Abstract:
Traditional Bone Setting (TBS) is the most commonly utilised healthcare for Bone, Joint and Muscle Conditions (BJMCs) in developing countries, accounting for over 70% of BJMCs treatment in Nigeria. Studies have focused mainly on the adverse treatment outcomes and attendant consequences of TBS, with little attention devoted to its socio-cultural peculiarities and utilisation in Nigeria. Therefore, this study examined the utilisation of TBS, nature and structure, interface with modern healthcare and strategies for the development of TBS among the Nupe of Kwara State, Nigeria.
Parsons’ Theory of the Social System was adopted as the framework, while exploratory and cross-sectional research designs were adopted. Edu and Patigi Local Government Areas of Kwara State, mainly of indigenous Nupe, were purposively selected due to the widespread practice of TBS. Godden’s sample formula was used to proportionately select and administer a questionnaire to 660 respondents in Tsaragi (67), Saba-Gina (42), Patidzuru (67), Kpankorogi (42), Kocitako (47), Bacita (62), Sokingi (42), Patiko (42), Pututa (44), Lema (62), Ndako-Yissa (42), Dada (42), Fey (24) and Ndanaku (35). The questionnaire focused on utilisation and social organisation of TBS, and its interface with modern healthcare. Thirty-three in-depth interviews were conducted with practitioners and patients, while 15 key informant interviews were conducted with traditional chiefs and Primary Health Care (PHC) providers. Quantitative data were analysed using descriptive statistics and multiple linear regression at p≤0.05. Qualitative data were content-analysed.
Respondents’ age was 40.5±8.1 years, males were 69.6% while majority (74.4%) were rural dwellers and belonged to informal occupational groups (77.2%). Majority (93.6%) of the respondents had utilised TBS as a source of care for BJMCs due to its perceived advantages, including easy access and perceived efficacy. There was no significant joint influence of socio-demographic characteristics and TBS utilisation among the Nupe of Kwara State.The practice of TBS was guided by socio-cultural mythologies which prohibited the economic exploitation of patients. Practitioners, mostly without western education, combined socio-cultural and spiritual resources with bio-medical approaches in TBS practice. Patients’ wards comprised rooms that were freely released for use by community members, but mostly in poor conditions. The practice of TBS was inherited within families and practitioners were not organised into associations. The TBS was devoid of state regulation, while leadership and influence on decisions were primarily determined by age and years of experience. There were no official referrals between TBS and modern healthcare. However, practitioners employed modern healthcare methods and materials in treating patients using some modern PHC resources. Community mobilisation, basic biomedical training and establishment of referral channels, and state regulations were strategies identified for the development of TBS.
Despite strong belief and positive attitude toward traditional bone setting among the Nupe, social factors such as poor infrastructure and low level of education affect treatment outcomes. There is the need to develop infrastructure, while providing basic healthcare education and training to practitioners for consolidating the existing capacity of traditional bone setting.
