Trauma Ward Mental Health Traditional Healer Concurrent Care Initiation and Post-Traumatic Stress Disorder Treatment Disengagement Among Ghanaian Survivors: A Multilevel Analysis of Dual-Care Pathway Competition

The framework treats the trauma ward, the traditional healer's compound, and the household as nested care domains whose consultation logics compete for survivor time, money, and interpretive allegiance. It specifies three mechanisms—interpretive substitution, logistical depletion, and stigma management—through which concurrent care initiation raises the hazard of formal treatment disengagement, and it proposes that these mechanisms operate differently at the individual, household, and facility levels. To anchor the framework in measurable quantities, the paper draws on the DHS Program indicator 'Knowledge of any method of contraception among married women' (FP_KMET_W_ANY) across 38 African countries and 162 country-survey observations from 1986 to 2024 (mean 91.776, SD 11.342, range 57.80 in Chad to 99.90 in Eswatini) as a demonstration case for how population-level care-knowledge indicators can be modelled with multilevel structure. It does not report original empirical findings on Ghanaian trauma survivors; rather, it provides the theoretical and methodological scaffolding required for such a study.