access to social services such as education and health clinics are also taking their toll: with only one health clinic in the Mikea Forest area and low access to water for bathing, rates of diseases such as tuberculosis, leprosy and skin disease are disproportionately prevalent. Family affiliation Mikea tend to trace their lineage back to specific villages within one or more of three main lineages, associated respectively with the northern, southern and central parts of the Mikea Forest. Most also have relatives living in Vezo and/or Masikoro villages in the region. Many Mikea families have established ziva (a "joking relationship", commonly found in southern and eastern Africa) with the Vohitse Vanovato clan of the Masikoro, which indicates a degree of familial closeness with this subclan. Mikea encampments are typically family groups. These consist of an elder couple, their married sons and daughters-in-law, the grandchildren of these marriages, and the elder couple's own unmarried children of any age. Adult daughters typically move to join their husband's family encampment upon marriage, but married couples often share their time between the husband's or wife's parents' encampments. Family unions are formed through a fandeo ceremony in which the man is presented to his intended bride's family, and the acceptance of her parents legitimizes the union. Children of the marriage are legitimized by the husband's bestowal of presents to his wife's parents. The relationship between the wife's brother (renilahy, "male mother") and her children can be very strong in Mikea marriages, and the renilahy will commonly adopt children that his sister's husband does not legitimize. Both the husband and the wife have the right to divorce at any time and remarry. Polygamy is also practiced. Religious affiliation Like other Malagasy, the Mikea spiritual belief system revolves around respect for ancestors. They also share the common Malagasy belief in a creator god, termed Andrianajanahary. Many Mikea believe in various types of forest spirits (koko), which are associated with certain natural spots in the forest deemed sacred; these sites serve as the focus of various ceremonies, in which rum has spiritual and symbolic significance. The greatest of the nature spirits is Ndrianazo, the lord of the forest. The extended family group, which spreads through multiple encampments, is united around a central priest figure, the mpitoka hazomanga, who officiates over major family ceremonies dedicated to the ancestors. In addition, within each encampment is at least one ombiasy (wiseman)