Socio-Cultural Factors Associated With Buruli Ulcer Management In The Obom Sub-District Of The Ga South Municipality Of Ghana

Abstract

This study was conducted with three specific objectives: to describe community knowledge and perception about Buruli ulcer and wound management; determine health seeking behaviour for Buruli ulcer by community members and determine cultural and local acceptability of wound management at the clinic and community. The study was conducted in the Obom sub-district of the Ga South Municipality of Ghana. This was a mixed method study employing qualitative and quantitative techniques for data collection. Interviews and Focus Group Discussions were conducted with some selected community elders, traditional healers, Buruli ulcer patients and some patient caretakers in selected communities. Fifty five (55) in-depth interviews were conducted and groups of 8 community elders (Ga, Ewe and Akan) were each selected for focus group discussions in the study area. There were therefore a total of three focus group discussions that were done. Observations were also done on Buruli ulcer patients to document how they integrate local and modern wound management practices in the day to day handling of their wounds. Survey questionnaires were also used to collect data. Content analysis was done after thematic coding of the qualitative data whiles for the quantitative data; Epi-Info 7 was used to perform basic frequencies to measure the level of knowledge, perceptions and treatment seeking behaviour of Buruli ulcer in the endemic communities. Findings from the study revealed a high level (95.3%) of knowledge about Buruli ulcer in the selected endemic communities. Local names of Buruli ulcer vary by the local languages (Ga, Ewe and Akan) spoken by communities. However, the various local names have common meanings and interpretations for Buruli ulcer disease. Findings revealed varied perceptions of community members about Buruli ulcer and the infected. Some respondents perceived Buruli ulcer patients as people who have been bewitched, people who are witches/wizards while others perceived them as people who did not take good care of themselves and got infected. It came to light that most respondents (41.0%) would resort to self-medication as their first treatment option when infected with Buruli ulcer disease. However, it was also found that, cultural practices and beliefs significantly affected the patients' wound care and treatment seeking behaviour. It came up that there were two categories of wounds depending on their causes. Those caused by charms or spirits and required the attention of traditional healers, while those not caused by charm should be treated either at home or at the health facility. Various materials were used for such wound dressing and these included urine and concoctions made of charcoal and gun powder. There is the need for community education to make a strong case for early reporting to avoid ulcers or at least severe ones reporting at the biomedical facilities. It is pertinent for both Buruli ulcer endemic community members and clinicians to be educated to understand each other‘s expectations regarding wound care, as local beliefs could significantly impact wound care and treatment outcomes.