AIM: It is the aim of this study to understand how and why South Sudanese women living in refugee settlements in Adjumani look for treatment in regard to Tuberculosis (TB), by answering the main...Show moreAIM: It is the aim of this study to understand how and why South Sudanese women living in refugee settlements in Adjumani look for treatment in regard to Tuberculosis (TB), by answering the main question ‘What are the health beliefs and health-seeking behaviour within the South Sudanese community in Adjumani district in regard to Tuberculosis?’. The sub-questions focus on different factors that influence health-seeking behaviour and health beliefs. METHODS: Focus group discussions (FGDs) (15) and individual interviews (3) with South Sudanese women were held in different refugee settlements in the Adjumani district in Northern Uganda. These were transcribed and analysed through ‘open’, ‘axial’ and ‘selective’ coding. Also, respondents were asked to draw something TB related, to make a visual interpretation of their knowledge about TB. By using Seale’s (2008) scheme, factors that influence health beliefs and health-seeking behaviour were formulated to answer the main question. Additionally, the district TB focal person was interviewed. RESULTS: The main health beliefs were that TB is a contagious disease which is mainly transmitted through sharing a cup with an infected person and that it is curable. Still, in more than half of the FGDs respondents said TB is caused by other factors (such as heavy work or fear) and in about one third of the FGDs no respondents mentioned the early symptoms of TB. In more than half of FGDs respondents said they would isolate someone with TB. The health-seeking behaviour of the respondents was commendable, since all respondents sought to find treatment when necessary. However, the majority would end up looking for treatment at a private clinic or a distant health facility, since the closest health facility would not provide them with medicine or the treatment they were expecting. In one in five of the FGDs a respondent mentioned self-treatment in the form of finishing old medication or using local herbs. The main factors that influence health beliefs about TB in this study are body perception, perception of susceptibility, supernatural beliefs, levels of education and familiarity with TB. The main factors that influence health-seeking behaviour are experiences with health care in Uganda, distance to the health facility, familiarity with TB, compliance and identity. CONCLUSION: To conclude, even though the health beliefs and perceptions about TB among the South Sudanese women were often different from medical or professional points of view, the health seeking behaviour was very much present and the South Sudanese women were willing to find treatment whenever they considered it necessary. Nevertheless, due to bad experiences with the health facilities, which was mainly about frequent drug-stock-outs, bad attitude of health workers, lay-professional rivalry and inappropriate testing machines, the South Sudanese mothers believe that the district’s health facilities are often unable to make a proper diagnosis. With the insecurity of how the conflict in South Sudan will continue, it will be important for the district to more strongly monitor the spread of TB and include the perspective of the South Sudanese community in order to understand why and where people look for treatment. Recommendations for the district health office and for future research were formulated.Show less
The aim of this thesis is to examine the Developmental Origins of Health and Disease (DOHaD) theory and its usefulness in the analysis of past populations. The DOHaD hypothesis states that many...Show moreThe aim of this thesis is to examine the Developmental Origins of Health and Disease (DOHaD) theory and its usefulness in the analysis of past populations. The DOHaD hypothesis states that many modern day diseases and a negative health in adulthood can be attributed to stressful events that happened earlier in pregnancy, infancy or childhood. This thesis analyses if individuals that were affected by physiological stress during childhood were more likely to develop tuberculosis. Individuals from two Dutch skeletal collections are studied: Middenbeemster, a post medieval rural community and Alkmaar, a medieval city. To identify childhood stress in the past, several non-specific indicators of stress are examined in juveniles and adults: stature, Harris lines, cribra orbitalia and dental enamel hypoplasia. Although these skeletal markers have multiple and overlapping aetiologies, the presence and severity of these skeletal lesions may provide insight into the resistance to stress and which sort of environmental stress could have been a risk factor to tuberculosis. Further, it is examined if any of the skeletal markers can be associated with a specific category of tuberculous lesions. Skeletal tuberculosis is divided in definitive, probable and possible lesions. Statistical analyses were performed to determine if there was a difference in the prevalence of each stress marker in the group affected with tuberculosis (definitive, possible or probable cases) and the group of individuals that was not affected by this infection. Statistical results demonstrates that delayed growth may have been a risk factor to tuberculosis in the Alkmaar population, though it was not statistically significant. The prevalence rates of Harris lines, cribra orbitalia (CO) and dental enamel hypoplasia (DEH) were high in the Alkmaar population, in contrast to the Middenbeemster population. However, these three stress markers were associated with tuberculosis in the Middenbeemster sample, in contrast to Alkmaar. CO and DEH were particularly associated with possible tuberculous lesions (new bone formation on the ribs and vascularization of or pits/grooves on the vertebral bodies). Additionally, CO could also be associated with definitive tuberculous lesions. Results show that childhood stresses, such as poor nutrition or disease could have been a risk factor that made individuals more susceptible to tuberculosis. This thesis also discusses the interpretational and methodological limitations of using the DOHaD on the skeletal remains of past populations. Factors that may have influenced the interpretation if early stress increases the risk to tuberculosis are considered.Show less
