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Tehrani JM, Vos IA, Kisabacak R, Topper MK, Steinhorst J, Phillips RO, Abass KM, Osei-Mireku S, Anokye CO, Adu Poku JK, Stienstra Y, Amoako YA. Traditional healers' perception on scabies causation and management in Ghana. Trop Med Int Health 2024; 29:477-488. [PMID: 38599337 DOI: 10.1111/tmi.13989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Scabies is an underdiagnosed skin infestation caused by the Sarcoptes scabiei mite. The infection causes severe itching and a skin rash but can be effectively treated using topical or systemic drugs. Scabies outbreaks are commonly reported in resource-poor countries, including Ghana. Traditional healers play an important role in primary care in rural areas. The role of these traditional healers in the management of scabies has so far not been explored. The aim of this study was therefore to investigate the perceptions of traditional healers regarding the causation and management of scabies. METHODS A phenomenological qualitative approach was employed. Traditional healers in the Asante Akim North and Central districts in Ghana were approached with an interview request. Using a semi-structured interview protocol, 15 traditional healers were interviewed. The results were coded and analysed, after which seven themes were extrapolated. RESULTS Scabies infections were frequently reported by traditional healers. Itching and skin rash were unanimously regarded as the major symptoms of scabies. The majority acknowledged the infectious nature of scabies, but no participant reported the causative organism. A dichotomous disease classification was noted, consisting of 'natural' and 'spiritual' variants each with a unique disease profile and management requirements, as reported by the traditional healers. All but two traditional healers reported to treat scabies using almost exclusively herbs and spiritual rituals. CONCLUSION The majority of traditional healers were open to collaboration with allopathic healthcare providers. Collaboration could broaden the primary care network in rural areas, but mistrust and lack of transparency form potential barriers to collaboration. We, therefore, emphasise the need for additional efforts to investigate strategies for future collaboration.
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Affiliation(s)
- Jian M Tehrani
- Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ingmar A Vos
- Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, Groningen, The Netherlands
| | - Robin Kisabacak
- Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marten K Topper
- Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jonathan Steinhorst
- Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, Groningen, The Netherlands
| | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Samuel Osei-Mireku
- Agogo Presbyterian Hospital, Agogo, Ghana
- The Trust Hospital, Accra, Ghana
| | | | | | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Yaw Ampem Amoako
- Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, Groningen, The Netherlands
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Onche EJ, Oluwasanu MM, John-Akinola YO. Knowledge, perception, attitude, and practice of complementary and alternative medicine by health care workers in Garki hospital Abuja, Nigeria. BMC Complement Med Ther 2024; 24:177. [PMID: 38724936 PMCID: PMC11080117 DOI: 10.1186/s12906-024-04429-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 03/07/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Healthcare workers are currently making efforts to offer services that cater to the holistic care needs of their patients. Previous studies have shown that some healthcare workers encounter challenges when advising patients about Complementary and Alternative Medicine (CAM), even though its use is widespread. Many health care workers may not have received formal education or training in CAM and consequently are unable to address their patients' questions about it. This study explored the knowledge, perception, attitude and practice of CAM by healthcare workers in Garki Hospital, Abuja, Nigeria. METHODS This was an institution-based cross-sectional study, design and a convergent parallel, mixed methods design was used for data collection. Five (5) healthcare workers were purposively selected as participants for the key informant interviews, while two hundred and fifty (250) selected using a simple random sampling method completed the questionnaire. The data collection instruments used were a key informant interview guide and a 35-item self-administered questionnaire. Knowledge was assessed with a 4-item scale with a maximum score of 8. Perceptions and attitudes were assessed using Likert scales with a maximum score of 45 and 20, respectively. Practice was assessed with a 6-item scale with a maximum score of 18. Qualitative data was analysed using framework analysis. Quantitative data was analysed using descriptive and inferential statistics. Data acquired from both methods were integrated to form the findings. RESULTS The average age of respondents for the quantitative study was 34.0 ± 7.8 years, and they were predominantly females (61.2%) with one to ten years of work experience (68.8%). The mean knowledge, perception and attitude scores were 1.94 ± 1.39, 13.08 ± 2.34 and 32.68 ± 6.28, respectively. Multiple linear regression result showed that knowledge (t = 2.025, p = 0.044) and attitude (t = 5.961, p = 0.000) had statistically significant effects on the practice of CAM. Qualitative data revealed that the majority of the participants perceive CAM favourably, provided it is properly introduced into mainstream medicine with evidence of safety and research to prove its efficacy. CONCLUSION The study has shown the gaps in knowledge and the practices of CAM by conventional medical practitioners. This has implications for their ability to counsel and refer patients who may require CAM therapies. Policy, research and programmatic initiatives that seek to enhance their knowledge of CAM, and improve collaboration with CAM practitioners are recommended.
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Affiliation(s)
- Enole Jennifer Onche
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mojisola Morenike Oluwasanu
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Yetunde Olufisayo John-Akinola
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Tuck CZ, Cooper R, Aryeetey R, Gray LA, Akparibo R. A critical review and analysis of the context, current burden, and application of policy to improve cancer equity in Ghana. Int J Equity Health 2023; 22:254. [PMID: 38066530 PMCID: PMC10709985 DOI: 10.1186/s12939-023-02067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Cancer causes a major disease burden worldwide. This is increasingly being realised in low and middle-income countries, which account disproportionately for preventable cancer deaths. Despite the World Health Organization calling for governments to develop policies to address this and alleviate cancer inequality, numerous challenges in executing effective cancer policies remain, which require consideration of the country-specific context. As this has not yet been considered in Ghana, the aim of this review was to bring together and critique the social-environmental, health policy and system factors to identifying opportunities for future health policies to reduce cancer burden in the Ghanian context. A critical policy-focused review was conducted to bring together and critique the current health systems context relating to cancer in Ghana, considering the unmet policy need, health system and social factors contributing to the burden and policy advances related to cancer. CONCLUSION The findings highlight the changing burden of cancer in Ghana and the contextual factors within the socio-ecosystem that contribute to this. Policies around expanding access to and coverage of services, as well as the harmonization with medical pluralism have potential to improve outcomes and increase equity but their implementation and robust data to monitor their impact pose significant barriers.
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Affiliation(s)
- Chloe Zabrina Tuck
- School of Medicine and Population Health, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.
- School of Public Health, University of Ghana, Accra, Ghana.
| | - Richard Cooper
- School of Medicine and Population Health, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | | | - Laura A Gray
- School of Medicine and Population Health, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Robert Akparibo
- School of Medicine and Population Health, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.
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Okyere Asante PG, Tuck CZ, Atobrah D. Medical pluralism, healthcare utilization and patient wellbeing: The case of Akan cancer patients in Ghana. Int J Qual Stud Health Well-being 2023; 18:2238994. [PMID: 37490583 PMCID: PMC10392249 DOI: 10.1080/17482631.2023.2238994] [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: 10/18/2022] [Accepted: 07/17/2023] [Indexed: 07/27/2023] Open
Abstract
PURPOSE As cancers increase in Ghana and in many low-and middle-income countries, healthcare utilization has become critical for disease management and patients' wellbeing. There is evidence that medical pluralism is common among cancer patients in Ghana and many other African countries, which results in lack of adherence to and absconding from hospital treatments. The objective of this study was to examine ways in which beliefs in disease causation influence medical pluralism among Akan cancer patients in Ghana. METHODS A qualitative research approach was employed in this study. In-depth interviews were conducted for thirty (30) cancer patients who were purposively recruited from Komfo Anokye Teaching Hospital in Ghana. Thematic content analysis was used in analysing data. RESULTS Our findings revealed that cancer patients ascribed both physical and spiritual causality to their illness. As such, they combined orthodox treatment with spiritual healing and herbal medicine. Regarding the order of therapeutic search, patients reported to herbal and spiritual centres before going to the hospital, a phenomenon which contributes to the late reporting and diagnosis as well as bad prognosis of cancers in Ghana. CONCLUSION The findings of this research elucidate the relationship between culture and health care choices of cancer patients in Ghana. Increased awareness creation is crucial in eradicating myths surrounding cancers in Ghana.
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Affiliation(s)
| | - Chloe Z Tuck
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Deborah Atobrah
- Institute of African Studies, University of Ghana, Legon, Accra, Ghana
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Sundararajan R, Alakiu R, Ponticiello M, Birch G, Kisigo G, Okello E, Peck RN. Understanding traditional healer utilisation for hypertension care using the Andersen model: A qualitative study in Mwanza, Tanzania. Glob Public Health 2023; 18:2191687. [PMID: 36973183 PMCID: PMC10065353 DOI: 10.1080/17441692.2023.2191687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
ABSTRACTHypertension disproportionately affects people living in African countries, where there are many challenges to appropriate diagnosis and treatment, and many people with hypertension utilise traditional healers as their primary source of healthcare. In this study, we sought to understand factors driving healer utilisation among people with hypertension. We conducted 52 semi-structured interviews with traditional healers, patients and healthcare providers in the Mwanza region of Tanzania. We used the Andersen model of healthcare utilisation to organise our findings on factors driving utilisation of traditional healers for hypertension care. Traditional healers routinely provide care to hypertensive patients and are a critical component of the healthcare landscape. However, healers also operate independently of the biomedical healthcare system, and biomedical providers may hold negative perceptions of healers. Further, healers were described as preferential by patients due to the convenient locations of their practices and perceived improvement of hypertension symptoms with traditional treatment. Finally, healers expressed a desire for more formal collaboration with biomedicine to improve patient care. Our findings may guide future interventions in Tanzanian communities and elsewhere where traditional healers may act as partners to allopathic providers and patients in the continuum of hypertension care.
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Affiliation(s)
- Radhika Sundararajan
- Weill Cornell Medicine, Center for Global Health, New York NY USA
- Weill Cornell Medicine, Department of Emergency Medicine, New York NY USA
| | - Rinu Alakiu
- Weill Cornell Medical College, New York, NY USA
| | | | | | - Godfrey Kisigo
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Bugando Medical Center, Mwanza, Tanzania
| | | | - Robert N. Peck
- Weill Cornell Medicine, Center for Global Health, New York NY USA
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Bugando Medical Center, Mwanza, Tanzania
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Wang J, Liu YM, Hu J, Chen C. Trained immunity in monocyte/macrophage: Novel mechanism of phytochemicals in the treatment of atherosclerotic cardiovascular disease. Front Pharmacol 2023; 14:1109576. [PMID: 36895942 PMCID: PMC9989041 DOI: 10.3389/fphar.2023.1109576] [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: 11/29/2022] [Accepted: 01/27/2023] [Indexed: 02/23/2023] Open
Abstract
Atherosclerosis (AS) is the pathology of atherosclerotic cardiovascular diseases (ASCVD), characterized by persistent chronic inflammation in the vessel wall, in which monocytes/macrophages play a key role. It has been reported that innate immune system cells can assume a persistent proinflammatory state after short stimulation with endogenous atherogenic stimuli. The pathogenesis of AS can be influenced by this persistent hyperactivation of the innate immune system, which is termed trained immunity. Trained immunity has also been implicated as a key pathological mechanism, leading to persistent chronic inflammation in AS. Trained immunity is mediated via epigenetic and metabolic reprogramming and occurs in mature innate immune cells and their bone marrow progenitors. Natural products are promising candidates for novel pharmacological agents that can be used to prevent or treat cardiovascular diseases (CVD). A variety of natural products and agents exhibiting antiatherosclerotic abilities have been reported to potentially interfere with the pharmacological targets of trained immunity. This review describes in as much detail as possible the mechanisms involved in trained immunity and how phytochemicals of this process inhibit AS by affecting trained monocytes/macrophages.
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Affiliation(s)
- Jie Wang
- Guang'anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing, China
| | - Yong-Mei Liu
- Guang'anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing, China
| | - Jun Hu
- Guang'anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing, China
| | - Cong Chen
- Guang'anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing, China
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Tuck CZ, Akparibo R, Gray LA, Aryeetey RNO, Cooper R. What influences cancer treatment service access in Ghana? A critical interpretive synthesis. BMJ Open 2022; 12:e065153. [PMID: 36198450 PMCID: PMC9535186 DOI: 10.1136/bmjopen-2022-065153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Multiple social-cultural and contextual factors influence access to and acceptance of cancer treatment in Ghana. The aim of this research was to assess existing literature on how these factors interplay and could be susceptible to local and national policy changes. DESIGN This study uses a critical interpretive synthesis approach to review qualitative and quantitative evidence about access to adult cancer treatment services in Ghana, applying the socioecological model and candidacy framework. RESULTS Our findings highlighted barriers to accessing cancer services within each level of the socioecological model (intrapersonal, interpersonal community, organisational and policy levels), which are dynamic and interacting, for example, community level factors influenced individual perceptions and how they managed financial barriers. Evidence was lacking in relation to determinants of treatment non-acceptance across all cancers and in the most vulnerable societal groups due to methodological limitations. CONCLUSIONS Future policy should prioritise multilevel approaches, for example, improving the quality and affordability of medical care while also providing collaboration with traditional and complementary care systems to refer patients. Research should seek to overcome methodological limitations to understand the determinants of accessing treatment in the most vulnerable populations.
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Affiliation(s)
- Chloe Zabrina Tuck
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Robert Akparibo
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Laura A Gray
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | | | - Richard Cooper
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
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Ng JY, Kim M, Suri A. Exploration of facilitators and barriers to the regulatory frameworks of dietary and herbal supplements: a scoping review. J Pharm Policy Pract 2022; 15:55. [PMID: 36064655 PMCID: PMC9442913 DOI: 10.1186/s40545-022-00447-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background Over the last decade, the use of dietary and herbal supplements (DHSs) has expanded greatly across national healthcare settings for the prevention, management and/or treatment of a variety of health issues. Although regulatory policies for DHSs across different countries have been aimed towards evaluating safety and efficacy, performing quality controls, monitoring the manufacturing practices, and encouraging further research, significant safety issues have emerged from inappropriate regulatory classification, lack of suitable quality controls, and inadequate testing and labeling of these products. Therefore, the purpose of this scoping review was to identify facilitators and barriers to DHS regulation across different countries. Methods A scoping review was conducted and informed by the five-stage methodological framework proposed by Arksey and O’Malley and further enhanced by Levac et al. MEDLINE, EMBASE, AMED, and PsycINFO databases were systematically searched for eligible articles from database inception to September 29, 2020. Studies analyzing DHS regulatory frameworks were eligible for review. Relevant data from eligible articles were extracted and categorized into themes to provide a descriptive overview of the literature. Results Searches generated 4314 results, 1800 of which were duplicates, followed by 2472 that were excluded after screening the titles and abstracts of these articles. Of the remaining 42 full-texts, 15 eligible articles were included in this review. Themes identified include: (1) increased financial and human resources encouraging knowledge expansion as a facilitator to DHS regulation; (2) variances in DHS classification and regulatory requirements across countries as a barrier to DHS regulation, and (3) collaboration between various stakeholders (experts, policymakers, representatives of regulatory bodies, product companies and research institutions) facilitating DHS regulation. Conclusion The present scoping review identified facilitators and barriers to DHS regulation across different countries. We highlight that safety assessments of DHSs continue to be inadequate, and emerging technologies could potentially play a significant role in establishing common reference standards of herbal materials and products between regulatory agencies. Regulatory harmonization, increased scientific research, and collaboration could improve regulations globally through appropriate categorization and safe application of DHSs.
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Affiliation(s)
- Jeremy Y Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Michael G. DeGroote Centre for Learning and Discovery, McMaster University, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Minji Kim
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Michael G. DeGroote Centre for Learning and Discovery, McMaster University, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Ayush Suri
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Michael G. DeGroote Centre for Learning and Discovery, McMaster University, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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Ampomah IG, Malau-Aduli BS, Seidu AA, Malau-Aduli AEO, Emeto TI. Integrating traditional medicine into the Ghanaian health system: perceptions and experiences of traditional medicine practitioners in the Ashanti region. Int Health 2022:6692348. [PMID: 36063112 DOI: 10.1093/inthealth/ihac059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Traditional medicine (TM) plays a vital role in the Ghanaian health system by serving as an alternative healthcare delivery system for the majority of people. However, the quality of practice and level of TM practitioners' involvement in the integration of TM into the health system have not been fully investigated. METHODS This study employed a phenomenological qualitative study design to explore the perceptions, experiences and recommendations of TM practitioners in the Ashanti region regarding TM integration. Data were collected through individual interviews with 17 participants. RESULTS Participants had knowledge about TM integration. They cited effective alternative healthcare delivery and improved patient outcomes as the key benefits of TM integration. However, they reported a shortage of approved TM products, poor visibility of TM integration and poor relational coordination of care as factors hampering the integration. Participants recommended improved interprofessional relationships, provision of financial support and improved publicity of TM as possible strategies to enhance TM integration in Ghana. CONCLUSIONS The findings of the study clearly demonstrate that the Ghanaian health system is currently operating a consumer-led, tolerant health system with a parallel (between orthodox and TM practitioners) healthcare delivery model. Successful implementation of an effective TM integration would require improved integrative collaborative coordination of care between orthodox and TM practitioners in Ghana.
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Affiliation(s)
- Irene G Ampomah
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia.,Department of Population and Health, University of Cape Coast, Cape Coast, Post Office Box UC 182, Ghana
| | - Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia.,Department of Population and Health, University of Cape Coast, Cape Coast, Post Office Box UC 182, Ghana
| | - Aduli E O Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
| | - Theophilus I Emeto
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia.,World Health Organization Collaborating Centre for Vector-Borne and Neglected Tropical Diseases, James Cook University, Townsville, QLD 4811, Australia
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Orman E, Bekoe SO, Jato J, Spiegler V, Asare-Nkansah S, Agyare C, Hensel A, Bekoe EO. Quality assessment of African herbal medicine: A systematic review and the way forward. Fitoterapia 2022; 162:105287. [PMID: 36031027 DOI: 10.1016/j.fitote.2022.105287] [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: 07/12/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND In Africa, herbalism supplements allopathic medicine's efforts to ensure Universal Health Coverage attainment. This review was conducted to identify and to summarise current literature on methodological approaches used for quality control of herbal medicines in Africa, to evaluate the gaps associated with existing strategies within context of best practices, and make recommendations for future improvements. METHODS A systematic search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were screened and assessed for eligibility. RESULTS 118 articles were included into the study. There was a high preference for impurity profiling tests (77%) indicating the prioritization for tests that guarantee safety despite the limited analytical resources available. Other classes of tests reported included identification tests (29%), physicochemical tests (18%), and content assays (12%). Although standard methods exist in preparing samples for impurity tests, different techniques were observed in different studies, and this could lead to differences in analytical outcomes. Content assays focused on single marker assessments, which may be inadequate to comprehensively assess the quality of products. CONCLUSION This review provides knowledge of existing strengths and challenges for herbal medicine quality assessments in Africa. For future it is recommended to implement more studies on contaminants (e.g. mycotoxins) and pharmaceutical adulterants. The use of chemometrics to develop analytical methods should be promoted. Also, stakeholders in the medicine quality industry in Africa need to effectively collaborate to establish a well co-ordinated and harmonized system to provide a sustainable framework for the GACP and GMP guided production and quality assurance of herbal medicines.
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Affiliation(s)
- Emmanuel Orman
- Institute of Pharmaceutical Biology and Phytochemistry, University of Münster, Corrensstraße 48, D-48149 Münster, Germany; Department of Pharmaceutical Chemistry, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana; Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Samuel Oppong Bekoe
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jonathan Jato
- Institute of Pharmaceutical Biology and Phytochemistry, University of Münster, Corrensstraße 48, D-48149 Münster, Germany; Department of Pharmacognosy and Herbal Medicine, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Verena Spiegler
- Institute of Pharmaceutical Biology and Phytochemistry, University of Münster, Corrensstraße 48, D-48149 Münster, Germany
| | - Samuel Asare-Nkansah
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Christian Agyare
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Andreas Hensel
- Institute of Pharmaceutical Biology and Phytochemistry, University of Münster, Corrensstraße 48, D-48149 Münster, Germany.
| | - Emelia Oppong Bekoe
- Department of Pharmacognosy and Herbal Medicine, School of Pharmacy, University of Ghana, Accra, Ghana
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Longden-Naufal C, Rolfe V, Mackonochie M. Narratives of Herbal Medicine Utilisation in the United Kingdom: Scoping Literature Review. Front Pharmacol 2022; 13:886574. [PMID: 36091802 PMCID: PMC9452627 DOI: 10.3389/fphar.2022.886574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Using thematic analysis of existing literature, this scoping review aims to explore the narratives of people using herbal medicine (HM) in the United Kingdom. Understanding who is using HM and why will enable better ways of facilitating the use of HM, as well as assist in designing future research. Ethnic groups were found to be primary users of HM in the United Kingdom. A sense of heritage continues to be important for these participants as it allows tradition and culture to stay alive within communities, as well as the ritualistic purposes of these plants. For women, another key demographic, concepts surrounding the naturalness of HMs are associated with the idea of femineity and self-healing. A reoccurring theme in the literature focusing on both ethnic groups and women’s perceptions is the judgement from healthcare practitioners/professionals (HCPs) when addressing the use of HM. However, studies that investigated the perceptions of HCPs on HM confirmed that they often were supportive of using HM where standard treatments had been unsuccessful, and if a patient had anecdotal evidence of a herb having been effective. Delving deeper into public narratives of HM usage will allow conventional healthcare systems to effectively integrate alternative approaches, as well as ensuring that future research into the benefits of HMs is relevant to how people use them.
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Affiliation(s)
| | | | - Marion Mackonochie
- Pukka Herbs Ltd., Keynsham, United Kingdom
- *Correspondence: Marion Mackonochie,
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Ampomah IG, Malau-Aduli BS, Seidu AA, Malau-Aduli AEO, Emeto TI. The practice of integrated healthcare and the experiences of people in Ghana's Ashanti region. BMC Health Serv Res 2022; 22:32. [PMID: 34986828 PMCID: PMC8734307 DOI: 10.1186/s12913-021-07340-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background The Ghanaian government has implemented interventions that integrate traditional medicine (TM) into its national health system in response to the high prevalence of TM use. However, empirical evidence of the experiences of service users and the practice of integrated health in Ghana is scanty. Therefore, this study explored the experiences of people with TM integration into the formal health system in Ashanti region using an adapted TM integration framework. Methods A sequential explanatory mixed methods study design comprising survey administration and in-depth interviews for data collection was utilised to address the research objective. Framework analysis was used in analysing the qualitative data and for triangulation of results. Results Participants were aware of licensing and training of TM practitioners in a science-based university in Ghana. However, knowledge of the existence of TM units in selected hospitals in the region was minimal. Integration knowledge was largely influenced by sex, marital status, household size and residential status, where males and urban dwellers were more familiar with the process than females and rural dwellers. Low patronage of integrated health services in the region was attributable to weak cross referrals. However, service users who had engaged with the integrated system recounted a satisfactory outcome. Conclusion Service users’ unfamiliarity with the presence of integrated facilities in Ghana could be an impediment to the practice of integrated healthcare. Sensitisation of the public about the practice of an integrated system could refine the Ghanaian integrated system. Regular evaluation of patient satisfaction and outcome measures might also serve as an effective strategy for improving health services delivery since evaluation is becoming an important component of health service design and implementation. There is the need for future studies to focus on exploring the perceptions and experiences of health practitioners and hospital administrators regarding the practice of integrated health in Ghana. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07340-0.
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Affiliation(s)
- Irene G Ampomah
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia.,Department of Population and Health, University of Cape Coast, Cape Coast, Post Office Box UC 182, Ghana
| | - Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townville, QLD, 4811, Australia
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia.,Department of Population and Health, University of Cape Coast, Cape Coast, Post Office Box UC 182, Ghana
| | - Aduli E O Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia
| | - Theophilus I Emeto
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia. .,World Health Organization Collaborating Centre for Vector-Borne and Neglected Tropical Diseases, James Cook University, Townsville, QLD, 4811, Australia.
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Ampomah IG, Malau-Aduli BS, Seidu AA, Malau-Aduli AEO, Emeto TI. Perceptions and Experiences of Orthodox Health Practitioners and Hospital Administrators towards Integrating Traditional Medicine into the Ghanaian Health System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11200. [PMID: 34769719 PMCID: PMC8582872 DOI: 10.3390/ijerph182111200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/13/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022]
Abstract
The government of Ghana has been piloting traditional medicine (TM) integration in 17 health facilities across the country. However, the nature of current practice of integrated healthcare has not been thoroughly explored. This paper sought to explore the experiences and recommendations of orthodox health practitioners and hospital administrators in the Ashanti region regarding the practice of integrated healthcare in Ghana. The study adopted a qualitative, phenomenological approach involving 22 interviews. Purposive sampling technique was used in selecting study participants. Framework analysis was used to draw on the experiences of participants relating to TM integration. Participants were knowledgeable about the existence of integrated health facilities and stated that TM integration has created options in health services. However, participants deemed the integrated system ineffective and attributed the inefficiency to poor processing and certification of TM products, opposition of medical doctors to TM usage, absence of a protocol to guide the integration process, and inadequate publicity. Professional training of TM practitioners and inclusion of TM in medical school curriculum could improve collaboration between the health practitioners. Future research should focus on assessing the opinions and involvements of TM practitioners regarding the integration of traditional therapies into national health systems.
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Affiliation(s)
- Irene G. Ampomah
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia; (I.G.A.); (A.-A.S.); (A.E.O.M.-A.)
- Department of Population and Health, University of Cape Coast, Cape Coast P.O. Box UC 182, Ghana
| | - Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia;
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia; (I.G.A.); (A.-A.S.); (A.E.O.M.-A.)
- Department of Population and Health, University of Cape Coast, Cape Coast P.O. Box UC 182, Ghana
| | - Aduli E. O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia; (I.G.A.); (A.-A.S.); (A.E.O.M.-A.)
| | - Theophilus I. Emeto
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia; (I.G.A.); (A.-A.S.); (A.E.O.M.-A.)
- World Health Organization Collaborating Centre for Vector-Borne and Neglected Tropical Diseases, James Cook University, Townsville 4811, Australia
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Hong MH, Na SW, Jang YJ, Yoon JJ, Lee YJ, Lee HS, Kim HY, Kang DG. Betulinic Acid Improves Cardiac-Renal Dysfunction Caused by Hypertrophy through Calcineurin-NFATc3 Signaling. Nutrients 2021; 13:3484. [PMID: 34684485 PMCID: PMC8540639 DOI: 10.3390/nu13103484] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/25/2021] [Accepted: 09/29/2021] [Indexed: 01/03/2023] Open
Abstract
Cardiac hypertrophy can lead to congestive heart failure and is a leading cause of morbidity and mortality worldwide. In recent years, it has been essential to find the treatment and prevention of cardiac hypertrophy. Betulinic acid (BA), the main active ingredient in many natural products, is known to have various physiological effects. However, as the potential effect of BA on cardiac hypertrophy and consequent renal dysfunction is unknown, we investigated the effect of BA on isoprenaline (ISO)-induced cardiac hypertrophy and related signaling. ISO was known to induce left ventricular hypertrophy by stimulating the β2-adrenergic receptor (β2AR). ISO was injected into Sprague Dawley rats (SD rats) by intraperitoneal injection once a day for 28 days to induce cardiac hypertrophy. From the 14th day onwards, the BA (10 or 30 mg/kg/day) and propranolol (10 mg/kg/day) were administered orally. The study was conducted in a total of 5 groups, as follows: C, control; Is, ISO (10 mg/kg/day); Pr, positive-control, ISO + propranolol (10 mg/kg/day); Bl, ISO + BA (10 mg/kg/day); Bh, ISO + BA (30 mg/kg/day). As a result, the total cardiac tissue and left ventricular tissue weights of the ISO group increased compared to the control group and were significantly reduced by BA treatment. In addition, as a result of echocardiography, the effect of BA on improving cardiac function, deteriorated by ISO, was confirmed. Cardiac hypertrophy biomarkers such as β-MHC, ANP, BNP, LDH, and CK-MB, which were increased by ISO, were significantly decreased by BA treatment. Also, the cardiac function improvement effect of BA was confirmed to improve cardiac function by inhibiting calcineurin/NFATc3 signaling. Renal dysfunction is a typical complication caused by cardiac hypertrophy. Therefore, the study of renal function indicators, creatinine clearance (Ccr) and osmolality (BUN) was aggravated by ISO treatment but was significantly restored by BA treatment. Therefore, it is thought that BA in cardiac hypertrophy can be used as valuable data to develop as a functional material effective in improving cardiac-renal dysfunction.
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Affiliation(s)
- Mi-Hyeon Hong
- Hanbang Cardio-Renal Research Center, Wonkwang University, Iksan 54538, Korea; (M.-H.H.); (S.-W.N.); (Y.-J.J.); (J.-J.Y.); (Y.-J.L.); (H.-S.L.)
- College of Oriental Medicine and Professional Graduate School of Oriental Medicine, Wonkwang University, Iksan 54538, Korea
| | - Se-Won Na
- Hanbang Cardio-Renal Research Center, Wonkwang University, Iksan 54538, Korea; (M.-H.H.); (S.-W.N.); (Y.-J.J.); (J.-J.Y.); (Y.-J.L.); (H.-S.L.)
- College of Oriental Medicine and Professional Graduate School of Oriental Medicine, Wonkwang University, Iksan 54538, Korea
| | - Youn-Jae Jang
- Hanbang Cardio-Renal Research Center, Wonkwang University, Iksan 54538, Korea; (M.-H.H.); (S.-W.N.); (Y.-J.J.); (J.-J.Y.); (Y.-J.L.); (H.-S.L.)
- College of Oriental Medicine and Professional Graduate School of Oriental Medicine, Wonkwang University, Iksan 54538, Korea
| | - Jung-Joo Yoon
- Hanbang Cardio-Renal Research Center, Wonkwang University, Iksan 54538, Korea; (M.-H.H.); (S.-W.N.); (Y.-J.J.); (J.-J.Y.); (Y.-J.L.); (H.-S.L.)
| | - Yun-Jung Lee
- Hanbang Cardio-Renal Research Center, Wonkwang University, Iksan 54538, Korea; (M.-H.H.); (S.-W.N.); (Y.-J.J.); (J.-J.Y.); (Y.-J.L.); (H.-S.L.)
| | - Ho-Sub Lee
- Hanbang Cardio-Renal Research Center, Wonkwang University, Iksan 54538, Korea; (M.-H.H.); (S.-W.N.); (Y.-J.J.); (J.-J.Y.); (Y.-J.L.); (H.-S.L.)
- College of Oriental Medicine and Professional Graduate School of Oriental Medicine, Wonkwang University, Iksan 54538, Korea
| | - Hye-Yoom Kim
- Hanbang Cardio-Renal Research Center, Wonkwang University, Iksan 54538, Korea; (M.-H.H.); (S.-W.N.); (Y.-J.J.); (J.-J.Y.); (Y.-J.L.); (H.-S.L.)
| | - Dae-Gill Kang
- Hanbang Cardio-Renal Research Center, Wonkwang University, Iksan 54538, Korea; (M.-H.H.); (S.-W.N.); (Y.-J.J.); (J.-J.Y.); (Y.-J.L.); (H.-S.L.)
- College of Oriental Medicine and Professional Graduate School of Oriental Medicine, Wonkwang University, Iksan 54538, Korea
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Ojo T, Ryan N, Birkemeier J, Appleton N, Ampomah I, Glozah F, Adongo PB, Adanu R, Boden-Albala B. Adapting a skills-based stroke prevention intervention for communities in Ghana: a qualitative study. Implement Sci Commun 2020; 1:104. [PMID: 33292870 PMCID: PMC7672911 DOI: 10.1186/s43058-020-00084-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 10/08/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Stroke is a major cause of death in Ghana. Evidence-based interventions for stroke prevention have been successful in the US; however, in low- and middle-income countries (LMICs), such interventions are scarce. The "Discharge Education Strategies for Reduction of Vascular Events" (DESERVE) intervention led to a 10-mmHg reduction in systolic blood pressure (SBP) among Hispanic survivors of mild/moderate stroke and transient ischemic attack (TIA) at 1-year follow-up. Our objectives were to capture the perceptions of a diverse set of stakeholders in an urban community in Ghana regarding (1) challenges to optimal hypertension management and (2) facilitators and barriers to implementation of an evidence-based, skills-based educational tool for hypertension management in this context. METHODS This exploratory study used purposive sampling to enroll diverse stakeholders in Accra (N = 38). To identify facilitators and barriers, we conducted three focus group discussions: one each with clinical nurses (n = 5), community health nurses (n = 20), and hypertensive adults (n = 10). To further examine structural barriers, we conducted three key informant interviews with medical leadership. All interviews were audio recorded and transcribed. Thematic analysis was carried out via deductive coding based on Proctor's implementation outcomes taxonomy, which conceptualizes constructs that shape implementation, such as acceptability, adoption, appropriateness, cost, and feasibility. RESULTS Findings highlight facilitators, such as a perceived fit (appropriateness) of the core intervention components across stakeholders. The transferable components of DESERVE include: (1) a focus on risk knowledge, medication adherence, and patient-physician communication, (2) facilitation by lay workers, (3) use of patient testimonials, (4) use of a spirituality framework, and (5) application of a community-based approach. We report potential barriers that suggest adaptations to increase appropriateness and feasibility. These include addressing spiritual etiology of disease, allaying mistrust of biomedical intervention, and tailoring for gender norms. Acceptability may be a challenge among individuals with hypertension, who perceive relative advantage of alternative therapies like herbalism. Key informant interviews highlight structural barriers (high opportunity costs) among physicians, who perceive they have neither time nor capacity to educate patients. CONCLUSIONS Findings further support the need for theory-driven, evidence-based interventions among hypertensive adults in urban, multiethnic Ghana. Findings will inform implementation strategies and future research.
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Affiliation(s)
- Temitope Ojo
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA.
| | - Nessa Ryan
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
| | - Joel Birkemeier
- Global Health Program, New York University School of Global Public Health, New York, NY, USA
| | - Noa Appleton
- Department of Population Health, New York University Langone Health, New York, NY, USA
| | | | - Franklin Glozah
- Department of Social and Behavioral Sciences, University of Ghana School of Public Health, Accra, Ghana
| | - Philip Baba Adongo
- Department of Social and Behavioral Sciences, University of Ghana School of Public Health, Accra, Ghana
| | - Richard Adanu
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Bernadette Boden-Albala
- Departments of Health Society and Behavior and Epidemiology, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
- Department of Neurology, School of Medicine, University of California, Irvine, CA, USA
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Marshall J, Scott B, Delva J, Ade C, Hernandez S, Patel J, Moreno-Cheek M, Rojas D, Tanner JP, Kirby RS. An Evaluation of Florida's Zika Response Using the WHO Health Systems Framework: Can We Apply These Lessons to COVID-19? Matern Child Health J 2020; 24:1212-1223. [PMID: 32583172 PMCID: PMC7314660 DOI: 10.1007/s10995-020-02969-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES From 2016 to 2018 Florida documented 1471 cases of Zika virus, 299 of which were pregnant women (Florida Department of Health, https://www.floridahealth.gov/diseases-and-conditions/mosquito-bornediseases/surveillance.html , 2019a). Florida's response required unprecedented rapid and continuous cross-sector communication, adaptation, and coordination. Zika tested public health systems in new ways, particularly for maternal child health populations. The systems are now being challenged again, as the Coronavirus COVID-19 pandemic spreads throughout Florida. This qualitative journey mapping evaluation of Florida's response focused on care for pregnant women and families with infants exposed to Zika virus. METHODS Fifteen focus groups and interviews were conducted with 33 public health and healthcare workers who managed outbreak response, case investigations, and patient care in south Florida. Data were thematically analyzed, and the results were framed by the World Health Organization's (WHO) Healthcare Systems Framework of six building blocks: health service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership and governance (World Health Organization, https://www.who.int/healthsystems/strategy/everybodys_business.pdf , 2007, https://www.who.int/healthinfo/systems/monitoring/en/ , 2010). RESULTS Results highlighted coordination of resources, essential services and treatment, data collection, communication among public health and healthcare systems, and dissemination of information. Community education, testing accuracy and turnaround time, financing, and continuity of health services were areas of need, and there was room for improvement in all indicator areas. CONCLUSIONS The WHO Framework encapsulated important infrastructure and process factors relevant to the Florida Zika response as well as future epidemics. In this context, similarities, differences, and implications for the Coronavirus COVID-19 pandemic response are discussed.
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Affiliation(s)
- Jennifer Marshall
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
| | - Blake Scott
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Jennifer Delva
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Cedrick Ade
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Santiago Hernandez
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Jaladhikumar Patel
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Mantero Moreno-Cheek
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Dogeli Rojas
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Jean-Paul Tanner
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Russell S Kirby
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
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Ampomah IG, Malau-Aduli BS, Malau-Aduli AE, Emeto TI. Effectiveness of Integrated Health Systems in Africa: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E271. [PMID: 32486110 PMCID: PMC7353894 DOI: 10.3390/medicina56060271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/17/2022]
Abstract
Background and objective: Traditional medicine (TM) was integrated into health systems in Africa due to its importance within the health delivery setup in fostering increased health care accessibility through safe practices. However, the quality of integrated health systems in Africa has not been assessed since its implementation. The objective of this paper was to extensively and systematically review the effectiveness of integrated health systems in Africa. Materials and Methods: A systematic literature search was conducted from October, 2019 to March, 2020 using Ovid Medline, Scopus, Emcare, Web of Science, Cumulative Index to Nursing and Allied Health (CINAHL), and Google Scholar, in order to retrieve original articles evaluating the integration of TM into health systems in Africa. A quality assessment of relevant articles was also carried out using the Quality Assessment Tool for Studies with Diverse Designs (QATDSS) critical appraisal tool. Results: The results indicated that the formulation and execution of health policies were the main measures taken to integrate TM into health systems in Africa. The review also highlighted relatively low levels of awareness, usage, satisfaction, and acceptance of integrated health systems among the populace. Knowledge about the existence of an integrated system varied among study participants, while satisfaction and acceptance were low among orthodox medicine practitioners. Health service users' satisfaction and acceptance of the practice of an integrated health system were high in the countries assessed. Conclusion: The review concluded that existing health policies in Africa are not working, so the integration of TM has not been successful. It is critical to uncover the barriers in the health system by exploring the perceptions and experiences of stakeholders, in order to develop solutions for better integration of the two health systems.
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Affiliation(s)
- Irene G. Ampomah
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville QLD 4811, Australia; (I.G.A.); (A.E.O.M.-A.)
| | - Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville QLD 4811, Australia;
| | - Aduli E.O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville QLD 4811, Australia; (I.G.A.); (A.E.O.M.-A.)
| | - Theophilus I. Emeto
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville QLD 4811, Australia; (I.G.A.); (A.E.O.M.-A.)
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Hashimoto K, Adrien L, Rajkumar S. Moving Towards Universal Health Coverage in Haiti. Health Syst Reform 2020; 6:e1719339. [PMID: 32101069 DOI: 10.1080/23288604.2020.1719339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Haiti announced in 2018 its aim to achieve universal health coverage. In this paper, we discuss what this objective means for the country and what next steps should be taken. To contextualize the notion, we framed Haiti en route to the 2030 goal and analyzed qualitatively the status quo in terms of geographic, financial, and service access. For each dimension, we focused on the context, the government's policies and political agendas, their implementation progress, and key influential factors. Our analysis found little progress and numerous challenges. Geographic access was limited due principally to the insufficient number of facilities, difficulties in reaching health facilities, and local customs. Financial coverage was low because of the government's insufficient budgets, inefficient budget allocation, and ineffective management. Service access also had room for significant improvement for a lack of basic infrastructure and resources, gaps between the essential service package guidelines, health professionals' skills, and the needs, as well as deficiencies in people-centered care. These factors affected not only health service coverage but also its quality. We found that the root causes of these issues were composed of unstable financing mechanisms, opportunistic resource allocation, and ineffective management control systems. We suggest that to overcome these issues and achieve universal health coverage with decent service quality, Haiti's health system needs to be reformed by implementing strategic financing, decentralized management systems, and community engagement in primary health care.
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Affiliation(s)
- Ken Hashimoto
- Independent Global Health Consultant (Former Advisor of Japan International Cooperation Agency for the Ministry of Health in Haiti), Kakogawa, Japan
| | - Lauré Adrien
- Direction Générale, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Sunil Rajkumar
- Health, Nutrition & Population, World Bank, Washington, DC, USA
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Macquart de Terline D, Kane A, Kramoh KE, Ali Toure I, Mipinda JB, Diop IB, Nhavoto C, Balde DM, Ferreira B, Dèdonougbo Houenassi M, Ikama MS, Kingue S, Kouam Kouam C, Takombe JL, Limbole E, Mfeukeu Kuate L, N’guetta R, Damorou JM, Sesso Z, Sidy Ali A, Perier MC, Azizi M, Empana JP, Jouven X, Antignac M. Factors associated with poor adherence to medication among hypertensive patients in twelve low and middle income Sub-Saharan countries. PLoS One 2019; 14:e0219266. [PMID: 31291293 PMCID: PMC6619761 DOI: 10.1371/journal.pone.0219266] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/19/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction Over the past few decades, the prevalence of hypertension has dramatically increased in Sub-Saharan Africa. Poor adherence has been identified as a major cause of failure to control hypertension. Scarce data are available in Africa. Aims We assessed adherence to medication and identified socioeconomics, clinical and treatment factors associated with low adherence among hypertensive patients in 12 sub-Saharan African countries. Method We conducted a cross-sectional survey in urban clinics of both low and middle income countries. Data were collected by physicians on demographics, treatment and clinical data among hypertensive patients attending the clinics. Adherence was assessed by questionnaires completed by the patients. Factors associated with low adherence were investigated using logistic regression with a random effect on countries. Results There were 2198 individuals from 12 countries enrolled in the study. Overall, 678 (30.8%), 738 (33.6%), 782 (35.6%) participants had respectively low, medium and high adherence to antihypertensive medication. Multivariate analysis showed that the use of traditional medicine (OR: 2.28, 95%CI [1.79–2.90]) and individual wealth index (low vs. high wealth: OR: 1.86, 95%CI [1.35–2.56] and middle vs. high wealth: OR: 1.42, 95%CI [1.11–1.81]) were significantly and independently associated with poor adherence to medication. In stratified analysis, these differences in adherence to medication according to individual wealth index were observed in low-income countries (p<0.001) but not in middle-income countries (p = 0.17). In addition, 26.5% of the patients admitted having stopped their treatment due to financial reasons and this proportion was 4 fold higher in the lowest than highest wealth group (47.8% vs 11.4%) (p<0.001). Conclusion This study revealed the high frequency of poor adherence in African patients and the associated factors. These findings should be useful for tailoring future programs to tackle hypertension in low income countries that are better adapted to patients, with a potential associated enhancement of their effectiveness.
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Affiliation(s)
- Diane Macquart de Terline
- Department of Pharmacy, Saint Antoine hospital, HUEP, AP-HP, Paris, France
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
- Paris Descartes University, Paris, France
- * E-mail:
| | - Adama Kane
- Cardiology Department, University Hospital of Aristide Le Dantec, Dakar, Senegal
| | | | - Ibrahim Ali Toure
- Internal Medicine and Cardiology Department, University Hospital of Lamorde, Niamey, Niger
| | | | | | | | - Dadhi M. Balde
- Department of Cardiology, University Hospital of Conakry, Conakry, Guinea
| | | | | | - Méo Stéphane Ikama
- Cardiology Department, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | - Samuel Kingue
- University of Yaoundé, Ministry of Public Health, Yaoundé, Cameroon
| | | | | | - Emmanuel Limbole
- Department of Internal Medicine of la Gombe (CMCG), Department of Internal Medicine, Ngaliema Hospital, Kinshasa; Democratic Republic of the Congo
| | | | | | | | | | | | - Marie-Cécile Perier
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
| | - Michel Azizi
- Paris Descartes University, Paris, France
- Hypertension Unit, Assistance-Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- Institut National de la Santé et de la Recherche Médicale, Centre d’Investigation Clinique, Paris, France
| | - Jean Philippe Empana
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
- Paris Descartes University, Paris, France
- Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Marie Antignac
- Department of Pharmacy, Saint Antoine hospital, HUEP, AP-HP, Paris, France
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France
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