Parker Melissa, Allen Tim, Hastings Julie
Centre for Research in International Medical Anthropology, Brunel University, UK.
J Biosoc Sci. 2008 Mar;40(2):161-81. doi: 10.1017/S0021932007002301. Epub 2007 Aug 30.
A strong case has recently been made by academics and policymakers to develop national programmes for the integrated control of Africa's 'neglected tropical diseases'. Uganda was the first country to develop a programme for the integrated control of two of these diseases: schistosomiasis and soil-transmitted helminths. This paper discusses social responses to the programme in Panyimur, north-west Uganda. It shows that adults are increasingly rejecting free treatment. Resistance is attributed to a subjective fear of side-effects; divergence between biomedical and local understandings of schistosomiasis/bilharzia; as well as inappropriate and inadequate health education. In addition, the current procedures for distributing drugs at a district level are problematic. Additional research was carried out in neighbouring areas to explore the generalizability of findings. Comparable problems have arisen. It is concluded that the national programme will not fulfil its stated objectives of establishing a local demand for mass treatment unless it can establish more effective delivery strategies and promote behavioural change in socially appropriate ways. To do so will require new approaches to social, economic and political aspects of distribution. There are reasons why populations infected with the 'neglected tropical diseases' are themselves neglected. Those reasons cannot just be wished away.
最近，学者和政策制定者大力倡导制定非洲“被忽视的热带病”综合防治国家计划。乌干达是首个制定其中两种疾病（血吸虫病和土壤传播的蠕虫病）综合防治计划的国家。本文探讨了乌干达西北部潘伊穆尔地区对该计划的社会反应。研究表明，成年人越来越拒绝接受免费治疗。这种抵触情绪归因于对副作用的主观恐惧；生物医学与当地对血吸虫病/裂体吸虫病认知的差异；以及健康教育的不恰当和不足。此外，目前在地区层面分发药物的程序存在问题。在邻近地区开展了进一步研究，以探究研究结果的普遍性。类似问题也出现了。研究得出结论，除非国家计划能够制定更有效的分发策略，并以符合社会实际的方式促进行为改变，否则将无法实现其设定的建立当地对大规模治疗的需求这一目标。要做到这一点，需要在社会、经济和政治方面采取新的分发方法。感染“被忽视的热带病”的人群被忽视是有原因的。这些原因不能仅仅被忽视。
