In the fields of development and public health, the decisions of the rural poor are often treated as simple, unanimous, and driven by cultural preconceptions and beliefs. This is particularly the case for sub-Saharan Africa, where a dehistoricizing tendency presupposes an ontological link between an African culture and its tendency to interpret the world through the lens of belief. Generally, household activities are not seen as the kinds of modes of objectifying social practice that are the outcome of complex historical struggles over representation, and pre-disposing cultural factors are presumed to be the key determinants of household behavior. The three papers that constitute this alternative-format, article-based dissertation interrogate these assumptions. Although they address diverse subjects (the rise of West African Pentecostalism; the logic of treatment-seeking behavior in Benin; credit and savings strategies in rural Mali), they share a methodological concern with close analysis of the complexity of household decision-making in the moment, study over time, and attention to local concerns in the context of larger social transformations. In both medical and economic contexts, this approach demonstrates not only that behavior is primarily determined by enabling factors, but that the cultural factors that do condition behavior can be understood as creative, rational, and instructive of larger concerns, rather than merely as an impediment to development goals.

No description available.

Despite the availability of effective drugs to prevent malaria during pregnancy using intermittent preventive treatment with Sulfadoxine-Pyrimethamine or Fansidar and insecticide bed net, use of these methods are still little used in Sub-Saharan Africa, including Tanzania. As a result, many pregnant women are at risk of malaria consequences such as maternal anemia and low birth weight babies, which increase the rate of infant mortality. Data from the Demographic Health Survey for Tanzania HIV/AIDs and the Malaria Indicator Survey 2011-2012 were used in a cross-sectional design guided by the health belief model. Logistic regression examined the association between (a) preventive treatment-seeking behavior and (b) SES, malaria media exposure, knowledge of malaria signs and symptoms, perceived seriousness of malaria, and knowledge of malaria preventive measures. After controlling for transportation, family responsibility, and age, significant associations (p < 0.05) were found between SES, malaria media exposure, knowledge of malaria signs and symptom, perceived seriousness of malaria, knowledge of malaria preventive measures, and treatment-seeking behavior. This study contributes to positive social change by helping design and implement policies and programs to improve the knowledge of Tanzanian pregnant women about the risk of malaria infection and the benefits of preventive treatments. Interventions to reduce malaria infection during pregnancy will reduce the associated morbidity and mortality of both mothers and infants; as a result, families and communities will be healthier and prevent unnecessary medical cost of malaria.

It has been reported that Asian people have negative views of mental illness, including beliefs that it is incurable and shameful. Asian people also tend to attribute causes of mental disorders to factors less susceptible to personal influence such as supernatural factors, and are likely to have an external health locus of control which reflects beliefs that health outcomes are a product of external factors such as luck. In the present study, each of the above constructs were compared between American and Asian students. In addition, the above constructs were used to predict self-report of utilization of various treatment modalities. Four inventories were developed to assess the above constructs and treatment preferences. Reliability and validity of the new measures were examined. Results revealed that Asian students were more likely than American students to identify psychological disorder as shameful and its sufferers as socially untrustworthy and dangerous. Asian students were also more likely to attribute the causes of psychological disorder to supernatural factors than American students, and were more likely to seek folk medicine remedies for psychological disorder than were American students were. Both American and Asian students endorsed family care as the most preferable treatment approach, followed by psychological intervention, medical intervention, folk medicine intervention, and no treatment. An internal mental health locus of control predicted participants' willingness to seek no treatment. Among Asian students, beliefs in the untrustworthiness of the mentally ill predicted their willingness to seek folk medicine treatment. Attribution of psychological disorder to supernatural causes predicted their unwillingness to seek medical treatment. Among American students, an internal mental health locus of control predicted participants' willingness to seek no treatment. Attribution of supernatural causes and an internal mental health locus of control predicted their willingness to seek folk medicine treatment. A belief that mentally ill people were untrustworthy predicted a preference for medical interventions. / Master of Science

Contexte. Le paludisme provoque annuellement le décès d’environ 25 000 enfants de moins de cinq ans au Burkina Faso. Afin d’améliorer un accès rapide à des traitements efficaces, les autorités burkinabées ont introduit en 2010 la prise en charge du paludisme par les agents de santé communautaires (ASC). Alors que son efficacité a été démontrée dans des études contrôlées, très peu d’études ont évalué cette stratégie implantée dans des conditions naturelles et à l’échelle nationale. Objectif. L’objectif central de cette thèse est d’évaluer, dans des conditions réelles d’implantation, les effets du programme burkinabé de prise en charge communautaire du paludisme sur le recours aux soins des enfants fébriles. Les objectifs spécifiques sont : (1) de sonder les perceptions des ASC à l’égard du programme et explorer les facteurs contextuels susceptibles d’affecter leur performance ; (2) d’estimer le recours aux ASC par les enfants fébriles et identifier ses déterminants ; (3) de mesurer, auprès des enfants fébriles, le changement des pratiques de recours aux soins induit par l’introduction d’une intervention concomitante – la gratuité des soins dans les centres de santé. Méthodes. L’étude a été conduite dans deux districts sanitaires similaires, Kaya et Zorgho. Le devis d’évaluation combine des volets qualitatifs et quantitatifs. Des entrevues ont été menées avec tous les ASC de la zone à l’étude (N=27). Des enquêtes ont été répétées annuellement entre 2011 et 2013 auprès de 3002 ménages sélectionnés aléatoirement. Les pratiques de recours aux soins de tous les enfants de moins de cinq ans ayant connu un récent épisode de maladie ont été étudiées (N2011=707 ; N2012=787 ; N2013=831). Résultats. Les résultats montrent que le recours aux ASC est très modeste en comparaison de précédentes études réalisées dans des milieux contrôlés. Des obstacles liés à l’implantation du programme de prise en charge communautaire du paludisme ont été identifiés ainsi qu’un défaut de faisabilité dans les milieux urbains. Enfin, l’efficacité du programme communautaire a été négativement affectée par l’introduction de la gratuité dans les centres de santé. Conclusion. La prise en charge communautaire du paludisme rencontre au Burkina Faso des obstacles importants de faisabilité et d’implantation qui compromettent son efficacité potentielle pour réduire la mortalité infantile. Le manque de coordination entre le programme et des interventions locales concomitantes peut générer des effets néfastes et inattendus. / Context. In Burkina Faso, malaria causes approximately 25,000 deaths every year in children under five. In 2010, national health authorities introduced case management of malaria by community health workers (CHWs) as a way to increase prompt access to effective treatments. While this strategy’s efficacy has been demonstrated in controlled studies, very few studies evaluated its effectiveness under real-world and nation-wide conditions of implementation. Objective. The overarching aim of this thesis is to evaluate the effects of the Burkinabè program on treatment-seeking practices in febrile children. The specific objectives are: (1) to examine CHWs’ perceptions and investigate the contextual factors likely to affect their performance; (2) to estimate the use of CHWs in febrile children and its determinants; (3) to evalauate changes in treatment-seeking practices induced by the introduction of a concomitant intervention – the removal of user fees at health centres. Methods. The study was conducted in two similar health districts, Kaya and Zorgho. The evaluation design integrates quantitative and qualitative components. Interviews were carried out with all CHWs in the study area (N=27). Surveys were repeated every year from 2011 to 2013 in 3002 randomly selected households. Treatment-seeking practices of all children with a recent sickness episode (N2011=707; N2012=787; N2013=831) were examined. Results. Results show that the use of CHWs is really low in comparison to previous controlled studies. Feasibility issues in urban areas and barriers to implementation of the community case management of malaria programme were identified. Moreover, its effectiveness in rural areas was challenged by the removal of user fees at health centres. Conclusion. In Burkina Faso, community case management of malaria faces serious challenges of feasibility and implentation. These challenges compromise the programme’s potential to reduce child morbidity and mortality. The lack of integration between the programme and local concomitant interventions can generate unpredicted adverse effects.