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Makhavhu EM. Integrating traditional and allopathic child health: A healthcare transformation opportunity. Health SA 2024; 29:2501. [PMID: 38726057 PMCID: PMC11079414 DOI: 10.4102/hsag.v29i0.2501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/30/2024] [Indexed: 05/12/2024] Open
Abstract
Background Numerous forums both domestically and internationally have discussed integration of allopathic and traditional healthcare. In South Africa, using traditional child healthcare is popular practice. If properly controlled, integrating this aspect of traditional child-health with allopathic healthcare may be advantageous to communities that use both healthcare systems. Allopathic and traditional healthcare remain separate organisations in South Africa despite efforts and discussions to integrate them. Aim The study sought to explore the integration of traditional and allopathic child healthcare from the perspectives of children's caregivers and traditional healthcare practitioners. Setting The study was conducted in a semi-urban area in the city of Tshwane. Methods An exploratory qualitative research study was conducted using semi-structured interviews to collect data from 11 traditional healthcare practitioners and 15 children's caregivers who were sampled using snowball and convenient sampling respectively. Results The participants expressed their understanding of the usage of traditional healthcare practitioners in the care of children as well as their support for integration, and further indicated its necessity. Religion and its effects in health-seeking behaviour were cited as a factor in why there has not been greater integration between the two healthcare systems. Conclusion The undocumented and undisclosed use of traditional healthcare potentially hinders the delivery of therapeutic healthcare. As such, integrating the two systems is essential to ensure patients' safety. Contribution This article highlights understanding of culture congruence and safe child healthcare that may be brought forward by the integration of the two healthcare systems.
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Affiliation(s)
- Eugene M Makhavhu
- Department of Nursing Sciences, School of Healthcare Sciences, Sefako Makgatho Health Sciences University, Tshwane, South Africa
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Baheretibeb Y, Wondimagegn D, Law S. "Trust in God, but tie your donkey": Holy water priest healers' views on collaboration with biomedical mental health services in Addis Ababa, Ethiopia. Transcult Psychiatry 2024; 61:246-259. [PMID: 38314780 PMCID: PMC10943614 DOI: 10.1177/13634615241227681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
This exploratory qualitative study examines holy water priest healers' explanatory models and general treatment approaches toward mental illness, and their views and reflections on a collaborative project between them and biomedical practitioners. The study took place at two holy water treatment sites in Addis Ababa, Ethiopia. Twelve semi-structured interviews with holy water priest healers found eight notable themes: they held multiple explanatory models of illness, dominated by religious and spiritual understanding; they emphasized spiritual healing and empathic understanding in treatment, and also embraced biomedicine as part of an eclectic healing model; they perceived biomedical practitioners' humility and respect as key to their positive views on the collaboration; they valued recognition of their current role and contribution in providing mental healthcare; they recognized and appreciated the biomedical clinic's effectiveness in treating violent and aggressive patients; they endorsed the collaboration and helped to overcome patient and family reluctance to the use of biomedicine; they lamented the lack of spiritual healing in biomedical treatment; and they had a number of dissatisfactions and concerns, particularly the one-way referral from religious healers to the biomedical clinic. The study results show diversity in the religious healers' etiological understanding, treatment approaches and generally positive attitude and views on the collaboration. We present insights and explorations of factors affecting this rare, but much needed collaboration between traditional healers and biomedical services, and potential ways to improve it are discussed.
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Rezaei SJ, Cissé FA, Touré ML, Duan R, Rice DR, Ham AS, de Walque D, Mateen FJ. E = mc 2 : Education (E), medication (m), and conditional cash (c 2 ) to improve uptake of antiseizure medications in a low-resource population: Protocol for randomized trial. Epilepsia Open 2024; 9:445-454. [PMID: 38131270 PMCID: PMC10839367 DOI: 10.1002/epi4.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Most people with epilepsy (PWE) could live seizure-free if treated with one or more antiseizure medications (ASMs). The World Health Organization (WHO) estimates that 75% of PWE in low-resource settings lack adequate antiseizure treatment. Limited education surrounding epilepsy and the out-of-pocket costs of ASMs in particular pose barriers to managing epilepsy in resource-poor, low-income settings. The aim of this study is to implement and test a novel strategy to improve outcomes across the epilepsy care cascade marked by (1) retention in epilepsy care, (2) adherence to ASMs, and (3) seizure reduction, with the measured goal of seizure freedom. METHODS A randomized, double-blinded clinical trial will be performed, centered at the Ignace Deen Hospital in Conakry, Republic of Guinea, in Western Sub-Saharan Africa. Two hundred people with clinically diagnosed epilepsy, ages 18 years and above, will receive education on epilepsy and then be randomized to (i) free ASMs versus (ii) conditional cash, conditioned upon return to the epilepsy clinic. Participants will be followed for 360 days with study visits every 90 days following enrollment. SIGNIFICANCE We design a randomized trial for PWE in Guinea, a low-resource setting with a high proportion of untreated PWE and a nearly completely privatized healthcare system. The trial includes a conditional cash transfer intervention, which has yet to be tested as a targeted means to improve outcomes for people with a chronic neurological disorder. The trial aims to provide an evidence base for the treatment of epilepsy in such settings. PLAIN LANGUAGE SUMMARY We present a clinical trial protocol for a randomized, blinded study of 200 people with epilepsy in the low-resource African Republic of Guinea, providing an educational intervention (E), and then randomizing in a 1:1 allocation to either free antiseizure medication (m) or conditional cash (c2 ) for 360 days. Measured outcomes include (1) returning to outpatient epilepsy care, (2) adherence to antiseizure medications (ASMs), and (3) reducing the number of seizures. This study is an initial look at giving small amounts of cash for desired results (or "nudges") for improving epilepsy outcomes in the sub-Saharan African and brain disorder contexts.
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Affiliation(s)
- Shawheen J. Rezaei
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Fodé Abass Cissé
- Department of NeurologyIgnace Deen Teaching HospitalConakryGuinea
| | | | - Rui Duan
- Department of BiostatisticsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Dylan R. Rice
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Andrew Siyoon Ham
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | | | - Farrah J. Mateen
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
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Annick-Mélanie M, Daniel GM, Laure MM, Ghislaine M, Christian E, Eric-Lamou GB, Callixte KT. Beliefs and attitudes of traditional healers regarding epilepsy in Cameroon. Epilepsy Behav 2023; 145:109300. [PMID: 37336130 DOI: 10.1016/j.yebeh.2023.109300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/24/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION People living with epilepsy suffer from stigmatization, overprotection, or exclusion, thus, part of these population in developing countries uses traditional medicine as a first resort. METHODS We prospectively conducted a study to determine the knowledge, attitudes, and practices (KAP) of traditional healers (THs) concerning epilepsy. Over a 9-month period, we included 208 THs practicing in the Littoral, Center and West regions of Cameroon who agreed to participate in the study. The THs were interviewed using a standardized questionnaire. Data were analyzed using Epi Info version 7.2 software. RESULTS Two-hundred and eight THs were recruited, with a mean age ± standard deviation (SD) of 49.9 ± 11.4 years, and 169 (81.2%) were male. Primary 77(37.0%) and secondary 67(32.2%) levels of education were the most represented, and most of the THs had more than 10 years of professional experience. One hundred and forty-one TH (68,7%) had poor knowledge about epilepsy. The independent factors associated with poor knowledge were female sex, Muslim religion, and marital status of cohabitation. One hundred and eighty-four THs (88.4%) had a good attitude and practices toward people with seizures. Factors independently associated with poor practices and attitude were rural residence, Muslim religion, and education level. CONCLUSION Our result confirmed that THs had poor knowledge about epilepsy but good attitudes and practices about epilepsy. THs were in favor of future collaboration with modern medicine in the care of people living with epilepsy.
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Affiliation(s)
- Magnerou Annick-Mélanie
- Department of Neurology, Laquintinie Hospital of Douala, Cameroon; Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, Cameroon
| | | | | | - Meyo Ghislaine
- Higher Institute of Medical Technology, Nkolondom, Yaoundé, Cameroon
| | - Eyoum Christian
- Department of Neurology, Laquintinie Hospital of Douala, Cameroon; Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, Cameroon
| | | | - Kuate-Tegueu Callixte
- Department of Neurology, Laquintinie Hospital of Douala, Cameroon; Faculty of Medicine and Biomedical Sciences, The University of Yaoundé 1, Cameroon
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Exploring Knowledge about Fang Traditional Medicine: An Informal Health Seeking Behaviour for Medical or Cultural Afflictions in Equatorial Guinea. Healthcare (Basel) 2023; 11:healthcare11060808. [PMID: 36981465 PMCID: PMC10048063 DOI: 10.3390/healthcare11060808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
This study explores a range of informal health-seeking behaviors, including the use of Fang Traditional Medicine (FTM) for medical or cultural afflictions in Equatorial Guinea (EQ), the therapeutic methods used, the health problems handled, the learning process, traditional medicine user profiles and the social images of Fang Traditional Healers (FTHs). Ethnography was employed as a qualitative strategy using emic–etic approaches. Semi-structured interviews were conducted with 45 individuals, including 6 community leaders, 19 tribal elders, 7 healthcare professionals, 11 FTHs and 2 relatives of traditional healers in 5 districts of EQ. FTM offers a cure for malaria and treatments for reproductive health issues, bone fractures and cultural illnesses. Several methods used to learn FTM are based on empirical observation, and without the need for traditional schooling, unlike with Western medical professionals: for example, watching a family member, or the spirits or ancestors, can reveal healing knowledge. Materials from forests, including tree barks and plants, and rituals are used to keep Fang populations healthy; in addition, two rituals known as “osuiñ” and “etoak” (infusions of tree barks with the blood of sacrificed animals) are the most commonly used treatments. In addition, elders and women are the most active consumers of FTM. FTM plays a relevant role in curing medical and cultural afflictions in Fang communities. The informal health-seeking behavior among the Fang community is conditioned by the explanation model of illness.
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Nemathaga M, Maputle MS, Makhado L, Mashau NS. Diagnosis of Epilepsy by Traditional Healers and Its Implications on Management in the Selected Rural Communities of Limpopo and Mpumalanga Provinces: A Qualitative Study. Neuropsychiatr Dis Treat 2023; 19:973-983. [PMID: 37096026 PMCID: PMC10122469 DOI: 10.2147/ndt.s392479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/05/2023] [Indexed: 04/26/2023] Open
Abstract
Introduction Epilepsy is a neurological disorder which causes seizures and may be accompanied by loss of unconsciousness and control of bowel or bladder function. However, other types of epilepsy are only characterised by rapid blinking or a few seconds of staring into space. Many people living with epilepsy in rural communities consult traditional healers as their first line of treatment for epilepsy. Second preference is given to medical practitioners which causes unnecessary delay in the early diagnosis and treatment of epilepsy. This study aimed to explore how traditional healers diagnose epilepsy and its implications on management in the selected rural communities of Limpopo and Mpumalanga Provinces. Methods A qualitative approach using explorative, descriptive and contextual designs was adopted. Purposive sampling was used to sample six villages in Limpopo and Mpumalanga Provinces. Snowball sampling was used to sample twenty traditional healers. Data were collected through in-depth individual interviews at the participant's homes. Data were analysed using Tesch's eight steps of open coding data analysis. Results This study found that traditional healers have varied beliefs and misconceptions regarding the causes and diagnosis of epilepsy, hence this greatly influencing the management. The misconceptions on the causes include a calling by ancestors, urine contents, snake in the stomach, contaminated digestive system and witchcraft. The management included using herbal plants, insects, foam excreted during seizures and urine of the person living with epilepsy. Recommendation It is recommended that for effective management of epilepsy, there should be coordination between traditional healing and western medicine. Future research should look at the integration of traditional medicine and western medicine.
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Affiliation(s)
- Muofheni Nemathaga
- Department of Advanced Nursing, University of Venda, Thohoyandou, South Africa
| | - Maria S Maputle
- Department of Advanced Nursing, University of Venda, Thohoyandou, South Africa
- Correspondence: Maria S Maputle, Email
| | - Lufuno Makhado
- Department of Public Health, University of Venda, Thohoyandou, South Africa
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Kokota D, Stewart RC, Abbo C, Bandawe C. Views and experiences of traditional and Western medicine practitioners on potential collaboration in the care of people living with mental illness in Malawi. Malawi Med J 2022; 34:231-238. [PMID: 38125780 PMCID: PMC10645832 DOI: 10.4314/mmj.v34i4.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Introduction Collaboration between traditional and biomedical medicine can lead to holistic care and improved health outcomes for people with mental illnesses. The current study aimed to explore the views and experiences of traditional and western medicine practitioners on potential collaboration in the care of people living with mental illness in Blantyre, Malawi. Method A phenomenological qualitative research design was used. Data were collected using both one-on-one in-depth interviews (IDIs) and focus group discussions (FGDs). Participants were traditional healers and western medicine practitioners in Blantyre, Malawi. We conducted 10 in-depth interviews with traditional healers, 4 focus group discussions (2 for traditional healers and 2 for western medicine practitioners) and 6 key informant interviews with leaders of the two groups. The sample was determined based on data saturation. Thematic analysis was used to analyse the data. We used a combination of deductive and inductive coding. Results Five broad themes were identified from the data: experiences with collaboration, views on collaboration, models of collaboration, barriers to collaboration, and factors that can facilitate collaboration. participants had no experience of formal collaboration between traditional healers and western healthcare workers in the management of mental illness. However, some reported experience of successful collaborations in other health areas such as safe motherhood, tuberculosis and HIV/AIDS. Many participants showed a positive attitude toward collaboration and were in support of it. Barriers to collaboration included negative attitudes and a lack of resources. Factors that can facilitate collaboration were dialogue, training and respect. Referral and training were the preferred forms of collaboration. Conclusion With proper structures and respectful dialogue, a collaboration between traditional and western medicine practitioners is possible in Blantyre, Malawi.
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Affiliation(s)
- Demoubly Kokota
- Department of Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Catherine Abbo
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Chiwoza Bandawe
- Department of Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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The Next Frontier in Neurocritical Care in Resource-Constrained Settings. Crit Care Clin 2022; 38:721-745. [PMID: 36162907 DOI: 10.1016/j.ccc.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Neurocritical care (NCC) is an emerging field within critical care medicine, reflecting the widespread prevalence of neurologic injury in critically ill patients. Morbidity and mortality from neurocritical illness (NCI) have been reduced substantially in resource-rich settings (RRS), owing to the development of advanced technologies, neuro-specific units, and subspecialized medical training. Despite shouldering much of the burden of NCI worldwide, resource-limited settings (RLS) face immense hurdles when implementing guidelines generated in RRS. This review summarizes the current epidemiology, management, and outcomes of the most common NCIs in RLS and offers commentary on future directions in NCC practiced in RLS.
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Samia P, Hassell J, Hudson J, Ahmed A, Shah J, Hammond C, Kija E, Auvin S, Wilmshurst J. Epilepsy research in Africa: A scoping review by the ILAE Pediatric Commission Research Advocacy Task Force. Epilepsia 2022; 63:2225-2241. [PMID: 35729725 DOI: 10.1111/epi.17321] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Despite the high prevalence of epilepsy in Africa, evaluation of epilepsy research trends on the continent is lacking. Without establishing effective research, improvement in care for people with epilepsy cannot be effectively strategized or targeted. METHODS A scoping review of the peer-reviewed literature on epilepsy from Africa (1989-2019) was conducted. The aim was to understand from this what areas are well researched versus underresearched based on published epilepsy topics. RESULTS A total of 1227 publications were identified and assessed. A significant increase in publications occurred over the 30 years assessed. African author leadership was evident in most reports. Nine countries had >50 publications identified; the remaining 45 countries had <50 or no publications. Research studies were typically of lower quality (case series and observational studies). Research themes were more focused on clinical epilepsy (descriptive observational studies) and social aspects (qualitative surveys). However, there were a number of unique and strong themes, specifically for neurocysticercosis and nodding syndrome, where strong research collaborations were evident, basic science understandings were explored, and interventional models were established. SIGNIFICANCE Despite Africa being the continent with the most countries, it is lacking in the quantity, quality, and for some areas, relevance of research on epilepsy. Targeted approaches are needed to upskill the strength of research undertaken with more basic science, interventional, and randomized controlled studies. Themes of research need to promote those with unique African content but also to align with current international research areas that have impact on care delivery, such as epilepsy surgery and epilepsy genetics. For this to be possible, it is important to strengthen research hubs with collaborations that empower Africa to own its epilepsy research journey.
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Affiliation(s)
- Pauline Samia
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, Nairobi, Kenya.,Brain and Mind institute, Aga Khan University, Nairobi, Kenya.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Jane Hassell
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK.,Gertrude's Garden Children's Hospital, Nairobi, Kenya
| | - Jessica Hudson
- Department of Paediatrics, Oxford University Hospitals, Oxford, UK
| | - Azim Ahmed
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasmit Shah
- Brain and Mind institute, Aga Khan University, Nairobi, Kenya.,Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Charles Hammond
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Edward Kija
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stéphane Auvin
- Department of Pediatric Neurology, Public Hospital Network of Paris, Robert Debré Hospital, Neuro Diderot, National Institute of Health and Medical Research, University of Paris, Paris, France.,University Institute of France, Paris, France
| | - Jo Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Mkabile S, Swartz L. Traditional healers' explanatory models of intellectual disability in Cape Town. Transcult Psychiatry 2022; 59:263-273. [PMID: 35225090 DOI: 10.1177/13634615211055967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While intellectual disability is experienced worldwide, with much greater rates in contexts of poverty, relatively few studies on intellectual disability have been conducted in low- and middle-income countries. High levels of intellectual disability in South Africa exist alongside high levels of poverty, malnutrition and poor or inaccessible healthcare services. The lack of access to services partly explains why many turn to traditional healers. Within this context there is very limited research on the role that traditional healers play in relation to intellectual disability in South Africa. The current study investigated traditional healers' understanding and beliefs about intellectual disabilities and the treatment modalities that they use. An exploratory qualitative research design was used to examine the views and perspectives of traditional healers on intellectual disability. Fifteen traditional healers participated in the study. Key findings show that the naming of and the terminology used to describe and identify intellectual disability are very much similar to what has been observed in African cultures in general where intellectual disability is identified as an abnormality. Some traditional healers located the presentation of intellectual disability within the biomedical sphere while others gave supernatural explanations for how intellectual disability presents in children and for its causes. All traditional healers expressed a willingness to work with the Western formal healthcare system. Findings on traditional healers' views on future collaborations with the formal health system provide opportunities for these two forms of healthcare services to be synergised for the strengthening and improvement of services provided to children with intellectual disability and their families.
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Affiliation(s)
- Siyabulela Mkabile
- Department of Psychology, 26697Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, 26697Stellenbosch University, Stellenbosch, South Africa
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Patients' Explanatory Models about drug-resistant epilepsy in Argentina. A thematic analysis. Seizure 2021; 91:409-416. [PMID: 34303914 DOI: 10.1016/j.seizure.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study is to explore explanatory models (EM) about epilepsy in patients with drug-resistant epilepsy (DRE) in Buenos Aires, Argentina. DESIGN A qualitative approach gathered data through semi-structured interviews, oriented to gain an in-depth and contextual understanding of EM about epilepsy of patients with DRE. Data collection and analysis were followed by an inductive and interpretive approach informed by the principles of thematic analysis. RESULTS 75 patients from two public hospitals participated. Emerging codes were grouped into three categories: Biomedical EM, Psychosocial EM, and Traditional EM. Also, factors that trigger or increase the frequency of seizures were reported. CONCLUSIONS Patients' EM regarding epilepsy are complex, as biological, psychological, and supernatural aspects intertwine. EM represent a method of understanding the way people explain, recognize, and act in relation to a medical condition. Since patients' beliefs regarding their illness are related to mental disorders, and quality of life, EM could shed light on the real impact of illness in the life of people, and, in turn, guide those intervention strategies to the patients' subjectivity, in order to improve the treatment compliance, reduce distress, and improve health-related quality of life, among other aspects.
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van der Watt ASJ, Biederman SV, Abdulmalik JO, Mbanga I, Das-Brailsford P, Seedat S. Becoming a Xhosa traditional healer: The calling, illness, conflict and belonging. S Afr J Psychiatr 2021; 27:1528. [PMID: 33824752 DOI: 10.4102/sajpsychiatry.v27i0.1528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 11/16/2020] [Indexed: 11/01/2022] Open
Abstract
Background Traditional healers (THs) are an important part of the healthcare system in sub-Saharan Africa. Understanding their training, experiences of becoming healers and their perceived roles in society is critical. Aim This study aimed to explore the experience of becoming a TH, including accepting the calling, and sheds light on how the experience is conceptualised within the cultural and communitarian context of THs. Setting This study was conducted amongst Xhosa THs in the Western Cape, South Africa. Methods In-depth phenomenological interviews (n = 4) were conducted with Xhosa THs and analysed using Giorgi's descriptive pre-transcendental Husserlian phenomenological analysis. Results The experience of becoming a TH can be summarised in the context of three units of significance: (1) the gift of healing as an illness; (2) the experience of conflict (including with their families, the church and self-conflict); and (3) the experience of belonging. Familial conflict, specifically, was fuelled by the financial burden of becoming a TH and a lack of understanding of the process. Conclusion To develop a workable model of collaboration in the future, it is crucial that mental healthcare providers develop a better understanding of the experiences of THs in becoming care providers. The findings highlight an appreciation of the challenging process of becoming a TH. Finally, further research and culturally appropriate psychoeducation can provide trainee THs and their family members with the skills and knowledge to support each other through a difficult process.
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Affiliation(s)
- Alberta S J van der Watt
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sarah V Biederman
- Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jibril O Abdulmalik
- Department of Psychiatry, Faculty College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Irene Mbanga
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Pricilla Das-Brailsford
- Department of Clinical Psychology, The Chicago School of Professional Psychology, Washington, DC, United States of America
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Dusabimana A, Mandro MN, Siewe Fodjo JN, Dolo H, Coenen S, Colebunders R. Community perceptions and attitudes regarding epilepsy and disease cost after implementation of a community-based epilepsy treatment program in onchocerciasis-endemic communities in the Democratic Republic of Congo. Epilepsy Behav 2021; 116:107773. [PMID: 33515932 PMCID: PMC7960634 DOI: 10.1016/j.yebeh.2021.107773] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND In October 2017, a community-based epilepsy treatment program (CBETP) was initiated in the Logo health zone (Ituri province, Democratic Republic of Congo), consisting mainly of community epilepsy education, provision of free antiepileptic drugs (AEDs), and monthly follow-up of persons with epilepsy (PWE). Prior to the implementation of the CBETP, qualitative research had revealed several misconceptions about the cause of epilepsy, major epilepsy-related stigma, and high economic cost for families of PWE mainly because of costly treatment by traditional healers. One year after the implementation of the CBETP, we assessed the perceived effect of this program on the community's perceptions and attitudes regarding epilepsy and on disease costs. METHODS Focus group discussions (FGD) and semi-structured in-depth interviews (SSI) were conducted with different target groups. Additionally, the cost associated with epilepsy was evaluated using questionnaires administered to 74 PWE and/or their families. RESULTS Nine FGDs and 16 SSIs were conducted. There was a notable shift in perceptions and attitudes, as most community members no longer believed that epilepsy is contagious, while acknowledging that this condition can be treated in local health centers. Persons with epilepsy and their family experienced less epilepsy-related stigma and consulted less frequently traditional healers; the latter showed a growing willingness to collaborate with health professionals in the management of PWE. The direct and indirect costs for families caring for a PWE decreased by 95.2% and 95.7%, respectively. CONCLUSION The main perceived benefits of the CBETP were the decrease in misconceptions about epilepsy and epilepsy-related stigma. Families with PWE understood the benefit of seeking health care from trained health professionals rather than with traditional healers. The direct and indirect costs for families to take care of a PWE reduced considerably after the program. However, the cost-effectiveness and long-term sustainability of this approach remain to be assessed.
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Affiliation(s)
- Alfred Dusabimana
- Global Health Institute (GHI), Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, B-2610 Wilrijk, Belgium.
| | - Michel Ndahura Mandro
- Provincial Health Division Ituri, Ministry of Health, Bunia, Democratic Republic of Congo.
| | - Joseph Nelson Siewe Fodjo
- Global Health Institute (GHI), Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, B-2610 Wilrijk, Belgium.
| | - Husseini Dolo
- Filariasis Unit, International Center of Excellence in Research, Faculty of Medicine and Odontostomatology, Point G, Bamako, Mali.
| | - Samuel Coenen
- Department of Family Medicine & Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Doornstraat 331, 2610 Antwerp (Wilrijk), Belgium; Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Antwerp (Wilrijk), Belgium.
| | - Robert Colebunders
- Global Health Institute (GHI), Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, B-2610 Wilrijk, Belgium.
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Concepts, Beliefs, and Traditional Treatment for Childhood Seizures in a Quilombola Community in Northeastern Brazil: Analysis by the Discourse of the Collective Speech. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041875. [PMID: 33671929 PMCID: PMC7919030 DOI: 10.3390/ijerph18041875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 11/16/2022]
Abstract
Background: Non-pharmacological therapy related to traditional, magical, and/or religious treatments for managing recurrent and non-recurrent seizures in children persists in several traditional communities. The research aims to investigate the concepts, beliefs, and types of traditional treatments used for cases of seizures in children reported by residents of a quilombola community. Methods: The research took place in the quilombo community Sítio Arruda, Ceará, northeastern Brazil. The study population consisted of 19 participants, including healers, prayers, and midwives. Applied a socioeconomic form and a semi-structured interview script. For data analysis, the Discourse of the Collective Speech (DCS) technique was used. Results: For the questions asked, a total of 14 central ideas were found. The most prevalent was seizure is the most common type of disease in children (50.0%); The seizure occurs because of the fever (42.0%); In the community, we treat and prevent seizures with the use of plants (63.2%). Conclusions: The present study’s results addressed relevant issues that include valuing and understanding the traditional knowledge of the community, access to health services, and the need for clarification actions about seizures.
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Bounlu M, Auditeau E, Vorachit S, Chivorakoun P, Souvong V, Soukhasem T, Sannikone S, Preux PM, Boumediene F. Management of epilepsy in Laos: Perceptions of healthcare professionals from Vientiane Capital province and traditional healers in Southern Laos. J Tradit Complement Med 2021; 11:46-52. [PMID: 33511061 PMCID: PMC7817710 DOI: 10.1016/j.jtcme.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/21/2019] [Accepted: 12/26/2019] [Indexed: 11/03/2022] Open
Abstract
Background and aim Traditional practices are deeply rooted in Lao people's perceptions and beliefs about health and illness.The objective of the study was to understand the perceptions of healthcare professionals and traditional healers regarding the management of epilepsy in Laos, and their reciprocal views. Experimental procedure An observational study was carried out in two areas of Laos from February to May 2017. Semi directive questionnaires were used to collect quantitative and qualitative data. Semiotic square was carried out to highlight relationships between attitudes of traditional healers and healthcare professionals. For quantitative approach, the proportions were reported, and the test used was Fisher's test for nominal variables. The mean and standard deviation expressed the continuous variables and the Student's t-test was used. Results and conclusion Epilepsy was cited by 90.9% of traditional healers as a convulsive disease with saliva or urine, and herbal medicines were predominantly used (86.4%) to treat it. Few healthcare professionals (26.5%) pointed out that they knew remedies to treat epilepsy other than antiepileptic drugs (AEDs), and 76.5% of healthcare professionals mentioned that epilepsy was a disease which only AEDs could treat. On the other hand, 54.5% of traditional healers confirmed a traditional remedy could cure completely epilepsy through long-term use. Ninety percent of traditional healers said the collaboration with healthcare professionals was a good idea and 44.1% of the healthcare professionals group said was complicated.The combination of these medicines for the management of epilepsy needs to be adapted to Lao's medical context.
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Affiliation(s)
- Mayoura Bounlu
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Emilie Auditeau
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Somchit Vorachit
- Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Phetvongsinh Chivorakoun
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Vimalay Souvong
- Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Thidachanh Soukhasem
- Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Sonesimmaly Sannikone
- Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Pierre-Marie Preux
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Farid Boumediene
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
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Stakeholder views of the practical and cultural barriers to epilepsy care in Uganda. Epilepsy Behav 2021; 114:107314. [PMID: 32758404 DOI: 10.1016/j.yebeh.2020.107314] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Epilepsy is one of the most prevalent, treatable neurological diseases globally. In sub-Saharan Africa, people with epilepsy (PWE) frequently seek treatment from traditional or pastoral healers, who are more accessible than biomedical care providers. This often contributes to the substantial time delay in obtaining adequate biomedical care for these patients. In Uganda, the few biomedical providers who can treat epilepsy cannot meet the great need for epilepsy care. Additionally, patients are often hesitant to seek biomedical care, often preferring the easily accessible and trusted sociocultural treatment options. This study sought to elucidate the barriers to biomedical care for PWE as well as identify potential solutions to overcome these barriers from various stakeholder perspectives. METHODS This study used qualitative research methods. Semistructured interviews and focus group discussions were conducted with four major stakeholder groups: PWE or family members of PWE, neurologists and psychiatrists, traditional healers, and pastoral healers. All interviews and focus group discussions that were in English were audio recorded and transcribed verbatim. Those that were not in English were translated live and audio recorded. A translator later translated the non-English portion of audio recording to ensure proper interpretation. Two independent coders coded the dataset and conducted an inter-rater reliability (IRR) assessment to ensure reliable coding of the data. Thematic analysis was then performed to discern themes from the data and compare nuances between each of the study design groups. RESULTS Participants discussed several different causes of epilepsy ranging from spiritual to biological causes, often incorporating elements of both. Commonly endorsed spiritual causes of epilepsy included witchcraft and ancestral spirits. Commonly endorsed biological causes included genetics, fever, malaria, and brain injury. For patients and families, beliefs about the cause of epilepsy often played a role in whom they chose to seek treatment from. Three major barriers to biomedical care were discussed: practical barriers, medical infrastructure barriers, and barriers related to stigma. Practical barriers related to issues such as transportation, cost of medical care, and distance to the nearest healthcare facility. Under medical infrastructure, drug stock-outs and lack of access to antiepileptic drugs (AEDs) were the most consistent problems stated among patients. Stigma was heavily discussed and brought up by nearly every participant. Additionally, three significant solutions to improving epilepsy care in Uganda were highlighted by participants: collaboration among treatment providers, community sensitization efforts to address stigma, and building medical infrastructure. Within building infrastructure, all participant types, except traditional healers, proposed the development of an epilepsy clinic designed to specifically treat epilepsy. CONCLUSIONS Based on these findings, there are four critical interventions that should be considered for improving epilepsy care in Uganda: the creation of dedicated epilepsy clinics, infrastructure strengthening to address medication stock-outs, community outreach programs for sensitization, and collaboration between biomedical providers and traditional healers. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
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Abstract
PURPOSE OF REVIEW This review highlights what current research says about how local beliefs and norms can facilitate expansion of mental healthcare to meet the large unmet need for services in Africa. RECENT FINDINGS In contemporary Africa, religious beliefs exert important influences on mental health as well as the way people with mental illnesses are viewed and cared for. Mental healthcare practices based on traditional and other religious beliefs, and offered by complementary and alternative health providers (CAPs), reflect the people's culture and are often preferentially sought by a majority of the population. Despite important differences in the worldviews of CAPs and biomedical mental healthcare practitioners in regard to causal explanations, there are nevertheless overlaps in the approaches of both sectors to the management of mental health conditions. These overlaps may provide a platform for collaboration and facilitate the scaling-up of evidence-based mental health services to underserved African populations, especially those residing in ever-expanding urban centres. SUMMARY Faith-based mental healthcare is an important but informal component of the mental health system in much of Africa. Collaboration between its practitioners and biomedical practice may help to bridge the large treatment gap for mental health conditions on the continent.
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Mkabile S, Swartz L. Caregivers' and parents' explanatory models of intellectual disability in Khayelitsha, Cape Town, South Africa. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1026-1037. [PMID: 32232922 DOI: 10.1111/jar.12725] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 02/08/2020] [Accepted: 02/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Post-apartheid, understanding and management of intellectual disability remain poor in South Africa, complicated by various contextual and cultural explanations used to describe and conceptualize this condition. METHOD We conducted 20 semi-structured interviews with primary caregivers and parents of children with intellectual disability residing in Khayelitsha, a low-income setting in Cape Town, South Africa. We used Kleinman's Explanatory Models (EMs) of illness to explore terms used to describe and conceptualize this condition. RESULTS Carers' explanatory models included biomedical causes, injuries during pregnancy or birth, as well as spiritual causes. It was reported that there were significant difficulties in accessing services and support, and difficulties with coping in the context of extreme poverty and deprivation. CONCLUSIONS Current findings highlight a need for collaboration between the biomedical and alternative healthcare systems in educating carers and parents regarding intellectual disability.
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Affiliation(s)
- Siyabulela Mkabile
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.,Department of Psychiatry and Mental Health, Division of Intellectual Disabilities, University of Cape Town, Cape Town, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Knowledge, attitude, and practice towards epilepsy among religious cleric and traditional healers of Addis Ababa, Ethiopia. Seizure 2020; 78:57-62. [PMID: 32203881 DOI: 10.1016/j.seizure.2020.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Understanding clerics and healers' knowledge, attitude, and practice towards epilepsy are crucial to identify the mechanisms of epilepsy stigma in Ethiopia. The objective of this study is to characterize the social and demographic determinants of knowledge, attitude, and practices of clerics and healers towards people with epilepsy in Addis Ababa, Ethiopia. METHODS A total of 440 clerics and healers were interviewed by trained data collectors using a pretested structured questionnaire. The count sum of outcome variables was grouped into "biological and cultural" knowledge attitude and practice scores. Ordinal regression analysis was performed for each outcome variable against socio-demographic variables of interest. RESULTS The percentage of responses matching cultural causes (58%) surpassed biological causes. The most frequently mentioned cultural cause was an evil spirit (22.5%). While the most frequently mentioned biological cause was a head injury (12%). Consistent with the above findings, cultural treatment responses (77%) exceeded biological treatment responses. The most commonly referred cultural treatment response was Church healing session (12%). The type of faith followed by the study participants positively correlated with higher cultural knowledge, attitude, and practice score. CONCLUSIONS Clerics and traditional healers in Ethiopia have a partiality to the cultural epilepsy explanation model. Cultural metaphors attached to an evil spirit, curse of God, and witchcraft have formed and fostered existing 'epilepsy societal norms' in Ethiopia. The findings of this study contribute to the understanding of epilepsy stigma and treatment gap. Besides, it provided direction to design and implement epilepsy stigma intervention programs in Ethiopia.
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Green B, Colucci E. Traditional healers' and biomedical practitioners' perceptions of collaborative mental healthcare in low- and middle-income countries: A systematic review. Transcult Psychiatry 2020; 57:94-107. [PMID: 31937197 DOI: 10.1177/1363461519894396] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Access to mental healthcare in low- and middle-income countries (LMICs) is one of the greatest challenges in public health today. One suggestion for improving accessibility is through collaboration between biomedical practitioners and traditional healers. This paper reviews studies of traditional healers' and biomedical practitioners' perceptions of collaboration. We conducted a systematic review of online databases, selected journals, and reference lists for relevant studies. Eligible papers were assessed using a tool designed for this review for quality and study characteristics, and qualitative data demonstrating participants' views were extracted. A total of 14 papers from seven countries were included. The published literature on this topic is relatively homogenous and studies are of variable quality. The findings suggest that, despite differing conceptualisations of mental illness causation, both traditional healers and biomedical practitioners recognise that patients can benefit from a combination of both practices and demonstrate a clear willingness to work together. There are concerns about patients' safety and human rights regarding traditional methods and some healers are sceptical about the effectiveness of Western psychiatric medication. Despite keeping the inclusion criteria open to all LMICs, 13 of the studies were conducted in Africa, seven of which were in South Africa. This limits the applicability of the findings of this review to the wider LMIC context. The paper concludes with recommendations for research and practice.
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Kong C, Singh I. The ethics of global psychiatric genomics: Multilayered challenges to integrating genomics in global mental health and disability-A position paper of the Oxford Global Initiative in Neuropsychiatric GenEthics (NeuroGenE). Am J Med Genet B Neuropsychiatr Genet 2019; 180:533-542. [PMID: 30523674 DOI: 10.1002/ajmg.b.32697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/18/2018] [Indexed: 12/12/2022]
Abstract
Psychiatric genomics has the potential to radically improve the prevention and early intervention of serious mental and neurodevelopmental disorders worldwide. However, little work has been done on the ethics of psychiatric genomics-an oversight that could result in poor local uptake, reduced practical/clinical application, and ethical violations in this rapidly developing area of scientific research. As part of the Global Project of the Stanley Center for Psychiatric Research, the Global Initiative in Neuropsychiatric GenEthics (NeuroGenE) based at the University of Oxford aims to embed ethical inquiry within scientific investigation and engage with fundamental ethical questions around a psychiatric genomics approach to mental and neurodevelopmental disorder. This position paper sets out the core aims of the NeuroGenE research programme and explores the importance of a crosscutting research orientation in this field based on multidisciplinary methodologies which can ensure that efforts to translate and apply global psychiatric genomics in public policy and clinical practice are ethically grounded strategies, respectful of different cultures and contexts.
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Affiliation(s)
- Camillia Kong
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Ilina Singh
- Department of Psychiatry and Oxford Uehiro Centre, University of Oxford, Warneford Hospital, Oxford, United Kingdom
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Martin F. Volunteering in a mental health service in Uganda: challenges and rewards. BJPsych Int 2019; 16:93-96. [PMID: 32167096 PMCID: PMC7054330 DOI: 10.1192/bji.2019.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Fiona Martin is a psychiatry trainee who spent 6 months volunteering in a mental health service in Uganda between her core and higher psychiatry training. In this article, she reflects upon this experience, including the challenges and rewards, and in particular the benefits to training of such an experience.
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Keikelame MJ, Swartz L. Decolonising research methodologies: lessons from a qualitative research project, Cape Town, South Africa. Glob Health Action 2019; 12:1561175. [PMID: 30661464 PMCID: PMC6346712 DOI: 10.1080/16549716.2018.1561175] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: It is becoming increasingly important for researchers to critically reflect on approaches that can have a positive impact on the health outcomes of indigenous people. Such issues are of great importance and perhaps of special relevance to researchers in the Global South, and to the African context in which we work. Objective:To share some lessons learned from our fieldwork to contribute to current knowledge and conversations on decolonising research process. Methods: We used an African lens to critically reflect upon some issues raised from individual interviews and focus group discussions with our participants which we deem to be important for consideration in a decolonising research process. Results: The major issues that we raise are about important structures such as power, trust, cultural competence, respectful and legitimate research practice and recognition of individual and communities’ health assets in a decolonising research process. Conclusions: Our paper argues for alternative approaches which are culturally appropriate for health research and for improved health outcomes of marginalised groups. In addition, we argue that participatory and transformative research methods which recognises individual and communities’ assets are needed. We hope that the lessons that we share in this paper can contribute towards a respectful and good research practice among the marginalised population groups in our context.
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Affiliation(s)
| | - Leslie Swartz
- a Department of Psychology , Stellenbosch University , Cape Town , South Africa
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Bitta MA, Kariuki SM, Gona J, Abubakar A, Newton CRJC. Priority mental, neurological and substance use disorders in rural Kenya: Traditional health practitioners' and primary health care workers' perspectives. PLoS One 2019; 14:e0220034. [PMID: 31335915 PMCID: PMC6650073 DOI: 10.1371/journal.pone.0220034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 07/07/2019] [Indexed: 11/21/2022] Open
Abstract
Background Over 75% of people with mental neurological and substance use disorders (MNSD) live in low and middle-income countries with limited access to specialized care. The World Health Organization’s Mental Health Gap Action Program (mhGAP) aims to address the human resource gap but it requires contextualization. Aims We conducted a qualitative study in rural coastal Kenya to explore the local terms, perceived causes and management modalities of priority MNSD listed in the mhGAP, to inform implementation in this setting. Methods We conducted 8 focus group discussions with primary health care providers and traditional health practitioners and used the framework method to conduct thematic analysis. We identified local terms, perceived causes and treatment options for MNSD. We also explored possibilities for collaboration between the traditional health practitioners and primary health care providers. Results We found local terms for depression, psychoses, epilepsy, disorders due to substance use and self-harm/ suicide but none for dementia. Child and adolescent mental and behavioral problems were not regarded as MNSD but consequences of poor parenting. Self-harm/suicide was recognized in the context of other MNSD. Causes of MNSD were broadly either biological or supernatural. Treatment options were dependent on perceived cause of illness. Most traditional health practitioners were willing to collaborate with primary health care providers mainly through referring cases. Primary health care providers were unwilling to collaborate with traditional health practitioners because they perceived them to contribute to worsening of patients’ prognoses. Conclusions Local terms and management modalities are available for some priority MNSD in this setting. Community level case detection and referral may be hindered by lack of collaboration between traditional health practitioners and primary health care providers. There is need for training on the recognition and management of all priority MNSD.
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Affiliation(s)
- Mary A. Bitta
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Symon M. Kariuki
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Joseph Gona
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Amina Abubakar
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Aga Khan University, Nairobi, Kenya
| | - Charles R. J. C. Newton
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Lampiao F, Chisaka J, Clements C. Communication Between Traditional Medical Practitioners and Western Medical Professionals. FRONTIERS IN SOCIOLOGY 2019; 4:37. [PMID: 33869360 PMCID: PMC8022779 DOI: 10.3389/fsoc.2019.00037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/09/2019] [Indexed: 06/03/2023]
Abstract
The high burden of disease in Malawi is exacerbated by a lack of healthcare professionals, and the inaccessibility of healthcare services to many Malawians, due to geographical and financial barriers. The World Health Organization commends the contribution that traditional and complementary medicine could make to achieve such coverage through its integration into health systems. This study aimed to evaluate the barriers that exist between traditional healers and biomedical practitioners for them to collaborate with each other. Semi-structured interviews were conducted with traditional healers and biomedical practitioners. Results showed that the two groups were willing to collaborate with each other, but to differing degrees. Traditional healers were more enthusiastic than biomedical practitioners, who had several reservations about traditional healers, and placed certain conditions on prospective collaboration. While traditional healers clearly had confidence in biomedical practitioners' competencies and respect for their practice, biomedical practitioners lacked trust in traditional healers and would not refer patients to them due to several reservations, such as the lack of scientific basis for traditional medicine. This study points out barriers that affects collaboration between traditional healers and biomedical practitioners and it suggests possible solutions.
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Affiliation(s)
- Fanuel Lampiao
- Africa Centre of Excellence in Public Health and Herbal Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Joseph Chisaka
- Biomedical Sciences Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Carol Clements
- Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
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Kpobi LNA, Swartz L. Muslim Traditional Healers in Accra, Ghana: Beliefs About and Treatment of Mental Disorders. JOURNAL OF RELIGION AND HEALTH 2019; 58:833-846. [PMID: 29992474 DOI: 10.1007/s10943-018-0668-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Traditional and faith healing is a common practice in many low- and middle-income countries due to resource limitations and belief systems, particularly for disorders such as mental disorders. We report on the beliefs about mental illness from the perspective of one category of alternative healers in Ghana-the Muslim faith healers. We also report on their methods of diagnoses and treatment for mental disorders. Results show that the healers' beliefs about mental illness revolved around the notion of Jinn as causing most mental illness. Emerging themes are discussed with reference to their potential implications for patients' care and health-seeking behaviour.
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Affiliation(s)
- Lily N A Kpobi
- Department of Psychology, Stellenbosch University, 2nd Floor RW Wilcocks Building, Stellenbosch, South Africa.
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, 2nd Floor RW Wilcocks Building, Stellenbosch, South Africa
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Auditeau E, Chassagne F, Bourdy G, Bounlu M, Jost J, Luna J, Ratsimbazafy V, Preux PM, Boumediene F. Herbal medicine for epilepsy seizures in Asia, Africa and Latin America: A systematic review. JOURNAL OF ETHNOPHARMACOLOGY 2019; 234:119-153. [PMID: 30610931 DOI: 10.1016/j.jep.2018.12.049] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 12/29/2018] [Accepted: 12/30/2018] [Indexed: 06/09/2023]
Abstract
RELEVANCE More than 70 million people suffer epilepsy worldwide. Low availability of anti-epileptic drugs, side-effects and drug-resistant epilepsy affect the quality of life of persons with epilepsy in countries with a poorly developed health system. Herbal medicine is frequently used for this neurological condition. OBJECTIVES The main objective was to provide a detailed analysis of Herbal Medicine used for neurological conditions related with epilepsy in Asia, Africa and Latin America. More broadly, this study aims to highlight species with assessed efficacy (cross-cultural use, pharmacological effects on models of epileptic seizures) and safety (toxicological data in laboratory) information, in order to point out species of interest for further studies. A critical assessment of models used in pharmacological evaluations was done. MATERIALS AND METHODS The systematic search for Herbal Medicine treatments for epilepsy was performed considering all the articles published until February 2017 through three scientific databases. It was made with MeSH terms and free text defining the epilepsy seizures and plant species. We included studies carried out in Asia, Africa and Latin America. All articles reporting the use of Herbal Medicine to treat epilepsy seizures and/or their pharmacological evaluation were retained for further analysis. RESULTS The search yielded 1886 articles, from 30 countries. Hundred and six articles published between 1982 and 2017 were included, corresponding to a total of 497 use reports for 351 plant species belonging to 106 families. Three hundred and seventy seven use reports corresponding to 264 species in ethnopharmacological surveys and 120 evaluation reports corresponding to 107 species were noted. Twenty-nine reports, for 29 species, combined both ethnopharmacological and pharmacological evaluation. Fifty eight studies originated from Africa, 35 studies from Asia and 18 from Latin America. Highest use report was noted for rhizomes of Acorus calamus L. (12 use report in 1 country) and leaves of Bacopa monnieri (L.) Wettst. (8 use report in 2 countries). Therefore these species display the highest use convergence. Regarding pharmacological evaluation most studied species were: Leonotis leonurus (L.) R.Br. (4 evaluation reports in 1 country), Uncaria rhynchophylla (Miq.) Miq. ex Havil. (3 evaluation reports in 2 countries) and Calotropis gigantea (L.) Dryand. (3 evaluation reports in 1 country). In vivo models of chronic epilepsy were more relevant than in vitro models or chemical models inducing acute seizures for pharmacological assessment. CONCLUSION Species with the highest use report were not those with pharmacological evaluation. It will be pertinent to assess the pharmacological effects and safety of medicinal plants used mostly by traditional healers on predictive models of seizures.
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Affiliation(s)
- Emilie Auditeau
- INSERM, U1094, Tropical Neuroepidemiology, 2 rue du Dr Marcland, 87025 Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, 2 rue du Dr Marcland, 87025 Limoges, France.
| | - François Chassagne
- UMR 152 Research Institute for the development, University Toulouse 3, Pharmaceutical sciences Faculty, 35 chemin des Maraîchers, 31400 Toulouse, France; Center for the Study of Human Health, Emory University, Atlanta, GA, USA.
| | - Geneviève Bourdy
- UMR 152 Research Institute for the development, University Toulouse 3, Pharmaceutical sciences Faculty, 35 chemin des Maraîchers, 31400 Toulouse, France.
| | - Mayoura Bounlu
- INSERM, U1094, Tropical Neuroepidemiology, 2 rue du Dr Marcland, 87025 Limoges, France; Institute of Francophonie for Tropical Medicine, Vientiane, Lao Democratic People's Republic.
| | - Jérémy Jost
- INSERM, U1094, Tropical Neuroepidemiology, 2 rue du Dr Marcland, 87025 Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, 2 rue du Dr Marcland, 87025 Limoges, France.
| | - Jaime Luna
- INSERM, U1094, Tropical Neuroepidemiology, 2 rue du Dr Marcland, 87025 Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, 2 rue du Dr Marcland, 87025 Limoges, France.
| | - Voa Ratsimbazafy
- INSERM, U1094, Tropical Neuroepidemiology, 2 rue du Dr Marcland, 87025 Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, 2 rue du Dr Marcland, 87025 Limoges, France.
| | - Pierre-Marie Preux
- INSERM, U1094, Tropical Neuroepidemiology, 2 rue du Dr Marcland, 87025 Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, 2 rue du Dr Marcland, 87025 Limoges, France.
| | - Farid Boumediene
- INSERM, U1094, Tropical Neuroepidemiology, 2 rue du Dr Marcland, 87025 Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, 2 rue du Dr Marcland, 87025 Limoges, France.
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Dhabangi A, Idro R, John CC, Dzik WH, Siu GE, Opoka RO, Ayebare F, van Hensbroek MB. Community perceptions of paediatric severe anaemia in Uganda. PLoS One 2019; 14:e0209476. [PMID: 30605461 PMCID: PMC6317806 DOI: 10.1371/journal.pone.0209476] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 12/06/2018] [Indexed: 01/08/2023] Open
Abstract
Background Severe anaemia remains a major cause of morbidity and mortality among children in sub-Saharan Africa. There is limited research on the beliefs and knowledge for paediatric severe anaemia in the region. The effect of these local beliefs and knowledge on the healthcare seeking of paediatric severe anaemia remains unknown. Objective To describe community perceptions of paediatric severe anaemia in Uganda. Methods Sixteen in-depth interviews of caregivers of children treated for severe anaemia and six focus group discussions of community members were conducted in three regions of Uganda between October and November 2017. Results There was no common local name used to describe paediatric severe anaemia, but the disease was understood in context as ‘having no blood’. Severe anaemia was identified to be a serious disease and the majority felt blood transfusion was the ideal treatment, but concomitant use of traditional and home remedies was also widespread. Participants articulated signs of severe pediatric anemia, such as palmar, conjunctival, and tongue pallor. Other signs described included jaundice, splenomegaly, difficulty in breathing and poor appetite. Poor feeding, malaria, splenomegaly and evil spirits were perceived to be the common causes of severe anaemia. Other causes included: human immunodeficiency virus (HIV), haemoglobinuria, fever, witchcraft, mosquito bites, and sickle cell. Splenomegaly and jaundice were perceived to be both signs and causes of severe anaemia. Severe anaemia was interpreted to be caused by evil spirits if it was either recurrent, led to sudden death, or manifested with cold extremities. Conclusion The community in Uganda perceived paediatric severe anaemia as a serious disease. Their understanding of the signs and perceived causes of severe anaemia to a large extent aligned with known clinical signs and biological causes. Belief in evil spirits persists and may be one obstacle to seeking timely medical care for paediatric severe anaemia.
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Affiliation(s)
- Aggrey Dhabangi
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - Richard Idro
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Chandy C. John
- Ryan White Centre for Paediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Walter H. Dzik
- Department of Pathology (Transfusion), Harvard University / Massachusetts General Hospital, Boston, MA, United States of America
| | - Godfrey E. Siu
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert O. Opoka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Florence Ayebare
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Michael B. van Hensbroek
- Department of Global Child Health, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Keikelame MJ, Swartz L. “I wonder if I did not mess up….”: Shame and resistance among women with epilepsy in Cape Town, South Africa. Seizure 2018; 61:50-56. [DOI: 10.1016/j.seizure.2018.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 07/26/2018] [Accepted: 07/28/2018] [Indexed: 11/30/2022] Open
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du Toit A, Pretorius C. Seizures in Namibia: A study of traditional health practitioners. Epilepsia Open 2018; 3:374-382. [PMID: 30187008 PMCID: PMC6119750 DOI: 10.1002/epi4.12240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Countries in sub-Saharan Africa are plagued by poor healthcare facilities, lack of specialist care, and limited financial resources. People with seizures often rely on the help of traditional health practitioners (THPs). Traditional health practices are not acknowledged in Namibia and remain unregulated and open to exploitation. We conducted a qualitative study to gain an understanding of THPs' perceptions and experiences in delivering seizure care in Namibia. METHODS This study formed part of a larger mixed-method study that explored seizure care among healthcare providers (HCPs) in Namibia. Semi-structured interviews were conducted with 11 THPs in Namibia. Thematic analysis was used to identify themes and subthemes in the data. Themes were interpreted using the different levels of Bronfenbrenner's Ecological Systems Theory to illustrate the perceptions and experiences of THPs in the management of seizures. RESULTS THPs distinguish between seizures with physical causes and those caused by witchcraft, evil spirits, and supernatural forces. THPs acknowledge the role of Western medicine in the treatment of medically explained seizures (physical causes). Seizures as a result of medically unexplained symptoms (spiritual) are deemed best treated by traditional medicine (TM). Diagnostic and treatment practices are person-specific and are guided by divination and the use of plant and animal material. Treatment success is measured by the complete absence of seizures. Biomedical treatment is seen as lacking due to its focus on seizure control and failure to provide a permanent cure. SIGNIFICANCE In countries with limited healthcare resources, the untapped potential of THPs may play a valuable role in bridging the treatment gap for seizures. Incorporating THPs into the healthcare system depends on proper regulation and clear demarcation of roles between service providers. Improved referral practices and collaboration between service providers will be of benefit for people with seizures who are often exposed to stigma and discrimination.
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Affiliation(s)
- Anina du Toit
- Department of PsychologyStellenbosch UniversityStellenboschSouth Africa
| | - Chrisma Pretorius
- Department of PsychologyStellenbosch UniversityStellenboschSouth Africa
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Kpobi L, Swartz L, Keikelame MJ. Ghanaian traditional and faith healers' explanatory models for epilepsy. Epilepsy Behav 2018; 84:88-92. [PMID: 29754110 DOI: 10.1016/j.yebeh.2018.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 01/07/2023]
Abstract
Epilepsy is the most common neurological condition in sub-Saharan Africa. A significant number of people with epilepsy in low- and middle-income countries do not receive formal biomedical care. They utilize the services of various traditional and alternative medicine practitioners. However, there is relatively little information about the beliefs and methods of alternative healthcare providers about epilepsy in many African countries. Using explanatory models of illness framework, we interviewed thirty-six traditional and faith healers in Ghana on their beliefs and perceptions about epilepsy, as well as how they would treat epilepsy. The healers' beliefs about the nature of epilepsy were reflected in the labels they assigned to the condition. These indicated a belief in the influence of the moon in epilepsy. Furthermore, the participants held multiple, simultaneous explanatory models of causes for epilepsy, including biological, social, and supernatural causes. Epilepsy was also considered to have serious social implications for patients, especially for women. Finally, their treatment methods involved a range of herbal and spiritual practices. These varied based on the identified cause of the condition, as well as the orientation of the healer. We discuss these findings with reference to their implications for potential collaboration between biomedical and alternative healthcare systems.
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Affiliation(s)
- Lily Kpobi
- Department of Psychology, Stellenbosch University, South Africa.
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, South Africa
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Pattern and determinants of self-reported enacted stigma among rural dwellers living with epilepsy attending a tertiary health facility in Enugu State Nigeria. Seizure 2018; 56:60-66. [DOI: 10.1016/j.seizure.2018.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 12/15/2022] Open
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Bantjes J, Swartz L, Cembi S. "Our lifestyle is a mix-match": Traditional healers talk about suicide and suicide prevention in South Africa. Transcult Psychiatry 2018; 55:73-93. [PMID: 28847227 DOI: 10.1177/1363461517722065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Practitioners of traditional African medicine (traditional healers) are an important part of the health care system in South Africa, yet their voices are often absent from discussions about public health. In this context, we set out to investigate how a group of traditional healers in South Africa understand suicide and suicide prevention. In-depth, semistructured interviews were conducted with 6 traditional healers and analysed using thematic content analysis. The traditional healers report they are frequently consulted by suicidal individuals and they are confident about their ability to help people in a suicidal crisis. Findings suggest that traditional healers understand suicidal behaviour as a symptom of social disconnection and cultural discontinuity. Traditional healers report that suicidal individuals can be helped by reestablishing interpersonal connections, reconnecting to family and ancestors, and renewing their cultural identities through rituals. These findings suggest that there is some congruence between the way traditional healers understand suicide and the Western scientific and biomedical literature. Our findings raise important questions about cultural approaches to suicide research which are commonly premised on dualistic thinking that constructs culture as something distinct from Western biomedicine.
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Affiliation(s)
| | - Leslie Swartz
- Alan J. Flisher Centre for Public Mental Health Stellenbosch University
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Mugumbate J, Zimba AM. Epilepsy in Africa: Past, present, and future. Epilepsy Behav 2018; 79:239-241. [PMID: 29169812 DOI: 10.1016/j.yebeh.2017.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/07/2017] [Indexed: 11/17/2022]
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Keikelame MJ, Swartz L. "By working together and caring for one another we can win this fight": A qualitative exploration of a traditional healer's perspectives of care of people with epilepsy in a South African urban township in Cape Town. Epilepsy Behav 2018; 79:230-233. [PMID: 29249449 DOI: 10.1016/j.yebeh.2017.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/22/2017] [Indexed: 10/18/2022]
Abstract
There is a gap in knowledge about the construction of care in the Global South where biomedical care remains largely inaccessible to many people, resulting in people seeking health care from the indigenous sector of health care. As part of a larger study, in this, article we present findings from a single individual interview with an indigenous healer using a semi-structured interview guide that was based on Kleinman's Explanatory Model Framework. Key themes that emerged from the thematic analysis of our indigenous healer's audio-recorded transcribed transcript were about "care". The four overarching subthemes were the following: (i) care in the family, (ii) care in the community, (iii) care in the health system, and (iv) respondents' construction of care. A key feature of care, for this healer, is its explicit location in lineages of community - care is seen not as an individual or organizational issue, but part of the shared social fabric. We argue that it is crucial to attend to the lay understandings and practices of care which reflect diverse ways of understanding care and relationality in context. Future research is needed to close this gap.
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Affiliation(s)
- Mpoe Johannah Keikelame
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602 Cape Town, South Africa.
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602 Cape Town, South Africa.
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Musyimi CW, Mutiso VN, Ndetei DM, Unanue I, Desai D, Patel SG, Musau AM, Henderson DC, Nandoya ES, Bunders J. Mental health treatment in Kenya: task-sharing challenges and opportunities among informal health providers. Int J Ment Health Syst 2017; 11:45. [PMID: 28775764 PMCID: PMC5540195 DOI: 10.1186/s13033-017-0152-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background The study was conducted to explore challenges faced by trained informal health providers referring individuals with suspected mental disorders for treatment, and potential opportunities to counter these challenges. Methods The study used a qualitative focus group approach. It involved community health workers, traditional and faith healers from Makueni County in Kenya. Ten Focus Group Discussions were conducted in the local language, recorded and transcribed verbatim and translated. Using a thematic analysis approach, data were entered into NVivo 7 for analysis and coding. Results Results demonstrate that during the initial intake phase, challenges included patients’ mistrust of informal health providers and cultural misunderstanding and stigma related to mental illness. Between initial intake and treatment, challenges related to resource barriers, resistance to treatment and limitations of the referral system. Treatment infrastructure issues were reported during the treatment phase. Various suggestions for solving these challenges were made at each phase. Conclusions These findings illustrate the commitment of informal health providers who have limited training to a task-sharing model under difficult situations to increase patients’ access to mental health services and quality care. With the identified opportunities, the expansion of this type of research has promising implications for rural communities.
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Affiliation(s)
- Christine W Musyimi
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya.,Vrije Universiteit, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands
| | - Victoria N Mutiso
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya
| | - David M Ndetei
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya.,University of Nairobi, P.O Box 30197, Nairobi, 00100 Kenya
| | - Isabel Unanue
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304 USA
| | - Dhru Desai
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304 USA
| | - Sita G Patel
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304 USA
| | - Abednego M Musau
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya
| | - David C Henderson
- Boston University School of Medicine, 72 E. Concord St, Boston, MA 02118 USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Erick S Nandoya
- Africa Mental Health Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O Box 48423, Nairobi, 00100 Kenya
| | - Joske Bunders
- Vrije Universiteit, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands
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Keikelame MJ, Swartz L. 'Whom will I give him to? The difficulty is mine' : Psychosocial difficulties experienced by care givers of patients with epilepsy in Cape Town, South Africa. J Health Psychol 2016; 21:2550-2561. [PMID: 25986918 PMCID: PMC4651857 DOI: 10.1177/1359105315581065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Epilepsy has been reported as one condition that can cause psychological difficulties and distress to care givers of patients suffering from the condition. This study explored psychological difficulties experienced by lay care givers of patients with epilepsy in an urban township in South Africa. Nine individual in-depth interviews were conducted with lay carers who provide care to their relatives, friends and neighbours who have epilepsy. A thematic data analysis method was used. Some fears, social concerns and worries affecting care giving were reported. Community interventions that promote cultural sensitivity in mental health care and empowerment of these carers are needed.
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Keikelame MJ, Swartz L. "It is always HIV/AIDS and TB": Home-based carers' perspectives on epilepsy in Cape Town, South Africa. Int J Qual Stud Health Well-being 2016; 11:30213. [PMID: 27258583 PMCID: PMC4891967 DOI: 10.3402/qhw.v11.30213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2016] [Indexed: 11/17/2022] Open
Abstract
The study highlights the complex cultural religious factors affecting epilepsy and a need for integrated home-based care services. Two focus group discussions exploring home-based carers’ (HBCs) perspectives on epilepsy were conducted using a semi-structured focus group interview guide, which was based on Kleinman's explanatory model framework. The audio-recorded data were transcribed verbatim, and a thematic analysis was done. The three main themes were epilepsy names and metaphors, religious beliefs about the cause and treatment of epilepsy, and HBCs’ perceived roles and strategies for engaging in epilepsy care. Findings provide some insights for research, policy, and practice.
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Affiliation(s)
- Mpoe Johannah Keikelame
- Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa;
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Musyimi CW, Mutiso VN, Nandoya ES, Ndetei DM. Forming a joint dialogue among faith healers, traditional healers and formal health workers in mental health in a Kenyan setting: towards common grounds. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2016; 12:4. [PMID: 26742992 PMCID: PMC4705751 DOI: 10.1186/s13002-015-0075-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 12/21/2015] [Indexed: 05/17/2023]
Abstract
BACKGROUND Qualitative evidence on dialogue formation and collaboration is very scanty in Kenya. This study thus aimed at the formation of dialogue and establishment of collaboration among the informal (faith and traditional healers) and formal health workers (clinicians) in enhancing community-based mental health in rural Kenya. METHODS Qualitative approach was used to identify barriers and solutions for dialogue formation by conducting nine Focus Group Discussions each consisting of 8-10 participants. Information on age, gender and role in health care setting as well as practitioners' (henceforth used to mean informal (faith and traditional healers) and formal health workers) perceptions on dialogue was collected to evaluate dialogue formation. Qualitative and quantitative data analysis was performed using thematic content analysis and Statistical Package Social Sciences (SPSS) software respectively. RESULTS We identified four dominant themes such as; (i) basic understanding about mental illnesses, (ii) interaction and treatment skills of the respondents to mentally ill persons, (iii) referral gaps and mistrust among the practitioners and (iv) dialogue formation among the practitioners. Although participants were conversant with the definition of mental illness and had interacted with a mentally ill person in their routine practice, they had basic information on the causes and types of mental illness. Traditional and faith healers felt demeaned by the clinicians who disregarded their mode of treatment stereotyping them as "dirty". After various discussions, majority of practitioners showed interest in collaborating with each other and stated that they had joined the dialogue in order interact with people committed to improving the lives of patients. CONCLUSION Dialogue formation between the formal and the informal health workers is crucial in establishing trust and respect between both practitioners and in improving mental health care in Kenya. This approach could be scaled up among all the registered traditional and faith healers in Kenya.
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Affiliation(s)
- Christine W Musyimi
- University of Nairobi and Founding Director Africa Mental Health Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya
| | - Victoria N Mutiso
- University of Nairobi and Founding Director Africa Mental Health Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya
| | - Erick S Nandoya
- University of Nairobi and Founding Director Africa Mental Health Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya
| | - David M Ndetei
- University of Nairobi and Founding Director Africa Mental Health Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya.
- University of Nairobi, Nairobi, Kenya.
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Bansal P, Kaur R, Gupta V, Kumar S, Kaur R. Is There Any Scientific Basis of Hawan to be used in Epilepsy-Prevention/Cure? J Epilepsy Res 2015; 5:33-45. [PMID: 26819935 PMCID: PMC4724851 DOI: 10.14581/jer.15009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/01/2015] [Indexed: 11/03/2022] Open
Abstract
Epilepsy is a neuropsychiatric disorder associated with religiosity and spirituality. Nasal drug delivery systems are the best for diseases related to brain. In older times RishiMuni, ancient scholars and physicians used to recommend Hawan for mental peace and well being. Gayatri Mantra also tells that sughandhim (aroma, fragrance) puushtivardhanam (gives rise to good health). Om triambkum yajamahe, sughandhim puushtivardhanam, urvarukmev vandhanaat, mrityu mokshay mamritaat! Hawan is a scientific experiment in which special herbs (Hawan Samagri) are offered in the fire of medicinal woods ignited in a specially designed fire pit called agnikuñda. Hawan seems to be designed by the ancient scholars to fight with the diseases of the brain. Our metadata analysis demonstrates that the components of Hawan are having a number of volatile oils that are specifically useful for epilepsy through one or the other mechanism of action. Due to high temperature of fire the vapors of these oils enter into the central nervous system through nasal route. The routine of performing Hawan might keep the threshold value of the therapeutic components in the body and help in preventing epilepsy. In the present manuscript authors have tried to highlight and integrate the modern and ancient concepts for treatment and prevention of epilepsy.
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Affiliation(s)
- Parveen Bansal
- Baba Farid University of Health Sciences University Centre of Excellence in Research; India
| | - Ramandeep Kaur
- Baba Farid University of Health Sciences University Centre of Excellence in Research; India
| | - Vikas Gupta
- Baba Farid University of Health Sciences University Centre of Excellence in Research; India
| | - Sanjiv Kumar
- National Medicinal Plant Board, Department of AYUSH, Punjab, India
| | - RamanPreet Kaur
- Baba Farid University of Health Sciences University Centre of Excellence in Research; India
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