Child witchcraft confessions as an idiom of distress in Sierra Leone; results of a rapid qualitative inquiry and recommendations for mental health interventions

Abstract Background Reports about child witchcraft are not uncommon in sub-Saharan Africa. In this study we approach as an idiom of distress. environment that may prohibit children from openly expressing distress, the shared imagery can provide a cultural to communicate psychosocial suffering. We used ecological how some distressing circumstances come confession, with aim set out pathways for mental health interventions. Methods employed rapid qualitative inquiry methodology, inductive and iterative approach, combining emic etic perspectives. conducted 37 interviews 12 focus group discussions total 127 participants Freetown, Sierra Leone. Inductive analysis was identify risk protective factors related accusations confessions. Results identified individual child, family, peer relations, teachers other professionals child’s life, traditional healers, pastors wider society. found context macrosystem supports witchcraft, suspicions formed at mesosystem level, where actors microsystem interact each child. The involvement healer or pastor often forms tipping point leads confession witchcraft. Conclusions Child is so much owned by well systems around Mental interventions should be systemic multi-sectoral, prevent confessions, address suffering both surrounding Interventions contextually relevant service providers helped conscious subconscious fears Beyond interventions, advocacy, peacebuilding legislation needed deeper issues poverty, conflict abuse.