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Biomedical subjects

C Vlassoff

Publications and source records attributed to C Vlassoff.

At least 19 recordsLinked to original sources
PubMed2001

Introducing Health Workers for Change: from transformation theory to health systems in developing countries.

This introductory paper provides the theoretical basis behind the Health Workers for Change methodology, and the role of interactive, participatory learning approaches in promoting social change. The methodology has its origins in Latin America and Kenya, where participatory research methods have been used widely to raise social consciousness and promote change. The paper discusses the resistance of health institutions to participatory ways of learning and the reasons why this occurs. It also presents the logic for the subsequent papers in this special issue and provides a summary of their respective contributions.

Adult↗
PubMed2001

An evaluation of Health Workers for Change in seven settings: a useful management and health system development tool.

This paper presents the findings of a multi-centre study assessing the impact of Health Workers for Change (HWFC) workshops in seven different primary care sites, based on the common core protocol described in this paper. The paper discusses a common methodology used by the studies, consisting of a triangulation of qualitative and quantitative methods. Such methodologies are inherently complex as they require comparisons across systems, sites and procedures. The studies were conducted in six sites in Africa and one site in Argentina. Generally, the intervention resulted either in positive change or in no change, except in the area of staff relationships where conflicts were more frequent after the intervention than before. This may reflect a willingness to confront problems or contentious issues. Implementing the HWFC workshops improved provider-client relations, facility level functioning and aspects of staff interrelationships, and had some impact at the system level. All studies indicated that overall health system development is essential for improved service provision including quality of care. The findings also indicated that this intervention complemented and could assist health sector reform efforts and can play a role in sensitizing health workers to gender issues. The paper concludes with a discussion of the robustness of the methodology used in the studies.

Africa↗
PubMed2001

Health Workers for Change as a health systems management and development tool.

In this paper we draw overall conclusions concerning the Health Workers for Change (HWFC) methodology as a management and health systems development tool. We examine how HWFC has contributed to an elucidation of the four main themes with which this special Issue is concerned, namely: the value of participatory training; the need for gender sensitivity in health services; the impact of the HWFC intervention on gender sensitivity and quality of care in health services; and the ability to replicate the HWFC intervention in a variety of cultural and geographical sites. The paper concludes that HWFC is a useful health systems development tool, discusses other applications of HWFC beyond those reported in this Issue and makes several recommendations concerning its future use.

Adolescent↗
PubMed2000

Gender and the stigma of onchocercal skin disease in Africa.

This paper reports results from a multicenter study of gender differences in the stigma associated with onchocercal skin disease (OSD) in five African sites: Cameroon, Ghana, Nigeria (Awka and Ibadan) and Uganda. The studies used a common protocol to compare affected and unaffected respondents, that is, men and women with onchodermatitis in highly endemic areas and respondents from communities with low endemicity or no onchocerciasis. The methods were both quantitative and qualitative, allowing for the comparison of stigma scores and people's verbal descriptions of their experiences and attitudes. Questions to the unaffected were asked after providing them with photographs and short descriptions (vignettes) depicting typical cases. We found that stigma was expressed more openly by the unaffected, who perceived OSD as something foreign or removed from themselves, whereas the affected tended to deny that they experienced stigma as a result of the condition. Gender differences in stigma scores were not significantly different for men and women, but qualitative data revealed that stigma was experienced differently by men and women, and that men and women were affected by it in distinctive ways. Men were more concerned about the impact of the disease on sexual performance and economic prospects, whereas women expressed more concern about physical appearance and life chances, especially marriage. Similar trends were found in the different sites in the responses of affected and unaffected respondents, and differences between them, despite geographical and cultural variations.

Adult↗
PubMed1998

Incorporating gender in the anthropology of infectious diseases.

The paper focuses on key issues in research and control of infectious diseases and demonstrates the utility of combining a gender perspective with anthropological investigation both for understanding disease and for designing and evaluating interventions for its control. Based on a definition of gender as opposed to sex, it illustrates, with the help of a gender framework for tropical diseases, how this concept is applied. It argues that gender-sensitive research is essential to the understanding of the nature of the disease, its prevalence, distribution, determinants and consequences. Examples are taken from anthropological studies on infectious diseases, including research on urinary schistosomiasis, malaria, leprosy, leishmaniasis and onchocerciasis. How gender-sensitive qualitative research can guide the design and evaluation of appropriate interventions for the prevention and control of infectious diseases is also discussed.

Anthropology↗
PubMed1996

Filariasis in northern Ghana: some cultural beliefs and practices and their implications for disease control.

This article reports on how some endemic rural communities in northern Ghana perceive and manage lymphatic filariasis. The disease was mainly attributed to supernatural and spiritual factors. Except for a few instances of neglect, the community was generally caring towards people with the disease. Issues related to marriage, stigma, concealment and leadership are discussed. On the whole, the importance of social and cultural perceptions of a disease and its relevance to control cannot be over emphasized.

Culture↗
PubMed1996

Double jeopardy: women and leprosy in India.

This article presents evidence from two states of India, Bihar and Maharashtra, on the process of "dehabilitation" among male and female leprosy patients, and suggests gender-sensitive interventions to address existing problems in leprosy control. While the study investigated a wide range of gender differences in the impact of leprosy, this article focuses on only two-marriage and family reactions. Important gender differences were apparent in the impact of the disease. While both men and women were negatively affected in terms of their family and marital lives, women suffered more isolation and rejection. Psychologically, women appeared more vulnerable because they were deprived of personal contact with others in the domestic environment where they were accustomed to receiving their greatest emotional rewards. Women reported that indifference to them by other family members, or seeming negation of their presence, caused them the greatest suffering. This underscores the importance of providing information to both leprosy patients and their families about the disease and its treatment, including the possibility of cure with MDT (multi-drug therapy) and of counselling family members about their crucial role in helping patients cope and recover. This support is even more critical for women, who often lack access to the variety of outside advice and assistance available to men. The evidence presented in the article demonstrates the importance of analysing leprosy from a gender perspective, not only because this approach helps to inform our understanding of the determinants and consequences of the disease, but also because it provides new insights for improved disease control.

Adolescent↗
PubMed1994

Evaluating agency initiatives: building social science capability in tropical disease research.

In recent years, in an endeavour to increase social and economic research in tropical diseases, WHO/TDR has used a number of alternative models to develop social science research capability in countries endemic for the designated tropical diseases. These have included small grants schemes to encourage junior researchers to gain familiarity with the subject area and methods, and protocol development and methodology workshops, either for specific research topics (e.g. adolescent women's health; community perceptions of schistosomiasis) or for any topic of interest to the participants. Participants have included medical researchers, social science researchers, and interdisciplinary teams (e.g. a medical researcher and a collaborating social scientist). This paper develops a typology and critically analyses these alternative approaches to developing research capability, and assesses their effectiveness in terms of cost, short-term effectiveness, and sustainability of the initiative.

Evaluation Studies as Topic↗
PubMed1994

Gender inequalities in health in the Third World: uncharted ground.

Gender differences in health in developing countries have, until recently, received little attention from researchers, health programmes and international development efforts. This paper highlights several issues related to gender and health in the Third World on which information, especially of an empirical nature, is inadequate. These include certain health conditions and diseases for which gender differences remain largely uncharted, gender inequalities in the development of health and contraceptive technology, the lack of gender-sensitivity in the provision of health services, and gender inequalities in health policies, focusing mainly on structural adjustment. Questions urgently requiring research are identified and suggestions are made for improving the gender sensitivity of health policies and interventions.

Contraception↗
PubMed1994

Gender-related differences in the impact of tropical diseases on women: what do we know?

This paper explores the importance of gender differences in the impact of tropical diseases on women. Malaria and schistosomiasis are used as examples but most of the observations also apply to other diseases endemic to developing countries. The distinction between sex and gender is discussed and evidence of sex and gender differences in the determinants and consequences of malaria and schistosomiasis, particularly their economic, social and personal dimensions, is reviewed. Issues on which research and intervention studies are needed are identified.

Developing Countries↗
PubMed1994

Reversing the flow: agricultural development and changing migration patterns in rural Maharashtra.

"In this paper we investigate the impact of rapid change from subsistence to irrigated farming [in Maharashtra, India,] and human dynamic responses to these changes from a longitudinal perspective (1975 to 1987). The study focuses on a single village, providing an in-depth and extensive analysis of both in and out-migration, characteristics of migrants, motivations for migration, experience at destination, and links with home areas, both social and economic.... The importance of migration, not only to the study village, but also to other rural areas from which in-migrants came, is also assessed." (SUMMARY IN FRE AND SPA)

Acculturation↗
PubMed1994

Gender, HIV and AIDS.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Social and economic factors and the control of lymphatic filariasis: a review.

Formal control programmes do not exist for lymphatic filariasis in much of the endemic world. The literature on the social, economic and clinical impacts of the disease is so sparse as to provide virtually no guidance on whether the disease should be accorded more importance in national or local public health programmes. This type of research is a major priority. Putting together what little is known about the socioeconomic determinants of filariasis with the fairly extensive experience in control leads to a finding that control programmes must be undertaken at the community level to be effective. Diethylcarbamazine (DEC) is a readily available and apparently safe drug that can be deployed successfully for community control. While research currently is exploring the potential for individuals to protect themselves with DEC or a newer drug, ivermectin, community-wide control is unlikely to be achieved in that way. Under some special circumstances, controlling the mosquito vectors may be sufficient to control the disease, and in other cases, it may complement chemotherapy, but in general, it cannot be relied upon as a primary measure. DEC may be used in a variety of regimens which vary in their cost, duration, incidence of side effects and degree of community participation. Some, including DEC-medicated salt, are particularly attractive alternatives for many filariasis-endemic areas. The search for less expensive, yet effective, control options must continue, and this requires research not only into the costs of the various options, but also into the determinants of community acceptance, compliance and participation.

Animals↗
PubMed1993

Gender and tropical diseases: a new research focus.

This paper examines the underlying assumptions that have led to a lack of attention to women's health, particularly in developing countries, beyond the context of their reproductive roles. It is argued that the peculiar nature of women' responsibilities both in economic production and within the family, may have a profound impact on the extent to which they are affected by tropical diseases and their responses to disease. It is suggested that the gender relations of health are of considerable significance in explaining the differential consequences of tropical disease on women, men and children. The paper proposes a framework for gender-sensitive research on this topic and suggests some new directions for research.

Developing Countries↗
PubMed1992

New approaches to social and economic research on schistosomiasis in TDR (Special Programme for Research and Training in Tropical Diseases).

This paper describes new approaches to social and economic research being developed by the Social and Economic Research component of the Special Programme for Research and Training in Tropical Diseases of the World Health Organization. One of these is a study to assess the possibility of identifying high risk communities for urinary schistosomiasis through a "mailed" questionnaire approach distributed through an existing administrative system, thereby eliminating the need for face-to-face interviews by the research or disease control team. This approach, developed by the Swiss Tropical Institute in Ifakara, Tanzania, is currently being tested in seven other African countries. The paper also describes a change of emphasis of economic research on schistosomiasis, focusing on the intra-household effects of the disease on rural households, rather than, as previously done, studying the impact of the disease on the productivity of individual wage labourers. Other priorities involve the identification of epidemiological information needed for improved decision-making regarding acceptable treatment strategies in endemic areas with limited financial capacity, as well as research on how the adverse effects of economic development projects can be alleviated.

Child↗