Search for: All records

Abstract BackgroundAs Namibia attempts to eradicate locally transmitted cases of malaria, epidemiological strategies, interventions, and outreach require a sound understanding of indigenous knowledge and practice. Research describing local explanatory models of disease can be of value in these efforts by elucidating how disease is interpreted and treated. To understand how perceptions of malaria infection and treatment may influence health-seeking behaviour, cultural models of the disease were explored in two ethnic groups in rural northwest Namibia. MethodsMixed-sex focus groups of 4–8 individuals were conducted in the Kunene region of Namibia. All participants were either Himba or Herero and lived between 14 and 57 km of the regional town centre of Opuwo. Discussion prompts were designed to assess knowledge, beliefs, and norms about malaria, including causes, symptoms, treatment, and prevention. ResultsFocus groups reported universal difficulty in discrimination between malaria and respiratory infections, the former of which was often only diagnosed at the hospital. Some recognized mosquitoes as the source of malaria, particularly the more formally educated Herero, but all also reported other causes. Notably these causes, including dietary and temperature-based origins, were considered unavoidable. Himba and Herero believed that malaria was infectious person-to-person and incorrectly believed that malaria was most common during the wintertime. Both groups also relied on a number of traditional remedies to alleviate symptoms, which were used as primary treatment, with formal healthcare treatment typically only sought when the illness progressed. ConclusionsThese results highlight significant differences between local cultural models and biomedical ones that could be detrimental to malaria eradication efforts. Kunene pastoralists have limited understanding of the causes of malaria, and beliefs about environmental and dietary causes may undermine attempts at prevention. Seeking healthcare solutions to malaria was normative, but secondary to use of at home traditional remedies. These findings indicate public health outreach and information campaigns are needed, particularly in rural groups with less formal education. 

Substantial research indicates that local explanatory models of disease shape heath behaviors. However, less is known regarding how cultural models of disease influence interpretations of vaccines. Vaccination decisions are based around a plethora of social and cultural factors, including beliefs about disease, cultural-historical experiences with healthcare, and recent vaccination experiences. To understand how local interpretations of vaccination influence vaccination-decision making, we explore cultural models of health, vaccine norms, and COVID-19 beliefs and experiences in Himba and Herero pastoralists of the Kunene region of northern Namibia. Mixed sex focus groups were conducted in July and August of 2024 in communities across a rural and peri-urban gradient. Discussion prompts were designed to elicit dialogue on vaccination beliefs, norms, and experiences, as well as their recent experience with COVID-19. Results from these focus groups indicate that there was substantial confusion differentiating vaccinations from other types of injections. For childhood vaccines, immunization is normative and expected. Women were the primary decision-makers for childhood immunization, reflecting the matrilineal bias of Himba and Herero kinship. For adults, while local leaders had some influence interfacing with public health outreach, the decision to get vaccinated was largely a personal one. Beliefs about COVID-19 were interpreted through pre-existing cultural models of illness, and beliefs about the origins of COVID-19 reflected mistrust in international actors. Fears about COVID-19 vaccines were common, particularly concerns about vaccine safety. However, fears of the illness typically overrode fears of the vaccine, and most report receiving the vaccine despite these worries. These results highlight the importance of extending research beyond a knowledge, attitude, practice framework to incorporate local explanatory models and cultural-historical experiences in understanding vaccine-decision making. These features are particularly important in more traditional, rural, and marginalized populations where medical mistrust is common and local explanatory models of disease drive healthcare decision-making. 

Objectives Substantial inequalities in access to healthcare are common in rural and marginalized populations in the Global South, and these inequalities can drive health disparities. Historical mistrust of healthcare institutions can further impact healthcare behaviors, including vaccination. Here, we apply the concept of medical mistrust, which has been widely applied to healthcare decisions in industrialized countries, across a rural–urban spectrum of communities in Namibia, and assess its utility in understanding vaccination decisions. Methods Otjiherero-speaking indigenous communities of Kunene, Namibia, were surveyed to assess medical mistrust. Participants also answered questions about COVID-19 vaccination status, vaccine safety, and interest in a hypothetical malaria vaccine. Bayesian multilevel models were used to compare medical mistrust across communities and its influence on vaccination and vaccine perceptions. Results The level of medical mistrust varied across contexts, with the highest level of mistrust in peri-urban communities. Medical mistrust predicted beliefs about vaccine safety and interest in the malaria vaccine, but not COVID-19 vaccine status, which was largely driven by access to the vaccine. For rural and peri-urban Himba, participants also expressed disinterest in the COVID-19 vaccine and worries about its safety. Conclusion Addressing global health disparities requires understanding how locally contextualized social and ecological experiences shape healthcare and vaccination decisions. Results of this study show fundamental differences in medical mistrust by community, which may be contributing to beliefs about vaccines. Understanding how medical mistrust varies across these contexts, and how it impacts perceptions about vaccination, can inform health communication and public policy in underserved communities. 

Extensive work in the social sciences suggests that vaccination decisions are subject to incentives, biases, and social learning processes, including prestige bias transmission. High status figures, like doctors and public health officials, can be effective messengers for vaccination information and uptake under certain conditions. In communities where there is significant medical mistrust and less interaction with markets and formal medical systems, prestige bias social learning may operate through different channels. Here, we examine the role of prestige bias on vaccine decisions in two ethnic groups (Himba and Herero) with varying levels of market integration and experiences with formal healthcare systems. Participants completed a ranking task, comparing the influence of four prestigious individuals on vaccine decisions and a survey on medical mistrust. Using Plackett-Luce models, we compare the influence of location, ethnic affiliation, and other covariates on rankings. A multi-level model compared the influence of those within and outside one's ethnic group, as well as specialist (doctor/healer) and generalist (chief/governor) prestige figures. Results indicate changes in the rank of prestigious individuals across the rural-urban gradient. Our results demonstrate significant variability in prestige-biased social learning about vaccine decision making. Medical mistrust did not impact rankings. Contrary to previous work, we find that whether a prestigious individual is locally prominent is more important than their expertise in the relevant domain (health and healing). These findings emphasize the need for more context-specific studies of prestige bias, which can improve our understanding of healthcare decision-making and guide public health messaging across diverse contexts. 

Arid pastoralism is often understood as an adaptive strategy to marginal environments. As pastoralists become increasingly market integrated, novel dietary preferences and access to low quality market foods can erode traditional diets. These market‐based dietary shifts are particularly problematic during sustained drought, where reductions in traditional foods make pastoralists increasingly reliant on a cash economy. Among the Himba of the Kunene region in Namibia, colonial policies prohibiting access to livestock markets inhibit access to a cash‐based economy, leaving them vulnerable to food insecurity when nontraditional foods are needed to supplement traditional lifeways during drought. To understand the impacts of long‐term drought on diet and food insecurity, we collected longitudinal survey data on diet breadth and food insecurity across 4 years during a multi‐year drought.Participants completed a five‐item food insecurity survey and recalled diet breadth survey over the course of 4 years. Additionally, women completed a short survey of recent stressors, including health and resource stressors . We used a set of multilevel models to estimate changes in food insecurity items and diet breadth changes over the course of the study period.Multilevel models predicted score outcomes, as well as individual item responses, by year of data collection. Results indicate a 43% increase in average food insecurity and a 15% decline in average diet breadth over the study period. Dietary recall indicates that drought caused a reduction in sour milk intake, and an increase in nontraditional foods, but no change in meat or maize consumption.Conclusions Sustained drought in the Kunene region is having long‐term impacts on food insecurity, which could result in dietary shifts that outlast the current period of drought. We consider the implications of this change, especially as it relates to increasing market integration and reliance on a cash‐based over a subsistence‐based economy. 

While it is commonly assumed that farmers have higher, and foragers lower, fertility compared to populations practicing other forms of subsistence, robust supportive evidence is lacking. We tested whether subsistence activities—incorporating market integration—are associated with fertility in 10,250 women from 27 small-scale societies and found considerable variation in fertility. This variation did not align with group-level subsistence typologies. Societies labeled as “farmers” did not have higher fertility than others, while “foragers” did not have lower fertility. However, at the individual level, we found strong evidence that fertility was positively associated with farming and moderate evidence of a negative relationship between foraging and fertility. Markers of market integration were strongly negatively correlated with fertility. Despite strong cross-cultural evidence, these relationships were not consistent in all populations, highlighting the importance of the socioecological context, which likely influences the diverse mechanisms driving the relationship between fertility and subsistence.