Search for: All records

Abstract This article draws on a combination of archival and oral sources in order to highlight the connected histories of water and malaria on the Indian Ocean island of Zanzibar (Unguja) over the past century. We argue that in both the past and the present, water and malaria have been deeply connected, through the lifecycle of the disease, through control measures enacted, and in how Zanzibari residents continue to talk about the relationship between rain, puddles, stagnant water, and disease. Archival sources show that between roughly 1913 and 1957, the British colonial government managed malaria by managing water. That entailed a focus on watery breeding sites that included attention to both the micro: cattle hoofprints, and the macro: a multi-decade drainage of the tidal creek and surrounding swamp. These water-based malaria control efforts were limited in their efficacy by being geographically restricted to urban Zanzibar Town, and often limited to just the Stone Town area. 98 interviews conducted with Zanzibaris about malaria indicate that people continue to draw strong connections between malaria and the environment (mazingira), and that they most commonly discuss water’s relationship with malaria in terms of puddles (dimbwi/madimbwi), small puddles (kidimbwi/vidimbwi) and stagnant water (maji yaliyotuama). 

The objectives of this study were to 1) identify vaccination rates among PWID in Oregon at a time when vaccines were easily accessible, 2) quantitatively identify convergence with demographic correlates of vaccination willingness and uptake to promote generalizability, and 3) explore the factors PWID were considering when deciding whether or not to receive the COVID-19 vaccine. We conducted a mixed-methods study design including 260 quantitative surveys and 41 in-depth qualitative interviews with PWID, conducted July - September 2021 at syringe services programs in Lane County, Oregon. Among the 260 survey respondents, 37.3% indicated that they had received a COVID-19 vaccine by October 1, 2021. In the same period, an estimated 70.1% of the total Lane County population had completed their COVID-19 vaccinations (not including booster rounds). We explored alignment with the WHO’s 3C model of vaccine hesitancy and identified, instead, five common factors as key motivators for vaccine decisions: confidence, convenience, concern, communication, and community implications among PWID. Interviews with PWID describe systemic barriers which prevented them from accessing healthcare resources. We highlight that our proposed 5C model may more accurately depict how PWID navigate vaccine decisions by incorporating the ways that social inequities, infrastructural barriers, and community values influence an individual’s vaccine deliberation. 

The United States is in the midst of an epidemic of opioid-related overdose deaths. In response, harm reduction programs commonly distribute the opioid antagonist naloxone directly to PWUD so that they can act as first responders when an overdose occurs. Naloxone reverses respiratory depression and can save the life of a person overdosing on opioids. Little research has been conducted about the lived experiences of PWUD who use naloxone, particularly their motivations for carrying it, their experiences serving as first responders to overdoses, and how new communities of care have sprung up around the widespread use of naloxone. To better understand the lived experiences of PWUD, semi-structured interviews were conducted with seventeen syringe exchange participants who currently carry and/or have administered naloxone. In interviews, participants describe taking on the role of peer naloxone administrator as empowering, partially because it contrasts with the powerlessness they recounted in other areas of their lives. Peer administrators also use naloxone in a way that reinforces overdose care among people who use drugs. Future programs distributing naloxone to PWUD should be aware of its potential not only to save lives, but to increase participants’ self-confidence and strengthen the network of overdose care in their communities. 

Global health is a multidisciplinary field, yet rarely productively incorporates historical knowledge. Local historical processes, interactions with past biomedical campaigns, and dynamic ecological narratives shape how disease outbreaks, health crises, and international interventions are received and remembered. The residues and afterlives of past interactions influence contemporary understandings. We argue for a broadening of the types of knowledge that are integrated into global health research, interventions, and policymaking by paying attention to project afterlives and better integrating forms of vernacular knowledge. Recognizing, understanding, respecting, and incorporating this knowledge is critical to the efficacy of global health-related interventions and the resulting outcomes. 

Resumo Independentemente da perspetiva ou do critério de análise, os efeitos do paludismo no continente africano têm sido persistentes e profundos. Centrando-se na doença da malária e nas intervenções biomédicas do último século, Graboyes e Alidina levantam questões históricas, éticas e científicas essenciais relativamente à transmissão da verdade, à autonomia africana e às obrigações dos investigadores estrangeiros. Neste artigo, apresentam um resumo da história das iniciativas contra o paludismo que tiveram lugar em África nos últimos 120 anos, com destaque para a história global das tentativas frustradas de eliminar ou controlar a doença. Através de um estudo de caso sobre os riscos da malária ressurgente, exemplificam os problemas práticos e morais que emergem sempre que os conhecimentos históricos são ignorados. Perante os atuais apelos para que se intensifiquem os esforços em prol da erradicação da doença, Graboyes e Alidina demonstram, através de dados factuais, as razões pelas quais o conhecimento histórico tem de ser mais bem integrado nos domínios epistémicos da saúde global.