Medical pluralism in beliefs and practices surrounding epilepsy care in Uganda
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Background: In the context of a massive epilepsy treatment gap in Sub-Saharan Africa, people with epilepsy consult multiple sources of treatment, including biomedical, traditional and pastoral providers. Thus, in this study, patient and caregiver beliefs about epilepsy etiology and their health-seeking behaviors were investigated as a first step towards exploring a possible basis for collaboration within Uganda’s pluralistic health system. Methods: 626 participants were interviewed in three hospitals in Uganda regarding their beliefs about epilepsy and care-seeking behaviors. Analyses were conducted to determine whether beliefs about epilepsy etiology tended to encompass solely biological explanations or whether they were more pluralistic, drawing upon biological, mystical and spiritual explanations for their conditions. The associations of these beliefs with various demographics and care-seeking behaviors were also investigated. Results: More than two thirds of the sample held pluralistic beliefs about epilepsy etiology, encompassing biological as well as mystical and spiritual concepts in their explanations for seizures. These pluralistic beliefs tended to be associated with greater delays in seeking biomedical care (p<0.005) and greater likelihood of accessing traditional or pastoral healers for care (p<0.1). People with pluralistic beliefs also tended to be younger (p<0.01), less educated (p<0.05) and have lower incomes(p<0.05) than those with only biological beliefs. Conclusions: These results suggest reveal the importance of understanding sociocultural beliefs in mediating treatment bottlenecks for epilepsy care associated with medical pluralism. In order to adequately treat patients with epilepsy, there needs to be more inclusive approach to health care delivery that respects pluralistic beliefs. Understanding the complex imbrications in beliefs, practices and health care systems related to epilepsy will be crucial for making progress towards the WHO’s strategic plans for integrating traditional and complementary medicine and for addressing the mental health gap.
DepartmentGlobal Health Institute
CitationSmith, Caleigh (2019). Medical pluralism in beliefs and practices surrounding epilepsy care in Uganda. Honors thesis, Duke University. Retrieved from https://hdl.handle.net/10161/18465.
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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.
Rights for Collection: Undergraduate Honors Theses and Student papers