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The nursing behaviour of rural Nepali women, from two castes inhabiting the same village, is quantified on the basis of 2202 hr of continuous and direct day-time observation over 1 year. Feed duration, interval, total time and daily frequency are examined in relation to women's work, particularly the type of subsistence activity and seasonality. 'Opportunity' feeds are governed both by infant demands and maternal activity. Caste differences in birth intervals are also discussed.From 1982-1983, researchers observed working women from 2 castes (16 Tamang and 8 Kami) in Salme, Nepal for 11-13 hours/day to determine if breast feeding and working behaviors explain fertility differences between them. Work loads greatly increased for the agropastoralist Tamang women during the monsoon (p.0007), but not so for the low caste Kami women who worked mainly at home. Intervals between feeds and agricultural activities averaged 98 minutes while they averaged 47 minutes for husbandry activities (p.05). Neither affected feed duration. If Tamang women worked in a labor group rather than alone, they tended to provide shorter breast feeds only during the monsoon (p.05). Infant age greatly affected duration of breast feeds (p.0005), interval between feeds (p.004), and total frequency and nursing time (p.0001) among the Tamang. Seasonality did not affect these relationships, except for 3 year olds in which seasonality was significantly reduced during the monsoon. On the other hand, it did have a strong effect on interval (p.05), total frequency (p.01), and total time (p.001) for the Kami. Tamang women provided longer feeds for their infants than did the Kami women during the winter (p.0002), but differences between the 2 castes were minor during spring. Yet Tamang women breast feed their 2 year olds for shorter times than Kami women during the spring (p.01). Among the Kami, infant age did not affect duration, interval, total frequency, and total time. Therefore the 2 castes were not alike in how they planned feeds from day to day. In fact, the Kami women fed their children at very irregular intervals regardless of the child's age. As for Tamang women, intervals grew more irregular with increasing age of the child. Supplementary foods most likely accounted for the high variability between the 2 castes. No 3 year old Kami children were breast fed. The interval between feeds rose consistently with infant age for the Tamang but not for the Kami.

SummaryStroke is an emerging problem in sub-Saharan Africa, about which little is known since most research to date has been based on retrospective, hospital-based studies. This anthropological work, designed to complement a large community-based project on stroke incidence, focuses on local understandings and treatment-seeking behaviours in urban (Dar-es-Salaam) and rural (Hai) areas of Tanzania. Semi-structured interviews (n=80) were conducted with 20 stroke patients, 20 relatives of stroke patients, ten traditional healers, and 30 other local residents. In contrast to common expectations, and literature that finds witchcraft beliefs to be most common in rural areas, stroke in urban Dar was widely believed to emanate from supernatural causes (demons and witchcraft), while in rural Hai, explanations drew mostly on ‘natural’ causes (hypertension, fatty foods, stress). These different beliefs and explanatory models fed into treatment-seeking behaviours. The first option in Hai was hospital treatment, while in Dar-es-Salaam, where belief in demons led to hospital avoidance, it was traditional healers. In both sites, multiple treatment options (serially or simultaneously) were the norm. Analysis of patient and carer narratives suggested that causation beliefs outweighed other factors, such as cost and distance, in shaping effective treatment. Three policy implications are drawn. First, as other studies have also shown, it is important to engage with, rather than dismiss, local explanations and interpretations of stroke. Stroke awareness messages need to take into account the geographical and belief systems differences. Developing an understanding of explanatory models that recognizes that local beliefs arise from dynamic processes of social interaction will be critical to designing effective interventions. Second, there is a clear role for multiple healing systems with possibility of cross-reference in the case of a chronic, disabling condition like stroke, since biomedical treatment cannot offer a ‘quick fix’ while traditional healers can help people come to terms with their condition. Third, issues of communication between health services and their patients are particularly critical.

SummaryChanges in body weight were examined for non-pregnant women in rural Nepal, using 183 anthropometric measures between the early winter and monsoon seasons in 1982, 1982–83, 1990–91 and 1993. The women gained weight when work loads decreased after the monsoon, but despite substantial changes in total energy expenditure, which were out of phase with changes in food intake, seasonal changes were small, averaging only up to 2.6% of initial body weight.There were notable differences between individual women, changes in body weight ranging from-5·6 kg to 4·8 kg. Weight change was examined with respect to lactation status, age, body mass index, mid upper arm circumference and skinfolds as well as total energy expenditure and intake. Non-lactating women, very thin women and women aged under 25 years gained more weight than their counterparts, both before and after the monsoon. Data for a sub-sample in 1982–83 indicated that women who maintained high physical activity levels throughout the year were less prone to weight loss than women whose activity fluctuated between seasons. Initial energy reserves, age-related maturation factors, levels of physical activity and energy intake combine to produce the notable inter-individual variation in body weight changes observed in this population.