Koenraad Stroeken

HIV among out-of-school youth in Eastern and Southern Africa: a review

The overall decline of the HIV epidemic in Sub-Saharan Africa conceals how the HIV burden has shifted to fall on areas that have been more difficult to reach. This review considers out-of-school youth, a category typically eluding interventions that are school-based. Our review of descriptive studies concentrates on the most affected region, Southern and Eastern Africa, and spans the period between 2000 and 2010. Among the relatively small but increasing number of studies, out-of-school youth was significantly associated with risky sexual behavior (RSB), more precisely with early sexual debut, high levels of partner concurrency, transactional sex, age-mixing, low sexually transmitted infection (STI)/HIV risk perception, a high lifetime number of partners, and inconsistent condom use. Being-in-school not only raises health literacy. The in-school (e.g., age-near) sexual network may also be protective, an effect which the better-studied (and regionally less significant) variable of educational attainment cannot measure. To verify such double effect of being-in-school we need to complement the behavioral research of the past decade with longitudinal cohort analyses that map sexual networks, in various regions.

Nodding syndrome or disease? On the conceptualization of an illness-in-the-making

Objective To explore processes of conceptualizing nodding syndrome (NS), an unknown illness which has been reported to affect thousands of children in post-conflict northern Uganda, in South Sudan and in Tanzania. Design This qualitative study comprised 40 in-depth interviews with affected families, health workers and politicians during five months of fieldwork in northern Uganda and a review of available reports, newspapers and academic literature on NS. In addition, observations have been made at treatment centers and during outreaches and meetings. Focus is put on how meanings of key terms related to NS are produced and negotiated. Attention is being paid to the circulation of different discourses and explanatory models. Results Discourses and explanatory models play an active role in the conceptualization of illness, as much by medical personnel as by affected families and the media. The prominent use of biomedical terms in the academic discourse on NS is striking; links are suggested with onchocerciasis and epilepsy. In contrast, the local discourse associates NS with social issues. The illness experiences are connected to the trauma of past conflict, to poverty and to (region-bound) frustration over neglect. The cultural significance of physical symptoms raises the question of the impact of culture on health. Conclusion By only looking at the biomedical significance of this new syndrome, we will miss important aspects of how this illness is being experienced and understood. In our future dealings with NS, we will have to consider and re-conceive the relation between culture and neurobiology.

Community Knowledge, Beliefs, Attitudes, and Practices towards Children with Spina Bifida and Hydrocephalus in Uganda.

This article describes the findings of a qualitative study on knowledge, beliefs, attitudes, and practices towards children with spina bifida and hydrocephalus in four regions of Uganda. Focus group discussions and semi-structured interviews were held with parents of children with spina bifida and hydrocephalus, policy-makers, and service providers. Our findings describe how negative knowledge, beliefs, attitudes, and practices create barriers to treatment and inclusion of children with spina bifida and hydrocephalus and their parents in Uganda. The findings show how knowledge, beliefs, attitudes, and practices evolve over time, are both similar and differ in the various regions, and become more conducive towards accessing treatment and achieving inclusion. Sensitisation and early intervention including parents and service providers in dissemination of knowledge, rehabilitative care to set the trend for positive change and support, as well as longitudinal studies of children with spina bifida and hydrocephalus and their parents are recommended.

The impact of education and globalization on sexual and reproductive health: Retrospective evidence from eastern and southern Africa

The objective of this study is to qualify the relationship between sexual and reproductive health (SRH) and educational attainment in eastern and southern Africa (ESA). We hypothesize that the regional level of globalization is a moderating factor in the relationship between SRH and educational attainment. Using retrospective data from Kenya, Malawi, Tanzania, and Zambia, the associations between SRH (eight indicators), educational attainment, and globalization were examined using multilevel logistic regression analysis. It was found that the model fit for every SRH outcome indicator increased significantly after including the interaction between globalization and educational attainment, supporting the hypothesis. Depending on the level of globalization, three types of relationships between education and SRH were found: (1) for the indicators “more than four children,” “intercourse before 17 years,” “first child before 20 years,” and “one or more child died” education is risk-decreasing, and the reduction is stronger in more globalized regions; (2) for the indicators “condom use at last intercourse” and “current contraceptive use” education is risk-decreasing, and the reduction is stronger in less globalized regions; (3) for the indicators “HIV positive” and “more than four lifetime sexual partners” education is risk increasing, but only in less globalized regions. In conclusion, these effects are related to three types of access: (1) access to services, (2) access to information, and (3) access to sexual networks. The findings highlight the relevance of globalization when analyzing the association between SRH and education, and the importance of structural factors in the development of effective SRH promotion interventions.

Zone-it before IT zones you: a location-based digital notice board to build community while preserving privacy

The current success of ephemeral communication apps such as Snapchat points to the growing awareness among users about online ‘biographic mining’ through information technology by advertisers, companies and government agencies. Based on the literature, we argue that location-based services (LBS) can be the answer to preserving privacy, on the condition that they target trusted communities of anonymous users and that the communication is transient. The paper describes in three steps the development of an app fulfilling these conditions. From the interdisciplinary exchange between digital anthropologists, GIScientists and ICT engineers resulted Zone-it, a virtual notice board for self-zoning, permitting the user to start location-based interactions under certain categories. We present the results of a user survey that determined the apps functionalities. The functionalities offer a way for LBS to invert the purpose of social media such as Facebook by shifting attention from person-based to goal-oriented communication. The paper discusses why this move away from ‘faces’ to ‘places’ meets the purpose of community-building, rather than jeopardising it.

Questioning cognitive and interpretive takes on ritual

Is ‘nature’ the only basis we have for explaining universal patterns in culture, such as religious practices? Cognitive and interpretive approaches seem to agree so in surprisingly Cartesian fashion. This paper proposes cosmologies as a second, ‘cultural’ type of universality. For an ethnographer affected by the field, culture is not something out there to either ‘explain’ (Sperber, Lévi-Strauss) or ‘interpret’ (Geertz, Weber). Culture is to be comprehended by ‘getting into’ a variety of shared cosmological states. These cosmological states are (1) reflexive, (2) exhaustive and (3) mutually exclusive categories, which can account for (4) the semantic shifts characterizing practices such as rituals. These four conditions are lacking in the binary mechanisms of cognitive modules of the Standard Model of religion (e.g. Boyer and Liénard’s hazard-precaution) and the epidemiological model (Sperber and Bloch).

When a rash has two names: pese sorcery and kisigo spirits at Lake Tanganyika

ABSTRACT This explorative and qualitative study, based on 27 interviews during two months of fieldwork, describes pese, an affliction of the skin that has conspicuously stayed under the radar of medico-anthropological research in Kigoma, a rural city in the northwest Tanzania. The condition reminds of a locally better known condition labeled kisigo, raising the question why two concepts of the same affliction exist side by side. It seems indicative that the two illness concepts stem from different cultures and that each specializes in an explanatory model: the former witchcraft (sorcery) and the latter spirit possession. Moreover, a symbiotic relation seems to exist between the healing traditions of the Bembe and the Ha. Government policies prohibiting witchcraft and targeting traditional healers seem to have created a situation where witchcraft practices and beliefs have come to represent the periphery and survive there, clandestinely.

Witchcraft Simplex: Experiences of Globalized Pentecostalism in Central and Northwestern Tanzania

Gluckman’s distinction between simplex and multiplex relationships is applied here to ethnographic data in two locations of Tanzania and one in Congo, spanning a research period of 20 years. The study links the rising success of Pentecostalism in rural areas not only to a globalizing and neoliberal society establishing the sense of bewitchment conducive to such spirituality but also to ongoing struggles over cultural reproduction in the community, converging particularly on witches and spirits. Indications of experiential atrophy are discussed and interwoven: the suitability of Pentecostal sermon to current lifeworlds, the simplex experience of conversion, the impact of simplex sociality, the loss of experiential shifts in magic, the globalist equation of the latter with witchcraft, the vanishing of spirit cults and their replacement by Charismatic possession, the structural intrusion and the choice for Pentecostalism by the ‘nuclearized’ families of village communities.

UDUBSit. A location based mobile application for the University of the Western Cape a living lab approach in support of participatory ICT4D

ZoneIT - at the University of the Western Cape renamed in UDUBSit - was first developed by the University of Ghent in Belgium as a sharing application for and by the student community. This app is adapted and contextualised to the UWC context by way of a living lab approach. This paper describes and analyses the results from the needs analysis, which formed the first step in the living lab approach of adapting and implementing the app. The premise of the whole project is, that a living labs approach to ICT4D - much more than a technology transfer approach - leads to better adaptation and adoption of technology in different contexts. The main reason is that a living lab approach is inherently participative in nature.