Search

In recent years, the demand for cost-effective evidence of health impact has grown exponentially, often to the exclusion of other disciplines and of epidemiology's longstanding interest in the multivariate determinants of health. Drawing on an ethnography of the Safe Motherhood Initiative, this paper focuses on experts who, in producing historical case-study evidence, exceptionally inhabit a stigmatising epistemological position while still successfully commanding the respect of policy makers. To theorise the sources and effects of this epistemic diversity, we draw on the anthropology and sociology of science, and specifically on Holmes and Marcus' analyses of "para-ethnographic" modes of reasoning.

Inexistem na literatura estudos sobre o possível papel das chupetas na transmissão da diarréia. Realizou-se um estudo transversal em 354 crianças menores de dois anos em duas vilas da periferia urbana de Pelotas, RS, Brasil, com precárias condições socioeconómicas. A maioria das crianças (79%) usava chupeta, 15% nunca as haviam utilizado e 6% já haviam abandonado o hábito. Dentre os usuários, 38% passavam a maior parte do tempo fazendo uso da chupeta (uso intenso). Foram realizadas culturas para coliformes fecais em 93% das chupetas em uso, indicando que 49% estavam contaminadas. Nas duas semanas anteriores à entrevista, 35% das crianças apresentaram diarréia - 40% entre as de uso intenso, 32% entre usuárias em tempo parcial e 37% entre não usuárias. Apesar da forte presença de coliformes fecais, parece não existir associação entre uso de chupeta e diarréia.

Research linking teen motherhood to psychoneurodevelopmental causes and pathologies has proliferated in the past two decades. In Brazil, a psychodevelopmental project of teen motherhood has gained traction despite many experts' long-standing commitment to psychodynamic psychiatry and social epidemiology, generating epistemic tension rather than substitution. Drawing on historical ethnography conducted in Southern Brazil, I explore how this project materialized through the co-production of epistemic struggles, remedial interventions, and ontological politics. In showing how this co-production became interwoven with incremental changes in young women's emotions, sexualities, relationships, and bodies, I describe how one particular "kind" of teen motherhood emerged and became entangled with both psychiatric knowledge-production and the angst of working-class political agency. In giving women a contested psychiatric language with which to rework their social-moral worlds, I argue that science did more than conceptualize teen childbearing in pathological terms; it contributed to its troubled transformation. [ABSTRACT FROM AUTHOR]

The MMR – maternal mortality ratio – has risen from obscurity to become a major global health indicator, even appearing as an indicator of progress towards the global Sustainable Development Goals. This has happened despite intractable challenges relating to the measurement of maternal mortality. Even after three decades of measurement innovation, maternal mortality data are widely presumed to be of poor quality, or, as one leading measurement expert has put it, ‘guilty until proven innocent’. This paper explores how and why leading epidemiologists, demographers and statisticians have devoted the better part of the last three decades to producing ever more sophisticated and expensive surveys and mathematical models of globally comparable MMR estimates. The development of better metrics is publicly justified by the need to know which interventions save lives and at what cost. We show, however, that measurement experts’ work has also been driven by the need to secure political priority for safe motherhood and by donors’ need to justify and monitor the results of investment flows. We explore the many effects and consequences of this measurement work, including the eclipsing of attention to strengthening much-needed national health information systems. We analyse this measurement work in relation to broader political and economic changes affecting the global health field, not least the incursion of neoliberal, business-oriented donors such as the World Bank and the Bill and Melinda Gates Foundation whose institutional structures have introduced new forms of administrative oversight and accountability that depend on indicators. [ABSTRACT FROM PUBLISHER]

Copyright of História, Ciências, Saúde - Manguinhos is the property of Casa de Oswaldo Cruz and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In recent years, the demand for cost-effective evidence of health impact has grown exponentially, often to the exclusion of other disciplines and of epistemology's longstanding interest in the multivariate determinants of health. Drawing on an ethnography of the Safe Motherhood Initiative, this paper focuses on experts who, in producing historical case-study evidence, exceptionally inhabit a stigmatising epistemological position while still successfully commanding the respect of policy makers. To theorise the sources and effects of this epistemic diversity, we draw on the anthropology and sociology of science, and specifically on Holmes and Marcus' analyses of 'para-ethnographic' modes of reasoning. [ABSTRACT FROM AUTHOR]

The article focuses on the collaboration between anthropology and epidemiology. It describes some epistemological lessons learned through the experience of cross-disciplinary collaboration. It notes that the demand for anthropological input in public health appeared less from academic epidemiology and more from the restrictions that professionals in leading organizations, including the World Health Organization (WHO) and bilateral donor agencies, experienced when relying only on epidemiology for enhancing program development evaluation.

Objective: To analyze social determinants of early sexual initiation among young adults from a birth cohort., Methods: Individuals from the 1982 birth cohort (N=4,297) were interviewed in 2004-5, city of Pelotas, Southern Brazil. Early sexual initiation (<13 years of age) was the outcome. Descriptive and stratified analyses were performed according to sex. Variables analyzed were family income in 1982, ethnicity, young adult's level of education and change in income (between 1982 and 2004-5). Ethnographic data were used to complement result analysis., Results: Prevalence of early sexual initiation was higher among black and mixed men, and those with low level of education and low family income in 1982 and 2004-5. More traditional male sexual role requirements, such as virility and sexual initiative, showed more repercussion and adherence from an early age among men. Young family women with higher income and level of education tended to delay their sexual initiation. Imposition of traditional values was found to influence early sexual initiation among men and women with lower level of education and income., Conclusions: Results found re-established the economic factor as a determinant of behavior or uses of sexuality for both sexes. To focus on political efforts that help the economically disadvantaged to have opportunities and egalitarian future perspectives is an important strategy for health outcomes.

Objective: Although the relationship between epidemiology and anthropology has a long history, it has generally been comprised of the integration of quantitative and qualitative methods. Only recently have the two fields begun to converge along theoretical lines, leading to a growing mutual interest in explaining rather than simply describing phenomena. This paper aimed to illustrate how ethnographic analyses can be used to assist with the in-depth and theoretically-imbued interpretation of epidemiological results., Methods: The anthropological analysis presented in this paper used ethnographic data collected as part of the ongoing 1982 birth cohort study, between 1997 and 2007 in Pelotas, Southern Brazil. Analyses were framed according to the results presented in two of the epidemiological articles published in this series on the determinants of mental morbidity and age of sexual initiation., Results and Conclusions: The ethnographic results show that statistical associations consist of multiple pathways of influence and causality that generally correspond to the unique experiences of specific subgroups. In exploring these pathways, the paper highlights the importance of an additional set of mediating factors that account for epidemiological results; these include the awareness and experience of inequities, the role of violence in everyday life, traumatic life events, increasing social isolation and emotional introversion as a response to life's difficulties, and differing approaches towards socio-psychological maturation. Theoretical and methodological collaboration between anthropology and epidemiology is important for public health, as it has positively modified both fields.