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UNIT 10:Scientific Research, Health and Well Being
Key unit competence: To be able to analyse the role of science andtechnology to improve healthy behaviours.
Introduction
This unit is about the major role played by science and education in enhancing
health in the social lives of Rwandan citizens and the world at large.
Study these pictures and say how they promote or show decline of goodhealth in the society.
10.1 Rwanda’s socio – economic and demographic indicators
(RDHS)
A
10.1.1 Incidence and prevalence of HIV/AIDS by age and
gender
Activity 1
Study the graph below showing HIV prevalence by age as captured inRwanda in 2011. In groups, answer the question that follows.
Question
Explain the HIV prevalence in the following age brackets:
a) Below 15 years
b) 15 – 24 years
c) Above 25 years
Even though Rwanda was among the first African countries to record cases
of HIV and AIDS, she has had a remarkable improvement in the war against
AIDS with incidents of HIV and AIDS mortality dropping with more than
8% per year. This can be seen in the decreasing new cases of infection per
year. For example: During the early 1990s, Rwanda experienced over 25,000
new HIV cases per year. In 2013, the country recorded about 10,200 new
HIV infections, half the number in the previous decade even as the overall
population grew. Studies have also showed that 83% of Rwandans living with
HIV and AIDS have successfully repressed the virus. This improvement can
be attributed to the Rwandan government’s early action and high standards
for HIV care.
According to a study carried out by United Nations in the year 2014, people
living with HIV and AIDS in Rwanda were estimated to be 210, 000 of the
total population. 190, 000 of these were adults aged 15 years and above and
22, 000 were children aged 0-14 years. 85, 000 children were orphaned as a
result of AIDS. Deaths caused by AIDS in 2014, were estimated to be 3,000.
From these numbers, it is estimated that 60% of the adult population living
with HIV/AIDS are women.
HIV and AIDS is more prevalent among women and girls than their male
peers in every age group. Young women aged 18-19 years are 10 times more
likely to acquire HIV and AIDS than young men of the same age. HIV and
AIDS is higher among women living in urban areas, those who are widowed,
divorced or separated, women with secondary education or higher, and
among those living in the highest wealthy class. In the 20-24 age categories,
young women have a 5 times higher risk of HIV and AIDS infection than
their male peers.
Among men, HIV and AIDS prevalence is higher among older men, although
men have a lower HIV and AIDS prevalence than women in all age groups
except those aged 40-44. It is higher in men living in urban areas, those who
are divorced or separated, and those with no education. Research also shows
that HIV and AIDS is more common among the wealthy men than the poor.
From these statistics on HIV and AIDS prevalence, it is clear that a large
population of those at risk of HIV and AIDS are in the most productive age
of their lives. In addition to the health strain this condition puts on individuals
and their families, it is also significant to the country’s economy because
when a large population of the most productive workforce either lose their
lives or the capacity to take up their responsibilities, the whole economy is
distabilised. Orphaned children also may lack opportunities to better their
lives, such as education and moral support. A large amount of the country’s
resources are also directed to medical concerns and matters of developmentno longer get first priority. What results is a weak economy.
Exercise 1
The table below shows the HIV prevalence by age and gender among
Rwandans in 2013. Study it and answer the questions that follow.HIV prevalence by age and sex
Source: Rwanda AIDS Indicator and HIV Incidence Survey 2013 (Rwanda
Biomedical Centre)
Questions
1. Explain HIV prevalence among men.
2. Explain HIV prevalence among women.3. Comment on the general prevalence of HIV by age in Rwanda.
10.1.2 Infant and maternal mortality rate
Activity 2
Study the table below showing the evolution of child mortality rate between1978 and 2012 by sex and then answer the questions that follow.
Sources: Rwandan 1978, 1991, 2002 and 2012 Censuses (NISR) as
captured in January 2014 Thematic Report: Mortality by NationalInstitute of Statistics of Rwanda.
Questions
1. Explain the trend that can be seen in the table above.
2. Critically analyse this trend giving reasons why this trend is the way it is.
3. Why do you think the mortality rate among males is higher than that of
females?
According to the table shown in Activity 1, infant mortality has been going
down in Rwanda. This is except for the year 2002 when it went up. However,
with the improved quality of health services provided by the government,
the situation has improved drastically. This has dropped to a record low of
deaths among males and deaths among females by 2012.
The major cause of mortality amongst children is malaria, followed by
anaemia, acute respiratory infection, and diarrhoea – all of which are
preventable through comprehensive and well-coordinated interventions,
such as the distribution of mosquito nets, improved access to water and
sanitation, better cooking stoves, and simple health interventions such asrehydration salts (Ministry of Health et al 2009)
Exercise 2
Explain the causes of child mortality as displayed in the pie chart below.
10.1.3 Factors contributing to a reduction in infant mortality rate
1. The increase in skilled health care providers during childbirth has been
especially important for women and for children. The government of
Rwanda has been improving the maternal health services by ensuring
that there are enough trained doctors, nurses and midwives to offer the
required services in ensuring that there are as few death cases as possible
associated with maternity and child care. By 2012, there was one doctor
per 16,000 people and one nurse per 1,300 people. Before 1997, Rwanda
had no trained midwives, but now there are around 1,000.
2. Improvements in immunisation to children of five years and below and
exclusive breastfeeding of children up to six months after birth have also
been very effective in reducing child mortality in Rwanda.
3. The fact that parents have been encouraged to plan their families to a size
they can provide sufficient care for, has also been a positive factor towards
maintaining healthy families, where mothers have good reproductive
health and children are have access to health facilities and live healthily.Today the average family size in Rwanda is about four children per family.
Exercise 3
1. Brainstorm on the causes of the high HIV and AIDS prevalence in the
Rwandan society.
2. There has been an improvement on the maternity related deaths
in Rwanda since 1994. Explain some of the reasons leading to theimprovement.
10.2 Medical research and ethics on HIV and AIDS
Activity 3
There are many diseases today whose cause, cure/ prevention are
known. In groups brainstorm on how these causes, cure or prevention
were discovered.
Medical research refers to an organised way to learn more about health
in general, and also about better ways to prevent and treat diseases in the
future. Research involves finding out the facts about a situation in order to
address it in the best way possible. Without research therefore, leaders in a
government would be making decisions based on assumptions which can at
times be untrue. This makes it absolutely important especially on matters
of health such as HIV and AIDS. The government of Rwanda has come up
with policies that encourage research such as The Health Sector Research
Policy which establishes research projects on three main communicable
diseases; HIV and AIDS, malaria and tuberculosis. Research on these areas
will enhance proper use of resources in the prevention and treatment of
these diseases.
In conducting this research, information has to come from the people within
the society. Most of the sources of information may be victims of the disease.
Therefore people seeking this information have to be sensitive and have the
right judgement of the right approach to use; rules and standards can also
be applied to draw a line on what is acceptable and what is not when doing
research on HIV and AIDS. These specific rules and values are known as
ethics.
Ethics are specific values, standards, rules and agreements people adopt to
conduct any practice such as professions.
The medical profession is one that critically requires ethics because it
deals with delicate social matters and if not ethically practised, can causepsychological and social harm to the people concerned.
Ethics on HIV and AIDS research
Activity 4
If you were a researcher, how would you apply ethics to get information
about HIV and AIDS from patients suffering from the disease?
HIV and AIDS is a disease characterised by a suppressed immune system. Its
cure is yet to be discovered but research by doctors has come up with Antiretro
viral drugs that help in HIV/AIDS management. With the ARV therapy,
patients can realise their full lives. HIV/ AIDS just like any other disease is a
sensitive issue especially when victims are involved and as such professionals
must apply ethics when gathering information for research purposes.
The following are some of the ethics to be observed:
1. Matters of socio-cultural setting must be considered. When conducting
research, AIDS should be viewed as a disease that affects humans not
merely biologically, but also socially in terms of their conceptions of
sexual behavior and their belief systems of disease, illness and sickness.
2. There is need observe medical ethics in order to avoid stigma in the
process of research. ‘Vulnerable populations’ refers to people in need
of special care, support, or protection because of risk of abuse or
neglect. For example; if not treated with respect and human dignity,
people suffering from HIV and AIDS can be vulnerable to stigma. That
is why it is important to be sensitive and conscious to other people’s
vulnerability when conducting research.
3. In order to interview or take any pictures of individuals, they must be
well informed of how the information will be used for them to make
a decision whether they want to be involved or not. This aspect is
called informed consent. It is against ethics to gather information from
children in the absence of an adult who’s taking responsibility of them.
4. The dignity and rights of vulnerable populations must be upheld.
Matters of privacy and confidentiality, of people suffering from HIV
and AIDS must be observed. Individual health status is confidential to
the individual. When gathering data on HIV and AIDS from people, the
information gathered should be maintained anonymous as a way of
protecting them from any unwanted negative publicity.
5. Stigma and discrimination; because of the stigma surrounding HIV
and AIDS, many people are unwilling to openly discuss the illness.
According to UNAIDS, ‘The stigma associated with AIDS has silenced
open discussion, both of its causes and of appropriate responses.
6. Considering this situation the risk of harm when researching on HIV
and AIDS must be minimal. Participation in giving information and
informed consent must be carefully obtained; consent should be given
not due to desperation or lack of other options but out of willingness.
7. Fair representation of both sexes when doing research is part of ethics.This is because, some cultures consider women inferior and this may
lead to gender imbalance especially if the information gathered is
meant to be used in decision making for the whole society. Sexual roles
and gender relationships play a great role in the understanding of HIV
and AIDS.
The power set up in the society between men and women influences HIV
transmission. Women are attributed lower rank in many societies, making
them particularly vulnerable to HIV infection as they lack the support and
socio-economic status to fully determine their sexual relations. That is, in
some traditional cultures, women do not have the power to determine who
their sexual partners are. When collecting data therefore, researchers should
make sure that their sources represent both sexes fairly. In this way, the
information gathered will not be biased in any way.
In conclusion, it is important to note that as much as medical research is
important in determining crucial social aspects such as ways of controlling
the spread of HIV and AIDS and improving human life, the process of research
must be undertaken with responsibility. Ethics should guide any research in
order to avoid socio- cultural/ psychological harm to the interviewees or thepeople helping in giving information
Exercise 4
As partners discuss the ways in which you would ethically relate with
your friend if he/she openly shared with you that he/she is HIV positive.Refer both to school and community environments.
10.3 The role of health education in promoting sustainable
health behaviour in relation to HIV/ AIDS and reproductive
health
Activity 5
You must have some knowledge on how unbalanced diet, unhygienic
habits and irresponsible sexual behaviour cause diseases. Share your
knowledge in groups.
Health education is a process of learning aimed at helping people to improve
their health by adding on to their knowledge and influencing their attitude
towards a healthier lifestyle. Education plays a great role in exposing people
to information about possible causes of diseases and therefore enlightens
them on preventive measures. Diseases come in different circumstances;
some are caused by unhygienic habits such as failure to adopt hand washing
habits or not boiling drinking water, others are caused by poor diet such
unbalanced nutrition.
Reproductive health refers to a state of physical, mental and social wellbeing
in all matters relating to the reproductive system, at all stages of life.
Importance of health education on reproductive health
1. Education on sexuality and health imparts skills on how to relate
appropriately with people of the opposite sex and other interpersonal
relationships, such as relationships with parents and peers. Communication
and decision making when it comes to peer pressure and knowledge
about the body and how it functions, the menstrual cycle of girls, among
other related topics on sexuality are some of the important things to
learn.
2. Health education saves lives and improves reproductive health.
Reproductive health education in most developing countries has not
been well utilised because discussion of issues such as sexual intercourse
and sexuality make people feel uncomfortable. This influences parents
and guardians and other knowledgeable members of the society to be
silent on reproductive health matters. This has consequences because
teenagers due to lack of knowledge end up messing up by experimenting
their sexuality and through peer influence, they engage in irresponsible
sexual behaviour.
3. People especially women have lost their lives due to reproductive health
related issues. Care before and during pregnancy, during delivery and
after childbirth saves women’s and children’s lives and prevents ill health
and disabilities.
4. A number of people especially adolescents contract sexually transmitted
infections due to lack of knowledge on how to prevents the spread and
treatment of such diseases.
5. Prevention of unwanted pregnancies can reduce cases of unsafe abortion
which is one of the causes of maternal deaths.
6. Sexual and reproductive health information and services can reduce
the prevalence of STIs, including HIV, to which many young people are
especially vulnerable.
7. Sexual and reproductive health care education can also be a way to
engage men as well as address gender roles and responsibilities, gender
based violence, sexual abuse and harmful practices. Some of the harmful
sexual behaviour include sexual harassment and abuse cases such as
rape.
8. Girls between the ages of 20-24 years are more vulnerable to STIs including
HIV than young men. Despite this situation, they rarely make use of the
available health services partly due to the fact that they have little or no
knowledge on how to best use them when they need them. Increased
knowledge and a positive attitude towards acquiring reproductive health
knowledge is necessary among the youth. This will no doubt reduce the
risk of infection and facilitate treatment to those already affected.
9. It fosters knowledge of positive living by giving guidance to those suffering
from HIV and AIDS and other diseases on how to go about treatment
and live their lives as desired by working towards achieving their goals.
In the same way, discrimination and stigmatisation against any member
of society on the basis of his/ her health situation is highly discouraged.
This is because all members of the society should live harmoniously
supporting each other in order to achieve social cohesion.
The following activities are important in carrying out reproductive health
education:
• Promotion of healthy sexual behaviour; this includes, abstinence, proper
use of condoms and avoiding high risk sexual behaviour such as: having
multiple sex partners, or engaging in commercial sex relationships.
• Encouraging the use of health services for diagnosis and treatmentfor
example, in case an individual develops symptoms of a sexually
transmitted disease, he/ she should seek medical diagnosis and advice
on treatment.
• Prevention and care at the primary healthcare level- emphasis should
be put on preventive lifestyles rather than curative measures. That is
even though there is cure for the sexually transmitted diseases, the best
approach should be to abstain from irresponsible sexual behaviour, as
this helps in maintaining a well lived life without early responsibilities of
parenting and also keeps one safe from diseases and anxieties of early
pregnancy.
• Encouraging parent/ guardian/ teacher/ peer educator to adolescent
communication on sexual matters- adolescents should be able to open
up on their challenges in order to get proper advice.
In a nutshell therefore, reproductive health education, empowers the
vulnerable members of the society especially adolescents and women by
equipping them with knowledge on the best way to approach issues of sexual
and reproductive health. It is also relevant to the male gender in encouraginga responsible sexual behaviour.
Exercise 5
The picture shows Gasore and his
mother. His mother is talking to him
about responsible sexual behaviour.
What is the importance of holding suchtalks with our parents/guardians?
10.4 The impact of progress and innovation in science and
technology including ICT
Activity 6
Imagine a world without the technological gadgets shown. How differentwould it be from the current situation?
Technology has been part of our lives it plays very crucial roles in our daily
lives. Practically almost all sectors of life involve use of technology. It saves
life, makes work easier and the world a better place to live in.
Innovation is creating new value or modifying what already exists into
something more valuable and efficient.
Innovation can be viewed as appreciation of better solutions that meet
arising needs. Some of the ways in which innovation occurs is by:
1. Creating new technology in infrastructure such as communication and
transport
2. New production techniques in production enterprises or
3. New farming methods in agriculture
The question then is: how does this innovation impact on science and
technology?
Science is the coordinated human effort to understand the history of the
world and how it works. Scientists apply the knowledge and understanding
of the natural world to improve the living conditions.
Technology refers to knowledge that deals with the creation and use of
technical means. Innovation therefore is central to technology since it is all
about creation that adds value to the existing means.
Innovation also directly impacts on science as it makes it easier to carry out
scientific procedures of finding evidence and meaning of nature in relation
to social life.
Innovation has led to advances in science and technology and in return due
to the increased ability to create, distribute and exploit knowledge there has
been an improvement in wealth creation and the quality of life.
ICT (Information and Communications Technology) is evidence of how great
an impact innovation can have on the society. Were it not for innovation,
the information and communications industry would not be as advanced
as it is today. So many applications have been innovated on cell phones
and computers which make life easier and more comfortable. Individuals,
companies and governments have been empowered to use more efficient
means in going about their businesses. For example, through the introduction
of electronic business transactions such as western union, banking, money
transfers and other ways of electronic commerce. An example is M-pesa in
Kenya, a mobile payment under vodaphone subsidiary Safaricom.
Business has also been enabled online via internet. Companies transact their
services on the website which makes it convenient and reduces costs.
Social life has also been upgraded through availability of advanced technology
in entertainment and media such as radio networks and television, music
systems and internet. Communication via social media also provides a
medium for people to interact and share ideas which is a major aspect of
development. It has led to introduction of improved social media platforms
including the internet, Facebook, Twitter and Skype through the use of
electronic gadgets such as computers and mobile and the mobile phones. All
these make communication easy, cheap and convenient.
The internet has made it possible for people from all over the world to share
knowledge on virtually all fields. This provides information for research
purposes in scientific research. This includes health research about HIV and
AIDS and other epidemics like Ebola, Marburg, Yellow fever, food science
research, medical research for vaccines, synthetic biology, medical theories
and technologies, and climatic research. Researchers can access scientific
information from the internet which links the whole world irrespective of
space and time.
Innovation can be shared as knowledge through institutions that offer
technology courses and inspire creativity in young minds. In this way, human
capacity is built and an enabling environment provided for future innovation.
This spurs economic growth at the national and global level.
Innovation has also led to improvement in education. This is because teachers
can use technology such as projections as their teaching tools so as to cater
for visual aids of learning.
Innovation is playing a significant role in health. Most medical procedures
including tests and treatments are done through technology. In the past it
was difficult to carry out medical checkups because doctors/physicians
didn’t have tools but now, technology has made it very easy.
There are many diseases without cure and many treatments for diseases that
still need to be improved.
In the transport system, technology eases movement of both people
and goods. This is made possible by the existence of various means of
transport such as the road, water or air transportation. Since transport has
made movement over long distances possible, people are able to travel to
other continents and this enhances cultural interaction and international
relationships.
The use of traffic lights to coordinate movement and control traffic congestion
is a result of technology. Innovators are still coming up with new ideas on
how to conserve the environment while still embracing technology. For
example ideas have been proposed on alternative sources of energy apart
from the commonly used fossil fuels.
Agricultural sector has also greatly improved as a result of technological
advancement. Through progress and innovation highly productive seeds,
animal species and environmental-friendly agricultural fertilisers have been
invented. This has improved commercial and subsistence farming in different
global societies, thereby improving global economic development.
Innovation provides a source of income to so many people. Information
Technology experts, for example, in sharing their knowledge through teaching
or in business deals such as mobile phone and other electronics traders are
able to earn a living from it. Businesses also earn revenue for the country,
China for example is widely known for its extensive businesses in mobile
phone trade.
In conclusion, progress in innovation contributes a great deal to science
and technology as it is the backbone of all technology. Without the creation
and invention of new ideas technology and science would not advance.
Technological advancement has far reaching implications most of which are
positive as already discussed as it decreases the need for manpower and is
time saving e.g. use of computers and home appliances such as washing
machines, cookers, among others. Some implications however can be
detrimental. For example: environmental pollution, moral values degradation
due to uncontrolled information from the internet and disruption of natural
relationships among members of a society as people get used to use of
electronic gadgets over interpersonal social interaction.
Exercise 6
In your groups, discuss in detail the impact that science and technology
has had on the Rwandan health sector in the last decade
.
10.5 Extended work
Either
1. Refer to any orphanage in your country. Identify and explain the reasons
for the high numbers of children living in orphanages in Rwanda.
2. What challenges do the caretakers face and have they tried to overcome
them?
Or
You have been asked to find out the causes of the HIV/AIDS prevalence
particularly in your community. What ethical values are you going to observe?
What challenges do public health units face with HIV/AIDS patients and
how have they been tackled?
10.6 Unit summary
Medical research and ethics on HIV and AIDS
1. Be sensitive to the beliefs and culture of people involved.
2. Avoid any form of stigma in the process of research.
3. Seek permission from participations, subjects or their guardians
beforehand.
4. Respect the dignity and rights of all.
Ways in which health education promotes sustainable reproductive
health
1. It imparts skills on how to relate appropriately with people of the
opposite sex.
2. It saves lives and improves reproductive health.
3. It equips women with knowledge on the necessary measures to take
during and after pregnancy in order to have healthy children and also
live healthy lives.
4. It equips adolescents with knowledge on how to manage and prevent
the spread of sexually transmitted infections.
5. It reduces cases of unsafe abortions and maternal deaths.
10.7 Test your competence
1. Discuss the impact of health education on the lives of the people of
Rwanda.
2. Explain how progress in innovation, science and technology haveaffected the medical field and therefore people’s lives.