Copyright @ 2012 Taylor & Francis. This article has been made publically available through the Brunel Open Access Publishing Fund.It is recognized that the control of schistosomisais in Uganda requires a focus on\ud fisherfolk. Large numbers suffer from this water-borne parasitic disease; notably along the shores of lakes Albert and Victoria and along the River Nile. Since 2004, a policy has been adopted of providing drugs, free of charge, to all those at risk. The strategy has been reported to be successful, but closer investigation reveals serious problems. This paper draws upon long-term research undertaken at three locations in northwestern and southeastern Uganda. It highlights consequences of not engaging with the day to day realities of fisherfolk\ud livelihoods; attributable, in part, to the fact that so many fisherfolk live and work in places located at the country’s international borders, and to a related\ud tendency to treat them as "feckless" and "ungovernable". Endeavours to roll out\ud treatment end up being haphazard, erratic and location-specific. In some places,\ud concerted efforts have been made to treat fisherfolk; but there is no effective\ud monitoring, and it is difficult to gauge what proportion have actually swallowed\ud the tablets. In other places, fisherfolk are, in practice, largely ignored, or are\ud actively harassed in ways that make treatment almost impossible. At all sites, the current reliance upon resident "community" drug distributors or staff based at static clinics and schools was found to be flawed.The Schistosomiasis Control Initiative, Imperial College, under the auspices of the Bill and Melinda Gates Foundation
SummaryMass drug administration has been less successful as a technique for controlling intestinal schistosomiasis (S. mansoni) than anticipated. In Uganda, the mass distribution of praziquantel has been provided to populations at risk of infection since the early 2000s, but prevalence mostly remains high. This is the case, for example, at locations in north-western and south-eastern Uganda. However, there is a remarkable exception. Among Madi fishing populations and their immediate neighbours, living close to the border with South Sudan, the rate of infection has dropped dramatically. A parasitological survey carried out at twelve fishing sites in 2013 identified only three cases of S. mansoni among 383 adults tested. This article asks: why is the prevalence of S. mansoni so low among fisherfolk in northern Uganda? Taking a biosocial approach, it suggests that the mass distribution of drugs, free of charge, has had an impact. However, the low prevalence of infection cannot be attributed to this alone. Other important factors may also have contributed to the decline in infection. These include changing fishing livelihoods, local attitudes to public health interventions, access to water and sanitation facilities, hygiene practices and the use of anti-malarial treatments. Above all, the article highlights the importance of investigating both social and biological dimensions of infection simultaneously, and of recognizing the local complexities of sustainably treating this debilitating parasitic disease.
Qualitative life history data were used to explore the experiences of women who live at five fish-landing sites on Lake Victoria, Uganda. We explored what economic and social opportunities women have in order to try to understand why some women are more vulnerable to violence and other risks than others and why some women are able to create successful enterprises while others struggle to make a living. The ability of women to create a viable livelihood at the landing sites was influenced by a wide variety of factors. Women who had or were able to access capital when they arrived at the landing site to set up their own enterprise had a significant advantage over those who did not, particularly in avoiding establishing sexual relationships in order to get support. Being able to establish their own business enabled women to avoid lower paid and more risky work such as fish processing and selling or working in bars. The development of landing sites and the leisure industry may be having an impact on how women earn money at the landing sites, with the most desirable economic opportunities not necessarily being connected directly to fishing.
BackgroundAn understudied disease, little research thus far has explored responses to Buruli ulcer and quests for therapy from biosocial perspective, despite reports that people seek biomedical treatment too late.Methods and findingsTaking an inductive approach and drawing on long-term ethnographic fieldwork in 2013–14, this article presents perspectives on this affliction of people living and working along the River Nile in northwest Uganda. Little is known biomedically about its presence, yet ‘Buruli’, as it is known locally, was and is a significant affliction in this region. Establishing a biosocial history of ‘Buruli’, largely obscured from biomedical perspectives, offers explanations for contemporary understandings, perceptions and practices.Conclusions/SignificanceWe must move beyond over-simplifying and problematising ‘late presentation for treatment’ in public health, rather, develop biosocial approaches to understanding quests for therapy that take into account historical and contemporary contexts of health, healing and illness. Seeking to understand the context in which healthcare decisions are made, a biosocial approach enables greater depth and breadth of insight into the complexities of global and local public health priorities such as Buruli ulcer.
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