities > poverty > educational attainment > self-reported household quality of life > ethnicity. The multivariate analysis explained 95% of the variance in the relationship between NTD risks and the theoretically-relevant covariates. Compositional (biosocial and sociocultural) factors explained more variance at the neighbourhood level than at the regional level, whereas contextual factors, such as access to health services and household quality, in districts explained a large proportion of variance at the regional level but individually had modest statistical significance, demonstrating the complex interactions between compositional and contextual factors in generating NTD risks. Conclusions NTD risks were inequitably distributed over geographic space, which has several important policy implications. First, it suggests that localities of high burden of NTDs are likely to diminish within statistical averages at higher (regional or national) levels. Second, it indicates that curative or preventive interventions will become more efficient provided they can be focused on the localities, particularly as populations in these localities are likely to be burdened by several NTDs simultaneously, further increasing the imperative of multi-disease interventions. Neglected Tropical Diseases (NTDs) are characterized by their high incidence in low-income countries, thus maintaining the disastrous poverty-disease-poverty cycle. Apart from poverty, however, little is known of the magnitude of importance of both compositional and contextual factors in creating disease risk at the local level, although this knowledge is critical to disease control and policy action. In this study, we show that the order of importance of both sets of factors is as follows: NTD comorbidities > poverty > educational attainment > self-reported household quality of life > ethnicity.
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Affiliation(s)
- Frederick Ato Armah
- Environmental Health and Hazards Laboratory, Department of Geography, University of Western Ontario, London, Ontario, Canada
| | - Reginald Quansah
- Biological, Environmental & Occupational Health Sciences, School of Public Health College of Health Science, University of Ghana, Legon, Accra, Ghana
- Noguchi Memorial Institute for Medical Research, College of Health Science, University of Ghana, Legon, Accra, Ghana
- * E-mail:
| | - Isaac Luginaah
- Department of Geography, University of Western Ontario, London, Ontario, Canada
| | - Ratana Chuenpagdee
- Department of Geography, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Herbert Hambati
- Department of Geography, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Gwyn Campbell
- Indian Ocean World Centre (IOWC), Montréal, Quebec, Canada
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Thumbi SM, Njenga MK, Marsh TL, Noh S, Otiang E, Munyua P, Ochieng L, Ogola E, Yoder J, Audi A, Montgomery JM, Bigogo G, Breiman RF, Palmer GH, McElwain TF. Linking human health and livestock health: a "one-health" platform for integrated analysis of human health, livestock health, and economic welfare in livestock dependent communities. PLoS One 2015; 10:e0120761. [PMID: 25798951 PMCID: PMC4370696 DOI: 10.1371/journal.pone.0120761] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/26/2015] [Indexed: 11/23/2022] Open
Abstract
Background For most rural households in sub-Saharan Africa, healthy livestock play a key role in averting the burden associated with zoonotic diseases, and in meeting household nutritional and socio-economic needs. However, there is limited understanding of the complex nutritional, socio-economic, and zoonotic pathways that link livestock health to human health and welfare. Here we describe a platform for integrated human health, animal health and economic welfare analysis designed to address this challenge. We provide baseline epidemiological data on disease syndromes in humans and the animals they keep, and provide examples of relationships between human health, animal health and household socio-economic status. Method We designed a study to obtain syndromic disease data in animals along with economic and behavioral information for 1500 rural households in Western Kenya already participating in a human syndromic disease surveillance study. Data collection started in February 2013, and each household is visited bi-weekly and data on four human syndromes (fever, jaundice, diarrhea and respiratory illness) and nine animal syndromes (death, respiratory, reproductive, musculoskeletal, nervous, urogenital, digestive, udder disorders, and skin disorders in cattle, sheep, goats and chickens) are collected. Additionally, data from a comprehensive socio-economic survey is collected every 3 months in each of the study households. Findings Data from the first year of study showed 93% of the households owned at least one form of livestock (55%, 19%, 41% and 88% own cattle, sheep, goats and chickens respectively). Digestive disorders, mainly diarrhea episodes, were the most common syndromes observed in cattle, goats and sheep, accounting for 56% of all livestock syndromes, followed by respiratory illnesses (18%). In humans, respiratory illnesses accounted for 54% of all illnesses reported, followed by acute febrile illnesses (40%) and diarrhea illnesses (5%). While controlling for household size, the incidence of human illness increased 1.31-fold for every 10 cases of animal illness or death observed (95% CI 1.16–1.49). Access and utilization of animal source foods such as milk and eggs were positively associated with the number of cattle and chickens owned by the household. Additionally, health care seeking was correlated with household incomes and wealth, which were in turn correlated with livestock herd size. Conclusion This study platform provides a unique longitudinal dataset that allows for the determination and quantification of linkages between human and animal health, including the impact of healthy animals on human disease averted, malnutrition, household educational attainment, and income levels.
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Affiliation(s)
- S. M. Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- * E-mail:
| | | | - Thomas L. Marsh
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- School of Economic Sciences, Washington State University, Pullman, Washington, United States of America
| | - Susan Noh
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Animal Diseases Research Unit, Agricultural Research Service, United States Department of Agriculture, Pullman, Washington, United States of America
| | - Elkanah Otiang
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Peninah Munyua
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Linus Ochieng
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eric Ogola
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Jonathan Yoder
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- School of Economic Sciences, Washington State University, Pullman, Washington, United States of America
| | - Allan Audi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Godfrey Bigogo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Guy H. Palmer
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
| | - Terry F. McElwain
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
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