RETHINKING HEARING CARE PATHWAYS IN OSUN STATE, NIGERIA: COMMUNITY NORMS, FOLK EXPLANATORY MODELS, AND THE PUBLIC HEALTH RISKS OF OTC SELF-MEDICATION

Abstract

Objective: The paper is a perspective article focusing on how community norms and folk explanatory models determine attitudes towards over-the-counter (OTC) self-medication for hearing-related problems in Osun State, Nigeria, and the consequential effects on overall public health and audiology practice.

Design: A literature review based on a narrative synthesis of literature, policy documents, and regional reports, alongside the development of a conceptual framework to map care pathways. The research utilizes peer-reviewed articles, health reports, and qualitative information about hearing health, self-medication behaviors and sociocultural determinants of hearing in southwestern Nigeria, particularly, Osun State.

Results: Folk models of blockage (e.g. wax or dirt in the system), infection (e.g. perceived worms or heat), spiritual (e.g. curses or witchcraft), aging (e.g. old age), and noise exposure (e.g. generators and loud music) are dominant folk explanatory models. Practices driving OTC use include oils, kerosene, ear drops, antibiotics, herbal remedies, prayers, and analgesics. These behaviors are upheld by community norms (trust in peers and traditional healers, stigma of hearing loss, financial limitations), which result in ear canal trauma, antimicrobial resistance (AMR), missed professional treatment, and missed rehabilitation. These pathways are conceptualized through the suggested framework (Norm " Explanatory Model  " OTC Practice  "  Consequence), illustrating broader systemic effects, including extra strain on healthcare facilities.

Conclusions:  To reduce unsafe OTC dependence, multisectoral and culturally sensitive interventions are required. Key strategies in Osun State include training pharmacists and traditional healers as referral gatekeepers, regulation of antibiotic stewardship by regulatory agencies, dissemination of culturally sensitive public health messages through local media, school- and community-based screening programs, and subsidized rehabilitation services. Urgent implementation research is needed to evaluate the effectiveness of these methods. Incorporating local beliefs into policy and practice is essential to attain equitable hearing care in resource-limited settings such as Nigeria.

Keywords: Hearing loss; Nigeria; Osun State; explanatory models; over-the-counter medication; audiology; public health; antimicrobial resistance