Katerini T. Storeng

Health of women after severe obstetric complications in Burkina Faso: a longitudinal study

BACKGROUND Little is known about the health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect a range of health, social, and economic indicators in the first year post partum. METHODS We did a prospective cohort study of women with severe obstetric complications recruited in hospitals when their pregnancy ended with a livebirth (n=199), perinatal death (74), or a lost pregnancy (64). For every woman with severe obstetric complications, two unmatched control women with uncomplicated delivery were sampled in the same hospital (677). All women were followed up for 1 year. FINDINGS Women with severe obstetric complications were poorer and less educated at baseline than were women with uncomplicated delivery. Women with severe obstetric complications, and their babies, were significantly more likely to die after discharge: six (2%) of the 337 women with severe obstetric complications died within 1 year, compared with none of the women with uncomplicated delivery (unadjusted p=0.001); 17 babies of women with severe obstetric complications died within 1 year, compared with 18 of those born by uncomplicated delivery (hazard ratio for mortality 4.67, 95% CI 1.68-13.04, adjusted for loss to follow-up and confounders; p=0.003). Women with severe obstetric complications were significantly more likely to have experienced depression and anxiety at 3 months (odds ratio 1.82, 95% CI 1.18-2.80), to have experienced suicidal thoughts within the past year at all time points (2.27, 1.33-3.89 at 3 months; 2.30, 1.17-4.50 at 6 months; 2.26, 1.30-3.95 at 12 months), and to report the pregnancy having had a negative effect on their lives at all time points (1.54, 1.04-2.30 at 3 months; 2.30, 1.56-3.39 at 6 months; 2.44, 1.63-3.65 at 12 months) than were women with uncomplicated delivery. INTERPRETATION Women who give birth with severe obstetric complications are at greater risk of death and mental-health problems than are women with uncomplicated delivery. Greater resources are needed to ensure that these women receive adequate care before and after discharge from hospital.

Detecting depression after pregnancy: the validity of the K10 and K6 in Burkina Faso.

Objective  The K10 and K6 are short rating scales designed to detect individuals at risk for depressive disorder, with or without anxiety. Despite being widely used, they have not yet been validated for detecting postnatal depression. We describe the validity of these scales for the detection of postnatal depression in Burkina Faso.

Short communication : Detecting depression after pregnancy: the validity of the K10 and K6 in Burkina Faso

Objective  The K10 and K6 are short rating scales designed to detect individuals at risk for depressive disorder, with or without anxiety. Despite being widely used, they have not yet been validated for detecting postnatal depression. We describe the validity of these scales for the detection of postnatal depression in Burkina Faso.

Collapsing the Vertical-Horizontal Divide: An Ethnographic Study of Evidence-Based Policymaking in Maternal Health

Using the international maternal health field as a case study, we draw on ethnographic research to investigate how public health researchers and policy experts are responding to tensions between vertical and horizontal approaches to health improvement. Despite nominal support for an integrative health system approach, we found that competition for funds and international recognition pushes professionals toward vertical initiatives. We also highlight how research practices contribute to the dominance of vertical strategies and limit the success of evidence-based policymaking for strengthening health systems. Rather than support disease-and subfield-specific advocacy, the public health community urgently needs to engage in open dialogue regarding the international, academic, and donor-driven forces that drive professionals toward an exclusive interest in vertical programs.

“Playing the Numbers Game”: Evidence‐based Advocacy and the Technocratic Narrowing of the Safe Motherhood Initiative

Based on an ethnography of the international Safe Motherhood Initiative (SMI), this article charts the rise of evidence-based advocacy (EBA), a term global-level maternal health advocates have used to indicate the use of scientific evidence to bolster the SMIs authority in the global health arena. EBA represents a shift in the SMIs priorities and tactics over the past two decades, from a call to promote poor womens health on the grounds of feminism and social justice (entailing broad-scale action) to the enumeration of much more narrowly defined practices to avert maternal deaths whose outcomes and cost effectiveness can be measured and evaluated. Though linked to the growth of an audit- and business-oriented ethos, we draw from anthropological theory of global forms to argue that EBA—or “playing the numbers game”—profoundly affects nearly every facet of evidence production, bringing about ambivalent reactions and a contested technocratic narrowing of the SMIs policy agenda.

Living Positively: Narrative Strategies of Women Living with HIV in Cape Town, South Africa.

Therapeutic interventions to address HIV in Africa mean that individuals are increasingly diagnosed with HIV prior to severe health crisis. This paper contributes to the anthropological literature on living with HIV by focusing on the creation and use of narrative and practical strategies for addressing HIV in a setting where such experiences have to date received little attention. Specifically, focus is on the discursive strategy of ‘living positively’, a forceful and much propagated orientation to life following an HIV diagnosis. In this paper the authors examine how this strategy is embraced not only by individuals living with HIV, but also by activists, HIV support organizations and public health agencies. The paper is based on fieldwork in and around Cape Town, South Africa in 2002 and draws on open-ended interviews with 12 women living with HIV and observations from support groups, activist events and public health meetings. The research indicates that the living positively dictum is imbued with a multiplicity of meanings and that it is used in diverse ways. For women living with HIV the practical and philosophical elements of positive living have social and political force in transforming personal and social attitudes about HIV, especially about HIV testing and treatment access. At the same time, however, the dictum poorly addresses the structural constraints of living with HIV and places the responsibility for positive living squarely on the individual. Despite this, the political context that prevailed in Cape Town at the time of the research created a particularly fertile juncture for embracing the living positively philosophy.

Maternal, neonatal and child health interventions and services: moving from knowledge of what works to systems that deliver

The Publisher regrets that an error occurred in the name of the 6th listed co-author for this paper. B. Matthias was listed in the original paper instead of M. Borchert; the correct listing can be seen above.

Politics and practices of global health: Critical ethnographies of health systems

Over the past decade, growing recognition that weak health systems threaten global health progress has galvanised renewed global and national commitment to strengthening health systems (Hafner & Shiffman, 2012). Global health leaders from the World Health Organization to the GAVI Alliance, national governments and donors today endorse the goal of health system strengthening (HSS), though there is little, if any consensus on what this entails. Mirroring the business-oriented and technical bias of dominant global health actors (Birn, 2006), HSS is often approached as a technical challenge, focused on efforts to strengthen implementation and management structures within health service delivery, with little attention to the politics and social relations that shape health systems. This special issue aims to demonstrate the potential of ethnographic enquiry to reinvigorate a political – rather than technical – debate about ‘health systems’.

Too poor to live? A case study of vulnerability and maternal mortality in Burkina Faso.

This paper examines the concept of vulnerability in the context of maternal morbidity and mortality in Burkina Faso, an impoverished country in West Africa. Drawing on a longitudinal cohort study into the consequences of life-threatening or ‘near miss’ obstetric complications, we provide an in-depth case study of one woman’s experience of such morbidity and its aftermath. We follow Kalizeta’s trajectory from her near miss and the stillbirth of her child to her death from pregnancy-related hypertension after a subsequent delivery less than two years later, in order to examine the impact of severe and persistent illness and catastrophic health expenditure on her health and on her family’s everyday life. Kalizeta’s case illustrates how vulnerability in health emerges and is maintained or exacerbated over time. Even where social arrangements are supportive, structural impediments, including unaffordable and inadequate healthcare, can severely limit individual resilience to mitigate the negative social and economic consequences of ill health.

Capitals diminished, denied, mustered and deployed. A qualitative longitudinal study of women's four year trajectories after acute health crisis, Burkina Faso

Accumulating evidence indicates that health crises can play a key role in precipitating or exacerbating poverty. For women of reproductive age in low-income countries, the complications of pregnancy are a common cause of acute health crisis, yet investigation of longer-term dynamics set in motion by such events, and their interactions with other aspects of social life, is rare. This article presents findings from longitudinal qualitative research conducted in Burkina Faso over 2004–2010. Guided by an analytic focus on patterns of continuity and change, and drawing on recent discussions on the notion of ‘resilience’, and the concepts of ‘social capital’ and ‘bodily capital’, we explore the trajectories of 16 women in the aftermath of costly acute healthcare episodes. The synthesis of case studies shows that, in conditions of structural inequity and great insecurity, an individuals social capital ebbs and flow over time, resulting in a trajectory of multiple adaptations. Womens capacity to harness or exploit bodily capital in its various forms (beauty, youthfulness, physical strength, fertility) to some extent determines their ability to confront and overcome adversities. With this, they are able to further mobilise social capital without incurring excessive debt, or to access and accumulate significant new social capital. Temporary self-displacement, often to the parental home, is also used as a weapon of negotiation in intra-household conflict and to remind others of the value of ones productive and domestic labour. Conversely, diminished bodily capital due to the physiological impact of an obstetric event or its complications can lead to reduced opportunities, and to further disadvantage.