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The epidemiology of ‘bewitchment’ as a lay-reported cause of death in rural South Africa
  1. Edward Fottrell1,2,
  2. Stephen Tollman3,
  3. Peter Byass1,
  4. Frederick Golooba-Mutebi4,
  5. Kathleen Kahn3
  1. 1Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  2. 2Centre for International Health and Development, Institute of Child Health, University College London, UK
  3. 3MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
  4. 4Makerere Institute of Social Research, Makerere University, Kampala, Uganda
  1. Correspondence to Dr Edward Fottrell, Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901-85 Umeå, Sweden; Edward.Fotrell{at}


Background Cases of premature death in Africa may be attributed to witchcraft. In such settings, medical registration of causes of death is rare. To fill this gap, verbal autopsy (VA) methods record signs and symptoms of the deceased before death as well as lay opinion regarding the cause of death; this information is then interpreted to derive a medical cause of death. In the Agincourt Health and Demographic Surveillance Site, South Africa, around 6% of deaths are believed to be due to ‘bewitchment’ by VA respondents.

Methods Using 6874 deaths from the Agincourt Health and Socio-Demographic Surveillance System, the epidemiology of deaths reported as bewitchment was explored, and using medical causes of death derived from VA, the association between perceptions of witchcraft and biomedical causes of death was investigated.

Results The odds of having one's death reported as being due to bewitchment is significantly higher in children and reproductive-aged women (but not in men) than in older adults. Similarly, sudden deaths or those following an acute illness, deaths occurring before 2001 and those where traditional healthcare was sought are more likely to be reported as being due to bewitchment. Compared with all other deaths, deaths due to external causes are significantly less likely to be attributed to bewitchment, while maternal deaths are significantly more likely to be.

Conclusions Understanding how societies interpret the essential factors that affect their health and how health seeking is influenced by local notions and perceived aetiologies of illness and death could better inform sustainable interventions and health promotion efforts.

  • South Africa
  • witchcraft
  • cause of death
  • verbal autopsy
  • lay perceptions
  • developing countr CG
  • developing countr SI
  • epidemiology ME
  • health beliefs SI
  • mortality SI

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  • Funding This work was undertaken within the Umeå Centre for Global Health Research at the Division of Epidemiology and Global Health, Umeå University, with support from FAS, the Swedish Council for Working Life and Social Research (grant no. 2006-1512). The Agincourt Health and Socio-Demographic Surveillance System was funded by the Wellcome Trust, UK (grant nos. 058893/Z/99/A and 069683/Z/02/Z), the William and Flora Hewlett Foundation, USA, and the University of the Witwatersrand and Medical Research Council, South Africa.

  • Competing interests None.

  • Ethics approval This study was part of surveillance-based activities in Agincourt, which are conducted with the approval of the Committee for Research on Human Subject (Medical) at the University of Witwatersrand, South Africa.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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