The study, conducted by Tinsae Ashagrie Dagnew of the Department of Sociology at Debre Tabor University, is based on semi-structured and key informant interviews with 27 participants. The group included ordinary community members, religious leaders, traditional healers, healthcare professionals and elders, giving the researcher access to multiple perspectives on how illness is understood and treated. The work was approved by the university’s Institutional Research Ethics Review Committee, and all participants gave informed consent. Data were analyzed thematically, and the analysis was guided by three established theoretical frameworks: Arthur Kleinman’s explanatory model of illness, medical pluralism theory, and Pierre Bourdieu’s theory of practice.

One of the study’s central findings is that illness itself is not interpreted in a single way. Residents understood sickness through physical, spiritual, social and divine frameworks simultaneously. A symptom might be seen as a biological malfunction, but it could also be read as a spiritual affliction, a rupture in social relations, or a test or punishment with divine origins. Because illness carries these layered meanings, treatment cannot be confined to one system. This interpretive plurality sustains reliance on traditional and faith-based healing even when biomedical services are available, and it explains why many patients move between modalities rather than choosing one exclusively.

The concept of medical pluralism, the coexistence of multiple healing systems within one society, is at the heart of the research. In Debre Tabor City, pluralism manifested in two characteristic patterns: sequential and complementary therapeutic practices. In sequential use, a patient tries one system after another, perhaps starting with a traditional remedy and turning to a clinic if the condition persists, or the reverse. In complementary use, different treatments are pursued at the same time, with prayers running alongside prescribed medication. This pattern was especially pronounced for chronic conditions, where prolonged suffering and uncertain outcomes encourage people to keep multiple therapeutic doors open.

Religion emerged as a powerful force in the study, but not merely as an alternative to medicine. Religious belief and practice provided psychological resilience and social support, helping individuals cope with the fear and uncertainty that accompany illness. Congregations and faith communities functioned as networks of care, offering prayer, encouragement and practical assistance. Religious leaders, as trusted figures, also influenced how people interpreted symptoms and which treatments they considered legitimate. This means that faith institutions are not peripheral to health in Debre Tabor; they are active participants in the therapeutic process, shaping both meaning and behavior.

Family and community networks proved equally decisive. Treatment decisions were rarely individual choices. Elders, relatives and neighbors weighed in on what an illness meant, which healer or facility should be consulted, and how much money should be spent. In a society where social standing and collective identity matter deeply, the opinions of trusted others can carry more weight than the advice of a clinician who may be a stranger. This finding aligns with Bourdieu’s theory of practice, which the study used to show how health decisions are shaped by habitus, the ingrained dispositions people acquire from their social environment, and by the forms of capital, economic, social and cultural, that they can mobilize.

Structural constraints added another layer to the picture. Economic limitations, geographic accessibility and perceived service quality all influenced healthcare choices. For households with limited income, the cost of transport, consultation fees and medications can make biomedical care feel out of reach, while traditional and religious options may appear cheaper or closer at hand. Where health facilities are perceived as crowded, impersonal or ineffective, confidence in them erodes, reinforcing preference for familiar community-based modalities. The study suggests that these constraints do not simply reflect individual preference; they are structural conditions that push people toward traditional and religious healing, sometimes by default rather than conviction.

The implications for health policy are significant. If patients routinely combine biomedical, traditional and faith-based care, then health systems that ignore or dismiss the latter two risk losing contact with the very populations they aim to serve. The study concludes that effective healthcare delivery in Debre Tabor City requires culturally responsive strategies that integrate biomedical, traditional and faith-based healing systems rather than treating them as separate or competing domains. Collaborative engagement with trusted community actors, including religious leaders and traditional healers, is identified as essential to enhance utilization of formal services and improve health outcomes.

Such collaboration could take many forms, from referral relationships between clinics and healers to health education delivered through religious institutions. The point is not to romanticize traditional medicine or to medicalize religion, but to recognize the empirical reality that patients already inhabit a plural therapeutic world. Programs that acknowledge this reality can meet people where they are, building on existing trust rather than demanding that patients abandon cultural frameworks before receiving care. In contexts of medical pluralism, the choice is rarely between tradition and science; it is about how the two can coexist in ways that protect patients.

As Ethiopia continues to expand access to healthcare, studies like this one offer a reminder that utilization is not determined by supply alone. Health-seeking behavior is deeply embedded in sociocultural contexts, and understanding those contexts is a prerequisite for designing interventions that actually work. The Debre Tabor findings, drawn from the voices of community members, healers, religious leaders and professionals alike, suggest that the path to better health outcomes runs through the community’s own map of meaning, not around it.

Subject of Research: Health-seeking behavior and medical pluralism in Debre Tabor City, Ethiopia

Article Title: Understanding health-seeking behavior at the intersection of culture, religion and traditional healing in Debre Tabor City, Ethiopia: a qualitative sociological inquiry

Article References: Dagnew, T. A. (2026). Understanding health-seeking behavior at the intersection of culture, religion and traditional healing in Debre Tabor City, Ethiopia: a qualitative sociological inquiry. International Journal for Equity in Health. https://doi.org/10.1186/s12939-026-03074-9

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03074-9

Keywords: health-seeking behavior, medical pluralism, Ethiopia, traditional healing, religion and health, qualitative research, medical sociology, Debre Tabor, sociocultural determinants, health equity, Kleinman explanatory model, community health

The study set out to answer a deceptively simple question: how do people living in Debre Elias understand and manage scabies in their everyday lives? To find out, the researchers deployed a rapid ethnographic approach that combined observations with semi-structured interviews. Fieldwork ran from February to July 2022 and produced 57 interviews with a deliberately broad cross-section of the community: people who had experienced scabies, people who had not but considered themselves at risk, local health workers, traditional healers, and government officials. Alongside the interviews, the team carried out participant and non-participant observation in homes, workplaces, social events and treatment facilities, watching how people with and without scabies moved through their daily routines. The researchers also undertook a critical analysis of scabies control and policy documents to understand the official framing of the disease and how it compared with the realities on the ground.

What emerged from this fieldwork is a picture of medical pluralism that official programmes have largely failed to acknowledge. People in Debre Elias routinely navigate both biomedical and traditional healing systems to manage a wide range of health problems, and scabies is no exception. These two systems are not seen as mutually exclusive alternatives but as complementary resources that can be drawn upon in sequence or in parallel. However, the study found that this everyday practice remains largely informal, because traditional healing is often marginalised in official scabies control strategies. The formal system, in other words, pretends that only one of the two pathways exists, even though nearly everyone in the community uses both.

One of the most striking findings concerns the order in which people seek care. Most individuals affected by scabies initially turn to traditional healers, and only afterwards, if the condition persists or worsens, do they seek out biomedical services. This sequencing matters enormously for control programmes. Mass drug administration campaigns assume that affected populations will present themselves to, or be reached by, the formal health system, but if the first port of call is a traditional healer, then a substantial portion of the treatment journey happens outside the sight of programme planners. Delays in reaching effective biomedical treatment can prolong infections, sustain transmission chains within households and communities, and undermine the epidemiological logic of mass treatment, which depends on treating as much of the affected population as possible within a short window to interrupt the cycle of reinfection.

The researchers identify several factors that shape these health-seeking and treatment decisions. The first is the perceived cause of the disease. In many Ethiopian communities, skin conditions such as scabies are understood not solely as biological infestations but as conditions with social, spiritual or moral dimensions, and traditional healers are often seen as better equipped to address those perceived causes. The second factor is the cultural relevance and affordability of traditional medicine. Traditional treatments are embedded in local systems of meaning and are frequently cheaper and physically closer than formal clinics, which may be distant, understaffed, or associated with costs that households struggle to bear. The third factor is limited access to biomedical services themselves, which makes the formal option less practical for many families even when they are aware of it. Together, these forces create a treatment landscape in which traditional healing is not a relic of the past but a rational, accessible and culturally resonant first choice.

From a technical standpoint, the persistence of scabies despite repeated interventions illustrates a well-known problem in neglected tropical disease control: biomedical efficacy does not automatically translate into programme effectiveness. Permethrin and other acaricides used in mass drug administration can kill the mites on treated individuals, but the success of such campaigns depends on high coverage, timely treatment, and simultaneous management of household contacts. When people delay seeking biomedical care because they first visit traditional healers, or when they never enter the formal system at all, the effective coverage of a campaign can fall well below its nominal reach. The mite continues to circulate within and between households, and the region experiences what the study describes as persistent scabies incidence despite the deployment of biomedical interventions intended to contain the disease.

The authors’ conclusion is not that traditional healing should replace biomedical treatment, which remains essential for effectively clearing infestations. Rather, they argue that recognising and engaging with the existing medical pluralism could improve the acceptability, reach and effectiveness of scabies programmes. In practice, this could mean involving traditional healers in outbreak response, creating referral pathways between healers and clinics, and designing health communication that speaks to local understandings of the disease rather than dismissing them. Such collaboration could shorten the delay between the onset of symptoms and effective treatment, extend the reach of campaigns into households that formal services rarely touch, and build the kind of community trust that top-down interventions often lack. The researchers frame this as a shift from co-existence, in which the two systems operate side by side without acknowledgment, to genuine collaboration, in which both are treated as legitimate parts of an inclusive, pluricultural management approach.

The implications extend well beyond one district in Amhara. Scabies is a global problem, disproportionately affecting resource-poor communities in tropical and subtropical regions, and the World Health Organization has included it among the neglected tropical diseases targeted for control. In many endemic countries, the same pluralistic treatment patterns documented in Debre Elias are likely to exist, with traditional healers serving as first-line providers for skin conditions. If control programmes continue to design strategies as though biomedical services were the only relevant pathway, they risk repeating the pattern observed in Ethiopia: technically sound interventions that produce temporary reductions in transmission but fail to achieve durable control. The study suggests that the marginalisation of traditional healing in official strategies is not merely a cultural oversight but an operational liability that directly affects disease outcomes.

There is also a deeper conceptual point in the paper, reflected in its call for an inclusive, pluricultural approach. The researchers argue that supporting pluralistic treatment pathways should be considered an opportunity rather than a liability for scabies control. Traditional healers possess local trust, detailed community knowledge, and established relationships with the very households that biomedical programmes find hardest to reach. Rather than treating these healers as competitors or obstacles, programmes could treat them as partners whose involvement makes interventions more acceptable and more widely used. This reframing challenges a long-standing assumption in global health that the formalisation of care must come at the expense of informal providers, and it aligns with a growing body of research showing that community-engaged approaches tend to outperform purely biomedical ones in settings of deep medical pluralism.

For the people of Debre Elias, the stakes are immediate and physical. Scabies causes intense itching, skin damage from scratching, secondary bacterial infections, and in severe cases complications such as post-streptococcal glomerulonephritis, a kidney disease linked to streptococcal skin infection. Beyond the physical burden, the observational component of the study, which followed people with and without scabies in their homes and public spaces, points to the social weight of a visible, stigmatising skin disease in a close-knit community. An approach that meets people where they actually begin their treatment journey, rather than where programmes wish they would begin it, offers a realistic path toward reducing both the transmission of the mite and the burden carried by affected families. The study’s central message is that the tools for better scabies control may already exist in Debre Elias, distributed across both of its healing traditions, and that the task of public health is to connect them rather than to choose between them.

Subject of Research: Ethnographic research on pluralistic health-seeking behaviour and scabies management in Debre Elias, Ethiopia

Article Title: From co-existence to collaboration: The need to move towards an inclusive (pluricultural) scabies management approach in Debre Elias (Ethiopia)

Article References: Wonde, D., Engdawork, K., Roemer-Mahler, A., Tadele, G., & Trueba, M. (2026). From co-existence to collaboration: The need to move towards an inclusive (pluricultural) scabies management approach in Debre Elias (Ethiopia). PLOS Neglected Tropical Diseases, 20(10), e0014773. https://doi.org/10.1371/journal.pntd.0014773

Image Credits: AI Generated

DOI: 10.1371/journal.pntd.0014773

Keywords: scabies, Ethiopia, Amhara region, traditional healing, medical pluralism, neglected tropical diseases, mass drug administration, health-seeking behaviour, ethnography, public health, Debre Elias, Sarcoptes scabiei

The research team, led by Yesika Natali Fernández-Ortiz of the Institute of Public Health at Pontificia Universidad Javeriana in Bogotá, used a concurrent mixed-methods design that combined a structured household survey with ethnographic fieldwork. In 2022, six surveyors recruited from within the community, selected by traditional authorities and trained by the researchers, administered questionnaires to 819 individuals across 161 households, a participation rate of 78.1 percent of the total population of 1,049. Because internet connectivity in the region is limited, the surveyors used mobile devices equipped with offline software and GPS devices to record household locations. Interviews were conducted in Spanish and, where necessary, in Tikuna, the community’s own language. The team also carried out two field stays during 2022, one in the rainy season and one in the dry season, conducting fourteen semi-structured interviews with healers, midwives, community leaders, teachers, and health professionals, alongside participant observation and a social cartography workshop.

The technical findings reveal a health system that exists mostly on paper for the Arara. Although 97.9 percent of respondents were formally affiliated with Colombia’s General System of Social Security in Health, actual use of Western services was low. The nearest hospital with primary care capacity lies in Leticia, roughly 20 kilometers away by boat, and 97.3 percent of respondents who did receive institutional care had to travel there to get it. Departmental data show that Amazonas has 12 service sites, 137 beds, and just two mobile units for a vast, river-dispersed territory, with no public ambulances recorded in the dataset and a workforce skewed toward generalists rather than specialists. Sixteen percent of respondents said they would not seek Western care even for serious health problems, and only 10.6 percent attended routine medical appointments or check-ups.

What the numbers describe, the qualitative accounts explain. Traditional healers in Arara do far more than treat symptoms; they maintain what the community understands as balance between territory, spirits, and people. Their treatments include medicinal plant infusions and baths, prayers, smoke rituals, dietary restrictions, spiritual dances, and cleansing of the surrounding environment. Illness itself is categorized differently than in biomedicine. Alongside headaches, which 35.3 percent of respondents reported, and respiratory infections at 19.8 percent, the community recognizes conditions with spiritual origins, including spiritual harm or bewitchment, a condition called pecho abierto or open chest, and pérdida del cigarrillo, the loss of a baby’s spiritual protection after a fall or shock. A former Curaca, a traditional Magüta authority, told the researchers that the elders’ remedy was always found within the community, not in the city.

The survey also mapped the social architecture of traditional medicine, and it turned out to be gendered in unexpected ways. Among respondents aged 14 and older, 94 percent attributed importance to traditional healers and midwives, with no statistically significant difference between women and men. But participation in the traditional system followed distinct gendered patterns: 12.1 percent of women identified as midwives compared with 2.1 percent of men, and women were also more likely to be apprentice midwives, while men predominated as prayer healers and showed a non-significant tendency toward bonesetting. Education mattered too. Individuals with higher educational attainment were more likely to resort to pharmacies or self-care, whereas use of both health institutions and traditional healers was more frequent among those with lower educational levels, a counterintuitive pattern that suggests Western schooling does not simply displace traditional health beliefs.

Then came COVID-19, and the community’s response became a natural experiment in medical pluralism. Traditional healers interpreted the virus’s arrival through dreams, receiving a vision that the virus was destined mainly for whites or settlers and would not seriously affect Indigenous peoples, a reading that shaped early perceptions of the threat. Yet the community did not reject biomedical prevention outright. Among residents aged 12 and over, 76.9 percent wore face masks in public, 63.5 percent practiced regular hand washing, and 47.8 percent followed quarantine measures. These were layered with traditional practices: 23.5 percent used herbal remedies, 19.7 percent used vapor treatments with medicinal plants, and 14.9 percent observed community diets, collective restrictions that suspended dances and football matches and closed the community to outsiders. One traditional medical leader described the settlement filled with incense smoke that protected those inside it.

Treatment patterns during the pandemic confirmed where trust lay. Of the 223 people who reported having contracted COVID-19, 80.3 percent identified the illness through symptoms alone, without laboratory testing, and about 80 percent refused diagnostic tests when health workers went house to house, with some believing the tests themselves could transmit the virus. Among the infected, 40.8 percent relied exclusively on traditional healers, 36.8 percent combined traditional medicine with support from family and friends, and only 5.4 percent used treatments based solely on Western medicine. Hospitals were perceived as places of death rather than healing, with one community leader stating bluntly that intubation was what killed patients. Vaccination revealed a more negotiated picture: 87.2 percent of the population received at least one vaccine dose, but only 70.8 percent completed the full schedule, as fears circulated on WhatsApp that the vaccine contained a chip or could transform people into animals, and traditional authorities recommended limiting the number of doses.

The researchers are careful about what these findings do and do not show. They document meanings, preferences, and constraints rather than a fully developed service-level integration between the two systems. High formal affiliation with the Colombian health system, they conclude, does not translate into trust or routine use of biomedical services. The authors trace this mistrust to a longer colonial and postcolonial history in which official systems privileged biomedicine as modern and scientific while Indigenous knowledge was stigmatized as backward. Colombian law, including Law 21 of 1991 ratifying ILO Convention 169, formally recognizes Indigenous medical practices, and initiatives such as the Indigenous and Intercultural Health System, SISPI, aim to articulate them with the national system, but structural barriers, institutional racism, and mutual distrust have kept these efforts largely normative rather than operational.

What emerges instead is what medical anthropologists call intermedicality: a selective, negotiated, community-mediated relationship between therapeutic systems rather than a binary choice. The Arara did not treat biomedical care, home remedies, and ritual practice as mutually exclusive; they combined them according to the meaning of the illness, the perceived appropriate response, and the practical conditions of access and trust. Crucially, Indigenous authorities acted as gatekeepers and mediators, determining when public health measures became acceptable and when vaccination teams could enter the community. This suggests that vaccine hesitancy in Indigenous settings cannot be reduced to misinformation alone; it is also bound up with cultural autonomy, historical grievances, and the legitimacy of outside intervention.

The study’s implications are direct. The authors argue that intercultural health must be understood not as an abstract principle but as a lived practice grounded in respect, negotiation, and genuine recognition of Indigenous knowledge. That would mean health services that are not only geographically accessible but capable of engaging with local understandings of illness and community authority, stronger local primary care capacity, better communication between traditional leaders and health institutions, and training that prepares health professionals to work respectfully within Indigenous realities. The researchers also acknowledge limitations: the survey instrument was adapted from tools designed for a mestizo-Western population, the qualitative component relied on a small number of interviews, and the study captured community perspectives far more deeply than those of health providers. Even so, the Arara case delivers a clear message to global public health: in Indigenous territories, formal coverage on paper means little without trust, and trust is built through the community’s own authorities, not around them.

Subject of Research: The interaction and coexistence of traditional and Western medicine in an Indigenous Tikuna community in the Colombian Amazon, including health-seeking behavior and responses to COVID-19.

Article Title: Integration of traditional and Western medicine in the Arara community, Colombian Amazon

Article References: Fernández-Ortiz, Y. N., Amaya-Lara, J. L., Ariza-Ruiz, L. K., Barrera-Aguilera, D. C., Vivas-Sánchez, P., & Mejía-Rocha, M. M. (2026). Integration of traditional and Western medicine in the Arara community, Colombian Amazon. Discover Social Science and Health, 6(1), Article 96. https://doi.org/10.1007/s44155-026-00428-0

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00428-0

Keywords: traditional medicine, Western medicine, Indigenous health, Colombian Amazon, Tikuna, COVID-19, vaccination, intercultural health, medical pluralism, health-seeking behavior, medical anthropology, public health policy