Willing the Spirits to Reveal Themselves: Rural Kenyan Mothers' Responsibility to Restore Their Children's Health

Women's contributions to the improvement and maintenance of health are being acknowledged the world over. Recent studies show that most health care is domestic and that women provide nearly 95 percent of this care. Their role as healers, nurses, doctors, folk practitioners, and lay therapists has also been recognized. This research report analyses exorcism as a special function performed by Duruma mothers on behalf of their ailing children. The women represent their children and identify the spirit(s) responsible for illnesses. This role is based on Duruma recognition of the close relationship between mothers and their children, specifically through pregnancy, lactation, and daily contact. For local people who believe in the spirit world, mothers' spirits are held to be responsible for exorcising children's illnesses. Thus health production by Duruma women goes a step further than that of women in other communities. [mothers, childhood illnesses, traditional healing, Duruma, Kenya]     

Traditional Medicine and Childcare in Western Africa: Mothers’ Knowledge,Folk Illnesses,and Patterns of Healthcare-Seeking Behavior

Background

In spite of the strong role of traditional medicine in childcare in the pluralistic healthcare system in Western Africa, little information is known on mothers’ domestic plant knowledge. Identifying local perspectives and treatments of children’s illnesses, including folk illnesses, is essential to having a comprehensive understanding of how mothers make healthcare treatment decisions. We aimed to identify which infant illnesses Beninese and Gabonese mothers knew to treat with medicinal plants and for which illnesses they sought biomedical care or traditional healers.

Methods

We conducted 81 questionnaires with mothers in Bénin and Gabon and made 800 botanical specimens of cited medicinal plants. We calculated the number of species cited per illness and the proportion of participants knowledgeable on at least one herbal remedy per illness. Using qualitative data, we described folk illnesses in each country and summarized responses on preferences for each of the three healthcare options.

Results

Participants from both countries were most knowledgeable on plants to treat respiratory illnesses, malaria, diarrhea, and intestinal ailments. Mothers also frequently mentioned the use of plants to encourage children to walk early, monitor the closure of fontanels, and apply herbal enemas. Major folk illnesses were atita and ka in Bénin and la rate and fesses rouges in Gabon. Traditional healers were reported to have specialized knowledge of cultural bound illnesses. Malaria was frequently cited as an illness for which mothers would directly seek biomedical treatment.

Conclusion

Mothers largely saw the three systems as complementary, seamlessly switching between different healing options until a remedy was found. Folk illnesses were found to give insight into local treatments and may reveal important neglected diseases. Due to high reported levels of knowledge on treating top statistical causes of infant mortality and folk illnesses, mothers’ medicinal plant knowledge should be included in the analysis of healthcare-seeking behavior for childcare.     

Mother-infant contact and maternal maintenance activities among free-ranging rhesus monkeys

Mother-infant dyads were observed among three populations of rhesus monkeys (Macaca mulatta) in India and Nepal. Physical contact between mothers and infants, essential for effective maternal care in rhesus, was found to be influenced by the mothers' feeding behavior. As early as the second week of life, infants exhibited a diminished probability of being in contact with their mothers if their mothers were feeding rather than resting. Rhesus mothers disproportionately rejected their infants within feeding contexts, indicating that mothers were actively discouraging contact attempts by their infants during feeding bouts—perhaps because an active infant, if it remained in contact, would diminish its mother's foraging efficiency. In contrast to the mothers' feeding behavior, mother-infant contact was found to be little influenced by maternal locomotion. Most infants were found to be neither disproportionately in, nor out of contact while their mothers were in motion. However, as the amount of time mothers spent walking increased, so did the probability that infants would be carried. These data suggest that rhesus mothers behave so as to minimize their energetic costs during locomotion.     

Letting the Air Out: <Emphasis Type="Italic">Aire</Emphasis> as an Empty Signifier in Oaxacan Understandings of Illness

“Air (aire, also aigre) in the body” is a frequent explanation of illness according to the traditional medical beliefs in Mexico. Anthropologists have generally scrutinized aire in the context of other common folk illnesses treated by traditional healers (curanderas). However, drawing on my research in the communities of Northern Oaxaca I suggest that aire occupies a more distinct position in the folk medical cosmology than it has usually been credited with. This distinction rests on the notion’s exceptional ambivalence and openness to multiple interpretations. “Air” is recurred to as the cause of illness mainly in situations where every other explanation, either “traditional” or “biomedical,” seems to be inadequate. The physical properties of air—its transparency, invisibility, apparent immateriality, near omnipresence, and virtual “nothingness”—render it a suitable explanation of the last resort. Local understandings of what aire “is” are often vague and elusive, and in many respects the term functions in folk medical discourse as an “empty signifier.”     

Effects of nonmaternal restraint on the vocalizations of infant rhesus monkeys (Macaca mulatta)

This study explored the effects of restraint by females other than the mother on the vocalizations of infant rhesus macaques (Macaca mulatta) in a captive social setting. In this species, females are very attracted to young infants and will frequently approach, groom, and hold the infant. Incompetent handling, abusive behavior, or extended periods away from the mother that prevent the infants from nursing represent potentially significant risks for infants. Vocal responses to such risky conditions appear to be the infants' only means to promote a return to their mothers. We examined the association between the severity of the threat posed to the infant and the nature of its vocal response to restraint, and whether the infants' calls influenced the behavior of their mothers or captors. The results suggest that situations posing greater risks for the infants, i.e., longer periods of restraint, were associated with a greater use of noisy screams. Furthermore, mothers' responding was associated with a greater use of noisy screams as well. The mothers' reactions, however, could be described as cautious, and consisted mostly of closer monitoring; such tempered response might be related to the risk of injury to the infant that could result from a more forceful and direct attempt at retrieval.     

Ecological and Technological Knowledge of Fire: Aborigines Versus Park Rangers in Northern Australia

The attitudes held by Euro-Australians about "bush fires" are markedly different from those of Aborigines. These contrasting perspectives confront each other in different practices of prescribed burning employed by Aborigines and Australian National Parks and Wildlife Service (ANPWS) rangers at Kakadu National Park in the Northern Territory. A large part of the problem that ANPWS personnel have in understanding Aboriginal knowledge and practice involves the perceptions that Euro-Australians have about "simple technologies," "aboriginality," and what is or is not "traditional."     

Serotonin transporter allelic variation in mothers predicts maternal sensitivity, behavior and attitudes toward 6-month-old infants

Maternal behavior in the new mother is a multidimensional set of responses to infant cues that are influenced by the mother's early life experiences. In this study, we wanted to test if mothers' early life experiences and mothers' genotype have interactive effects on maternal behaviors and attitudes, something which has not been previously explored. In a sample of 204 mothers, we assessed maternal genotype at the serotonin transporter-linked polymorphic region (5-HTTLPR) and an adjacent upstream polymorphism (rs25531), together giving rise to three alleles: short (S), L(G) and L(A). Controlling for maternal age and parity, we showed that this genotype can predict differences in maternal sensitivity at 6 months postpartum: mothers with an S (or the functionally similar L(G)) allele were more sensitive than mothers who lacked the allele during a 30-min recorded mother-infant interaction (F (4,140) = 3.43; P = 0.01). Furthermore, we found highly significant gene-environment interactions in association with maternal behavior, such that mothers with no S or L(G) alleles oriented away more frequently from their babies if they also reported more negative early care quality (F (5,138) = 3.28; P = 0.008). Finally, we found significant gene-environment associations with maternal attitudes; mothers with the S allele and with greater early care quality scored higher on ratings of their perceived attachment to their baby (F (5,125) = 3.27; P = 0.008). The regression results show significant interactions between the reported quality of care mothers received from their own parents and genotype on both their frequency of orienting away from the infant during the interaction (F(5, 138) = 3.28; P = 0.008, Fig. 1a) and their perceived attachment feelings to the infant (F(5, 125) = 3.27; P = 0.008, Fig. 1b); however the direction of the effects for these two outcome measures were different from one another. With increasing care quality, mothers with the L(A)L(A) genotype (no S or L(G) allele) oriented away less frequently, while S or L(G) allele carriers showed no significant change. In contrast, with increasing early care quality. L(A)L(A) (no S or L(G) allele) mothers scored lower on perceived attachment to their infants, whereas S or L(G) allele carrying mothers scored higher. [corrected].     

The development of range of action in infant cynomolgus monkeys (Macaca fascicularis) reared by restrained mothers

In order to study the effects of the mothers' range of action on the development of their infants' range of action during the first year of life, mother cynomolgus monkeys were restrained in their range of action by penning them in a separation cage within the large cage of the harem group they belonged to. The infants, however, could leave their mothers' separation cage. The control group consisted of infants growing up with unrestrained mothers in the same group. It appeared that infants of restrained mothers were initially retarded in the development of their range of action but at the end of the first year they did not differ anymore from infants of unrestrained mothers. It is concluded that the maternal range of action only temporarily affects the development of the infant's range of action.     

Socio-Cultural Determinants of Health-Seeking Behaviour on the Kenyan Coast: A Qualitative Study

Background

Severe childhood illnesses present a major public health challenge for Africa, which is aggravated by a suboptimal response to the child''s health problems with reference to the health-seeking behaviour of the parents or guardians. We examined the health-seeking behaviour of parents at the Kenyan coast because understanding impediments to optimal health-seeking behaviour could greatly contribute to reducing the impact of severe illness on children''s growth and development.

Methods and Results

Health-seeking behaviour, and the factors influencing this behaviour, were examined in two traditional communities. We held in-depth interviews with 53 mothers, fathers and caregivers from two rural clinics at the Kenyan Coast. Biomedical medicine (from health facilities and purchased over the counter) was found to be the most popular first point of treatment. However, traditional healing still plays a salient role in the health care within these two communities. Traditional healers were consulted for various reasons: a) attribution of causation of ill-health to supernatural sources, b) chronic illness (inability of modern medicine to cure the problem) and c) as prevention against possible ill-health. In developing an explanatory model of decision-making, we observed that this was a complex process involving consultation at various levels, with elders, but also between both parents, depending on the perceived nature and chronicity of the illness. However, it was reported that fathers were the ultimate decision makers in relation to decisions concerning where the child would be taken for treatment.

Conclusions

Health systems need to see traditional healing as a complementary system in order to ensure adequate access to health care. Importantly, fathers also need to be addressed in intervention and education programs.     

Knowledge and Uses of African Pangolins as a Source of Traditional Medicine in Ghana

Traditional medicine has been practised in Ghana for centuries with the majority of Ghanaians still patronising the services of traditional healers. Throughout Africa a large number of people use pangolins as a source of traditional medicine, however, there is a dearth of information on the use of animals in folk medicine in Ghana, in particular the use of pangolins. The aim of this study was to determine the prevalent use of pangolins and the level of knowledge of pangolin use among traditional healers in Ghana for the treatment of human ailments. Data was gathered from 48 traditional healers using semi-structured interviews on the traditional medicinal use of pangolin body parts in the Kumasi metropolis of Ghana. The cultural importance index, relative frequency of citation, informant agreement ratio and use agreement values were calculated to ascertain the most culturally important pangolin body part as well as the level of knowledge dissemination among traditional healers with regards pangolin body parts. Our study revealed that 13 body parts of pangolins are used to treat various medicinal ailments. Pangolin scales and bones were the most prevalent prescribed body parts and indicated the highest cultural significance among traditional healing practices primarily for the treatment of spiritual protection, rheumatism, financial rituals and convulsions. Despite being classified under Schedule 1 of Ghana’s Wildlife Conservation Act of 1971 (LI 685), that prohibits anyone from hunting or being in possession of a pangolin, our results indicated that the use of pangolins for traditional medicinal purposes is widespread among traditional healers in Ghana. A study on the population status and ecology of the three species of African pangolins occurring in Ghana is urgently required in order to determine the impact this harvest for traditional medical purposes has on their respective populations as current levels appear to be unmonitored and unsustainable.     

Health seeking behavior and use of medicinal plants among the Hamer ethnic group,South Omo zone,southwestern Ethiopia

Background

Health seeking behavior of people around the globe is affected by different socio-cultural and economic factors. In Ethiopia, people living in rural areas in particular, are noted for their use of medicinal plants as a major component of their health care option. This study was conducted to document ethnopharmacological information of the Hamer semi-pastoralists ethnic group in southwestern Ethiopia.

Methods

A cross-sectional study was carried out whereby information on demographic characteristics, prevalence of perceived illnesses, factors associated with preference of health care seeking options, medicinal plants used and hoarded as well as some healers’ socio-economic characteristics were collected using two sets of semi-structured questionnaires – one for household (HH) heads and the other for traditional healers supplemented by focus group discussions (FGDs). Households were selected using a cluster sampling followed by systematic sampling techniques; whereas healers and FGD participants were purposively selected with the assistance of local leaders and elders from the community.

Results

The study revealed that the use of traditional medicine among the Hamer ethnic group is very high. Females preferred traditional medicine more than males. The main reasons for this preference include effectiveness, low cost and ease of availability. Malaria (gebeze) was the most frequently occurring illness in the area identified by all FGD participants. A total of 60 different medicinal plants were reported [34 by HH respondents, 14 by traditional healers and 12 by both]. Fifty-one medicinal plants were fully identified, 3 at generic level and 6 have not yet been identified.

Conclusion

It can be concluded that traditional medical practices, particularly herbal aspect, is widely used by the Hamer ethnic group, although health seeking behavior of the community is affected by different socio-economic and cultural factors.

     

Zezuru turn of the screw

Zezuru adults and children take into account concepts of evil in directing their lives, especially in managing incidents of trauma and sickness. Using the story The Turn of the Screw by Henry James to reflect on these notions, evil is traced in the expressions heard and treatment sessions witnessed during two years research with 60 traditional healers in Mashonaland, Zimbabwe.Evil, particularly as evidenced in witchcraft and possession by aggrieved spirits, is part of a discourse on human suffering — illness, misfortune, death — within a specific community. Healers' treatment of children and their conceptions of childhood form the base for a discussion of evil.     

Perceived insufficient milk as a barrier to optimal infant feeding: examples from Bolivia

In its recently adopted Global Strategy on Infant and Young Child Feeding, the World Health Assembly called for urgent action in addressing the barriers to optimal feeding practices. This paper examines mothers' concerns about milk insufficiency as a major contributor to suboptimal infant feeding decisions, using survey data from peri-urban areas of two Bolivian cities. Mothers in the lowland modernizing city of Santa Cruz were more likely than mothers in the highland traditional city of Cochabamba to express concern about insufficient milk, and also less likely to feed their infants according to international recommendations. Furthermore, perceived milk insufficiency was particularly common among mothers of infants younger than 6 months of age -- an age at which infants are particularly vulnerable to the adverse effects of breast-feeding cessation and complementary feeding initiation. The paper concludes with policy, programme and research recommendations to address the critical problem of perceived insufficient breast milk.     

Explanatory Models and Mental Health Treatment: Is Vodou an Obstacle to Psychiatric Treatment in Rural Haiti?

Vodou as an explanatory framework for illness has been considered an impediment to biomedical psychiatric treatment in rural Haiti by some scholars and Haitian professionals. According to this perspective, attribution of mental illness to supernatural possession drives individuals to seek care from houngan-s (Vodou priests) and other folk practitioners, rather than physicians, psychologists, or psychiatrists. This study investigates whether explanatory models of mental illness invoking supernatural causation result in care-seeking from folk practitioners and resistance to biomedical treatment. The study comprised 31 semi-structured interviews with community leaders, traditional healers, religious leaders, and biomedical providers, 10 focus group discussions with community members, community health workers, health promoters, community leaders, and church members; and four in-depth case studies of individuals exhibiting mental illness symptoms conducted in Haiti's Central Plateau. Respondents invoked multiple explanatory models for mental illness and expressed willingness to receive treatment from both traditional and biomedical practitioners. Folk practitioners expressed a desire to collaborate with biomedical providers and often referred patients to hospitals. At the same time, respondents perceived the biomedical system as largely ineffective for treating mental health problems. Explanatory models rooted in Vodou ethnopsychology were not primary barriers to pursuing psychiatric treatment. Rather, structural factors including scarcity of treatment resources and lack of psychiatric training among health practitioners created the greatest impediments to biomedical care for mental health concerns in rural Haiti.     

Commodity Fetichismo The Holy Spirit,and the turn to Pentecostal and African Independent Churches in Central Mozambique

Pentecostal and African Independent Churches have rapidly spread throughout central Mozambique in the aftermath of war and in the midst of a recent structural adjustment program that has hastened commoditization of community life and intensified local inequalities. This extraordinary expansion signals a shift away from reliance on “traditional” healers to treat persistent afflictions believed to have spiritual causes. Survey data and illness narratives collected from recent church recruits and local residents during research in 2002 and 2003 in the city of Chimoio reveal that healers have increased fees and tailored treatments to clients searching for good fortune in ways that have alienated many other help seekers in this changing social environment. While traditional healing has been celebrated in the international health world, community attitudes are less generous; many healers are increasingly viewed with suspicion because of their engagement with malevolent occult forces to foment social conflict, competition, and confrontation for high fees. Church healing approaches offer free and less divisive spiritual protection reinforced by social support in a new collectivity. One vital source of church popularity derives from pastors' efforts to tap the already considerable community anxiety over rising healer fees and their socially divisive treatments in an insecure environment.     

Traditional zootherapeutic studies in India: a review

Background

The objective of the present study was to reveal patterns in the treatment of health conditions in a Quechua-speaking community in the Bolivian Andes based on plant use data from traditional healers and patient data from a primary health care (PHC) service, and to demonstrate similarities and differences between the type of illnesses treated with traditional and biomedical health care, respectively.

Methods

A secondary analysis of plant use data from semi-structured interviews with eight healers was conducted and diagnostic data was collected from 324 patients in the community PHC service. Health conditions were ranked according to: (A) the percentage of patients in the PHC service diagnosed with these conditions; and (B) the citation frequency of plant use reports to treat these conditions by healers. Healers were also queried about the payment modalities they offer to their patients.

Results

Plant use reports from healers yielded 1166 responses about 181 medicinal plant species, which are used to treat 67 different health conditions, ranging from general symptoms (e.g. fever and body pain), to more specific ailments, such as arthritis, biliary colic and pneumonia. The results show that treatment offered by traditional medicine overlaps with biomedical health care in the case of respiratory infections, wounds and bruises, fever and biliary colic/cholecystitis. Furthermore, traditional health care appears to be complementary to biomedical health care for chronic illnesses, especially arthritis, and for folk illnesses that are particularly relevant within the local cultural context. Payment from patients to healers included flexible, outcome contingent and non-monetary options.

Conclusion

Traditional medicine in the study area is adaptive because it corresponds well with local patterns of morbidity, health care needs in relation to chronic illnesses, cultural perceptions of health conditions and socio-economic aspects of health care. The quantitative analysis of plant use reports and patient data represents a novel approach to compare the contribution of traditional and biomedical health care to treatment of particular health conditions.     

Role of health-seeking behaviour in child mortality in the slums of Karachi,Pakistan

The role of family health-seeking behaviour in under-five-year child mortality was explored through the combined approach of examining health-seeking behaviour regarding treatment generally, and in specific in relation to illness before death. A population-based case control study was carried out during the period 1993-1994 using 222 deaths from diarrhoea and acute respiratory illness (ARI) in children under five years of age in six slums of Karachi as cases, and 419 controls matched on age, disease (diarrhoea and ARI) and slum. Factors significantly associated (p<0.05) with child mortality in the multivariate analysis were: mothers changing healers quickly, using a traditional healer or an unqualified doctor and mothers to whom doctors did not explain the treatment, even when maternal education was controlled for. Seeking effective medical services is highly influential on whether the child survives or succumbs to ARI or diarrhoea. As mothers are the first providers of care, an attempt should be made to try and improve their skills through health education so that they can use simple and effective treatments for minor illnesses. They should also be taught to recognize potentially life-threatening conditions, to seek care early and to persist with treatment.     

A case-control study of maternal knowledge of malnutrition and health-care-seeking attitudes in rural South India.

INTRODUCTION: In India, approximately 20 percent of children under the age of four suffer from severe malnutrition, while half of all the children suffer from undernutrition. The contributions of knowledge and attitudes of nutrition-conscious behaviors of the mothers to childhood malnutrition has been unclear. The purpose of this study was to explore maternal knowledge of the causes of malnutrition, health-care-seeking attitudes and socioeconomic risk factors in relation to children''s nutritional status in rural south India. METHODS: A case-controlled study was conducted in a rural area in Tamil Nadu, India. Thirty-four cases and 34 controls were selected from the population of approximately 97,000 by using the local hospital''s list of young children. A case was defined as a mother of a severely malnourished child under four years of age. Severe malnutrition was defined as having less than 60 percent of expected median weight-for-age. A control had a well-nourished child and was matched by the location and the age of the child. Interviews obtained: (1) socioeconomic information on the family, (2) knowledge of the cause of malnutrition and (3) health-care-seeking attitudes for common childhood illnesses, including malnutrition. RESULTS: Poor nutritional status was associated with socioeconomic variables such as sex of the child and father''s occupation. Female gender (OR = 3.44, p = .02) and father''s occupation as a laborer (OR = 2.98, p = .05) were significant risk factors for severe malnutrition. The two groups showed a significant difference in nutrition-related knowledge of mild mixed malnutrition (OR = 2.62, p = .05). No significant difference was apparent in health-care-seeking attitudes. Based on their traditional beliefs, the mothers did not believe that medical care was an appropriate intervention for childhood illnesses such as malnutrition or measles. DISCUSSION: The results suggested that the gender of the child and socioeconomic factors were stronger risk factors for malnutrition than health-care availability and health-care-seeking attitudes. The father''s occupation was a more accurate indicator for malnutrition than household income. These results suggest a need for intensive nutritional programs targeted toward poor female children and their mothers.     

The Limits of Magic

This is the case of a Malay shaman who narrowed the scope of her diagnoses to magic, evoking scorn from her colleagues and alarm from rural patients accustomed to a variety of illness etiologies. But she found success as part of a team catering to urban Malays. Her performance satisfied expectations of clients unused to traditional shamanism and set the stage for acceptance of her partner's diagnoses couched in "common sense," educated, urbane language which nevertheless restored elements of Malay illness etiology she had discarded.