Factors associated with changes in adequate antenatal care visits among pregnant women aged 15-49 years in Tanzania from 2004 to 2016.

BACKGROUND: Antenatal care (ANC) is crucial for the health of the mother and unborn child as it delivers highly effective health interventions that can prevent maternal and newborn morbidity and mortality. In 2002, the World Health Organization (WHO) recommended a minimum of four ANC visits for a pregnant woman with a positive pregnancy during the entire gestational period. Tanzania has sub-optimal adequate (four or more) ANC visits, and the trend has been fluctuating over time. An understanding of the factors that have been contributing to the fluctuating trend over years is pivotal in increasing the proportions of pregnant women attaining adequate ANC visits in Tanzania. METHODS: The study used secondary data from Tanzania Demographic Health Survey (TDHS) from 2004 to 2016. The study included 17976 women aged 15-49 years. Data were analyzed using Stata version 14. Categorical and continuous variables were summarized using descriptive statistics and weighted proportions. A Poisson regression analysis was done to determine factors associated with adequate ANC visits. To determine factors associated with changes in adequate ANC visits among pregnant women in Tanzania from 2004 to 2016, multivariable Poisson decomposition analysis was done. RESULTS: The overall proportion of women who had adequate ANC visits in 2004/05, 2010 and 2015/16 was 62, 43 and 51% respectively. The increase in the proportion of women attaining adequate ANC from 2010 to 2015/16 was mainly, 66.2% due to changes in population structure, thus an improvement in health behavior. While 33.8% was due to changes in the mother's characteristics. Early initiation of first ANC visit had contributed 51% of the overall changes in adequate ANC attendance in TDHS 2015/16 survey. CONCLUSION: Early ANC initiation has greatly contributed to the increased proportion of pregnant women who attain four or more ANC visits overtime. Interventions on initiating the first ANC visit within the first twelve weeks of pregnancy should be a priority to increase proportion of women with adequate ANC visit.

Facial and body sexual dimorphism are not interconnected in the Maasai.

BACKGROUND: In this paper, we investigate facial sexual dimorphism and its' association with body dimorphism in Maasai, the traditional seminomadic population of Tanzania. We discuss findings on other human populations and possible factors affecting the developmental processes in Maasai. METHODS: Full-face anthropological photographs were obtained from 305 Maasai (185 men, 120 women) aged 17-90 years. Facial shape was assessed combining geometric morphometrics and classical facial indices. Body parameters were measured directly using precise anthropological instruments. RESULTS: Sexual dimorphism in Maasai faces was low, sex explained 1.8% of the total shape variance. However, male faces were relatively narrower and vertically prolonged, with slightly wider noses, narrower-set and lower eyebrows, wider mouths, and higher forehead hairline. The most sexually dimorphic regions of the face were the lower jaw and the nose. Facial width-to-height ratio (fWHR), measured in six known variants, revealed no significant sexual dimorphism. The allometric effects on facial traits were mostly related to the face growth, rather than the growth of the whole body (body height). Significant body dimorphism was demonstrated, men being significantly higher, with larger wrist diameter and hand grip strength, and women having higher BMI, hips circumferences, upper arm circumferences, triceps skinfolds. Facial and body sexual dimorphisms were not associated. CONCLUSIONS: Facial sex differences in Maasai are very low, while on the contrary, the body sexual dimorphism is high. There were practically no associations between facial and body measures. These findings are interpreted in the light of trade-offs between environmental, cultural, and sexual selection pressures.

Evaluation of an integrated intervention to reduce psychological distress and intimate partner violence in refugees: Results from the Nguvu cluster randomized feasibility trial.

INTRODUCTION: The complex relationship between intimate partner violence and psychological distress warrants an integrated intervention approach. In this study we examined the relevance, acceptability, and feasibility of evaluating a multi-sectoral integrated violence- and mental health-focused intervention (Nguvu). METHODS: We enrolled 311 Congolese refugee women from Nyarugusu refugee camp in Tanzania with past-year intimate partner violence and elevated psychological distress in a feasibility cluster randomized trial. Women were recruited from local women's groups that were randomized to the Nguvu intervention or usual care. Participants from women's groups randomized to Nguvu received 8 weekly sessions delivered by lay refugee incentive workers. Psychological distress, intimate partner violence, other wellbeing, and process indicators were assessed at baseline and 9-weeks post-enrollment to evaluate relevance, acceptability, and feasibility of implementing and evaluating Nguvu in refugee contexts. RESULTS: We found that Nguvu was relevant to the needs of refugee women affected by intimate partner violence. We found reductions in some indicators of psychological distress, but did not identify sizeable changes in partner violence over time. Overall, we found that Nguvu was acceptable and feasible. However, challenges to the research protocol included baseline imbalances between study conditions, differential intervention completion related to intimate partner violence histories, differences between Nguvu groups and facilitators, and some indication that Nguvu may be less beneficial for participants with more severe intimate partner violence profiles. CONCLUSIONS: We found evidence supporting the relevance of Nguvu to refugee women affected by partner violence and psychological distress and moderate evidence supporting the acceptability and feasibility of evaluating and implementing this intervention in a complex refugee setting. A definitive cluster randomized trial requires further adaptations for recruitment and eligibility screening, randomization, and retention. TRIAL REGISTRATION: ISRCTN65771265, June 27, 2016.

Re-examining Norms of Disrespect and Abuse in the Second Stage of Labor in Tanzanian Maternity Care.

Globally, the widespread occurrence of disrespect and abuse (D&A) on maternity wards is well-documented. Using ethnography and cultural consensus analysis we explore how the practice of midwives hitting women who are in the second stage of labor (pushing) has become a locally accepted form of care in Tanzania if a baby's life appears to be at risk. This analysis interrogates the deep uncertainty of birth outcomes in this setting that may motivate abuse during this time. Seriously engaging with local discourses on abuse and care sheds light on hegemonic norms and power dynamics and is critical for improving maternity services.

Preferences for family planning education among men and women in rural, highly religious Tanzanian communities: a discrete choice experiment.

Unmet need for family planning (FP) remains prevalent worldwide. In Tanzania, 21.7% of women desire to delay pregnancy, but do not use modern contraception despite its free availability at local clinics. Our prior data suggest that this is related to complex gender and religious dynamics in rural communities. To understand how education about FP could be improved, we developed a discrete choice experiment (DCE) to rank preferences of six attributes of FP education. Results were stratified by gender. Sixty-eight women and 76 men completed interview-assisted DCEs. Participants significantly preferred education by a clinician (men = 0.62, p < .001; women = 0.38, p < .001) and education in mixed-gender groups (men = 0.55, p < .001; women = 0.26, p < .001). Women also significantly preferred education by a religious leader (0.26, p = .012), in a clinic versus church, mosque, or community centre (0.31, p = .002), and by a female educator (0.12, p = .019). Men significantly preferred a male educator (0.17, p = .015), whom they had never met (0.25, p < .001), and educating married and unmarried people separately (0.22, p = .002). Qualitative data indicate women who had not previously used contraception preferred education led by a religious leader in a church or mosque. FP education tailored to these preferences may reach a broader audience, dispel misconceptions about FP and ultimately decrease unmet need.

Fertility and infant survival in men and women from rural regions of Northern Tanzania: gene candidates and sex-specific genetic associations.

Numerous factors, including family planning and modern contraception, disturb the potential associations between the number of children born and genetic factors in modern Western societies. The current progress of medicine and a relatively high level of well-being make it hard to test the association between children's survival rates and genetic factors in Western societies either. The goal of the current study was to reveal the possible associations between the number of children born and the number of children survived till the age of 5 y. by the time of our study with a set of six genetic polymorphisms associated with serotonin, dopamine, androgen oxytocin behavioral effects; and to test for sex-specific effects of these polymorphisms in a traditional rural sample from Arusha and Singida Districts of Northern Tanzania. The data on 965 healthy individuals (520 men and 415 women) from traditional rural communities with high reproduction profiles were collected. All participants provided information on the number of children born and survived, and other demographic information, as well as buccal epithelium samples for DNA analysis. The data were analyzed using GLM ANCOVA and the APSampler nonparametric methodology. The gene association effects on reproduction and infant survival in men and women were demonstrated. We suggest that sex differences revealed in this study are in line with sexual selection pressure on reproduction and parenting in traditional societies.

Changes in Juvenile Foraging Behavior among the Hadza of Tanzania during Early Transition to a Mixed-Subsistence Economy.

The Hadza foragers of Tanzania are currently experiencing a nutritional shift that includes the intensification of domesticated cultigens in the diet. Despite these changes, no study, to date, has examined the possible effects of this transition on the food collection behavior of young foragers. Here we present a cross-sectional study on foraging behavior taken from two time points, 2005 and 2017. We compare the number of days foraged and the type and amount of food collected for young foragers, aged 5-14 years, in age- and season-matched samples. Compared with 2005, in 2017 fewer subadults left camp to forage, and overall, they targeted a smaller variety of wild foods, with the noticeable absence of wild honey, figs, and tubers. In addition, participants in 2017 were significantly more likely to have attended school. Despite the increased presence of domesticated plant foods in the diet and increased attendance at school, some young foragers continue to be highly productive in collecting wild, undomesticated foods. Despite the preliminary nature of our results, our findings suggest that the range of wild foods targeted by subadults is decreasing as the amount of domesticated cultigens in the diet increases. These data underscore the importance of studying diet composition and foraging decisions across temporal, nutritional, and ecological landscapes.

Emotion Perception in Hadza Hunter-Gatherers.

It has long been claimed that certain configurations of facial movements are universally recognized as emotional expressions because they evolved to signal emotional information in situations that posed fitness challenges for our hunting and gathering hominin ancestors. Experiments from the last decade have called this particular evolutionary hypothesis into doubt by studying emotion perception in a wider sample of small-scale societies with discovery-based research methods. We replicate these newer findings in the Hadza of Northern Tanzania; the Hadza are semi-nomadic hunters and gatherers who live in tight-knit social units and collect wild foods for a large portion of their diet, making them a particularly relevant population for testing evolutionary hypotheses about emotion. Across two studies, we found little evidence of universal emotion perception. Rather, our findings are consistent with the hypothesis that people infer emotional meaning in facial movements using emotion knowledge embrained by cultural learning.

To the hunter go the spoils? No evidence of nutritional benefit to being or marrying a well-reputed Hadza hunter.

OBJECTIVES: The incentives underlying men's hunting acquisition patterns among foragers are much debated. Some argue that hunters preferentially channel foods to their households, others maintain that foods are widely redistributed. Debates have focused on the redistribution of foods brought to camp, though the proper interpretation of results is contested. Here we instead address this question using two nutritional variables, employed as proxies for longer-term food access. We also report on broader patterns in nutritional status. MATERIALS AND METHODS: We measured male hunting success, hemoglobin concentration and body fatness among bush-living Hadza. Hunting success was measured using an aggregated reputation score. Hemoglobin concentration, a proxy for dietary red meat, was measured from fingerprick capillary blood. Body fatness, a proxy for energy balance, was measured using BMI and bioelectrical impedance. RESULTS: We find no statistically significant relationship between a hunter's success and any measure of his nutritional status or that of his spouse. We further find that: women are, as elsewhere, at greater risk of iron-deficiency anemia than men; men had slightly lower BMIs than women; men but not women had significantly lower hemoglobin levels than in the 1960s. DISCUSSION: The absence of an association between hunting reputation and nutritional status is consistent with generalized food sharing. Null results are difficult to interpret and findings could potentially be a consequence of insufficient signal in the study measures or some confounding effect. In any event, our results add to a substantial corpus of existing research that identifies few nutritional advantages to being or marrying a well-reputed Hadza hunter.

Barriers to the uptake of modern family planning methods among female youth of Temeke District in Dar es Salaam, Tanzania: A qualitative study.

OBJECTIVES: Despite the accessibility of modern family planning (FP) methods, unwanted pregnancies remains a serious problem in Tanzania. This study aimed to identify the barriers to the uptake of modern FP methods among female youth reached by the Chaguo la Maisha project in Temeke District, Tanzania. STUDY DESIGN: Qualitative study conducted in March 2017 involving 15 female youths aged 18-24 years. MAIN OUTCOME MEASURES: Purposive sampling was used to select study participants and sampling followed the principle of data saturation. The study participants were those who received contraceptive counseling from community health mobilizers and agreed to visit a nearby health facility for FP services but did not go for the services. A semi-structured interview guide, translated into Kiswahili language was used. Data were transcribed; analyzed following qualitative content analysis. Major categories and subcategories that hindered visitations were identified. RESULTS: Three categories and their subcategories were identified as hindering FP method uptake. (1) individual perception factors: (a) myths and misconceptions, (b) fear of side effects, (c) fear of the possibility of being pregnant at the time of FP counseling; (2) community perception factors: discouragement from an intimate partner and closest friends; and (3) health facility system factors: unavailability of the preferred method and absence of the trained personnel for the FP method. CONCLUSIONS: The main barriers to FP uptake were myths and misconceptions, and fear of side effects. The intimate partner or closest friends were significant decision influencers on contraceptive use, implying that FP campaigns should focus beyond the individual level.

Factors influencing adoption of facility-assisted delivery - a qualitative study of women and other stakeholders in a Maasai community in Ngorongoro District, Tanzania.

BACKGROUND: Tanzania's One Plan II health sector program aims to increase facility deliveries from 50 to 80% from 2015 to 2020. Success is uneven among certain Maasai pastoralist women in Northern Tanzania who robustly prefer home births to facility births even after completing 4+ ANC visits. Ebiotishu Oondomonok Ongera (EbOO) is a program in Nainokanoka ward to promote facility births through a care-group model using trained traditional birth attendants (TBAs) as facilitators. Results to date are promising but show a consistent gap between women completing ANC and those going to a facility for delivery. A qualitative study was conducted to understand psychosocial preferences, agency for decision-making, and access barriers that influence where a woman in the ward will deliver. METHODS: In-depth interviews, focus group discussions and key-informant interviews were conducted with 24 pregnant and/or parous women, 24 TBAs, 3 nurse midwives at 3 health facilities, and 24 married men, living in Nainokanoka ward. Interviews and discussions were transcribed, translated, and analyzed thematically using a grounded theory approach. RESULTS: Most women interviewed expressed preference for a home birth with a TBA and even those who expressed agency and preference for a facility birth usually had their last delivery at home attributed to unexpected labor. TBAs are engaged by husbands and play a significant influential role in deciding place of delivery. TBAs report support for facility deliveries but in practice use them as a last resort, and a significant trust gap was documented based on a bad experience at a facility where women in labor were turned away. CONCLUSIONS: EbOO project data and study results show a slow but steady change in norms around delivery preference in Nainokanoka ward. Gaps between expressed intention and practice, especially around 'unexpected labor' present opportunities to accelerate this process by promoting birth plans and perhaps constructing a maternity waiting house in the ward. Rebuilding trust between facility midwives, TBAs, and the community on the availability of health facility services, and increased sensitivity to women's cultural preferences, could also close the gap between the number of women who are currently using facilities for ANC and those returning for delivery.

Monitoring the body: grandmothers' ability to provide 'expert' care for grandchildren living with HIV in northwest Tanzania.

Drawing on long-term ethnographic fieldwork on older caregivers and their shifting roles since the introduction of antiretroviral therapy in northwest Tanzania, this article explores grandmothers' roles in caring for grandchildren who are HIV positive and on treatment. While AIDS treatment programmes usually focus on cultivating expert patients who can perform self-care, this study focuses on older caregivers and how they become experts in caring for their grandchildren living with HIV. How is expert care enacted and what supports or limits its quality? Based on observations and in-depth interviews, this article argues that grandmothers become 'expert caregivers' by merging knowledge acquired in the clinic and support groups with intimate practices of grandparental care. However, the grandmother's gendered and generational position within kin networks affects her ability to provide expert care. The findings indicate that in analysing treatment outcomes among adolescents, it is important to understand the broader family dynamic that influences the actual possibility of expert caregivers to support children living with HIV.

No Association between 2D:4D Ratio and Hunting Success among Hadza Hunters.

The ratio of index- and ring-finger lengths (2D:4D ratio) is thought to be related to prenatal androgen exposure, and in many, though not all, populations, men have a lower average digit ratio than do women. In many studies an inverse relationship has been observed, among both men and women, between 2D:4D ratio and measures of athletic ability. It has been further suggested that, in hunter-gatherer populations, 2D:4D ratio might also be negatively correlated with hunting ability, itself assumed to be contingent on athleticism. This hypothesis has been tested using endurance running performance among runners from a Western, educated, and industrialized population as a proximate measure of hunting ability. However, it has not previously been tested among actual hunter-gatherers using more ecologically valid measures of hunting ability and success. The current study addresses this question among Tanzanian Hadza hunter-gatherers. I employ a novel method of assessing hunting reputation that, unlike previous methods, allows granular distinctions to be made between hunters at all levels of perceived ability. I find no statistically significant relationship between digit ratio and either hunting reputation or two important hunting skills. I confirm that Hadza men have higher mean 2D:4D ratios than men in many Western populations. I discuss the notion that 2D:4D ratio may be the consequence of an allometric scaling relationship between relative and absolute finger lengths. Although it is difficult to draw clear conclusions from these results, the current study provides no support for the theorized relationship between 2D:4D ratio and hunting skill.

'He usually has what we call normal fevers': Cultural perspectives on healthy child growth in rural Southeastern Tanzania: An ethnographic enquiry.

INTRODUCTION: While parents' construction of and actions around child growth are embedded in their cultural framework, the discourse on child growth monitoring (CGM) has been using indicators grounded in the biomedical model. We believe that for CGM to be effective, it should also incorporate other relevant socio-cultural constructs. To contribute to the further development of CGM to ensure that it reflects the local context, we report on the cultural conceptualization of healthy child growth in rural Tanzania. Specifically, we examine how caregivers describe and recognize healthy growth in young children, and the meanings they attach to these cultural markers of healthy growth. METHODS: Caregivers of under-five children, including mothers, fathers, elderly women, and community health workers, were recruited from a rural community in Kilosa District, Southeastern Tanzania. Using an ethnographic approach and the cultural schemas theory, data for the study were collected through 19 focus group discussions, 30 in-depth interviews, and five key informant interviews. Both inductive and deductive approaches were used in the data analysis. RESULTS: Participants reported using multiple markers for ascertaining healthy growth. These include 'being bonge' (chubby), 'being free of illness', 'eating well', 'growing in height', as well as 'having good kilos' (weight). Despite the integration of some biomedical concepts into the local conceptualization of growth, the meanings attached to these concepts are largely rooted in the participants' cultural framework. For instance, a child's weight is ascribed to the parents' adherence to postpartum sex taboos and to the nature of a child's bones. The study noted conceptual differences between the meanings attached to height from a biomedical and a local perspective. Whereas from a biomedical perspective the height increment is considered an outcome of growth, the participants did not see height as linked to nutrition, and did not believe that they have control over their child's height. CONCLUSIONS: To provide context-sensitive advice to mothers during CGM appointments, health workers should use a tool that takes into account the mothers' constructs derived from their cultural framework of healthy growth. The use of this approach should facilitate communication between health professionals and caregivers during CGM activities, increase the uptake and utilization of CGM services, and, eventually, contribute to reduced levels of childhood malnutrition in the community.

Parent-offspring conflict unlikely to explain 'child marriage' in northwestern Tanzania.

Approximately 40% of women in sub-Saharan Africa marry before their eighteenth birthday1. Within the international development sector, this phenomenon is referred to as 'child marriage', widely equated to forced marriage, and recognized as damaging to multiple dimensions of female well-being1,2. An escalating global campaign to end early marriage typically assumes that its high prevalence is driven by a conflict of interests between parents and daughters, with parents coercing daughters to marry early for the parents' economic benefit3. However, a parent-offspring conflict model of early marriage has not been explicitly tested. Here we present a study of marriage transitions in rural Tanzania, where marriage before or just after 18 years of age is normative. Consistent with parental coercion, we find that bridewealth transfers are highest for younger brides. However, autonomy in partner choice is very common at all ages, relationships between age at marriage and female well-being are largely equivocal, and women who marry early achieve relatively higher reproductive success. We conclude that, in contexts in which adolescents have autonomy in marriage choices and in which marriage promotes economic and social security, early marriage may be better understood as serving the strategic interests of both parents and daughters.

Similarities in Color Preferences Between Women and Men: The Case of Hadza, the Hunter-Gatherers From Tanzania.

Evidence for cross-cultural patterns of sexual differences in color preferences raised the question of whether these preferences are determined by universal principles. To address this question, we investigated most- and least-favorite color choices in a nonindustrialized community, the Hadza that has an egalitarian hunter-gatherer culture, fundamentally different from those previously investigated. We also compared color preference patterns in the Hadza with published data from Poland and Papua. Our results show that Hadza have very different color preferences than Polish and Papuan Yali respondents. Unlike many industrialized and nonindustrialized cultures, Hadza color preferences are practically the same for women and men. These observations question the idea of universal differences of color preferences between sexes and raise important questions about the determinants of color preferences.

Maternal perceptions of breastfeeding and infant nutrition among a select group of Maasai women.

BACKGROUND: Adverse health outcomes are higher among Maasai children in the Ngorongoro Conservation Area compared to other co-located ethnic groups and regions of Tanzania. The Mama Kwanza Socioeconomic Health Initiative, a Canadian-Tanzanian partnership delivering healthcare at clinics in this region, gathered perceptions of mothers regarding breastfeeding and infant nutrition in order to inform culturally sensitive, realistic, and effective health promotion efforts. METHODS: A qualitative description approach was used in interviewing 30 Maasai mothers of infants zero to six months of age to explore their infant feeding practices, beliefs, knowledge, and recommendations to support breastfeeding. A local research team was trained to conduct and transcribe the interviews and assist with data interpretation. Qualitative content analysis was used in analyzing the interview transcripts. RESULTS: Lactation is universal in this culture with all the mothers planning to breastfeed for at least one year and most having initiated breastfeeding within one hour of birth. Lactation skills and knowledge are passed down intergenerationally from the elder women. None of the infants less than six months were exclusively breastfed, with a variety of liquid and semi-solid supplements given. Mothers perceived their milk alone was nutritionally insufficient with maternal dietary deficiencies cited as a factor. CONCLUSIONS: While there is a strong breastfeeding culture among the Maasai in Ngorongoro, intersectoral efforts are required to provide culturally respectful health education on the benefits of exclusive breastfeeding and to ensure the maternal dietary adequacy required to achieve this goal. The findings reinforce the importance of international health projects adapting health promotion initiatives to local realities and beliefs in efforts to improve maternal child health.

"A child may be tall but stunted." Meanings attached to childhood height in Tanzania.

Stunting affects large numbers of under-fives in Tanzania. But do caretakers of under-fives recognize height as a marker of child growth? What meanings do they attach to linear growth? An ethnographic study using cultural schemas theory was conducted in a rural community in Southeastern Tanzania to investigate caregivers' conceptualizations of child height in relation to growth and the meanings attached to short stature. Data for the study were collected through 19 focus group discussions, 30 in-depth interviews, and five key informant interviews with caregivers of under-fives, including mothers, fathers, elderly women, and community health workers. Principles of grounded theory guided the data management and analysis. Although caregivers could recognize height increments in children and were pleased to see improvements, many held that height is not related to nutrition, health, or overall growth. They referred to short stature as a normal condition that caregivers cannot influence; that is, as a function of God's will and/or heredity. While acknowledging short stature as an indicator of stunting, most participants said it is not reliable. Other signs of childhood stunting cited by caregivers include a mature-looking face, wrinkled skin, weak or copper-coloured hair, abnormal shortness and thinness, delayed ability to crawl/stand/walk, stunted IQ, and frequent illness. Culturally, a child could be tall but also stunted. Traditional rather than biomedical care was used to remedy growth problems in children. Public health programmers should seek to understand the local knowledge and schemas of child stature employed by people in their own context before designing and implementing interventions.

Links between environment, diet, and the hunter-gatherer microbiome.

The study of traditional populations provides a view of human-associated microbes unperturbed by industrialization, as well as a window into the microbiota that co-evolved with humans. Here we discuss our recent work characterizing the microbiota from the Hadza hunter-gatherers of Tanzania. We found seasonal shifts in bacterial taxa, diversity, and carbohydrate utilization by the microbiota. When compared to the microbiota composition from other populations around the world, the Hadza microbiota shares bacterial families with other traditional societies that are rare or absent from microbiotas of industrialized nations. We present additional observations from the Hadza microbiota and their lifestyle and environment, including microbes detected on hands, water, and animal sources, how the microbiota varies with sex and age, and the short-term effects of introducing agricultural products into the diet. In the context of our previously published findings and of these additional observations, we discuss a path forward for future work.

Universal classifications, national approaches and specific situations: a comparative study on the conceptualization of nodding syndrome in Uganda and Tanzania.

This paper presents a comparative study on conceptualizations of the poorly understood nodding syndrome (NS) in Uganda and Tanzania. NS has been constructed as a biomedical category to serve global health discourse as well as national contexts of managing the condition. The paper looks into the shifting meanings and conceptualizations of NS in the affected areas of Kitgum (UG) and Mahenge (TZ) district. The perceived universality of biomedical classifications is problematized as conflicting with the specific contexts of lucluc and kifafa cha kusinzia. Reconciliation proves to be challenging, poignantly evoking the cultural construction as such of any medical condition.