resulting in
serious and life-threatening
complications.
The frequent practice of female
genital
mutilation was confirmed, and in
addition
practices such as milk tooth extraction,
uvulectomy,
uterus massage and tonsillectomy
were prevalent.
The focus of the study is not to
confirm the
existence of the traditional
practices in
question, but rather to explore the
medical
complications in an Ethiopian context.
The study aimed
at establishing whether the
listed
procedures were practised or not in the
different
geographical areas, and not the level
of occurrence in
the population as such. The
strategically
selected
health
workers,
representing
different areas in proportion to the
size of the
areas, may be an appropriate source
of information
for that type of question. They
were
specifically asked to report from their own
observations and
experiences, and not only
from general
knowledge or perceptions. Thus,
the information
obtained is probably reflecting
if these
traditions are implemented in the areas,
and if
complications have been observed at the
health institutions. The findings are applicable
to the Ethiopian
context, but may also be
relevant in
other cultural settings, whenever the
prevalence of
disability, occurrence of death
and costs linked
to harmful traditional practices
are discussed.
We have
demonstrated that drastic surgical and
other
traditional procedures, e g uterus
massage, were
performed in many areas of
Ethiopia. While
studies on traditional health
practices
previously have focused female
genital
mutilation, other customs affecting
women and
children have received little
attention.
Several of the listed practices, e.g.
uvulectomy and
milk tooth extraction, were
found in most
geographical areas, while others,
like rectal
ulceration, were more geographically
restricted.
It should be
noted, that HIV was reported as an
observed
complication to two of the practices
(uvulectomy and
venesection). To our
knowledge, this
has not been previously shown,
and the finding
warrants further in-depth
studies.
Whereas a number
of authors have described
the frequency
and the complications of female
genital
mutilation (1, 5, 8) information on other
types of drastic
surgical practices are more
based on
individual case reports rather than
larger surveys.
This study covers some of the
major drastic
surgical interventions throughout
most of
Ethiopia. The reports on occurrence of
these practices
confirm previous case reports
that we have
found. In addition, we have found
that these
practices often result in
complications
adverse to health, an observation
that may seem
logical, but previously
overlooked. The
overall conclusion from this
study is that
the practices in question seem to
be common and,
more importantly that
resulting
complications also seem to be
frequent. It
should be noted, that only few
interviewees
mentioned the risk of spreading
infections
through surgical practices. In a time
when serious
chronic infections, like HIV and
hepatitis are
prevalent, there is reason to
address issue
more specifically.
Lack of health facilities and modern health
services may
contribute to the performance of a
number of
traditional surgical health practices,
but maybe not to
female genital mutilation,
since the latter
is usually not perceived as being
related to
health (13, 14). A recent study in
rural Ethiopia
reported a low usage of health
care in spite of
a huge burden of perceived,
indicating large
unmet needs facing the health
delivery system
(15). In a milieu where modern
health care is not available, decisions
concerning
health are influenced by the fact
that people must
create different ways to handle
disease. This
further means that different
models for
explaining disease are naturally
created and
maintained.
In a longer
perspective, a transformation of the
Ethiopian
society is likely to bring a change to