Why Am I Ill? Beliefs in Supernatural and Natural Causes of Ill Health at the Time of Diagnostic Workup of Patients With Esophageal Cancer in Tanzania

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PURPOSE: An understanding of the cultural and context-specific perceptions of the causes of cancer is an important prerequisite for designing effective primary health prevention and early detection strategies. We aimed to use the Murdock Ill Health Theoretical Model to conceptualize views on illness causation among dysphagia-suffering patients undergoing diagnostic workup for esophageal cancer (EC) in Tanzania. METHODS: At the end of a structured interview on lifestyle habits, patients with suspected EC were asked about beliefs on the reasons behind their illness through (1) a set of questions with fixed binary answers, whose determinants were analyzed using logistic regression, and (2) a single question with free-text answers. Responses were coded using a hierarchy of natural and supernatural (godly and social constructs) causes. RESULTS: Among 322 patients interviewed between November 2015 and December 2019, we found complex and varied views about the origins of their illness. Overall, 49% of patients attributed illness to natural causes and 39% to supernatural causes. Natural causes ranged from infection, use of alcohol and tobacco, other ailments, and the environment. The supernatural causes included attributing illness to God, curses, and spells from personal acquaintances. Belief in supernatural causes was more common in the less educated and those who sought help first via a traditional healer. CONCLUSION: The results underscore the need for increased community awareness of biomedical causes of ill health and patient-based participatory research to inform prevention programs. The results also highlight the importance of building health systems that support a series of health-seeking behaviors that acknowledge both biomedical and local traditional healing belief systems.

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