'If I have only two children and they die. who will take care of me?' : a qualitative study exploring knowledge, attitudes and practices about family planning among Mozambican female and male adults

Background: By focusing upon family planning counselling services, the Mozambican government has significantly enhanced the general health of female and male clients. However, little is known about the experiences of family planning by female and male adults. This article focuses on knowledge, attitudes and practices regarding contraceptive methods and fertility intentions. Methods: An in-depth qualitative study of female and male clients was conducted in two settings in Maputo province - Ndlavela and Boane. A total of sixteen in-depth interviews, four informal conversations, and observations were equally divided between both study sites. The analysis followed a constructionist approach. Three steps were considered in the analysis: examining commonalities, differences and relationships. Results: Although there was a high level of family planning knowledge, there were discrepancies in clients' everyday practices. Male and female clients are confronted with a variety of expectations concerning fertility intentions and family size, and are under pressure in numerous ways. Social pressures include traditional expectations and meanings connected to having children, as well as religious factors. Short interaction time between clients and health workers is a problem. Additionally, imposed contraceptive methods, and typically brief conversations about birth control between couples only adds to the burden. Because family planning is largely viewed as a woman's concern, most clients have never attended counselling sessions with their partners. Attitudes towards responsibility for contraceptive use and risk-taking are strongly gendered. Conclusions: Female and male clients have differing expectations about contraceptive use and fertility intentions. They participate differently in family planning programs leading to their inconsistent and ambivalent practices as well as vague perceptions of risk-taking. Therefore, policymakers must address the reasons behind ambivalence and inconsistency regarding contraceptives and family planning

Between compliance and resistance : exploring discourses on family planning in Community Health Committees in Mozambique

Objectives: Although the Mozambican government has implemented a community-based approach to family planning (FP), little is known about the appropriateness of this process. We explore how members of Community Health Committees (CHCs) address and act regarding FP. Methods/settings: An in-depth qualitative study of CHCs was conducted at two sites in Maputo province -Ndlavela and Boane-using focus group discussions (n=6), informal conversations (n=4) and observation. The analysis followed a phenomenological approach. Results: CHCs in Ndlavela appeared to transfer more of the expected information than those in Boane. However, in the CHCs at both study sites, we found heterogeneity in CHCs' perspectives leading to conflicting views among committee members (CMs). Arising issues included contraceptive type, target groups, the desirable number of children per family as well as the way FP was to be represented. Moreover, weak communication between CMs and health workers, and lack of payment for CMs' activities influenced promotion of FP. Conclusions: The two CHCs framed FP in different ways leading to inconsistent participation of CHC members in promoting FP. Policymakers should consider the diversity of discourses and aspirations of these committees when delivering information to them

Targeting vulnerable populations : a synthetic review on alcohol use and risky sexual behaviour among migrant populations

Background: Research has demonstrated a link between alcohol use and risky sexual behaviour among different types of migrant populations. Therefore, research investigating risk factors associated with alcohol consumption among them is a public health priority. This review aimed to explore the intersection between migration, alcohol consumption and risky sexual behaviour. Methods: This article is a synthetic review of empirical studies on the association of alcohol and high-risk sexual behaviour among different types of the migrant populations, focusing on measurable outcomes generated from quantitative data. A descriptive analysis generated from global and situational studies was used to interpret the reviewed research and to discuss critically the factors that drive migrants to engage in alcohol consumption and high-risk behaviour. Results: This review found out that there is a significant and positive association between global and situational alcohol use and several outcomes of risky sexual behaviour among different types of migrant populations. This association was however mainly observed at high quantities and frequencies of alcohol use, mainly among male migrants, and was often tied to a specific situation or context, for instance the type of sexual partner, the level of mobility and to environmental factors such as living arrangements and entertainment venues. Conclusions: The study supports previous research that alcohol use is associated with risky sexual behaviour among different types of migrant populations. Therefore, future interventions should target mobile, male migrant heavy drinkers. Additional research is needed using more event-level and longitudinal methodologies that overcome prior methodological limitations

Magic Mountains and multi-disciplines in international medical mobilities Comment on “Patient mobility in the global marketplace: a multidisciplinary perspective”

Medical mobilities offer both opportunities and challenges. This tension follows the same ratio as many other historic fora, but offers at the same time a sustainable equilibrium. Multi-disciplines are, therefore, the key to the medical lifeworld for the global health and well-being of transnational health users around the globe

Healthcare-seeking behaviour among clinic-based tuberculosis patients

This study investigated the factors influencing recourse to healthcare in a sample of 220 tuberculosis (TB) patients. Data collection was by means of face-to-face interviews. Patients sought help mainly from primary healthcare clinics (46%) and private doctors (40%). The mean patient delay was seven weeks, with only 21% of patients seeking professional healthcare within less than two weeks. The results show that lack of awareness of TB and use of a home remedy were significantly associated with a delay of longer than two weeks in seeking healthcare. These findings indicate an urgent need to educate communities on the signs and symptoms of TB, as well as the need to  attend designated health facilities for early diagnosis and proper treatment

Drie ontmoetingen: In memoriam Albert Mok (1930-2017)

Op 5 augustus overleed Albert Louis Mok op 87-jarige leeftijd. Daarmee heeft de Nederlandse en Belgische sociologie één van haar grondleggers verloren

TB control: a matter of lifestyle

In the West, TB was controlled before there was medication on the market. In South Africa this is far from the case: the inheritance of apartheid, poverty among certain social groups, and an exponential increase in HIV/AIDS make TB control almost impossible. The co-existence of two medical traditions (the Western medical system and traditional healing) exacerbates the challenge of finding effective measures for TB control. This paper aims to understand the underlying patterns of the persistant spread of this disease. Its point of reference is Max Weber’s notion of Stilisierung des Lebens, or lifestyle, in which the dialectic process of “chance” and “choice” plays an important role. In the category of chance, much can be done by policy-makers to create successful healthcare programmes, such as DOTS within TB control. Policy-makers, however, are not the only players responsible. Individuals must also take responsibility by opting for the chances provided. Even then, the spectre of the past may continue to bedevil the health outcomes of South Africans as they endeavour to build a new nation

Tuberculosis: the complexity of the phenomenon and the magnitude of the problem

From text: The rationale for studying tuberculosis (TB) in a multidisciplinary manner is to be found in both the complex nature of the TB phenomenon and the magnitude of the TB problem. TB is caused, spread and sustained by various factors. To control the epidemic this multiplicity of factors has to be unravelled and coherently addressed

Tuberculosis control in South Africa: reasons for persistent failure

This study reviews the origins and spread of tuberculosis in South Africa in the international context. It shows that TB is far from being under control, despite the availability of effective technology. Five arguments offer   explanations for this failure. First, control strategies fail to eradicate the macro-conditions that create a breeding ground for TB. Secondly, new disease conditions — especially HIV/AIDS and MDRTB — confound efforts at control. Thirdly, the health system and its priorities are insufficiently focused and resourced to cope with TB. Fourthly, healthcare staff responsible for TB care are often weak links in the chain of control. Fifthly, TB patients fail due to ignorance, delay in seeking care, and non-adherence to treatment regimens. TB consequently remains a major public health challenge, today more than ever in its protracted history