Child nutrition, illness and behavior are studied during the first baseline health surveys for Ranomafana National Park in the southeastern rain forest of Madagascar. Research objectives include: (1) documenting the prevalence and causes of undernutrition and illness, (2) evaluating the dietary importance of forest resources, (3) demonstrating how undernutrition affects children's work and social activities, and (4) examining the utility of resource shortage behavioral models in conservation-development management. Anthropometric, dietary, time allocation and socioeconomic data were collected during a 1989 cross-sectional health survey of 613 0 to 9 year old children in 7 representative communities, and during a 1990-91 multi-season study of 40 6 to 9 year old children and their households. Respiratory infections, malaria, helminths, scabies and diarrhea are the major illnesses. Chronic undernutrition and illness result from poor sanitation and frequent resort to alternative staples, which are deficient in nutrients compared to the ideal meal of rice, greens and legumes or meat. Nevertheless, in addition to rice production, cultivating a variety of these staples is important for obtaining food security, green leafy vegetables, and good child growth status in a land and labor limited environment. In the 1989 dry season, 9.4% of the children fall below $-$2 s.d. weight/height. This proportion increases in the wet season. Six to nine year old children become more sedentary around $-$1.5 s.d. weight/height, although their play and productive behavior is surprisingly varied until about $-$3 s.d. weight/height, or below 1000 kilocalories intake. This low weight/height status or caloric intake is likely if alternative staples are eaten more than one meal per day. The children's households demonstrate retrenchment coping strategies, or moderately irreversible levels of household commitment of assets. Some foods come from the forest, more so during harsh cyclones, but the sale of forest products becomes important much earlier to obtain cash to buy food. While extremely dependent on forest resources for household products and cash, the poorest households were not the largest forest exploiters. Some elements of the resource shortage models, with local modification, may be useful for long-term monitoring in conservation-development management. These surveys are the protocol for other Malagasy park projects.

<p> This study investigates how heterosexual young people understand and manage risks related to meeting sexual partners online in the United States. The purpose of this study is to help inform the development of culturally-appropriate sexual risk communication and health promotion messages for young people by linking public health knowledge of adolescent sexual health and eHealth with anthropological theories of risk. With qualitative data from two rounds of semi-structured interviews and two group interviews with university students in central Florida, this study shows how young people experience and prioritize more social-emotional risks in meeting online-to-offline sexual partners compared to physical risks. The prominence of these social-emotional risks implies the need for more health promotion messages that incorporate both physical and social-emotional health risk communication.</p>

<p> The relationship to food, whether on an individual or societal basis, carries with it potential for nourishment on multiple levels. A mindful, healthy connection to the sourcing, preparation, serving, and enjoyment of food can become a catalyst for inner transformation, psychologically and physiologically. Utilizing hermeneutic methodology, this thesis explores food in relation to the soul by examining historical and cultural practices and beliefs about food. Various works of literature and the writings of culinary aficionados are discussed, giving examples of savoring food and receiving deep nourishment. In addition, a heuristic approach is undertaken to demonstrate the influence food has had on this researcher by recording personal reflections on her life and on literature that include memorable stories about the healing power of food. Depth psychological practices and theory may be positively impacted by the results of this research, due to the far-reaching implications for both mind and body.</p>

<p> Research on homelessness has tended to be divided theoretically between looking at personal pathology and emphasizing structural forces, but both have focused on street and shelter life. While there is a growing consensus in Anthropology that research should place homelessness within structural context, homelessness continues to be framed within the discourse of medicalization. This discourse continues into supportive housing programs for the formerly homeless, an area that has not yet been focused on much in research.</p><p> Based on ethnographic research conducted at Lamp Community in Los Angeles, California this thesis examines the continuity of struggle and vulnerability that continues even once the homeless are placed in supportive housing. It explores how this vulnerability has structural origins and how various levels of subjective and objective violence play out in the course of people's lives to maintain that vulnerability. By reuniting the issues of extreme poverty and homelessness, current measures to address homelessness are called into question.</p>

Contemporary literature pertaining to “race” reveals that it is an arbitrary socio-political construct. Contemporary population surveillance continues to use racial and ethnic variables when describing population parameters in the United States. Through an analysis tracing the historical process of shifting racial/ethnic categories and identities in the late nineteenth and early twentieth century United States, this dissertation investigates why vital statistics researchers continue to use these variables when describing patterns of health and disease. I define, trace, and investigate race as socio-historical process and hypothesize that it is invalid to assume that a racial classificatory standard exists. As a socio-historical process, racial categorizations and identifications vary over time and evidence of misclassification bias contribute to their invalidity. However, I do not assume that low misclassification bias equates validity. This assumption is potentially flawed and may lead to misguided research attempting to improve validity through reliability. Rather, low misclassification bias in reality masks the unstable and shifting nature of racial and ethnic categories and identifications. The data used in this investigation is representative of individuals dying from tubercular infections in Manhattan Borough between 1890–1930. Similar to the present, the four-decade period, 1890–1930 was a time of rapid population growth of New York City and a period of international/national ethnic migration. International immigrant populations consisted of those individuals originating from Western Europe, Eastern Europe, Southern Europe and the Caribbean; National migrants included African Americans and other marginalized “Native born” groups. All these populations shared a common experience of material hardship, resulting in their being at a higher risk for a number of communicable infectious and contagious diseases. However, the conflation of assigned race with socio-economic status adds a further dimension to be explored. The study demonstrates that the United States possesses a racial culture where individuals both racially self-identify and impose racial identifications on others. Health and vital statisticians actively assist in the perpetuation and re-invention of racial culture when they collect, report and interpret data using racial variables. (Abstract shortened by UMI.)

<p> This dissertation focuses on young people's and staffs discourses about, and participation in, day treatment mental health programs in Ontario. These experiences and perspectives are situated within broader structural contexts of power, policy and societal expectations. In doing so, I adapt and update Scheper-Hughes and Lock's (1987) Three Bodies model as an overarching structure for the thesis. I differ from their distinct division between the three bodies as my grounded theory approach to fieldwork data highlights the relational aspects of therapeutic practices, and in turn I draw attention to the interaction between and within Scheper-Hughes and Lock's individual-social-politic bodies. </p> <p> I completed fieldwork at two services, one for 13-18 and one for 5-12 year olds. These institutional settings are primarily concerned with (re)creating mental health and educational well-being. As such both they and my research are at the intersection of multiple academic disciplines, which means that my dissertation draws heavily on a variety of anthropological, sociological and childhood studies literatures and methodologies, as well as on influences from psychiatry and psychology, in addition to a broad range of post-structuralist I post-modem theorizing. </p> <p> In addition to this academic approach, my work has applicability, which was necessitated in part by the fieldwork sites' demand that they see benefits from research. My applied approach was also necessitated by my position that anthropological research can fruitfully combine both applied and academic approaches to research, known as praxis. </p> <p> Key issues addressed within my thesis are: the need for multiple qualitative methodologies, both to address questions around working with young people and questions arising from fieldwork sites primarily informed by quantitative research; the usefulness of combining aspects from the theoretical work of Bourdieu and Foucault in understanding how mental health therapies act to reenculturate young people; the importance of the role that the young people play in their own therapeutic recovery which I explore through my concept of con.fined agency; that (perhaps surprisingly) rites de passage and liminality can be useful conceptual frameworks to approach the sociality of individual bodies in the daily material activities at the fieldwork sites; and the negotiation by young people and staff of the ongoing negative impacts of stigma associated with mental illness. Within my ethnographic theorizing is the importance ofrelational interaction between individual-social-politic level bodies. </p> / Thesis / Doctor of Philosophy (PhD)

Objectives: The overall aim of this research was to describe the health-seeking behaviours (HSBs) of people in rural Makwanpur, Nepal, and to analyse the patient, household, community, health-system, knowledge and illness factors, and the psychological, social and cultural processes which explain these behaviours. Background: Much about the health status of populations and individuals can be understood by studying how people utilise their health services and the factors associated with this utilisation. HSB studies act as a starting point for the planning of health programmes and the structuring of health systems. Nepal, with its shortage of health providers and funding, its low service usage and its pluralistic medical landscape provides an interesting setting in which to examine HSBs. Most health policies in this context have been devised without taking into account the perspectives of the system users. Moreover, limited formal research on this topic has been carried out in this context. Methods: This study involved a mixed-methods, explanatory sequential design consisting of two phases – quantitative data collection followed by qualitative data collection. Quantitative data was collected using a cross-sectional household survey carried out in 2,334 households across ten VDCs in Makwanpur district between April 2011 and August 2011. Households were selected using a random sampling method. The survey asked about care-seeking in response to an acute episode of illness in the previous one month. Qualitative data was collected after the quantitative data using semi-structured household interviews (n=90) in three VDCs between November and December 2012. The Qualitative interviews were designed to compliment the quantitative findings and to determine the explicit factors associated with care decisions. Results: Of the 2,334 households surveyed,46% had at least one episode of illness in the month prior. The majority of illnesses were infectious or parasitic diseases (42%). Of those households experiencing illnesses, 69% chose to seek care outside of the home; 22% used traditional healers, 37% used allopathic providers and 12% opted for pharmacies as a first option. Sixteen did nothing to address their illnesses, sighting geography, finances, workload and lack of severity as the reasons. Regression models revealed that a host of different patient, household, community, illness, health facility and knowledge factors were associated with care decisions depending on the decision, but illness factors had the greatest impact overall on whether or not a household sought some care or care outside of the home, while household level factors had the greatest impact on the type of care sought outside of the home and the length of delays before seeking care. Patient gender had an impact on whether or not allopathic care was used at least once. Qualitative results revealed that health facility factors were also equally important in determining households’ conscious decision-making about specific providers. Conclusions: Overall it appears that people in Makwanpur are not underutilising health services as suspected. Households use certified government providers most frequently to address their illnesses, and do not rely too heavily on traditional healers or informal providers exclusively. The results indicate that while illness and household factors are important, in order to improve HSBs and increase allopathic care utilisation, a focus should be on improving health service delivery rather than on changing HSBs. However, in order to decrease delays in care-seeking, a focus should be made to reduce household-level barriers to care as well.

Lady Health Workers (LHWs) are community health workers who work under the Pakistani government’s National Programme for Family Planning and Primary Health Care, and provide basic medication, contraceptives, and nutrition and prenatal advice to expectant mothers. LHWs are a pivotal bridge between mothers, especially those who live in traditional households, and medical practitioners and policymakers. Several studies indicate that LHWs have been instrumental in decreasing maternal and infant mortality rates, lowering the incidence of tuberculosis in urban and rural populations, and treating depression among patients. In addition, they conduct vaccination campaigns including the WHO-supervised polio campaign. Since 2007 tensions have emerged between LHWs and the government regarding pay and working conditions. The LHWs have staged sit-ins, demonstrations as well as a march to the capital to highlight their plight and demand better working conditions from the government. This has resulted in disruptions in vaccination and awareness campaigns. Reports suggest that a higher morale amongst workers translates to higher productivity and more effective work results. Thus, understanding the issues affecting LHWs is essential to a more productive health care work force. By analyzing the dynamics underpinning the relationship between LHWs, the Pakistani government, and the community, policymakers can obtain a better understanding of how the intersecting influences of gender, culture and spaces impact the implementation of health care policies. This analysis could also shed light on the issue of worker retention in the medical field. Drawing from a series of semi-structured interviews conducted over a four-month period in the Pakistani city of Karachi, I analyse how LHWs view their work in relation to gender, agency, self-worth and human security in an urban setting. In addition, I locate the workers’ experiences within neocolonial and postcolonial systems. Findings indicate that while LHWs are extremely devoted to their work, a lack of security, compounded by irregular pay and gender discrimination, has contributed to low morale. The masculine and hierarchal systems LHWs operate within have contributed to the workers’ struggle to be recognised professionally. In addition, international development organisations’ agendas and government policies have had unintended and often negative consequences on LHWs’ morale and experiences. / Thesis (Master, Global Development Studies) -- Queen's University, 2013-07-03 16:28:46.91

In August 2008, a biomedical intervention providing free drugs to school aged children to treat two endemic diseases –schistosomiasis haematobium and soil-transmitted helminths - in Morogoro region, Tanzania, was suspended after violent riots erupted. Parents and guardians rushed to schools to prevent their children taking the drugs when they heard reports of children dying in Morogoro town after receiving treatment. When pupils heard these reports, many of those who had swallowed the pills began to complain of dizziness and fainted. In Morogoro town hundreds of pupils were rushed to the Regional Hospital by their parents and other onlookers. News of these apparent fatalities spread throughout the region, including to Doma village where I was conducting fieldwork. Here, protesting villagers accused me of bringing the medicine into the village with which to “poison” the children and it was necessary for me to leave the village immediately under the protection of the Tanzanian police. This thesis, based on eleven months fieldwork between 2007 and 2010 in Doma village and parts of Morogoro town, asks why was this biomedical intervention so vehemently rejected? By analysing local understandings and responses to the mass distribution of drugs in relation to the specific historical, social, political, and economic context in which it occurred, it shows that there was a considerable disjuncture between biomedical understandings of these diseases, including the epidemiological rationale for the provision of preventive chemotherapy, and local perspectives. Such a disjuncture, fuelled by the reports of fatalities and the pupil’s fainting episodes brought about considerable conjecture both locally and nationally, that the drugs had been faulty, counterfeit, or hitherto untested on humans. Among many of the poorer inhabitants of Morogoro town, there was suspicion that this had been a covert sterilization campaign. From an official perspective, such conjecture was dismissed as mere rumour, proliferated by “ignorant” people. However, from an anthropological perspective, these ‘rumours’ reveal profound local anxieties including a pervasive fear that poor Africans are being targeted for covert eugenics projects by governments in the industrialized world. The thesis also shows that many of the assumptions embedded in global policies seeking to control neglected tropical diseases are mistaken. Indeed, it is suggested that it is unlikely that schistosomiasis haematobium and soil-transmitted helminths will be controlled so long as policy makers persist with the idea that one policy, designed by staff working for the World Health Organisation – with minor modifications added in Dar es Salaam - can be rolled out uniformly, irrespective of the political, social and economic context in which the programme occurs.

<p> Puerto Rico has the highest prevalence of type 2 diabetes, low birth-weight, and the second highest prevalence of preterm-birth in all the U.S. and its non-incorporated territories. These conditions are related. Birth-weight at both ends of the spectrum and preterm-birth are associated with an increased risk for developing type 2 diabetes and immune-inflammatory dysregulations. Maternal psychosocial stressors during pregnancy have also been recognized as potential risk factors for type 2 diabetes, and have been consistently associated with preterm-birth and low birth-weight across populations. Current evidence points toward epigenetic fetal metabolic-programming as the mechanism that underlies the increased risk for the previously mentioned morbidities. However, the particular psychosocial stressors that may contribute to the high prevalence of low birth-weight and preterm-birth in the population of Puerto Rico have not been well studied.</p><p> The present study assesses the relationships between particular psychosocial stressors, socioeconomic status, food insecurity, and birth outcomes. The results of this study show that low-risk pregnancy women were more likely to have babies with a higher ponderal index if they were exposed to stressors during gestation months 5, 6, and 7, or if exposed to "relationship stress" at any time during pregnancy. Women exposed to "financial difficulties" at any time during pregnancy were more likely to deliver babies at an earlier gestational age. Differences in birth outcomes between the exposed and non-exposed women were independent of maternal anthropometric measurements, maternal age at birth, number of previous births, and sex of the baby. Significant differences in birth outcomes were found between categories of father's self-identified and identified by others ethnicity, but sample size within categories was small. Although mothers with children at home had higher levels of food insecurity, and the level of food insecurity was correlated with higher levels of stress, no birth outcome measure was associated with food insecurity.</p><p> Some results are atypical in comparison with other populations, and therefore these findings may contribute to the understanding of population differences in the relationship between maternal stress during pregnancy and birth outcomes. The relatively small sample size and strict exclusion criteria of this study may limit the generalizability of the findings. Epidemiological similarities between Puerto Rico and other populations, and the possibility of a higher ponderal index increasing the risk for type 2 diabetes in the population of Puerto Rico need to be examined in future research.</p>