Abstract
This research is a multidisciplinary study constituting both indigenous knowledge systems and medical anthropology, which focuses on people’s health and well-being and the possible cultural ways of dealing with factors influencing their health and well-being. This study aimed to explore and describe what are the views of Moletjie-Ramakgaphola community on the causes of measles. Lastly to come up with recommendations on how indigenous knowledge can be incorporated in the epidemiology of measles. The study followed a qualitative research approach. Purposive sampling was used with snowballing as a technique. Data were collected and fieldnotes were written during the interviews to record the non-verbal cues from the participants and face-to-face interviews with an interview schedule. Scientific research procedures and ethics were respected and maintained throughout the research process from the initial stage to the last. The collected data were analysed using thematic analysis. Our research findings are threefold. The first category is the terminology used in a vernacular language (Sepedi) to refer to measles. The second category is the limited knowledge by participants regarding the causes and symptoms of measles form both African and Western perspectives. The third category is the knowledge by participants on curative measures from indigenous point of view and otherwise.
Contribution: This research sought to make a scholarly contribution to the field of anthropology and indigenous knowledge systems with specific reference to the epidemiology of measles.
Keywords: anthropological; epidemiology; health; indigenous knowledge systems; Limpopo.
Introduction
Around the global village, measles has been and continues to be a contagious disease. To fight the spread of measles, the World Health Organization (WHO) has introduced a preventative strategy of eradicating measles. The strategy included two doses of measles-containing vaccination (Coughlin et al. 2017). According to Coughlin et al. (2017), the World Health Organization Global Measles Strategy (WHOGMS) as well as Rubella Laboratory Network (RLN) made a huge stride in terms of eliminating cases of measles globally.
Contributing to the epidemiology of measles, Hong et al. (2017) assert that measles has been a major cause of child morbidity and mortality for more than thousands of years. Within the context of South Africa, single-dose measles vaccination was introduced in 1975; subsequently, in 1995, the implementation of two-dose strategy at 9 and 18 months was introduced. The above intervention of two doses is in line with the WHO strategy of curbing measles.
Moreover, Hong et al. (2017) argued that South Africans over the years have experienced many measles epidemics. There were 1676 laboratory-confirmed case-patients in 2003–2005. There were more than 18 000 laboratory-confirmed measles case-patients from 2009 to 2011. From 2012 to 2016, there were 17 laboratory-confirmed cases reported. In 2017, there were three measles outbreaks in South Africa, particularly in the following provinces: Western Cape, Gauteng, and KwaZulu-Natal.
The vantage point of this research is in Moletjie-Ramakgaphola, which is geographically situated in Limpopo province in South Africa. Moletjie-Ramakgaphola is a rural place with limited or non-medical facilities where the community still rely on indigenous knowledge and methods to deal with measles cases.
Problem statement
The WHO has, over the years, pronounced that measles is one of the contagious diseases that has troubled the global village for a long time. Furthermore, studies on measles have been conducted by various scholars to corroborate what the WHO has already discovered. The main concern about measles is that it affects innocent young children, and fatalities have caused misery in some families. This study focuses specifically on measles as a problem within the context of Moletjie-Ramakgaphola in Limpopo province, South Africa.
Research questions
To understand measles as one of the chronic diseases that the global village has encountered and continue to experience for many years, the researchers have posed two fundamental questions with specific reference to Moletjie-Ramakgaphola. These questions are as follows: (1) What are the causes of measles from the perspective of the Moletjie community members? (2) Which healing methods do the Moletjie-Ramakgaphola community members rely on to manage measles?
Research objectives
The study has investigated the perceptions and the knowledge of the community regarding the causes of measles. The findings obtained from this research contribute immensely within the medical anthropology as well as indigenous knowledge system domains with specific reference to Moletjie-Ramakgaphola in Limpopo province in South Africa. In the final analysis, the researchers provide the etic perspective by making recommendations on how indigenous knowledge can be incorporated in the epidemiology of measles with the view of resolving some of the problems related to measles.
Research techniques
This study has followed a qualitative approach, which included among others, individual interviews of participants in Moletjie-Ramakgaphola. Observation of participants by the researchers was utilised as the research tool to supplement the interviews. Moreover, relevant literature on both research techniques and measles was consulted to corroborate the scholarly and methodological arguments raised in this article.
The scholars who have contributed some insight into qualitative research domain include, among others, Basias and Pollalis (2018) who argued about the essence of qualitative research. According to Basias and Pollalis (2018), qualitative research affords researchers an allowance to observe, interview, summarise, describe, analyse, and interpret phenomena in their real dimension. Concurring with the above notion, Ataro (2020) argued that qualitative research approach is commonly preferred in studies where the researchers seek to explore, uncover, describe, and understand the phenomena under investigation. With reference to the above, qualitative research approach was used in the study. The researchers conducted interviews and observed the participants, and from these interviews and observations, the researchers were able to generate some rich ethnographic information from the participants in Moletjie-Ramakgaphola.
Using a snowballing effect, a total number of 15 interviews were conducted in Moletjie-Ramakgaphola. The participants included 3 diviners, 1 herbalist and 11 members of the community. An interview schedule document containing semi-structured questions was used, and the participants responded to the questions regarding the aetiology of measles. The interviews were conducted in Northern Sesotho, and this afforded the participants to express themselves freely. The participants range between the ages of 46 years and 59 years and to be gender sensitive, the participants comprised of females and males.
Ethical considerations
The researchers have complied with the research ethics protocol from the initial to the last stages of this research. The above-mentioned ethics protocol is in line with Alderson and Morrow (2020) who have emphasised the importance of respecting and protecting the research participants throughout the research process, and this is normally achieved through agreed standards. Adhering to the research protocol, the researchers submitted the research proposal and the ethics application, which were duly approved by the higher research committee within Nelson Mandela University Central Ethics Committee. The ethics approval reference number is H/21/HUM/SA-0011. The traditional leadership within the Moletjie-Ramakgaphola was initially approached by the researchers to gain entry, and permission was duly granted in writing. A consent form was explicitly explained in Sepedi language and made available to the participants before conducting interviews, and all the participants agreed to participate in this research with the view of sharing their knowledge on measles.
Conceptual framework (Indigenous healing)
We have used indigenous healing as a conceptual framework to understand the epidemiology of measles within the context of the community members of Moletjie-Ramakgaphola Village. According to Sofowora (1996), traditional healing is not a homogenous healing system but varies from culture to culture and from region to region. Craffert (1997) mentioned that every society develops its own cultural way of dealing with illnesses. Furthermore, Craffert (1997) mentioned that illness and healthcare systems in any society, whether traditional or western, are in one way or another determined by or closely connected to the culture or worldviews of those societies.
Contributing to the discourse regarding indigenous healing, Petrus and Bogopa (2007) assert that the diviners are the spiritual specialists and use divination to communicate with their ancestral spirits to diagnose their patients’ misfortunes or medical conditions. Furthermore, Petrus and Bogopa (2007:3) explained that:
[T]here is an acute awareness, among African societies, of the three-dimensional nature of human beings, as simultaneously, biological, social, and spiritual beings and that humans exist in three interrelated worlds: the human, nature and supernatural worlds.
Fokunang (2011:284) defines tradisional medicine as:
The health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral-based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to diagnose, treat and prevent illnesses or maintain well-being. Traditional medicine is by no means an alternative.
Contributing to indigenous healing discourse, Bogopa (2010) has demonstrated on how ritual performance to address health-related issues forms an integral part of an individual and collective through life stages. Further contribution was made by Mokgobi (2014), who argued that traditional healers serve different roles, and these roles are not limited to custodians of the traditional religion and customs.
Moreover, Sobiecki (2014) investigated some popular examples of spiritual plant use in traditional medicine using phytopharmacological studies coupled with anthropological methods to demonstrate the empirical basis for the use of some plants in divination among the Bantu speaking people in South Africa.
Literature review
This section firstly provides the definition of measles. Secondly, it articulates on earlier studies on measles by various scholars in different contexts. Lastly, it focusses on the recent studies on measles from various perspectives.
One of the earlier studies on measles was conducted by Nzimande (1994) who mentioned blindness being caused by measles and recommended the use of milk to be given to children affected by measles. Vlok (1996) has discovered the performance of a ritual among the Tsonga culture in Limpopo province to deal with measles. Boyle and Andrews (1995) argued that measles in South Africa was rife despite 50% of children under the age of five were immunised. According to the Limpopo Province Department of Health and Statistics (1998), 411 measles cases were reported from January to April 1998. Further contribution on the epidemiology of measles was made by Kibel and Wagstaff (2001) who mentioned that 25% of deaths related to measles in South Africa were from acute respiratory infections.
Moreover, Ehreth (2003) made some contribution on the area of vaccine regarding measles. According to Ehreth (2003), the global village benefitted greatly from the vaccination initiative. Vaccination of children saved 386 million lives and prevented 96 million cases of disability. Janssens (2011) covered issues of women empowerment regarding the decision making on vaccination of their children.
Recent studies on measles include, among others, Manakongtreecheep and Davis (2017) whose focus was the Republic of Kenya. According to Manakongtreecheep and Davis (2017), Kenya was grappling with the fight on measles and some of the challenges included funding, with the view to vaccinate children. The introduction of Measles-Rubella (MR) in Kenya benefitted the nation and the number of measles cases dropped significantly because Kenya was able to reach out in terms of providing vaccination. In addition, Rodrigues and Plotkin (2020) have mentioned that during the 20th century, the development, licensing, and implementation of vaccines as systematic immunisation programmes started to address global health inequities. The global village is still grappling with access to vaccines that prevent life-threatening infectious diseases.
Within the context of Indonesia, Visnu (2020) covered the issues of malnutrition and measles at the place known as Asmat. According to Visnu (2020), ancestral belief at Asmat has formed their way of life and shaped their behaviours as well as choices towards health issues.
Results
Our research findings are in threefold: the first category is the terminology used in a vernacular language (Sepedi) to refer to measles. The second category is the limited knowledge by participants regarding the causes and symptoms of measles form both African and Western perspectives. The third category is the knowledge by participants on curative measures from indigenous point of view and otherwise. The above three categories are briefly discussed next.
Taxology of measles
We have discovered the different taxology used by the participants for measles. For example, some participants refer to measles as mooko, while other participants refer to measles as segagane. In the light of different terminology to measles, we have discovered that the participants were referring to the same disease. We are therefore using mooko and segagane interchangeably referring to the same medical condition known as measles.
Aetiology of measles
Comparatively, we have discovered that most of the participants were clueless about the aetiology of measles. However, few of the participants seemed to have some limited knowledge of the causes of measles.
The participants with some of the knowledge on the aetiology of measles cited, among others, high body temperature, red eyes, rash all over the body, loss of appetite and refusal by the child to be breastfed by the mother. Moreover, some participants with the knowledge of measles mentioned the aetiology being the rash which is sometimes found on the tongue of an affected child; sometimes the child vomits or has a runny tummy; and the child does not play actively with other children.
Furthermore, participants’ knowledge of the causes of the transmission of measles from one person to another include physical contact with the one not infected, for example: (1) if the person who has never had measles before looks after a child or a person with measles; (2) if people without measles use the same utensils as the person infected with measles; and (3) if a child with measles plays with children without measles, these people are likely to get measles.
We have discovered that participants are aware or have a knowledge of the age group that were mostly vulnerable and affected by measles within the community. For example, the most vulnerable are children from birth up to 10 years if not vaccinated for measles as well as adult members who were not vaccinated for measles.
Curative measures for measles
Furthermore, we have discovered that some of the curative measures for measles used by the participants are as follows: Firstly, to put the child with measles in their own separate room. The above seclusion of the child lasts for a period of three days, and during the seclusion period, the child must refrain from sharing the same cup or calabash with the family when drinking water.
Secondly, the child affected by measles is prohibited to eat food cooked from the same pot or eat from the same plate with other family members. Thirdly, the food prepared for the child must be prepared by a dedicated person and the food must be less salty. Fourthly, members of the family are prohibited to enter the secluded room where the child is placed during this period.
The dedicated person responsible for taking care of the sick child with measles must ensure that the child drinks medication for 3 days. The medication used for measles is a mixture of goat dung, mabele thoro, or dipeu tša nyoba, mohule and water. This concoction is strictly for drinking and smearing the entire body until the child is healed. The child drinks the liquid and the remaining mixture in the cup [magweregwere] is used to smear the body. During the above-mentioned period of medication, the child is prohibited from taking a bath.
We have discovered that an old woman who has reached menopause stage is prohibited to enter the secluded room of the child affected by measles. Furthermore, we discovered that should the person attend funerals, she must wash her hands with traditional medicines called mošungwane and mmale before entering the room of the affected child. The above-mentioned process is called go ilošwa. If the person engages in activities which are regarded to be unpurified (belief system from participants), the child’s condition will be aggravated, and it will exceed the recommended 3 days to heal. Over and above, the worst-case scenario is that the child might ultimately lose his or her life.
Ethnographic data presentation and analysis
This section presents some of the raw data from the participants. The sequence of these raw data demonstrates the participants’ knowledge on the symptoms of measles as well as the knowledge on preventative and curative measures of measles among the participants in Moletjie-Ramakgaphola Village.
Data were analysed using the thematic analysis method. Contributing on the discourse regarding thematic analyses method includes, among others, Braun and Clark (2021) as well as Owens et al. (2022), who have both used thematic analyses methods in their studies, respectively. According to Klooster et al. (2022), the usage of thematic analysis increasingly assists researchers to develop themes. Similarly, thematic analysis method has helped the researchers to understand, explain and make sense of the indigenous methods used in the epidemiology of measles among the Moletjie-Ramakgaphola community.
The narrative from the interviews seems to be a common thread among the 15 participants on what constitutes the causes and symptoms of measles. For example, one participant has uttered the following regarding the symptoms of measles:
‘Ngwana wa mooko o a ingwaya- ngwaya, ke gore o humana a ingwaya kudu, a ingwaya, napile e tlo re ka bošiu, masa ge a esa wa bona rash e tletše sefahlego se ka moka, le mmele o, le maoto a ka moka’. [A child with measles will start by scratching the body. Then the next early in the morning, one will notice rash on the entire face of the child, the body and the legs].(Participant 2, female, 54 years old [author’s own translation])
Sharing the same knowledge as the above participant, they mentioned the following regarding the symptoms of measles:
‘Ke gore lesea, ge le thoma go ba mengwaga e mebedi, ge o tla re o tshwere ke mooko, o tlo fetoga mahlo a, a ba a mahubedu, a tšwa dišo tše okarego ke mabelethoro, e bile o hloka takatso ya dijo’. [When the child is around two-year-old, when the eyes changes to be red, having sores on the body, with no appetite for food. That is then you are supposed to see that the child has measles]. (Participant 3, female, 59 years old [author’s own translation])
Adding to this list of symptoms, a herbalist said the following:
‘Mooko o hlolwa ke sethitho, ke nagana phišo. Ka gore ge go fiša, o humana re ingwaga re dira bjalo. Mooko wa fetela ka gore gona bjale ge ngwana a tšwile mooko, bana ba tla ka gae, napile ba tsena ka mo ntlong ya ngwana a tšwile mooko, ge a tšwile mooko, napile bana ba le ka bošiu wa ba tšwa mooko le bona’. [Measles is caused by sweat; I think hot temperatures. When it is hot, you might find that we often scratch ourselves. Normally it is transmitted when the child with measles plays with the child affected by measles]. (Participant 4, female, 58 years old, traditional healer [author’s own translation])
We have deduced from the 15 participants based at Moletjie-Ramakgaphola that measles commonly affects children under the age of five. The symptoms range from rash, red eyes, sweating, a lack of appetite, inactiveness of a child, hot temperature, and cultural practices if not adhered to might aggravate the condition.
In the light of the above, previous studies conducted on measles by Vlok (1996), Nzimande (1994) and Kassner (1998) among the VhaVenda speaking people corroborate the same. For example, the VhaVenda people also share the similar knowledge that rash, heat, red eyes, a lack of appetite constitute the symptoms of measles among children under the age of five.
The participants’ knowledge on measles management includes the following:
‘Ke gopola ba tšea dithokolo tša dipudi, meetsana le mabele ba šila ba hlakantšha, ba tlotšatlotša ngwanao, e ntše a dutše a enwa le magweregwere a tšona dilo tše, ke moka ka beke wa fola. O tlotša ke mmagwe le gona ge e le gore ga se moimana goba ga a matšatšing. Ge a le matšatšing o a mo tsenela, a napa a mo gatelela gore a seke a fola ka pela, ka nako e ngwee mooko o o golela godimo wa tšhabela ka mahlong, napile mahlo a, a fetoga, wa humana e le a masehla’. [I remember they take goat dung, water, and wheat, then crush them, mix them together, smear the mixture on the child. The child will then drink the remaining powder of the mixture, and then in a week the child will be healed. The mother is the one who will smear the child with the mixture provided the mother is not on her period or pregnant. If the mother is on her period, the child will relapse and experience more symptoms such as the eyes changing to be yellowish and the child as a result will heal later than normal]. (Participant 9, female, 58 years old [author’s own translation])
One participant’s knowledge about measles is as follows:
‘Sehlare sona a se go, ntle le gore ngwana o a je maswi a dipudi, le dijo tša go hloka letswai a tswaleletšwe ka ntlong ya gagwe a le tee go fihlela a fola, goba ba mo tsenela, ke mo a ka hlokofala goba a foufala, mara ntle le moo, mooko a se gore ke nto ya go tshwenya. Aowa naa wena o Mosotho wa kae (she laughs) akere ge motho akare a lwala gwa tsena motho wa go ima, wa go ba matšatšing, wa go se robale gae le wa go tšwa lehung, ka mo a dutšeng, goba a mo direla dijo, bolwetše bjola bja gola ke moka ra re o tsenetšwe’. [There is no medication for measles except that the child must eat goat’s milk, meals that do not contain salt, be indoors alone until is totally healed, unless the baby gets in contact with an impure person, that is then the child will die or go blind, but besides all that measles is not a problematic disease. If the child is sick and gets in contact with a pregnant woman, a woman on her periods, a person who just had sex, a person from a funeral or these people prepare him meals, the condition of the child worsens]. (Participant 11, male, 51 years old [author’s own translation])
Like in Moletjie-Ramakgaphola, the use of goat milk and goat dung mixture to cure children suffering from measles was also discovered in the study conducted by Lebese, Netshandama and Shai-Mahoko (2004) among the VhaVenda people. Cultural practices like the ones at Moletjie-Ramakgaphola feature prominently in various studies. For example, Lebese et al. (2004) have outlined various cultural practices among the VhaVenda people. Within the VhaVenda cultural group, menstruating women and people who have attended funeral as well as sexually active people were barred or restricted from entering the hut where a child suffering from measles is kept.
Furthermore, the restriction of people to enter the secluded hut in Moletjie-Ramakgaphola also corroborates with the research conducted by Monning (1967) among the Bapedi people as well as the work by Shai-Mahoko (1997) among the Batswana people.
Overall, the knowledge of measles from the indigenous perspective in Moletjie-Ramakgaphola correlates with the knowledge gathered in other studies regarding measles. For example, the participants’ notion of rash as the symptom of measles is also expressed in Lebese et al.’s (2004) study, including other studies. Performing rituals and seclusion of a child affected by measles are commonly known within the participants of this study as well as expressed in literature consulted.
Recommendations of the study
Based on the data collected and findings of the study, the researchers suggest the following recommendations:
In terms of different terminology used for measles, it is our etic perspective that the terminology used for measles be popularised within the Moletjie-Ramakgaphola community. This message could be spread through community health forums or workshops. These workshops could be organised by the local health clinics with the view of blending indigenous knowledge and western knowledge on measles. These proposed interventions could benefit the community members a great deal. Because most community members in Moletjie-Ramakgaphola have limited knowledge regarding measles, we strongly recommend that regular awareness campaigns organised by the traditional healers and western practitioners on a quarterly basis could benefit the community. These awareness campaigns should focus on preventative measures.
We fully concur with the saying in Northern Sesotho that goes as follows ‘Rutang bana ditaola le seke laya natšo natso badimong’ Rakoma (1983). The interpretation of this saying is that it is imperative for the adult community members to impart their knowledge to the young ones. This saying alerts elders about the danger of not sharing important knowledge. Once the adult population passes on without sharing the important knowledge, the remaining members of the community will end up not knowing the cultural practices. It is, therefore, critical, and important to impart cultural knowledge to the young people. Cultural preservation is important for each community to survive.
It has been proven that during harvest time, when community members are working on [mabele] sorghum, the dust and the dihloka [powder released during the process of winnowing] spread all over the place and sometimes fall on children. This sorghum dust [mabele] causes skin irritation, which ends up causing measles. In the light of the aforesaid, it is highly recommended by the researchers that during harvest time, children should be protected by strictly not allowing them to be near the process of harvesting [mabele] sorghum.
Methods of prevention and treatment of measles
The authors have discovered that the children affected by measles are obliged to consume non-salty food, for example, porridge with milk is highly recommended. We have further discovered that the Moletjie-Ramakgaphola community’s procedures of treatment involve the smearing of goat dung and the drinking of a medication made of a mixture that involves goat dung.
Further research on measles regarding the epidemiology and indigenous healing is highly recommended. The above could be achieved through research funding and the availability of human resources to conduct research.
Limitations of the study
The authors acknowledge as researchers that a sample of 15 participants limited them to reach out to a broader Moletjie-Ramakgaphola community. Time constraints and financial resources also limited them to stay longer within the community with the view of obtaining more ethnographic data. Having more time to spend within the research area and financial resources could have yielded more ethnographic data.
Conclusion
Access to modern technology and knowledge on issues of vaccination seems to be a huge problem in rural areas of South Africa. The Moletjie-Ramakgaphola Village is not immune to these challenges. Clearly the available resources should be an option and therefore, the indigenous way of looking at the epidemiology of measles as well as the curative measures seem to be currently working. It is, therefore, advisable that the Moletjie-Ramakgaphola community and other communities having the indigenous knowledge to manage measles be encouraged to do so. This indigenous strategy will save many children’s lives.
Acknowledgements
The authors would like to acknowledge the reviewers of the article at different levels, as well as the participants and the language editor.
Competing interests
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
Authors’ contributions
D.H. contributed to the conceptualisation, methodology, investigation and writing, whereas D.B. contributed to the conceptualisation, formal analysis, writing and supervision.
Funding information
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Data availability
Data sharing is not applicable to this article as no new data were created or analysed in this study.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. It does not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The authors are responsible for this article’s results, findings, and content.
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