Abstract-To explore the pattern and determinants of traditional cautery practices for management of ailments among infants visiting the outpatient clinics of governmental hospitals in Aseer District.

Methods: This study was conducted at the Pediatrics'

Outpatient Clinics of governmental hospitals within Aseer Region. The data collection sheet included personal characteristics and variables related to cautery practices. The study group comprised 150 infants and an age-and gendermatched control group (134 infants) who did not have any cautery marks in their bodies.

Results: Parents sought cautery for their infants mainly because of abdominal distension (28%), prolonged cough (27.3%), persistent vomiting (22%) and excessive crying (14%). The main sites for cautery were the infant's chest (50.7%) and the abdomen (38.7%). The person who performed cautery to the infants was mainly a professional traditional healer (89.3%). Inflammation of skin at the cautery site occurred in 26.7% of infants. Wound infection occurred in 4% while the 6.7% of infants had to be hospitalized after cautery. The complaint of more than one fifth of the infants (21.3%) got cured after cautery, while 50% improved, 26.7% did not improve and 2% worsened. There were significant differences according to parents' attained educational level (p<0.001 for both fathers and mothers), with more cautery among infants whose parents had lower levels of education. Mothers' employment was significantly associated with less practice of cautery for infants (p<0.001). Cautery was significantly more practiced for infants with high number of siblings (p=0.017) and for infants within extended families (p=0.018).

The perception of parents is in favor of practicing cautery for their infants' ailments. However, the observed improvement or cure of infants' after cautery is questionable.

Further detailed studies are needed to explore if there are genuine effects for cautery on the human body.

Keywords: cautery, infants, perception, saudi arabia.

raditional medicine constitutes any treatment or therapy that is not routinely and universally available to patients via the national health care system. It has always been an "invisible mainstream" within the health care delivery system that is practiced by faith or traditional healers (1).

Traditional medicine includes practices selfdefined by their users as preventing or treating illnesses or promoting health and wellbeing. It views health and disease in the context of the human totality of body, mind and spirit (2).

Social, cultural and political values, as well as socioeconomic factors, influence the use of traditional medicine. Some people often continue to use their cultures' traditional medicine alongside, or even in place of, conventional medicine. Some cannot afford to pay for conventional health care services and find traditional medicine affordable and accessible (3).

Moreover, Stekelenburg et al. (4) reported that prolonged waiting time, for being clinically examined or operated upon, turned out to be an encouraging factor for going to traditional healers. In the hospital, 48% of the respondents are not helped within time, while only 28% are not helped in time by the traditional healers. The cost of treatment from a traditional healer is affordable, but paid only if the patient is cured.

In developing countries, the affordability, availability, and cultural familiarity of traditional medicine, as well as family influence, contribute to the continued visits to traditional healers (3). Reasons include influence of grandparents, religious beliefs and failure of modern medicine to find the answer to some chronic disorders (5).

Traditional healing practices are widely used today, as have been since ancient times (6). Traditional ways of healing illnesses originating in ancient societies are currently called complementary medicine. Many of the traditional medical systems are based on sound fundamental principles and an experience that dates centuries gained by healers' practices (7).

Author ? ?: Professor of Pediatrics and pediatric gastroenterology college of medicine, child health department King Khalid Universit. e-mail: [email protected]

In the Arab world, the main areas of traditional therapy comprise herbal, kaiy (cautery) and cupping (8). It has been observed that most patients in the Arab countries, especially those who have strong religious background, first consult faith or traditional healers, who usually explain the etiology of diseases by magic and witchcraft, evil eye, demons and other cultural factors. Two types of treatment modalities are mainly followed, either non-invasive practices, mostly reading from the Holy Quran, (known as roqyah), or invasive, mostly cautery, which is a frequent treatment option. A large number of patients rotate between traditional healers and biomedical doctors (9-10).

Al-Rowais et al. (11) reported that, in the Kingdom of Saudi Arabia, most of native healers were illiterate, who mainly used herbs (45%), cautery (28%), while 25% were reciting Quran. They concluded that traditional healers give a significant contribution to the health care system. Almost half of the population in Riyadh City consulted traditional healers at least once in their life.

The medical services in Saudi Arabia have improved tremendously over the last few decades, and health care centers are easily accessible to the population. Nevertheless, traditional medicine practices, including cautery, are still widely practiced (12).

Abou-Elhamd( 13) noted that the practice may be associated with considerable health risks. However, Albilani (8) noted that traditional therapies are becoming increasingly popular even in developed countries being used by 33% to 42% of the general American population.

Recently, some clinical research studies have been employed to shed light on the patterns and efficacy of traditional medicine practices. However, more studies in different fields of traditional medicine practices are still needed (14).

This study aim to explore the pattern and determinants of traditional cautery practices for management of ailments among infants visiting the outpatient clinics of governmental hospitals in Aseer District.

II.

This study followed a case-control study design. It was conducted within the period from January until December 2012, at the Pediatrics'' Outpatient Clinics of hospitals within Aseer Region, whose population is mainly tribal in nature for which traditional medicine practices are common. The included hospitals were Aseer Central Hospital, Mahayel, Al-Berk, Sarat Obeida, Zahran Al-Janoub and Al-Farsha hospitals.

The data collection sheet included personal characteristics, regarding parents' age, education, mother's employment, number of siblings and type of family (i.e., nuclear or extended) in addition to variables related to cautery practices, e.g., reason for practicing cautery, the person who performed it, site of cautery and outcome. The data collection sheets were filled by the treating physician.

The study group comprised 150 infants. The inclusion criterion was having cautery mark(s) on their bodies explained by their parents as being for the management of certain health problems.

An age-and gender-matched control group comprised 134 infants who did not have any cautery marks on their bodies. Table (1) shows no statistically significant differences between both groups regarding their age or gender. Data were coded, validated and analyzed using the SPSS PC + software package. Descriptive statistics were performed and the Chi square test was applied to test significance of differences between groups, at 5% level.

The study received the approval of the Research and Ethics Committee at King Khalid University, College of Medicine (REC-2011-03-02).

Parents sought cautery for their infants mainly because of abdominal distension (28%), prolonged cough (27.3%), persistent vomiting (22%) and excessive crying (14%).

The main sites for cautery were the infants' chest (50.7%) and the abdomen (38.7%). The person who performed cautery to the infant was mainly a professional traditional healer (89.3%).Inflammation of skin at the cautery site occurred in 26.7% of infants. Wound infection occurred in 4% while the 6.7% of infants had to be hospitalized after cautery. The complaint of more than one fifth of the infants (21.3%) got cured after cautery, while 50% improved, 26.7% did not improve and 2% worsened (Table2). Table (3) shows that infants in the study group did not differ significantly from those in the control group regarding their parents' age groups. However, there were significant differences according to parents' attained educational level (p<0.001 for both fathers and mothers), with more cautery among infants whose parents had lower levels of education. Mothers' employment was significantly associated with less practice of cautery for infants (p<0.001). Cautery was significantly more practiced for infants with high number of siblings (p=0.017). cautery was significantly more practiced for infants within extended families (p=0.018).

Moreover, the condition of some infants deteriorated after cautery and they had to be hospitalized. Despite the claimed cure of infants' complaints of more than fifth of the infants and the improvement among half of them after cautery, yet the complaint of one fourth did not improve and that of 2% worsened.

Such cure and/ or improvement might be explained to some extent by: relief of endogenous opioids in response to cautery, the natural history of such disease which usually improves with time, regardless of treatment, such as reflux, colicky pain and even chest problems.

Azaizeh et al. (17) stated that people will

IV.

This study showed that cautery has been practiced in Aseer District to manage health care disorders among patients as early as their first year of life. It has been revealed that parents commonly seek cautery for their infants even when they suffer from symptoms of ailments that can be controlled medically, like abdominal distension, prolonged cough, persistent vomiting or excessive crying.

El-Ghazali et al. (15) noted that traditional medicine practices occupy a significant part of Saudi Arabia's heritage and are widely accepted. Sheikh and Hatcher (16) stated that, for centuries, people have been using traditional means for treating ailments, and continued to use them alongside modern medicine. Despite all the marvelous advancements in modern medicine, traditional medicine has always been practiced.

This study showed that the main sites for cautery were the infants' chest and abdomen. This is perhaps because the main infants' complaints were affecting these sites chest, e.g., prolonged cough and abdominal distension.

The person who performed cautery for infants in this study was mainly a traditional healer. Consequently, complications of cautery were common, e.g., inflammation of the skin at the cautery site and burn wound infection. The controversy, that traditional healers are popular in spite of the fact that their practices may be harmful has been widely described and explained in literature. Sheikh and Hatcher (16) stated that some of the traditional healers are quacks, who are at the same time very caring people, and extraordinarily skilled in communication and counseling. In spite of the fact that there are certain horrible ones who would harm their patients at every turn, traditional healers are usually respected within their own communities, and they are often their opinion leaders. However, traditional healers lack education, training, regulation and evidence base (16).

Abou-Elhamd (12) stressed that it is not logic to burn patients to make them suffer more pain in order to treat their pain. Patients who have received cautery reported that it gives temporary relief followed by severe pain. Such treatment may possibly act by stimulating the release of endogenous opioids and other neurotransmitters.

Kim et al. (18) noted that, in spite of the relatively high extend of patients' satisfaction toward traditional medicine, it is important to be aware of the Physicians should inquire about traditional medicine practices by their patients to protect them from harm. Moreover, clinicians should consider the cultural and personal meaning associated with diverse health beliefs and practices of patients (19).

IV.

In conclusion, the perception of parents is in favor of practicing cautery for their infants' ailments. However, detailed studies are needed to explore if there are genuine effects for cautery on the human body.