Lenore Manderson

An epidemic in the field? Rapid assessment procedures and health research

This paper reviews the development of various methods designed to generate relevant social information, pertaining to health and disease control, quickly and accurately. In so doing, we examine the use of KAP surveys and the subsequent development of community diagnosis, rapid appraisal methods, rapid epidemiological assessment, and rapid assessment procedures (RAP) for anthropological studies. Our focus is on the development of anthropological RAPs, in response to the lack of professionally trained social scientists to work with disease control programmes and ministries of health, and in light of the demonstrable need for social science input in the development of health policies and programmes. These developments are assessed in terms of scope and method. Issues relating to the representativeness, reliability and validity of RAP studies are discussed, and mechanisms by which to maximise the yield of valid data are presented.

The diagnosis and management of fever at household level in the Greater Accra Region, Ghana

> Qualitative research methods were used in rural and urban areas of the Greater Accra Region to generate data to describe the folk diagnosis, etiology and management of malaria. Respondents defined as fever a set of symptoms loosely concordant with clinical malaria. Primary cause of fever as heat and particularly in rural areas, an understanding of the role of mosquitos in transmitting fever was limited. First- and second-line treatments adopted by caretakers, when either they or their children were sick, involved considerable self-medication with chloroquine and paracetamol. Ethnographic data were supplemented and tested for generalizability through a cross-sectional survey, and the paper discusses this methodological approach.

MOSQUITO AVOIDANCE AND BED NET USE IN THE GREATER ACCRA REGION, GHANA

Qualitative research and cross-sectional survey methods were used in a study conducted in rural and urban areas of the Greater Accra Region, Ghana, to explore peoples understanding of the cause of malaria and patterns of mosquito avoidance, in particular bed net ownership and use. The study indicated far higher bed net ownership and use in rural than urban areas, which was related partly to perceived affordability and partly to the different contexts of and reasons for avoiding mosquitoes. Knowledge of an association between mosquitoes and malaria, the most common cause of illness in both areas, was related to residence but not to literacy or formal education, and this knowledge did not predict bed net use. The paper points to the complexity of social and personal factors implicated in behavioural interventions for malaria control, and questions behavioural models that assume a linear relationship between knowledge and practice.

Applying medical anthropology in the control of infectious disease

This paper focuses on two roles of anthropology in the control of infectious disease. The first is in identifying and describing concerns and understandings of disease, including local knowledge of cause and treatment relevant to disease control. The second is in translating these local concerns into appropriate health interventions, for example, by providing information to be incorporated in education and communication strategies for disease control. Problems arise in control programmes with competing knowledge and value systems. Anthropologys role conventionally has been in the translation of local concepts of illness and treatment, and the adaptation of biomedical knowledge to fit local aetiologies. Medical anthropology plays an important role in examining the local context of disease diagnosis, treatment and prevention, and the structural as well as conceptual barriers to improved health status. National (and international) public health goals which respect local priorities are uncommon, and generic health goals rarely coincide with specific country and community needs. The success of interventions and control programmes is moderated by local priorities and conditions, and sustainable interventions need to acknowledge and address country‐specific social, economic and political circumstances.

Local knowledge and treatment of malaria in Agusan del Sur, The Philippines

Information about local knowledge of malaria, its transmission, treatment and prevention were gathered at the outset of a Malaria Control Program in order to incorporate this information into community interventions. Data were collected using focus groups and indepth interviews with caretakers of children who had had a recent episode of malaria. These were supplemented as baseline data through a survey and the ongoing participation of researchers in the intervention. Local knowledge of malaria was influenced by clinical diagnosis and was based on the coexistence of signs of illness. People conventionally self-medicated or used herbs for symptomatic relief prior to seeking clinical diagnosis and treatment, with treatment delay influenced by the logistic difficulties within the region, direct and indirect costs associated with treatment seeking, and delays in the return of results once a blood film for diagnosis was made. People were familiar with mosquito control activities conducted by the Malaria Control Service and, as a result, most respondents associated malaria with mosquitos. However, the role of the mosquito as the sole vector, and the means by which malaria was transmitted, were not well appreciated.

Empowering women: Participatory approaches in women's health and development projects

The authors describe the experience of NGOs (nongovernmental organizations) and community-based organizations in implementing projects aimed at improving womens health. The study included 16 projects, reflecting Australian NGO experiences in Africa, China, Southeast Asia, the Pacific, and South America. They illustrate the value of participatory approaches in determining needs and priorities, and the value of the continued involvement of women in implementation, monitoring, and evaluation. Approaches that succeeded in increasing womens access to and use of health services addressed gender issues, set realistic and achievable objectives, and recognized and enhanced the roles and status of women.

Public sex performances in patpong and explorations of the edges of imagination 1

This paper draws on observations of sex acts, including dances, pornographic tricks and intercourse, performed in four bars in the central area of sex tourism in Bangkok, Patpong. Following a discussion of the nature of dramatic pornography, and discursive and interpretive issues which arise from the nature of the inquiry, the paper describes and analyses the acts, which are treated as a commentary on Thai understandings of (western) male sexuality. These acts are varied and structured to maximize their capture of libidinal fantasy and erotic and violent imagination for commercial purpose. At the same time, the physical positioning of the performers and the texts of various acts provide them with an opportunity for silent satire of the voyeur/patrons. While in structure and content the acts are similar to those performed in night clubs and bars elsewhere in Southeast Asia and the west, the paper also examines ways in which the repertoire draws on indigenous erotic performance. The paper then proceeds to l...

Migration and mainstreaming: matching health services to immigrants' needs in Australia

The provision of special services for people of non-English speaking background in Australia emerged in the context of the development of policies of multiculturalism. This article documents the trends in state and federal policy development and service provision in the 1990s, as influenced by the sometimes-competing forces of political will, financial resources and community demand. The sustainability of various programmes is examined in the context of the continuing need to provide for people whose access to mainstream health services remains problematic.

Evaluating agency initiatives: Building social science capability in tropical disease research

In recent years, in an endeavour to increase social and economic research in tropical diseases, WHO/TDR has used a number of alternative models to develop social science research capability in countries endemic for the designated tropical diseases. These have included small grants schemes to encourage junior researchers to gain familiarity with the subject area and methods, and protocol development and methodology workshops, either for specific research topics (e.g. adolescent womens health; community perceptions of schistosomiasis) or for any topic of interest to the participants. Participants have included medical researchers, social science researchers, and interdisciplinary teams (e.g. a medical researcher and a collaborating social scientist). This paper develops a typology and critically analyses these alternative approaches to developing research capability, and assesses their effectiveness in terms of cost, short-term effectiveness, and sustainability of the initiative.

Social aspects of malaria in Heping Hainan.

This paper presents findings from a study conducted in Heping Town, Qiongzhong County, Hainan Province, China. The study, conducted in 1992, used qualitative as well as quantitative methods to gather social, cultural and behavioural data associated with the acquisition, transmission and prevention of malaria, and the diagnosis and treatment of disease. These methods included focus groups, key informant and other in-depth interviews, and observations, a household survey and tests of school children of knowledge of malaria. The study is among the first to our knowledge that has utilized this broad mix of methods for tropical disease research in China.