NRU :: Browsing by Author "Pool, Robert"

Browsing by Author "Pool, Robert"

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The adventures of the Randy Professor and Angela the Sugar Mummy: Sex in fictional serials in Ugandan popular magazines
(AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 2005) Gysels, M.; Nyanzi, Stella; Pool, Robert
In 1996 newspaper vendors in Ugandan towns started selling a new kind of locally produced ‘lifestyle’ magazine. On the covers there were young, scantily dressed girls and inside news articles, fictional serials, lifestyle articles, agony aunt columns, etc. The new magazines gained an enormous popularity in a short space of time. Everywhere people were seen reading them and copies became brown and tattered from use. Using content analysis, we analyse the fictional serials which appeared in three of these magazines. We focus on these because they were the most sexually explicit type of content and, from a public health perspective, the most relevant with regard to HIV prevention. The stories were presented as simple entertainment, depicting the adventures of stereotypical characters. They provided people with explicit and unrestricted sexual fantasy which was, at the same time, devoid of any real risk. Although they could be interpreted as providing a discourse which challenged the main messages of HIV-prevention campaigns (sex is good for you, have as much of it as possible, and don’t let condoms spoil the enjoyment), they also suggest that behaviour change may be more popular if sex and sexual health are not separated from sexual pleasure, and safe sex is promoted from a positive perspective (emphasis on sexual enjoyment) rather than a negative one (prevention of disease). The popularity of the magazines underscores the importance of entertainment value when discussing sex, and suggests alternative possibilities for disseminating health messages. Illustrated popular magazines such as those discussed here could be suitable as intervention, though they would need some adaptation to counter gender stereotypes and sexual violence.
Breastfeeding practices and attitudes relevant to the vertical transmission of HIV in rural south-west Uganda
(Annals of tropical paediatrics, 2001) Nyanzi, Stella; Pool, Robert; Whitworth, James A. G.
Breastfeeding has been associated with a doubling of the risk of HIV transmission. In developed countries, it is recommended that HIV-positive women do not breastfeed, but this is not a feasible option in most of Africa. It is therefore important to know the extent to which breastfeeding practices are amenable to change. To study this, we carried out 24 focus group discussions with 208 women attending maternity clinics in three rural sites in rural south-west Uganda. Breastfeeding starts from a few minutes to a few days after delivery; most women reported starting after 2 days. The main reason for delay is lack of milk or that the breasts are ‘blocked’. Most women thought that this delay was good for the baby, or at least not harmful. Almost all women reported giving the child a soup made of boiled mushrooms before starting to breastfeed. Once they have started breastfeeding, various supplementary foods are gradually introduced at 4–6 months. Women thought that ideally breastfeeding should last for 2–3 years, but in practice most stopped after 18 months. The father and his female relatives generally decide when the child should be weaned. The women thought that commercial milk formula foods were good but could not use them because they are too expensive and anyway unavailable in rural areas. Most women were unaware that HIV could be passed to the child through breastfeeding. Various practices identi ed as potentially risky are common in this population. Arti cial feeding is not a viable option in this area, and although women were prepared to make sacri ces to prevent vertical transmission of HIV, practices are deeply ingrained in traditional culture and will need to be addressed in future interventions. Male partners will also need to be involved.
Female Control Of Sexuality: Illusion Or Reality? Use Of Vaginal Products In South West Uganda
(Social Science & Medicine, 2001) Green, Gill; Pool, Robert; Harrison, Susan; Hart, Graham J.; Wilkinson, Joanie; Nyanzi, Stella; Whitworth, James A.G.
This paper reports on a trial of vaginal products that were distributed and used by 131 women and 21 men in south west Uganda. It focuses specifically upon the issue of female control in heterosexual relationships and examines whether methods which are ostensibly under women’s control, will in practice give women greater control of their sexual health. Participants were invited to select two from a range of vaginal products that included the female condom, contraceptive sponge, film, tablets, foam and gel, and use each for five weeks and their favourite product for a further three months. They were interviewed up to seven times over a five-month period. Although the women perceived that a major advantage of the products (with the exception of the female condom) was that they could be used secretly, less than 40% were using the products without their partner’s knowledge after one week and this proportion declined over time with only 22% using the products secretly after ten weeks. In the main male partners were told as women felt it their duty to inform them. In general the women were very much more positive about the products than they were about the male condom, as were the men. A contributory factor to their popularity among women was the greater control they gave them. Even though, use of these products in practice often involved negotiation with male partners, the fact that use was contingent on women’s action was empowering and increased somewhat their ability to control their sexual health.
The first mile: community experience of outbreak control during an Ebola outbreak in Luwero District, Uganda
(BMC public health, 2016) de Vries, Daniel H.; Rwemisisi, Jude T.; Musinguzi, Laban K.; Turinawe, Benoni E.; Muhangi, Denis; de Groot, Marije; Kaawa-Mafigiri, David; Pool, Robert
A major challenge to outbreak control lies in early detection of viral haemorrhagic fevers (VHFs) in local community contexts during the critical initial stages of an epidemic, when risk of spreading is its highest (“the first mile”). In this paper we document how a major Ebola outbreak control effort in central Uganda in 2012 was experienced from the perspective of the community. We ask to what extent thecommunity became a resource for early detection, and identify problems encountered with community health worker and social mobilization strategies. Methods: Analysis is based on first-hand ethnographic data from the center of a small Ebola outbreak in Luwero Country, Uganda, in 2012. Three of this paper’s authors were engaged in an 18 month period of fieldwork on community health resources when the outbreak occurred. In total, 13 respondents from the outbreak site were interviewed, along with 21 key informants and 61 focus group respondents from nearby Kaguugo Parish. All informants were chosen through non-probability sampling sampling. Results: Our data illustrate the lack of credibility, from an emic perspective, of biomedical explanations which ignore local understandings. These explanations were undermined by an insensitivity to local culture, a mismatch between information circulated and the local interpretative framework, and the inability of the emergency response team to take the time needed to listen and empathize with community needs. Stigmatization of the local community – in particular its belief in amayembe spirits – fuelled historical distrust of the external health system and engendered community-level resistance to early detection. Conclusions: Given the available anthropological knowledge of a previous outbreak in Northern Uganda, it is surprising that so little serious effort was made this time round to take local sensibilities and culture into account. The “first mile” problem is not only a question of using local resources for early detection, but also of making use of the contextual cultural knowledge that has already been collected and is readily available. Despite remarkable technological innovations, outbreak control remains contingent upon human interaction and openness to cultural difference.
Linking Communities to Formal Health Care Providers through Village Health Teams in Rural Uganda: Lessons from Linking Social Capital
(Human resources for health, 2017) Musinguzi, Laban Kashaija; Turinawe, Emmanueil Benon; Rwemisisi, Jude T.; Vries, Daniel H. de; Mafigiri, David K.; Muhangi, Denis; Groot, Marije de; Katamba, Achilles; Pool, Robert
Community-based programmes, particularly community health workers (CHWs), have been portrayed as a cost-effective alternative to the shortage of health workers in low-income countries. Usually, literature emphasises how easily CHWs link and connect communities to formal health care services. There is little evidence in Uganda to support or dispute such claims. Drawing from linking social capital framework, this paper examines the claim that village health teams (VHTs), as an example of CHWs, link and connect communities with formal health care services.Data were collected through ethnographic fieldwork undertaken as part of a larger research program in Luwero District, Uganda, between 2012 and 2014. The main methods of data collection were participant observation in events organised by VHTs. In addition, a total of 91 in-depth interviews and 42 focus group discussions (FGD) were conducted with adult community members as part of the larger project. After preliminary analysis of the data, we conducted an additional six in-depth interviews and three FGD with VHTs and four FGD with community members on the role of VHTs. Key informant interviews were conducted with local government staff, health workers, local leaders, and NGO staff with health programs in Luwero. Thematic analysis was used during data analysis.The ability of VHTs to link communities with formal health care was affected by the stakeholders’ perception of their roles. Community members perceive VHTs as working for and under instructions of “others”, which makes them powerless in the formal health care system. One of the challenges associated with VHTs’ linking roles is support from the government and formal health care providers. Formal health care providers perceived VHTs as interested in special recognition for their services yet they are not “experts”. For some health workers, the introduction of VHTs is seen as a ploy by the government to control people and hide its inability to provide health services. Having received training and initial support from an NGO, VHTs suffered transition failure from NGO to the formal public health care structure. As a result, VHTs are entangled in power relations that affect their role of linking community members with formal health care services. We also found that factors such as lack of money for treatment, poor transport networks, the attitudes of health workers and the existence of multiple health care systems, all factors that hinder access to formal health care, cannot be addressed by the VHTs.As linking social capital framework shows, for VHTs to effectively act as links between the community and formal health care and harness the resources that exist in institutions beyond the community, it is important to take into account the power relationships embedded in vertical relationships and forge a partnership between public health providers and the communities they serve. This will ensure strengthened partnerships and the improved capacity of local people to leverage resources embedded in vertical power networks.
Men’s Attitudes To Condoms And Female Controlled Means Of Protection Against HIV And STDS In South-Western Uganda
(Culture, Health & Sexuality, 2000) Pool, Robert; Hart, Graham; Green, Gillian; Harrison, Susan; Nyanzi, Stella; Whitworth, Jimmy
There is widespread demand for the development of female controlled methods of protection against sexually transmitted diseases (STDs) and HIV. The success of such methods will not only depend on their acceptability to women but also to their male partners. This paper reports on men's attitudes to female controlled methods in south west Uganda. Data was gathered in individual interviews with 50 men and 7 focus group discussions with 42 men. Male attitudes to the male condom, the female condom and female controlled methods of protection generally were characterized by ambiguity and anxiety. They liked the male condom because it protects against infection and unwanted pregnancy, but were worried by rumours that it was unreliable. The central theme in the discussions was men's anxiety about retaining control over their female partners. The men wanted women to be protected (and therefore safe as potential partners) but they also wanted to remain in control, at least to some extent, of the means of protection. Once suitable female controlled methods have been identified, it will be necessary to use education and social marketing in such a way that men can be reassured of the positive benefits of these products to them, as well as to women.
A Mixed Methods and Triangulation Model for Increasing the Accuracy of Adherence and Sexual Behaviour Data: The Microbicides Development Programme
(PLoS ONE, 2010) Pool, Robert; Montgomery, Catherine M.; Morar, Neetha S.; Mweemba, Oliver; Ssali, Agnes; Gafos, Mitzy; Lees, Shelley; Stadler, Jonathan; Crook, Angela; Nunn, Andrew; Hayes, Richard; McCormack, Sheena
The collection of accurate data on adherence and sexual behaviour is crucial in microbicide (and other HIVrelated) research. In the absence of a ‘‘gold standard’’ the collection of such data relies largely on participant self-reporting. After reviewing available methods, this paper describes a mixed method/triangulation model for generating more accurate data on adherence and sexual behaviour in a multi-centre vaginal microbicide clinical trial. In a companion paper some of the results from this model are presented. Methodology/Principal Findings: Data were collected from a random subsample of 725 women (7.7% of the trial population) using structured interviews, coital diaries, in-depth interviews, counting returned gel applicators, focus group discussions, and ethnography. The core of the model was a customised, semi-structured in-depth interview. There were two levels of triangulation: first, discrepancies between data from the questionnaires, diaries, in-depth interviews and applicator returns were identified, discussed with participants and, to a large extent, resolved; second, results from individual participants were related to more general data emerging from the focus group discussions and ethnography. A democratic and equitable collaboration between clinical trialists and qualitative social scientists facilitated the success of the model, as did the preparatory studies preceding the trial. The process revealed some of the underlying assumptions and routinised practices in ‘‘clinical trial culture’’ that are potentially detrimental to the collection of accurate data, as well as some of the shortcomings of large qualitative studies, and pointed to some potential solutions
Mobility, sexual networks and exchange among bodabodamen in southwest Uganda
(An International Journal for Research, Intervention and Care, 2004) Nyanzi, Stella; Nyanzi, Barbara; Kalina, Bessie; Pool, Robert
In order to examine the sexual behaviour of a highly mobile social group, qualitative data and quantitative data were elicited from 212 private motorbike taxi-men, locally called bodabodamen, from two study sites in Masaka, Uganda. Selection criteria were availability and willingness to participate in the study. Research techniques employed were a questionnaire, focus group discussions, in-depth interviews and case studies. Findings indicate that bodabodamen are a highly mobile group who engage in frequent seasonal rural-urban migration. Consequent to this, bodabodamen have a wide network of both occasional and regular sexual partnerships. Both serial and concurrent multiple partnerships are with adults, youths, widows, students, sugar-mummies, barmaids, commercial sex workers, tailors. Exchange plays a significant role in sexual negotiations but the act of giving to a sexual partner is ambivalent in its social interpretation. Since bodabodamen have regular access to cash, they have higher bargaining power for sex. Implications for HIV/ AIDS prevention are discussed.
Selection and Performance of Village Health Teams (VHTS) in Uganda: Lessons from the Natural Helper Model of Health Promotion
(Human resources for health, 2015) Turinawe, Emmanueil Benon; Rwemisisi, Jude T.; Musinguzi, Laban K.; Groot, Marije de; Muhangi, Denis; Vries, Daniel H. de; Mafigiri, David K.; Pool, Robert
Community health worker (CHW) programmes have received much attention since the 1978 Declaration of Alma-Ata, with many initiatives established in developing countries. However, CHW programmes often suffer high attrition once the initial enthusiasm of volunteers wanes. In 2002, Uganda began implementing a national CHW programme called the village health teams (VHTs), but their performance has been poor in many communities. It is argued that poor community involvement in the selection of the CHWs affects their embeddedness in communities and success. The question of how selection can be implemented creatively to sustain CHW programmes has not been sufficiently explored. In this paper, our aim was to examine the process of the introduction of the VHT strategy in one rural community, including the selection of VHT members and how these processes may have influenced their work in relation to the ideals of the natural helper model of health promotion.As part of a broader research project, an ethnographic study was carried out in Luwero district. Data collection involved participant observation, 12 focus group discussions (FGDs), 14 in-depth interviews with community members and members of the VHTs and four key informant interviews. Interviews and FGD were recorded, transcribed and coded in NVivo. Emerging themes were further explored and developed using text query searches. Interpretations were confirmed by comparison with findings of other team members.The VHT selection process created distrust, damaging the programme’s legitimacy. While the Luwero community initially had high expectations of the programme, local leaders selected VHTs in a way that sidelined the majority of the community’s members. Community members questioned the credentials of those who were selected, not seeing the VHTs as those to whom they would go to for help and support. Resentment grew, and as a result, the ways in which the VHTs operated alienated them further from the community. Without the support of the community, the VHTs soon lost morale and stopped their work.As the natural helper model recommends, in order for CHW programmes to gain and maintain community support, it is necessary to utilize naturally existing informal helping networks by drawing on volunteers already trusted by the people being served. That way, the community will be more inclined to trust the advice of volunteers and offer them support in return, increasing the likelihood of the sustainability of their service in the community.
Socializing influences and the value of sex: the experience of adolescent school girls in rural Masaka, Uganda
(Uganda. Culture, health & sexuality, 2000) Kinsman, John; Nyanzi, Stella; Pool, Robert
In order to explore the socializing in¯uences which have shaped rural adolescent schoolgirls’ views and values about sex in a high HIV prevalence area of Uganda, detailed qualitative data was obtained over a one year period from 15 schoolgirls (aged 14±17), chosen for their willingness to participate actively in a series of role plays, focus group discussions (FGD) and one-to-one interviews. Findings suggest that the girls have been subjected to a wide range of in¯uences, including parents, social functions, other young children, nature, their ssengas, peers, school, and various media, such as pornography. There was disagreement about the relative values of sex and virginity. Some were determined to retain their virginity, but the majority felt that sex bene®ts them socially and personally. Peer pressure was a major factor shaping many girls’ opinions, while traditional in¯uences are in decline. Because of the small sample size, care should be taken in generalizing from the ®ndings. However, the data suggest that sex has a high value for at least a substantial minority of adolescent girls in rural Masaka, Uganda. Policy makers and health educators should therefore consider how best to devise safe sex messages that are both relevant and applicable to this especially vulnerable group.
Towards Promotion of Community rewards to Volunteer Community Health Workers? Lessons from Experiences of Village Health Teams in Luwero, Uganda
(Res Health Sci,, 2016) Turinawe, Emmanueil Benon; Rwemisisi, Jude T.; Musinguzi, Laban K.; Groot, Marije de; Muhangi, Denis; Mafigiri, David K.; Vries, Daniel H. de; Pool, Robert
In the debate regarding volunteer Community Health Workers (CHWs) some argue that lack of remuneration is exploitation while others caution that any promise to pay volunteers will decrease the volunteer spirit. In this paper we discuss the possibility of community rewards for CHWs. Ethnographic fieldwork that lasted 18 months utilised methods including participant observation, FGDs, in-depth interviews and key informant interviews to gain insight into the dynamic relationship between volunteer CHWs known as Village Health Teams (VHTs) and the community. Contextual transcription was done and data was thematically analysed. Findings show that community members are willing to reward volunteer CHWs with cash, material and symbolic rewards in appreciation for their help. Factors crucial for this gesture included: care and recognition of the VHTs’ work by medical staff, fulfilment of the promises made to the community by government and exemplary behaviour by CHWs. Therefore, effort should be made to facilitate volunteer CHWs to be seen as helpful to their communities. Especially, there needs to be a smooth operation at the intersection between the VHTs, local government and medical structures. Community rewards could be a more sustainable way of motivating CHWs while a solution to health personnel shortage is sought.
Traditional Birth Attendants (TBAS) as Potential Agents in Promoting Male Involvement in Maternity Preparedness: Insights from a Rural Community in Uganda
(Reproductive health, 2016) Turinawe, Emmanueil Benon; Rwemisisi, Jude T.; Musinguzi, Laban K.; Groot, Marije de; Muhangi, Denis; Vries, Daniel H. de; Mafigiri, David K.; Katamba, Achilles; Parker, Nadine; Pool, Robert
Since the 1994 International Conference on Population and Development, male involvement in reproductive health issues has been advocated as a means to improve maternal and child health outcomes, but to date, health providers have failed to achieve successful male involvement in pregnancy care especially in rural and remote areas where majority of the underserved populations live. In an effort to enhance community participation in maternity care, TBAs were trained and equipped to ensure better care and quick referral. In 1997, after the advent of the World Health Organization’s Safe Motherhood initiative, the enthusiasm turned away from traditional birth attendants (TBAs). However, in many developing countries, and especially in rural areas, TBAs continue to play a significant role. This study explored the interaction between men and TBAs in shaping maternal healthcare in a rural Ugandan context.This study employed ethnographic methods including participant observation, which took place in the process of everyday life activities of the respondents within the community; 12 focus group discussions, and 12 in-depth interviews with community members and key informants. Participants in this study were purposively selected to include TBAs, men, opinion leaders like village chairmen, and other key informants who had knowledge about the configuration of maternity services in the community. Data analysis was done inductively through an iterative process in which transcribed data was read to identify themes and codes were assigned to those themes.Contrary to the thinking that TBA services are utilized by women only, we found that men actively seek the services of TBAs and utilize them for their wives’ healthcare within the community. TBAs in turn sensitize men using both cultural and biomedical health knowledge, and become allies with women in influencing men to provide resources needed for maternity care.In this study area, men trust and have confidence in TBAs; closer collaboration with TBAs may provide a suitable platform through which communities can be sensitized and men actively brought on board in promoting maternal health services for women in rural communities.

Browsing by Author "Pool, Robert"

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