Texte remanié de: Ph. D.--University of London, 1951. / Bibliogr. p. 108-118. Index.

Im Rahmen der Zusammenarbeit des Missionsärztlichen Instituts in Würzburg mit dem Sacred Heart Hospital (Nigeria) wurden vor Ort im Hinblick auf das Problem der Arzneimittelfälschungen in Nigeria und dem Auftreten von einzelnen Resistenzen gegen Artemisinin-Derivate Untersuchungen bezüglich der aktuellen Situation im Kampf gegen Malaria im Großraum Abeokuta durchgeführt. Der Kenntnisstand über Malaria und das Gesundheitsverhalten einer für die nigerianische Bevölkerung möglichst repräsentativen Probandengruppe (n=100) wurden mithilfe eines Fragebogens erfasst. Ebenfalls mithilfe eines Fragebogens wurden die Therapiestrategien der einheimischen Ärzte (n=34) gegen Malaria untersucht und die Verfügbarkeit und Qualität von Artemisinin- Derivaten im Untersuchungsgebiet durch den Erwerb von Medikamenten-Samples (n=29) und anschließende Labortests überprüft. Die Befragung der Bevölkerung ergab, dass Wissen bezüglich der Ursachen, Symptome und Prävention der Malaria durchaus vorhanden ist, wobei große Unterschiede abhängig vom Bildungsstand bestanden. Vor allem ältere Menschen verfügten über wesentlich geringere Schulbildung und verließen sich deshalb sehr viel mehr auf die traditionelle Medizin. Darüber hinaus war eine oftmalige Bagatellisierung der Malaria auffällig, weshalb viele Probanden (53%) sich im Krankheitsfall gegen das Aufsuchen eines Krankenhauses entschieden. Die Befragung bezüglich der Therapiestrategien der einheimischen Ärzte zeigte, dass die Richtlinien der WHO bezüglich der Verwendung von ACT offensichtlich optimal angenommen und angewandt werden. Als mögliches Problem stellte sich die von 76,7% der Ärzte nur selten angewandte Labordiagnostik dar, eine Tatsache, die Fehldiagnosen begünstigt. Bei der Testung der Medikamente erwiesen sich 14,3% der Proben als minderwertig oder sogar gefälscht, was offiziellen Angaben entspricht. Zudem handelte es sich bei 37,9% der Arzneimittelproben um Monopräparate, was im Hinblick auf Resistenzbildung mehr als bedenklich ist. Diese Resultate weisen darauf hin, dass im Südwesten Nigerias die Malaria-Problematik noch immer nicht adäquat gelöst ist. Immer noch erhalten viel zu wenige Menschen eine optimale Therapie, was zu einem großen Teil an fehlendem Wissen und damit verbundenem falschem Gesundheitsverhalten, an dem großen Einfluss der traditionellen Medizin und an der Präsenz von gefälschten, wirkungslosen Arzneimitteln auf dem Markt liegt. / Considering the problem of counterfeit drugs in Nigeria and the occurrence of resistances against artemisinin-derivates, investigations regarding the current situation in Abeokuta and its surrounding areas had to be carried out. Knowledge about malaria and healthcare-seeking behaviour of the local population (n=100) was investigated by means of a questionnaire, as well as antimalarial treatment strategies of local doctors (n=34). Furthermore availability and quality of artemisinin-derivates were checked by purchasing drug samples (n=29) and subjecting them to laboratory tests. Questioning the local population showed that knowledge about malaria (causes, symptoms, prevention) is definitely existing, although major differences depending on the level of education could be observed. Especially the elderly had a very low level of education and, therefore, relied a lot more on traditional medicine. Moreover it became obvious that malaria is often trivialized, so that many people didn’t choose to go to the hospital in case of an infection. Questioning the local doctors regarding their treatment strategies showed that WHO treatment guidelines were obviously widely accepted and applied. A possible problem could be that 76,7 % of the interviewed doctors stated that they rarely use laboratory test for diagnostics. A fact, which favours misdiagnosis. By testing the drug samples, 14,3% proved to be substandard or even counterfeit. Moreover, 37,9% of the samples were monotherapies, which is more than alarming regarding the development of resistances. These results indicate that the problem of malaria is still not adequately solved in south-west Nigeria. Too few people receive an optimal therapy due to lack of knowledge, wrong healthcare-seeking behaviour, the big influence of traditional medicine and the presence of ineffective counterfeit drugs on the market.

By separating the local from the global, extant historiography fails to capture a total sense of how Africans engaged with change in the 19th and 20th centuries. Existing approaches are Eurocentric in assuming that global forces like colonialism, racism, nationalism and capitalism were the only issues that Africans confronted and thought about. A more complete history of social change is one which integrates local concerns and ideas, expressed in local languages and cosmologies, with Atlantic discourses. The history of Abeokuta in Western Nigeria had been written in a modernization model which interprets the Egba past as how a modern missionary-created elite tried to transform the society from a traditional one. By focusing on elite discourses in a wider scope than the modernization premise, a more complex history emerges in which European influence and colonial power were only part of many forces and resources which the Egba struggled over, modulated and coped with. Power in 19th century Abeokuta was invented by the construction of a national identity, history and traditions to legitimize a central monarchy. The interests of ruling elites converged with those of colonial power towards consolidating these innovations and political centralization. However, other displaced elites always contested such constructions. The crises and violence of the early 20th century were therefore not simply anti-colonial resistance. They were complicated expressions of political dissent against local, colonial and global forces of domination, and reactions to socio-economic challenges. Public health discourse reveals that the Egba did not conceive of European medicine as a dichotomous binary to local medical practices. Rather, it represented an addition of choices to a corpus of medical options. Similarly, Atlantic ideas like democracy and modernization were reduced to local understanding such that they correlated to local knowledge. Modernity for the Egba was therefore not about becoming like Europe; but about pursuing life‘s best-options in the variety of free and forceful influences. Egba society was shaped in the multiple struggles among elites advancing various claims and deploying instruments of power. This history transcends the colonial and renders Africans much more fully as actors in the making of their lives and society.

Self Supply Systems (SSS) can be defined as privately owned household level water sources. The research focus is on urban self supply hand dug wells in Abeokuta, Nigeria. Self supply wells serve an estimated 45% of Abeokuta’s population. SSS can be gradually upgraded to improve water quality, but water quality can also be improved through effective risk management. The World Health Organization (WHO) has developed a risk management tool known as Water Safety Plans (WSP), but the tool has not been tried for SSS. This research focuses on the relevance of the generic WHO water safety plans tool to SSS, with the aim to develop an appropriate water safety framework for self supply sources to ensure acceptable household water. Water from self supply wells is used for both ingestion and non-ingestion household activities. The water quality of the sources is poor and not safe for consumption with faecal coliform counts in excess of 100 cfu/100 ml of water. Self supply wells in Abeokuta are plagued by four main water safety threats; style of source operation – primarily through bucket and rope -, construction problems, proximity to sources of contamination, and user’s hygiene practices. Users are in denial of the health consequences of unsafe water. There is a predominantly reactive attitude to water safety management. The main source management approaches include access and hygiene management. To appropriate existing WSP to SSS, source and water safety control measures require user acceptability to be sustainable in terms of adoption and compliance. Incentives are needed for the adoption of SSS water safety plans. A two- phase supporting program is necessary: awareness and enlightenment campaigns and relevant training activities. Water safety development for self supply wells need to be initiated and coordinated by an established institution other than the source owners. This research suggests the Department of Public Health as the institution to facilitate the development of water safety plans for SSS in Abeokuta, Nigeria.