Contemporary views on dementia as witchcraft in sub‐Saharan Africa: A systematic literature review

Abstract

Aim To explore the impact of cultural beliefs of dementia as witchcraft in sub‐Saharan Africa. Background The population of sub‐Saharan Africa is ageing, which increases the number of those at risk of dementia. Mental health and physical diseases that affect behaviour have often been associated with witchcraft. Accusations of witchcraft leave individuals vulnerable and at risk. Method A systematic review, which followed the Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and completed a PRISMA checklist. CINAHL, PsycINFO, Web of Knowledge, PubMed and Science Direct databases were searched for relevant studies published from their inception to 31 May 2019 by applying appropriate Medical Subject Headings. Data analysis adhered to Thomas and Harding's thematic synthesis. Results The review identified limited literature on this topic, with only five papers meeting the inclusion and exclusion criteria. Studies explored health provision, and knowledge and beliefs of dementia in Tanzania and South Africa. Three themes emerged as follows: (a) poor knowledge of dementia, including the belief of dementia as witchcraft; (b) challenges of supporting a family member with dementia in the community; and (c) health‐seeking behaviours of and for people with dementia. Conclusion There remains a need for dementia awareness and education across sub‐Saharan Africa communities, including faith and traditional healers, and healthcare professionals to support pluralistic healthcare provision. Nurses are the best‐placed healthcare professionals to support these initiatives and the development and implementation of low‐resource nonpharmacological interventions to support people with dementia and their families living in the community. Relevance to clinical practice Nurses working in sub‐Saharan Africa and those caring for patients from sub‐Saharan Africa can only provide person‐centred care and support for a person with dementia and their family if they understand their cultural beliefs, one of which may include witchcraft.

“We Are Doing These Things So That People Will Not Laugh at Us”: Caregivers’ Attitudes About Dementia and Caregiving in Nigeria

“…In addition, in Nigeria, although caring for a person living with dementia who may be exhibiting associated symptoms (e.g., inappropriate language, aggression) can be difficult, caregivers rarely seek external or professional help. This is likely due to problems with health care access and the unacceptance of formal long-term care mentioned earlier (Ogunniyi et al, 2005; Okoye, 2012; Welcome, 2011), as well as the stigma associated with dementia (Adebiyi et al, 2016; Brooke & Ojo, 2019; Nwakasi et al, 2019; Spittel et al, 2019). As a result, care for people living with dementia in Nigeria is assumed to be substantially worse compared with developed countries (Ogunniyi et al, 2005).…”

“…According to George-Carey et al (2012), dementia prevalence likely doubles every 5 years after age 65, which will lead to increases in Nigeria as the population ages. In addition, like other Sub-Saharan African (SSA) countries, this increasing prevalence is not matched with increasing scientific knowledge and awareness about dementia (Brooke & Ojo, 2019; Spittel et al, 2019), but rather remains grounded in folk or everyday beliefs (Kleinman, 1978) coupled with reliance on unpaid caregivers (Schatz & Seeley, 2015). Subsequently, Nigeria also shares some similarities to other SSA countries in that dementia carries stigma for people living with dementia and their families because some believe that dementia is a punishment for transgressions earlier in life or is caused by witchcraft (Brooke & Ojo, 2019; Spittel et al, 2019; Yusuf & Baiyewu, 2012).…”

“…In addition, like other Sub-Saharan African (SSA) countries, this increasing prevalence is not matched with increasing scientific knowledge and awareness about dementia (Brooke & Ojo, 2019; Spittel et al, 2019), but rather remains grounded in folk or everyday beliefs (Kleinman, 1978) coupled with reliance on unpaid caregivers (Schatz & Seeley, 2015). Subsequently, Nigeria also shares some similarities to other SSA countries in that dementia carries stigma for people living with dementia and their families because some believe that dementia is a punishment for transgressions earlier in life or is caused by witchcraft (Brooke & Ojo, 2019; Spittel et al, 2019; Yusuf & Baiyewu, 2012). To complicate matters, family members of persons with dementia risk being ostracized by others, including other family members, because of these beliefs (Adebiyi et al, 2016).…”

Witchcraft and Mathematics Learning in South African Rural Schools

“…Although most legislation, politics and economics in South Africa generally views witchcraft and beliefs in it as nothing of value, a wild imagination embedded in people's backwardness and obliviousness, the existence of witchcraft as lived experiences remains a reality for many Africans (Schnoebelen, 2009;Brooke & Ojo, 2020). Belief in witchcraft enables some individuals to explain their misfortunes by linking it to acts of evil (Agyapong, 2020).…”

Knowledge of Ghanaian Graduating Undergraduate Nurses About Ageing

“…It is important to understand that intellectual performance in older people remains unchanged ( Bernoth & Winkler, 2018 ; Eberstole et al., 2008 ; Touchy & Jett, 2016 ). Ageing changes in neurological functioning are also often interpreted through a cultural lens, for example older women with dementia are considered witches in some Ghanaian communities and are usually sent to witches camps, banished from their communities or tortured to death ( ActionAid, 2012 ; Brooke & Ojo, 2020 ; Tawiah, 2011 ; Whitaker, 2012 ). Parallel to this is the belief in many communities in Ghana that pain is normal in older people ( Aziato et al., 2016 ).…”