Onchocerciasis and women's reproductive health: indigenous and biomedical concepts

Abstract

Women in a rural farming community in Etteh, Nigeria, have traditional beliefs about onchocerciasis which differ from the concepts of modern science. Recognizing these beliefs may allow health workers to gain the confidence and participation of the people and increase the effectiveness of control programmes.

PIP: The beliefs of women in a rural farming community in Etteh, Nigeria, about the causes, transmission, and treatment of onchocerciasis were determined in order to assess how to organize an acceptable control program. Etteh is an onchocerciasis-endemic community located on the Ubelle river, which is a known breeding ground for Simulium damnosum, the major vector. No treatment or vector control program has been conducted here, so the concepts about the disease are entirely indigenous. Data were collected from 75 infected and 70 noninfected multiparous women aged 16-49 years old using a questionnaire, interviews, and 2 focus groups in each of 5 randomly selected villages. In each village traditional healers and 2 midwives were interviewed. It was found that 83% of the women believe that each of the 4 signs of the disease (onchocercal dermitis with atrophic dermis and urticopapular eruptions, hanging groin, leopard skin, and onchocercal nodules) has a different cause. 88% believe that only the onchocercal nodule is caused by the blackfly vector. 55% of the infected women (versus 36% of noninfected) believe that the lesions are inherited. 80% of the women believe the disease is transmissible from mother to child during pregnancy. Local advice is to treat children, especially girls, before they reach marriageable age. Traditional treatments are external only. Tradition holds that onchocerciasis is responsible for infertility, sterility, habitual abortion, and problems with lactation. These consequences are not totally incompatible with modern science, but biomedical researchers recognize only blindness and lesions as the consequences of the disease. A further distinction between traditional and modern views is the traditional targeting of the adolescent for treatment. By paying attention to the beliefs of a local population, better cooperation may be gained in developing treatment and control programs. The women interviewed in this study were more concerned about the effects of the disease on reproductive health and transmission to offspring than about skin lesions or even blindness. Knowledge of this fact should help develop an effective control program.