Understanding the Factors Influencing the Mental Health and Emotional Well-being of Women Residents at the Witches’ Camps of Northern Ghana

Yakubu, Yakubu H.
Holroyd, Eleanor
Siegart , Richard
Krageloh, Chris
Aziato, Lydia
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Doctor of Philosophy
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Auckland University of Technology

Background: Witchcraft accusations have occurred in Ghanaian society and elsewhere in Sahara, Africa, for many decades. Witchcraft accusations commonly reveal a cultural predisposition to apportion blame for mishaps in the community, such as a disability or misconceptions surrounding ageing and dementia. Such labelling severely curtails the lives of the women, who are banished to live in the “witches” camps with resultant social isolation and accompanying stressors impacting their well-being. Yet, little is known specifically about these women’s mental health and emotional well-being. This research aimed to understand the factors influencing older women’s mental and emotional well-being in the witches’ camps in northern Ghana.

Methodology: A two-phase exploratory sequential mixed methods design was employed, using the socio-ecological model, Kleinman's explanatory model, and the social determinants of health as framing lenses. In phase one, an interpretive descriptive approach was used, drawing on purposive sampling to recruit and interview 15 women from one of the "witches' camps" in northern Ghana, along with three allied stakeholders. Additionally, observational photos of the camp's facilities were taken to provide further triangulated data to supplement the interviews. The precise ages of the women were unavailable due to their unknown birth dates. The participants stayed in the camp for a period ranging from 8 to 30 years.

Phase two aimed to investigate anxiety and depression symptoms among a cohort of women from the camps and validate the Dagbani Hospital Anxiety and Depression Scale (HADS). A cross-sectional descriptive method was applied, utilizing the cross-culturally translated HADS. A total of 168 women were recruited through random sampling from the witches' camps, and 100 women from the general population completed the Dagbani version of the HADS.

Findings: Thematic analysis of phase one data identified nine broad themes: ‘the presence of physical health problems impacting general health and well-being’, ‘anxiety, nervousness, and suicidal ideation’, ‘forgetfulness’, and ‘loneliness, sadness from family disconnection’. Other themes included ‘stigma – self and others’, ‘lack of resources for basic needs and social facilities’, ‘health access barriers affecting general and mental healthcare’, ‘enabling factors for improving social connections’, and ‘recommendations for improving mental health and general well-being’. These themes, in turn, were contextualised by the subthemes of ‘poor housing conditions’, ‘lack of healthcare facilities’, ‘lack of potable water’ and ‘psychological support’ and ‘problems with sleep or difficulty sleeping at night’, ‘frailty and loss of independence’, ‘feeling restless’ or ‘can’t sit still’, ‘worried and scared’, ‘expressing thoughts of suicide and anger’, ‘difficulty concentrating’, ‘confusion’, ‘being sad and alone’, ‘worries associated with separation and lack of family support in the camp’, ‘loss of respect and dignity (“Dariza”)’, ‘feelings of helplessness, unhappiness and despair’, ‘feelings of shame, hopelessness, and isolation’. Data from phase two revealed that anxiety and depression were more prevalent in women in the camps than in the general population of women. A breakdown of the mean scores by group demonstrated higher scores for both anxiety (mean 14.73, SD 1.46) and depression (mean 17.85, SD 1.55) for women in the camp when compared with women from the general population (mean 4.18, SD 2.43, and mean 6.18, SD 3.00, respectively).

Conclusion: The triangulation of the two phases provides a contextualized response to the research aim. Common mental health concerns were identified, including anxiety and depressive symptoms among women in the camps and women from the general population. Recommendations are provided for addressing mental health and general well-being, focusing on culturally targeted health and social care provision. These include providing critical and basic social and healthcare resources and amenities, such as good housing, food, safe drinking water, healthcare facilities, and insurance coverage. In addition, resilience training through counselling and linking the women with psychological support is highlighted. Importantly, this study constituted the first time the Dagbani HADS has been translated and validated. Further recommendations are made for the long-term reintegration of these women safely back into their communities.

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