Article

Establishing the causes of childhood mortality in Ghana: The 'spirit child'

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  • United Nations University International Institute for Global Health (UNU-IIGH)
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Abstract

Communities in remote regions of northeast Ghana record some of the highest rates of under five mortality in West Africa (23.9 per 1000 children/year (Binka, Maude et al. (1995). International Journal of Epidemiology, 24(1), 127-135). The communities, isolated geographically and culturally from the main tribal groups in Ghana continue to adhere very strongly to traditional beliefs and practices. A qualitative study of both traditional and modern maternal and child health care systems in the area, demonstrated that almost 15% of deaths of infants under 3 months of age were due to a belief in chichuru or spirit children, resulting in infanticide. It is therefore a significant public health problem, which has to be addressed in programs for the control of child mortality. A modification of the verbal autopsy method is proposed to assist in the identification of non-biomedical causes of death.

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... Other causes of child death are diarrheal from contaminated foods and water, measles, and severe malnutrition (Seal et al. 2021) or congenital abnormalities Liu et al., 2015;Liu et al. al., 2012). Also, Allotey and Reidpath (2001) found that traditional beliefs contribute to child death, especially in the developing economies of Africa. However, Van Poppel and Van der Heijden (1997) stress that improvements in clean drinking water, hygiene, and sanitary conditions can help to reduce diarrheal diseases. ...
... First, this study enriches the literature on health by focusing on child health and life expectancy. Existing literature on child health is focused either on mortality rate (Karimi and Shokrinezhad 2020;Karimi and Shokrinezhad 2020;He et al. 2017;Liu et al., 2015;Liu et al., 2012;Allotey and Reidpath 2001;Van Poppel and Van der Heijden 1997). We argue that mortality rate and life expectancy are used because they comprise the death and longevity ratios necessary to determine health status. ...
... Second, we contribute to the literature on child mortality and life expectancy by accounting for cultural beliefs. Unlike the previous studies (Allotey and Reidpath 2001), who measure cultural value as chichuru, we argued that chichuru is just a cultural belief peculiar to only Ghanaian and should not reflect the tradition or culture of Africans. Therefore, we will use Hofstede's national culture to account for various cultural beliefs of nations. ...
Article
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Africa is a region with abundant natural resources, but the child mortality rate is higher. Despite World Health Organization (WHO) support, the region remained the highest with the number of child mortality rate. Given this fact, this study examines the role of environmental degradation, clean water source, and sanitation facilities on child mortality and life expectancy/longevity in Africa. To achieve this objective, we employ pooled regression and system generalized method of moment (S-GMM) on 33 African countries between 2000 and 2014. We found that environmental degradation is positively related to child mortality and life expectancy or longevity. However, clean water sources and sanitation facilities help to reduce the child mortality rate and help to improve life expectancy. Also, we found cultural norms improve child mortality and life expectancy. Our results imply that African countries are benefitting from cultural values, clean water sources, and sanitation facilities.
... These children are called by various names across communities within the region. They are referred to as chichuru or chinchirisi by Kassena-Nankana ethnic group, kinkirigo/kinkirisi by Gurunne or Frafra people (Allotey & Reidpath, 2001;Amenga-Etego, 2008;Azumi et al., 2018), binani by the Dagbamba (Alhassan, 2013;Mahama, 2012) and Kikiruk among the Bulsa people (Achuroa, 2019). ...
... Given the varied views on disability within communities in northern Ghana, it is believed that there are various ways through which spirit children come to inhabit human settlements. Some examples include but are not limited to sexual intercourse in the bush, bathing at midnight, eating while entering sacred places, easing oneself in prohibited places such as sacred groves, and travelling at night especially by pregnant women (Allotey & Reidpath, 2001;Anas, 2013;Azumi et al., 2018;Denham et al., 2010). Other ways are believed to be through witchcraft, sorcery, jealousy or envy (Kpobi & Swartz, 2019;Mahama, 2012). ...
... Considering the ontological view of disabilities among some communities in this part of the country, the counsel of medicine man or ritual specialist is usually sought when a child with disability is suspected to be an evil child, and some rituals are usually performed to send the supposed evil child back to where it came from (Denham et al., 2010). But there is also the belief of 'good' spirit children who are entertained because they are said to bring good fortunes to their families (Allotey & Reidpath, 2001). ...
Article
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This manuscript is part of a bigger study on inclusionary and exclusionary practices of children with disabilities in northern Ghana. In the past, because of attitudinal, structural and cultural barriers, children with disabilities were neglected and, in some cases, even excluded completely from the society. This paper argues that while Ghana has ratified many international conventions to protect persons with disabilities, the rights of children with certain disabilities are still in danger. Applying critical ethnographic methodological lens, Erving Goffman’s stigma theory, and cultural and moral disability models, this study explores twenty-six (26) participants’ views of exclusionary practices against children with disabilities in northern Ghana. The study finds that historical portrayal of disability in northern Ghana might have serious impact on the manner children with certain disabilities are treated; the actions of medicine men/spiritualist could lead to all forms of abuse. Finally, parents and families of children with certain disabilities might be pressured to resort to a range of exclusionary practices against their own children due to stigma and pressure from the communities. The study calls for comprehensive measures and effective community sensitization activities to stop all forms of exclusionary practices against children with disabilities, especially in the rural areas of Ghana.
... According to Awolalu (1976), West African culture stems from African Traditional Religion (ATR), an oral religion whose practices and belief system have become deeply entrenched in the lives of West Africans, regardless of their modern religious affiliations or level of Western education. As exemplified in Bayat's (2015) and Allotey and Reidpath's (2001) studies, both teachers and social workers in West Africa admit using corporal punishment to reinforce communication and social skills in children with intellectual disabilities because they believe that these children are non-human; as such, physical chastisement is not aimed at causing discomfort to the child but at driving away the evil spirit which is believed to possess them. A more familiar example is the abuse and subsequent killing of Victoria Climbié all in the name of spiritual possession and witchcraft (Laming, 2003). ...
... This figure, they said, is evenly spread in terms of geography and ethnicity, meaning that the ratio of ASD sufferers to non-ASD sufferers in any given population in the UK is 1: 100. A general West African belief, for example, is that children are reincarnations of their ancestors and, as such, disability is perceived as punishment from the gods (see Senah, 1993;Allotey, 1995;Allotey and Reidpath, 2001;Gottlieb, 2004;Clapton, 2009;Sossou and Yogtiba, 2009;Magesa, 2014;Mbiti, 2015, andBayat, 2015). This is an underlying cause of the shame and stigma attached to children with ASDs and their families in West African communities, which results in social isolation. ...
... Researchers investigating Western Judeo-Christian religion in the region have recently coined the term Pentecostalism with reference to the spread of Christianity in West Africa, a spread they believe has pushed ATR into extinction in the region (Meyer, 2004;Kalu, 2008). Qualitative research carried out in the region has, however, shown that all Muslims and Christians in West Africa who embrace Western education also believe in the fundamental traditions of ATR (Allotey and Reidpath, 2001;Bayat, 2015). One such tradition is the belief that the birth of a healthy child suggests harmony between ancestral and natural spirits, whilst the birth of a disabled baby suggests some form of punishment from the ancestors in the form of possession by an evil spirit (Magesa, 1997). ...
Research
This dissertation explores the experiences of West African mothers in caring for children with Autistic Spectrum Disorders (ASDs) in southeast London. Through my voluntary and paid employment working with individuals with learning difficulties over the last ten years within the London borough of Southwark, I realised that cultural perceptions of disabilities, particularly ASDs, vary amongst ethnic groups. I have observed that the families of these individuals, particularly within West African communities, become socially isolated. The study utilised semi-structured interviews to investigate the subjective experiences of four mothers who were raising their ASD children. Using thematic and discourse analysis methods, the research found that the mothers reported a high level of anxiety, stress and social isolation due to the extreme stigma associated with ASDs within West African communities.
... In other cases, children with disability themselves are believed to be non-human, either traditional bush or river spirits (Denham et al, 2010) or demons/devils in a Christian sense (Kassah, 2014). Interestingly, while two of the articles state that "spirit children" are killed regularly (Allotey and Reidpath, 2001;Botts and Evans, 2010), Denham and his colleagues (2010) report that infanticide is less common than previously thought. ...
... However, there is a problem in that, rather than investigate cultural beliefs among their informants, the majority of articles that implicate culture as a root of stigma draw on a small group of previous studies. In fact, only three (Allotey and Reidpath, 2001;Denham et al, 2010;Guerts and Komabu-Pomeyie, 2017) offer detailed analyses of cultural attitudes based on first-hand interviews, and they complicate the prospects of integrating cultural beliefs into disability policies. Two of them (Allotey and Reidpath, 2001;Denham et al, 2010) connect infanticide to the notion of spirit children. ...
... In fact, only three (Allotey and Reidpath, 2001;Denham et al, 2010;Guerts and Komabu-Pomeyie, 2017) offer detailed analyses of cultural attitudes based on first-hand interviews, and they complicate the prospects of integrating cultural beliefs into disability policies. Two of them (Allotey and Reidpath, 2001;Denham et al, 2010) connect infanticide to the notion of spirit children. However, while Allotey and Reidpath (2001) believe that it is common and attribute it completely to beliefs, Denham et al (2010) argue that many spirit children cases do not result in infanticide, and that all cases of infanticide emerge out of poverty and competition for resources rather than beliefs in and of themselves. ...
Article
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Purpose: This is a survey of peer-reviewed articles focussed on the causes and consequences of stigma towards persons with physical disability in Ghana.Method: After a systematic search of the online databases EBSCOhost, ProQuest, PubMEd and Web of Science for peer-reviewed articles on disability in Ghana, 26 articles were chosen for critical review. The three main selection criteria were: the articles had to be peer-reviewed, they had to be based on interviews with Ghanaians in the field, and they had to discuss stigma and human rights. For analysis, the content of the articles was grouped under two sections: major themes (human rights, causes of stigma, consequences of stigma) and policy recommendations (economics, medical services/healthcare, affirmative action, attitudes and awareness-raising, inclusion of cultural beliefs).Results: This review found that most of the studies attribute stigma to negative attitudes towards Ghanaians with disability, and many highlight beliefs among Ghanaians that disability is caused by spiritual and supernatural forces. The consequences, according to most authors, are social, economic and political exclusion. Policy recommendations include improving government policy, increasing funding for disability programmes, changing public attitudes, and paying attention to Ghanaian culture and tradition in designing disability interventions. While these are valid points, the authors of this paper are of the opinion that the literature also suffers from lack of a deep understanding of the historical and socio-cultural roots of supernatural beliefs in Ghana. Conclusion: The 26 studies discussed in this review show that since 2006 very good work has been produced on disability in Ghana, especially by Ghanaian disability scholars. It is hypothesised, however, that a full understanding of disability and stigma in Ghana must be based on deeper research into the roots of the beliefs that drive stigma. Future work therefore should focus on deepening the analysis of cultural beliefs towards disability in Ghana, in order to understand fully the roots of culturally-based disability stigma. More research into the economic causes and consequences of disability is also recommended, without which a full analysis of cultural stigma will not be possible.
... These beliefs are powerfully illustrated in rituals following the death of children in the KND believed to be ‘spirit children’ or chuchuru. The belief in ‘spirit children’ is closely bound to maternal and perinatal morbidity and mortality (23, 37), and it is culturally inappropriate to discuss the death of a ‘spirit child’ without provoking traditional sensitivities. The belief system is considered important enough to override any public health requirement to determine cause of death. ...
... Coders are research clinicians who understand and appreciate the VA process, and therefore their views were relevant in shaping the data collection process. Limitations in the data that they use in making the cause of death determination could lead to a significant number of cases being classified as undetermined, as identified by Allotey and Reidpath (23). ...
Article
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Background: Due to a paucity of statistics from vital registration systems in developing countries, the verbal autopsy (VA) approach has been used to obtain cause-specific mortality data by interviewing lay respondents on the signs and symptoms experienced by the deceased prior to death. In societies where the culture of mourning is adhered to, the use of VA could clash with traditional norms, thus warranting ethical consideration by researchers. Objective: The study was designed to explore the ethics and cultural context of collecting VA information through a demographic and health surveillance system in the Kassena-Nankana District (KND) of Ghana. Study design: Data were collected through qualitative in-depth interviews (IDIs) with four field staff involved in the routine conduct of VAs, four physicians who code VAs, 20 selected respondents to the VA tool, and eight opinion leaders in the KND. The interviews were supplemented with observation by the researchers and with the field notes of field workers. Interviews were audio-recorded, and local language versions transcribed into English. Thematic analysis was performed using QSR NVivo 8 software. Results: The data indicate that cultural sensitivities in VA procedures at both the individual and family levels need greater consideration not only for ethical reasons but also to ensure the quality of the data. Discussions of some deaths are culturally prohibited and therefore lead to refusal of interviews. Families were also concerned about the confidentiality of information because of the potential of blame for the death. VA teams do not necessarily engage in culturally appropriate bereavement practices such as the presentation of tokens. The desire by families for feedback on the cause of death, which is currently not provided by researchers, was frequently expressed. Finally, no standard exists on the culturally acceptable time interval between death and VA interviews. Conclusion: Ethical issues need to be given greater consideration in the collection of cause of death data, and this can be achieved through the establishment of processes that allow active engagement with communities, authorities of civil registrations, and Institutional Review Boards to take greater account of local contexts.
... Raise Community Awareness and Map Populations Based on Social Risks. Some community beliefs, cultural practices and attitudes have detrimental impacts on child health in Ghana [23,84]. For example, some communities promote the exclusive use of (i) traditional medicine as first-line treatment for sick children, and (ii) untrained traditional birth attendants in childbirth services [85,86]. ...
... Some traditional neonatal illnesses are often classified as non-clinically treatable [87]. An example is that 15% of infant deaths were attributed to a belief in "chichuru" or spirit children [23]. These beliefs and practices can cause significant delays in childtreatment seeking. ...
Article
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Objectives: Social factors have profound effects on health. Children are especially vulnerable to social influences, particularly in their early years. Adverse social exposures in childhood can lead to chronic disorders later in life. Here, we sought to identify and evaluate the impact of social factors on child health in Ghana. As Ghana is unlikely to achieve the Millennium Development Goals' target of reducing child mortality by two-thirds between 1990 and 2015, we deemed it necessary to identify social determinants that might have contributed to the non-realisation of this goal. Methods: ScienceDirect, PubMed, MEDLINE via EBSCO and Google Scholar were searched for published articles reporting on the influence of social factors on child health in Ghana. After screening the 98 articles identified, 34 of them that met our inclusion criteria were selected for qualitative review. Results: Major social factors influencing child health in the country include maternal education, rural-urban disparities (place of residence), family income (wealth/poverty) and high dependency (multiparousity). These factors are associated with child mortality, nutritional status of children, completion of immunisation programmes, health-seeking behaviour and hygiene practices. Conclusions: Several social factors influence child health outcomes in Ghana. Developing more effective responses to these social determinants would require sustainable efforts from all stakeholders including the Government, healthcare providers and families. We recommend the development of interventions that would support families through direct social support initiatives aimed at alleviating poverty and inequality, and indirect approaches targeted at eliminating the dependence of poor health outcomes on social factors. Importantly, the expansion of quality free education interventions to improve would-be-mother's health knowledge is emphasised.
... VA interviews are about death, as well as inevitably about the circumstances surrounding the death and the illness leading up to it (Allotey and Reidpath, 2001). Cultural understandings of adverse health events can be important to gaining an insight into how a death occurred. ...
... As D' Ambruoso et al. (2010) note, VA questionnaires are focused on deaths that occur outside hospitals, the deaths of people that probably experienced barriers to health services, and therefore present a unique opportunity to collect valuable lessons on health systems and how they can fail. Furthermore, in many settings where VA will be applied, cultural understandings of disease and explanations of death are likely to play important roles in the acceptance of the methods as well as provide important information for health service provision and effective interventions (Allotey and Reidpath, 2001;D'Ambruoso et al., 2010). ...
... Maternal mortality declined by 40.0% when the figure for years 2002-2004 is compared to that for years 1995-1996 [18]. e practice of infanticide, otherwise known as the "spirit child phenomenon," reduced from 15.0% in the 1990s [19] to 4.9% in 2002 [20]. Similar improvements have been reported in many other variables that are bound to have an impact on the overall health status of the people. ...
... Accelerating the reduction in child mortality in the Kassena-Nankana district would therefore require effective preventive and curative interventions that target these main causes of child deaths. ough still among the top 10 killers of children in the district, it is worth mentioning that the spirit child phenomenon which was found to contribute to about 1.7% of deaths in this study is a decline from the 15.0% found by Allotey and Reidpath in 2001 [19], which is encouraging and shows that progress is being made albeit slow at stamping out the practice from the culture of the people. Risk factor studies on child mortality have been equivocal in reporting factors such as sex of child, age of mother at birth of child, educational attainment of mother, household socioeconomic status, and residence to be significantly related to child mortality. ...
Article
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Child mortality continues to be a major public health problem in Ghana, especially in northern Ghana where child survival rates are among the lowest. Though strategies are in place to address it, progress made is unsatisfactory and the Sustainable Development Goal 3 risks being missed. This makes the reexamination of the risk factors for child mortality crucial as results will aid in the modification of existing strategies aimed at addressing the problem. This study was a population-based case control study utilizing data (2007–2011) from the Demographic Surveillance System database of the Navrongo Health Research Center. Cases and controls were selected from the database and analysed unmatched. Cases were children who died before age five and controls were live children within the same year group. Univariate and bivariate analyses were performed using STATA (v13). The results revealed the main causes of death in the area to include malaria, diarrhoeal diseases, respiratory infections, and malnutrition. Mother’s age at birth, mother’s educational level, and mother’s household socioeconomic status were significantly related to child mortality. On the basis of these results, we conclude that the known risk factors for child mortality in the Kassena-Nankana district have not changed much over the years. Current child survival strategies therefore need to be evaluated and modified where necessary to yield desired results.
... A lot of children are still accused of being possessed and causing harm and misfortunes to family members and neighbors in the community. Allotey and Reidpath (2001) assert that 15% deaths of babies less than three months age in Ghana is due to the practice of Chuchuru. ...
... Families interpret a child's failure to make eye contact as its fear of being looked at, as evidence that the child is hiding something. Other authors describe similar characteristics (Allotey & Reidpath, 2001;Awedoba, 2000;Howell, 1997). ...
Article
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The Chuchuru (spirit child) is a socio-cultural practice among the Kasena-Nankana people in the Upper East Region of Ghana. The practice is based on the belief that bush spirits take over unborn children whose mothers breach particular taboos during their conception. They are believed to deliberately inflict disabilities on the born child who is given a duty to punish the mother. Such children are forcefully killed to prevent them from bringing untold calamity on their parents and the entire community. A qualitative study with descriptive research method was carried out to investigate into the socio-cultural practice to enlighten the general public on it. The data for the study were collected from a 100 purposively sampled respondents via personal and focus group discussions as well as direct observations. The qualitative data analysis method was used for analyzing the solicited data. The study revealed that the Chuchuru socio-cultural practice is believed to be used by the people in preventing and appeasing the anger of their deities and ancestors. This negative socio-cultural practice results in the high toll of deaths of innocent children with physical abnormalities who could have been saved medically. The study recommends that there should be stringent measures put in place by the Ministry of Women and Children Affairs, the Ministry of Health as well as the National Commission on Civic Education to educate the people on the need to shun this inhumane socio-cultural practice while prosecuting culprits of the Chuchuru socio-cultural practice.
... Generally, in Ghana, there is a very high propensity for a woman to be blamed for giving birth to a child with disability. Such women are believed to have been cursed by the gods for some wrongdoing (Allotey and Reidpath, 2001;Botts and Evans, 2010). As a result, a mother who finds herself in such a situation must be deserving of her misfortune, and therefore needs not to be pitied. ...
... As researchers on disability in Ghana, we are witnesses to the unfortunate realities of marginalization, exclusion, and brutalities faced by PWDs in Ghanaian societies (Allotey and Reidpath, 2001;Botts and Evans, 2010;Moasun and Sottie, 2014;Tawiah et al., 2015). We therefore analyzed proverbs as a discourse in promoting Ghanaian cultures and practices as part of an effort to understand their potential role in labeling and rendering PWDs vulnerable to mistreatments. ...
Article
Full-text available
Proverbs are an important feature of any language worldwide. In Africa, for instance, people in their everyday conversations use proverbs to add special effects and flavour. However, the inclusion of proverbs in speech goes beyond mere decoration. As a repository of African knowledge and culture, proverbs serve as a medium for educating present and future generations about society’s cultural values, beliefs, and ethics. In this powerful role, proverbs may have significant effects on speakers and their listeners. While these effects may be positive, in terms of their references to certain groups of people, proverbs may have telling effects. In this paper, we examined samples of Ghanaian Akan proverbs on mental and physical disabilities and their meanings, using critical discourse analysis and guided by labeling theory. We conclude that Akan proverbs predominantly label people with disabilities negatively, thereby leading to their stigmatization, marginalization, and exclusion. We recommend using proverbs with negative connotations for people with disabilities as a tool to educate society on how not to treat people with disabilities.
... The outcome of a cause-of-death investigation in a region would depend on the choice of study design pursued by the investigator, that is, whether the perspective was from an " epidemiological " approach of obtaining a biomedical cause of death, or from an " anthropological " approach of obtaining a cause of death as perceived by the caregiver (Allotey and Reidpath 2001; Boerma et al. 1997). In our study, attribution to a supernatural cause of death (e.g., spirits), at less than 2%, was much lower than the level of 15% noted in Africa (Allotey and Reidpath 2001 ). ...
... The outcome of a cause-of-death investigation in a region would depend on the choice of study design pursued by the investigator, that is, whether the perspective was from an " epidemiological " approach of obtaining a biomedical cause of death, or from an " anthropological " approach of obtaining a cause of death as perceived by the caregiver (Allotey and Reidpath 2001; Boerma et al. 1997). In our study, attribution to a supernatural cause of death (e.g., spirits), at less than 2%, was much lower than the level of 15% noted in Africa (Allotey and Reidpath 2001 ). This could be attributed to the predominantly biomedical approach in study design undertaken in our investigation. ...
Article
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The aim of this investigation was to identify operational and ethical issues encountered in the application of verbal autopsy (VA) in a rural community in south India. A qualitative study involving semi-structured interviews was conducted with 183 bereaved caregivers in rural Andhra Pradesh, India. Simple descriptive analysis was undertaken. Only 16% of adult deaths and 27% of child deaths occurred in healthcare settings. Healthcare utilization for the terminal illness was reported in two thirds of medical (non-injury) causes of death. Supporting medical evidence was available in <10% of cases to supplement the interpretation of verbal autopsies. About 14% of bereaved caregivers refused to give written consent but provided oral consent. Additional ethical concerns included inability to ensure privacy in 15% of interviews and unsolicited information from unauthorized neighbours in 5% of cases. Such methodological, logistical and ethical issues operate to impact on the quality of VAs. Consideration of these issues would strengthen ongoing efforts in the harmonization of VA procedures.
... The child must take a poisonous potion. If the child survives, he or she is left in the bush for two nights; if he or she lives through it, the child can again take his or her place (Allotey and Reidpath 2001). Twins are often subject to specific treatments. ...
Article
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Carrying out a focused literature review on child abandonment and care in Africa, this paper aims to show that the understanding of this question remains very incomplete, the classification of situations is unsettled and their measurement is lacking in terms of both prevalence and trends. Argumentation is founded on a conceptual framework that gives a central place to the concept of disruption in the process of childcare, and that suggests determinant factors causing disruption and possible responses from families or from institutions. Some socio-cultural and economic factors highlight disruptions in the process of child care. Responses to these disruptions are largely familial, but also institutional. Some circumstances can lead to abandonment or child endangerment. The anthropology of infancy gives a great deal of information on cultural and social foundations of abandonment and on family systems of child circulation. Child demography remains focused on mortality, nutrition, education and birth registration. Demographic analyses give few answers on disruption in child care. It appears important today to improve data collection in order to better understand 1) child status in the family and mechanisms of solidarity that involve children; 2) issues concerning street children and working children; 3) situation of child endangerment outside as well as inside the family. Thus, progress of social science research, particularly in demography, on these issues in Africa would give important results necessary for improving policies regarding child protection.
... In Ghana, a still birth is regarded as a "spirit" child and the belief as in other cultures around the world is that such an event is the natural selection of a baby not meant to be part of the world of the living. [47,48] These women are not meant to view such an occurrence as a misfortune and barred from mourning. [49] Equally interesting is the finding that experience of a still birth is associated with both prevalent PND and persistence AND. ...
Article
Risk factors for postnatal depression (PND), one of the most pervasive complications of child bearing, are poorly understood in Africa. A recent systematic review of 31 studies found that the strongest predictors are social and economic disadvantage and gender-based factors; only six of these studies were community based, and almost all were in South Asia. Cohort study nested within 4 weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths in the Kintampo Health Research Centre study area of Ghana. Women were screened for depression during pregnancy and after birth using the Patient Health Questionnaire to ascertain DSM-IV major or minor depression. Information was collected on determinants relating to the mother, birth, and baby, which were examined using logistic regression; effect sizes reported as relative risks with 95% confidence intervals. Thirteen thousand nine hundred and twenty nine women were screened both during pregnancy and after birth, of whom 13,360 (95.9%) had complete data on potential determinants. Two hundred and fifty five (3.8%, 95% CI: 3.5%, 4.1%) had PND. Antenatal depression (AND) was the strongest determinant accounting for 34.4% of PND cases. Other determinants were season of delivery, peripartum/postpartum complications, newborn ill health, still birth, or neonatal death. Common determinants were observed for onset and persistent depression. Although most AND resolves in this setting, more than a third of women with PND also had AND. Adverse birth- and baby-related outcomes are the other main determinants. We recommend that programs detect and treat depression during pregnancy and provide support to women with adverse birth outcomes.
... The design of contextualized studies of why loss in childbearing is still a serious public health problem has recently been encouraged by " joining-up thinking " from multi-disciplinary perspectives [10] . The " thinking " highlights the importance of non-medical factors that may play a determinant role in understanding healthcareseeking behaviors such as the gender aspects of decision-making and local perceptions of illness and treatment111213141516. The local and contextual processes of how loss and the risk of loss are interpreted provide insights, not only on the sequencing of seeking treatment , but also on caregivers' rationales for preferences for private and public care. ...
Article
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Background There are profound social meanings attached to bearing children that affect the experience of losing a child, which is akin to the loss of a mother in the household. The objective of this study is to comprehend the broader processes that shape household healthcare-seeking during fatal illness episodes or reproductive health emergencies in resource-poor communities. Methods The study was conducted in six purposively selected poor, rural communities in Lao PDR, located in two districts that represent communities with different access to health facilities and contain diverse ethnic groups. Households having experienced fatal cases were first identified in focus group discussions with community members, which lead to the identification of 26 deaths in eleven households through caregiver and spouse interviews. The interviews used an open-ended anthropological approach and followed a three-delay framework. Interpretive description was used in the data analysis. Results The healthcare-seeking behavior reported by caregivers revealed a broad range of providers, reflecting the mix of public, private, informal and traditional health services in Lao PDR. Most caregivers had experienced multiple constraints in healthcare-seeking prior to death. Decisions regarding care-seeking were characterized as social rather than individual actions. They were constrained by medical costs, low expectations of recovery and worries about normative expectations from healthcare workers on how patients and caregivers should behave at health facilities to qualify for treatment. Caregivers raised the difficulties in determining the severity of the state of the child/mother. Delays in reaching care related to lack of physical access and to risks associated with taking a sick family member out of the local community. Delays in receiving care were affected by the perceived low quality of care provided at the health facilities. Conclusions Care-seeking is influenced by family- and community-based relations, which are integrated parts of people’s everyday life. The medical and normative responses from health providers affect the behavior of care-seekers. An anthropological approach to capture the experience of caregivers in relation to deciding, seeking and reaching care reveals the complexity and socio-cultural context surrounding maternal and child mortality and has implications for how future mortality data should be developed and interpreted.
... A similar high infant mortality was registered also at the nearby sample of 96/129 in the Tanezzuft Valley . In that case a cultural explanation, among others, was put forward : the practice of infanticide associated with the mother's death (di Lernia et al. 2001; see also Sofaer Derevensky 2000; Allotey and Reidpath 2001). At Fewet there is no clear archaeological evidence of what observed at 96/129, although two excavated structures, containing together the burial of an adult woman and that/those of a child/children, could be interpreted in a similar way. ...
Chapter
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The field seasons 2004-2006 at the necropolis of Fewet provided 33 human ske-letons in various state of preservation. A comprehensive description of the human skeletal sample is reported here, with the aim to provide anthropological data related to the emer-gence of the Garamantian society in the Fezzan. Overall, the study includes: a tentative paleodemographic profile of Fewet population; the analysis of metric and morphological features of cranial, dental, and postcranial remains; the scoring of skeletal/dental patho-logies and aspecific markers of stress. The picture of a rather poor community emerges, characterized by harsh life conditions (heavy daily work load, malnutrition, poor health status), high infant mortality, and low life expectancy among the adults. The analysis of cranial morphology at Fewet, compared to other skeletal samples from neighbouring are-as, suggests biological continuity between populations living in the Fezzan from the Late Pastoral to Roman times, together with the evidence of gene flow with other (tentatively sub-Saharan) populations. Dental dimensions are consistent with this conclusion. The sta-ture documented among adults is remarkably low. Postcranial measurements suggest a moderate division of labour between the sexes, with the females mostly devoted to activities involving the use of the upper limbs (mostly manual activities), while males used intensively the lower limbs (for walking over long distances).
... However, we did find that the presence of a child with SCD could exact a major toll on family relations. Beliefs that a child with SCD reflects a curse or punishment on the family may be powerful (Allotey & Reidpath, 2001;Nzewi, 2001). Focus group participants recommended addressing stigmatizing beliefs headon with such messaging as "SCD is not caused by witchcraft". ...
Article
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Sickle cell disease (SCD), sickle cell trait (SCT) and related conditions are highly prevalent in sub-Saharan Africa. Despite the public health implications, there is limited understanding of the unique needs regarding establishing and implementing extensive screening for newborns and appropriate family counseling. We sought to gain understanding of community attitudes and beliefs about SCD/SCT from counselors and potential counselors in Ghana; obtain their input about goals for counseling following newborn screening; and obtain guidance about developing effective counselor education. Five focus groups with 32 health care providers and health educators from 9 of 10 regions in Ghana were conducted by trained facilitators according to a structured protocol. Qualitative data were coded and categorized to reflect common themes. Saturation was achieved in themes related to genetics/inheritance; common complications of SCD; potential for stigmatization; marital strain; and emotional stress. Misconceptions about SCT as a form of SCD were prevalent as were cultural and spiritual beliefs about the causes of SCD/SCT. Potential positive aspects included affected children's academic achievement as compensation for physical limitations, and family cohesion. This data informed recommendations for content and structure of a counselor training program that was provided to the Ministry of Health in Ghana.
... Además del género, las anomalías del menor constituyen un importante factor de riesgo muy presente en numerosas tribus africanas, en los pueblos esquimales y en los indios Mohaves, donde se considera que éstos hijos suponen una carga para la familia (Resnick, 1970;Stanton y Simpson, 2002). Otro factor histórico a tener en cuenta es la creencia en espíritus, situación muy evidente en países africanos como Ghana, donde hasta un 15% de las muertes de menores de tres meses se explica por la presencia del espíritu Chichuru, cometiéndose el filicidio para así evitar la posesión del vástago (Allotey y Reidpath, 2001;Stanton y Simpson, 2002). ...
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Resumen A pesar de que el que un padre termine con la vida de su propio hijo parezca un hecho excepcional, hoy en día este tipo de violencia intrafamiliar constituye una de las más destacadas causas de fallecimiento de menores en los países desarrollados. En el presente artículo, se revisan las principales aportaciones de los conceptos infanticidio, filicidio y neonaticidio encontradas en la literatura científica. Se realiza una revisión histórica sobre el asesinato de menores por sus propios progenitores a lo largo de diversas culturas y civilizaciones. También se analizan las características fundamentales del filicidio y del neonaticidio presentando las más sustanciales entre ambos (en los agresores implicados y en el contexto). PALABRAS CLAVE: Infanticidio, filicidio, neonaticidio, muerte de niños. Abstract Parents' putting an end to their own child's life is an exceptional event, but this kind of intra-family violence is one of the causes of death of minors in developed countries. In the present work, the most important articles on infanticide, filicide, and neonaticide are reviewed. A historical analysis of the murder of minors by their own parents throughout various cultures and civilizations is carried out. The chief characteristics of filicides and neonaticides are also studied, revealing clear differences between these two concepts, such as the number of aggressors involved and the context in which they occur. Neonaticide is more uniform and better defined. KEY WORDS: Infanticide, filicide, neonaticide, death of children.
... Although not examining specifically connections between religion and utilization of reproductive health care services for prenatal consultations and child delivery, some studies in sub-Saharan Africa have reported about religious-based interpretation of health of women and children that has implications in decisions whether to use modern health services or resort to traditional health practices (Adetunji, 1991;Allotey & Reidpath, 2001;Kirby, 1997). For example, Kirby (1997) reported about underutilization of health care services by residents of some areas of Northern Ghana, whose beliefs about management of illness made them delay seeking modern health care services, often looking for help when there was already little hope for survival. ...
... Access to full audio recordings and qualitative analysis of the transcripts provides invaluable insights and will continue to be a routine part of data collection in verbal autopsies in SEACO. The full record of verbal autopsy interviews provides rich descriptions (to be reported elsewhere) that not only enable determination of cause specific mortality but can also contribute to our understanding of how communities understand chronic illness, terminal illness, death, and dying (35). These latter concepts and insights are critical to planning for community and home-based care of populations that are living longer and with increasing prevalence of chronic noncommunicable diseases (36). ...
Article
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Verbal autopsies have gained considerable ground as an acceptable alternative to medically determined cause of death. Unlike with clinical or more administrative settings for data collection, verbal autopsies require significant involvement of families and communities, which introduces important social and cultural considerations. However, there is very little clear guidance about the methodological issues in data collection. The objectives of this case study were: to explore the range of bereavement rituals within the multi-ethnic, multi-faith population of the district; to investigate the preparedness of communities to talk about death; to describe the verbal autopsy process; to assess the effects of collecting verbal autopsy data on data collectors; and to determine the most accurate sources of information about deaths in the community. A case study approach was used, using focus group discussions, indepth interviews and field notes. Thematic analyses were undertaken using NVivo. Consideration of cultural bereavement practices is importance to acceptance and response rates to verbal autopsies. They are also important to the timing of verbal autopsy interviews. Well trained data collectors, regardless of health qualifications are able to collect good quality data, but debriefing is important to their health and well being. This article contributes to guidance on the data collection procedures for verbal autopsies within community settings.
... Haws et al. found that women in Tanzania did not share pregnancy loss or neonatal death with their community [31]. Research in South Africa and Ghana found that women hide pregnancies to protect against witchcraft [52,53]. Given this level of discretion, CHWs may be in a strong position to document these hard-to-capture events, given their presence in the community and their role as service providers. ...
Article
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Background While community health workers are being recognized as an integral work force with growing responsibilities, increased demands can potentially affect motivation and performance. The ubiquity of mobile phones, even in hard-to-reach communities, has facilitated the pursuit of novel approaches to support community health workers beyond traditional modes of supervision, job aids, in-service training, and material compensation. We tested whether supportive short message services (SMS) could improve reporting of pregnancies and pregnancy outcomes among community health workers (Health Surveillance Assistants, or HSAs) in Malawi. Methods and Findings We designed a set of one-way SMS that were sent to HSAs on a regular basis during a 12-month period. We tested the effectiveness of the cluster-randomized intervention in improving the complete documentation of a pregnancy. We defined complete documentation as a pregnancy for which a specific outcome was recorded. HSAs in the treatment group received motivational and data quality SMS. HSAs in the control group received only motivational SMS. During baseline and intervention periods, we matched reported pregnancies to reported outcomes to determine if reporting of matched pregnancies differed between groups and by period. The trial is registered as ISCTRN24785657. Conclusions Study results show that the mHealth intervention improved the documentation of matched pregnancies in both the treatment (OR 1.31, 95% CI: 1.10–1.55, p<0.01) and control (OR 1.46, 95% CI: 1.11–1.91, p = 0.01) groups relative to the baseline period, despite differences in SMS content between groups. The results should be interpreted with caution given that the study was underpowered. We did not find a statistically significant difference in matched pregnancy documentation between groups during the intervention period (OR 0.94, 95% CI: 0.63–1.38, p = 0.74). mHealth applications have the potential to improve the tracking and data quality of pregnancies and pregnancy outcomes, particularly in low-resource settings.
... Burials are therefore quick and without ceremony, lacking formal expressions of grief for fear that the family may become recipients of supernatural malevolent harm. [11][12][13] In this Journal of Perinatology, Diallo et al. 14 report their findings from an important study designed to enumerate neonatal mortality and investigate its predictors in rural Burkina Faso in West Africa. The authors enrolled 864 infants whom they followed from birth until 6 months of age in 24 villages in the Bonfora Health District. ...
Article
JPER is a multi-disciplinary journal that promotes the health of the preterm infant.
... The creation or strengthening of a vital registration system is not an easy feat given complex health system weaknesses, bureaucratic inertia, and the range of health issues vying for program support and funding. Moreover, some socio-cultural beliefs at the community level act as barriers to registration [5][6][7][8]. ...
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Background: Malawi ratified a compulsory birth and death registration system in 2009. Until it captures complete coverage of vital events, Malawi relies on other data sources to calculate mortality estimates. We tested a community-based method to estimate annual under-five mortality rates (U5MR) through the Real-Time Monitoring of Under-Five Mortality (RMM) project in Malawi. We implemented RMM in two phases, and conducted an independent evaluation of phase one after 21 months of implementation. We present results of the phase two validation that covers the full project time span, and compare the results to those of the phase one validation. Methods and findings: We assessed the completeness of the counts of births and deaths and the accuracy of disaggregated U5MR from the community-based method against a retrospective full pregnancy history for rolling twelve-month periods after the independent evaluation. We used full pregnancy histories collected through household interviews carried out between November 2013 and January 2014 as the validation data source. Health Surveillance Agents (HSAs) across the 160 catchment areas submitted routine reports on pregnancies, births, and deaths consistently. However, for the 15-month implementation period post-evaluation, average completeness of birth event reporting was 76%, whereas average completeness of death event reporting was 67% relative to that expected from a comparable pregnancy history. HSAs underestimated the U5MR by an average of 21% relative to that estimated from a comparable pregnancy history. Conclusions: On a medium scale, the community-based RMM method in Malawi produced substantial underestimates of annualized U5MR relative to those obtained from a full pregnancy history, despite the additional incentives and quality-control activities. We were not able to achieve an optimum level of incentive and support to make the system work while ensuring sustainability. Lessons learned from the implementation of RMM can inform programs supporting community-based interventions through HSAs in Malawi.
... There is little published literature on infant abandonment/infanticide in Africa. Most of the papers have been qualitative [10,11], although one from Ghana asserted that nearly 15% of deaths under the age of 3 mo could be linked to infanticide practices [12]. A survey of violent deaths in the city of Dar es Salaam, Tanzania [13], estimated a rate of neonaticide (within 24 h of birth) of 27.7 per 100,000 live births, which is one of the highest reported. ...
Article
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Background: Homicide of children is a global problem. The under-5-y age group is the second largest homicide age group after 15-19 y olds, but has received little research attention. Understanding age and gender patterns is important for assisting with developing prevention interventions. Here we present an age and gender analysis of homicides among children under 5 y in South Africa from a national study that included a focus on neonaticide and infanticide. Methods and findings: A retrospective national cross-sectional study was conducted using a random sample of 38 medico-legal laboratories operating in 2009 to identify homicides of children under 5 y. Child data were abstracted from the mortuary files and autopsy reports, and both child and perpetrator data data were collected from police interviews. We erred towards applying a conservative definition of homicide and excluded sudden infant death syndrome cases. We estimated that 454 (95% CI 366, 541) children under the age of 5 y were killed in South Africa in 2009. More than half (53.2%; 95% CI 46.7%, 59.5%) were neonates (0-28 d), and 74.4% (95% CI 69.3%, 78.9%) were infants (under 1 y), giving a neonaticide rate of 19.6 per 100,000 live births and an infanticide rate of 28.4 per 100,000 live births. The majority of the neonates died in the early neonatal period (0-6 d), and abandonment accounted for 84.9% (95% CI 81.5%, 87.8%) of all the neonates killed. Distinct age and gender patterns were found, with significantly fewer boy children killed in rural settings compared to urban settings (odds ratio 0.6; 95% CI 0.4, 0.9; p = 0.015). Abuse-related killings and evidence of sexual assault were more common among older girls than in all other age and gender groups. Mothers were identified as the perpetrators in all of the neonaticides and were the most common perpetrators overall (71.0%; 95% CI 63.9%, 77.2%). Abandoned neonates were mainly term babies, with a mean gestational age of 38 wk. We did not have information on abandonment motives for all newborns and did not know if babies were abandoned with the intention that they would die or with the hope that they would be found alive. We therefore considered all abandoned babies as homicides. Conclusions: Homicide of children is an extreme form or consequence of violence against children. This national study provides one of the first analyses of neonaticide and infanticide by age and gender and shows the failure of reproductive and mental health and social services to identify and help vulnerable mothers. Multi-sectoral prevention strategies are needed.
... These differences point to the potential importance of the role of cultural beliefs and norms of whether women use health facilities and professionals for delivery. Religion, traditional birth practices, community attitudes, and the decision-making process within families all interact to determine whether a woman will use healthcare resources, and these factors and their importance differ not only within countries in SSA, but also within regions 11,12,19 . ...
Article
Objective: To examine the association between type of birth attendant and place of delivery, and infant mortality (IM). Methods: This cross-sectional study used self-reported data from the Demographic Health Surveys for women in Ghana, Kenya, and Sierra Leone. Logistic regression estimated odds ratios (ORs) and95% confidence intervals. Results: In Ghana and Sierra Leone, odds of IM were higher for women who delivered at a health facility versus women who delivered at a household residence (OR=3.18, 95% confidence interval, CI: 1.29-7.83, p=0.01 and OR=1.62, 95% CI: 1.15-2.28, p=0.01, respectively). Compared to the use of health professionals, the use of birth attendants for assistance with delivery was not significantly associated with IM for women in Ghana or Sierra Leone (OR=2.17, 95% CI: 0.83-5.69, p=0.12 and OR=1.25, 95% CI: 0.92-1.70, p=0.15, respectively). In Kenya, odds of IM, though nonsignificant, were lower for women who used birth attendants than those who used health professionals to assist with delivery (OR=0.85, 95% CI: 0.51-1.41, p=0.46), and higher with delivery at a health facility versus a household residence (OR=1.29, 95% CI: 0.81-2.03, p=0.28). Conclusions: Women in Ghana and Sierra Leone who delivered at a health facility had statistically significant increased odds of IM. Birth attendant type-IM associations were not statistically significant.Future research should consider culturally-sensitive interventions to improve maternal health and help reduce IM.
... There is considerable evidence, largely from the ethnographic record, that this is the case. Children are not bound by the laws that others are bound by, they are frequently believed to be interlocutors for the spirit world and even themselves ghosts or spirits (Allotey and Reidpath 2001;Denham et al 2010) and, similarly, spirits may be conceptualised as children (Sinnot 2014). ...
Chapter
Book synopsis: Geographies of children and young people is a rapidly emerging sub-discipline within human geography. There is now a critical mass of established academic work, key names within academia, growing numbers of graduate students and expanding numbers of university level taught courses. There are also professional training programmes at national scales and in international contexts that work specifically with children and young people. In addition to a productive journal of Children’s Geographies, there’s a range of monographs, textbooks and edited collections focusing on children and young people published by all the major academic presses then there is a substantive body of work on younger people within human geography and active authors and researchers working within international contexts to warrant a specific Major Reference Work on children’s and young people’s geographies.
... Qualitative accounts have been published from developed countries (Rapp 1988, Featherstone et al. 2006, with specific attention to issues of discrimination (Atkin et al. 1998), but much of the data on experiences of genetic conditions from Africa (Bamisaiye et al. 1974, Akenzua 1990, Ohaeri et al. 1995, Adeodu et al. 2000, Assimadi et al. 2000, Ohaeri and Shokunbi 2001, Ohaeri and Shokunbi 2002 draws on quantitative surveys and illustrates issues in limited geographic areas, particularly West Africa. Exceptions are qualitative accounts of SCD beliefs as reincarnation in Nigeria (Nzewi 2001) and Ghana (Allotey and Reidpath 2001), a description of biosocial illness associated with SCD carrier status in Senegal (Fullwiley 2006) and experiences of stigmatisation around the genetically influenced disorder podoconiosis in Ethiopia (Tekola et al. 2009). The prominence of SCD testing in these studies is expected given its public health prominence as a genetic disorder in Africa. ...
Article
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To explore early experiences of sickle cell disorder (SCD) in families with a young affected child, and the way these experiences influence relations within families. To consider ways in which stigma could be counteracted in health and research programmes in sub Saharan Africa. A qualitative study was conducted in a rural area of coastal Kenya including in-depth interviews with 13 families affected by SCD and 12 staff of a local biomedical research progamme. Purposive selection aimed to maximize diversity in socioeconomic and educational status, religion, severity of illness burden and religion amongst families and draw on relevant experience for staffs. Interviews were recorded, transcribed and analysed using the constant comparative method for family interviews and a thematic framework approach for staff data. Low initial recognition of SCD and its cause were associated with lay practices of surveillance within affected families, contributing to stigmatisation that occurred independently of genetic knowledge. Blame was often placed on mothers, including a risk of blame for misaligned paternity. Mothers are often particularly affected by SCD through the loss of independent livelihoods and their limited options in coping with this chronic condition. Mothers of children with SCD were particularly vulnerable to stigmatisation within families, with underlying structural influences that suggest these findings may apply to other similar settings in Africa, and have relevance for other genetic conditions. The potential, nature and form of stigmatisation point to the role of effective communication and SCD management in addressing for blame and discriminative effects of having a child with SCD. The findings highlight the importance of broader social programmes targeting underlying gender and economic inequalities.
... Four of the syndromes could not be diagnosed and so we simply tagged them "syndromic babies". We believe that congenital malformation and syndromes among babies are under reported as in some communities in Ghana these babies are not brought to hospital for medical intervention but rather end up in infanticide according to remote traditional believe that they are rather 'spirits' and so they cannot live among human beings [29]. ...
... Stigma and discriminatory practices came not only from strangers, but also from family members at a much more intimate level. Making matters worse, as others have shown (Allotey & Reidpath, 2001;Read, 2016) our participants revealed that many Ghanaians consider mental illness to be spiritually caused, rooted in witchcraft or demonic possession. These beliefs worsened stigma and discrimination, and led to abuse, abandonment, and social exclusion. ...
Article
Despite advances in human rights and treatments, stigma toward individuals diagnosed with mental illness is common across the African continent. This article explores experiences of stigma and social exclusion among individuals diagnosed with mental illness and receiving treatment in a psychiatric facility in Ghana. The study, based on in-depth, semi-structured interviews generated the following themes: beliefs in spiritual causes of mental illness; spirituality as a coping mechanism; mistreatment and abuse. The findings highlight the significance of social exclusion and spirituality as the main roots of stigma; also the importance of awareness-raising as tools for anti-stigma work in the global South.
... It could be in the form of visitation of ancestral spirits or god or the supreme being (god) (Botts & Evans, 2010;Denham et al., 2010). There is also the belief that children with disabilities possess evil spirits and these beliefs contribute to their maltreatment, including various forms of exclusion and in some communities results in death (Allotey & Reidpath, 2001;Denham, Adongo, Freyberg & Hodgson, 2010). Most of these beliefs and cultural thought processes are inherently transferred and perpetuated by our traditional system via our oral tradition, which is a traditional African theoretical framework and passes from one generation to the other. ...
Article
There is evidence that persons with disabilities continue to encounter barriers in society globally, which impede on their participation and inclusion. In Ghana, the effects of the barriers could be profound because of attitudes that are deeply rooted in Ghanaian socio-cultural beliefs and practices. The lockdowns, social distancing, physical distancing, hygiene and health practices are among safety measures against the impact of the COVID-19 pandemic, which affects individuals, families, businesses, institutions and communities. Persons with disabilities are less likely to be employed, but more likely to lose their jobs. The majority work in vulnerable employment, characterised by low income, lack of job security and job-related benefits. Both categories of workers with disabilities are more likely to lose their jobs in the COVID-19 era, which could further worsen their income and savings and their economic resilience. Inadequate social protection, healthcare benefits and familial support, coupled with disability-related expenses, could add layers to the vulnerabilities of persons with disabilities noted to be among the poorest of the poor. The Ghana government COVID-19 response strategy, unfortunately, does not specifically address the needs of persons with disabilities. The vulnerabilities of persons with disabilities in the COVID-19 pandemic and recommendations to better address their needs are explored in this paper.
... In communities where children have been labelled child spirits, they may be subjected to various forms of physical and psychological harm. According to Allotey and Reidpath (2001) child spirits are "spirits who occasionally managed to come to this world to play for a short time and cause distress to the communities to which they belonged" (p. 1009). ...
Article
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Objectives Australian Child Protection practitioners who work with children from sub-Saharan African migrant backgrounds often face challenges when applying child protection laws and policies to address childrearing and parenting issues. The aim of this study is to examine the influence of cultural beliefs, values, attitudes and practices on childrearing practices within sub-Saharan African communities. Methods The systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases searched included Science Direct, ProQuest Central, Embase, EbescoHOST (Medline; PsychINFO; CINAHL; ERIC; SocINDEX; PsycARTICLES), Web of Science (SCI-EXPANDED; SSCI) and Google Scholar; the search dates were from January 2000 to December 2016. The studies were assessed using the Consolidated Criteria for Reporting Qualitative Research (COREQ) and the Strengthening the Reporting of Observational studies in Epidemiology guidelines (STROBE). The search strategy identified 2631 articles, of which 57 met the inclusion criteria for the review. Participants were children aged from three months old to seventeen years and adults aged eighteen years or older. Results Data analysis resulted in 7 primary themes: Illness Conception, Traditional Beliefs and Health-seeking Behaviour; Fosterage and Community Responsibility; Family Dynamics; Discipline; Child Spirits and the Supernatural; Body Stimulation; and Female Genital Mutilation. Conclusion Framed within the acculturation theory, the review identifies important factors that converge to provide insight into the specific caregiving context of sub-Saharan African families. It further makes clear that, for the most part, the childrearing practices of sub-Saharan African migrants who settle in Australia are influenced by their cultural values and norms.
... 24 This blend of structural and cultural factors contribute to shaping community members' understanding and conceptualisation of HTN and treatment options and influence health behaviour and practices. Indeed, previous studies conducted in northern Ghana show that community perceptions and practices differ from biomedical explanations for childhood illness 28 and childhood mortality 29 and for infectious diseases such as malaria 30 and filariasis, 31 yet scant evidence exists on if community perceptions and practices for HTN differ from biomedical practices and the factors that contribute to shaping such perceptions and practices towards HTN. Janzen identifies this group of people, that is, family and community members in African societies, as the 'therapy managing group' who take responsibility during illness by playing a 'brokerage function' between the patient and the specialist. ...
Article
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Objective Adherence to hypertension treatment is a major public health challenge for low and middle-income countries particularly in sub-Saharan Africa. One potential reason could be the discordance between lay and medical explanatory models of hypertension and its treatment. Understanding community perceptions and practices may contribute to improving hypertension control as they present insights into psychosocial and cultural factors that shape individual behaviour. We explore community perceptions regarding hypertension and its treatment in rural northern Ghana and how they differ from medical understanding. Design This was a qualitative study using semi-structured interviews and focus group discussions to collect data, which were analysed using a thematic approach. Setting A multisite study conducted in four rural communities in two regions of northern Ghana. Participants We conducted 16 semi-structured interviews and eight focus group discussions with community leaders and members, respectively. Results Three major themes were identified: community perceptions, treatment options and community support for people with hypertension. Community perceptions about hypertension include hypertension perceived as excess blood in the body and associated with spiritual or witchcraft attacks. Traditional medicine is perceived to cure hypertension completely with concurrent use of biomedical and traditional medicines encouraged in rural communities. Community members did not consider themselves at risk of developing hypertension and reported having inadequate information on how to provide social support for hypertensive community members, which they attributed to low literacy and poverty. Conclusion There is a substantial mismatch between communities’ perceptions and medical understanding of hypertension and its treatment. These perceptions partly result from structural factors and social norms shaped by collective processes and traditions that shape lay beliefs and influence individual health behaviour. Socioeconomic factors also thwart access to information and contribute to inadequate social support for persons with hypertension. These findings highlight the need for a public health approach to hypertension control targeting families and communities.
... Si l'esprit est découvert, il ne peut pas rester au monde. L'enfant doit absorber une potion toxique ; s'il y survit, on le pose dans la brousse pendant 2 nuits ; si de nouveau, il survit à ces 2 nuits, l'enfant pourra reprendre sa place (Allotey et Reidpath, 2001). ...
... When a child is born with an impairment, the family may not understand what caused it to happen and it may be attributed to God or an unknown force [18]. This view of a child as a non-human spirit is influenced by West African religion and animism and may lead to killing of children with impairments [19]. Some of these reported experiences of violence have been described in earlier studies focusing on ritual killing of children born in West Africa and noting that children with a "body difference" were killed, but a dearth of information exists as the practice is not officially observed and records of death from infanticide are not often available. ...
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Background Despite the building evidence on violence against children globally, almost nothing is known about the violence children with disabilities in low and middle-income countries (LMICs) experience. The prevalence of violence against children with disabilities can be expected to be higher in LMICs where there are greater stigmas associated with having a child with a disability, less resources for families who have children with disabilities, and wider acceptance of the use of corporal punishment to discipline children. This study explores violence experienced by children with disabilities based on data collected from four countries in West Africa- Guinea, Niger, Sierra Leone, and Togo. MethodsA qualitative study design guided data generation with a total of 419 children, community members, and disability stakeholders. Participants were selected using purposive sampling. Stakeholders shared their observations of or experiences of violence against children with disabilities in their community in interviews and focus groups. Thematic analysis guided data analysis and identified patterns of meaning among participants’ experiences. ResultsResults illuminate that children with disabilities experience violence more than non-disabled children, episodes of violence start at birth, and that how children with disabilities participate in their communities contributes to their different experiences of violence. Conclusions The study recommends policy-oriented actions and prevention programs that include children and their families in strategizing ways to address violence.
... In Ghana, as in much of SSA, Eurocentric approaches to the management of disease and disability have been adopted, however traditional beliefs and the use of traditional interventions also continue to commonplace [35][36][37]. Spiritual beliefs regarding disability causation and treatment are widespread in SSA, including Ghana [29,37,38] with a number of traditional responses being linked historically to neglect, abuse, and infanticide [39][40][41], however a mix of beliefs is likely to be present in the community, influenced by a variety of factors including the adoption of religion and Western lifestyles [29,42]. ...
Article
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Background: In low and middle-income countries, such as Ghana, communication disability is poorly recognised and rehabilitation services for people with communication disability are limited. As rehabilitation services for communication disability develop, and the profession of speech-language pathology grows, it is important to consider how services can most appropriately respond to the needs and preferences of the community. Understanding the ways in which people currently self-help and seek help for communication disability is central to developing services that build on existing local practices and are relevant to the community. Methods: A qualitative descriptive survey was used to explore likely self-help and help-seeking behaviours for communication disability, in Accra, Ghana. The survey required participants to describe responses to hypothetical scenarios related to communication disability. A mix of theoretical sampling and convenience sampling was used. Qualitative content analysis was used to analyse data and develop categories and subcategories of reported self-help behaviours and sources of help and advice for communication disability. Results: One hundred and thirty-six participants completed the survey. Results indicated that community members would be likely to engage in a variety self-help strategies in response to communication disability. These included working directly with a person with a communication disability to attempt to remediate a communication impairment, altering physical and communication environments, changing attitudes or care practices, educating themselves about the communication disability, providing resources, and responding in spiritual ways. Participants indicated that they would seek help for communication disability across a range of sectors - including the Western healthcare, religious, and traditional sectors. Conclusions: Understanding existing community actions to self-help and help-seek may allow emerging communication rehabilitation services, including the profession of speech-language pathology, to build on existing community practices in resource-limited contexts such as Ghana.
... Las creencias en los espíritus también contribuyen a explicar ciertos fi licidios, situación evidente en países africanos como Ghana, donde 15% de las muertes de los menores de tres meses en la zona noreste se explican por la presencia del espíritu de los niños, Chichuru, que es percibida por los padres que cometen fi licidio para evitar la posesión de su vástago (Allotey y Reidpath, 2001;Stanton y Simpson, 2002). ...
Article
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Introduction: Verbal autopsy (VA) is a method that determines the cause of death by interviewing a relative of the deceased about the events occurring before the death, in regions where medical certification of cause of death is incomplete. This paper aims to review the ethical standards reported in peer-reviewed VA studies. Methods: A systematic review of Medline and Ovid was conducted by two independent researchers. Data were extracted and analysed for articles based on three key areas: Institutional Review Board (IRB) clearance and consenting process; data collection and management procedures, including: time between death and interview; training and education of interviewer, confidentiality of data and data security; and declarations of funding and conflict of interest. Results: The review identified 802 articles, of which 288 were included. The review found that 48% all the studies reported having IRB clearance or obtaining consent of participants. The interviewer training and education levels were reported in 62% and 21% of the articles, respectively. Confidentiality of data was reported for 14% of all studies, 18% did not report the type of respondent interviewed and 51% reported time between death and the interview for the VA. Data security was reported in 8% of all studies. Funding was declared in 63% of all studies and conflict of interest in 42%. Reporting of all these variables increased over time. Conclusions: The results of this systematic review show that although there has been an increase in ethical reporting for VA studies, there still remains a large gap in reporting.
Conference Paper
Purpose: More than 2 million newborn deaths occur each year in the home, therefore understanding community perceptions of neonatal illness is critical to developing effective neonatal mortality reduction programs. This study explored household beliefs and practices regarding neonatal illness in rural Kassena-Nankani District, Northern Ghana. Methods: 61 in-depth interviews were conducted with 35 women with newborn infants, 13 health care providers and 13 community leaders. Additionally, 18 focus group discussions were conducted among grandmothers, compound heads and mothers. All interviews and focus groups were audiotaped, transcribed into English and imported into NVivo 9.0. Results: Respondents clearly recognized danger signs of illness in the pregnant mother and infant. Responses to that recognition varied, with some respondents suggesting immediate referral to health facilities and others opting for traditional healers, particularly for we yuu zugah (convulsions). Traditional practices varied widely for newborns with breathing difficulties, with many respondents applying water or a poultice to the newborn's chest or beating a hoe or implement close to the ear. All respondents knew about the presence of health facilities, and many were aware of the value of preventive care. Husbands were responsible for offering sacrifices and interfacing with sooth-sayers, while grandmothers were the decision-makers regarding facility-based attendance, bathing and praying. Conclusions and implications: Traditional practices surrounding neonatal health in rural Ghana are widespread and do not always match clinical recommendations. Fathers and grandmothers play a pivotal role in the household management of newborn illness and should be included in any program interventions.
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Neonaticide, infanticide, and filicide are painful problems that may confront any society. What is the history of these brutal behaviors? Who are the perpetrators? What are the motives? What are risk factors? Are these behaviors prevalent in contemporary times? What are prevention measures? Biblical texts were examined and verses which describe neonaticide are studied closely from a contemporary viewpoint. Infanticide and filicide are also examined.
Article
Improving education equity and quality is a major focus of global developmental movements. Within that overarching goal, educators and advocates around the world are working to ensure children with special needs receive a quality education. For many, this means pursuing programs of inclusion. The author of this article uses the tools of education diplomacy being shaped by the Association for Childhood Education International to discuss the influence of local religious and cultural practices on the education of children with disabilities, the dominant models of disability, and the differences in conceptualizing inclusive education across the world. The article highlights the need to take an approach informed by education diplomacy when advocates of inclusive education seek to collaborate with various stakeholders in the fields of early education and special needs education.
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This paper engages critically with the global assemblage framing sickle cell and thalassaemia disorders as a ‘global health crisis’; and the promise of genomics, largely DNA-based carrier/pre-conceptual screening, prenatal diagnosis with a view to terminations, deployed in framing a solution to these historically racialised spectrum of diseases as essentially preventable. Sickle cell and thalassaemia are recessively inherited, potentially life-threatening haemoglobin disorders with significant variation of severity, often needing life-long treatment. I argue that the re-classification of inherited blood disorders (IBDs) under ‘prevention and management of birth defects’ by the WHO in 2010 can be read as an ethical moment within the ‘globalising turn’ of IBDs and the use of genomics in addressing structural inequalities underpinning health in low- and middle-income countries. Using an Indian case study, the paper aims at first examining the language of risk through which genes and IBDs are mapped onto pre-existing populations (e.g. caste and tribe) as discrete, categories. Second, it discusses the likely social and ethical ramifications of classifying these recessive gene disorders as essentially preventable, despite cheaply available diagnostic tests and treatment options available in most countries in the South.
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Killing and abuse of children with disabilities are covert phenomena, occurring in some developing regions, such as in some African countries. Similar to the practice of ritual killing of spirit children in Ghana, the phenomenon of the snake child in Cote d'Ivoire (known as Ivory Coast), is the ritual abandonment or killing of children with intellectual disability (ID). This study is a qualitative ethnographic investigation into understanding this phenomenon. Three major questions were of interest: (1) Who are the snake children? (2) How are these children viewed and treated? (3) What are ways of changing negative attitudes towards children with developmental disabilities? The practices of killing, abandonment and abuse of children with disabilities take place in Cote d'Ivoire today, although the extent is not known. Killing and abuse of children with ID are explained within the context of indigenous African religions, animism and folk culture. The concept of disability 'otherness' and inferiority is also explored as a framework for reflection and ethical debate.
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Disability issues have taken a prominent role on international stages in recent years. Beginning with the May 2005 World Health Assembly Resolution 58.23 and culminating in the June 2011 World Bank and World Health Organization World Report on Disability, comprehensive disability analyses from nations at various stages of development can now be accessed and used by relevant stakeholders in health, policy, and aide arenas. The implementation of this landmark report is critical for the advancement of social inclusion in diverse countries, including those with limited resources. However, activating the World Report on Disability in resource-limited countries remains a significant challenge because of threadbare data and cultural, institutional, and physical barriers to social inclusion. This review summarizes current national disability data and describes challenges and opportunities for the implementation of the World Report on Disability in Ghana. As a structural point of departure, the article uses the three broad categories of challenges outlined by the World Health Organization: attitudinal, physical, and institutional.
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The main goal of this study was to analyze the information available on homicides of children younger than five years of age in Mexico. Mexican databases on mortality of the last ten years, referring to the time of initiating the study, were used (1992-2001). Results indicate that the homicide rate in the childhood decreased by 38 percent during the analyzed period; even so, the infanticide rate in 2001 (3.81 per 100 000) and the homicide rate in children aged 1 to 4 years (1.37 per 100 000) are among the highest, when compared to the ones of western countries, except the United States; invariably, homicides of boys were more frequent than the ones girl (the ratio boys/ girls was 1.13 in 2001). Standing out is the fact that, throughout the period, at least 45 percent of all homicides of children of 0 to 4 years were registered in Mexico State.
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Objective: To explore community understanding of perinatal illness in northern Ghana. Study design: A cross-sectional descriptive study design. Result: 253 community members participated in in-depth interviews and focus group discussions, including women with newborn infants, grandmothers and health care providers. Four overarching themes emerged: (1) Local understanding of illness affects treatment practices. Respondents recognized danger signs of illness spanning antenatal to early neonatal periods. Understanding of causation often had a distinctly local flavor, and thus treatment sometimes differed from mainstream recommendations; (2) Mothers are frequently blamed for their infant's illness; (3) Healthcare decisions regarding infant care are often influenced by community members aside from the infant's mother and (4) Confidence in healthcare providers is issue-specific, and many households use a blended approach to meet their health needs. Conclusion: Despite widespread recognition of danger signs and reported intentions to treat ill infants through the formal health care system, traditional approaches to perinatal illness remain common. Interventions need to be aligned with community perceptions if they are to succeed.
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Verbal autopsy (VA) methods are designed to collect cause-of-death information from populations where many deaths occur outside of health facilities and where death certification is weak or absent. A VA consists of an interview with a relative or carer of a recently deceased individual in order to gather information on the signs and symptoms the decedent presented with prior to death. These details are then used to determine and assign a likely cause-of-death. At a population level this information can be invaluable to help guide prioritisation and direct health policy and services. To date VAs have largely been restricted to research contexts but many countries are now venturing to incorporate VA methods into routine civil registration and vital statistics (CRVS) systems. Given the sensitive nature of death, however, there are a number of ethical, legal and social issues that should be considered when scaling-up VAs, particularly in the cross-cultural and socio-economically disadvantaged environments in which they are typically applied. Considering each step of the VA process this paper provides a narrative review of the social context of VA methods. Harnessing the experiences of applying and rolling out VAs as part of routine CRVS systems in a number of low and middle income countries, we identify potential issues that countries and implementing institutions need to consider when incorporating VAs into CRVS systems and point to areas that could benefit from further research and deliberation.
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Recent international literature review identified an immense lack of publications on parenting capacity assessment and childhood disability. This is problematic given the established and substantially higher risk of neglect and abuse that disabled children encounter. This heightened risk is also compounded by multiple barriers to effective professional safeguarding practice. This paper particularly focuses on one complex aspect of these capacity assessments. Specifically, the convergence of identities such as gender, ethnicity and disability are considered through an intersectionality lens rather than dealing with these identities in a separate way. Specifically, Crenshaw’s theory of intersectionality is applied to existing research evidence to derive themes. These themes are presented in the paper as a means of informing critical thinking, for practitioners seeking to address convergent identities, within existing parenting capacity assessment frameworks and disability supplemental tools.
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This chapter argues for the explanatory efficacy of conceptualizing childhood as a liminal space and children as liminal subjects. It argues for recognition of an ontological difference between children and adults that make children’s personhood precarious and insists on the importance of children’s social relationships for their material and symbolic survival. The chapter begins with an account of liminality in childhood and then moves on to explore how liminality renders the child sacred in the double sense of divine/otherworldly and sacrificial. This is particularly marked in infancy when the child is most vulnerable to bodily harm. The entry of the child into the symbolic order when he or she learns to talk is then explored to emphasize how speech is taken to be the signifier of human culture and asks what is the subject before speech? The child’s gradually increasing competence in language shadows or parallels the gradual decrease in its liminal position – a dance between culture and nature which eventually brings the child to the threshold of adulthood. If infancy marks one particularly intense moment in the liminality of the child, adolescence marks another. This chapter explicates genital cutting as a form of bodily injury that is explicitly related to the transition from one identity (child) to another (gendered adult).
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Background Contrary to evidence from the Western literature, cases of filicide in Ghana are mostly unreported because they are rooted in cultural practices and hidden from the general public. Objective The purpose of this study was to explore the cultural context of filicide in a rural community. Particularly, to provide an understanding of the spirit child (SC) phenomenon, how the killing of a SC is performed and to provide a general understanding of filicide within a particular context. Participants and setting: Four relatives of a family that engaged in a filicide incident took part in the study. The interviews were conducted in a rural community in Ghana where the incident occurred. Methods Short written narratives were used to explore the experiences and perceptions of relatives whose family engaged in filicide. Results Children with severe deformities are likely to be associated with matters of divinity which gives way for the conceptualization of the SC and its attendant filicide. The findings highlight the critical role of traditional healers in rural communities and the consequences of strong community beliefs and expectations that influence parents to commit filicide. Conclusion The study provides directions for child protection workers to address the stigma parents face for having children with severe deformities and to provide education on child welfare legislation.
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Although most studies on the effect of vitamin A supplementation have reported reductions in childhood mortality, the effects on morbidity are less clear. We have carried out two double-blind, randomised, placebo-controlled trials of vitamin A supplementation in adjacent populations in northern Ghana to assess the impact on childhood morbidity and mortality.The Survival Study included 21 906 children aged 6-90 months in 185 geographical clusters, who were followed for up to 26 months. The Health Study included 1455 children aged 6-59 months, who were monitored weekly for a year. Children were randomly assigned either 200 000 IU retinol equivalent (100 000 ID under 12 months) or placebo every 4 months; randomisation was by individual in the Health Study and by cluster in the Survival Study. There were no significant differences in the Health Study between the vitamin A and placebo groups in the prevalence of diarrhoea or acute respiratory infections; of the symptoms and conditions specifically asked about, only vomiting and anorexia were significantly less frequent in the supplemented children. Vitamin-A-supplemented children had significantly fewer attendances at clinics (rate ratio 0·88 [95% Cl 0·81-0·95], p=0·001), hospital admissions (0·62 [0·42-0·93], p=0·02), and deaths (0·81 [0·68-0·98], p=0·03) than children who received placebo. The extent of the effect on morbidity and mortality did not vary significantly with age or sex. However, the mortality rate due to acute gastroenteritis was lower in vitamin-A-supplemented than in placebo clusters (0·66 [0·47-0·92], p=0·02); mortality rates for all other causes except acute lower respiratory infections and malaria were also lower in vitamin A clusters, but not significantly so.Improving the vitamin A intake of young children in populations where xerophthalmia exists, even at relatively low prevalence, should be a high priority for health and agricultural services in Africa and elsewhere.
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A population-based case-control study was carried out to investigate potential risk factors for post-neonatal and child mortality in northern Ghana were child survival rates are among the lowest in Africa. Cases were post-neonatal infant and child deaths identified within a large population under continuous demographic surveillance. For each case, one living control, matched for age, sex and locality, was selected from the demographic database. Mothers of each case and control were interviewed to obtain information on social, enconomic, demographic, environmental and other possible risk factors. Matched analyses of the 317 cases and their controls were performed using discordant pairs analysis and conditional logistic regression. The mortality rate for children aged 6 months to 4 years was estimated as 23.9/1000 children/year. An increased risk of death was observed where the delivery was not performed by a trained person (OR = 1.8, 95% CI: 1.0-3.2), if the preceding birth interval was < 24 months (OR = 2.2, 95% CI: 1.1-3.9), if the father beat the child's mother (OR = 4.3, 95% CI: 1.2-15.6) or if the water source was unprotected (OR = 1.6, 95% CI: 1.0-2.7). No association was found between weaning practices, parental education, or any of the socioeconomic or hygiene variables considered. Few strong risk factors for mortality were identified, perhaps because living conditions within the study population are relatively homogeneous. While mortality rates may be reduced by targeted interventions, such as increasing deliveries by trained people, more general improvements in the socioeconomic status in the region are essential.
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During one year of follow-up, 306 deaths of children under the age of 5 years were included in a concurrent case-referent study that was based on a population estimated at 28,780 in 1987. A total of 612 live referents, matched for age, sex and study area, were also selected from the study population through density sampling. Data were collected by lay reporters by verbal autopsy. For the study period the estimated cumulative under-five mortality rate was 293 and the infant (0-11 months old) mortality rate was 136 per 1000. Major probable causes of death were diarrhoeal disease or acute respiratory infections (ARI). The relative importance of parental and environmental characteristics was assessed using conditional multiple logistic regression analysis. Under-five mortality was associated with paternal illiteracy, maternal ethnicity, and not being in the committee of people's organizations. Parental factors affected the infants relatively more than they did the children, especially with regard to ARI mortality. This was also noted with "absence of window", a proxy measure for evaluating the type of housing. In terms of etiological fractions a greater number of under-five deaths could be ascribed to parental than environmental conditions, with relatively more infants being affected than children.
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While knowledge of causes of deaths is important for health sector planning, little is known from conventional sources about the causes of deaths in Bangladesh. This is partly due to deficiencies in the registration system and partly because few deaths are attended by qualified physicians. The present study was undertaken to update the information available on causes of deaths among under-5-year-olds, taking advantage of advances in verbal autopsy methodology and of the national Bangladesh Demographic and Health Survey conducted in 1993-94. About 25% of the deaths were associated with acute lower respiratory infections (ALRI) and about 20% with diarrhoea. Neonatal tetanus and measles remained important causes of death, and drowning was a major cause for 1-4-year-olds. Research and programmes to enable mothers to identify ALRI cases, particularly pneumonia, and to encourage timely and appropriate care-seeking and strengthening of ALRI case management at the primary care facilities are important priorities. While promotion of oral rehydration for watery diarrhoea and antibiotic treatment for dysentery should continue, broader preventive interventions including provision of safe water and sanitation, and improvements in personal hygiene require more attention. Further intensification of immunization programmes and innovative experimental interventions to reduce childhood from drowning should be designed and tested.
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ABOUT THE BOOK Set in an unnamed African country at an unspecified time (though the similarities with Nigeria in the early 1960s are unmistakable), The Famished Road is narrated by Azaro, an African spirit-child or abiku who, in the folklore of southern Nigeria, is destined to move continually between life and spiritual paradise in an unending cycle of infant death and rebirth. Azaro, however, is tired of never staying long enough to experience life, and decides on this occasion to remain. Pursued by vengeful spirits, and endowed with special powers that lead him into mischief, Azaro introduces us to a whole world of wonders. However, as political corruption becomes endemic and as old tribal traditions clash with the forces of urbanisation, the author shows us the extraordinary mix of hope, despair and the sheer vitality that characterises his community. ABOUT THE AUTHOR Ben Okri was born in Nigeria in 1959 and travelled to Britain when he was just four-years-old. He is a journalist and writer by trade and published his first novel, Flowers and Shadows, in 1980, whilst studying Comparative Literature at the University of Essex. In 1987, his book of short stories, Incidents at the Shrine was shortlisted for the Commonwealth Prize and in the following year, his second book of short stories, Stars of the New Curfew, was shortlisted for the Guardian Fiction Prize. In1994 he won the Booker Prize for his most famous novel, The Famished Road. Ben continues to write and has also written for several leading Newspapers such as the Guardian, Observer and New Statesman.
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We summarize the ethnographic literature illustrating that "abnormal birth" circumstances and "ill omens" operate as cues to terminate parental investment. A review of the medical literature provides evidence to support our assertion that ill omens serve as markers of biological conditions that will threaten the survival of infants. Daly and Wilson (1984) tested the prediction that children of demonstrably poor phenotypic quality will be common victims of infanticide. We take this hypothesis one stage further and argue that some children will be poor vehicles for parental investment yet are not of demonstrably poor quality at birth. We conclude that when people dispose of infants due to "superstitious beliefs" they are pursuing an adaptive strategy in eliminating infants who are poor vehicles for parental investment.
Article
Female infanticide in Tamil Nadu, South India, has recently received widespread attenton within India and abroad. This paper contains reflections based on over a decade of field work and study of this phenomenon, and information gathered from NGOs, activists and officials. It discusses the recent history of the practice of female infanticide, and the circumstances which forced the state government in 1992 to acknowledge its existence. Activities to prevent female infanticide, such as the ‘Girl Child Protection Scheme’ and coercive actions against those committing female infanticed, by the state government and non-governmental organisations are critically reviewed. The unwantedness of girl children manfests itself not only in female infanticide, but also in selective abortion of female fetuses and neglect of girl children, leading to excess female child mortality. Prevention and eradication of female infanticide calls for sustained and long-term efforts to ameliorate the subordinate status of women. Under the circumstances, the tendency of several governements to deny the phenomenon, remain silent about it, or engage in interventions which stand little chance of succeeding, is cause for concern.
Article
The verbal autopsy (VA) is an epidemiological tool that is widely used to ascribe causes of death by interviewing bereaved relatives of children who were not under medical supervision at the time of death. This technique was assessed by comparison with a prospective survey of 303 childhood deaths at a district hospital in Kenya where medically confirmed diagnoses were available. Common causes of death were detected by VA with specificities greater than 80%. Sensitivity of the VA technique was greater than 75% for measles, neonatal tetanus, malnutrition, and trauma-related deaths; however, malaria, anaemia, acute respiratory-tract infection, gastroenteritis, and meningitis were detected with sensitivities of less than 50%. There may have been unwarranted optimism in the ability of VAs to detect some of the major causes of death, such as malaria, in African children. VA used in malaria-specific intervention trials should be interpreted with caution and only in the light of known sensitivities and specificities.
Article
In the absence of medical certification of deaths in developing countries, lay reporting and verbal autopsy have emerged as useful alternative methods for collecting data on causes of death. Of these, verbal autopsy offers advantages and is widely used in field studies and child survival programmes. However, because uniform and valid criteria for the diagnosis of common causes of death are lacking, comparison of the results of different studies becomes meaningless. This article proposes such a set of criteria for the cause of death among neonates and for those aged 1-59 months. The criteria are based on the findings of earlier validation studies, a Delphi survey and the experience gained from performing 1000 verbal autopsies in Gadchiroli, India. The emergence of such standardized criteria of causes of death should be of immense value for health planning, monitoring and evaluation purposes and for interregional comparisons.
Article
Among Amerindian children living at high altitude in the Andes in southern Peru, high child mortality rates have been reported in the literature, especially in the perinatal and neonatal period. We compared mortality rates in children calculated from retrospective survey data in 86 rural families from 2 Aymara and 3 Quechua peasant communities living at the same level of altitude (3825m) in southern Peru. Relations between land tenure, socio-cultural factors and child mortality were studied, and methodological considerations in this field of interest are discussed.
Article
This study of health care allocation to children in northern Puno, Peru, utilizes quantitative and qualitative data to explore differential resource allocation to children in rural Andean households. As part of a broader ethnographic study of health in two communities, quantitative data on reported health status, symptoms, and treatments (both lay and specialist) were collected for 23 children under the age of 7 over a one year period. Additional data were collected from local health post records. Data were analyzed by gender, and by three age groups (birth to 1 year, 1-3 years, 4-6 years) to determine if differences existed in the allocation of health care. The data suggest a pattern of discrimination against females and younger children, especially infants under age one, despite the fact that these groups were reported to be sicker. Differences were especially significant in the allocation of biomedical treatments, the most costly in terms of parental time, effort, and money. Ethnographic data on child illness, gender, and developmental concepts help to explain why children of different genders and ages may be treated differently in the rural andes. They provide a context in which to interpret health care allocation data, and, in the absence of a population-based study, reinforce findings based on the limited study sample. Female children are valued less because of their future social and economic potential. Females are also regarded to be less vulnerable to illness than male children, meaning that less elaborate measures are necessary to protect their health. Young children are thought to have a loose body-soul connection, making them more vulnerable to illness, and are though to be less human than older individuals. The folk illnesses uraña (fright) and larpa explain child deaths in culturally acceptable ways, and the types of funerals given to children of different ages indicate that the death of young children is not considered unusual. Health care allocation and ethnographic data suggest that selective neglect (passive infanticide) may be occurring in rural Peru, possibly as a means of regulating family size and sex ratio. It is important to go beyond placing blame on individual parents or on culture, however, to address the underlying causes of differential health care allocation, such as poor socioeconomic conditions, lack of access to contraceptives, and female subordination.
African health and healing systems: Proceedings from a symposium
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Yoder, P. (editor) (1982). African health and healing systems: Proceedings from a symposium. Los Angeles: African Studies Center.
Concepts an classification in the study of human infanticide: Sectional introduction and some cau-tionary notes
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A sociobiological analysis of human infanticide
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Daly, M., & Wilson, M. (1984). A sociobiological analysis of human infanticide. In S. B. Hrdy, & G. Hausfater, Infanticide (pp. 487-502). New York: Aldine Publishing Company.
The burden of illness in pregnancy in rural Ghana: A study of maternal morbidity and interventions in Northern Ghana
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Allotey, P. (1995). The burden of illness in pregnancy in rural Ghana: A study of maternal morbidity and interventions in Northern Ghana. Ph.D. thesis, The University of Western Australia, Perth.
Socio-cultural aspects of child morbidity and mortality in the Kassena Nankana District. Legon: Department of Sociology
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Senah, K. (1993). Socio-cultural aspects of child morbidity and mortality in the Kassena Nankana District. Legon: Department of Sociology, University of Ghana.
Concepts an classification in the study of human infanticide: Sectional introduction and some cautionary notes
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Dickeman, M. (1984). Concepts an classification in the study of human infanticide: Sectional introduction and some cautionary notes. In S. B. Hrdy, & G.. Hausfater,. Infanticide. New York: Aldine Publishing Company.
Socio-cultural determinants of child mortality in Southern Peru
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Causes of childhood deaths in Bangladesh
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Concepts an classification in the study of human infanticide
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Abnormal births and other “Ill Omens”
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Childhood deaths in Africa
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Infanticide in human populations
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The Butajira project in Ethiopia
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