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Gyasi RM, Poku AA, Boateng S, Amoah PA, Mumin AA, Obodai J, Agyemang-Duah W. Integration for coexistence? Implementation of intercultural health care policy in Ghana from the perspective of service users and providers. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2018; 15:44-55. [PMID: 28088259 DOI: 10.1016/s2095-4964(17)60312-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE In spite of the World Health Organization's recommendations over the past decades, Ghana features pluralistic rather than truly integrated medical system. Policies about the integration of complementary medicine into the national health care delivery system need to account for individual-level involvement and cultural acceptability of care rendered by health care providers. Studies in Ghana, however, have glossed over the standpoint of the persons of the illness episode about the intercultural health care policy framework. This paper explores the health care users, and providers' experiences and attitudes towards the implementation of intercultural health care policy in Ghana. METHODS In-depth interviews, augmented with informal conversations, were conducted with 16 health service users, 7 traditional healers and 6 health professionals in the Sekyere South District and Kumasi Metropolis in the Ashanti Region of Ghana. Data were thematically analysed and presented based on the a posteriori inductive reduction approach. RESULTS Findings reveal a widespread positive attitude to, and support for integrative medical care in Ghana. However, inter-provider communication in a form of cross-referrals and collaborative mechanisms between healers and health professionals seldom occurs and remains unofficially sanctioned. Traditional healers and health care professionals are skeptical about intercultural health care policy mainly due to inadequate political commitment for provider education. The medical practitioners have limited opportunity to undergo training for integrative medical practice. We also find a serious mistrust between the practitioners due to the "diversity of healing approaches and techniques." Weak institutional support, lack of training to meet standards of practice, poor registration and regulatory measures as well as negative perception of the integrative medical policy inhibit its implementation in Ghana. CONCLUSION In order to advance any useful intercultural health care policy in Ghana, the government's total commitment in informed training and provider education, enforcement of regulatory instrument and improved community engagement is needed. Evidence-based incorporation of traditional medical therapies into clinical practice will provide safer, faster and more effective health care for the underserved and resource-poor, particularly in the rural areas.
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Affiliation(s)
- Razak Mohammed Gyasi
- Department of Sociology and Social Policy, Faculty of Social Sciences, Lingnan University, Hong Kong, China.,Department of Geography and Rural Development, Faculty of Social Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Adjoa Afriyie Poku
- Department of Geography Education, Faculty of Social Science Education, University of Education, Winneba, Ghana
| | - Simon Boateng
- Department of Geography and Rural Development, Faculty of Social Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Padmore Adusei Amoah
- Department of Sociology and Social Policy, Faculty of Social Sciences, Lingnan University, Hong Kong, China
| | - Alhassan Abdul Mumin
- Department of Geography and Rural Development, Faculty of Social Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jacob Obodai
- Department of Planning and Development, Christian Service University College, Kumasi, Ghana
| | - Williams Agyemang-Duah
- Department of Geography and Rural Development, Faculty of Social Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Pattern of Traditional Medicine Utilization among HIV/AIDS Patients on Antiretroviral Therapy at a University Hospital in Northwestern Ethiopia: A Cross-Sectional Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:1724581. [PMID: 28421118 PMCID: PMC5380827 DOI: 10.1155/2017/1724581] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/15/2017] [Accepted: 03/13/2017] [Indexed: 11/30/2022]
Abstract
The objective of this study was to assess traditional, complementary, and alternative medicine (TCAM) utilization pattern among HIV/AIDS patients on antiretroviral therapy at University of Gondar Comprehensive Specialized Hospital. Materials and Methods. Data on sociodemographic profile and clinical and TCAM utilization were collected using a structured, pretested questionnaire from April 01 to May 28, 2014, through interviews with patients. Data on CD4 count, HIV stage, and ART regimen were collected from patient records. Analysis was conducted descriptively using SPSS version 20. Results. Of the 300 participants, 43.7% reported using TCAM, with the largest proportion of them from religious institutions (churches/mosques) (41.22%), followed by home prepared (32.82%) and traditional healers (16.03%). The leading forms of TCAM used were spiritual and herbal therapies constituting 56.49% and 36.64% of the patients, respectively. The most frequently used herbal products included Nigella sativa (22.92%) and Moringa oleifera (20.83%). Most of the patients (73.30%) using TCAM reported improvement in their conditions. Conclusions. TCAM utilization among HIV/AIDS patients on ART was common and different sources and types were used alongside ART, with improvement reported by most. Further research is needed to identify CAM therapies which may be used as adjunct treatments among these patients.
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Gyasi RM, Siaw LP, Mensah CM. Prevalence and pattern of traditional medical therapy utilisation in Kumasi Metropolis and Sekyere South District, Ghana. JOURNAL OF ETHNOPHARMACOLOGY 2015; 161:138-146. [PMID: 25523371 DOI: 10.1016/j.jep.2014.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/30/2014] [Accepted: 12/01/2014] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Whilst over three-quarters of the world׳s population continues to use traditional medicine (TRM) with an increasing trend globally, limited data exist in the Ashanti Region regarding TRM utilisation. This study espoused a retrospective cross-sectional quantitative approach to examine the prevalence and pattern of TRM use among the general population in the Kumasi Metropolis and Sekyere South District, Ghana. MATERIALS AND METHODS A sample of 324, drawn through systematic random sampling was used. The main instrument for data collection was formal face-to-face interviewer-administered questionnaire. Data were analysed using Chi-square and Fisher's exact tests from the PASW (V.17.0) with p ≤ 0.05 as significant. RESULTS The survey found that TRM use alongside conventional medicines was pervasive with prevalence of 86.1%. Biologically-based therapies (88.5%) and distant prayer interventions (58.4%) were commonly used modalities through the influence of families (50.3%), friends (19.4%) and the mass media (18.0%). Whilst self-administration and purchases from pharmacy shops remained important sources of TRM, TMPs׳ consultation was less credible (p<0.005). The disclosure rate of TRM use to health care professionals remained low (12.2%; p<0.001). CONCLUSION Concomitant TRM use with conventional therapies without disclosure may interfere with the potency of treatment regimen and result in drug interactions. Inclusion of alternative medicines on the National Health Insurance Scheme's drug plan will fortify monitoring and professional administration of TRM. Information as regards TRM use needs to be incorporated into clinical and medical practice, hence the need to prioritise patient-physician communication.
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Affiliation(s)
- Razak Mohammed Gyasi
- Department of Geography and Rural Development, Faculty of Social Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Lawrencia Pokuah Siaw
- Department of Geography and Rural Development, Faculty of Social Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Charlotte Monica Mensah
- Department of Geography and Rural Development, Faculty of Social Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Naidoo P. Other health-seeking behaviour of HIV and AIDS patients visiting private sector doctors in the eThekwini Metropolitan Municipality of KwaZulu-Natal. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786190.2014.953884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Wu XF, Wang J, Li Y, Tang YL, Zhao DD. Thoughts on intervention in HIV/AIDS with traditional Chinese medicine. J TRADIT CHIN MED 2012; 31:265-8. [PMID: 22462228 PMCID: PMC7147201 DOI: 10.1016/s0254-6272(12)60001-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
HIV/AIDS has become a worldwide pandemic and highly active antiretroviral therapy (HAART) is the only generally recognized effective therapy at present. However, various unresolvable problems appear with the widespread use of HAART. Traditional Chinese Medicine shows good efficacy for intervention in HIV/AIDS and could become an effective treatment option.
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Affiliation(s)
- Xin-fang Wu
- Guang'an men Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
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Lubinga SJ, Kintu A, Atuhaire J, Asiimwe S. Concomitant herbal medicine and Antiretroviral Therapy (ART) use among HIV patients in Western Uganda: a cross-sectional analysis of magnitude and patterns of use, associated factors and impact on ART adherence. AIDS Care 2012; 24:1375-83. [PMID: 22292937 DOI: 10.1080/09540121.2011.648600] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Use of herbal medicines among patients receiving Anti-retroviral Therapy (ART) remains by far an uncharacterised phenomenon in Africa and Uganda specifically. We evaluated the use of herbal medicines among patients on ART at the HIV clinic of Mbarara Regional Referral Hospital (MRRH), examined factors associated with their concomitant use and their impact on ART adherence. This was a cross-sectional study among 334 systematically sampled patients receiving ART at the HIV clinic of MRRH from February to April 2010. We collected data on patient demographics, clinical characteristics, perceptions of quality of care received, self-perceived health status, information on ART received, herbal medicines use and ART adherence. Study outcomes were concomitant herbal medicine and ART use, and ART adherence. Descriptive analysis and logistic regression were conducted using Stata10.0. Close to half, 155 (46.4%) reported concomitant herbal medicines and ART use, with 133 (39.8%) using herbal medicines at least once daily. Most (71.6%) used herbal medicines to treat HIV-related symptoms. A majority (92.3%) reported that the doctors were unaware of their use of herbal medicines, 68.5% citing its minimal importance to the attending physician. Most frequently used herbs were Aloe vera (25%) and Vernonia amygdalina (21%). Time since start of ART (OR 1.14 95% CI: 1.01-1.28, for each one year increase), number of ART side effects reported (≥3 vs.≤1, OR 2.20 95% CI 1.13-4.26) and self-perceived health status (Good vs. Poor, OR 0.31 95% CI 0.12-0.79) were independently associated with concomitant herbal medicine and ART use. Concomitant herbal medicine and ART use was not associated with poor ART adherence (OR 0.85 95% CI 0.47-1.53). There is widespread concomitant herbal medicines and ART use among our patients, with no association to poor ART adherence. Patients appear to use these therapies to complement as opposed to substituting ART.
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Affiliation(s)
- S J Lubinga
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda.
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Littlewood RA, Vanable PA. A global perspective on complementary and alternative medicine use among people living with HIV/AIDS in the era of antiretroviral treatment. Curr HIV/AIDS Rep 2012; 8:257-68. [PMID: 21822625 DOI: 10.1007/s11904-011-0090-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Complementary and alternative medicine (CAM) is a popular adjunct to conventional medicine across medical populations, and is particularly relevant in the global HIV epidemic. Use of antiretroviral therapy (ART) to treat HIV is ubiquitous in high-resource areas and efforts to increase coverage in low-resource areas are underway. To better understand the role of CAM in HIV treatment and the implications of CAM use for ART uptake and adherence, we review international research published between 2007 and 2011. Findings confirm that CAM is commonly used as an adjunct to ART; however, in countries where ART is less accessible, many HIV-positive individuals take a pluralistic approach to health care, incorporating both traditional and, when available, conventional medicine. The reviewed studies provide no consensus on whether the use of CAM interferes with ART uptake or adherence; instead, research suggests that illness-related behaviors are driven by multiple factors and determined, at least in part, by the availability and accessibility of ART.
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Zhang ZJ, Tan QR, Tong Y, Wang XY, Wang HH, Ho LM, Wong HK, Feng YB, Wang D, Ng R, McAlonan GM, Wang CY, Wong VT. An epidemiological study of concomitant use of Chinese medicine and antipsychotics in schizophrenic patients: implication for herb-drug interaction. PLoS One 2011; 6:e17239. [PMID: 21359185 PMCID: PMC3040227 DOI: 10.1371/journal.pone.0017239] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 01/26/2011] [Indexed: 12/11/2022] Open
Abstract
Background Herb-drug interactions are an important issue in drug safety and clinical practice. The aim of this epidemiological study was to characterize associations of clinical outcomes with concomitant herbal and antipsychotic use in patients with schizophrenia. Methods and Findings In this retrospective, cross-sectional study, 1795 patients with schizophrenia who were randomly selected from 17 psychiatric hospitals in China were interviewed face-to-face using a structured questionnaire. Association analyses were conducted to examine correlates between Chinese medicine (CM) use and demographic, clinical variables, antipsychotic medication mode, and clinical outcomes. The prevalence of concomitant CM and antipsychotic treatment was 36.4% [95% confidence interval (95% CI) 34.2%–38.6%]. Patients using concomitant CM had a significantly greater chance of improved outcomes than non-CM use (61.1% vs. 34.3%, OR = 3.44, 95% CI 2.80–4.24). However, a small but significant number of patients treated concomitantly with CM had a greater risk of developing worse outcomes (7.2% vs. 4.4%, OR = 2.06, 95% CI 2.06–4.83). Significant predictors for concomitant CM treatment-associated outcomes were residence in urban areas, paranoid psychosis, and exceeding 3 months of CM use. Herbal medicine regimens containing Radix Bupleuri, Fructus Gardenia, Fructus Schisandrae, Radix Rehmanniae, Akebia Caulis, and Semen Plantaginis in concomitant use with quetiapine, clozapine, and olanzepine were associated with nearly 60% of the risk of adverse outcomes. Conclusions Concomitant herbal and antipsychotic treatment could produce either beneficial or adverse clinical effects in schizophrenic population. Potential herb-drug pharmacokinetic interactions need to be further evaluated.
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Affiliation(s)
- Zhang-Jin Zhang
- School of Chinese Medicine, Faculty of Medicine, the University of Hong Kong, Hong Kong, China
- Department of Psychiatry, Fourth Military Medical University, Xijing Hospital, Xi'an, Shaanxi, China
- * E-mail: (ZJZ); (QRT)
| | - Qing-Rong Tan
- Department of Psychiatry, Fourth Military Medical University, Xijing Hospital, Xi'an, Shaanxi, China
- * E-mail: (ZJZ); (QRT)
| | - Yao Tong
- School of Chinese Medicine, Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Xue-Yi Wang
- Mental Health Center, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Huai-Hai Wang
- Department of Psychiatry, Fourth Military Medical University, Xijing Hospital, Xi'an, Shaanxi, China
| | - Lai-Ming Ho
- School of Public Health, the University of Hong Kong, Hong Kong, China
| | - Hei Kiu Wong
- School of Chinese Medicine, Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Yi-Bin Feng
- School of Chinese Medicine, Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Di Wang
- School of Chinese Medicine, Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Roger Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong, China
| | | | - Chuan-Yue Wang
- Capital Medical University, Beijing Anding Hospital, Beijing, China
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Chen WT, Shiu CS, Simoni J, Fredriksen-Goldsen K, Zhang F, Starks H, Zhao H. Attitudes toward antiretroviral therapy and complementary and alternative medicine in Chinese patients infected with HIV. J Assoc Nurses AIDS Care 2009; 20:203-17. [PMID: 19427598 DOI: 10.1016/j.jana.2008.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 12/28/2008] [Indexed: 11/30/2022]
Abstract
HIV is an emerging health issue in China, and effective antiretroviral therapy (ART) is now available throughout the country. Complementary and alternative medicine (CAM) includes traditional Chinese medicine (TCM) and has been used in Chinese society for more than 5,000 years. In the West, CAM use is widespread among HIV-infected individuals; however, rates of CAM use among HIV-infected individuals in China are unknown. This qualitative study explores issues related to attitudes toward ART and CAM in HIV-infected individuals in Beijing, China. Semistructured, in-depth interviews were used to explore attitudes, experiences, and perceptions about ART and CAM among people living with HIV (PLWH). Results indicate that Chinese PLWH have both positive and negative attitudes toward ART and CAM, which led many to report taking CAM not only for daily discomforts but to counteract the side effects of ART. This study shows that social, cultural, and governmental factors coalesced to shape Chinese PLWH attitudes toward ART and CAM.
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Affiliation(s)
- Wei-Ti Chen
- Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA, USA
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