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Analysis of Factors Influencing Traditional Medicines Utilisation in Ghana: Evidence from Kumasi Metropolis and Sekyere South District

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Analysis of Factors Influencing Traditional Medicines Utilisation in Ghana: Evidence from Kumasi Metropolis and Sekyere South District ANALYSIS OF FACTORS INFLUENCING TRADITIONAL MEDICINES UTILISATION IN GHANA: EVIDENCE FROM KUMASI METROPOLIS AND SEKYERE SOUTH DISTRICT BY RAZAK MOHAMMED GYASI, BA (HONS); CERT. ED A THESIS SUBMITTED TO THE DEPARTMENT OF GEOGRAPHY AND RURAL DEVELOPMENT, KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PHILOSOPHY DEPARTMENT OF GEOGRAPHY AND RURAL DEVELOPMENT FACULTY OF SOCIAL SCIENCES COLLEGE OF ART AND SOCIAL SCIENCES AUGUST, 2014 CERTIFICATION I hereby declare that this submission is my own work towards the MPhil and that, to the best of my knowledge, it contains no material previously published by another person nor material which has been accepted for the award of any other degree of the University, except where due acknowledgement has been made in the text. RAZAK MOHAMMED GYASI …………… …………… (PG 1173407) Signature Date CERTIFIED BY: DR. (MRS.) CHARLOTTE MONICA MENSAH …………… …………… (SUPERVISOR) Signature Date MRS. LAWRENCIA POKUAH SIAW …………… …………… (SUPERVISOR) Signature Date CERTIFIED BY: DR. ALEX Y. SEGBEFIA …………… …………… (HEAD OF DEPARTMENT) Signature Date ii ABSTRACT Utilisation of traditional medical therapy dates back into antiquity; virtually every culture in the world has relied on it to treat/prevent one ill-health or another. Despite the current advances in conventional health care, traditional medicine (TRM) use continues to upsurge at both local and global scales. Whereas findings of studies on why this trend persists remain confounding and erratic, there is paucity of data from research on determinants of TRM use in the Ashanti Region. This study investigated the nature of TRM utilisation and the factors that influence such utilisation patterns in Ghana using data from Kumasi Metropolis and Sekyere South District of Ashanti Region. This cross- sectional survey espoused a mixed-approach of social research to access data from 386 participants from rural and urban prefectures through systematic random sampling, theoretical sampling and snow ball techniques. Face-to-face structured interviewer- administered questionnaire and in-depth interview guides were the main data collection instruments used. Whereas the quantitative data were analysed using bivariate logit regression model, Pearson’s chi-square and Fisher’s exact tests from the PASW for Windows application programme (version 17.0), the qualitative data were subjected to content analysis with deductive and a posteriori normative quotes. Findings indicate that 86.1% of the sample utilised traditional health care, of which 87.8% did not disclose it use to biomedical providers. Biologically-based therapies and family/relatives were respectively, the main form and source of knowledge regarding TRM. TRM users were more likely to be traders [OR = 2.321 (95.0% CI 1.037—5.194; p = 0.040)], having lower income [OR= 2.883 (95.0% CI 1.142—7.277; p = 0.025)], perceiving TRM as effective [OR= 4.430 (95.0% CI 1.645—11.934; p = 0.003)] reporting fewer side effects of use of TRM [OR = 2.730 (95.0% CI 0.986—4.321; p = 0.031)], having chronic diseases [OR = 3.821 (95.0% CI 1.213—11.311; p = 0.005)] and good attitudes of iii traditional healers towards service users [OR = 2.943 (95.0% CI 0.875—9.896; p = 0.030)]. Whilst support was expressed for full medical integration, education/training and inter-referral mechanisms needed to fuel the process were not officially sanctioned. Study hypotheses were validated by the results. The hypotheses that there are no differences in residential status (χ2 = 0.232, df = 1, p > 0.05), sex of respondents (χ2 = 0.406, df = 1, p > 0.05) and health insurance status (χ2 = 0.401, df = 1, p > 0.05) regarding TRM utilisation were confirmed. These findings contribute to the empirical and theoretical debate on TRM utilisation. The study has bequeathed a conceptual model for studies on TRM utilisation. It has further provided empirical evidence to argue against dogmatic thoughts that uninsured, uneducated, rural residents and females are principal users of TRM. Policy initiatives that seek to ameliorate TRM and address challenges encountered by intercultural health care in Ghana are recommended. Further research is directed to examine barriers/ways to improve patient-physician communication on TRM utilisation and why urban residents patronise TRM. iv TABLE OF CONTENTS CERTIFICATION .............................................................................................................. ii ABSTRACT ..................................................................................................................... iii TABLE OF CONTENTS ................................................................................................... v LIST OF TABLES .............................................................................................................. x LIST OF FIGURES ........................................................................................................... xi LIST OF MAPS ................................................................................................................ xii LIST OF ABBREVIATIONS......................................................................................... xiii DEDICATION ................................................................................................................. xvi ACKNOWLEDGEMENTS ............................................................................................ xvii CHAPTER ONE ............................................................................................................... 1 INTRODUCTION ............................................................................................................ 1 1.1 Background to the Study .............................................................................................. 1 1.2 Problem Statement ........................................................................................................ 5 1.3 Research Questions ....................................................................................................... 9 1.4 Study Objectives ......................................................................................................... 10 1.5 Hypotheses .................................................................................................................. 10 1.6 Definition of Key Concepts ........................................................................................ 11 1.7 Study Design, Fieldwork and Methodological Issues ................................................ 13 1.7.1 Introduction ......................................................................................................... 13 1.7.2 The Study Design ................................................................................................ 14 1.7.3 Variables, Definitions and Preferred Cut-off Values .......................................... 15 1.7.4 Sampling Techniques and Procedure .................................................................. 17 1.7.5 Data Collection Tools and Procedure ................................................................. 21 1.7.6 Data Management and Analysis .......................................................................... 26 1.8 Significance of the Study ............................................................................................ 28 1.9 Organisation of the Study ........................................................................................... 29 v CHAPTER TWO ............................................................................................................ 32 UTILISATION OF TRADITIONAL MEDICINE: REVIEW OF RELATED LITERATURE ................................................................................................................ 32 2.1 Introduction ................................................................................................................. 32 2.2 Profile of Ghana and Overview of Health Sector ....................................................... 32 2.2.1 Background and Profile of Ghana ....................................................................... 32 2.2.2 Overview of Ghana’s Health System .................................................................. 36 2.3 Distribution of Health Facilities ................................................................................. 41 2.4 Traditional Medicine in Retrospect ............................................................................ 45 2.4.1 Evolution and Historical Trajectory of Traditional Medicine (TRM) ................ 45 2.4.2 The Concept and Contested Definition of Traditional Medicine (TRM) ........... 47 2.4.3 Traditional Medical Practice ............................................................................... 50 2.4.4 The Role of TRM in Primary Health Care .......................................................... 52 2.5 Characterisation, Categories of Traditional Medical Practitioners (TMPs) and Forms of Traditional Medicine (TRM) .................................................................................. 56 2.5.1 Characterising Traditional Medical Practitioners (TMPs) .................................. 56 2.5.2 Categories of Traditional Medical Practitioners (TMPs) .................................... 57 2.5.3 Forms of Health Care System ............................................................................. 59 2.5.3.1 Intolerant Medical Orthodoxy and Tolerant Medical Orthodoxy ...............
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