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Msoka EF, Bunn C, Msoka P, Yongolo NM, Laurie E, Wyke S, McIntosh E, Mmbaga BT. Rapid ethnographic appraisal of community concepts of and responses to joint pain in Kilimanjaro, Tanzania. BMJ Glob Health 2024; 9:e013245. [PMID: 38296532 PMCID: PMC10831465 DOI: 10.1136/bmjgh-2023-013245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/06/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Musculoskeletal disorders, experienced as joint pain, are a significant global health problem, but little is known about how joint pain is categorised and understood in Tanzania. Understanding existing conceptualisations of and responses to joint pain is important to ensure both research and interventions are equitable and avoid biomedical imposition. METHODS Rapid ethnographic appraisal was conducted in a periurban and rural community in Kilimanjaro, documenting language used to describe joint pain, ideas about causes, understandings of who experiences such pain, the impacts pain has and how people respond to it. We conducted 66 interviews with community leaders, traditional healers, community members and pharmacists.Photographs were taken and included in fieldnotes to supplement the interview data and develop thick descriptions. Data were analysed by constant comparison using QDA Miner software. RESULTS Across the sample, dominant concepts of joint pain were named ugonjwa wa baridi, cold disease; ugonjwa wa uzee, old age disease; rimatizim, disease of the joints; and gauti, gout. Causes mentioned included exposure to the cold, old age, alcohol and red meat consumption, witchcraft, demons and injuries/falls. Age, gender and occupation were seen as important factors for developing joint pain. Perceived impacts of joint pain included loss of mobility, economic and family problems, developing new health conditions, death, reduction in sexual functioning and negative self-perceptions. Responses to joint pain blended biomedical treatments, herbal remedies, consultations with traditional healers and religious rituals. CONCLUSIONS Conceptualisations of and responses to joint pain in the two communities were syncretic, mixing folk and biomedical practices. Narratives about who is affected by joint pain mirror emerging epidemiological findings, suggesting a strong 'lay epidemiology' in these communities. Anthropological methods can support the decolonisation of global health by decentring the imposition of English language biomedicine and pursuing synthetic, dignified languages of care.
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Affiliation(s)
- Elizabeth F Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Christopher Bunn
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Perry Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Emma Laurie
- School of Geographical & Earth Sciences, University of Glasgow, Glasgow, UK
| | - Sally Wyke
- School of Health & Wellbeing Social Sciences, University of Glasgow, Glasgow, UK
| | - Emma McIntosh
- School of Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Newton A, Awuviry‐Newton K, Oppong Nkansah J, Abekah‐Carter K. Understanding older adults' functioning and health-seeking behaviour during the COVID-19 pandemic in Ghana: A descriptive qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e823-e831. [PMID: 34032345 PMCID: PMC8239829 DOI: 10.1111/hsc.13452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/04/2021] [Accepted: 05/04/2021] [Indexed: 05/06/2023]
Abstract
Little research has been conducted to explore the functional status of community-dwelling older adults in sub-Saharan Africa, including Ghana, especially during the COVID-19 pandemic. This study investigated the functional status and the health-seeking behaviour of older adults during the COVID-19 pandemic in Ghana. Utilising a descriptive qualitative approach, semi-structured interviews were used to collect data from 12 eligible older adults from southern Ghana. With the use of NVivo (v12), descriptive and focused coding techniques were employed to analyse the data. The following five themes were identified after the data analysis: (a) older adults' health status during COVID-19 pandemic, (b) feeling limited, (c) feeling of unhappiness for being inactive, (d) striving to be active and (e) seeking healthcare during COVID-19 pandemic. This study revealed the unique health and social-related needs of Ghanaian older adults during the COVID-19 pandemic. This study's findings draw attention to the urgent need for the state to devise practical health and social-related initiatives to support older adults during and after the COVID-19 pandemic.
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Affiliation(s)
- Abraham Newton
- Department of Social StudiesUniversity of EducationWinnebaGhana
| | - Kofi Awuviry‐Newton
- African Health and Ageing Research Centre (AHARC)WinnebaGhana
- Priority Research Centre for Generational Health and AgeingDepartment of Public Health and MedicineThe University of NewcastleCallaghanNSWAustralia
| | | | - Kwamina Abekah‐Carter
- African Health and Ageing Research Centre (AHARC)WinnebaGhana
- Department of Social WorkUniversity of GhanaLegonGhana
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Awuviry-Newton K, Tavener M, Wales K, Byles J. Interpretative Phenomenological Analysis of the Lived Experiences of Older Adults Regarding Their Functional Activities in Ghana. J Prim Care Community Health 2021; 11:2150132720931110. [PMID: 32584195 PMCID: PMC7318820 DOI: 10.1177/2150132720931110] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction: Research on disability largely draws on epidemiological data, often conducted in more developed countries. To date, there is little research related to older adults in Ghana, Africa. The purpose of this study was to strengthen understanding of how older adults in Ghana perform functional activities, referenced against the World Health Organization’s International Classification of Functioning, Disability and Health (WHO-ICF) framework. Methods: Interpretative phenomenological analysis (IPA) of semistructured interview data was employed as the methodological approach. Using purposive criterion sampling, 8 older adults admitted to Komfo Anokye Teaching Hospital in Ghana, presenting with any identified health condition and/or frailty were recruited. Results: Analysis of interview data identified 5 interrelated themes: (1) feeling anxious, (2) feeling restricted, (3) understanding and admitting difficulty, (4) striving to be healthy and being productive, and (5) managing functional difficulty. These concerns were classified and related to the WHO-ICF, particularly the contextual factors. Discussion: This study examined in detail experiences of older adults performing functional activities. Our study highlights the relevance of the WHO-ICF framework for understanding the health needs of older adults, emphasizing the functional, social, and environmental factors influencing the functional status of older adults. The findings offer unique insight into the health needs of older adults, drawing attention to the implications for policy and care.
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Affiliation(s)
- Kofi Awuviry-Newton
- The Priority Research Centre for Generational Health and Ageing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Meredith Tavener
- The Priority Research Centre for Generational Health and Ageing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Kylie Wales
- The Priority Research Centre for Generational Health and Ageing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Julie Byles
- The Priority Research Centre for Generational Health and Ageing, The University of Newcastle, Callaghan, New South Wales, Australia
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Chihambakwe M, O'Connor L, Orton PM, Hondras MA. If I was more informed about what exactly they do: perceptions of Botswana district hospital healthcare providers about World Spine Care. Chiropr Man Therap 2019; 27:28. [PMID: 31304006 PMCID: PMC6607584 DOI: 10.1186/s12998-019-0250-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/09/2019] [Indexed: 11/18/2022] Open
Abstract
Background In 2011, World Spine Care (WSC) opened their pilot clinic at the Botswana Mahalapye District Hospital (MDH) aiming to develop a low-cost model of evidence-based spine care for underserved communities. Providing sustainable, integrated, evidence-based care will require buy-in from local healthcare providers (HCPs) and the communities served. The purpose of this project was to understand how MDH HCPs perceive WSC. Methods We used a qualitative descriptive methodology to conduct individual, semi-structured interviews with MDH HCPs who had some familiarity about WSC services. Interviews were conducted in English, audio-recorded, and transcribed verbatim. We used an iterative coding process for thematic content analysis and interpretations were regularly reviewed by all co-authors. Results In March 2017, interviews with 20 HCPs, from diverse disciplines with a range in years’ experience at MDH, revealed three overlapping themes: knowledge about WSC and spinal related disorders, perceived role of WSC, and challenges for WSC integration. Participants who attended WSC conferences or self-referred for care were more informed and, generally, held positive perceptions. Participants lacked knowledge about managing spinal-related disorders, asserted hospital protocols did not meet patient needs, and perceived WSC is ‘filling a gap’ to manage these conditions. There were mixed perceptions about care received as WSC patients; some ultimately obtained relief, while others reported the treatment painful and unfamiliar, discharging themselves from care. Challenges to integrate WSC into the healthcare system were: lack of knowledge about scope of practice and unclear referral pathways; reversing the isolated care WSC provides by increasing collaboration between WSC and hospital staff; and, high turnover of WSC clinicians that undermines program sustainability. Conclusions MDH healthcare providers had adequate general knowledge about World Spine Care and spinal-related disorders, but did not understand the WSC scope of practice nor referral pathways to and from providers. Participants advocated for greater collaboration between WSC and hospital staff to increase acceptance and integration to deliver spine care services and foster wider adoption of the WSC model, particularly if WSC expands services across Botswana. Future efforts that incorporate interviews with patients and government officials also can provide valuable perspectives to achieve sustainable, integrated, evidence-based spine care. Electronic supplementary material The online version of this article (10.1186/s12998-019-0250-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mufudzi Chihambakwe
- 1Department of Chiropractic, Faculty of Health Sciences, Durban University of Technology, 11 Ritson Road, Durban, 4001 South Africa
| | - Laura O'Connor
- 1Department of Chiropractic, Faculty of Health Sciences, Durban University of Technology, 11 Ritson Road, Durban, 4001 South Africa
| | - Penelope M Orton
- 2Department of Nursing, Faculty of Health Sciences, Durban University of Technology, 11 Ritson Road, Durban, 4001 South Africa
| | - Maria A Hondras
- 3Department of Anesthesiology, School of Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd. Mail Stop 1034, Kansas City, KS 66160 USA.,World Spine Care Research Team, 801 North Tustin Avenue, Suite 202, Santa Ana, California, USA
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Outerbridge G, Eberspaecher S, Haldeman S. World Spine Care: providing sustainable, integrated, evidence-based spine care in underserved communities around the world. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2017; 61:196-206. [PMID: 29430048 PMCID: PMC5799839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | - Stefan Eberspaecher
- World Spine Care
- Department of Orthopedics, Princess Marina Hospital, Botswana Ministry of Health and Wellness
| | - Scott Haldeman
- World Spine Care
- Department of Neurology, University of California
- Department of Epidemiology, School of Public Health, University of California
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Brady O, Nordin M, Hondras M, Outerbridge G, Kopansky-Giles D, Côté P, da Silva S, Ford T, Eberspaecher S, Acaroğlu E, Mmopelwa T, Hurwitz EL, Haldeman S. Global Forum: Spine Research and Training in Underserved, Low and Middle-Income, Culturally Unique Communities: The World Spine Care Charity Research Program's Challenges and Facilitators. J Bone Joint Surg Am 2016; 98:e110. [PMID: 28002378 DOI: 10.2106/jbjs.16.00723] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The World Spine Care (WSC), established by volunteers from 5 continents, is dedicated to providing sustainable, evidence-based spine care to individuals and communities in low and middle-income countries consistent with available health-care resources and integrated within the local culture. The research committee approves and oversees the WSC's collaborative research and training projects worldwide and serves to create a sustainable research community for underserved populations focused on preventing disability from spinal disorders. The purpose of this article is to describe 4 projects overseen by the WSC research committee and to discuss several challenges and specific facilitators that allowed successful completion of initiatives. These novel projects, which involved establishing spine surgery expertise and data collection in the WSC clinics and surrounding communities, all met their aims. This was achieved by overcoming language and resource challenges, adapting to local customs, and taking time to build mutual respect and to nurture relationships with local investigators and stakeholders.
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Affiliation(s)
- O'Dane Brady
- 1World Spine Care, Santa Ana, California 2Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY 3Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark 4Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada 5Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada 6Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario, Canada 7UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada 8World Spine Care, Moca, Dominican Republic 9Ankara ARTES Spine Center, Ankara, Turkey 10Mahalapye District Hospital, Mahalapye, Botswana 11Department of Epidemiology, Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, Hawaii 12Department of Epidemiology, School of Public Health, University of California, Los Angeles, Los Angeles, California 13Department of Neurology, University of California, Irvine, Irvine, California
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Shaibu S. Caring for HIV-positive orphans in the context of HIV and AIDS: perspectives of Botswana grandmothers. Int J Older People Nurs 2016; 11:315-323. [PMID: 27325553 DOI: 10.1111/opn.12122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 04/20/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Botswana has a human immunodeficiency virus (HIV) prevalence of 18.6% and an estimated 137 805 orphans in a population of approximately two million people. Many of these orphans are cared for by their grandmothers, who struggle with caring for orphans suffering from a disease they know very little about. METHODS The purpose of this exploratory qualitative study was to explore experiences of grandmothers caring for HIV-positive orphan grandchildren. RESULTS The ages of the grandmothers interviewed ranged from 60 to 80 years, while the number of orphans under their care ranged from one to nine. The themes that emerged included the following: challenges of HIV treatment, HIV-related stigma, disclosure of HIV status, communication of sexuality issues and the adolescent pregnancies. Cultural beliefs prevented them from talking about sexuality and in some cases, accepting HIV as the cause of death. CONCLUSIONS Grandmothers were challenged by HIV treatment of orphans and their supportive role as caregivers. The lack of knowledge of the disease must be addressed to improve adherence and communication about HIV. HIV programs need to address older persons' dynamic and diverse needs as individuals. Community home-based care nurses need to support grandmothers caring for HIV-positive grandchildren and refer them to relevant professionals who can assist with the care responsibilities. IMPLICATIONS FOR PRACTICE Nurses working with older people caring for HIV positive orphans need to develop culturally sensitive HIV education programs that address needs specific to.
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Affiliation(s)
- Sheila Shaibu
- New York University Rory Meyers College of Nursing & the Human Resources for Health (HRH), Program in Rwanda, College of Medicine and Health Sciences, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda
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