Helle Samuelsen

Keeping Up Appearances: Perceptions of Street Food Safety in Urban Kumasi, Ghana

The growing street food sector in low-income countries offers easy access to inexpensive food as well as new job opportunities for urban residents. While this development is positive in many ways, it also presents new public health challenges for the urban population. Safe food hygiene is difficult to practice at street level, and outbreaks of diarrheal diseases have been linked to street food. This study investigates local perceptions of food safety among street food vendors and their consumers in Kumasi, Ghana in order to identify the most important aspects to be included in future public health interventions concerning street food safety. This qualitative study includes data from a triangulation of various qualitative methods. Observations at several markets and street food vending sites in Kumasi were performed. Fourteen street food vendors were chosen for in-depth studies, and extensive participant observations and several interviews were carried out with case vendors. In addition, street interviews and Focus Group Discussions were carried out with street food customers. The study found that although vendors and consumers demonstrated basic knowledge of food safety, the criteria did not emphasize basic hygiene practices such as hand washing, cleaning of utensils, washing of raw vegetables, and quality of ingredients. Instead, four main food selection criteria could be identified and were related to (1) aesthetic appearance of food and food stand, (2) appearance of the food vendor, (3) interpersonal trust in the vendor, and (4) consumers often chose to prioritize price and accessibility of food—not putting much stress on food safety. Hence, consumers relied on risk avoidance strategies by assessing neatness, appearance, and trustworthiness of vendor. Vendors were also found to emphasize appearance while vending and to ignore core food safety practices while preparing food. These findings are discussed in this paper using social and anthropological theoretical concepts such as ‘purity’, ‘contamination’, ‘hygiene puzzles’, and ‘impression behaviors’ from Douglas, Van Der Geest, and Goffman. The findings indicate that educating vendors in safe food handling is evidently insufficient. Future public health interventions within the street food sector should give emphasis to the importance of appearance and neatness when designing communication strategies. Neglected aspects of food safety, such as good hand hygiene and cleanliness of kitchen facilities, should be emphasized. Local vendor networks can be an effective point of entry for future food hygiene promotion initiatives.

A study of risk factors for intestinal helminth infections using epidemiological and anthropological approaches

This study. conducted in Kisumu District, Kenya, identified important risk factors for infection with intestinal helminths using traditional epidemiological methods. This was combined with a rapid assessment study using qualitative methods, which focused on sanitation practices and local illness perceptions. The multiple logistic regression analysis revealed that the absence of latrines was a significant predictor for hookworm infection with an odds ratio (OR) of 1.9. The analysis also revealed that households without soap had a 2.6 times higher risk of being infected with Ascaris lumbricoides compared with households where soap was available, and that the number of inhabitants living in a household was a significant predictor for infections with hookworms (OR=3.2). Furthermore, the presence of children of 5 years and under in the household was a predictor for infection with A. lumbricoides (OR=2.7), while the absence of this age group was a predictor for hookworm infection (OR=3.8). The qualitative part of the study revealed that people did not consider worms as a serious health threat, but as a nuisance. Among the population. latrines were seen as beneficial because they were believed to prevent disease, to provide privacy and to keep the environment free of faeces. Handwashing was done many times a day but usually not with soap, which was mainly used when bathing or washing the whole body. Many inhabitants in a household or the presence of children of 5 years and under were never mentioned as being a disadvantage, and these elements would therefore be difficult to include in a control strategy. Since the lack of latrines and of soap were identified as risk factors for infection, while latrines, soap and medicine were seen as assets by the population, it is suggested that helminth control interventions should be concentrated within these areas in this particular society.

The relevance of Foucault and Bourdieu for medical anthropology: exploring new sites

The works of Michel Foucault and Pierre Bourdieu have served as substantial sources of inspiration for researchers working in the field of medical anthropology, health policies and social technologies. Analytical concepts such as power, governmentality, technology, discourse, field, habitus and symbolic capital have enriched our understanding of health care practices in various cultural settings. While medical anthropology in general seems to have struggled to find a path between approaches stressing either the semantics of illness and disease or the political economy of sickness and health, Foucault and Bourdieu may provide a bridging of these two poles. One of the strengths of the concepts and theories developed by these two thinkers has been to point out how the structures of societies influence and form individual lives, and how power can never be seen as a thing in itself, but always as a relational phenomenon working on all levels of social interaction. The aims of this special issue of A&M are to explore the potentials and limitations of using such theoretical perspectives for the analysis of everyday health care practices in both western and non-western societies. Our ambition is not to develop new high-flying theories, but rather eclectically to explore how selected ideas and concepts of Foucault and Bourdieu can be usefully applied to new empirical fields. The challenge for the contributors of this issue has been to use analytical concepts and theories of Foucault and Bourdieu creatively and heuristically to explore new sites and new possibilities – very much in line with Bourdieu himself, when he states that:

Love, lifestyles and the risk of AIDS: The moral worlds of young people in Bobo‐Dioulasso, Burkina Faso

The HIV epidemic has had a profound impact on peoples everyday life in most African societies. A large proportion of all new HIV infections involves young people between 15 and 25 years. The objective of this paper is to explore local moral worlds of young people in Bobo‐Dioulasso, Burkina Faso, and discuss how the HIVS epidemic affects their reflections on their everyday life and their perceptions of sexual relationships. Based on anthropological fieldwork, including focus‐group discussions, in‐depth interviews and participant observation, a total of 57 young people between 15 and 25 years were followed over a 3‐month period. Using the notion of ‘lifestyle’, the paper shows how structural factors of unemployment and poverty paired with global discourse on AIDS present the young people with frustrations and quandaries in relation to their hopes and images of love, faithfulness and modern living. The data shows that the HIV epidemic contributes to and accelerates their feeling of living in a risk society and of being at risk. In order to cope with these uncertainties and contingencies, local discourses of trust and fidelity become extremely important and to most young people HIV prevention is synonymous with finding a faithful partner and/or using condoms.

Do health systems delay the treatment of poor children? A qualitative study of child deaths in rural Tanzania

BackgroundChild mortality remains one of the major public-health problems in Tanzania. Delays in receiving and accessing adequate care contribute to these high rates. The literature on public health often focuses on the role of mothers in delaying treatment, suggesting that they contact the health system too late and that they prefer to treat their children at home, a perspective often echoed by health workers. Using the three-delay methodology, this study focus on the third phase of the model, exploring the delays experienced in receiving adequate care when mothers with a sick child contact a health-care facility. The overall objective is to analyse specific structural factors embedded in everyday practices at health facilities in a district in Tanzania which cause delays in the treatment of poor children and to discuss possible changes to institutions and social technologies.MethodsThe study is based on qualitative fieldwork, including in-depth interviews with sixteen mothers who have lost a child, case studies in which patients were followed through the health system, and observations of more than a hundred consultations at all three levels of the health-care system. Data analysis took the form of thematic analysis.ResultsFocusing on the third phase of the three-delay model, four main obstacles have been identified: confusions over payment, inadequate referral systems, the inefficient organization of health services and the culture of communication. These impediments strike the poorest segment of the mothers particularly hard. It is argued that these delaying factors function as ‘technologies of social exclusion’, as they are embedded in the everyday practices of the health facilities in systematic ways.ConclusionThe interviews, case studies and observations show that it is especially families with low social and cultural capital that experience delays after having contacted the health-care system. Reductions of the various types of uncertainty concerning payment, improved referral practices and improved communication between health staff and patients would reduce some of the delays within health facilities, which might feedback positively into the other two phases of delay.

Impact of slow-release Bacillus sphaericus granules on mosquito populations followed in a tropical urban environment.

ABSTRACT A floating, slow-release, granular formulation of Bacillus sphaericus (Neide) was used to control mosquito larvae in two suburban areas of two tropical cities: Ouagadougou and Bobo-Dioulasso, Burkina Faso. A circular area of 2 km2, diameter 1,600 m, was treated in each city using a similar, smaller area 1 km away as an untreated control. Mosquito captures were made in houses in four concentric circles, from the periphery to the center; each circle was 50 m in width. Mosquitoes were captured in CDC light traps or from human landings. More than 95% of the mosquitoes were Culex quinquefasciatus (Say) (Diptera: Culicidae). The human landing catches provided twice as many mosquitoes as did the CDC traps/night/house. The treatments resulted in important reductions relative to the control area and to preintervention captures. The reduction was more prominent in the inner circle (up to 90%) than in the outer circle (50–70%), presumably because of the impact of immigrating mosquitoes from nontreated breeding sites around the intervention area. This effect was more pronounced for light trap catches than from human landings. The impact of treatment was also measured as the mean ratio of mosquito density in the two outer circles to that of the two inner circles. This ratio was ∼1:1 before the intervention and reached 1:0.43 during the intervention. This comparison does not depend on the assumption that, in the absence of intervention, the mosquito population development in the two areas would have been identical, but does depend on the homogeneity of the intervention area. The study showed that it is possible to organize mosquito control in a tropical, urban environment by forming and rapidly training teams of young people to carry out the mosquito control mostly using a biopesticide that can be applied without any tools except an iron bar to lift lids on some cesspits.

Smell: an overlooked factor in sanitation promotion

Bad smell from human waste carries so many social, moral, aesthetic, and disease-related concerns that it represents a major barrier to successful sanitation adaptation for people all over the world. This paper summarizes the authors experiences from sanitation research in low- and middle-income settings from several continents and research disciplines, and addresses the often-overlooked issue of reduction of smell for effective sanitation promotion. The paper argues that people therefore have developed strategies to avoid smell, some of these being of concern to public health specialists. It is recommended that smell and smellavoiding strategies are integrated into all phases of sanitation promotion programmes, from investigatory, to design, and maintenance planning.

Illness Transmission and Proximity: Local Theories of Causation among the Bissa in Burkina Faso

Anthropological studies of African conceptions of illness have often worked with a division between the natural and the supernatural, with the focus being on the efficient, or final, causes of an illness. This approach tends to maintain local African explanations of sickness within a framework of exoticism. Based on a study among the Bissa in southeastern Burkina Faso, this paper offers an alternative analysis, with the main focus being on how the process of transmission is conceived. Four different modes of illness transmission are identified: (1) ingestion of improper substances, (2) breaking of social taboos, (3) sorcery, and (4) improper interaction with spirits. Notions of proximity and improper sharing of space play a role in all four types of illness transmission. I demonstrate how local theories of illness transmission indicate a dynamic interaction between spatial domains and social relationships. Such a focus may well be more useful for health planners than the one that emphasizes the differences between African and biomedical notions of causation.

Muted voices: HIV/AIDS and the young people of Burkina Faso and Senegal

This article explores the discrepancies between the vocal public discourse on HIV/AIDS and sexuality as generally encouraged by policy-makers and donor communities in Africa, and the often hushed voices of their target groups: young people in African communities. Based on fieldwork among urban youth in Senegal and Burkina Faso, we describe the silence of young people with regard to HIV/AIDS and sexuality as a social phenomenon, with focus given to family relations, peer relations and gender aspects in partnerships. Drawing on Foucault and Morrell, an inability and unwillingness to speak about HIV/AIDS and sexuality are analysed as a response to an everyday life characterised by uncertainty. This response represents a certain degree of resistance, while it constitutes a major barrier to any HIV/AIDS prevention effort. Finally, we stress that despite great constraints in their everyday lives, young people have some room to manoeuvre and are able to apply some negotiating strategies to reduce sexually-related health risks.

Teaching minority children hygiene: investigating hygiene education in kindergartens and homes of ethnic minority children in northern Vietnam.

Objectives. Ethnic minority children in Vietnam experience high levels of hygiene- and sanitation-related diseases. Improving hygiene for minority children is therefore vital for improving child health. The study objective was to investigate how kindergarten and home environments influence the learning of hygiene of pre-school ethnic minority children in rural Vietnam. Design. Eight months of ethnographic field studies were conducted among four ethnic minority groups living in highland and lowland communities in northern Vietnam. Data included participant observation in four kindergartens and 20 homes of pre-school children, together with 67 semi-structured interviews with caregivers and five kindergarten staff. Thematic analysis was applied and concepts of social learning provided inputs to the analysis. Findings. This study showed that poor living conditions with lack of basic sanitation infrastructures were important barriers for the implementation of safe home child hygiene. Furthermore, the everyday life of highland villages, with parents working away from the households resulted in little daily adult supervision of safe child hygiene practices. While kindergartens were identified as potentially important institutions for improving child hygiene education, essential and well-functioning hygiene infrastructures were lacking. Also, hygiene teaching relied on theoretical and non-practice-based learning styles, which did not facilitate hygiene behaviour change in small children. Minority children were further disadvantaged as teaching was only provided in non-minority language. Conclusions. Kindergartens can be important institutions for the promotion of safe hygiene practices among children, but they must invest in the maintenance of hygiene and sanitation infrastructures and adopt a strong practice-based teaching approach in daily work and in teachers education. To support highland minority children in particular, teaching styles must take local living conditions and caregiver structures into account and teach in local languages. Creating stronger links between home and institutional learning environments can be vital to support disadvantaged highland families in improving child health.