Beliefs and perception of ill-health causation: a socio-cultural qualitative study in rural North-Eastern Ethiopia

Background: Understanding perceptions of the causes of ill-health common in indigenous communities may help policy makers to design effective integrated primary health care strategies to serve these communities. This study explored the indigenous beliefs of ill-health causation among those living in the Tehuledere Woreda/district/in North East Ethiopia from a socio-cultural perspective. Methods: The study employed a qualitative ethnographic method informed by Murdock's Theory of Illness. Participatory observation, over a total of 5 months during the span of one year, was supplemented by focus group discussions (n = 96 participants in 10 groups) and in-depth interviews (n = 20) conducted with key informants. Data were analyzed thematically using narrative strategies. Results: In these communities, illness is perceived to have supernatural (e.g., almighty God/Allah, nature spirits, and human agents of the supernatural), natural (e.g., environmental sanitation and personal hygiene, poverty, biological and psychological factors) and societal causes (e.g., social trust, experiences of family support and harmony; and violation of social taboos). Therefore, the explanatory model of illness causation in this community was very similar to that of the Murdock model with one key difference: social elements need to be added to the model. Conclusion: Members of the study community believes that supernatural, natural and social elements are linked to illhealth causation. A successful integrated primary health care strategy should include strategies for supporting patients' needs in all three of these domains.