Knowledge, attitudes and practice of traditional bone setting in iftin division, Garissa

Abstract

The main aim of the study was to determine the knowledge, attitude and practice of traditional bone setting among the people of Iftin in Garissa County. The study was a cross sectional descriptive study carried out at Iftin Division of Garissa County between October 2013 and May 2014. Socio-demographic characteristics of age, religion, socio-economic status, marital status and level of education of the participants were assessed. A semi-structured questionnaire was used to collect quantitative data from FGDs, KIs, case narratives, and community participants. The TBS practitioners were interviewed using a set score matrix criteria and tested by the Cronbach alpha estimation reliability test and a value of 5.14 obtained. Both qualitative and quantitative data analytical methods were used in the study. A total of 151 participants were selected through nonprobability selection criteria and interviewed by the principal investigator and three plaster technicians as research assistants. The community knowledge on traditional bone setting was at 95%, and the utilisation of the services of TBS by the community was at 90%.The preference for the service was determined by the level of education, Muslim religion and influence by family and friends. Being a Muslim was 22 times more likely to prefer TBS. Other reasons for patronage of TBS was cost, easy accessibility, cultural beliefs, and pressure from relatives and friends. While other factors such as gender, marital status and age did not influence the preference for TBS. The four traditional bone setters scored highly on their basic knowledge to treat fractures. Out of a maximum score of 35, two TBSs scored above 30 and the other two scored 23 each. However, all the TBSs scored poorly on classification of dislocations. Complications associated with TBS in this study included joint stiffness, shortening of the limb, angulations, osteomylitis and gangrene leading to amputations. xvii The Iftin community have significant knolwlegde on TBS and have positively and strongly embraced TBS and consider it as a cultural norm. They believe that the orthodox form of fracture management is time consuming, and tied it to prolonged and expensive hospital protocols and procedures. While the community perceived low cost as a major influence on the choice of TBS, some charges by TBS were relatively high compared to the orthodox treatment costs. Although TBS practice had no formal documentation and training, their skills and knowledge on bone setting was reasonable and quantifiable. It is therefore recommended that TBS cannot be ignored at Iftin and an impartial third party organisation be charged by the Garissa County healthcare system to bring the orthodox orthopaedic proponents and the traditional bone setter proponents together to set up and maintain acceptable working systems for TBS