Gender, Behavior, and Health: Schistosomiasis Transmission and Control in Rural Egypt

Front Cover
American Univ in Cairo Press, 2002 - Medical - 229 pages
An estimated 200 million people in the world suffer from schistosomiasis (bilharzia), and according to the World Health Organization it ranks second behind malaria in terms of socioeconomic and public health importance in tropical and subtropical areas. The disease was present in Egypt in the Old Kingdom (c. 2600 BCE), and in 1998 it was estimated that almost six million Egyptians -- one fifth of the rural population -- were infected. Thus it remains one of the most serious public health problems in rural Egypt. This study is the first to paint a broad picture of schistosomiasis in rural Egypt. The authors' research in three Nile Delta villages between 1991 and 1997 provides an in-depth community-level view of patterns of transmission and strategies for control. An analysis of recent research and policy presents the national context for the study.

Schistosomiasis is primarily a behavioral disease, associated with human behavior in relation to water, especially canals; strategies for disease control and treatment need to consider what people do, where, when, and why. Gender, Behavior, and Health stresses an area of particular concern to social scientists: gender issues are most fully revealed at the local level, where an infection such as schistosomiasis is transmitted, diagnosed, treated, and ultimately (it is hoped) prevented. This book is unique in presenting schistosomiasis primarily from the viewpoint of the social sciences, yet fully incorporating material from the biomedical sciences and other relevant disciplines.
 

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Contents

Overview
1
The social science perspective
3
Studying gender
4
Studying a community
5
Actionoriented research
6
The arrangement of the book
7
Gender Issues in Rural Egypt
9
A national dialogue
11
Toilets and latrines
103
Contamination behavior
104
The sewerage system in alGarda
105
Disposal of latrine effluent
107
Water qualitycanals
108
Snail vectors
109
The irrigation system and schistosomiasis transmission
113
Gender Human Behavior and Exposure to Schistosomiasis
115

continuity and change
13
Gender health services and health status
16
Gender illness and health seeking behavior
18
Gender literacy and education
20
Gender and employment
22
Women as housewives
23
Gender and power
24
Schistosomiasis A Global Public Health Problem
29
The schistosomiasis transmission cycle
31
Schistosoma mansoni
32
Schistosoma haematobium
33
Targeting schoolage children
34
Human behavior and schistosomiasis transmission
36
The development of water resources and schistosomiasis transmission
37
Human behavior gender and biomedicine
38
An integrated approach to schistosomiasis control
39
The Growing Awareness of Schistosomiasis in Egypt to 1988
42
A growing knowledge base
44
The burden of infection
48
Schistosomiasis control programs in Egypt
49
What happened to women and girls in the Egyptian record?
50
Schistosomiasis in Egypt 198896
53
objectives
55
The organization of the Program
56
The Schistosomiasis Research Project
58
distribution and intensity of disease
59
Identifying those at risk of infection
62
Morbidity due to schistosomiasis
63
What we need to know about gender differences in infection
65
Research Concepts Methods and Procedures
68
A model for a holistic village level study
69
The household as a unit of study
70
Identifying the study communities
71
Establishing a research base
72
Training
73
Epidemiological surveys
74
Environmental studies
75
Interviews and group discussions
76
Observations
77
Schistosomiasis in the Village Setting
79
The people of the village
83
Household structure
84
Living conditions
85
Earning a living
87
Education
89
Schistosomiasis in alGarda and alSalamuniya
91
The household and spatial clustering of infection
95
The Environmental Setting
98
The impact of water and sanitation systems on infection
99
Domestic water supply and water use
101
Water qualitydomestic supplies
102
Gendered space within the builtup areas
116
Gender farming and schistosomiasis infection
118
What farmers doIrrigation related behavior
120
Farmers attitudes toward water contact
122
Womens domestic tasks at the canal
123
Why do women continue to use the canals?
128
Other activities at the canal
131
Infection rates and canal use
134
Local Peoples Understanding of Schistosomiasis
136
Schistosomiasis as a dangerous illness
139
Deciding where to go for treatment
141
The medicalization of schistosomiasis
143
Screening and Treatment Programs in Practice
146
Health unit staff and responsibilities
147
Staff knowledge and perceptions of schistosomiasis
151
Training
153
The recordkeeping system
154
Improving the local records
155
The schoolbased screening program
156
Designing and testing a gendersensitive screening strategy
158
Reaching children who are not in school
160
Female genital schistosomiasis
161
Gender issues in diagnosis
162
Treatment with Praziquantela genderbased assessment
163
CommunityBased Approaches to Schistosomiasis Control
165
Health promotion in schistosomiasis control
166
Mass media health messages
168
Health promotion in schools
170
Summer clubs
173
Social capital
174
Communitybased health promotion for schistosomiasis control
176
A proposed laundry intervention
177
Conclusion
182
Gendered human behavior
183
Why environmental control?
185
Covering canals
186
Weed control
187
Toward safe water and sanitation
188
Solid waste collection
191
Praziquantel resistence and a future vaccine
193
The role of the rural health units
194
The role of the MOHP
195
the Egyptian health care system
196
Communication processes
198
Prevention and the need for intersectoral collaboration
199
Methodology
201
C Short surveys
202
E Focus group discussions
203
Bibliography
205
Index
221
Copyright

Common terms and phrases

Popular passages

Page 219 - Vision 21: A Shared Vision for Hygiene, Sanitation and Water Supply and a Framework for Action'.
Page 210 - F., 1975. Relationship between pure Schistosoma haematobium infection in Upper Egypt and irrigation systems. Part II. Host characteristics. The general prevalence of Schistosoma haematobium, age and sex distribution.
Page 216 - The cost of large-scale school health programmes which deliver anthelmintics to children in Ghana and Tanzania, Acta Tropica, 73, 183,1999.
Page 218 - Scott, JA 1937. The incidence and distribution of the human schistosomes in Egypt.

About the author (2002)


Samiha El Katsha and Susan Watts are senior consultants at the Social Research Center at the American University in Cairo.

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