Academic journal article Journal of Health Population and Nutrition

Perceptions of and Management Practices for Diarrhoeal Diseases by Traditional Healers in Northeastern Nigeria

Academic journal article Journal of Health Population and Nutrition

Perceptions of and Management Practices for Diarrhoeal Diseases by Traditional Healers in Northeastern Nigeria

Article excerpt

INTRODUCTION

Despite the launching of the national programme of Control of Diarrhoeal Diseases (CDD) in Nigeria in 1986, the home management of diarrhoea has remained suboptimal (1-4). Although awareness of oral rehydration therapy (ORT) is high, its use-rate is still low (5); many child caretakers incorrectly prepare sugar-salt solution (SSS)-the recommended home fluid in the Nigerian CDD programme-and use it only for brief periods during the diarrhoea episode (3,4,6); many caretakers also lack appropriate knowledge of the action of ORT and expect that it would stop diarrhoea (4); and about two-thirds of children with diarrhoea in some areas are given drugs, alone or with ORT (5). This situation might be due to conflicts between the culture-specific perceptions, practices, and the recommendations of the CDD programme. This demands understanding of the local cultural beliefs and practices, some of which may be built upon to promote the home management of diarrhoea (7).

Lack of alternatives to medical treatment is associated with increased use of ORT (8). On the other hand, folk assessment of diarrhoea in a medically-pluralistic society may hinder its adoption as the treatment of choice (9).

Nigeria is medically pluralistic. This pluralism includes traditional healers as an important group of caregivers who are usually more readily available than orthodox medical services, especially in rural areas (10). The traditional healers specialize in treating specific folk categories of diarrhoeal illnesses (11-13). Diarrhoea and dehydration are popularly thought of as symptoms of folk illnesses and may be treated as such (11). For example, in Brazil, diarrhoea, perceived to be due to 'evil eye,' may be treated ritually; diarrhoea due to 'sunken fontanelle' may be treated by physical manouvers; and diarrhoea is thought to be due to 'spirit intrusion' by negotiation with the spirit (12). In Cameroon, the traditional treatment is also based on the perceived causes (13). Thus, herbal solution is administered to mothers to restore the quality of 'sour' breast-milk (13). Despite this 'specialization,' the traditional healers can be trained to become effective promoters of ORT (11).

Diarrhoea is an important cause of morbidity and mortality among Nigerian children (14,15). As in other developing countries (11, 13), a good proportion of child caretakers in Nigeria often resorts to the traditional healers and traditional practices in the management of diarrhoea. In this context, the problem of food taboos among the Yorubas is illustrative of the diversity or complexity of traditional medical practices in the management of childhood diseases in Nigeria (16).

Despite the significance of diarrhoea and the involvement of traditional healers in its management, and despite the fact that the knowledge and practices of traditional healers can be built upon and strengthened to promote the appropriate home management of diarrhoea (11,17), no study had, to our knowledge, specifically assessed their role in the home management of diarrhoea in Nigeria. There is also a general need to involve them in disease management and control (10,18,19). This study, part of a larger project that also examined perceptions and practices of caretakers regarding diarrhoea (4,20,2 1), was carried out to provide baseline qualitative data on the beliefs and practices of traditional healers as a first step toward their integration into the national healthcare-delivery system through the CDD programme. The study also compared their perceptions with those of child caretakers in the region (20,21).

MATERIALS AND METHODS

The study focused on two ethnic groups (20,21)-the Kanuris who are predominantly Muslims and the Buras who are almost equally Christians and Muslims. The Kanuris are relatively less literate (western education) than the Buras due to the influence of several decades of Christian missionary activity in their area (Bwala BA. …

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