Suchergebnisse

This study investigates the role of emotional attachment to competing institutional logics on women's uptake of cervical cancer screening in Mozambique. Through a qualitative study conducted in Xai-Xai, Southern Mozambique, we identify 2 concurrent logics in the context of screening: preservation logic, influenced by social-cultural norms, and the prevention logic, centered around screening. Women, affected by emotions such as shame, fear, and marital subordination, often become attached to the preservation logic, which influences their values and contradicts acceptance of screening. However, some women with marital autonomy may reflect on both logics and gradually detach themselves from the preservation norms and show their intention to adopt life-saving behavior by accepting screening. It is through their emotions that women show their attachment to and detachment from competing logics, reinforcing traditional norms on the one hand, or giving them the means to adopt preventive measures on the other. The study indicates that cultural expectations, shame and the desire to preserve intimacy tie women to the logic of preservation and have a negative impact on participation in cervical cancer screening. Consequently, to improve screening uptake in Mozambique, the authorities need to adapt screening to socio-cultural and emotional factors, empower women, and effectively engage communities.

Background: Antimicrobial misuse is common in low-income and middle-income countries (LMICs), and this practice is a driver of antibiotic resistance. We compared community-based antibiotic access and use practices across communities in LMICs to identify contextually specific targets for interventions to improve antibiotic use practices. Methods: We did quantitative and qualitative assessments of antibiotic access and use in six LMICs across Africa (Mozambique, Ghana, and South Africa) and Asia (Bangladesh, Vietnam, and Thailand) over a 2·5-year study period (July 1, 2016–Dec 31, 2018). We did quantitative assessments of community antibiotic access and use through supplier mapping, customer exit interviews, and household surveys. These quantitative assessments were triangulated with qualitative drug supplier and consumer interviews and discussions. Findings: Vietnam and Bangladesh had the largest proportions of non-licensed antibiotic dispensing points. For mild illness, drug stores were the most common point of contact when seeking antibiotics in most countries, except South Africa and Mozambique, where public facilities were most common. Self-medication with antibiotics was found to be widespread in Vietnam (55·2% of antibiotics dispensed without prescription), Bangladesh (45·7%), and Ghana (36·1%), but less so in Mozambique (8·0%), South Africa (1·2%), and Thailand (3·9%). Self-medication was considered to be less time consuming, cheaper, and overall, more convenient than accessing them through health-care facilities. Factors determining where treatment was sought often involved relevant policies, trust in the supplier and the drug, disease severity, and whether the antibiotic was intended for a child. Confusion regarding how to identify oral antibiotics was revealed in both Africa and Asia. Interpretation: Contextual complexities and differences between countries with different incomes, policy frameworks, and cultural norms were revealed. These contextual differences render a single strategy inadequate and instead necessitate context-tailored, integrated intervention packages to improve antibiotic use in LMICs as part of global efforts to combat antibiotic resistance.