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Brubacher LJ, Berrang-Ford L, Clark SN, Patterson K, Lwasa S, Namanya D, Twesigomwe S, Harper SL. Place, displacement, and health-seeking behaviour among the Ugandan Batwa: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003321. [PMID: 38865306 PMCID: PMC11168611 DOI: 10.1371/journal.pgph.0003321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/15/2024] [Indexed: 06/14/2024]
Abstract
For many Indigenous Peoples, relationships to the land are inherent in identity and culture, and to all facets of health and wellbeing, physically, emotionally, psychologically, and spiritually. The Batwa are Indigenous Peoples of rural, southwest Uganda who have experienced tremendous social and economic upheaval, due to relatively recent forced displacement and land dispossession. This loss of physical connection to their ancestral lands has significantly impacted Batwa health, and also affected available healthcare options for Batwa. This exploratory study (1) identified and characterized factors that influence Batwa health-seeking behaviour, using acute gastrointestinal illness, a critical public health issue, as a focal point for analysis; and (2) explored possible intersections between the Batwa's connection to place-and displacement-and their health-seeking behaviour for acute gastrointestinal illness. Twenty focus group discussions, stratified by gender, were conducted in ten Batwa settlements in Kanungu District, Uganda and eleven semi-structured interviews were conducted with primary healthcare workers, community health coordinators, clinical officers, and development program coordinators. Qualitative data were thematically analyzed using a constant comparative method. Batwa identified several significant motivators to engage with Indigenous and/or biomedical forms of healthcare, including transition to life outside the forest and their reflections on health in the forest; 'intellectual access' to care and generational knowledge-sharing on the use of Indigenous medicines; and Batwa identity and way of life. These nuanced explanations for health-seeking behaviour underscore the significance of place-and displacement-to Batwa health and wellbeing, and its relationship to their health-seeking behaviour for acute gastrointestinal illness. As such, the results of this study can be used to inform healthcare practice and policy and support the development of a culturally- and contextually-appropriate healthcare system, as well as to reduce the burden of acute gastrointestinal illness among Batwa.
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Affiliation(s)
- Laura Jane Brubacher
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Lea Berrang-Ford
- School of Earth and Environment, University of Leeds, Leeds, United Kingdom
| | - Sierra Nicole Clark
- Environmental and Social Epidemiology Section, Population Health Research Institute, St. George’s, University of London, London, United Kingdom
| | - Kaitlin Patterson
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Shuaib Lwasa
- Department of Geography, Makerere University, Kampala, Uganda
| | - Didacus Namanya
- Ugandan Ministry of Health, Kampala, Uganda
- Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
| | | | | | - Sherilee L. Harper
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Amondo EI, Kirui OK, Mirzabaev A. Health gender gap in Uganda: do weather effects and water play a role? Int J Equity Health 2022; 21:173. [PMID: 36471369 PMCID: PMC9720924 DOI: 10.1186/s12939-022-01769-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 10/06/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Vulnerabilities of men and women to adverse health effects due to weather variability and climate change are not equal. Uganda was among the countries in the world most affected by extreme weather events during the last decade. However, there is still limited gendered empirical evidence on the links between weather variability and health and the possible pathways through which these health effects occur. Therefore, this study analyses the effect of weather variability on illness, and the extent to which water collection 'time burden' mediates the relationship between weather anomalies and illness among men and women of working age in Uganda. The study also quantifies the health inequalities to be eliminated if resources are equalized. METHODS Socioeconomic, health and time use data were obtained from the World Bank Living Standards Measurement Studies - Integrated Surveys on Agriculture (LSMS -ISA), combined with high resolution remotely-sensed weather data. Two-parts and non-linear decomposition regression analysis were used on the national representative pooled dataset from the four household survey waves collected between 2009 to 2014, comprising a total of 22,469 men and women aged between 15 and 64 years. RESULTS Empirical results show that low rainfall below the long-term mean increased the likelihood of illness by at least 8 and 6 percentage points for women and men, respectively. The indirect effect of low rainfall on illness through water access pathway was estimated at 0.16 percentage points in women. Decomposition results reveal that health inequalities among women and men would have been narrowed by 27-61%, if endowments were equalized. CONCLUSIONS Strategies that promote women empowerment (such as education, labor force participation, access to financial services and clean water), health adaptation and time poverty reduction strategies (such as rain water harvesting and improved access to quality health care) would reduce gender-based health inequalities in Uganda despite changing climatic conditions.
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Affiliation(s)
- Emily Injete Amondo
- grid.10388.320000 0001 2240 3300Center for Development Research (ZEF), University of Bonn, Genscherallee 3, D - 53113 Bonn, Germany
| | - Oliver K. Kirui
- International Food Policy Research Institute (IFPRI), 7th Amarat Street, P.O. Box 474 – 11111, Khartoum, Sudan
| | - Alisher Mirzabaev
- grid.10388.320000 0001 2240 3300Center for Development Research (ZEF), University of Bonn, Genscherallee 3, D - 53113 Bonn, Germany
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Scarpa G, Berrang-Ford L, Twesigomwe S, Kakwangire P, Galazoula M, Zavaleta-Cortijo C, Patterson K, Namanya DB, Lwasa S, Nowembabazi E, Kesande C, Cade JE. Socio-economic and environmental factors affecting breastfeeding and complementary feeding practices among Batwa and Bakiga communities in south-western Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000144. [PMID: 36962281 PMCID: PMC10021580 DOI: 10.1371/journal.pgph.0000144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/19/2022] [Indexed: 11/19/2022]
Abstract
Improving breastfeeding and complementary feeding practices is needed to support good health, enhance child growth, and reduce child mortality. Limited evidence is available on child feeding among Indigenous communities and in the context of environmental changes. We investigate past and present breastfeeding and complementary feeding practices within Indigenous Batwa and neighbouring Bakiga populations in south-western Uganda. Specifically, we describe the demographic and socio-economic characteristics of breastfeeding mothers and their children, and individual experiences of breastfeeding and complementary feeding practices. We investigate the factors that have an impact on breastfeeding and complementary feeding at community and societal levels, and we analysed how environments, including weather variability, affect breastfeeding and complementary feeding practices. We applied a mixed-method design to the study, and we used a community-based research approach. We conducted 94 individual interviews (n = 47 Batwa mothers/caregivers & n = 47 Bakiga mothers/caregivers) and 12 focus group discussions (n = 6 among Batwa & n = 6 among Bakiga communities) from July to October 2019. Ninety-nine per cent of mothers reported that their youngest child was currently breastfed. All mothers noted that the child experienced at least one episode of illness that had an impact on breastfeeding. From the focus groups, we identified four key factors affecting breastfeeding and nutrition practices: marginalisation and poverty; environmental change; lack of information; and poor support. Our findings contribute to the field of global public health and nutrition among Indigenous communities, with a focus on women and children. We present recommendations to improve child feeding practices among the Batwa and Bakiga in south-western Uganda. Specifically, we highlight the need to engage with local and national authorities to improve breastfeeding and complementary feeding practices, and work on food security, distribution of lands, and the food environment. Also, we recommend addressing the drivers and consequences of alcoholism, and strengthening family planning programs.
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Affiliation(s)
- Giulia Scarpa
- School of Environment, University of Leeds, Leeds, United Kingdom
- School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Lea Berrang-Ford
- School of Environment, University of Leeds, Leeds, United Kingdom
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
| | - Sabastian Twesigomwe
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
| | - Paul Kakwangire
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
| | - Maria Galazoula
- Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Carol Zavaleta-Cortijo
- Facultad de Salud Publica y Administracion, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kaitlin Patterson
- Department of Population Medicine, University of Guelph, Guelph, Canada
| | - Didacus B Namanya
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
- Ministry of Health, Kampala, Uganda
| | - Shuaib Lwasa
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
- Department of Geography, Makerere University, Kampala, Uganda
- The Global Center on Adaptation, Rotterdam, Netherlands
| | - Ester Nowembabazi
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
| | - Charity Kesande
- Indigenous Health Adaptation to Climate Change Research Team, Kanungu District, Buhoma, Uganda
| | | | - Janet E Cade
- School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
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Brubacher LJ, Berrang-Ford L, Clark S, Patterson K, Lwasa S, Namanya DB, Twesigomwe S, Harper SL. 'We don't use the same ways to treat the illness:' A qualitative study of heterogeneity in health-seeking behaviour for acute gastrointestinal illness among the Ugandan Batwa. Glob Public Health 2021; 17:1757-1772. [PMID: 34097579 DOI: 10.1080/17441692.2021.1937273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The Batwa (Twa), an Indigenous People of southwest Uganda, were evicted from their ancestral forest lands in 1991 due to establishment of the Bwindi Impenetrable Forest. This land dispossession forced Batwa to transition from a semi-nomadic, hunting-gathering livelihood to an agricultural livelihood; eliminated access to Indigenous food, medicines, and shelter; and shifted their healthcare options. Therefore, this exploratory study investigated why Batwa choose Indigenous or biomedical treatment, or no treatment, when experiencing acute gastrointestinal illness. Ten gender-stratified focus groups were conducted in five Batwa settlements in Kanungu District, Uganda (n = 63 participants), alongside eleven semi-structured interviews (2014). Qualitative data were analysed thematically, using a constant comparative method. Batwa emphasised that health-seeking behaviour for acute gastrointestinal illness was diverse: some Batwa used only Indigenous or biomedical healthcare, while others preferred a combination, or no healthcare. Physical and economic access to care, and also perceived efficacy and quality of care, influenced their healthcare decisions. This study provides insight into the Kanungu District Batwa's perceptions of biomedical and Indigenous healthcare, and barriers they experience to accessing either. This study is intended to inform public health interventions to reduce their burden of acute gastrointestinal illness and ensure adequate healthcare, biomedical or Indigenous, for Batwa.
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Affiliation(s)
| | | | - Sierra Clark
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Kaitlin Patterson
- Department of Population Medicine, University of Guelph, Guelph, Canada
| | - Shuaib Lwasa
- Department of Geography, Makerere University, Kampala, Uganda
| | - Didacus B Namanya
- Ugandan Ministry of Health, Kampala, Uganda.,Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
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- School of Public Health, University of Alberta, Edmonton, Canada
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Patterson K, Berrang-Ford L, Lwasa S, Namanya DB, Ford J, Research Team IHACC, Harper SL. Food security variation among Indigenous communities in South-western Uganda. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2020.1852146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Kaitlin Patterson
- Dept. Of Population Medicine, University of Guelph, Guelph, Ontario, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta
| | - Lea Berrang-Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, UK
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Shuaib Lwasa
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Dept. Of Geography Geoinformatics and Climatic Sciences, Makerere University, Kampala, Uganda
| | - Didacus B. Namanya
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Ugandan Ministry of Health, Kampala, Uganda
| | - James Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, UK
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - IHACC Research Team
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sherilee L. Harper
- Indigenous Health Adaptation to Climate Change Research Group, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Kraay ANM, Man O, Levy MC, Levy K, Ionides E, Eisenberg JNS. Understanding the Impact of Rainfall on Diarrhea: Testing the Concentration-Dilution Hypothesis Using a Systematic Review and Meta-Analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:126001. [PMID: 33284047 PMCID: PMC7720804 DOI: 10.1289/ehp6181] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Projected increases in extreme weather may change relationships between rain-related climate exposures and diarrheal disease. Whether rainfall increases or decreases diarrhea rates is unclear based on prior literature. The concentration-dilution hypothesis suggests that these conflicting results are explained by the background level of rain: Rainfall following dry periods can flush pathogens into surface water, increasing diarrhea incidence, whereas rainfall following wet periods can dilute pathogen concentrations in surface water, thereby decreasing diarrhea incidence. OBJECTIVES In this analysis, we explored the extent to which the concentration-dilution hypothesis is supported by published literature. METHODS To this end, we conducted a systematic search for articles assessing the relationship between rain, extreme rain, flood, drought, and season (rainy vs. dry) and diarrheal illness. RESULTS A total of 111 articles met our inclusion criteria. Overall, the literature largely supports the concentration-dilution hypothesis. In particular, extreme rain was associated with increased diarrhea when it followed a dry period [incidence rate ratio ( IRR ) = 1.26 ; 95% confidence interval (CI): 1.05, 1.51], with a tendency toward an inverse association for extreme rain following wet periods, albeit nonsignificant, with one of four relevant studies showing a significant inverse association (IRR = 0.911 ; 95% CI: 0.771, 1.08). Incidences of bacterial and parasitic diarrhea were more common during rainy seasons, providing pathogen-specific support for a concentration mechanism, but rotavirus diarrhea showed the opposite association. Information on timing of cases within the rainy season (e.g., early vs. late) was lacking, limiting further analysis. We did not find a linear association between nonextreme rain exposures and diarrheal disease, but several studies found a nonlinear association with low and high rain both being associated with diarrhea. DISCUSSION Our meta-analysis suggests that the effect of rainfall depends on the antecedent conditions. Future studies should use standard, clearly defined exposure variables to strengthen understanding of the relationship between rainfall and diarrheal illness. https://doi.org/10.1289/EHP6181.
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Affiliation(s)
- Alicia N. M. Kraay
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Olivia Man
- Department of Epidemiology, University of Michigan–Ann Arbor, Ann Arbor, Michigan, USA
| | - Morgan C. Levy
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, California, USA
- School of Global Policy and Strategy, University of California San Diego, La Jolla, California, USA
| | - Karen Levy
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Edward Ionides
- Department of Epidemiology, University of Michigan–Ann Arbor, Ann Arbor, Michigan, USA
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Using Machine Learning to Uncover Hidden Heterogeneities in Survey Data. Sci Rep 2019; 9:16061. [PMID: 31690743 PMCID: PMC6831673 DOI: 10.1038/s41598-019-51862-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 10/07/2019] [Indexed: 11/20/2022] Open
Abstract
Survey responses in public health surveys are heterogeneous. The quality of a respondent’s answers depends on many factors, including cognitive abilities, interview context, and whether the interview is in person or self-administered. A largely unexplored issue is how the language used for public health survey interviews is associated with the survey response. We introduce a machine learning approach, Fuzzy Forests, which we use for model selection. We use the 2013 California Health Interview Survey (CHIS) as our training sample and the 2014 CHIS as the test sample. We found that non-English language survey responses differ substantially from English responses in reported health outcomes. We also found heterogeneity among the Asian languages suggesting that caution should be used when interpreting results that compare across these languages. The 2013 Fuzzy Forests model also correctly predicted 86% of good health outcomes using 2014 data as the test set. We show that the Fuzzy Forests methodology is potentially useful for screening for and understanding other types of survey response heterogeneity. This is especially true in high-dimensional and complex surveys.
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