Social construction of diarrheal illness among the Sabiny in Kween District, Eastern Uganda

Abstract

Globally, diarrhea continues to pose a major public health challenge, persisting despite numerous prevention and control efforts. While inadequate access to clean water, poor sanitation, and limited hygiene practices are widely recognized contributors, most existing interventions tend to largely focus on biomedical interventions while ignoring social and cultural roots of illness experience. Using an exploratory ethnographic design, this study examined the social construction of water-borne illness among the Sabiny in Kween District, Eastern Uganda. Specifically, the study sought to: examine the local conception of water-borne illness among the Sabiny; assess adults’ understanding of diarrheal illness; explore adults’ understanding of diarrheal illness in children; and identify local strategies for its treatment and management. Four complementary qualitative methods, namely In-depth interviews, Focus Group Discussions, Observation and Document review, were used to collect data from 42 participants. Data was thematically analyzed. The findings reveal that diarrheal illness was not seen as a single condition but different syndromes, each associated with specific meanings and attributed to different causes. These syndromes were described as Poortya-moiyet, Kayiinyet, Kabundoiyet, Kaserrik, Chekwalashet, and Sirigtya. The local syndrome Poortya-moiyet referred to a general term for all disturbances experienced in the stomach. Kayiinyet referred to the pain or disturbance felt before passing watery stooling, and was often seen as mild. Siringta described the experience of diarrheal illness among infants, which was associated with suffering indigestion, and sometimes seen as symbolizing disturbance by ancestral spirits. Kabundoiyet and Kaserrik were seen as severe and life-threatening experiences of diarrhea, marked by suffering violent and uncontrolled stooling that resulted in experience of body weakness and dehydration. Chekwalashet, which was defined as ‘rainbow’, described the suffering of diarrheal illness believed to afflict those individuals whose behaviors violated sacred spaces while the rainbow appeared in the skies. Concerning causation, the Sabiny relied on physical, psychosocial, and supernatural explanations of diarrhea illness. The physical explanations linked the suffering of diarrhea to the ingestion of dirty water and spoiled food. The psychosocial causes included having worries, being angry, and feeling aggrieved. The supernatural or spiritual causes included angering ancestors and breaking taboos. Treatment followed a sequence of health-seeking actions involving the use of home remedies such as herbs and charcoal water, the use of traditional medical solutions (rituals and prayers), and seeking biomedical care when illness persisted. As a result, healing was viewed as a restoration of the balance between the body, emotions, and the spirit/soul. Consequently, this study is of critical public health significance. The study not only reveals how the different experiences of diarrheal illness are socially constructed among the Sabiny but also provides important insights that can inform culturally appropriate interventions that can significantly improve the prevention and control of diarrheal illness in this cultural group and similar populations in Uganda.