Sociocultural Aspects of Tuberculosis Control in Ethiopia

Abstract

This article examines ethnomedical knowledge and practices related to tuberculosis conceptualization and management in a rural southern Ethiopian community. An adult health-status survey, administered to 217 adults selected through quota sampling procedures, investigated prevailing nosological structures. Additionally, disease-enhancing behaviors were identified through qualitative-research methods. The findings show that while symptomatological concepts coincide with biomedicine, the local etiological model postulates empirically based causational factors unrelated to tubercle bacilli. Therapeutic preference hinges on the utilization of ethnobotanical remedies and their expected emetic effects. The relevance of tuberculosis-related ethnomedical knowledge and management practices is discussed in relation to primary health care and disease-control programs in Ethiopia. It is recommended that health-education interventions, illustrating the nature and transmission avenues of tuberculosis and the effects of biomedical therapies, precede and/or accompany vaccination campaigns or chemotherapy. Teaching materials should valorize existing ethnomedical notions that emphasize contagion as an avenue of disease transmission, and the importance of nutritional adequacy in fighting the disease.

Tuberculosis patients’ pre-hospital delay and non-compliance with a longstanding DOT programme: a mixed methods study in urban Zambia

“…Qualitative findings provided insight that many patients were unsure how to combine the variety of TB perceptions available. Previous studies have shown the importance of perceptions on health care seeking behaviour [28–32] and have stressed the importance of cultural-sensitive sensitisation programmes [7, 8, 33]. We propose interactive awareness programmes that acknowledge and appropriately address the variety of local perceptions to enhance early case-finding and reduce hospital delay.…”

Perceptions, health care seeking behaviour and implementation of a tuberculosis control programme in Lambaréné, Gabon

“…However, these social expectations and associated power structures have not been reported by previous socio-anthropological TB studies. 5,6,11,25 This fi nding highlights the need for culturally sensitive TB health education in which traditional/religious perceptions and practices are not neglected, but identifi ed as part of the cultural context. Similarly, embedding the medical perspective in the socio-cultural context could advance communications between health care providers and patients.…”

“…Felt or feared stigma occasionally led to fear of disclosure and self-exclusion from health care services. 25 One study described how the chronic nature of TB aggravated stigma. 7 Interestingly, during focus group discussions and interviews, TB stigma was often denied because of the curable nature of the disease.…”

“…Similarly, embedding the medical perspective in the socio-cultural context could advance communications between health care providers and patients. 6,7,25 Interaction between hospitals and traditional/spiritual healers is advocated by the WHO. 28 In the light of the fact that 30% of the TB patients presented to traditional healers, such calls for integration of traditional healers into national health systems should receive continued support.…”

¿Colonialismo biomédico o autonomía de lo local? Sanadores tradicionales contra la tuberculosis

“…que cobra sentido las prácticas y conocimientos locales. De hecho, no aparece estudio social previo ni referencias bibliográficas a otros autores que, desde otras disciplinas, han estudiado los factores socioculturales que han influido en el control de la TBC (Vecchiato, 1997). Tal y como se deduce de estas publicaciones, los proyectos a pesar de sus equívocos títulos son, en realidad, una manera de 'captar' agentes para la puesta en marcha de la terapia farmacológica antituberculosa.…”