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This paper presents the qualitative part of a project in a traditional community in East Bhutan, which, among other items, investigates the effects on child health of breastfeeding, weaning and subsequent pregnancy of the mother. Quantitative data from the project have shown that children who are weaned during a subsequent pregnancy of the mother have a reduced weight gain and an increased incidence of infectious diseases during weaning, while this is not so for children weaned from non-pregnant mothers. In-depth interviews with 35 women with experience from breastfeeding were carried out in the local language in order to obtain qualitative data regarding the processes underlying the mothers decisions during weaning. Breastfeeding was found to fulfil a valuable social function in addition to its biological and emotional properties. The breastfed child had an undebatable 'right of access' to the mother's care, not only her breast, whenever it wanted. This child also assumed a status in the family in which both its vulnerability, its special needs and its value were clearly recognized. The mothers expressed a basic motivation to breastfeed 'as long as possible'. There were, however, important limitations as to how this was manifested in the practical weaning process. If the mother was pregnant at the time of weaning, these limitations tended to be mother - centred. Most of the women had experienced tenderness of the breasts and a reduced milk production from the start of the next pregnancy. It was believed that the breast milk of a pregnant woman could 'rot' and cause disease in the child. In spite of this belief, concurrent breastfeeding and pregnancy were common, but a pregnant mother whose breastfed child got ill, e.g. with diarrhoea, would immediately stop breastfeeding. The child would thereby abruptly loose the most important protection against the negative effects of the disease, when this protection was most needed. Concurrent pregnancy and lactation are common in many areas of the poor world. This has important consequences for the health of mothers and children, and has only recently been given the attention it deserves. Key words - breastfeeding, weaning, pregnancy, Bhutan

Abstract Background This article discusses the link between disability and malaria in a poor rural setting. Global malaria programmes and rehabilitation programmes are organized as vertical and separate programmes, and as such they focus on prevention, cure and control, and disability respectively. When looking at specific conditions and illnesses, the impairing long-term consequences of illness incidents during childhood are not questioned. Methods The study design was ethnographic with an open, exploratory approach. Data were collected in Mangochi District in Malawi through qualitative in-depth interviews and participant observation. Results Despite a local-based health service system, people living in poor rural areas are confronted with a multitude of barriers when accessing malaria prevention and treatment. Lack of skilled health personnel and equipment add to the general burden of poverty: insufficient knowledge about health care, problems connected to accessing the health facility in time, insufficient initiatives to prevent malaria attacks, and a general lack of attention to the long term disabling effects of a malaria attack. Conclusions This study points to the importance of building malaria programmes, research and statistics that take into consideration the consequences of permanent impairment after a malaria attack, as well as the context of poverty in which they often occur. In order to do so, one needs to develop methods for detecting people whose disabilities are a direct result of not having received health services after a malaria episode. This may be done through qualitative approaches in local communities and should also be supplemented by suitable surveys in order to estimate the problem on a larger scale.

A social anthropologist and a child psychologist interviewed 171 Norwegian families with preschool children having nine different handicaps regarding consequences of the handicap for the family, respite care assistance, kindergartens, home help, community aid, and financial assistance. Findings indicated the major problem to be underutilization of available aid. (Author/MC)

A model is presented for analyzing the influence of culture on the coping behavior of families with disabled children, using examples from families in Norway and Botswana. The model considers culture's impact on the process of coping through emotional patterning, expectations of life and future, life experiences, and actual opportunities. (JDD)