Lory Laing

Care burden and self-reported health status of informal women caregivers of HIV/AIDS patients in Kinshasa, Democratic Republic of Congo

Abstract We conducted a cross-sectional study on women who were caregivers of HIV/AIDS-affected spouses in Bumbu in Kinshasa, Democratic Republic of Congo. The sample consisted of 80 women randomly selected from a client visitation list of the home-based care program for AIDS patients. A semi-structured questionnaire was applied. A self-reported health status was calculated with five items from the questionnaire. The self-reported health status score of participants indicated poor health. The study highlights the great burden on caregivers in sub-Saharan Africa.

Racial Discrimination Experienced by Aboriginal University Students in Canada

Objectives: Racial discrimination is an established life course social determinant of health associated with adverse psychological outcomes among minority populations. However, little is known about the extent to which Aboriginal people in Canada may experience racial discrimination and consequent adverse psychological effects. This study sought to measure the extent to which Aboriginal university students living in an urban area of Canada experienced racism, to triangulate this evidence with US data and qualitative findings, and to examine the impact of these experiences on mental health. Methods: Data for this mixed method study were collected via in-person surveys with a volunteer sample of Aboriginal university students (n = 60) living in a mid-sized city in central Canada in 2008–2009. Results: Results indicate Aboriginal university students experienced more frequent racism across a greater number of life situations than African- and Latino-American adults in the United States. Student reactions to these experiences were symptomatic of what has been termed racial battle fatigue in the United States. Students who considered themselves traditional or cultural Aboriginal persons were significantly more likely to experience discrimination. Conclusions: Results underline the need for policies aimed at reducing racism directed at Aboriginal people in urban areas and the growth of services to help Aboriginal people cope with these experiences. Results highlight the need for further research to determine the potential pathogenic consequences of racial discrimination for Aboriginal people in Canada.

Adolescent reproductive health in Uganda: issues related to access and quality of care.

UNLABELLED Adolescent health in Kabarole district, Uganda, is seriously jeopardized by both high teenage pregnancy rates and high rates of sexually transmitted diseases, including HIV infection. OBJECTIVES To elucidate views, perceptions and attitudes of key informants who are involved in the delivery of reproductive health services to adolescents. STUDY GROUP Four managers of youth-related nongovernmental organizations, two government nurses, and four youth leaders. METHODS Qualitative study with content analysis using in-depth interviews. RESULTS Participants agreed that reproductive health services in Kabarole district are not adolescent friendly. Most often, lack of privacy and confidentiality for the adolescents attending a health unit was cited as one important reason. Other factors contributing to a less adolescent friendly service environment were inconvenience of services including the fragmentation of different service components and lack of specific traIning for health workers on how to relate appropriately to adolescents. Also noted was that several participants had a negative attitude toward the sexual activity of adolescents. Suggestions for service improvement were limited to training of health workers and increased support for the infrastructure. CONCLUSIONS Reproductive health services for adolescents in Kabarole district could be strengthened by improving the privacy and confidentiality of services. Health workers must also be trained in counseling and in treating adolescents in a youth-appropriate and high quality fashion. Staff attitudes must also be addressed.

Illicit and prescription drug problems among urban Aboriginal adults in Canada: the role of traditional culture in protection and resilience.

Illicit and prescription drug use disorders are two to four times more prevalent among Aboriginal peoples in North America than the general population. Research suggests Aboriginal cultural participation may be protective against substance use problems in rural and remote Aboriginal communities. As Aboriginal peoples continue to urbanize rapidly around the globe, the role traditional Aboriginal beliefs and practices may play in reducing or even preventing substance use problems in cities is becoming increasingly relevant, and is the focus of the present study. Mainstream acculturation was also examined. Data were collected via in-person surveys with a community-based sample of Aboriginal adults living in a mid-sized city in western Canada (N = 381) in 2010. Associations were analysed using two sets of bootstrapped linear regression models adjusted for confounders with continuous illicit and prescription drug problem scores as outcomes. Psychological mechanisms that may explain why traditional culture is protective for Aboriginal peoples were examined using the cross-products of coefficients mediation method. The extent to which culture served as a resilience factor was examined via interaction testing. Results indicate Aboriginal enculturation was a protective factor associated with reduced 12-month illicit drug problems and 12-month prescription drug problems among Aboriginal adults in an urban setting. Increased self-esteem partially explained why cultural participation was protective. Cultural participation also promoted resilience by reducing the effects of high school incompletion on drug problems. In contrast, mainstream acculturation was not associated with illicit drug problems and served as a risk factor for prescription drug problems in this urban sample. Findings encourage the growth of programs and services that support Aboriginal peoples who strive to maintain their cultural traditions within cities, and further studies that examine how Aboriginal cultural practices and beliefs may promote and protect Aboriginal health in an urban environment.

Maternal deaths in Pakistan: intersection of gender, caste, and social exclusion

BackgroundA key aim of countries with high maternal mortality rates is to increase availability of competent maternal health care during pregnancy and childbirth. Yet, despite significant investment, countries with the highest burdens have not reduced their rates to the expected levels. We argue, taking Pakistan as a case study, that improving physical availability of services is necessary but not sufficient for reducing maternal mortality because gender inequities interact with caste and poverty to socially exclude certain groups of women from health services that are otherwise physically available.MethodsUsing a critical ethnographic approach, two case studies of women who died during childbirth were pieced together from information gathered during the first six months of fieldwork in a village in Northern Punjab, Pakistan.FindingsShida did not receive the necessary medical care because her heavily indebted family could not afford it. Zainab, a victim of domestic violence, did not receive any medical care because her martial family could not afford it, nor did they think she deserved it. Both women belonged to lower caste households, which are materially poor households and socially constructed as inferior.ConclusionsThe stories of Shida and Zainab illustrate how a rigidly structured caste hierarchy, the gendered devaluing of females, and the reinforced lack of control that many impoverished women experience conspire to keep women from lifesaving health services that are physically available and should be at their disposal.

Improving Maternal Health in Pakistan: Toward a Deeper Understanding of the Social Determinants of Poor Women’s Access to Maternal Health Services

Evidence suggests national- and community-level interventions are not reaching women living at the economic and social margins of society in Pakistan. We conducted a 10-month qualitative study (May 2010-February 2011) in a village in Punjab, Pakistan. Data were collected using 94 in-depth interviews, 11 focus group discussions, 134 observational sessions, and 5 maternal death case studies. Despite awareness of birth complications and treatment options, poverty and dependence on richer, higher-caste people for cash transfers or loans prevented women from accessing required care. There is a need to end the invisibility of low-caste groups in Pakistani health care policy. Technical improvements in maternal health care services should be supported to counter social and economic marginalization so progress can be made toward Millennium Development Goal 5 in Pakistan.

Enculturation and Alcohol Use Problems among Aboriginal University Students

Objective: To examine associations between Aboriginal enculturation, Canadian acculturation, and alcohol problems among Aboriginal university students living in an urban area in Canada. Methods: Data for this mixed methods study were collected through in-person surveys with a convenience sample of Aboriginal university students (n = 60) in 2008/2009. Results: Students evidenced high levels of Aboriginal enculturation and Canadian acculturation. Aboriginal enculturation was significantly associated with reduced alcohol problems for Aboriginal university students. There was no association between Canadian acculturation and alcohol problems. Qualitative findings suggest Aboriginal cultural practices helped students cope with problems in their daily lives and provided them with both personal and social rewards. Conclusions: This study found Aboriginal enculturation was significantly associated with reduced alcohol problems among Aboriginal university students. Results support the growth of programs and services that encourage Aboriginal students to maintain their cultural identity within the university setting.

Addressing disparities in maternal health care in Pakistan: gender, class and exclusion.

BackgroundAfter more than two decades of the Safe Motherhood Initiative and Millennium Development Goals aimed at reducing maternal mortality, women continue to die in childbirth at unacceptably high rates in Pakistan. While an extensive literature describes various programmatic strategies, it neglects the rigorous analysis of the reasons these strategies have been unsuccessful, especially for women living at the economic and social margins of society. A critical gap in current knowledge is a detailed understanding of the root causes of disparities in maternal health care, and in particular, how gender and class influence policy formulation and the design and delivery of maternal health care services. Taking Pakistan as a case study, this research builds upon two distinct yet interlinked conceptual approaches to understanding the phenomenon of inequity in access to maternal health care: social exclusion and health systems as social institutions.Methods/DesignThis four year project consists of two interrelated modules that focus on two distinct groups of participants: (1) poor, disadvantaged women and men and (2) policy makers, program managers and health service providers. Module one will employ critical ethnography to understand the key axes of social exclusion as related to gender, class and zaat and how they affect women’s experiences of using maternal health care. Through health care setting observations, interviews and document review, Module two will assess policy design and delivery of maternal health services.DiscussionThis research will provide theoretical advances to enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems in Pakistan. It will also provide empirical evidence to support formulation of maternal health care policies and health care system practices aimed at reducing disparities in maternal health care in Pakistan. Lastly, it will enhance inter-disciplinary research capacity in the emerging field of social exclusion and maternal health and help reduce social inequities and achieve the Millennium Development Goal No. 5.

Critical realism: a practical ontology to explain the complexities of smoking and tobacco control in different resource settings.

Background This paper presents critical realism (CR) as an innovative system for research in tobacco prevention and control. CR argues that underlying mechanisms are considered and explored to ensure effective implementation of any program/policy or intervention. Any intervention or program/policy that is transposed from one country to another or one setting to another is complex. Methods The research was undertaken and analyzed through a critical ethnography lens using CR as a philosophical underpinning. The study relied upon the following components: original fieldwork in Nigeria including participant observation of smokers, in-depth interviews and focus groups with smokers, and in-depth interviews with health professionals working in the area of tobacco control in Nigeria. Results Findings from this small ethnographic study in Nigeria, suggest that Critical Realism holds promise for addressing underlying mechanism that links complex influences on smoking. Conclusion This paper argues that understanding the underlying mechanisms associated with smoking in different societies will enable a platform for effective implementation of tobacco control policies that work in various settings.Background This paper presents critical realism (CR) as an innovative system for research in tobacco prevention and control. CR argues that underlying mechanisms are considered and explored to ensure effective implementation of any program/policy or intervention. Any intervention or program/policy that is transposed from one country to another or one setting to another is complex. Methods The research was undertaken and analyzed through a critical ethnography lens using CR as a philosophical underpinning. The study relied upon the following components: original fieldwork in Nigeria including participant observation of smokers, in-depth interviews and focus groups with smokers, and in-depth interviews with health professionals working in the area of tobacco control in Nigeria. Results Findings from this small ethnographic study in Nigeria, suggest that Critical Realism holds promise for addressing underlying mechanism that links complex influences on smoking. Conclusion This paper argues that understanding the underlying mechanisms associated with smoking in different societies will enable a platform for effective implementation of tobacco control policies that work in various settings.

Teaching community medicine: the community as the patient

This case study describes the change in a course for penultimate year medical students on public health, prevention, and health promotion from a didactic format to a community-based ‘clinical’ experience. This successful change produced a positive learning experience that demonstrated the relevance of public health to the class without the need for additional instructional hours.