The need to provide a comprehensive repository of indigenous health knowledge, practices, and seeking behaviour within a just transition and intergenerational learning framework augment the generation of empirical data from various segments of identified Fulbe communities. This paper examines the relationship between indigenous health knowledge and practices and their implications on intergenerational learning and future health aspirations. Using a mixed approach, data generated from 650 respondents in selected communities in Southern Ghana was examined. The demographic characteristics, and perceived effectiveness, and access to contemporary health systems were analysed using descriptive tools. Further, Cronbach alpha values of 0.799 involving 4 measured items and 0.674 involving 5 measured Likert scale items were established for the independent and dependent variables respectively. Thus, proving an internal consistency of the measured items for Fulbe health indigenous knowledge and practices (0.799) and future health aspirations (0.674). A multiple linear regression analysis examining factors influencing future health aspirations in Fulbe communities was conducted. Among educational levels, tertiary education was positively associated with future health aspirations (β = 0.261, p = 0.030). Place of residence indicated that peri-urban residence was positively associated with future health aspirations (β = 0.268, p < 0.001), while rural residence was marginally significant (β = 0.122, p = 0.073). Regarding origin, respondents from Burkina Faso (β = 0.213, p = 0.005), Niger (β = 0.204, p = 0.019), and those reporting the same nationality (β = 0.531, p < 0.001), as well as “other” origins (β = 0.461, p = 0.007), showed statistically significant positive associations. Migration generation also showed significant associations, with second-generation (β = -0.229, p = 0.003) and third-generation respondents (β = -0.283, p < 0.001) having lower coefficients compared to first-generation respondents.
The significant relationship between the socio-demographic variables and future health aspirations as linked to improved health outcomes and health seeking behaviour necessitate the documentation, transmission of indigenous health knowledge, and complementary implementation of sustainable health practices in Fulbe communities to sustain intergenerational learning and enhance future health aspirations.
BackgroundKnowledge transmission in migrant communities is influenced by indigenous knowledge, practice, and behaviour in both destination and source areas (Kohsaka and Rogel., 2021; Head, Klocker, and Aguirre-Bielschowsky, 2019). As the world moves towards a desire for an equitable and just community, it is important to provide a repository of knowledge related to the totality of factors that influence intergenerational learning and future aspiration of migrant communities. Looking at the dearth of knowledge in indigenous knowledge on traditional health practices and their implication on future health practices in marginalized Fulbe communities (Finn, Herne, and Castille, D., 2017; Konadu, 2007; Thompson, and Fulton, 2024; Kalu, 2022), the structural linkages between the social determinants of health in Fulbe community settings need to be examined.
Studies have shown that there is an inextricable linkage between health and community development. The nexus is established in the individual, household, and communal dimensions. What is then required is the examination of the relationships, interdependences, and apparent variations in health choices, and aspiration in areas where pluralistic health care delivery systems exist. Crucial in this study context is the intergenerational nature of the Fulbe migrant communities, their enculturation, and efforts to maintain their cultural identity and practices within the source area, and how these impacts on their existing health conditions and future health desires.
Whereas social and demographic variables have been postulated in theories and models such as the Health Belief Model, Plan Behaviour Theory of Plan Behaviour and Community Action Cycle as major constituents of individual and communal actions toward health, their levels of effect and roles may vary based on the context, and mode of knowledge transition, and intergenerational learning, especially in a migration and settlement context.
It has been proven that Fulbe cultural systems of pastoral nomadism has socio-religious and economic dimensions that affects livelihoods, social justice, and health systems (Halawayhi, Fusheini, and Nunfam, 2026; Napogbong, Domapielle, and Derbile, 2021). To create an improved system of health delivery without negating the sustenance of generationally held knowledge and practices, this study relies on empirical data to examine the relationship between Fulbe traditional health systems and their implications for intergenerational learning and future health aspirations with emphasis on the socio-demographic determinant within a just transition framework.
MethodsThe study premised on an exploratory principle, employed a mixed method approach to generate empirical data across selected sedentary and semi-sedentary nomadic Fulbe communities in Southern Ghana, precisely the Shai-Osudoku District. The location of Fulbe settlements and settlers were mapped out using existing map of the district, population data, and key informant information generated from community entry and transect walks. The district was zoned into four regions based on the distribution of Fulbe households, nomadic activities, and communal distribution. The uneven distribution of Fulbe settlers in the wider communities, the relatively secluded nature of Fulbe households in the communities and their physical location at the outskirt because of their initial land tenure agreement and extensive grazing field requirement made it difficult to apply rigid quantitative sampling approaches, hence the adoption of mixed and purposive approaches.
In all 650 individuals were surveyed across communities. Field data objective officers were trained to assist the research team in translating the tools in Fulfulde and help in the administration. Ethical clearance was sought from a review Board of the University of Ghana, and informed consent was received from each of the respondents in the study. Further in-depth interviews and ethnographic studies were also conducted. The quantitative data has been analysed and presented in the subsequent session of this paper.
ResultsTable 1 presents the results of the frequency distribution of respondents’ sociodemographic characteristics. The mean age of respondents was 35.47 years (SD = 16.12). In terms of gender distribution, 51.54% of respondents were female, while 48.46% were male. Regarding educational attainment, 31.54% of respondents had no formal education, followed by those with Makranta education (25.08%). Smaller proportions had JSS (14.92%), SHS (11.69%), primary education (11.38%), tertiary education (4.77%), and non-formal education (0.62%).
With respect to employment status, the largest proportion of respondents were unemployed (25.54%), followed by herdsmen/pastoralists (24.31%) and traders/merchants (17.23%). Other categories included housewives/homemakers (9.23%), farmers (6.15%), teachers (2.15%), artisans/craftsperson (1.38%), and other occupations (14.00%). In terms of respondent category, the majority were parents (51.08%), followed by children (31.08%) and grandparents (16.46%), with a small proportion identified as caregivers/guardians (1.38%).
Most respondents were fully settled pastoralists (81.85%), while smaller proportions were nomadic (13.85%), sedentary (2.77%), and semi-sedentary (1.54%). Majority of respondents resided in rural areas (55.85%), followed by peri-urban (29.54%) and urban areas (14.62%). Regarding health insurance, 87.54% reported having a valid NHIS card, while 12.46% did not. Additionally, 68.77% of respondents had not received training on alternative livelihood activities, compared to 31.23% who had.
In terms of origin, 33.08% reported being from the same nationality as their current residence, while 32.00% were from Ghana. Other reported origins included Burkina Faso (14.77%), Niger (10.77%), Mali (4.77%), Nigeria (2.46%), and smaller proportions from Togo, Chad, Sudan, and other countries. Regarding migration generation, the largest proportion of respondents belonged to the third generation (32.31%), followed by second generation (28.46%), first generation (15.54%), and both fourth and fifth generations (11.85% each).
Table 1 :Frequency Distribution of Respondents’ Sociodemographic Characteristics (N = 650)
|
Variable |
Frequency (n) |
Percentage (%) |
|
Age |
Mean (SD) = 35.47 (16.12) |
|
|
Gender |
||
|
Male |
315 |
48.46 |
|
Female |
335 |
51.54 |
|
Educational Level |
||
|
None |
205 |
31.54 |
|
Primary |
74 |
11.38 |
|
JSS |
97 |
14.92 |
|
SHS |
76 |
11.69 |
|
Tertiary |
31 |
4.77 |
|
Non-formal |
4 |
0.62 |
|
Makranta |
163 |
25.08 |
|
Employment |
||
|
Unemployed |
166 |
25.54 |
|
Herdsman/Pastoralist |
158 |
24.31 |
|
Farmer |
40 |
6.15 |
|
Trader/Merchant |
112 |
17.23 |
|
Teacher |
14 |
2.15 |
|
Housewife/Homemaker |
60 |
9.23 |
|
Artisan/Craftsperson |
9 |
1.38 |
|
Other |
91 |
14.00 |
|
Respondent Category |
||
|
Grandparent |
107 |
16.46 |
|
Parent |
332 |
51.08 |
|
Child |
202 |
31.08 |
|
Caregiver/Guardian |
9 |
1.38 |
|
Type of Pastoralist |
||
|
Nomadic |
90 |
13.85 |
|
Semi-sedentary |
10 |
1.54 |
|
Sedentary |
18 |
2.77 |
|
Fully settled |
532 |
81.85 |
|
Place of Residence |
||
|
Urban |
95 |
14.62 |
|
Rural |
363 |
55.85 |
|
Peri-urban |
192 |
29.54 |
|
NHIS Card Ownership |
||
|
Yes |
569 |
87.54 |
|
No |
81 |
12.46 |
|
Training on Alternative Livelihood |
||
|
Yes |
203 |
31.23 |
|
No |
447 |
68.77 |
|
Origin |
||
|
Ghana |
208 |
32.00 |
|
Mali |
31 |
4.77 |
|
Togo |
1 |
0.15 |
|
Burkina Faso |
96 |
14.77 |
|
Nigeria |
16 |
2.46 |
|
Niger |
70 |
10.77 |
|
Chad |
1 |
0.15 |
|
Sudan |
1 |
0.15 |
|
Same as current nationality |
215 |
33.08 |
|
Other |
11 |
1.69 |
|
Migration Generation |
||
|
First generation |
101 |
15.54 |
|
Second generation |
185 |
28.46 |
|
Third generation |
210 |
32.31 |
|
Fourth generation |
77 |
11.85 |
|
Fifth generation |
77 |
11.85 |
Table 2 presents the results on Fulbe health indigenous knowledge and practices. For the statement that traditional Fulbe herbal medicine is more effective than orthodox medicine, 30.00% of respondents disagreed, while 19.69% strongly disagreed. In contrast, 18.92% agreed and 13.38% strongly agreed, with 18.00% remaining neutral. The mean score for this item was 2.76 (SD = 1.33).
Regarding trust in traditional healers as the most trusted healthcare providers, 31.54% of respondents agreed and 16.00% strongly agreed, while 29.38% disagreed and 7.69% strongly disagreed. A proportion of 15.38% reported neutral responses. This item had a mean score of 3.18 (SD = 1.23).
For the perception that traditional healing practices are superior to orthodox standards of care, 29.23% disagreed and 14.31% strongly disagreed, while 28.15% agreed and 12.46% strongly agreed. Neutral responses accounted for 15.85%, with a mean score of 2.95 (SD = 1.28).
For the perception that traditional healing practices are superior to orthodox standards of care, 29.23% disagreed and 14.31% strongly disagreed, while 28.15% agreed and 12.46% strongly agreed. Neutral responses accounted for 15.85%, with a mean score of 2.95 (SD = 1.28).
Concerning the statement that the traditional healing apprenticeship system prepares the younger generation, 30.77% agreed and 10.15% strongly agreed, whereas 28.62% disagreed and 13.38% strongly disagreed. Neutral responses constituted 17.08%, and the mean score was 2.96 (SD = 1.24). The overall mean score for Fulbe health indigenous knowledge and practices was 2.95 (SD = 1.00).
|
Variable |
Strongly Disagree n (%) |
Disagree n (%) |
Neutral n (%) |
Agree n (%) |
Strongly Agree n (%) |
Mean |
|
Traditional Fulbe herbal medicine is more effective than orthodox medicine |
128 (19.69) |
195 (30.00) |
117 (18.00) |
123 (18.92) |
87 (13.38) |
2.76 (1.33) |
|
Traditional healers are the most trusted healthcare providers among Fulbe |
50 (7.69) |
191 (29.38) |
100 (15.38) |
205 (31.54) |
104 (16.00) |
3.18 (1.23) |
|
Traditional healing practices are superior to orthodox standards of care |
93 (14.31) |
190 (29.23) |
103 (15.85) |
183 (28.15) |
81 (12.46) |
2.95 (1.28) |
|
The traditional healing apprenticeship system prepares the younger generation |
87 (13.38) |
186 (28.62) |
111 (17.08) |
200 (30.77) |
66 (10.15) |
2.96 (1.24) |
|
Total mean |
|
|
|
|
|
2.95 (1.00) |
Table 3 presents the results on future health aspirations among Fulbe. A large proportion of respondents agreed (46.92%) or strongly agreed (43.38%) that technology can help preserve Fulbe health traditions for future generations, with minimal disagreement (2.92%) and strong disagreement (0.77%). The mean score for this item was 4.29 (SD = 0.77).
For the statement that traditional Fulbe medicine alone is not sufficient to resolve health issues, 31.38% agreed and 42.62% strongly agreed, while 11.08% strongly disagreed and 7.85% disagreed. Neutral responses accounted for 7.08%, with a mean score of 3.87 (SD = 1.33). Regarding the need for Fulbe healers to master both traditional and orthodox medicine, 43.69% agreed and 46.31% strongly agreed, with only small proportions disagreeing or strongly disagreeing. The mean score for this item was 4.33 (SD = 0.75).
For the perception that orthodox medicine complements traditional Fulbe medicine, 38.00% agreed and 30.77% strongly agreed, while 17.23% were neutral and smaller proportions disagreed or strongly disagreed. This item had a mean score of 3.83 (SD = 1.06). Finally, for the statement that positive healthcare behaviour should be measured by the coexistence and use of both systems, 48.77% agreed and 36.62% strongly agreed, with minimal disagreement. The mean score was 4.15 (SD = 0.86). The overall mean score for future health aspirations was 4.09 (SD = 0.63).
|
Variable |
Strongly Disagree n (%) |
Disagree n (%) |
Neutral n (%) |
Agree n (%) |
Strongly Agree n (%) |
Mean (SD) |
|
Technology can help preserve Fulbe health traditions to future generation |
5 (0.77) |
19 (2.92) |
39 (6.00) |
305 (46.92) |
282 (43.38) |
4.29 (0.77) |
|
Traditional Fulbe medicine alone is not sufficient to resolve health issues |
72 (11.08) |
51 (7.85) |
46 (7.08) |
204 (31.38) |
277 (42.62) |
3.87 (1.33) |
|
Fulbe healers should master both traditional herbal medicine and orthodox medicine |
2 (0.31) |
19 (2.92) |
44 (6.77) |
284 (43.69) |
301 (46.31) |
4.33 (0.75) |
|
Orthodox medicine complements traditional Fulbe medicine |
15 (2.31) |
76 (11.69) |
112 (17.23) |
247 (38.00) |
200 (30.77) |
3.83 (1.06) |
|
Positive healthcare behaviour should be measured by coexistence and use of both systems |
11 (1.69) |
24 (3.69) |
60 (9.23) |
317 (48.77) |
238 (36.62) |
4.15 (0.86) |
|
Total mean |
|
|
|
|
|
4.09 (0.63) |
Table 4 presents the results of the multiple linear regression analysis examining factors influencing Fulbe peoples’ future health aspirations. Fulbe health indigenous knowledge and practices (β = -0.025, p = 0.278) and age (β = -0.004, p = 0.120) were not statistically significant predictors of future health aspirations. Gender was also not significantly associated with future health aspirations (β = -0.011, p = 0.850).
Among educational levels, tertiary education was positively associated with future health aspirations (β = 0.261, p = 0.030), while other educational categories were not statistically significant. In terms of employment status, none of the categories showed statistically significant associations at the 5% level, although the “other” category approached significance (β = -0.135, p = 0.082). Respondent category showed statistically significant associations, with parents (β = -0.436, p < 0.001), children (β = -0.465, p < 0.001), and caregivers/guardians (β = -0.419, p = 0.041) having lower coefficients relative to the reference category (grandparents). Among pastoralist types, being fully settled was positively associated with future health aspirations (β = 0.150, p = 0.025), while other categories were not significant.
Place of residence indicated that peri-urban residence was positively associated with future health aspirations (β = 0.268, p < 0.001), while rural residence was marginally significant (β = 0.122, p = 0.073). NHIS card ownership was not significantly associated (β = -0.041, p = 0.563). However, lack of training in alternative livelihood activities was negatively associated with future health aspirations (β = -0.131, p = 0.012). Regarding origin, respondents from Burkina Faso (β = 0.213, p = 0.005), Niger (β = 0.204, p = 0.019), and those reporting the same nationality (β = 0.531, p < 0.001), as well as “other” origins (β = 0.461, p = 0.007), showed statistically significant positive associations. Migration generation also showed significant associations, with second-generation (β = -0.229, p = 0.003) and third-generation respondents (β = -0.283, p < 0.001) having lower coefficients compared to first-generation respondents.
The overall model was statistically significant (F (39, 610) = 7.45, p < 0.001), explaining 32.3% of the variance in future health aspirations (R² = 0.323; Adjusted R² = 0.279).
|
Variable |
Coefficient |
Std. Error |
95% CI |
p-value |
|
Fulbes’ Health Indigenous Knowledge and Practices |
-0.025 |
0.023 |
[-0.071, 0.021] |
0.278 |
|
Age |
-0.004 |
0.003 |
[-0.009, 0.001] |
0.120 |
|
Gender (Ref: Male) |
||||
|
Female |
-0.011 |
0.059 |
[-0.128, 0.105] |
0.850 |
|
Educational Level (Ref: None) |
||||
|
Primary |
0.084 |
0.082 |
[-0.076, 0.245] |
0.302 |
|
JSS |
0.081 |
0.076 |
[-0.068, 0.229] |
0.286 |
|
SHS |
-0.031 |
0.087 |
[-0.202, 0.141] |
0.727 |
|
Tertiary |
0.261** |
0.120 |
[0.025, 0.497] |
0.030 |
|
Non-formal |
-0.264 |
0.273 |
[-0.799, 0.272] |
0.334 |
|
Makranta |
0.083 |
0.059 |
[-0.034, 0.200] |
0.163 |
|
Employment (Ref: Unemployed) |
||||
|
Herdsman/Pastoralist |
0.127 |
0.078 |
[-0.027, 0.282] |
0.105 |
|
Farmer |
-0.089 |
0.104 |
[-0.293, 0.114] |
0.390 |
|
Trader/Merchant |
0.115 |
0.070 |
[-0.023, 0.253] |
0.103 |
|
Teacher |
0.028 |
0.160 |
[-0.286, 0.342] |
0.862 |
|
Housewife/Homemaker |
-0.108 |
0.088 |
[-0.281, 0.065] |
0.221 |
|
Artisan/Craftsperson |
0.063 |
0.194 |
[-0.319, 0.445] |
0.746 |
|
Other |
-0.135* |
0.077 |
[-0.287, 0.017] |
0.082 |
|
Respondent Category (Ref: Grandparent) |
||||
|
Parent |
-0.436*** |
0.084 |
[-0.601, -0.270] |
0.000 |
|
Child |
-0.465*** |
0.124 |
[-0.708, -0.222] |
0.000 |
|
Caregiver/Guardian |
-0.419** |
0.204 |
[-0.820, -0.018] |
0.041 |
|
Pastoralist Type (Ref: Nomadic) |
||||
|
Semi-sedentary |
0.056 |
0.183 |
[-0.303, 0.415] |
0.760 |
|
Sedentary |
0.051 |
0.146 |
[-0.235, 0.338] |
0.725 |
|
Fully settled |
0.150** |
0.067 |
[0.019, 0.280] |
0.025 |
|
Residence (Ref: Urban) |
||||
|
Rural Area |
0.122* |
0.068 |
[-0.012, 0.256] |
0.073 |
|
Peri-Urban |
0.268*** |
0.073 |
[0.125, 0.410] |
0.000 |
|
NHIS Card Ownership (Ref: Yes) |
||||
|
No |
-0.041 |
0.071 |
[-0.179, 0.098] |
0.563 |
|
Alternative Training (Ref: Yes) |
||||
|
No |
-0.131** |
0.052 |
[-0.233, -0.029] |
0.012 |
|
Origin (Ref: Ghana) |
||||
|
Mali |
0.199* |
0.110 |
[-0.016, 0.415] |
0.070 |
|
Togo |
0.632 |
0.546 |
[-0.439, 1.703] |
0.247 |
|
Burkina Faso |
0.213*** |
0.076 |
[0.063, 0.363] |
0.005 |
|
Nigeria |
0.238 |
0.157 |
[-0.071, 0.548] |
0.130 |
|
Niger |
0.204** |
0.087 |
[0.034, 0.375] |
0.019 |
|
Chad |
0.125 |
0.544 |
[-0.944, 1.194] |
0.819 |
|
Sudan |
-0.059 |
0.545 |
[-1.128, 1.011] |
0.914 |
|
Same nationality |
0.531*** |
0.061 |
[0.412, 0.651] |
0.000 |
|
Other |
0.461*** |
0.171 |
[0.124, 0.797] |
0.007 |
|
Migration Generation (Ref: First Generation) |
||||
|
Second Generation |
-0.229*** |
0.077 |
[-0.381, -0.077] |
0.003 |
|
Third Generation |
-0.283*** |
0.080 |
[-0.441, -0.125] |
0.000 |
|
Fourth Generation |
-0.093 |
0.098 |
[-0.285, 0.100] |
0.346 |
|
Fifth Generation |
0.167 |
0.101 |
[-0.032, 0.366] |
0.101 |
The results demonstrates that the Fulbe community, though appears to share similar characteristics, is not socially homogeneous. This can be seen from the dimensions of age, employment and economic viability, the nature of nomadism and settlement with 81.8% being settled pastoralist and 55.8% been in rural areas. The variation in nationality with 32% indicating Ghana as their nationality, 10.7% from Niger and others come from other countries in Africa also depicts their cross-border nature. Thus, the heterogeneity in the socio-demographic characteristics in Fulbe communities, and their intergenerational characteristics with 32.3% being third generational migrant and first generation constituting 15.5% augment the need to create a repository for the intergenerational learning related to health knowledge and future health aspirations.
The results demonstrates that the Fulbe community, though appears to share similar characteristics, is not socially homogeneous. This can be seen from the dimensions of age, employment and economic viability, the nature of nomadism and settlement with 81.8% being settled pastoralist and 55.8% been in rural areas. The variation in nationality with 32% indicating Ghana as their nationality, 10.7% from Niger and others come from other countries in Africa also depicts their cross-border nature. Thus, the heterogeneity in the socio-demographic characteristics in Fulbe communities, and their intergenerational characteristics with 32.3% being third generational migrant and first generation constituting 15.5% augment the need to create a repository for the intergenerational learning related to health knowledge and future health aspirations.
The perceived varied efficacy of traditional Fulbe medicines as shown in a disagreement of 30% and 19.6% strong disagreement, as contrasted with 31.5% of the respondents who trusted in traditional healers and 16% having strong trust in same create a lacuna that is still not resolved as there is an unsettled argument on the superiority of traditional Fulbe healing practices over orthodox medicine. Thus, Fulbe people still accept aspects of their traditional health system and orthodox health systems, hence the need to put in place measures for complementary adoption to achieve optimal health outcome.
The findings conform to other studies that have shown the pluralistic existence of traditional and orthodox medicine and how these impact on health seeking behaviour, early diagnosis, and case management (Kalu, 2022; Amzat, and Razum, 2014; and Sarfo, 2022). It is imperative to discuss this situation and examine its effect on future health aspirations.
In line with the examination of the determinants of future health aspirations, it was ascertained that though Fulbe indigenous health knowledge and age were not significant predictors, tertiary educational level, respondents' roles, type of settled nomadism and place of residence were key determinants. Thus, it is advanced that educational exposure, stage of migration (settled/semi-settled), and place of residence and place of origin have a positive relationship with future health aspirations. The observance of a positive relationship between migration generation, ranging from highest coefficients for first generation to third generations clearly shows the hope and aspirations in the future health of the Fulbe people in this study context.
Consequently, there is the need to enhance all components of both health systems perceived to lead to an improved health outcome and ensure the preservation and efficient transmission of aspects of Fulbe indigenous health knowledge that can enhance intergenerational learning in a just manner.
The study sought to examine the relationship between indigenous Fulbe health knowledge and practices and their implications on future health aspirations, with strong emphasis on selected socio-demographic determinants in the study context. Thus, the study has provided an empirical basis and knowledge for identifying the key factors that can facilitate intergenerational learning among an identified marginalized migrant group in a safe, friendly, sustained, and just transition continuum.
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