‘We don't use the same ways to treat the illness:’ A qualitative study of heterogeneity in health-seeking behaviour for acute gastrointestinal illness among the Ugandan Batwa

ABSTRACT

The Batwa (Twa), an Indigenous People of southwest Uganda, were evicted from their ancestral forest lands in 1991 due to establishment of the Bwindi Impenetrable Forest. This land dispossession forced Batwa to transition from a semi-nomadic, hunting-gathering livelihood to an agricultural livelihood; eliminated access to Indigenous food, medicines, and shelter; and shifted their healthcare options. Therefore, this exploratory study investigated why Batwa choose Indigenous or biomedical treatment, or no treatment, when experiencing acute gastrointestinal illness. Ten gender-stratified focus groups were conducted in five Batwa settlements in Kanungu District, Uganda (n = 63 participants), alongside eleven semi-structured interviews (2014). Qualitative data were analysed thematically, using a constant comparative method. Batwa emphasised that health-seeking behaviour for acute gastrointestinal illness was diverse: some Batwa used only Indigenous or biomedical healthcare, while others preferred a combination, or no healthcare. Physical and economic access to care, and also perceived efficacy and quality of care, influenced their healthcare decisions. This study provides insight into the Kanungu District Batwa's perceptions of biomedical and Indigenous healthcare, and barriers they experience to accessing either. This study is intended to inform public health interventions to reduce their burden of acute gastrointestinal illness and ensure adequate healthcare, biomedical or Indigenous, for Batwa.

KEYWORDS:

• Indigenous health
• Batwa
• Uganda
• acute gastrointestinal illness
• health-seeking behaviour

Acknowledgements

We thank the residents of Bikuto, Buhoma, Kebiremu, Kitariro, and Mukongoro settlements in Uganda, as well as the interviewees, for their time and willingness to participate in this research, and their contributions to the larger IHACC project. We would also like to thank community members Evas Ninsiima and Yosam Besigensi, and local researcher Fortunate Twebaze, for their significant contributions to this research as facilitators and interpreters. We remember Grace Asasira, as well, for her meaningful contributions as a local researcher before she passed away. Thank you to Carlee Wright for her assistance in creating a figure for this paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research is part of an international project entitled the ‘Indigenous Health Adaptation to Climate Change (IHACC)’ project, with parallel field sites in the Canadian Arctic and Peru. Financial support was provided by the Canadian Institutes of Health Research/Natural Sciences and Engineering Research Council of Canada/Social Sciences and Humanities Research Council (CIHR/NSERC/SSHRC) and the International Development Research Council (IDRC) Tri-Council Initiative on Adaptation to Climate Change, Indigenous Health Adaptation to Climate Change (IHACC), [IDRC File nos. 106372-003, 004, 005]; CIHR Open Operating Grant, Adaptation to health effects of climate change among Indigenous Peoples in the global south (IP-ADAPT), Application no. 298312 awarded to the IHACC Research Team;and a Vanier Canada Graduate Scholarship (CIHR) awarded to Laura Jane Brubacher.