Introduction
Cavemen believed in the supernatural world, which could affect many things, such as health, livelihood, and social activities. Early humans believed that not all diseases were religiously or magically generated, and some diseases were caused by ordinary conditions, such as old age and fatigue (1). Throughout history, people have often incorporated superstitious beliefs into uncontrollable situations, such as complicated diseases (2). Uneducated individuals have shown up in the society when there has been a lack of trained practitioners or when treatment costs have been unaffordable for some populations. This has led to a wide array of quackeries in the presence of pressing issues in the community (3).
Quackery is defined as the fake misrepresentation of a person’s capability and skills in the diagnosis and treatment of diseases (4). In Iran, superstitious beliefs tinged with traditional healing are often involved in the treatment of various patients (1). Traditional healers khown as “Bandis” in Iran are a group of so-called healers, who use superstitious ideas for the healing of the ill, especially children, as well as those with prolonged fever and respiratory diseases. In most of the cases, these individuals claim that external objects (e.g., small pieces of foods such as nuts) have got stuck in the tonsillar valve of the pharynx, causing infection and fever. They try to bring out these objects with magical actions like blowing through the nose of the patients with pressure. Sometimes, they put their hands in the patient’s mouth to induce a gag reflex, pretending to have removed the external objects through the patient’s mouth. Afterwards, they show the taken-out materials to the patient and attendees to manifest their proficiency. Naturally, these actions could lead to the spread of various diseases due to the lack of hands and tools hygiene.
Most of these traditional healers are uneducated individuals and practice illegally in unclean places. They sometimes even charge the patient more than a pediatric visit in public hospitals. Therefore, physicians must increase their knowledge of such quackeries, as well as the possible complications of these practices (5).
The present study aimed to evaluate the education and social status of the patients and their reasons for referring to these quackeries.

Methods
This cross-sectional study was conducted on the pediatric patients admitted to the pediatric clinics of Dr. Sheikh Hospital for children, which is a tertiary care center, during August 2018-February 2019 in Mashhad, Iran. The study protocol was approved by the Ethics Committee of Mashhad University of Medical Sciences, and informed consent was obtained from the parents or legal guardians of the children.
The sample population consisted of 1,300 children aged 2.5-12 years, who were admitted to the pediatric clinics of Dr. Sheikh Hospital. The study had no exclusion criteria. Initially, the parents were asked to complete a checklist to collect the required data. The checklist consisted of two sections; the first section included the demographic characteristics of the subjects (e.g., occupation and education status). In the second section, the parents were asked about their familiarity with traditional healers, their reason for referral to these persons, and whether they had ever consulted any.
Data analysis was performed in SPSS version 16 using the appropriate χ2 and t-test to compare several indices. In the statistical analyses, the P-value of less than 0.05 was considered significant.

Results
In total, 1,300 children (621 females and 679 males) aged 2.5-12 years (mean age: 5.3±2.9 years) were enrolled in the study. Table 1 shows the demographic characteristics of the parents or guardians of the children, who completed the checklist.
According to the findings, 62.5% of the guardians of the patients were familiar with traditional healers, and 457 respondents (37.2%) had visited these individuals at least once. Among these cases, 106 participants had referred to traditional healers more than three times. The parents were enquired about the reasons for consulting traditional healers instead of physicians, and 46.7% believed that the methods used by the former were more effective, while 3.1% mentioned the lower treatment costs compared to physician visit fees, 2.9% reported the acute diseases of their children that did not respond to medical treatments, and 47.3% acknowledged these methods as real traditional practices.
The parents were asked about visiting traditional healers for the treatment of their children and the impact of the methods on their children’s diseases. According to the obtained results, 55.2% of the parents reported high and very high impact rates. In addition, the parents who were familiar with traditional healers were enquired about the way they were introduced to these individuals, and the mentioned routes were media and the Internet (1%), medical staff (2%), and suggestions of others (97%). Notably, the parents stated that 2% of the providers of these methods were medical staff, and 97% were other individuals. The parents were also asked whether they suggested these methods to other parents, and 17.7% stated that they would strongly recommend traditional healers. Figure 1 shows the specific complications for which the parents visited traditional healers to receive treatment for their children.
Table 2 shows the correlations between the occupation status of the parents, their familiarity with these methods, and referral history to traditional healers based on the results of Chi-square. Table 3 shows the correlations between the education level of the parents, their familiarity with these methods, and referral history to traditional healers based on the results of Chi-square. According to the obtained results, nosignificant correlations were observed between the education level of the parents and means of acquaintance with traditional healers (media and the Internet, medical staff, suggestions of others) (P=0.205).

Discussion
Today, many people are familiar with traditional healers, and in several cases, parents prefer visiting these individuals instead of physicians. According to the results of the present study, parental occupation and education status were significantly correlated with the referral history to traditional healers. Correspondingly, parents with lower education levels would refer to traditional healers more frequently to receive treatment for their children and are more satisfied with their methods, while the tendency was lower in the parents with higher education. The majority of the parents in the present study were familiar with these unconventional methods through the community, and most of the providers of such services were reported to be non-medical staff. Respiratory complications and digestive disorders were the primary causes of visiting traditional healers.
The practice and study of medicine in Iran has a long history. Iranian traditional medicine has been combined with various medical traditions from Mesopotamia, Egypt, India, China, and Greece through more than 4,000 years (6). Despite the remarkable progress in the practice of modern medicine, prescientific methods continue to be practiced. Superstition has had an inconsistent, yet continuous presence over time. The reason that such beliefs have persisted in medicine could be the fact that it eases the acceptance of difficulties (7). Superstitions are a characteristic of myth-oriented societies where people ignore facts and life experiences and rely more on myths, imaginations, magic and dreams. In other words, superstition is a product and a demand in the societies where causal relationships are neglected and replaced by false hopes and dreams. In such societies, there is a preference to explain relationships and events in a superficial manner based on magic and superstition. False religious beliefs and superstition are considered to be the foremost causes of the spread of diseases during the Qajar dynasty in Iran. At that time, Iranian traditional medicine was substantially tainted with superstitions, which gradually became persistent due to repetition and widespread use. The root of superstition is ignorance, fear, and popular thoughts (8).
Our study corroborates the findings of the previous studies in this regard. In a research focused on the superstitious beliefs among psychiatric patients in Iran, it was stated that the rate of superstitious beliefs and seeking related treatments were lower in the patients with higher education levels, and it was concluded that superstitious beliefs regarding the treatment of mental illnesses might postpone effective psychiatric treatments and cause irreversible damage to the patients (1).
In some cases, people mistake superstitious beliefs for Iranian traditional medicine. Traditional Iranian (Persian) medicine encompasses the practices used for disease diagnosis and treatment, which have been common since ancient times. These practices are founded upon the experience and observations of previous generations, which have been passed to the next generations. Traditional medicine is a cultural component, and its development is associated with the promotion and respect for the cultural heritage of a nation (9).
Considering that the methods used by traditional healers khown as “Bandis” are increasing in Mashhad city, people’s attitude toward the matter is of grave concern, especially when it comes to children’s diseases. Therefore, special attention must be paid to the role of public education and awareness in preventing the spread of superstitions in the community.

Conclusion
Traditional healers are considered to be a major public health concern as many people prefer these methods to conventional medicine for various reasons. Therefore, it is critical for healthcare authorities to raise the awareness of the community regarding this issue through implementing systematic planning in order to prevent future complications. This issue could be tackled by identifying the workplaces of the “Bandis” who practice illegally and stopping their activities, especially in the case of pediatric medicine.

Acknowledgements
Hereby, we extend our gratitude to the Research Deputy of Mashhad University of Medical Sciences for the financial support of this research project.

Conflict of Interest
The authors declare no conflict of interest.