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Culture and biomedical care in Africa: The influence of culture on biomedical care in a traditional African society, Nigeria, West Africa

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Abstract

Biomedical Care in Africa and the influence of culture on the health-seeking behaviour of Africans can not be underestimated; many African cultures have different understanding of the causes of disease which more often affect our public health system, policy, planning and implementations. The traditional African healer unlike a doctor trained in western biomedicine, looks for the cause of the patient's ailments as misfortune in relationship between the patient and the social, natural and spiritual environments. The complexity of African society with different cultural and religious practices also reflects on the people's attitude and understanding of their health matters. This paper is an overview of the cultural influence on biomedical care in a traditional African society, Nigeria, West Africa. A research on the patients' health seeking behaviour and Primary Health Care service organization in 10 health centres in the five eastern states of the Federal Republic of Nigeria was carried out using a multistage cross-sectional study. A semi-structured questionnaire was administered to the health care providers and patients while an in-depth semi- structured interview was also conducted. We observed there is underutilization of health care services at the primary level because most people do not accept the model of health care system provided for them. Most people believe diseases are caused by supernatural beings, the handiwork of neighbours or vengeance from an offended god as a result of transgressions committed in the past by an individual or parents. This group of people therefore prefers seeking traditional medicine to seeking orthodox medicine and often ends up in the hands of witch doctors who claim to have cure to almost all the diseases. Biomedical care in Africa is influence by culture because of different understanding of what ailment is and also due to limited knowledge of health matters, poverty and ignorance. There is a need therefore to focus on health out-reach programme, communication and enlightment campaign in Africa especially in the rural areas that are more vulnerable and are burdened with many of these diseases.
Culture and Biomedical Care in Africa: the influence of culture on biomedical care
in a traditional African society, Nigeria, West Africa.
1 2
CHUKWUNEKE F N, BDS, MPH, FIIA, FWACS, FICD; EZEONU CT, MB BS, FMC PAED;
3 4
ONYIRE BN MB BS, FWAC PAED; EZEONU PO, MB CH, FACH ARTZ GYNECOLOGIE/GERBURTHILFE
1
.Director Bioethics Unit, Association for Good Clinical Practice in Nigeria (BU-AGCPN). Senior Lecturer/Consultant,
Dept. of Oral and Maxillofacial Surgery, University of Nigeria Teaching Hospital, Enugu.
2. 3.
Consultant, Dept. of Paediatrician, Chief Consultant, Dept. of Obstetrics & Gynaecology,
4
Chief Consultant, Dept. of Obstetrics & Gynaecology, Federal Medical Centre Abakaliki Ebonyi Sate, Nigeria.
ABSTRACT
BACKGROUND: Biomedical Care in Africa and the
influence of culture on the health-seeking behaviour of
Africans can not be underestimated; many African
cultures have different understanding of the causes of
disease which more often affect our public health system,
policy, planning and implementations. The traditional
African healer unlike a doctor trained in western
biomedicine, looks for the cause of the patient's ailments
as misfortune in relationship between the patient and the
social, natural and spiritual environments. The
complexity of African society with different cultural and
religious practices also reflects on the people's attitude
and understanding of their health matters. This paper is
an overview of the cultural influence on biomedical care
in a traditional African society, Nigeria, West Africa.
METHODS: A research on the patients' health seeking
behaviour and Primary Health Care service organization
in 10 health centres in the five eastern states of the
Federal Republic of Nigeria was carried out using a
multistage cross-sectional study. A semi-structured
questionnaire was administered to the health care
providers and patients while an in-depth semi- structured
interview was also conducted.
RESULT: We observed there is underutilization of
health care services at the primary level because most
people do not accept the model of health care system
provided for them. Most people believe diseases are
caused by supernatural beings, the handiwork of
neighbours or vengeance from an offended god as a result
of transgressions committed in the past by an individual
or parents. This group of people therefore prefers seeking
traditional medicine to seeking orthodox medicine and
often ends up in the hands of witch doctors who claim to
have cure to almost all the diseases.
CONCLUSION: Biomedical care in Africa is influence
by culture because of different understanding of what
ailment is and also due to limited knowledge of health
matters, poverty and ignorance. There is a need therefore
to focus on health out-reach programme, communication
and enlightment campaign in Africa especially in the
rural areas that are more vulnerable and are burdened
with many of these diseases.
KEYWORDS: Biomedical Care; influence of Culture;
Africa; Nigeria
Date Accepted for Publication: 23rd November, 2011
NigerJMed 2012:331-333
Copyright Ó2012. Nigerian Journal of Medicine
INTRODUCTION
Primary Health Care (PHC) is accepted as the model for
delivering basic health care to low income populations in
1
developing countriessuch as Nigeria. Since the strength
of a country's primary health care system is associated
with improved population health outcomes for all-cause
2
mortality, Nigeria in 1988 adapted PHC as the
cornerstone of its national health policy till date. Despite
all the efforts and strategies adapted, Nigeria still has a
high level of morbidity and mortality from the diseases
that PHC is expected to control. Comparisons between
communities on health status indicators can reveal the
extent of any differences that exist, including the
dynamic changes which may be helpful in characterizing
the role of modifiable risk factors to the development of
3
these preventable diseases .
PHC programme in Nigeria at present appears to have a
theoretical framework which practice possess new
challenges for understanding and securing the health of
our population. Achieving health for all in Nigeria is a
process that is more than a simple stretching of health
issues, health problems and provision of basic health
facilities. In order to ensure effective implementation of
PHC in Nigeria, the programme should take a look at the
complex dynamics involved in the process considering
not only the wider socioeconomic context but also the
cultural and religious meanings and practices through
which the individual and group engage in health seeking
behaviour. Therefore, to achieve the objectives of PHC as
stated in the Alma Ata Declaration in 1978, our primary
health system must be directed towards the provision of
health services that is shaped around the health needs of
individuals, their families and communities taking into
consideration the socio-cultural construct in Nigerian.
The health system should therefore be responsive to
individual differences, cultural diversity and preferences.
In Nigeria, as it is often the case with most African
countries, understanding of health problems and their
causes differ from community to community, society to
society within the community, from religion to religion
and from culture to culture. Most people believe diseases
are caused by supernatural beings, the handiwork of
neighbours or vengeance from an offended god as a result
of transgressions committed in the past by an individual
or parents. These groups of people therefore prefer
Correspondent: Dr Felix N Chukwuneke, Dept. of Oral & Maxillofacial Surgery College of Medicine UNTH Enugu
+2347064531609
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Nigerian Journal of Medicine, Vol. 21 No. 3, July - September, 2012, ISSN 1115 - 2613
Original Article
The health care systems of Nigeria and most African
countries emergedfrom colonial medical services that
emphasized costly high-technology, urban-based,
9
curative care When Nigeria became independentin the
1960, she inherited health care systems modeledafter the
systems in industrialized western nations that colonized
them. Public health programs of international
development agencies during this period were also
largely targeted at eradicating specific diseasessuch as
10
smallpox, yaws, and malaria Each disease eradication
program operated autonomously, with its own
administration andbudget and very little integration into
11
the larger health system .
There were some successes during this period such as
eradicationof smallpox, chickenpox and yaws. However,
theseshort-term interventions were not addressing poor
12
populations' overall disease burden . The situation
worsened into the early 1970s, as populationscontinued
to expand and experiencing failing health outcomes
necessitating the changes in health policy and emergence
of Alma Ata Declaration in 1978 and Nigeria in 1988
adapted PHC as the cornerstone of its national health
13
policy till date .
Health Seeking Behaviour and the influence of
culture
Several factors play a role in shaping the health-seeking
behaviour of individuals and they include predisposing
variables such as age, gender, culture, religion,
occupation, prior experiences with illness, level of
education, general attitudes towards health services and
knowledge about the presenting illness. Others are the
enabling factors such availability of health services,
financial resources, social network and support services,
perception of the severity of the disease. Behaviours
cannot be deduced from one or various isolated factors.
For example, a certain practice can be correlated with
aetiology, but in the illness models, aetiologies often
have moral implications that give meaning to behaviour.
Identifying key factors relevant to the health-seeking
behaviour is helpful for planning health policy
interventions.
But in order to correctly understand behaviours, these
3
factors need to be contextualized . Health-seeking
behaviour studies acknowledge that health control tools,
where they exist, remain greatly under or inadequately
used. Understanding human behaviour is prerequisite to
change behaviour and improve health practices. Experts
in health interventions and health policy became
increasingly aware of human behavioural factors in
quality health care provision which in African is often
influenced by culture. In order to respond to community
perspectives and needs, health systems need to adapt
their strategies, taking into account the findings from
cultural disposition of the community which may some
seeking traditional medicine rather than orthodox
medicine. Unlike a doctor trained in western
biomedicine, the traditional African healer also looks for
the cause of the patient's misfortune in the relationship
between the patient and the social, natural and spiritual
4
environments and some of these healers claim to
specialize in one or more biomedical aspects, such as
5,6,7
herbalism, midwifery or even surgery .Most of our
rural dwellers more often find succor in the hands of these
local healers who are readily available because they live
within the community. Priority in these situations should
therefore be focused on educating and creating
awareness on proper health-seeking attitude among our
rural populace and these can be supported with not only
ensuring the existence of health centres in these areas but
also provision of adequate infrastructure and health care
services that will meet the needs and demands of the
people.There is a need therefore to assess the health
seeking behaviour of Nigerians as well as service
organization of the PHC providers.
Culture, Religion and Health Care in Nigeria
As a secular state, the Nigerian constitution guarantees
religious freedom. Consequently, many religions are
practiced in Nigeria. Christians predominantly live in the
southern part of the country which comprises of South
West, South-South and South East whereas Muslims live
predominantly in the northern part. Native religions in
which people believe in deities, spirits and ancestor
worship, are spread throughout the country.
Many Muslims and Christians may also intertwine their
beliefs with more unorthodox indigenous ones. Nigeria
has the largest population in Africa with over 250 ethnic
8
groups and more than 510 languages. This has made the
country a complex society with different cultural and
religious practices which also reflects on the people's
attitude and understanding of their health matters within
the same country. Extended families are still the norm
and in fact remain the backbone of the social system in
Nigerian. Grandparents, cousins, aunts, uncles, sisters,
brothers and in-laws all work as a unit through life.
Family relationships are guided by hierarchy and
seniority (Familismo). Individuals turn to members of
the extended family for financial aid and guidance, and
the family is expected to provide for the welfare of every
member even in time of ill health.
Therefore, individual that benefited from the family
structure is expected to owe allegiance to the system in
return and in certain situation, do not have autonomy to
decide on his or her health matters without the family
input. However, in most urban areas these days, with the
proliferation of western culture, the role of the extended
family system is gradually diminishing but a strong
tradition of mutual caring and responsibility among the
members still remains.
332
Nigerian Journal of Medicine, Vol. 21 No. 3, July - September, 2012, ISSN 1115 - 2613
Health Care (1978). In: Werner, David, Sanders,
David. Questioning the Solution: The Politics of
Primary Health Care and Child Survival: Health
Wrights, Palo Alto, California; 1997:pp 18-20.
3. Conner M, Sparks P (1995). The Theory of Planned
Behaviour and Health Behaviours, in Predicting
Health Behaviour (Conner, M. & Norman, P. eds.).
Buckingham; Open University Press
4. De Smet P (2000). African herbs and healers.
Compass Newsletter for Endogenous Development;
No.3: 26-28
5. Darshan S and Bertus H (2000). Vitality, health and
cultural diversity. Compas Newsletter for
Endogenous Development; No.3: 4 - 7.
6. De Smet P (1999). Herbs, health and healers:
Africana as ethnopharmacological treasury. Bert en
Dal. Afrika Museum.
7. Juan S, Ponce D, Lisperguer G (2000). Native cures
for body and spirit. Compas Newsletter for
Endogenous Development; No.3: 38-39.
8. Lewis P (2007). Growing Apart: Oil, Politics and
Economics Changes in Indonesia and Nigeria.
University of Mitchigan Press. 2007; P. 132.
Retrieved on 2008-11-23.
9. Morgan L (2001). Community participation in
health: perpetual allures, persistent challenge. Health
Policy and Planning; 16 (3): 221-230.
10. Scram R (1971). History of Nigerian Health
Services, (Ibadan, Nigeria: University of Ibadan
Press.
11. Werner D et al. (1997). Questioning the Solution: The
Politics of Primary Health Care and Child Survival
(Palo Alto, Calif: Healthwrights, 1997).
12. Ehiri J and Prowse JM (1999). "Child Health
Promotion in Developing Countries: The Case for
Integration of Environmental and Social
Interventions?" Health Policy and Planning 1999; 14
(1): 110.
13. Obionu CO (2006). Primary Health Care for
nd
Developing Countries (2 Edtn). University of
Nigeria College of Medicine: Delta Publications
Nigeria Limited.
14. Hausmann-Muela, S, Muela Ribera J, Mushi, A.K
(2002). Tanner M. Medical syncretism with
reference to malaria in a Tanzanian community.
Social Science & Medicine; 55:403-413
15.Smith D, Bryant J (1988). "Building the
Infrastructure for Primary Health Care: An Overview
of Vertical and Integrated Approaches," Social
Science and Medicine; 26 (9): 909 - 917.
16. Akerele O. WHO's traditional medicine pogramme:
progress and perspectives. WHO Chronicle 1984;
38(2):76-81
ISBN
0-472-06980-2.http://books.google.com/books?id=T4-
rlVeb1n0C&pg=PA132.
[Abstract/Free Full Text]
3
cases may be centered on behavioral studies. Culture and
personal beliefs play very important role to the health-
seeking behaviour of the people especially in most rural
areas. Some believe that most of the health problems are
spiritually related and therefore do not need the attention
of an orthodox medicine.
This belief is not exceptional to Nigerian situation; in
14
Tanzania for example, Hausmann-Muela et al.
described how malaria and witchcraft can be interrelated
in illness interpretations. According to them among the
Tanzanian population, the belief that witchcraft can
impede biomedical treatment from working or malaria
parasites from being detected in the blood is the fact that
witchcraft hides the parasites by putting a veil between
the body and the outside. This examples show sadly how
concepts from different knowledge sources could
amalgamate and give rise to new, syncretistic
interpretations, rather than how new knowledge would
replace existing concepts.
The logic of interacting concepts explains much of
treatment-seeking behaviour, as becomes clear in the
case of malaria and witchcraft. An individual suffering
from malaria who believed he or she has been bewitched
will seek treatment from a traditional healer who can
remove the witchcraft prior to attending the hospital for
malaria treatment if at all. Typically, observed treatment
sequences with alternating use of traditional and
biomedical resources follow logic of interpreting and re-
interpreting illness, using merged concepts from
15
biomedicine and local beliefs in witchcraft .
In conclusion the misconception that most diseases are
supernatural and do not need orthodox treatment thereby
exposing individual to the lure of witch doctors who
claim to have a cure to almost all the diseases, and lack of
awareness on the part of the communities about their own
health needs are chain reaction that leads to under
utilization of Primary Health Care Services in Nigeria.
Therefore, to increase the health-seeking behavior of
Nigerians and for the effective implementation of PHC in
Nigeria, the service organizations should among other
things be properly structured to understand and
appreciate the need for health outreach programme
especially in the rural communities. The local
government and the health caregivers should also
collaborate with private and public health providers and
establish a communication network linking health care
institutions and other care-giving systems like traditional
healers to ensure access to quality health care.
REFERENCES
1. World Health Organization (1978). The Alma-Ata
Conference on Primary Health Care: WHO
chronicle; vol. 32: 409-30.
2. Alma Ata and the Institutionalization of Primary
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Background. Malaria remains a public health issue in the world especially in resource-limited countries, where it has a negative impact on their economy. There is a body of recent reports outlining the crucial role of enterprises in control of malaria. The present study aimed at determining the knowledge, attitudes, and practices (KAP) towards malaria among employees from enterprises in the town of Douala, Cameroon. Methods. A cross-sectional descriptive study took place between February 2015 and June 2017 in 14 enterprises of Douala. A pretested structured questionnaire was used to document sociodemographic parameters and KAP of employees. Results. A total of 2705 employees, mainly consisted of males (83.1%), were included in the study. The mean age of respondents was 37:33 ± 9:78 years (range 19-87). Over 90% of respondents knew at least one sign/symptom (94.1%) and associated malaria transmission with mosquito bites (91%). Artemether-Lumefantrine (36.2%), under commercial name "Coartem," was the most cited antimalarial drug. Nearly 98.2% considered malaria as a dangerous disease. Misconceptions on malaria transmission, causative agent, prevention, and treatment were recorded. More than 77% of employees declared to use mosquito bed nets to prevent malaria. About 63% employees declared going to the hospital when they were feel having malaria while 12.9% were seeking care through street drugs. Educational level, socioprofessional category, area of residence, and enterprise were significantly associated with the level of knowledge on malaria transmission, causative agent, and preventive and treatment practices. Conclusion. This study showed a good level of knowledge, attitudes, and practices of employees even though some misconceptions and bad behaviors are still present especially in people with a low level of education. Hence, there is a need to develop strategies for sensitization especially in this fraction of employees. In addition, enterprises could be an interesting approach in order to control malaria in Cameroon.
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