The Allure of Abdominal Scarification (`UDE`) among the Esan Tribe in South-South Nigeria – A Prospective Analysis

Main Article Content

T. A. T. Salami
E. Irekpita
A. Emorinken
T. I. A. Oseni
A. A. Akinkugbe
O. E. Oziegbe
F. O. Agbebaku

Abstract

Background: The practice of inflicting cuts (incisions) on the anterior abdominal wall to treat splenomegaly of various causes is a very common one in some parts of Edo State, Nigeria. Such incisions may result in several complications including sepsis (especially in children who are the major targets); massive blood loss leading to symptomatic anemia that may require blood transfusions or lead to death and massive keloidal growth as sequelae in some of the patients. This practice is a long-term practice of the Esan people of the central part of Edo State Nigeria. This study aims to identify the factors that continue to make this practice attractive to members of the community, the common complications encountered, and how to develop an advocacy tool for health education and promote the health-seeking behavior of the populace.

Methods: This was a prospective community based cross-sectional descriptive study that was conducted in all the 5 Esan speaking local government areas of Edo State where this practice is very common. The study was done between January 2017 and June 2018. Participants were interviewed using a structured questionnaire by previously trained researchers, after pretesting and validation. The questionnaire was administered on 700 adults, however, 500 were returned. The data obtained were summarized as frequencies and percentages.

Results: The majority of the participants were middle-aged. Ninty-five percent (95%) of respondents were aware of the practice of abdominal scarification and 80% of them think it is effective. It was mainly carried out by herbalists in 95% of the respondents. Half of the respondents were unaware of any complications associated with the procedure.

Conclusion: Abdominal scarification is a common practice among the Esan people of south-south Nigeria. They believe it's effective, affordable, and risk-free. This is despite the availability of effective alternatives in orthodox medicine. There is, therefore, a need for advocacy and health education considering the dangers and complications associated with the practice.

Keywords:
Abdominal scarifications, Esan tribe, South-south Nigeria.

Article Details

How to Cite
Salami, T. A. T., Irekpita, E., Emorinken, A., Oseni, T. I. A., Akinkugbe, A. A., Oziegbe, O. E., & Agbebaku, F. O. (2020). The Allure of Abdominal Scarification (`UDE`) among the Esan Tribe in South-South Nigeria – A Prospective Analysis. International Journal of TROPICAL DISEASE & Health, 41(14), 9-19. https://doi.org/10.9734/ijtdh/2020/v41i1430349
Section
Original Research Article

References

Coleman H. Scarification and Cicatrisation among African cultures. Retrieved from rand African Art 2002. Available:www.randafricanart.com. Scarification and Cicatrisation among African Cultures.html.

Babatunde OP, Oyeronke AE. Scarification practice and scar complications among the Nigerian Yorubas. Indian J of Dermatol, Venereol, Leprol. 2010;76:571–2.

Tsiba JB, Mabiala-Babela JR, Lenga LI, Likiby D, Bounkouta AC, Moussodji D, et al. Scarification in children hospitalized in Congo. Med Trop (Mars).2011;71:509–10

Rush D. In remembrance of slavery: Tchamba vodun arts. Afr Arts. 2011;44:40–51.

Ludvico LR, Kurland JA. Symbolic or not-so-symbolic wounds: The behavioral ecology of human scarification. Ethol Sociobiol. 1995;16:155–72.

Guynup S. Scarification: Ancient Body Art Leaving New Marks. National Geographic Channel;2004. Available:https://www.nationalgeographic.com/news/2004/7/scarification-ancient-body-art-leaving-new-marks/

DeMello M. Encyclopedia of Body Adornment.Greenwood Press Westport Connecticut, London. 2007;235–238.

Ibadin OM, Ofili AN, Airauhi LU, Ozolua EI, Umoru AB. Splenic enlargement and abdominal scarification in childhood malaria. Beliefs, practices, and their possible roles in management in Benin City, Nigeria. Nigeria. Niger Postgrad Med J. 2008; 15:229–33.

Osifo OD, Evbuomwan, Efobi CA. Management of childhood abdominal masses by Nigerian traditional doctors: A worrisome cause of delay in presentation. Pak J Med Sci. 2007;23(5):809–13.

Emordi VC, Aisien E, Osagie OT, Osifo OD. Evisceration following abdominal scarification in neonates. J Trop Pediatr. 2018;64(3):237–40.

Peterside O, Duru C, Anene N. Harmful traditional practices in a newborn: A case report. Niger J Paed. 2015;42:151-53

Rutherford ME, Mulholland K, Hill PC. How access to health care relates to under-five mortality in sub-Saharan Africa: Systematic review. Trop Med Int Health. 2010;15:508–19.

Wagbatsoma VA, Aimuengheuwa O, Agabi J. Assessment of abdominal scarification as a treatment for malaria-induced splenomegaly in a rural community: Implications for child health. Vulnerable Child Youth Stud.2007;2:106–15.

Igoli J, Ogaji O, Tor-Anyiin T, Igoli N. Traditional Medicine Practice amongst the Igede People of Nigeria. Part II. Afr J Trad Complement Altern Med. 2005;2(2): 134-52

Dambisya YM, Tindimwebwa G. Traditional remedies in children around Eastern Cape, South Africa. East Afr Med J. 2003;80(8):402–5.

Shai-Mahoko SN. Indigenous healers in the North West Province: a survey of their clinical activities in health care in the rural areas. Curationis. 1996;19(4):31–4.

Grunitzky EK, Balogou AA, Dodzro CK. Clinical and epidemiological aspects of traditional therapeutic scarification in epilepsy in Togo. Bull Soc Pathol Exot. 2000;93:251–4.

Ayeni OA, Ayeni OO, Jackson R. Observations on the procedural aspects and health effects of scarification in sub-Saharan Africa. J Cutan Med Surg. 2007;11(6):217–21.

Abdulraheem IS, Parakoyi DB. Factors affecting mothers’ healthcare‐seeking behaviour for childhood illnesses in a rural Nigerian setting. Early Child Dev Care. 2009;179(5):671–83.

Towns AM, Eyi SM, Van Andel T. Traditional Medicine and Childcare in Western Africa : Mothers ’ Knowledge, Folk Illnesses, and Patterns of Healthcare-Seeking Behavior. PLoS One. 2014;9(8):1–9.

Etkin NL. Cultural constructions of efficacy. In: van der Geest S, Whyte SR, (Eds). The context of medicines in developing countries' culture, illness, and healing. Springer, Dordrecht; 1988;12: 299–326.

Adeleye OA, Iyeikhian PF. Parents ’ Attitude to Abdominal Scarification as Therapy for Splenic Enlargement in Children : A Community-Based Study in Southern Nigeria. Asian J Med Sci. 2011;3(3):134–8.

Young A. Some Implications of Medical Beliefs and Practices for Social Anthropology. Am Anthropol. 1976;78:5–24.

Latunji OO, Akinyemi OO. Factors Influencing Health-Seeking Behaviour Among Civil Servants in Ibadan, Nigeria. Ann Ib Pg Med. 2018;16:52–60.

Renedo A, Marston C. Developing patient-centred care: An ethnographic study of patient perceptions and influence on quality improvement. BMC Health Serv Res. 2015;15(1):15–7.

Foley EE. Your pocket is what cures you: The Politics of health in Senegal. Rutgers, The State University of New Jersey; 2010.

Colvin CJ, Smith HJ, Swartz A, Ahs JW, de Heer J, Opiyo N, et al. Understanding careseeking for child illness in sub-Saharan Africa: A systematic review and conceptual framework based on qualitative research of household recognition and response to child diarrhoea, pneumonia and malaria. Soc Sci Med. 2013;86:66–78.

Ribera JM, Hausmann-Muela S. The Straw That Breaks the Camel’s Back Redirecting Health-Seeking Behavior Studies on Malaria and Vulnerability. Med Anthropol Q. 2011;25:103–21.

Cohan JA. The Problem of Witchcraft in Africa. Suffolk U L Rev. 2011;64(4):803–72.

Maclean U. Magical Medicine. A Nigerian Case-Study. London Penguin Press. 1977.

Last M. Peculiar Political Problem behind Nigeria’s Primary Health Care Provision. In: Prince RJ, Marsland R (eds). Making and unmaking public health in Africa: ethnographic and historical perspectives. Ohio: Ohio University Press; 2014;55–74.

Ridde V, Olivier de Sardan JP. Abolishing user fees for patients in West Africa: lessons for public policy. Paris(France); 2013.

Ridde V, Sombie I. Street-level workers’ criteria for identifying indigents to be exempted from user fees in Burkina Faso. Trop Med Int Health. 2012;17: 782–91.

Yates R. Universal health care and the removal of user fees.The Lancet. 2009;373:2078–81.

3Makundi EA, Malebo HM, Mhame P, Kitua AY, Warsame M. Role of traditional healers in the management of severe malaria among children below five years of age: The case of Kilosa and Handeni Districts, Tanzania. Malaria J. 2006;5:58.

Stekelenburg J, Jager BE, Kolk PR, Westen EHMN, Kwaak A Van Der, Wolffers IN. Health care seeking behaviour and utilisation of traditional healers in Kalabo, Zambia. Health Policy. 2005;71:67–81.

Beiersmann C, Sanou A, Wladarsch E,De Allegri M, Kouyaté B, Müller O. Malaria in rural Burkina Faso: Local illness concepts, patterns of traditional treatment and influence on health-seeking behaviour. Malaria J. 2007;6:106.

Gruca M, van Andel TR, Balslev H. Ritual uses of palms in traditional medicine in sub-Saharan Africa: A review. J Ethnobiol Ethnomed. 2014;10:64

Lee R, Balick MJ. Palms, People, and Health. Explore-NY. 2008;4:59–62.

Macía MJ, Armesilla PJ, Cámara-Leret R, Paniagua-Zambrana N, Villalba S, Balslev H, et al. Palm Uses in Northwestern South America: A Quantitative Review. Bot Rev. 2011;77(4):462–570.

Asase A, Hesse DN, Simmonds MSJ. Uses of multiple plants prescriptions for treatment of malaria by some communities in southern Ghana. J Ethnopharmacol. 2012;144:448–52.

Hrdy DB. Cultural practices contributing to the transmission of human immunodeficiency virus in Africa. Rev Infect Dis.1987;9:1109–19.

Salami TAT, Irekpita E. Unusually Located Keloids - The Role of Cultural Practices in its Etiology. J Clin Exp Dermatol Res. 2011;02:05.

Alabi GO, George AO. Cutaneous Sarcoidosis and Tribal Scarifications in West Africa. Int J Dermatol. 1989;28:29–31.

Manz LA, Rodman OG. Reappearance of Quiescent Scars. Arch Dermatol. 1993; 129:105–6.

United Nations Fact Sheet No 23. Harmful Traditional Practices Affecting the Health of Women and Children.UN Office of the High Commissioner for Human Rights (OHCHR). 1995.

Tanne JH. Body Art: Marks of Identity. BMJ. 2000;320(7226):64.

Mayers LB, Chiffriller SH. Body Art (Body Piercing and Tattooing) among Undergraduate University Students: “Then and Now.” J Adol Health. 2008;42:201–3.

Braverman PK. Body Art: Piercing, Tattooing, and Scarification. Adol Med Clin. 2006;17:505–19.

Lawrence JW, Rosenberg L, Mason S, Fauerbach JA. Comparing parent and child perceptions of stigmatizing behavior experienced by children with burn scars. Body Image. 2011;8:70–3.

Knudson-Cooper MS. Adjustment to visible stigma: The case of the severely burned. Soc Sci Med Med Anthropol. 1981;15B:31–44.

Olaitan PB. Keloids: Assessment of effects and psychosocial- impacts on subjects in a black African population. Indian J Dermatol Venereol Leprol. 2009;75:368–72.