Traditional herbalists' methods of treating mental disorders in Ghana

The Influence of Culture on the Cause, Diagnosis and Treatment of Serious Mental Illness (Ufufunyana): Perspectives of Traditional Health Practitioners in the Harry Gwala District, KwaZulu-Natal

Cultural beliefs influence the perceived cause, methods of diagnosis and treatment of mental illnesses. A qualitative study was conducted among traditional health practitioners (THPs) in the Harry Gwala District Municipality to further explore this influence. Purposive sampling assisted in the recruitment of 31 participants (9 males and 22 females). The four key themes this study investigated in relation to mental illness included its causes, methods of diagnosis, common symptoms observed and treatment approaches used by THPs, and the system of patient management. Culturally, mental illness was reported to be caused by witchcraft and an ancestral calling in this study. Mental illness was predominantly diagnosed by spiritual intervention which included divination through consultation with the ancestors, familial background, burning of incense which can also be part of communicating with the ancestors and through examining the patient. The common symptoms included aggression, hallucination and unresponsiveness. Prevalent modes of treatment included the use of a medicinal concoction and performing cultural rituals where ancestors and other spirits were assumed influential. The duration of the treatment process was dependent on guidance from the ancestors. Most causal aspects of mental illness from diagnosis to treatment seemed to be influenced by cultural beliefs and ancestors.

Traditional healers' perception on scabies causation and management in Ghana

INTRODUCTION

Scabies is an underdiagnosed skin infestation caused by the Sarcoptes scabiei mite. The infection causes severe itching and a skin rash but can be effectively treated using topical or systemic drugs. Scabies outbreaks are commonly reported in resource-poor countries, including Ghana. Traditional healers play an important role in primary care in rural areas. The role of these traditional healers in the management of scabies has so far not been explored. The aim of this study was therefore to investigate the perceptions of traditional healers regarding the causation and management of scabies.

METHODS

A phenomenological qualitative approach was employed. Traditional healers in the Asante Akim North and Central districts in Ghana were approached with an interview request. Using a semi-structured interview protocol, 15 traditional healers were interviewed. The results were coded and analysed, after which seven themes were extrapolated.

RESULTS

Scabies infections were frequently reported by traditional healers. Itching and skin rash were unanimously regarded as the major symptoms of scabies. The majority acknowledged the infectious nature of scabies, but no participant reported the causative organism. A dichotomous disease classification was noted, consisting of 'natural' and 'spiritual' variants each with a unique disease profile and management requirements, as reported by the traditional healers. All but two traditional healers reported to treat scabies using almost exclusively herbs and spiritual rituals.

CONCLUSION

The majority of traditional healers were open to collaboration with allopathic healthcare providers. Collaboration could broaden the primary care network in rural areas, but mistrust and lack of transparency form potential barriers to collaboration. We, therefore, emphasise the need for additional efforts to investigate strategies for future collaboration.

The Epidemiology of Spinal Neurosurgery in Nigeria: A Systematic Review and Patient-Level Analysis

OBJECTIVE

Spinal pathologies are prevalent in Nigeria, though epidemiological data remains sparse. This systematic review used pooled patient-level data from across the country to generate a standardized epidemiological reference.

METHODS

Four research databases and gray literature sources were searched. Risk of bias assessment was conducted using Risk of Bias in Non-Randomised Studies - of Interventions and Cochrane's risk of bias tool. We descriptively analyzed all article metrics and statistically analyzed relevant data variables via paired t-test and χ2 independence tests (α = 0.05).

RESULTS

One hundred twenty-seven articles, comprising a patient cohort of 8425 patients, were analyzed. Most were retrospective cohort studies (46.5%) and case reports/series (31.5%), with an overall moderate-high risk of bias. Most studies were published in the last 20 years. Most patients were male (∼2.5 males per female), with an average age of 43.2 years (±16.4). Clinical diagnoses spanned the breadth of spinal neurosurgery. Approximately 45.0% of patients had complete spinal impairment. Pain (41.7%) was the most reported presenting feature. X-ray (45.1%) was the most common investigation used. Intervertebral disc herniation (18.9%) was the most prevalent imaging finding on MRI. Most patients were managed nonoperatively (57.8%), with a favorable outcome in 27.4% of patients. Posttreatment complications included pressure sores, infection, and motor deficits.

CONCLUSIONS

This systematic review and pooled analysis provide an epidemiological overview of spinal neurosurgery in Nigeria over the last 60 years and serves as a useful reference to direct future global research in this arena.

An exploratory study on becoming a traditional spiritual healer among Baganda in Central Uganda

Traditional medicinal knowledge and healing practices of indigenous spiritual healers play important roles in health care, and contribute towards achieving Universal Health Care. Traditional spiritual healers (TSHs) are grouped into three categories. One category of Baganda TSHs, Balubaale, engage ancestral spirits during health management. Balubaale are socially significant but not legally accepted. Their initiation and training practices have not been documented in Uganda. The study purpose was to understand and establish the training of traditional spiritual healers. Twelve (10M, 2F); practicing TSHs in Central Uganda were purposively selected and recruited between 15th July 2019 and 29th April 2020, and were prospectively interacted with for 24 months. Transcribed data was coded and thematically analyzed using ATLAS ti. 22 computer software and presented based on an inductive approach. Findings show key areas of TSHs training include connecting with ancestral spirits and the spiritual powers of non-materials and materials such as living and non-living things through rituals. Spiritual healers train in diagnosis and health management based on ancestral spirits and they finally pass out in a communal ceremony witnessed by family and community members. We conclude that TSHs undergo training and are supervised and supported by experienced spiritualists, family and the community. We recommend similar studies among other ethnic groups to contextualize the process of becoming a TSH, compare and harmonize findings to facilitate inter-medical systems communication and policy considerations.

Exploring the experiences of mental health nurses in the management of schizophrenia in the Upper East Region of Ghana: a qualitative study

OBJECTIVE

Schizophrenia is a chronic condition, of which the diagnosis and management require comprehensive care. The role mental health nurses play in this management cannot be overemphasised. In an effort to give their best, several challenges confront them which need to be sought and addressed. This study aimed to explore the factors that influence the management of schizophrenia by mental health nurses in the Upper East Region.

DESIGN AND PARTICIPANTS

A descriptive phenomenology design was used in this study. Individual in-depth interviews were conducted among 18 purposively sampled mental health nurses using a semistructured interview guide. Audio-recorded interviews were transcribed verbatim and analysed thematically using Colaizzi's approach.

SETTING

The study was conducted in five primary and secondary-level health facilities in the Upper East Region of Ghana.

FINDINGS

Five themes were deduced from the theoretical framework, which were as follows: individual factors, interpersonal factors, organisational factors, community-level factors, and policy-level factors. At the individual level, factors such as the condition of the patient at presentation, medication side effects, inadequate knowledge, and poor adherence were identified. Interpersonal factors identified were poor communication, lack of mutual respect, and poor communication, while organisational factors such as inadequate staff, inadequate infrastructure and logistics, and unavailability of antipsychotics were reported. Moreover, the study identified community-level factors such as stigma and cultural beliefs, while policy-level factors such as laws regarding suicide, patient rights, and non-inclusion of mental health services into the National Health Insurance Scheme were reported as factors influencing the management of schizophrenia by mental health nurses.

CONCLUSIONS

Addressing these factors is essential to ensure sustainable improvements and the effective management of schizophrenia. It is imperative to consider these factors when designing interventions and policies to optimise the management of schizophrenia by mental health nurses in Ghana.

Mental health literacy and its associated factors among traditional healers toward mental illness in Northeast, Ethiopia: A mixed approach study

BACKGROUND

Currently, the biggest issue facing the entire world is mental health. According to the Ethiopian Ministry of Health, nearly one-fourth of the community is experiencing any of the mental illness categories. Most of the cases were treated in religious and traditional institutions, which the community most liked to be treated. However, there were very limited studies conducted to show the level of mental health literacy among traditional healers.

AIMS

The study aimed to assess the level of mental health literacy and its associated factors among traditional healers toward mental illness found in Northeast, Ethiopia from September 1-30/2022.

METHOD

A mixed approach cross-sectional study design was carried out on September 130, 2022, using simple random sampling with a total sample of 343. Pretested, structured questionnaires and face-to-face interviews were utilized for data collection. The level of Mental Health Literacy (MHL) was assessed using the 35 mental health literacy (35-MHLQ) scale. The semi-structured checklist was used for the in-depth interview and the FGD for the qualitative part. Data was entered using Epi-data version 4.6 and, then exported to SPSS version 26 for analysis. The association between outcome and independent variables was analyzed with bivariate and multivariable linear regression. P-values < 0.05 were considered statistically significant. Thematic analysis was used to analyze the qualitative data, and the findings were then referenced with the findings of the quantitative data.

RESULTS

The findings of this study showed that the sample of traditional healers found in Dessie City scored a total mean of mental health literacy of 91.81 ± 10:53. Age (β = -0.215, 95% CI (-0.233, -0.05), p = 0.003, informal educational status (β = -5.378, 95% CI (-6.505, -0.350), p = 0.029, presence of relative with a mental disorder (β = 6.030, 95% CI (0.073, 7.428),p = 0.046, getting information on mental illness (β = 6.565, 95% CI (3.432, 8.680), p = <0.001, and mental health training (β = 4.889, 95% CI (0.379, 6.455), p = 0.028 were variables significantly associated with mental health literacy. Traditional healers provide a variety of explanations for the causes of mental illness, including biological, psychological, and supernatural ones.

CONCLUSION

The mean score of the Mental Health Literacy Scale (MHLS) is lower among traditional healers compared with other studies. Age, informal educational status, family history of mental illness, getting information on mental illness, and mental health training were significantly associated with mental health literacy. Therefore, different works to improve the levels of mental health literacy among traditional healers are essential.

Perceptions of causes and treatment of mental illness among traditional health practitioners in Johannesburg, South Africa

Mental disorders are among the most poorly treated illnesses in sub-Saharan Africa. It is estimated that 70%-80% of South Africans consult traditional health practitioners for the treatment of psychological ailments. As traditional health practitioners maintain a strong role in assessing and treating patients with mental illness in this context, this study contributes to the burgeoning research literature on the topic. Semi-structured in-depth interviews were conducted with 18 traditional health practitioners in Johannesburg, South Africa, between January and May 2022. Interviews were transcribed and translated into English. The data were managed using NVivo 12 software and thematically analysed. Traditional health practitioners interviewed generally perceived mental illness to be of supernatural causation, either as a result of bewitchment, a calling for patients to become THPs themselves, due to displeased ancestors, or due to natural causes. Traditional health practitioners identified eight primary treatments that they use for treating mental illness. Among these were throwing of bones (tinhlolo) to start communicating with ancestors, steaming (ukufutha) to start a cleansing process, sneezing (umbhemiso) to forcefully dispel the spirit causing the illness, induced vomiting (phalaza), and the administration of laxatives (mahlabekufeni) to remove the spirits poisoning the body as well as animal sacrifice to purge spirits and communicate with ancestors. This is all followed by cutting (ukucaba), which is the final part of the treatment and ensures that the evil spirit cannot return. Due to the ubiquity of traditional health practitioner usage for mental illness in sub-Saharan Africa, it is essential to understand what conceptions traditional health practitioners have of the aetiology of these disorders as well as their modalities for administering treatment.

The hermeneutics of recovery: Facilitating dialogue between African and Western mental health frameworks

The widespread use of faith-based and traditional healing for mental disorders within African contexts is well known. However, normative responses tend to fall within two camps: on one hand, those oriented towards the biomedical model of psychiatry stress the abuses and superstition of such healing, whilst critics adopting a more 'local' perspective have fundamentally challenged the universalist claims of biomedical diagnostic categories and psychiatric treatments. What seemingly emerges is a dichotomy between those who endorse more 'universalist' or 'relativist' approaches as an analytical lens to the challenges of the diverse healing strands within African contexts. In this article, we draw upon the resources of philosophy and existing empirical work to challenge the notion that constructive dialogue cannot be had between seemingly incommensurable healing practices in global mental health. First, we suggest the need for much-needed conceptual clarity to explore the hermeneutics of meaning, practice, and understanding, in order to forge constructive normative pathways of dialogue between seemingly incommensurable values and conceptual schemas around mental disorder and healing. Second, we contextualise the complex motives to emphasise difference amongst health practitioners within a competitive healing economy. Finally, we appeal to the notion of recovery as discovery as a fruitful conceptual framework which incorporates dialogue, comparative evaluation, and cross-cultural enrichment across divergent conceptualisations of mental health.

Traditional health practices: A qualitative inquiry among traditional health practitioners in northern Uganda on becoming a healer, perceived causes of illnesses, and diagnostic approaches

BACKGROUND

The practice of traditional and complementary medicine is increasing in most low-and middle-income countries especially for chronic communicable and non-communicable diseases. In this study, we aimed to understand how people gain healing power and become traditional health practitioners (THPs), perceived causes of illnesses, and how THPs diagnose illnesses.

METHODS

This was a cross-sectional qualitative interview-based study. We used semi-structured in-depth guides to collect data from THPs identified through the Acoli cultural institutions and snowball sampling technique. The study team visited the THPs and interviewed them in their homes. Some THPs allowed the study team to visit them more than once and as well observe their healing practices and medicines. Thematic analysis approach was used to analyze the data. Atlas.ti version 9.2 was used to support data analysis.

RESULTS

Twenty two THPs aged 39-80 years were included in the study. Most of the respondents were male, and married. We identified three main themes: (i) how people gain healing power and become traditional health practitioners; (ii) perceived causes of illnesses; and (iii) how illnesses are diagnosed. The majority of respondents reported that most people become THPs through: inheriting healing power from their parents or grandparents; transfer of healing powers from senior healers; instructions during visions and dreams; and, acquiring healing power during spirits possessions. Perceived causes of illnesses included: fate and natural causes, spirits attacks, curses by elders, witchcraft, contagion and infections, poor hygiene, heredity, and malevolent actions. THPs diagnose illnesses through various approaches including consultations with spirits, observing patterns of occurrences and events, evaluation of symptoms and signs of illnesses, use of bones from animals/birds and other objects to diagnose illnesses, performing diagnostic rituals, and using biomedical laboratory testing in health facilities.

CONCLUSION

Healing knowledge and powers are acquired in particular ways that can be traced to appraise authenticity of healers during registration and licensing to ensure safety of patients. Understanding perspectives of the THPS on causes of illnesses and how diagnoses are made potentially informs strategies for integration and or collaboration between the national biomedical health system and traditional health practices.

Investigation of the nephroprotective activity of Moringa peregrina leaves aqueous extract in mice

Traditional remedies for Moringa peregrina leaves have a variety of uses with confirmed biological and therapeutic effects, as per published reports. The current study aims to evaluate the ability of the leaves aqueous extract to protect from nephrotoxicity in gentamicin-treated mice. Phytochemical analysis for the aqueous extract was performed using DPPH (2,2-Diphenyl-1-picrylhydrazyl) assay for antioxidants, Folin-Ciocalteu, AlCl3 and HPLC- MS/MS analysis, focusing on phenol and flavonoid content. The nephroprotective activity of the prepared extract was evaluated by means of variable biochemical parameters including Creatinine (Cr), Uric Acid (UA), and Urea (Ur). In addition, histological examination of renal tissues was performed in all mice groups (control, gentamicin-induced (150 mg/Kg i.p) and aqueous extract-orally treated groups (500 and 1000 mg/Kg)). Findings reveal that the prepared extract has total phenols (555.57±0.92mg/g, equivalent to gallic acid), flavonoids (40.08±1.56 mg/g, equivalent to quercetin), and DPPH IC50 (3.10 µg/ml). HPLC-MS/MS analysis revealed the presence of 10 phenols and flavonoids compounds. In vivo studies showed a significant (P &lt; 0.05) reducing effect for the high-dose treatment, on serum and urine concentrations for UA, Cr, and U, among the nephrotoxicity induced mice. Low-dose treated group showed significant reduction on serum concentration of UA, Cr and U, but only for Cr concentration in urine. The histological examination showed an improvement in the image of the renal tissue among the induced-nephrotoxicity mice, which was treated with high-dose extract. In conclusion, leaves aqueous extract of M. peregrina have shown potential protective effect to counteract some of the gentamicin consequences on kidney functions.

Perceived causes, diagnosis methods and treatment practices of mental illness among traditional healers of the Berta community in Assosa, Ethiopia

INTRODUCTION

Mental illness is a non-communicable disease that is increasingly contributing to the global burden of diseases and disability. It affects a person's feelings, thinking, behavior, and daily life functioning.

OBJECTIVES

The purpose of this study was to explore perceived causes of mental illness, techniques for identifying mental illness, and treatment methods used by traditional healers in the Berta community.

METHODS

The study employed a qualitative research method. Data were collected using semi-structured in-depth interviews with seven traditional healers who were selected purposefully. We used thematic analysis to present and analyze the data.

RESULTS

The findings of this study indicated that witchcraft, supernatural power, hereditary, substance use, and food poising as the main perceived causes of mental illness among traditional healers in the Berta community. The traditional healers identify mental illness using different techniques such as patient observation, interviews with a patient's family, use of religious books, and use of herbals. The traditional healers in the Berta community identify mental illness based on behavioral symptoms like talking about things that don't make sense, laughing alone, taking off clothes in public places, collecting and carrying dirty materials, eating dirty foods, and harming or intention to harm others.

CONCLUSIONS

The traditional healers in the Berta community use herbals, religious books, and bone divination to guide their treatment of persons with mental illnesses. Some of these traditional healing practices options are peculiar to the Berta Community that are used to diagnosize and treat mental illnesses.

RECOMMENDATIONS

The traditional healing practices of the Berta community should be recognized, licensed, and supported by the Ministry of Health and the Ethiopian Food and Drug Administration and Control Authority.

Adolescent Health Series The status of adolescent mental health research, practice and policy in sub-Saharan Africa: A narrative review

Sub‐Saharan Africa (SSA) has the fastest growing adolescent population in the world. In addition to developmental changes, adolescents in SSA face health and socioeconomic challenges that increase their vulnerability to mental ill‐health. This paper is a narrative review of adolescent mental health (AMH) in SSA with a focus on past achievements, current developments, and future directions in the areas of research, practice and policy in the region. We describe the status of AMH in the region, critical factors that negatively impact AMH, and the ways in which research, practice and policy have responded to this need. Depression, anxiety and post‐traumatic stress disorders are the most common mental health problems among adolescents in SSA. Intervention development has largely been focused on HIV/AIDS service delivery in school or community programs by non‐specialist health workers. There is a severe shortage of specialised AMH services, poor integration of services into primary health care, lack of a coordinated inter‐sectoral collaboration, and the absence of clear referral pathways. Policies for the promotion of AMH have been given less attention by policymakers, due to stigma attached to mental health problems, and an insufficient understanding of the link between mental health and social determinants, such as poverty. Given these gaps, traditional healers are the most accessible care available to help‐seeking adolescents. Sustained AMH research with a focus on the socioeconomic benefits of implementing evidence‐based, contextually adapted psychosocial interventions might prove useful in advocating for much needed policies to improve AMH in SSA.

“The Question Is Not How but Why Things Happen comes from Mkize, 2003, p.4)”: South African Traditional Healers’ Explanatory Model of Mental Illness, Its Diagnosis and Treatment

While there is relatively high patronage of traditional healers in South Africa, their approaches toward mental illness remain shrouded in mystery. The research therefore explored the beliefs and practices of traditional healers at Dube Village, Soweto, South Africa regarding the reasons for and treatment of mental illness and was guided by an Afrocentric theoretical perspective. Qualitative interviews with 14 traditional healers revealed that mental illness could be identified by throwing the bones, observations, and history-taking. They attributed mental illness to spiritual, socio-cultural, psychosocial, and physical factors. Methods used to treat mental illness included removing evil spirits through washing, steaming, induced vomiting, and administering herbal remedies. Findings suggest that while there are many similarities with biomedicine, traditional healing differs in terms of its links with spirituality and the efforts of healers to answer the question why things happen from a collectivist perspective.

Natural products for the treatment of stress-induced depression: Pharmacology, mechanism and traditional use

ETHNOPHARMACOLOGICAL RELEVANCE

Depression, one of the most common psychiatric disorders, is the fourth leading cause of long-term disability worldwide. A series of causes triggered depression, including psychological stress and conflict, as well as biological derangement, among which stress has a pivotal role in the development of depression. Traditional herbal medicine has been used for the treatment of various disorders including depression for a long history with multi-targets, multi-levels and multi-ways, attracting great attention from scholars. Recently, natural products have been commercialized as antidepressants which have become increasingly popular in the world health drug markets. Major research contributions in ethnopharmacology have generated and updated vast amount of data associated with natural products in antidepressant-like activity.

AIMS OF THE REVIEW

This review aims to briefly discuss the pathological mechanism, animal models of stress-induced depression, traditional use of herbal medicines and especially recapitulate the natural products with antidepressant activity and their pharmacological functions and mechanism of action, which may contribute to a better understanding of potential therapeutic effects of natural products and the development of promising drugs with high efficacy and low toxicity for the treatment of stress-induced depression.

MATERIALS AND METHODS

The contents of this review were sourced from electronic databases including PubMed, Sci Finder, Web of Science, Science Direct, Elsevier, Google Scholar, Chinese Knowledge On frastructure (CNKI), Wan Fang, Chinese Scientific and Technological Periodical Database (VIP) and Chinese Biomedical Database (CBM). Additional information was collected from Yao Zhi website (https://db.yaozh.com/). Data were obtained from April 1992 to June 2021. Only English language was applied to the search. The search terms were 'stress-induced depression', 'pathological mechanism' in the title and 'stress', 'depression', 'animal model' and 'natural products' in the whole text.

RESULTS

Stress-induced depression is related to the monoaminergic system, hypothalamic-pituitary-adrenal (HPA) axis, neuronal plasticity and a series of inflammatory factors. Four main types of animal models of stress-induced depression were represented. Fifty-eight bioactive phytochemical compounds, fifty-six herb medicines and five formulas from traditional Chinese medicine were highlighted, which exert antidepressant effects by inhibiting monoamine oxidase (MAO) reaction, alleviating dysfunction of the HPA axis and nerve injury, and possessing anti-inflammatory activities.

CONCLUSIONS

Natural products provide a large number of compounds with antidepressant-like effects, and their therapeutic impacts has been highlighted for a long time. This review summarized the pathological mechanism and animal models of stress-induced depression, and the natural products with antidepressant activity in particular, which will shed light on the action mechanism and clinical potential of these compounds. Natural products also have been a vital and promising source for future antidepressant drug discovery.

Integrating Traditional Medicine and Healing into the Ghanaian Mainstream Health System: Voices From Within

In this study, I employed interpretive ethnographic qualitative design to explore perceptions of and proposals from traditional healers, biomedical practitioners, and health care consumers regarding integrating traditional medicine and healing in Ghana. Data were gathered through focus groups, in-depth individual interviews, and qualitative questionnaires and analyzed thematically. The results revealed positive attitudes toward integrating traditional medicine in Ghana and a discursive discourse of power relations. The power imbalance between biomedical and traditional practitioners regarding what integrative models to adopt is sanctioned by formal education and institutional structure. As a result, multiple approaches for integration were made, including patient co-referrals, collaborations between biomedical and traditional medical practitioners, and creating a unit for traditional medicine and healers at the outpatients' department for patients to choose either biomedicine or traditional medicine. Incorporating aspects of traditional healing in the training of biomedical practitioners and creating a space for knowledge sharing were also proposed. These integrative models reflected the distinctive interests of healers and biomedical practitioners. Considering these findings, I recommended policy options for consideration toward achieving an integrative health care system in Ghana.

Knowledge about epilepsy and factors associated with attitudes toward marrying, employing, and driving people with epilepsy: A cross-sectional survey of Asokore Mampong community dwellers in Ghana

BACKGROUND

Due to lack of information and illiteracy, epilepsy remains a stigmatized disease in sub-Saharan Africa.

OBJECTIVES

The main aim of the study was to determine, among community dwellers in Asokore Mampong Municipality (Ghana): (i) the knowledge on risk factors, signs and symptoms, management of epilepsy, and (ii) factors associated with attitudes toward marrying, employing, or driving people with epilepsy (PWE).

METHODS

A cross-sectional study of 100 randomly selected individuals aged 18 years and older in Asokore Mampong Municipality was conducted in February 2019. A self-administered questionnaire was used to assess the knowledge about epilepsy and attitudes toward marrying, employing, and driving people with epilepsy. Frequencies and corresponding percentages were used to describe the study participants, their knowledge regarding epilepsy and attitudes toward marrying, employing, or driving people with epilepsy. Univariate and multivariate logistic regression analyses were used to determine the factors associated with attitudes toward marrying, employing, or driving people with epilepsy.

RESULTS

Majority (33%) of the respondents indicated that epilepsy is caused by possession of evil spirits or witchcraft. More than 60% of the respondents correctly identified all signs and symptoms presented in the survey. Almost half (45%) of the respondents selected orthodox/medical treatment as the treatment for epilepsy. The odds of marrying PWE among Akans and Ewe/Ga Adangbe were 90% [adjusted Odds ratio (aOR) = 0.10, 95% CI: 0.01-0.67] and 84% lower [aOR = 0.16, 95% CI: 0.04-0.62] compared to odds of marrying PWE among Northerners, respectively. Compared to respondents with no formal education, the odds of employing PWE were 88% lower [aOR = 0.12, 95% CI: 0.03-0.40] among those with tertiary education. In addition, the odds of driving a person with an epileptic attack among Muslims/Traditionalists were 81% lower [aOR = 0.19, 95% CI: 0.05-0.68] than Christians. Respondents between 18 and 30 years old had more than 5 times higher odds of driving a person with an epileptic attack [aOR 5.28, 95% CI: 1.15-24.84] compared to respondents above 30 years.

CONCLUSIONS

Individuals in Asokore Mampong have less knowledge about the risk factors and treatment of epilepsy. Generally, they have negative attitudes toward marrying, employing, and driving PWE. Findings from this study highlight the need to increase education to reduce the stigma associated with epilepsy. We recommend that a massive educational campaign should be organized by the Ghana Health Service to address deficiencies in knowledge as well as the negative attitudes toward PWE.

Communicating Awareness About COVID-19 Through Songs: An Example From Ghana

Research has shown that music can be used to educate or disseminate information about public health crises. Grounded in the edutainment approach, we explored how songs are being used to create awareness about COVID-19 in Ghana, a sub-Saharan African country. YouTube was searched, and 28 songs met the study inclusion criteria. We conducted a thematic analysis of the song lyrics. Most lyrics were in English, Ghanaian Pidgin English, Akan, Ga, or Dagbani. Reflecting the multilingual population of Ghana, half of the songs contained three languages to convey their message, and only five songs were in one language. Eight themes emerged from the analysis: public health guidelines, COVID-19 is real and not a hoax, COVID-19 is infectious, prayer as method to stop the virus, emotional reaction and disruption of “everyday” activities; verbally expelling the virus, call for unity and collective efforts, and inspiring hope. We show that songs have the potential as a method for rapidly sharing information about emerging public health crises. Even though, it is beyond the scope of this study to draw conclusions about the reception and impact of songs on awareness and knowledge, the study shows that examining song lyrics can still be useful in understanding local attitudes toward COVID-19, as well as strategies for promoting preventive behaviors. We note that additional multidimensional efforts are needed to increase awareness among the general public about the COVID-19 pandemic.

The treatment of mental illness in faith-based and traditional healing centres in Ghana: perspectives of service users and healers

BACKGROUND

The maltreatment of people with mental illness in Ghana's traditional and faith-based healing centres, including shackling, flogging, and forced fasting, has been documented by numerous sources. Such treatment is potentially traumatising and may exacerbate mental health problems. Despite widespread use, few studies have focused on experiences and characteristics of people who seek traditional healing for mental illness or healers' perspectives treatment of these conditions.

METHOD

Purposeful sampling was used to recruit 82 individuals who were treated in healing centres and 40 traditional healers; all took part in semi-structured interviews. Those treated were asked about experiences in centres and assessed for prior trauma exposure, posttraumatic stress, and functional impairment. Healers were asked about beliefs and practices related to the treatment of mental illness.

RESULTS

Individuals treated in centres and healers generally believed that mental illness has a spiritual cause. Approximately 30.5% of those treated in centres were exposed to maltreatment; despite this, half would return. Individuals with a history of trauma were more likely to report maltreatment in the centre and had higher symptoms of posttraumatic stress. Most participants had impaired functioning. Healers who used practices like shackling believed they were necessary. Most healers were willing to collaborate with the official health structure.

CONCLUSION

Results provide insight into the treatment of mental illness by traditional healers in Ghana and the need for trauma-informed mental health services. Findings also highlight the importance of considering cultural beliefs when attempting to implement mental health interventions in the region.

Pathways to mental health treatment in Ghana: Challenging biomedical methods from herbal- and faith-healing perspectives

BACKGROUND

The clinical pathways for treating mental illness have received global attention. Several empirical studies have been undertaken on treatment pathways in Ghana. No study, however, has systematically reviewed the literature related to the pathways of mental health treatment in Ghana.

AIM

This article aims to identify the pathways used to treat mental illnesses; examine the evidence about the possibility of collaboration between biomedical, faith and traditional healing pathways; and draw attention to the barriers hindering such collaboration.

METHODS

A search of the published literature was conducted using Medline, Embase, PsycINFO, CINAHL (EBSCO), Web of Science and Scopus databases. The search was limited to the articles that were published in English and released between 2000 and June 2018. The review synthesises both qualitative and quantitative data.

RESULTS

The findings showed that mental illnesses in Ghana are treated using a mixture of biomedical and faith-based and traditional healing services. Faith and traditional healing pathways are typically used as a preliminary source of cultural assessment before seeking biomedical treatment. There is an increasing desire for collaboration between biomedical, faith and traditional healing pathways. However, several individual factors (attitude or stigma, the perceived efficacy of treatment and differences in the treatment process) and health system factors (a lack of policy and regulation, a limited number of biomedical service providers, limited financial support and geographical isolation of services) jointly contribute to barriers precluding establishing such collaboration.

CONCLUSION

This review recommends that policies, regulations, educational support and financial incentives should be developed to facilitate collaboration between biomedical, faith and traditional healing service provision.