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Kacholi DS. A comprehensive review of antimalarial medicinal plants used by Tanzanians. PHARMACEUTICAL BIOLOGY 2024; 62:133-152. [PMID: 38270178 PMCID: PMC10812860 DOI: 10.1080/13880209.2024.2305453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024]
Abstract
CONTEXT Tanzania has rich medicinal plant (MP) resources, and most rural inhabitants rely on traditional healing practices for their primary healthcare needs. However, available research evidence on antimalarial MPs is highly fragmented in the country. OBJECTIVE This systematic review compiles ethnomedicinal research evidence on MPs used by Tanzanians as antimalarials. MATERIALS AND METHODS A systematic web search was conducted using various electronic databases and grey materials to gather relevant information on antimalarial MPs utilized by Tanzanians. The review was per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The data were collected from 25 articles, and MS Excel software was used to analyse relevant ethnobotanical information using descriptive statistics. RESULTS A total of 227 MPs belonging to 67 botanical families and 180 genera were identified. Fabaceae (15.9%) is the most frequently utilized family. The ethnobotanical recipes analysis indicated leaves (40%) and trees (44%) are the preferred MPs part and life form, respectively. Decoctions (67%) are the dominant preparation method of remedies. Of the recorded MPs, 25.9% have been scientifically investigated for antimalarial activities with positive results. However, 74.1% of MPs have no scientific records on antimalarial activities, but they could be potential sources of remedies. CONCLUSIONS The study discloses a wealth of antimalarial MPs possessed by Tanzanians and suggests a need for research to authenticate the healing potential of antimalarial compounds from the unstudied MPs. Additionally, it indicates that some of the presented MPs are potential sources for developing safe, effective and affordable antimalarial drugs.
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Affiliation(s)
- David Sylvester Kacholi
- Department of Biological Sciences, Dar es Salaam University College of Education (DUCE), University of Dar es Salaam (UDSM), Dar es Salaam, Tanzania
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Klein A, Berger TC, Hapfelmeier A, Schaffert M, Matuja W, Schmutzhard E, Winkler AS. Does the presence of a specialist doctor reduce the burden of disease in people with epilepsy in low-resource settings? A comparison of two epilepsy clinics in rural Tanzania. Epilepsy Behav 2023; 139:109030. [PMID: 36577550 DOI: 10.1016/j.yebeh.2022.109030] [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] [Received: 08/26/2022] [Revised: 11/05/2022] [Accepted: 11/28/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND With an estimated lifetime prevalence of epilepsy of 7.6 per 1,000 people, epilepsy represents one of the most common neurological disorders worldwide, with the majority of people with epilepsy (PWE) living in low-income and middle-income countries (LMICs). Adequately treated, up to 70 % of PWE will become seizure-free, however, as many as 85% of PWE worldwide, mostly from LMICs, do not receive adequate treatment. OBJECTIVE To assess the impact of the presence of a neurologist on the management of PWE in Tanzania. METHODS Two epilepsy clinics in rural Tanzania, one continuously attended by a neurologist, and one mainly attended by nurses with training in epilepsy and supervised intermittently by specialist doctors (neurologists/psychiatrists) were comparatively analyzed by multivariable linear and logistic regression models with regard to the outcome parameters seizure frequency, the occurrence of side effects of antiepileptic medication and days lost after a seizure. RESULTS The presence of a neurologist significantly reduced the mean number of seizures patients experienced per month by 4.49 seizures (p < 0.01) while leading to an increase in the occurrence of reported side effects (OR: 2.15, p = 0.02). CONCLUSION The presence of a neurologist may play a substantial role in reducing the burden of the disease of PWE in LMICs. Hence, specialist training should be encouraged, and relevant context-specific infrastructure established.
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Affiliation(s)
- Ana Klein
- Center for Global Health, Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Germany.
| | - Toni Christoph Berger
- Center for Global Health, Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Germany; Department of Neurology, Oslo University Hospital, Oslo, Norway.
| | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, School of Medicine, Technical University of Munich, Germany; Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Germany.
| | - Matthias Schaffert
- Paracelsus Medical University, Department for Paediatric and Adolescent Surgery, Salzburg, Austria.
| | - William Matuja
- Department of Neurology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | | | - Andrea S Winkler
- Center for Global Health, Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Germany; Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
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Adejumo PO, Aniagwu TIG, Awolude OA, Adedokun B, Kochheiser M, Sowunmi A, Popoola A, Ojengbede O, Huo D, Olopade OI. Cancer Genetic Services in a Low- to Middle-Income Country: Cross-Sectional Survey Assessing Willingness to Undergo and Pay for Germline Genetic Testing. JCO Glob Oncol 2023; 9:e2100140. [PMID: 36854077 PMCID: PMC10166413 DOI: 10.1200/go.21.00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
PURPOSE Cancer genetic testing (CGT), a pathway to personalized medicine, is also being embraced in Nigeria. However, little is known about the influence of demographics and perceptions on individuals' willingness to access and pay for CGT. This study assessed patients' willingness to undergo CGT in southwest Nigeria as a catalyst for sustainable Cancer Risk Management Program. METHODS This was a cross-sectional study using semistructured questionnaire to interview 362 patients with cancer and 10 referred first-degree relatives between July 2018 and February 2020. Participants from three Nigerian teaching hospitals-University College Hospital, Ibadan, Lagos State University Teaching Hospital, Lagos, and Lagos University Teaching Hospital, Lagos, received genetic counseling and had subsequent CGT. Primary outcomes were willingness to undergo CGT in determining cancer risk and the willingness to pay for it. Ethical approval was from appropriate ethics committees of participating hospitals. Data were analyzed with SPSS version 22. Univariate comparison of categorical variables was performed by χ2 test, multivariate analysis by logistic regression. RESULTS The participants from University College Hospital (56.2%), Lagos State University Teaching Hospital (26.3%), and Lagos University Teaching Hospital (17.5%) were mostly female (98.4%). Mean age was 48.8 years ± 11.79. Three hundred twenty-two (86.6%) patients and first-degree relatives were willing to take the test, of whom 231 (71.1%) were willing to pay for it. more than half (53.6%) of the participants were willing to pay between N10,000 and N30,000, which is less than $100 US dollars. Sociodemographic variables and willingness to test showed no association (P > .05). Education and ethnicity were found to be associated with their willingness to pay for CGT (P ≤ .05). CONCLUSION Learning clinically relevant details toward cancer prevention informs health-related decisions in patients and relatives, a motivator for willingness to pay for genetic testing in low- and middle-income countries. Increased awareness may influence outcomes of cancer risk management.
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Affiliation(s)
- Prisca O Adejumo
- Department of Nursing, College of Medicine, University of Ibadan, Nigeria
| | - Toyin I G Aniagwu
- School of Occupational Health Nursing, University College Hospital, Ibadan, Nigeria
| | - Olutosin A Awolude
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo, Nigeria
| | - Babatunde Adedokun
- Center for Clinical Cancer Genetics & Global Health, Department of Medicine, The University of Chicago, Chicago, IL
| | - Makayla Kochheiser
- Center for Clinical Cancer Genetics & Global Health, Department of Medicine, The University of Chicago, Chicago, IL
| | | | | | - Oladosu Ojengbede
- Center for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Dezheng Huo
- Department of Public Health Sciences, The University of Chicago, Chicago, IL
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics & Global Health, Department of Medicine, The University of Chicago, Chicago, IL
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Verheyen GR, Pieters L, Maregesi S, Van Miert S. Insects as Diet and Therapy: Perspectives on Their Use for Combating Diabetes Mellitus in Tanzania. Pharmaceuticals (Basel) 2021; 14:ph14121273. [PMID: 34959673 PMCID: PMC8707174 DOI: 10.3390/ph14121273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022] Open
Abstract
More than 450 million people worldwide are suffering from diabetes and this number is expected to increase. In developing countries, such as Tanzania, the number of patients suffering from diabetes and associated diseases is increasing as well. Up to 80% of the Tanzanian people rely on traditional medicines for their health care services. The nature of Tanzanian is very rich in different plant and insect species, and this could be exploited through their implementation in preventive and/or curative approaches in the battle against diabetes. The implementation of healthy insects in the diets of people may help in the prevention of obesity, which is a risk factor in the etiology of diabetes, while the identification of small molecules in insects may help in the discovery of potential new drugs that can be used in the treatment of diabetes. In this paper, an overview on the potential implementation of insects against diabetes is presented.
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Affiliation(s)
- Geert René Verheyen
- RADIUS, Thomas More University of Applied Sciences, Kleinhoefstraat 4, 2440 Geel, Belgium;
- Correspondence: ; Tel.: +32-1474-0504
| | - Luc Pieters
- NatuRA, Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium;
| | - Sheila Maregesi
- Pharmacognosy Department, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar Es Salaam 65013, Tanzania;
| | - Sabine Van Miert
- RADIUS, Thomas More University of Applied Sciences, Kleinhoefstraat 4, 2440 Geel, Belgium;
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Zumpe L, Bensel T, Wienke A, Mtaya-Mlangwa M, Hey J. The Oral Health Situation of 12-Year-Old School Children in the Rural Region of Ilembula in Southwestern Tanzania: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212237. [PMID: 34831993 PMCID: PMC8618583 DOI: 10.3390/ijerph182212237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/10/2021] [Accepted: 11/17/2021] [Indexed: 12/29/2022]
Abstract
There has been no research on the prevalence of and factors associated with dental caries in rural southwestern Tanzania among schoolchildren. Determining the prevalence of and factors associated with dental caries will help to assess the need for dental intervention and prophylactic measures among children in the region. In February 2020, a cross-sectional study was conducted in the Wanging’ombe District of the Ilembula Ward. The data were collected through clinical examinations and personal interviews at two primary schools. Univariable and multivariable logistic regression analyses were performed to identify potential risk indicators for caries. The study included 319 students aged 11–12 years (average 11.92 ± 0.27 years). The mean Decayed, Missing and Filled Teeth index was 0.24 ± 0.68, and the mean Specific affected Caries Index was 1.66 ± 0.9. The greatest influences on the caries risk were poor oral hygiene (OR 8.05, 95% CI 0.49–133.23), low tooth brushing frequency (OR 3.03, 95% CI 1.26–7.26) and low level of education in parents (OR 2.63, 95% CI 0.99–6.98). Dental caries was low among students in rural areas in the Wanging’ombe District.
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Affiliation(s)
- Lisa Zumpe
- Clinic for Prosthodontics, Martin-Luther-University, 06112 Halle, Germany; (L.Z.); (T.B.)
| | - Tobias Bensel
- Clinic for Prosthodontics, Martin-Luther-University, 06112 Halle, Germany; (L.Z.); (T.B.)
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Computer Science, Martin-Luther-University, 06112 Halle, Germany;
| | - Matilda Mtaya-Mlangwa
- Department of Preventive and Community Dentistry, Muhimbili University of Health and Allied Science, Dar es Salaam P.O. Box 65014, Tanzania;
| | - Jeremias Hey
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 14197 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450-662-784
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Card EB, Obayemi JE, Shirima O, Rajaguru P, Massawe H, Premkumar A, Sheth NP. Patient patronage and perspectives of traditional bone setting at an outpatient orthopaedic clinic in Northern Tanzania. Afr Health Sci 2021; 21:418-426. [PMID: 34394324 PMCID: PMC8356595 DOI: 10.4314/ahs.v21i1.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Much of Sub-Saharan Africa meets the rising rates of musculoskeletal injury with traditional bone setting, especially given limitations in access to allopathic orthopaedic care. Concern for the safety of bone setter practices as well as recognition of their advantages have spurred research to understand the impact of these healers on public health. Objectives Our study investigates the role of bone setting in Tanzania through patient utilization and perspectives. Methods We surveyed 212 patients at the outpatient orthopaedic clinic at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Surveys were either self-administered or physician-administered. Summary statistics were calculated using XLSTAT. Open responses were analyzed using a deductive framework method. Results Of all surveys, 6.3% (n=13) reported utilizing traditional bone setting for their injury prior to presenting to KCMC. Of the self-administered surveys, 13.6% (n=6) reported utilizing bone setting compared to 4.3% (n=7) of the physician-administered surveys (p=0.050). Negative perceptions of bone setting were more common than positive perceptions and the main reason patients did not utilize bone setting was concern for competency (35.8%, n=67). Conclusion Our study found lower bone setting utilization than expected considering the reliance of Tanzanians on traditional care reported in the literature. This suggests patients utilizing traditional care for musculoskeletal injury are not seeking allopathic care; therefore, collaboration with bone setters could expand allopathic access to these patients. Patients were less likely to report bone setter utilization to a physician revealing the stigma of seeking traditional care, which may present an obstacle for collaboration.
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Affiliation(s)
| | - Joy E Obayemi
- University of Pennsylvania Perelman School of Medicine
| | - Octavian Shirima
- Kilimanjaro Christian Medical Centre, Department of Orthopaedic Surgery
| | | | - Honest Massawe
- Kilimanjaro Christian Medical Centre, Department of Orthopaedic Surgery
| | - Ajay Premkumar
- Hospital for Special Surgery, Department of Orthopaedic Surgery
| | - Neil P Sheth
- University of Pennsylvania, Department of Orthopaedic Surgery
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Abstract
Background: Traditional health practitioners remain a critical source of care in Tanzania, more than 50% of Tanzanians frequently using their services. With a severe shortage of orthopaedic surgeons (1:3.3 million Tanzanians) traditional bone setters (TBSs) could potentially expand access to musculoskeletal care and improve outcomes for morbidity as a result of trauma. Objective: We sought to identify the advantages and disadvantages of traditional bone setting in Tanzania and to assess potential for collaboration between TBSs and allopathic orthopaedic surgeons. Methods: Between June and July 2017 we interviewed six TBSs identified as key informants in the regions of Kilimanjaro, Arusha, and Manyara. We conducted semi-structured interviews about practices and perspectives on allopathic healthcare, and analyzed the data using a deductive framework method. Findings: The TBSs reported that their patients were primarily recruited from their local communities via word-of-mouth communication networks. Payment methods for services included bundling costs, livestock barter, and sliding scale pricing. Potentially unsafe practices included lack of radiographic imaging to confirm reduction; cutting and puncturing of skin with unsterile tools; and rebreaking healed fractures. The TBSs described past experience collaborating with allopathic healthcare providers, referring patients to hospitals, and utilizing allopathic techniques in their practice. All expressed enthusiasm in future collaboration with allopathic hospitals. Conclusions: TBSs confer the advantages of word-of-mouth communication networks and greater financial and geographic accessibility. However, some of their practices raise concerns relating to infection, fracture malunion or nonunion, and iatrogenic trauma from manipulating previously healed fractures. A formal collaboration between TBSs and orthopaedic surgeons, based on respect and regular communication, could alleviate concerns through the development of care protocols and increase access to optimal orthopaedic care through a standardized triage and follow-up system.
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Galson SW, Staton CA, Karia F, Kilonzo K, Lunyera J, Patel UD, Hertz JT, Stanifer JW. Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study. BMJ Open 2017; 7:e018829. [PMID: 29127232 PMCID: PMC5695455 DOI: 10.1136/bmjopen-2017-018829] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Sub-Saharan Africa is particularly vulnerable to the growing global burden of hypertension, but epidemiological studies are limited and barriers to optimal management are poorly understood. Therefore, we undertook a community-based mixed-methods study in Tanzania to investigate the epidemiology of hypertension and barriers to care. METHODS In Northern Tanzania, between December 2013 and June 2015, we conducted a mixed-methods study, including a cross-sectional household epidemiological survey and qualitative sessions of focus groups and in-depth interviews. For the survey, we assessed for hypertension, defined as a single blood pressure ≥160/100 mm Hg, a two-time average of ≥140/90 mm Hg or current use of antihypertensive medications. To investigate relationships with potential risk factors, we used adjusted generalised linear models. Uncontrolled hypertension was defined as a two-time average measurement of ≥160/100 mm Hg irrespective of treatment status. Hypertension awareness was defined as a self-reported disease history in a participant with confirmed hypertension. To explore barriers to care, we identified emerging themes using an inductive approach within the framework method. RESULTS We enrolled 481 adults (median age 45 years) from 346 households, including 123 men (25.6%) and 358 women (74.4%). Overall, the prevalence of hypertension was 28.0% (95% CI 19.4% to 38.7%), which was independently associated with age >60 years (prevalence risk ratio (PRR) 4.68; 95% CI 2.25 to 9.74) and alcohol use (PRR 1.72; 95% CI 1.15 to 2.58). Traditional medicine use was inversely associated with hypertension (PRR 0.37; 95% CI 0.26 to 0.54). Nearly half (48.3%) of the participants were aware of their disease, but almost all (95.3%) had uncontrolled hypertension. In the qualitative sessions, we identified barriers to optimal care, including poor point-of-care communication, poor understanding of hypertension and structural barriers such as long wait times and undertrained providers. CONCLUSIONS In Northern Tanzania, the burden of hypertensive disease is substantial, and optimal hypertension control is rare. Transdisciplinary strategies sensitive to local practices should be explored to facilitate early diagnosis and sustained care delivery.
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Affiliation(s)
- Sophie W Galson
- Division of Emergency Medicine, Department of Surgery, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Catherine A Staton
- Division of Emergency Medicine, Department of Surgery, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
- Division of Global Neurosurgery and Neuroscience, Department of Neurosurgery, Duke Global Health Institute, Durham, North Carolina, USA
| | - Francis Karia
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kajiru Kilonzo
- Department of Medicine, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Joseph Lunyera
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Uptal D Patel
- Department of Medicine, Duke Clinical Research Institute , Duke University, Durham, North Carolina, USA
| | - Julian T Hertz
- Division of Emergency Medicine, Department of Surgery, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | - John W Stanifer
- Duke Global Health Institute, Durham, North Carolina, USA
- Division of Nephrology, Department of Medicine, Duke University, Durham, North Carolina, USA
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Addressing Adolescent Depression in Tanzania: Positive Primary Care Workforce Outcomes Using a Training Cascade Model. DEPRESSION RESEARCH AND TREATMENT 2017; 2017:9109086. [PMID: 29333294 PMCID: PMC5733241 DOI: 10.1155/2017/9109086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/15/2017] [Accepted: 07/26/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND This is a report on the outcomes of a training program for community clinic healthcare providers in identification, diagnosis, and treatment of adolescent Depression in Tanzania using a training cascade model. METHODS Lead trainers adapted a Canadian certified adolescent Depression program for use in Tanzania to train clinic healthcare providers in the identification, diagnosis, and treatment of Depression in young people. As part of this training program, the knowledge, attitudes, and a number of other outcomes pertaining to healthcare providers and healthcare practice were assessed. RESULTS The program significantly, substantially, and sustainably improved provider knowledge and confidence. Further, healthcare providers' personal help-seeking efficacy also significantly increased as well as the clinicians' reported number of adolescent patients identified, diagnosed, and treated for Depression. CONCLUSION To our knowledge, this is the first study reporting positive outcomes of a training program addressing adolescent Depression in Tanzanian community clinics. These results suggest that the application of this training cascade approach may be a feasible model for developing the capacity of healthcare providers to address youth Depression in a low-income, low-resource setting.
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Lemire J, Budgell B. An interdisciplinary clinic in rural Tanzania - observations on chiropractic care in a developing nation. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2016; 60:131-136. [PMID: 27385832 PMCID: PMC4915471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
It appears that a great many chiropractors and chiropractic institutions are involved in health care initiatives in developing countries. Developing nations present extraordinary opportunities to do good, but also carry risks, for practitioners and organizations, which may not be obvious prior to actual local engagement. This paper describes the guiding principles under which one international collaboration has evolved in rural Tanzania, a so-called 'low resource' setting where the majority of families subsist in extreme poverty. Several challenges to effective care are also identified.
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Affiliation(s)
- Joe Lemire
- Chiropractic Department, University of Quebec at Trois-Rivières
| | - Brian Budgell
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College
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Asuk AA, Agiang MA, Dasofunjo K, Willie AJ. The biomedical significance of the phytochemical, proximate and mineral compositions of the leaf, stem bark and root of Jatropha curcas. Asian Pac J Trop Biomed 2015. [DOI: 10.1016/j.apjtb.2015.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Stanifer JW, Patel UD, Karia F, Thielman N, Maro V, Shimbi D, Kilaweh H, Lazaro M, Matemu O, Omolo J, Boyd D. The determinants of traditional medicine use in Northern Tanzania: a mixed-methods study. PLoS One 2015; 10:e0122638. [PMID: 25848762 PMCID: PMC4388565 DOI: 10.1371/journal.pone.0122638] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 02/23/2015] [Indexed: 11/23/2022] Open
Abstract
Introduction Traditional medicines are an important part of healthcare in sub-Saharan Africa, and building successful disease treatment programs that are sensitive to traditional medicine practices will require an understanding of their current use and roles, including from a biomedical perspective. Therefore, we conducted a mixed-method study in Northern Tanzania in order to characterize the extent of and reasons for the use of traditional medicines among the general population so that we can better inform public health efforts in the region. Methods Between December 2013 and June 2014 in Kilimanjaro, Tanzania, we conducted 5 focus group discussions and 27 in-depth interviews of key informants. The data from these sessions were analyzed using an inductive framework method with cultural insider-outsider coding. From these results, we developed a structured survey designed to test different aspects of traditional medicine use and administered it to a random sample of 655 adults from the community. The results were triangulated to explore converging and diverging themes. Results Most structured survey participants (68%) reported knowing someone who frequently used traditional medicines, and the majority (56%) reported using them themselves in the previous year. The most common uses were for symptomatic ailments (42%), chronic diseases (15%), reproductive problems (11%), and malaria/febrile illnesses (11%). We identified five major determinants for traditional medicine use in Northern Tanzania: biomedical healthcare delivery, credibility of traditional practices, strong cultural identities, individual health status, and disease understanding. Conclusions In order to better formulate effective local disease management programs that are sensitive to TM practices, we described the determinants of TM use. Additionally, we found TM use to be high in Northern Tanzania and that its use is not limited to lower-income areas or rural settings. After symptomatic ailments, chronic diseases were reported as the most common reason for TM use which may be particularly important in Northern Tanzania where non-communicable diseases are a rapidly growing burden.
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Affiliation(s)
- John W. Stanifer
- Department of Medicine, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Uptal D. Patel
- Department of Medicine, Duke University, Durham, North Carolina, United States of America
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States of America
| | - Francis Karia
- Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Nathan Thielman
- Department of Medicine, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Venance Maro
- Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Dionis Shimbi
- Kilimanjaro Christian Medical College, Moshi, Tanzania
| | | | - Matayo Lazaro
- Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Oliver Matemu
- Kilimanjaro Christian Medical College, Moshi, Tanzania
| | | | - David Boyd
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Mahiti GR, Kiwara AD, Mbekenga CK, Hurtig AK, Goicolea I. "We have been working overnight without sleeping": traditional birth attendants' practices and perceptions of post-partum care services in rural Tanzania. BMC Pregnancy Childbirth 2015; 15:8. [PMID: 25643622 PMCID: PMC4324777 DOI: 10.1186/s12884-015-0445-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 01/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In many low-income countries, formal post-partum care utilization is much lower than that of skilled delivery and antenatal care. While Traditional Birth Attendants (TBAs) might play a role in post-partum care, research exploring their attitudes and practices during this period is scarce. Therefore, the aim of this study was to explore TBAs' practices and perceptions in post-partum care in rural Tanzania. METHODS Qualitative in-depth interview data were collected from eight untrained and three trained TBAs. Additionally, five multiparous women who were clients of untrained TBAs were also interviewed. Interviews were conducted in February 2013. Data were digitally recorded and transcribed verbatim. Qualitative content analysis was used to analyze data. RESULTS Our study found that TBAs take care of women during post-partum with rituals appreciated by women. They report lacking formal post-partum care training, which makes them ill-equipped to detect and handle post-partum complications. Despite their lack of preparation, they try to provide care for some post-partum complications which could put the health of the woman at risk. TBAs perceive that utilization of hospital-based post-partum services among women was only important for the baby and for managing complications which they cannot handle. They are poorly linked with the health system. CONCLUSIONS This study found that the TBAs conducted close follow-ups and some of their practices were appreciated by women. However, the fact that they were trying to manage certain post-partum complications can put women at risk. These findings point out the need to enhance the communication between TBAs and the formal health system and to increase the quality of the TBA services, especially in terms of prompt referral, through provision of training, mentoring, monitoring and supervision of the TBA services.
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Affiliation(s)
- Gladys R Mahiti
- School of Public Health and Social Sciences, Department of Development Studies, Muhimbili University of Health and Allied Sciences, P.O. Box 65454, Dar es Salaam, Tanzania.
| | - Angwara D Kiwara
- School of Public Health and Social Sciences, Department of Development Studies, Muhimbili University of Health and Allied Sciences, P.O. Box 65454, Dar es Salaam, Tanzania.
| | - Columba K Mbekenga
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Anna-Karin Hurtig
- Division of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden.
| | - Isabel Goicolea
- Division of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden.
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14
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Lopes Ibanez-Gonzalez D, Mendenhall E, Norris SA. A mixed methods exploration of patterns of healthcare utilization of urban women with non-communicable disease in South Africa. BMC Health Serv Res 2014; 14:528. [PMID: 25367195 PMCID: PMC4231186 DOI: 10.1186/s12913-014-0528-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 10/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the growing burden of NCDs in South Africa, very little is known about how people living in urban townships manage these illnesses. In this article we expound upon the findings of a study showing that only one-third of women with an NCD participating in the Birth to Twenty (Bt20) cohort study of Soweto-Johannesburg, South Africa, had sought biomedical services in the previous six months. METHODS We evaluated quantitative data from a cross sectional health access survey conducted with adult women (mean age = 44.8) and examined 25 in-depth narrative interviews with twelve women who self-reported at least one NCD from the larger study. RESULTS The qualitative findings highlight the potential role of negative experiences of healthcare services and biomedicine in delaying the seeking of healthcare. Multivariate analysis of the quantitative findings found that the possession of medical aid (OR = 1.7, CI = 1.01-2.84) and the self-reported use of patient strategies in negotiating healthcare access (OR = 1.6, CI = 1.04-2.34) were positively associated with the utilization of healthcare services. Belief in the superior efficacy of traditional healers over doctors was associated with delay of NCD treatment (OR = 2.4, CI = 1.14-4.18). CONCLUSION Our data suggest that low healthcare utilization is due in part to low rates of expectation for consistent and high-quality care and potential mistrust of the medical system. We conclude that both demand-side and supply-side measures focusing on high trust management practices will prove essential in ensuring access to healthcare services.
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Affiliation(s)
- Daniel Lopes Ibanez-Gonzalez
- />MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Emily Mendenhall
- />Walsh School of Foreign Service, Georgetown University, Washington, DC USA
| | - Shane A Norris
- />MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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15
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Brinda EM, Andrés AR, Andrés RA, Enemark U. Correlates of out-of-pocket and catastrophic health expenditures in Tanzania: results from a national household survey. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2014; 14:5. [PMID: 24597486 PMCID: PMC3946236 DOI: 10.1186/1472-698x-14-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 02/24/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Inequality in health services access and utilization are influenced by out-of-pocket health expenditures in many low and middle-income countries (LMICs). Various antecedents such as social factors, poor health and economic factors are proposed to direct the choice of health care service use and incurring out-of-pocket payments. We investigated the association of these factors with out-of-pocket health expenditures among the adult and older population in the United Republic of Tanzania. We also investigated the prevalence and associated determinants contributing to household catastrophic health expenditures. METHODS We accessed the data of a multistage stratified random sample of 7279 adult participants, aged between 18 and 59 years, as well as 1018 participants aged above 60 years, from the first round of the Tanzania National Panel survey. We employed multiple generalized linear and logistic regression models to evaluate the correlates of out-of-pocket as well as catastrophic health expenditures, accounting for the complex sample design effects. RESULTS Increasing age, female gender, obesity and functional disability increased the adults' out-of-pocket health expenditures significantly, while functional disability and visits to traditional healers increased the out-of-pocket health expenditures in older participants. Adult participants, who lacked formal education or worked as manual laborers earned significantly less (p < 0.001) and spent less on health (p < 0.001), despite having higher levels of disability. Large household size, household head's occupation as a manual laborer, household member with chronic illness, domestic violence against women and traditional healer's visits were significantly associated with high catastrophic health expenditures. CONCLUSION We observed that the prevalence of inequalities in socioeconomic factors played a significant role in determining the nature of both out-of-pocket and catastrophic health expenditures. We propose that investment in social welfare programs and strengthening the social security mechanisms could reduce the financial burden in United Republic of Tanzania.
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Affiliation(s)
- Ethel Mary Brinda
- Department of Public Health, Section for Health Services Research and Health Promotion, Aarhus University, Aarhus C 8000, Denmark.
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16
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Vandebroek I. Intercultural health and ethnobotany: how to improve healthcare for underserved and minority communities? JOURNAL OF ETHNOPHARMACOLOGY 2013; 148:746-54. [PMID: 23727048 DOI: 10.1016/j.jep.2013.05.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 05/16/2013] [Accepted: 05/16/2013] [Indexed: 05/19/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The present conceptual review explores intercultural healthcare--defined as the integration of traditional medicine and biomedicine as complementary healthcare systems--in minority and underserved communities. This integration can take place at different levels: individuals (patients, healers, biomedical healthcare providers), institutions (health centers, hospitals) or society (government policy). BACKGROUND Contemporary ethnobotany research of traditional medicine has primarily dealt with the botanical identification of plants commonly used by local communities, and the identification of health conditions treated with these plants, whereas ethnopharmacology has focused on the bioactivity of traditional remedies. On the other hand, medical anthropology seems to be the scholarship more involved with research into patients' healthcare-seeking itineraries and their interaction with traditional versus biomedical healthcare systems. The direct impact of these studies on public health of local communities can be contested. AIM OF THE REVIEW To compare and discuss the body of scholarly work that deals with different aspects of traditional medicine in underserved and minority communities, and to reflect on how gaps identified in research can be bridged to help improve healthcare in these communities. KEY FINDINGS The literature covers a broad range of information of relevance to intercultural healthcare. This information is fragmented across different scientific and clinical disciplines. A conceptual review of these studies identifies a clear need to devote more attention to ways in which research on traditional medicine can be more effectively applied to improve local public health in biomedical resource-poor settings, or in geographic areas that have disparities in access to healthcare. CONCLUSIONS Scholars studying traditional medicine should prioritize a more interdisciplinary and applied perspective to their work in order to forge a more direct social impact on public health in local communities most in need of healthcare.
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Affiliation(s)
- Ina Vandebroek
- Institute of Economic Botany, The New York Botanical Garden, 2900 Southern Boulevard, Bronx, NY 10458, USA.
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Smith-Hall C, Larsen HO, Pouliot M. People, plants and health: a conceptual framework for assessing changes in medicinal plant consumption. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2012; 8:43. [PMID: 23148504 PMCID: PMC3549945 DOI: 10.1186/1746-4269-8-43] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 11/05/2012] [Indexed: 05/08/2023]
Abstract
BACKGROUND A large number of people in both developing and developed countries rely on medicinal plant products to maintain their health or treat illnesses. Available evidence suggests that medicinal plant consumption will remain stable or increase in the short to medium term. Knowledge on what factors determine medicinal plant consumption is, however, scattered across many disciplines, impeding, for example, systematic consideration of plant-based traditional medicine in national health care systems. The aim of the paper is to develop a conceptual framework for understanding medicinal plant consumption dynamics. Consumption is employed in the economic sense: use of medicinal plants by consumers or in the production of other goods. METHODS PubMed and Web of Knowledge (formerly Web of Science) were searched using a set of medicinal plant key terms (folk/peasant/rural/traditional/ethno/indigenous/CAM/herbal/botanical/phytotherapy); each search terms was combined with terms related to medicinal plant consumption dynamics (medicinal plants/health care/preference/trade/treatment seeking behavior/domestication/sustainability/conservation/urban/migration/climate change/policy/production systems). To eliminate studies not directly focused on medicinal plant consumption, searches were limited by a number of terms (chemistry/clinical/in vitro/antibacterial/dose/molecular/trial/efficacy/antimicrobial/alkaloid/bioactive/inhibit/antibody/purification/antioxidant/DNA/rat/aqueous). A total of 1940 references were identified; manual screening for relevance reduced this to 645 relevant documents. As the conceptual framework emerged inductively, additional targeted literature searches were undertaken on specific factors and link, bringing the final number of references to 737. RESULTS The paper first defines the four main groups of medicinal plant users (1. Hunter-gatherers, 2. Farmers and pastoralists, 3. Urban and peri-urban people, 4. Entrepreneurs) and the three main types of benefits (consumer, producer, society-wide) derived from medicinal plants usage. Then a single unified conceptual framework for understanding the factors influencing medicinal plant consumption in the economic sense is proposed; the framework distinguishes four spatial levels of analysis (international, national, local, household) and identifies and describes 15 factors and their relationships. CONCLUSIONS The framework provides a basis for increasing our conceptual understanding of medicinal plant consumption dynamics, allows a positioning of existing studies, and can serve to guide future research in the area. This would inform the formation of future health and natural resource management policies.
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Affiliation(s)
- Carsten Smith-Hall
- Department of Food and Resource Economics, Faculty of Science, University of Copenhagen, Rolighedsvej 23, Frederiksberg C, 1958, Denmark
| | - Helle Overgaard Larsen
- Department of Food and Resource Economics, Faculty of Science, University of Copenhagen, Rolighedsvej 23, Frederiksberg C, 1958, Denmark
| | - Mariève Pouliot
- Department of Food and Resource Economics, Faculty of Science, University of Copenhagen, Rolighedsvej 23, Frederiksberg C, 1958, Denmark
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