CULTURAL PERCEPTION OF MALARIA AND CHOICE OF THERAPY AMONG THE IBIBIO OF AKWA IBOM STATE, NIGERIA

Abstract

Interpretation and management of malaria in contemporary African societies are influenced by both western and indigenous perceptions of the disease. However, existing studies have focused on causes, prevalence and socio-environmental factors of malaria, using mainly Western paradigm, resulting in lack of conceptual balance in the literature. This study, therefore, examined etymology of the local terms for malaria and how they influence aetiology of malaria in Ibibioland, southern Nigeria. The thesis examined the cultural perception of malaria in comparison with bio-medical perception. This was done by determining how cultural interpretations of malaria and beliefs surrounding the disease influence management and therapeutic choices. The aim was to foster an integration of theory and practice in the management of malaria. The study adopted Clifford Geertz’s ethno-hermeneutics which theorizes interaction between local knowledge and construction of everyday realities. Data were obtained from four purposely selected local government areas (LGAs) out of 14 mainly occupied by the Ibibio, based on their strict Ibibio identity. Forty-three malaria cases; 10 orthodox, 15 traditional and 18 self-medication practices were observed. Key Informant Interviews (KIIs) were conducted on purposively sampled 11 orthodox and 10 traditional healthcare providers. Sixteen focus group discussion (FGD) sessions each for men and women knowledgeable in local interpretations of malaria were held. Data were analysed descriptively. Etymologically, the Ibibio describe malaria based on symbolic and symptomatic presentations, while bio-medical science describes malaria as a vector-borne infectious disease. Four manifestations were identified among the Ibibio: colour, related to uto-enyin, nutrition, related to adan/akom, bio-physical actions and spiritually-induced body temperature, related to atuatuak/nkpo ntokeyen and spiritually-induced anaemia, related to uto-enyin ekpo. While KII, showed that the belief in multiple cau ces of malaria fever was widespread in both rural and urban centres, FGDs revealed that more than one of these manifestations could be presented in one malaria episode. Aetiologically, uto-enyin was believed to be caused by exposure to sunlight; adan/akom by excessive consumption of oil; atuatuak /nkpo ntokeyen by preter-natural forces such as eka abasi (unidentified forces), and essien emana (spiritual age grade/ reincarnated births), and uto-enyin ekpo by witchcraft forces. Against the bio-medical position which stresses clinical diagnosis and care, KIIs revealed that there were many local remedies for malaria, and therapeutic choice depended on perception of each malaria episode. Thus, when malaria was perceived as uto-enyin, remedies were focused on removing the yellow matter. If it was perceived as adan/akom, oily deposits had to be washed from the body through herbal baths, purging and enema, while as atuatuak, nkpo ntokeyen and uto-enyin ekpo, remedies involved spiritual cleansing and rituals to appease supernatural forces. The use of herbal extracts for treatment cut across the four LGAs but their herbal contents differed from context to context. Cultural practices against malaria were widespread across the rural-urban divide. The cultural perception of malaria with regard to etymology and aetiology, contrasts completely with Western perception of the disease. The Ibibio relate malaria aetiology to colour, nutrition, and preter-natural forces. These symbolic representations determine therapeutic choices in Ibibioland. It is recommended that, useful aspects of the cultural care system should be integrated into the implementation of the healthcare plan for effective malaria control.