Self-rated health (SRH) is a validated epidemiological measure that captures an individual’s overall health perception and predicts morbidity and mortality. Despite extensive research on SRH among older adults in India, evidence on its transition across the life course remains limited. Using data from 70,595 individuals aged 45 years and above from the Longitudinal Aging Study in India (LASI) 2017–2018, this study examined transitions in SRH from childhood to older adulthood. An adverse SRH trajectory was defined as a shift from good childhood health to poor or fair health in later life. Descriptive, bivariate, and multivariable logistic regression analyses were conducted. Overall, 51% of older adults experienced an adverse SRH trajectory. Higher odds were observed among women (AOR: 1.30), individuals with substance consumption (AOR:1.24), chronic multimorbidity (AOR: 3.37), functional limitations (AOR: 2.03), and depression (AOR: 1.51). Early-life disadvantages – child labour, child marriage, and persistent household poverty – were also significant risk factors. In contrast, higher education and participation in social and physical activities were protective. These findings indicate that an adverse subjective health trajectory is shaped by cumulative life-course exposures rather than ageing alone. Strengthening early-life social investments and community-based wellness initiatives is vital to promote healthy and equitable ageing in India.

This cross-sectional study examines differentials in age at marriage, collecting data from 665 ever-married women in Howrah district, West Bengal, using a mixed-methods approach across three generational cohorts. Quantitative analyses included ANOVA and multinomial logistic regression, complemented by qualitative interviews to contextualize marriage timing. Results revealed a non-linear trajectory of marriage age across generations. Mean age at marriage was 21.4 years, 23.2 years, and 19.5 years in Generation I, Generation II, and Generation III, respectively, with significant differences. MLR results showed respondents in Generation II had higher odds of marrying at ages 19–24 (RRR = 1.5, CI = 0.6–2.7) and ≥25 years (RRR = 1.4, CI = 0.9–4.0), whereas Generation III women had lower odds at ages 19–24 (RRR = 0.3, CI = 0.2–0.9) and ≥25 years (RRR = 0.6, CI = 0.1–0.9), compared to Generation I. Urban women showed delayed marriage at ages 19–24 (RRR = 3.1, CI = 2.6–11.5) and ≥25 years (RRR = 4.5, CI = 2.2–15.5). Higher educated women increased the likelihood of delaying marriage at ages 19–24 (RRR = 1.6, CI = 0.4–1.9) and ≥25 years (RRR = 1.2, CI = 0.8–1.6). Fathers’ secondary education was associated with marriage at ages 19–24 (RRR = 1.5, CI = 1.0–2.3) and ≥25 years (RRR = 4.6, CI = 1.3–15.8), and fathers’ higher education was associated with marriage at ≥25 years (RRR = 2.6, CI = 1.3–12.8); mothers’ secondary education was associated with marriage at ages 19–24 (RRR = 1.7, CI = 1.0–2.9) and ≥25 years (RRR = 3.1, CI = 1.9–12.3), and mothers’ higher education was associated with marriage at ≥25 years (RRR = 3.2, CI = 1.6–10.4). Respondents in white-collar jobs were more likely to delay marriage at 19–24 (RRR = 1.5, CI = 0.3–2.0) and ≥25 years (RRR = 1.6, CI = 0.8–3.4). White-collar employment of fathers increased the odds of marriage at ages 19–24 (RRR = 1.7, CI = 0.7–2.1) and ≥25 years (RRR = 1.6, CI = 0.4–2.6) and of mothers at ages 19–24 (RRR = 1.2, CI = 0.4–1.6) and ≥25 years (RRR = 1.1, CI = 0.3–1.9). Women from the upper wealth quintile were more likely to marry at ≥25 years (RRR = 1.2, CI = 0.5–2.8). Muslim women showed significantly less likelihood to marry at ≥25 years (RRR = 0.2, CI = 0.1–0.6). Ethnographic narratives revealed tensions between aspirations for daughters’ education and parental anxieties related to employment insecurity, dowry, and premarital relationships, shaping marriage decisions.

What can be learned about pandemic preparedness from greater attention to perspectives of people who live in regions labelled as ‘hotspots’ for disease outbreaks? And how might such attention require us to reconfigure science, policy, and practice – as part of a broader shifting of power in pandemics? These are the questions that motivate and are explored through the papers in this special issue on pandemic preparedness, for which this paper serves as Introduction. All the contributions to this special issue present perspectives, experiences, and reflections from African settings, drawing on research co-designed and conducted in close engagement with local communities or in dialogue with African scientists and public health actors. They approach biosocial questions from the concerns of the disciplinary fields of social, medical, and political anthropology, of engaged interdisciplinary social science, and, crucially, of embedded, ‘grassroots’ fieldwork by researchers who have grown up with the communities they are studying. The team bringing these complementary areas of expertise came together for a collaborative programme on ‘Pandemic preparedness: local and global concepts and practices in tackling disease threats in Africa’ supported by a collaborative award from the Wellcome Trust during 2018–2023. This special issue thus forms part of wider advocacy for rethinking pandemic preparedness and for the value of anthropology in informing its meanings and practices, now more than ever.

Globally, child marriage is a persistent issue, adversely affecting the rights and well-being of girls. With a special focus on religious affiliation, this study explores the contributing factors leading to child marriage, such as cultural norms, religious beliefs, and socioeconomic conditions. From the Census of India 2011 data, percentage distributions of child marriage were used to assess the trends and magnitude of child marriage over the years. From NFHS-5 data, bivariate and multivariate analyses were conducted to assess factors like education and wealth index. Spatial analysis techniques, including Moran’s I statistics, helped identify the geographic distribution of child marriage. Findings reveal a history of relatively high child marriage rates among Muslims and their faster decline over the last decades. In 2011, under-14 marriages among Hindus exceeded 1.03% more than that of Muslims, with a 0.33% higher incidence of under-18 marriages among Muslims. The sample-based NFHS-5 study highlights significant disparities in child marriage based on the sample populations’ religious affiliations, regions, social categories, education, and wealth. In conclusion, the issue transcends religious boundaries, is rooted in broader social and economic contexts, and advocates for multidimensional interventions.

Persons with mental illnesses may experience stigma from their immediate family members in addition to other forms of stigma. The researchers used semi-structured interviews to investigate the experiences of familial mental illness stigma among 15 people diagnosed with mental illnesses in a mid-sized city in Canada. Five themes that spoke to participants’ experiences of familial mental illness stigma and ways to reduce it were identified by the investigators. The themes included: diagnosis as a ‘double-edged sword,’ potential familial isolation, familial stigma as societal stigma localized, stories of acceptance and support, and confronting potential familial mental illness stigma. Participants’ narratives indicate that familial mental illness stigma is rooted in the broader social or public stigma, which sees its way into familial relations as well. This stigma takes various forms, including relationship bias or unfair treatment, breakdown in romantic relationships, loss of status, verbal and emotional abuse, exclusion from decision-making, and alienation within their immediate and extended families. Familial mental illness stigma experiences negatively impact participant’s psychological well-being and personal empowerment. However, participants also shared ways that family members create supportive environments or actively confront or prevent stigma. Overall, this study has contributed to knowledge on mental illness stigma, particularly familial mental illness stigma from the perspective of participants living with a mental illness in a high-income country. Suggestions for future research include a focus on strategies to prevent ongoing familial mental illness stigma, and large-scale studies to explore familial mental illness stigma to understand why families might themselves at times perpetrate stigma.

Sexual-identity disparities in substance use among U.S. veterans, and whether mental-health treatment mitigates risk for those with depression, remain under-examined. Using data on veterans from the 2021–2023 National Survey on Drug Use and Health (NSDUH; N = 7,212), disparities were estimated in past-30-day nicotine, marijuana, binge drinking, and polysubstance use, as well as severe psychological distress (K6≥13) and past-year suicidal ideation. Guided by a biosocial/minority-stress framework, multiple imputation was applied (m = 20) and survey-weighted logistic regression adjusting for age, year, race/ethnicity, sex, education, metro status, insurance, marital status, employment, and income; among veterans with a past-year major depressive episode (MDE), interactions were tested between sexual identity and (a) depression-related clinical contact (DRC) and (b) prescription medication for depressive feelings. Bisexual veterans showed the highest prevalence of marijuana (33.5%) and polysubstance use (30.6%), exceeding that of heterosexual (11.8%, 14.9%) and gay/lesbian veterans (24.0%, 18.8%). Models restricted to veterans with MDE, past-year DRC (DRC defined as any visit or conversation with a health professional about depressive feelings) moderated risk for gay/lesbian veterans, with DRC associated with lower odds of binge drinking and polysubstance use; prescription medication showed a similar moderating pattern for nicotine and polysubstance outcomes. Findings for severe psychological distress and suicidal ideation were mixed and consistent with confounding by indication. Results should be interpreted cautiously given the cross-sectional data, self-report, small sexual-minority subgroups, and non-aligned recall windows (past-year mental health/treatment vs past-30-day substance use). Overall, sexual-identity disparities in substance use are evident, with bisexual veterans bearing the greatest burden, and engagement in DRC and medication among veterans with MDE, particularly gay/lesbian veterans, showing associations consistent with a buffering effect of affirming care. Longitudinal and qualitative studies are needed to test causal pathways and to illuminate lived experiences, and policy/clinical efforts should expand culturally competent, integrated services and routine SOGI data collection to monitor and reduce inequities.

This ethnographic study, conducted as part of the Pandemic Preparedness Project, explores the pandemic preparedness of communities in NG and its satellite settlements within Kailahun District, Eastern Province, Sierra Leone. The research site was particularly significant due to its history as one of the hardest-hit areas during the 2014–16 Ebola outbreak. NG is served by a Peripheral Health Unit (PHU) that provides health services to seven villages, as well as one distant village far from its designated facility. The study employed long-term observational research methods, where the researcher lived within the community, becoming an integrated observer familiar with local customs and daily life. This ethnographic approach aimed to understand the health-seeking behaviors of residents following the Ebola crisis. The onset of the Covid-19 pandemic during the study period shifted the focus to examine how the community understood and responded to a new pandemic threat. Additionally, the study reflects on the challenges faced by female social scientists in Sierra Leone, where few are trained in ethnographic methods. This article offers insights into the process of conducting ethnographic research in a challenging context, providing valuable guidance for other female researchers seeking to engage in similar bio-social studies.

Induced abortions (IAs) constitute a fundamental right contributing to women’s reproductive sexual health allowing them to decide whether they wish to avoid, postpone, space, or conclude their motherhood. In this study, fertility control through IA is analysed according to the age combined with the individual and contextual characteristics of the women. Data from the Voluntary Termination of Pregnancy Statistics (Ministry of Health) and the Vital Statistics (Movimiento Natural de la Población, National Statistics Institute) were combined to capture all pregnancy outcomes, including IAs, live births, stillbirths, and late foetal deaths. Binary logistic regression models were applied to each age group (15–19, 20–29, 30–39, and 40–44 years) to calculate the likelihood of opting for an abortion based on whether individuals have a partner, the number of children, and adjusted for other sociodemographic variables. In the early reproductive stages, the probability of opting for an IA was higher in women without a partner than in those with one. In contrast, in the later years of the reproductive cycle, women with two or more children were more likely to opt for an IA, indicating their desire to stop childbearing. The likelihood of opting for an IA varies according to the woman’s age. Furthermore, sociodemographic characteristics within each group of age undergo significant changes. A more detailed analysis of the reasons leading to the choice of abortion is necessary. Additionally, this study serves as valuable input for family planning public policies.

This paper compares community responses to Ebola and Covid-19 in two regions of southern and eastern Sierra Leone with reference to the theory of institutional dynamics proposed by the anthropologist Mary Douglas. Institutions, Douglas argued, are conveyed by styles of thought, shaped by the ways human communities, through everyday practices, reinforce systems of classification and denotation. Pandemic advice to ‘follow the science’ proved problematic, since there is no single institution of science, and institutions never stand alone but are bundled with other institutions, reflecting the manifold and intertwined practices of human social life. The paper explores some of the ways a traumatic epidemic of Ebola Virus Disease in Sierra Leone shaped a distinctive local response to this deadly infectious disease in the absence of an effective vaccine. This local approach emphasised social rules based on ideas about sequestration and testing. Communities then proposed to continue this rules-based approach to the pandemic of Covid-19 and showed little initial enthusiasm for vaccination. With Ebola, the adoption of rules resulted in dramatic drops in infection rates. But Covid-19 spreads in different ways, and good results from the application of social rules were much less apparent. The paper shows how communities began to grapple with this new situation. In some cases, vaccine hesitation was overcome by treating the requirement for vaccination as a new form of social discipline. More generally, it is concluded that epidemiologists need to pay specific attention to institutions and institutional dynamics in order to better understand and anticipate public reactions to new disease threats.

Despite biomedical explanations for diseases being increasingly accepted in sub-Saharan Africa, traditional African explanatory models of illness remain widespread. This study sought to understand local explanatory models for illness and patient experiences with different traditional health practitioners (THPs) among a population of rural women in Limpopo, South Africa. This was a cross-sectional qualitative study in which eighty-two in-depth interviews were conducted, and the data were thematically analysed. Study findings indicate that 68% of participants believed illnesses can be caused by bewitchment, and these diseases were often considered too taboo to even be discussed. High percentages of participants also believe that THPs can cure illnesses that medical doctors cannot treat. Additionally, several illnesses were identified related to traditional practices and cultural beliefs, which can only be cured traditionally, via THPs. While the hospital/clinic is often first approached, its failure to resolve illness can often be seen as a sign of the spiritual origin of the ailment. This study is a pre-context for more research around biomedical/traditional medicine collaborations.

This study examines how China’s former one-child policy has shaped fertility attitudes among the Chinese diaspora in the United States. Through semi-structured qualitative interviews with thirty reproductive-age women of Chinese descent, either born in China or first-generation immigrants to the United States, this study explored opinions towards the policy, self-reported impact on reproductive decision-making, and attitudes towards family size. Participants were recruited from an internet-based survey distributed through cultural groups on social media, paper flyers, and email listservs. Interviews were analysed using the principle of thematic analysis by three authors, who met after coding to resolve disagreements. The mean age of participants was 33. Six participants (20%) used an interpreter. Eighteen participants (60%) were born in China. The range of pregnancies was 0–5, and the range of births was 0–2. Authors found that while participants were no longer directly constrained by the one-child policy, many continued to demonstrate preferences for fewer children. Financial strains, resource allocation, societal shame, and internalised social norms emerged as key themes. These themes echo messages promoted during the one-child policy era through propaganda and enforcement measures, such as audits of family registrations, rewards for compliant families, fines, mandatory IUDs, or sterilisations for noncompliant ones, and even forced abortions for ‘unauthorized’ pregnancies. These messages reinforced that small families were more appropriate. These findings suggest a lasting cultural shift towards fewer children as a result of the policy, even after emigration. They also carry theoretical implications towards understanding the long-term social and psychological consequences of reproductive mandates and the generational transmission of policy-shaped fertility norms. This study offers a perspective for nations currently implementing pronatalist fertility regulations. These findings highlight the role of historical policies in shaping contemporary reproductive perspectives, family dynamics, and potentially, engagement with medicine beyond geographic, political, and temporal boundaries.

Vaccines for COVID-19 began to be available in Africa from mid-2021. This paper reports on local reactions to the possibility of vaccination in one West African country, Sierra Leone. We show that the history of institutionalisation of vaccine is highly relevant to understanding these reactions. Given lack of testing for the disease, medical authorities could not be sure whether there was a hidden epidemic. In addition, many people associate vaccination with care of children under 5 years, and not adults, and an emphasis on vaccinating the old at first seemed strange and worrying. This paper examines evidence from ethnographic studies in two rural areas selected for varying exposure to Ebola Virus Disease (EVD), supplemented by some interviews in two provincial urban centres, Bo and Kenema. We describe local ideas about vaccination (maklet) and body marking with leaf medicine (tεwi). We asked about attitudes to the idea of COVID-19 vaccination both before and after vaccines were available. A number of reasons were given for scepticism and hesitation. These included lack of experience with vaccines for adults and lack of experience of COVID-19 as a severe disease. Medical evidence suggests the vaccination protects against serious illness, but local people had their own views about control of infection, based both recent experience (notably EVD) and the history and institutionalisation of vaccination and public health measures in Sierra Leone more broadly.

This paper examines how past experience and legacies of epidemics shaped Sierra Leone’s response to COVID-19 and how these influences evolved over time. COVID-19 unfolded in the wake of the West African Ebola epidemic (2013–2016), a crisis which was unprecedented in scale. Despite differing markedly in both transmission patterns and clinical outcomes, the Sierra Leonean government repeatedly invoked Ebola when responding to COVID-19, framing the new outbreak through the lens of the old. Drawing on ethnographic fieldwork and interviews with policymakers, response personnel, health workers, and members of the public, the paper analyses how Ebola’s imprint surfaced across four domains of the COVID-19 response: public and governmental framings, the design and implementation of key control measures, disputes over incentives and hazard pay, and practices of data and testing. It shows that when confronting a new outbreak, the past manifests in diverse ways. The analysis reveals how these ‘epidemic pasts’ – contained in lessons, memories, legacies, and assumptions – actively constitute ‘epidemic presents’; and should be understood as politically mobilised and socially contested, shaping responses in both enabling and constraining ways. As such, it is suggested that past experience has been under-explored in preparedness and response, and that formal ‘lessons learned’ exercises offer a limited view of how the past is relevant.

Uganda has received praise for its success in dealing with the COVID-19 pandemic. This opinion piece uses publically available data from Johns Hopkins University to suggest that it is far from clear whether the Public Health and Social Measures (PHSM) introduced in Uganda influenced the course of the first outbreak. In addition, the analysis of data from the second and third waves in Uganda suggest that government action had little or no effect on these outbreaks. The dominant narrative of successful PHSM, therefore, needs to be reconsidered, and alternative explanations for the low rates of COVID-19-related mortality in the country need to be further understood.

Vaccination is one of the most recognised strategies in public health for preventing the spread of epidemics, and the availability of a vaccine is often expected by health actors to be a ‘game-changer’. However, the COVID-19 (coronavirus disease 2019) vaccine in Senegal was not the magic bullet that the international community expected. A very low vaccination coverage rate (less than 10% by April 2023) was observed in this country, once considered a model in West Africa for its epidemic response. Beyond the population’s alleged hesitancy to be vaccinated, was a lack of preparedness to blame? Previous analyses show that outbreak preparation limited to standard interventions is not sufficient in the face of the social, cultural, and political configurations of each epidemic context and that uncertainty limits response capacity. This paper examines the social life of the COVID-19 vaccine to identify the forms and contextual dimensions of uncertainty related to immunisation in Senegal. The authors explore how vaccination was implemented and compare experiences with the preparedness process, to offer insight on uncertainties. Using Stirling’s theoretical model that defines various expressions of incertitude, the authors identify four nexuses at various stages of the social life of COVID-19 vaccine in Senegal: (1) material uncertainty related to vaccine availability, (2) ambiguity of the population about the purpose of vaccination and the risks of the disease, (3) uncertainty related to side effects, and (4) uncertainty about vaccination strategies shared by scientific and health authorities. These uncertainties were only partly considered in the preparedness process, for they are related to systemic structural dimensions and reflect the impact of global/regional powers on the local level. The findings of this research are relevant not only to support better communication around vaccines in Senegal but also more generally to the prevention of emerging epidemics shaped by human behaviours.

The deliberations for the Pandemic Accord have opened an important moment of reflection on future approaches to pandemic preparedness. The concept had been increasingly prominent in global health discourse for several years before the pandemic and had concretised into a set of standardised mainstream approaches to the prediction of threats. Since 2019, the authors and the wider research team have led a research project on the meanings and practices of preparedness. At its close, the authors undertook 25 interviews to capture reflections of regional and global health actors’ ideas about preparedness, and how and to what extent these were influenced by Covid-19. Here, an analysis of interview responses is presented, with attention to (dis)connections between the views of those occupying positions in regional and global institutions. The interviews revealed that preparedness means different things to different people and institutions. Analysis revealed several domains of preparedness with distinct conceptualisations of what preparedness is, its purposes, and scope. Overall, there appear to be some changes in thinking due to Covid-19, but also strong continuities, especially with respect to a technical focus and an underplaying of the inequities that became evident (in terms of biosocial vulnerabilities but also global-regional disparities) and, related to this, the importance of power and politics. Here, the analysis has revealed three elements, cutting across the domains but particularly strong within the dominant framing of preparedness, which act to sideline direct engagement with power and politics in the meanings and practices of preparedness. These are an emphasis on urgent action, a focus on universal or standardised approaches, and a resort to technical interventions as solutions. A rethinking of pandemic preparedness needs to enable better interconnections across scales and attention to financing that enables more equitable partnerships between states and regions. Such transformation in established hierarchies will require explicit attention to power dynamics and the political nature of preparedness.