Supernatural Causes Research Articles

Public perception and attitude towards people living with epilepsy in Nigeria

ObjectiveThis study aimed to assess the community knowledge, awareness, and attitude towards people living with epilepsy (PLWE) in Lagos, Nigeria. This was to provide background information for formulating evidence-based campaign and intervention to reduce stigma and improve health-related quality of life amongst PLWE and their families. MethodsAdult respondents (n = 1614) selected via multistage probability sampling completed a set of questionnaires. A case vignette was used to depict epilepsy. The respondents' knowledge of, familiarity with, perceived cause, and preferred treatment option for epilepsy were assessed. Their attitude towards people's attitude was measured with Attitudes and Beliefs about Living with Epilepsy (ABLE) scale. ResultsWhile a total of 1258 (67.6%) could correctly name the illness as epilepsy, only 945 (58.5%) had witnessed an epileptic seizure episode before. The most endorsed causes of epilepsy were brain injury/infection (75.8%), evil spirit/witchcraft (73.0%), God's will (70.0%), and infection by contact (64.9%). Only 67.6% believe that epilepsy is treatable, and 42.5% preferred treatment by spiritualist. Generally, there was a positive attitude to PLWE; however, there were serious risk and safety concerns. The factors associated with negative attitude towards PLWE include male gender (adjusted odds ratio [AOR]: 2.44, 95% confidence interval [CI]: 1.98–3.00), lower educational status (AOR: 1.69, 95% CI: 1.32–2.16), poor knowledge of epilepsy (AOR: 1.74, 95% CI: 1.36–2.22), poor familiarity with epilepsy (AOR: 1.65, 95% CI: 1.14–2.42), and endorsement of supernatural causes of epilepsy (AOR: 1.59, 95% CI: 1.28–1.97). SignificanceClosing the treatment gap for epilepsy in Nigeria and other sub-Saharan Africa countries will involve steps to change the misconception of the Nigerian populace as regards the causes of epilepsy and help seeking pathway. There is need for nationwide educational programs for epilepsy that consider cognitive and affective processes and also involve all the major stakeholders like primary care workers, community leaders, and spiritual and traditional leaders.

The Pathophysiology and Therapy of Erectile Dysfunction in a Newly Discovered Treatise by Wolfgang Reichart (1486–circa 1547)

A newly-found treatise by Wolfgang Reichart (1486-circa 1547), town physician of Ulm, challenges the contemporary view that bewitchment as a cause of impotence defies any natural explanation. To understand the pathophysiological concept and therapy of erectile dysfunction in Reichart's treatise by examination of his sources and previous concepts. Source analysis of Reichart's treatise by comparison of the pathophysiological concepts and therapy of erectile dysfunction with original texts of the Corpus Hippocraticum (5th-3rd century BC) and Constantinus Africanus (11th century). By using rational thinking and medical knowledge mainly drawn from antiquity, especially Constantinus Africanus, Reichart shows that a supposed supernatural cause for impotence can be explained by reason and natural means. Reichart's treatise changes the view of bewitchment as cause of impotence. He makes eclectical use of previous concepts to explain his patient's condition. From the Middle Ages on, bewitchment was accepted as a cause for erectile dysfunction. Usually, physicians of that time accepted this etiology and advised a treatment based on theological concepts. Reichart challenges this view by emphasizing reason and medical knowledge as crucial for treating the patient, rejecting supernatural treatment approaches. In the 16th century, a type of rational thinking and medical knowledge emerges, which puts supernatural explanations into question and aims at treating patients with natural means. The analysis of Reichart's treatise is a much-needed contribution to understanding the historic development of pathophysiological concepts of and therapeutic measures for impotence, which is yet underresearched.

Indigenous Healing Practices and Beneficiaries’ Perception

Context: For centuries, the concept of indigenous healing has been regarded as a non-invasive medical practice, and despite the development of clinical treatments, many people still depend on it for mental health. It is estimated that in developing countries, 80% of the population living in rural areas depend on indigenous healers for their healthcare needs (WHO, 2001). Despite the establishment of modern hospitals and educational institutions, people from the southern region of Karnataka believe that unnatural occurrences are due to Bhootas (Spirits) and a certain portion of the population attribute mental illness to witchcraft and supernatural causes. In order to overcome these obstacles,people approach healers for a miracle solution. Acknowledging the significant role of the belief system of people seeking the help of traditional healers for various problems, the present study was conducted to understand the perception of the beneficiaries regarding indigenous healing. Based on the findings, the study concluded that the belief system remains prominent in every aspect of the life of individuals who seek the help of healers, while indigenous healers need to be trained in order to provide better mental healthcare to the patients.

Pain, somatic complaints, and subjective concepts of illness in traumatized female refugees who experienced extreme violence by the “Islamic State” (IS)

BackgroundRefugees with a history of war or sexual violence often experience somatic symptoms along with mental disorders. After being held in captivity by the so-called “Islamic State” (IS), 1100 especially vulnerable Yazidi women and children (around 400 women) received special medical and psychological support. We report on their (psycho-) somatic complaints and concepts of illness. MethodsFemale refugees (N = 116) were surveyed regarding their somatic complaints and concepts of illness. The Impact of Event Scale-Revised (IES-R) and self-developed questionnaire items with ratings on a five-point Likert scale from 0 (“not at all”) to 4 (“extremely”) were used. Subgroup analyses and a multiple linear regression model were computed. ResultsPain (M = 2.43, SD = 1.70) is the main somatic complaint with a moderate rated severity, followed by feelings of suffocation (M = 2.37, SD = 1.53), and movement disorders (M = 1.62, SD = 1.70). In a linear regression model, pain explains variance (R2 = 0.325) in the refugees' self-reported health-related wellbeing. Somatic symptoms are mainly attributed to psychological causes, followed by physical (e.g., physical origin of symptoms), religious, and supernatural causes. Women with pain symptoms attributed their symptoms more to physical causes (M = 1.90, SD = 1.78) than did women without pain symptoms (M = 1.07, SD = 1.59). ConclusionFemale Yazidi refugees being kept in IS captivity mainly suffer from pain, which is attributed to an explanatory psychological model. The study results show the specific psychosomatic and psychotherapeutic needs and demands for specifically tailored psychotherapy.

Determinants of Therapeutic Routes for Malaria Patients in Ivory Coast

Abstract Malaria patients in Ivory Coast pursue a wide variety of treatment routes, depending upon how they understand the aetiology of their illness, their association of illness with supernatural causes, their ability to afford standard consultation fees, their access to conventional health care facilities, and their confidence in traditional African therapies. This research took place in the context of the government’s policy of providing free management of ‘simple malaria’ for all. Working with four conventional doctors and four traditional African medical practitioners, treatment choices of 161 malaria patients were analysed at Kennedy-Clouétcha, a busy urban health care centre in Abidjan. Almost half (77) of the patients in the study cited mosquito bites, general poor health, and stagnant water sources as the causes of their malaria. A greater number of patients (84) indicated fatigue, sun exposure, mysticism, and diet as the cause. The scope of therapies sought by these patients covered conventional biomedical treatment, traditional African medicine, and prayer. When patients were not cured through methods of their first resort, they pursued second options for care. Despite the availability of free care in centrally located public health systems, the therapeutic trajectory of many patients diverted away from conventional treatment. The data suggests that a patient’s orientation away from the conventional biomedical model may be best explained by confusions surrounding the diagnostic label ‘simple malaria’.

Theories on Tornado and Waterspout Formation in Ancient Greece and Rome

Abstract Tornadoes and waterspouts have long fascinated humankind through their presence in myths and popular beliefs and originally were believed to have supernatural causes. The first theories explaining weather phenomena as having natural causes were proposed by ancient Greek natural philosophers. Aristotle was one of the first natural philosophers to speculate about the formation of tornadoes and waterspouts in Meteorologica (circa 340 BCE). Aristotle believed that tornadoes and waterspouts were associated with the wind trapped inside the cloud and moving in a circular motion. When the wind escapes the cloud, its descending motion carries the cloud with it, leading to the formation of a typhon (i.e., tornado or waterspout). His theories were adopted and further nuanced by other Greek philosophers such as Theophrastus and Epicurus. Aristotle’s ideas also influenced Roman philosophers such as Lucretius, Seneca, and Pliny the Elder, who further developed his ideas and also added their own speculations (e.g., tornadoes do not need a parent cloud). Almost ignored, Meteorologica was translated into Latin in the twelfth century, initially from an Arabic version, leading to much greater influence over the next centuries and into the Renaissance. In the seventeenth century, the first book-length studies on tornadoes and waterspouts were published in Italy and France, marking the beginning of theoretical and observational studies on these phenomena in Europe. Even if speculations about tornadoes and waterspouts proposed by Greek and Roman authors were cited after the nineteenth century only as historical pieces, core ideas of modern theories explaining these vortices can be traced back to this early literature.

Public Awareness, Beliefs, And Attitudes Toward Bipolar Disorder In Saudi Arabia.

ObjectivesTo examine public’s knowledge, beliefs, and attitudes toward bipolar disorder (BP) in Saudi Arabia (SA).MethodsA cross-sectional survey was performed in 2016 in Riyadh, SA. The survey included sociodemographic characteristics and BP awareness scale.ResultsOf 416 participants, 49.5% had prior knowledge of BP, mainly from internet and social media, and 57% considered it to be common in SA. About half believed BP is caused by a neurophysiological or neurochemical imbalance and that it can be treated with psychiatric medications. Supernatural causes, weak faith, and weakness of character were considered causes of BP by 55%, 48%, and 40% of participants, respectively. Recreational activities and head bandaging by traditional therapists were considered viable treatment options by 55% and 41% of participants, respectively. Students and healthcare professionals scored significantly higher on awareness scale. Regarding attitude, a majority believed that persons with BP can work effectively ‎(86%)‎, have to pull themselves together to get over it (47%), and consider it a shame to mention that someone in a family is affected by BP (32%). Regarding relationships, 22% were not willing to maintain a friendship and 39.3% were not willing to marry someone with BP.ConclusionsThis study revealed suboptimal public awareness towards BP in SA. It identified several misconceptions and negative attitudes toward patients with BP. Further studies are needed to investigate potential public interventions to improve literacy of BP.

Discrepancy in perception of infertility and attitude towards treatment options: Indonesian urban and rural area

BackgroundIn Indonesia infertility affects 10–15% of reproductive-age couples. In addition to medical problem, infertility in Indonesia poses significant social problem. Childlessness is often stigmatized as a failure which victimizes couples, moreover the females. Despite the high prevalence, there is no fertility awareness education which further passes down the common myth, misperception, and negative attitude towards infertility treatment in Indonesian society.ObjectiveThis study aims to reveal the knowledge, myth, and attitude towards infertility, likewise acceptance towards infertility treatment options.MethodCross-sectional study using standardized questionnaire was done to 272 individuals consisted of two parallel groups: Jakarta and Sumba representing urban and rural population respectively. Participants were all outpatients above 18 years old who visited the healthcare centers from February 2017 to June 2017.ResultsKnowledge on biological and lifestyle risk factors of infertility among Jakarta and Sumba groups were comparable. However, belief in supernatural causes of infertility is remarkable in Sumba population. There is a common misconception on the use of contraception as risk factors of infertility in both groups.Half respondents from both groups think infertility is a disease. In Jakarta 93.4% respondents consider both female and male should be investigated for infertility; in Sumba only 55.4% agree while 33.1% consider only female should be investigated. Infertility is an acceptable reason for polygamy for 41.3% respondents in Sumba, with 34.7% blaming maternal side for childlessness.Most respondents from both groups accept the use of Assisted Reproductive Technology and fertility enhancing drugs as treatment options.ConclusionLack of understanding, misleading myths, and negative attitude towards infertility have been illustrated in the sample population.

"When someone becomes old then every part of the body too becomes old": Experiences of living with dementia in Kintampo, rural Ghana.

Studies have suggested that in African countries, symptoms of cognitive decline are commonly seen as part of "normal ageing" or attributed to supernatural causes. The impact of folk beliefs about causality upon help-seeking is unclear. Likewise, there is a lack of evidence relating to how families cope with living with an older resident with dementia. Our study's aim was to explore the sociocultural beliefs, understandings, perceptions and behaviours relating to living with dementia in Kintampo, Ghana. We conducted in-depth interviews with a total of 28 people, using a series of case studies among 10 older people living with dementia and their families. Results revealed that symptoms of cognitive impairment were generally linked to inexorable bodily decline understood to be characteristic of "normal" ageing. Stigma was therefore perceived to be non-existent. Whilst managing the costs of care was often a challenge, care-giving was largely accepted as a filial duty, commonly shared among female residents of large compound households. Families experimented with biomedical and traditional medicine for chronic conditions they perceived to be treatable. Our findings suggest that whilst families offer a holistic approach to the needs of older people living with chronic conditions including dementia, health and social policies offer inadequate scaffolding to support this work. In the future, it will be important to develop policy frameworks that acknowledge the continued social and economic potential of older people and strengthen the existing approach of families, optimising the management of non-communicable diseases within primary care.

Knowledge and perceptions of type 2 diabetes among Ghanaian migrants in three European countries and Ghanaians in rural and urban Ghana: The RODAM qualitative study.

African migrants in Europe and continental Africans are disproportionately affected by type 2 diabetes (T2D). Both groups develop T2D at a younger age, and have higher morbidity and mortality from T2D and complications, compared to European populations. To reduce risk, and avoidable disability and premature deaths, culturally congruent and context specific interventions are required. This study aimed to: (a) assess perceptions and knowledge of T2D among Ghanaian migrants in Europe and their compatriots in Ghana and (b) identify specific perceptions and knowledge gaps that might predispose migrants to higher risk of diabetes. Data was gathered through 26 focus groups with 180 individuals, aged 21 to 70, from Amsterdam, Berlin and London and rural and urban Ashanti Region, Ghana. Thematic analysis of the data was informed by Social Representations Theory, which focuses on the sources, content and functions of social knowledge. Three key insights emerged from analysis. First, there was general awareness, across migrant and non-migrant groups, of T2D as a serious chronic condition with life threatening complications, and some knowledge of biomedical strategies to prevent diabetes (e.g healthy eating) and diabetes complications (e.g medication adherence). However, knowledge of T2D prevention and reduction of diabetes complications was not comprehensive. Secondly, knowledge of biomedical diabetes theories and interventions co-existed with theories about psychosocial and supernatural causes of diabetes and the efficacy of herbal and faith-based treatment of diabetes. Finally, migrants’ knowledge was informed by both Ghanaian and European systems of T2D knowledge suggesting enculturation dynamics. We discuss the development of culturally congruent and context-specific T2D interventions for the research communities.

Explanatory models of stroke in Ghana: perspectives of stroke survivors and their caregivers

ABSTRACT Objective: This study examines explanatory models (EMs) of stroke and its complications among people living with stroke, and their caregivers, in two urban poor communities in Accra (Ga Mashie) and Korle Bu Teaching Hospital (KBTH), Accra. Methods: Twenty-two stroke survivors and 29 caregivers were recruited from 2 urban poor communities in Accra and KBTH. Qualitative data were obtained using semi-structured interviews that lasted between 45 minutes and 2 hours. The interviews were audiotaped, transcribed and analysed thematically, informed by the concept of EMs of illness. Results: Participants referred to stroke as a sudden event and they expressed different emotional responses after the stroke onset. Stroke survivors and their caregivers attributed stroke with poor lifestyle practices, high blood pressure, unhealthy diet and dietary practices, supernatural causes, stress, family history, other chronic diseases, and delay in treatment of symptoms. While the stroke survivors associated stroke complications with physical disability and stigmatisation, the caregivers associated these with physical disability, behavioural and psychological changes, cognitive disability and death. These associations were mostly influenced by the biomedical model of stroke. Conclusion: The biomedical model of stroke is important for developing interventions that will be accepted by the stroke survivors and the caregivers. Nevertheless, sociocultural explanations of stroke need to be taken into consideration during delivery of medical information to the participants. This study proposes an integrated biopsychosociocultural approach for stroke intervention among the study participants.

Only women can whisper to gods: Voodoo, menopause and women’s autonomy

Abstract In various parts of the world women gain autonomy in decision-making as they get older. We hypothesize that part of this age-dividend is rooted in (historical) beliefs regarding the supernatural powers of menopaused women. To test this hypothesis, we study the age- and menopause-dividend in women’s decision-making autonomy in four West-African countries that include ethnic groups that practice(d) voodoo. Our empirical analysis relies on several rounds of DHS surveys, and a difference-in-differences strategy, in which we exploit the quasi-exogenous variation in the timing of menopause as well as the historical variation in magicoreligious beliefs across ethnicities. We find that (1) the age-dividend in women’s autonomy is more pronounced in ethnic groups that practice(d) voodoo, (2) the menopause-dividend is only observed among women from these groups, and (3) it is especially large for women whose husbands believe that illness can have a supernatural cause. We also document a tangible welfare effect, in terms of a higher Body Mass Index among menopaused women of voodoo-related ethnic groups. Our study constitutes the first attempt to unpack the cross-cultural age-dividend in women’s autonomy, thereby contributing to the detailed contextual knowledge needed for designing effective female empowerment policies.

Community perceptions and misconceptions of motorcycle accident risks in the Upper West Region of Ghana

The Ghana National Road Safety Commission indicates that over 2,200 people were involved in motorcycle accidents (MCAs) nationwide in 2016 partly due to the increased usage of motorcycles for commercial and private purposes. Several studies on the causes of MCAs in Ghana however, have focused on rational factors such as over speeding, drunk riding, fatigue, age and gender. What is less understood is the role of sociocultural construction of risk and community perceptions about MCAs. Using a mixed methods approach involving surveys and focus group discussions, this paper examines community perceptions of MCAs in the Upper West Region (UWR) of Ghana. Findings show that sociocultural misconceptions of accidents as outcomes of supernatural causes (OR = 1.41, P < 0.1) significantly contribute to the increased incidence of MCAs in the UWR. These sociocultural constructions seem to supersede critical explanatory factors of accidents such as alcohol consumption (OR = 1.91, P < 0.01) and over speeding (OR = 1.48, P < 0.05) in the context of poor road infrastructure. Apart from focusing on road traffic regulations and infrastructural development, this paper calls for the need to incorporate a sociocultural dimension into ongoing road safety programs to minimise these deeply rooted culturally-motivated misconceptions and attributions of MCAs to supernatural causes.

Pluralism and practicality: village health workers’ responses to contested meanings of mental illness in Southern Malawi

The individual and social construction of psychological distress is fundamental to help-seeking and the extent to which interventions are seen as credible. Where pluralistic attributions for mental health problems predominate, the development of global mental health (GMH) interventions in the form of task-shifting approaches create increased access to new ways of understanding and responding to distress. However, little is known about how participants in these initiatives manage these encounters. This qualitative study in Malawi explored village-based health workers’ (HSAs) and patients’ and carers’ views of the causes of distress and how these beliefs influenced help-seeking and the health workers’ response.Eight HSAs and nine paired patients/carers were interviewed separately to enable each of nine experiences of distress to be explored. Findings revealed a complex set of personal, social and cultural influences that informed causative attributions and help-seeking decisions. Patients/carers viewed psychosocial stresses as compelling explanations and readily reported others attributing their distress to supernatural causes (bewitchment). Yet attributional beliefs alone were not the only influence over help-seeking, which evolved pragmatically in response to the impact of treatments and social pressure for conformity. In turn HSAs navigated the interactions with patients/carers by emphasising the biomedical approach and discrediting bewitchment attributions. This caused tensions when biomedical interventions were unhelpful or the traditional healers’ approach proved beneficial.Conclusions add to the call for such task-shifting approaches to work with communities to discern authentic and practical responses to mental distress that mirror the ‘pluralism and pragmatism’ found in the communities they serve.

Leaving the Enchanted World Behind: Kant on the Order of Nature, Empirical Space and the Possibility of Miracles

AbstractDespite relative neglect in the literature, Kant’s published and unpublished writings in theoretical philosophy reveal a sustained and at times ambivalent effort to come to terms with the problem of miracles. Because they entail a form of supernatural causation that undermines the law-governedness of the order of nature, miracles pose a significant problem for Kant’s metaphysics. I explore in detail Kant’s account of miracles in conjunction with the relevant aspects of his metaphysics of nature in order to establish in what sense miracles are possible, and how they fit into Kant’s architectonic more generally.

Cultural Differences in Psychosis: The Role of Causal Beliefs and Stigma in White British and South Asians

While previous research has demonstrated the negative impact of stigma in individuals with mental health problems, little is known about cross-cultural differences in experiences and explanations of mental health, in particular in young people, despite the first episode of psychosis often occurring in adolescence. Aim of this study was to examine cultural differences in causal beliefs and stigma toward mental health, in particular psychosis. White British and South Asian young people ( N = 128) from two schools and colleges in the United Kingdom, aged 16 to 20 years, completed a cross-sectional survey. Results revealed significant associations between ethnic group and our dependent measures. White British reported more previous contact with a mental health service as well as with people with mental health problems than South Asians. They also reported lower stigma in form of a greater intentions to engage in contact with people with mental health problems. Furthermore, South Asians reported higher beliefs in supernatural causes of psychosis than White British. Psychotic experiences moderated the effect of ethnic group on supernatural beliefs, with South Asians reporting higher supernatural beliefs than White British when their own psychotic experiences were low to moderate. We discuss the implications of the findings, arguing that a greater culture-sensitive understanding of mental health is important to reach ethnic minorities with psychosis, and to challenge stigma toward psychosis from an early age on.

Illness Beliefs and Coping Strategies of Women Cancer Patients

This study relates to examining the illness beliefs of women cancer patients and the strategies they apply in coping with the illness. The sample consisted of 100 women cancer patients diagnosed with cervix cancer. They were administered the tools measuring illness beliefs and coping strategies. The results drawn suggest that patients adopting “avoidance coping” strategies had their causal beliefs that illnesses source from individual, psychological, social, environmental and supernatural aspects. This was comparable to those who adopted “approach coping” strategies. However, the groups differed significantly only for supernatural causes of illness. Patients adopting avoidance strategies were found to believe in supernatural causes compared to those who showed approach coping. The strategies of approach coping were found to be associated with less severe consequences in psychological, interpersonal and physiological domains apart from the pain experienced due to the illness along with hope for positive outcomes of illness management.

Autopsy Findings in Cases of Suspected Pediatric Homicide

Paediatric deaths in developing countries, especially in Africa, are often attributed to supernatural causes or to aged family members or unfriendly neighbors. This study aims to evaluate autopsybased causes of death in such cases. All autopsy deaths in children less than 15 years of age in which homicide was suspected from January 2001 to December 2015 were retrospectively reviewed. Their bio-data, circumstances surrounding death and cause of death were extracted, and presented in this report. In the 15 years reviewed, there were 55 pediatric homicide related cases. Based on autopsy findings (coupled with clinical and circumstantial evidences), manners of death were classified as natural (34%), accidental (31%), homicidal (9%) and unascertainable in the remaining 26% of the cases. The study highlights the need for forensic pathologists working in developing countries to be actively involved in all stages of investigating cases of suspected pediatric homicide.

"It's That Route That Makes Us Sick": Exploring Lay Beliefs About Causes of Post-traumatic Stress Disorder Among Sub-saharan African Asylum Seekers in Germany.

Many asylum seekers have been confronted with traumatizing events, leading to high prevalence rates of post-traumatic stress disorder (PTSD). Within the diagnostic context, clinicians should take into account patients' culturally shaped presentation of symptoms. Therefore, we sought to provide insights into beliefs about causes of PTSD held by Sub-Saharan African asylum seekers living in Germany. To this aim, we used a quantitative and qualitative methodological triangulation strategy based on a vignette describing symptoms of PTSD. In the first part of the study, asylum seekers (n = 119), predominantly from Eritrea (n = 41), Somalia (n = 36), and Cameroon (n = 25), and a German comparison sample without a migration background (n = 120) completed the Revised Illness Perception Questionnaire (IPQ-R). In the second part, asylum seekers reviewed the results within eight focus group discussions (n = 26), sampled from groups of the three main countries of origin. Descriptive analyses of the first part demonstrated that asylum seekers predominantly attributed PTSD symptoms to psychological and religious causes, and rather disagreed with supernatural causes. In comparison to the German sample without a migration background, asylum seekers attributed symptoms less strongly to terrible experiences, but more strongly to religious and supernatural causes. Within the focus group discussions, six attribution categories of participants' causal beliefs were identified: (a) traumatic life experiences, (b) psychological causes, (c) social causes, (d) post-migration stressors, (e) religious causes, and (f) supernatural causes. Our findings suggest that the current Western understanding of PTSD is as relevant to migrants as to non-migrants in terms of psychological causation, but might differ regarding the religious and supernatural realm. While awareness of culture-specific belief systems of asylum seekers from Sub-Saharan Africa regarding PTSD is important, our findings do underline, at the same time, that cultural differences should not be overstated.

Perceptions of Mental Disorders and Help-Seeking Behaviour for Mental Health Care Within the Maasai Community of Northern Tanzania: An Exploratory Qualitative Study

Mental disorders are rapidly becoming more prevalent worldwide and are estimated to contribute up to 15% of the global burden of disease by 2020. In Africa, the help-seeking behaviour for mental health care is complex and is hindered by misconceptions and negative attitudes towards mental disorders. This study aimed to explore perceptions of mental disorders and help-seeking behaviour for mental health care within the Maasai community in northern Tanzania.This qualitative study enrolled a purposive sample of 41 participants from a Maasai community in Arusha Region, northern Tanzania. Participants included modern health-care providers, religious leaders, traditional practitioners, local government leaders, local Maasai leaders, and workers from nongovernmental organisations dealing with mental health. Local interviewers used interview guides to conduct in-depth interviews and focus group discussions in the local language, Kiswahili. The interviews were completed between April and May 2013. We used content analysis to analyse the qualitative data.Study participants attributed mental disorders to supernatural causes, such as curses, witchcraft, demons, and God's will. A few participants also mentioned biological causes and risk behaviours, including perinatal insults, head injuries, and drug abuse. Furthermore, we found that the Maasai community seeks mental health care in a sequential and simultaneous manner from 3 sectors, namely, professional health-care providers, traditional healers, and religious leaders. Traditional healers and religious leaders were preferred over professional health-care providers for the treatment of mental disorders.The Maasai have pluralistic help-seeking behaviour for mental health disorders. Integrating traditional healers in the modern health-care system may be beneficial to addressing mental health issues in this setting.