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Gumede L, Nkosi PB, Sibiya MN. Allopathic medicine practitioners' experiences with non-disclosure of traditional medicine use. Health SA 2024; 29:2381. [PMID: 38322375 PMCID: PMC10839234 DOI: 10.4102/hsag.v29i0.2381] [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: 03/08/2023] [Accepted: 10/25/2023] [Indexed: 02/08/2024] Open
Abstract
Background A pertinent issue impacting patient treatment outcomes is the nondisclosure of traditional medicine (TM) use to Allopathic medicine practitioners (AMPs). For years, TM has been a controversial practice, with patients often using it alongside allopathic medicine without disclosing their use. It is imperitive to learn and understand the experiences of AMPs regarding the disclosure of TM use in Gauteng province to enable them to provide the best possible treatment outcomes for patients who use TM. Aim This study aimed to explore the experiences of AMPs regarding non-disclosure of TM use in Gauteng province. Setting This study was conducted in four district hospitals where outpatient care and services are rendered in Gauteng Province. Methods An interpretive phenomenological analysis (IPA) design was followed. Fourteen purposefully sampled AMPs participated in face-to-face, one-on-one, and semi-structured interviews. Interpretive phenomenological analysis in Atlas.ti was conducted. Results Three themes emerged: bedside manner of AMPs; stigmatising TM use; and individual belief systems. The belief of patients' disclosure hesitancy because of fear of judgment by the AMPs underpinned these themes. Conclusion Allopathic medicine practitioners are aware that patients who use TM could feel guilty and stigmatised. They acknowledged that patients use TM because of cultural and ethnic reasons, which should not be disregarded. Contribution The study highlighted that patients do not disclose their TM use because of AMPs' attitudes, stigmatising TM use, and their prejudices against the cultural beliefs of patients. Allopathic medicine practitioners should establish good communication with patients by providing patient-centred communication to facilitate disclosure of TM use.
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Affiliation(s)
- Lindiwe Gumede
- Department of Medical Imaging and Radiation Sciences, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Pauline B. Nkosi
- Department of Radiography, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Maureen N. Sibiya
- Faculty of Innovation and Engagement, Mangosuthu University of Technology, Durban, South Africa
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Okyere J, Ayebeng C, Owusu BA, Agbemavi W, Amoako JK, Dickson KS. Utilisation of traditional healers among older people living with HIV in South Africa: a WHO SAGE well-being of older people study. AIDS Res Ther 2023; 20:40. [PMID: 37355619 PMCID: PMC10290787 DOI: 10.1186/s12981-023-00537-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Within the African region, there are an estimated 8 million people living with HIV (PLHIV) in South Africa. Seeking healthcare services from traditional healers (TH) is one of the alternative and complementary approaches to HIV/AIDS treatment. Identifying the associated factors of TH utilisation among older PLHIV is crucial in developing healthcare interventions that cater to the unique needs of this vulnerable group. This study investigated the factors associated with TH utilisation among older PLHIV. METHODS We studied 516 older PLHIV using data from the WHO SAGE Well-Being of Older People Study (2011-2013). Chi-square, bivariate and multivariate logistic regression were computed in STATA Version 14. The results were presented with both crude and adjusted odds ratio (AOR) and at 95% confidence interval (CI). RESULTS Of the 516 participants, 15.89% utilised TH. The major reason for TH utilisation among older PLHIV was the perception of receiving better healthcare services from TH (51.2%) and the flexibility to pay with goods instead of money (14.6%). The factors associated with TH utilisation were age [AOR = 0.05; CI 0.01, 0.37], being hypertensive [AOR = 2.07; CI 1.04, 4.11], and having more than four servings of fruits [AOR = 10.64; CI 2.95, 38.34]. TH utilisation was significantly lower among those who visited the clinic once or twice [AOR = 0.17; CI 0.05, 0.63], three to six times [AOR = 0.16; CI 0.05, 0.56], and more than 6 times [AOR = 0.09; CI 0.03, 0.34] compared to those who had no clinic visits. CONCLUSION In conclusion, a low proportion of TH utilisation was reported among older PLHIV in South Africa. TH utilisation is associated with age, hypertension status, frequency of clinic visits and fruit servings consumed. Our study suggests that being hypertensive was a motivating factor for older PLHIV to utilise TH. Therefore, it is imperative for the South African health department to integrate the services of TH into the mainstream health system to manage non-communicable diseases, particularly hypertension, among older PLHIV.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Castro Ayebeng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Wonder Agbemavi
- School of Demography, Australian National University, Canberra, Australia
| | - Joseph Kwarteng Amoako
- Department of Molecular Biology and Biotechnology, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Cape Coast, Ghana
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Gittings L, Colvin C, Hodes R. Traditional and biomedical health practices of adolescent boys and young men living with perinatally-acquired HIV in the Eastern Cape Province of South Africa. Glob Public Health 2023; 18:2205917. [PMID: 37156226 PMCID: PMC10660542 DOI: 10.1080/17441692.2023.2205917] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 04/11/2023] [Indexed: 05/10/2023]
Abstract
Men are less vulnerable to HIV acquisition than women, but have poorer HIV-related health outcomes. They access HIV services less, and are more likely to die on antiretroviral therapy. The adolescent epidemic presents further challenges, and AIDS-related illness is the leading cause of death among adolescents in sub-Saharan Africa. We explored the health practices of adolescent boys and young men (aged 13-22) living with perinatally-acquired HIV and the processes through which these practices are formed and sustained. We engaged health-focused life history narratives (n = 35), semi-structured interviews (n = 32) and analysis of health facility files (n = 41), alongside semi-structured interviews with traditional and biomedical health practitioners (n = 14) in the Eastern Cape, South Africa. Participants did not access traditional products and services for HIV, a finding that deviates from much of the literature. Findings suggest that health practices are mediated not only by gender and culture, but also childhood experiences of growing up deeply embedded in the biomedical health system.
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Affiliation(s)
- Lesley Gittings
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Christopher Colvin
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Rebecca Hodes
- Centre for Sexualities, AIDS & Gender, University of Pretoria, Pretoria, South Africa
- Department of Historical and Heritage Studies, University of Pretoria, Pretoria, South Africa
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Feyissa M, Gedif Fenta T, Asres K, Gebremariam T. Prevalence, Perception and Predictors of Concomitant Herbal Medicine Use among HIV/AIDS and Tuberculosis Patients in Metekel Zone, Northwest Ethiopia: A Cross-Sectional Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:8235229. [PMID: 36437829 PMCID: PMC9691294 DOI: 10.1155/2022/8235229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 12/18/2023]
Abstract
BACKGROUND The use of herbal medicine is common in Ethiopia. However, evidence on the extent and predictors of concomitant use of herbal medicine with conventional treatment among HIV/AIDS and tuberculosis patients is limited. OBJECTIVE To assess the extent of concomitant use of herbal medicine with conventional therapy and associated factors among HIV/AIDS and tuberculosis patients in Metekel Zone, Northwest Ethiopia. METHOD A cross-sectional study was conducted from January to March 2020. HIV/AIDS and tuberculosis patients who visited the health facilities during the study were interviewed face-to-face using a structured and pretested questionnaire. The descriptive statistics and univariate and multivariate logistic regression analyses were conducted using SPSS version 25. A P-value of <0.05 was considered significant. RESULTS 412 patients on conventional treatment were included in this study; 355 (86.2%) were HIV patients, and 57 (13.8%) were TB patients. More than half, 217 (52.7%) participants reported using herbal medicine while on conventional therapy. Among those who claimed to have used herbal medicines, 32 (14.7%) received herbal medicine from traditional healers. About four of five herbal users did not disclose their use to their healthcare providers. The type of health facility on follow-up (P=0.03), disease status (P=0.01), occupation (P=0.02), discontinuing ART (P=0.03), and encountering side (P=0.04) were the determinant factors for the use of herbal medicine among our study participants. CONCLUSION In the Metekel Zone, concomitant consumption of herbal medication is common among HIV/AIDS and tuberculosis patients. Furthermore, most patients did not disclose the healthcare practitioners about their herbal use. Therefore, healthcare practitioners must assess and counsel patients regarding the potential adverse effects and herb-drug interaction to optimize therapy.
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Affiliation(s)
- Mamo Feyissa
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teferi Gedif Fenta
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kaleab Asres
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsige Gebremariam
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Volpe-Zanutto F, Vora LK, Tekko IA, McKenna PE, Permana AD, Sabri AH, Anjani QK, McCarthy HO, Paredes AJ, Donnelly RF. Hydrogel-forming microarray patches with cyclodextrin drug reservoirs for long-acting delivery of poorly soluble cabotegravir sodium for HIV Pre-Exposure Prophylaxis. J Control Release 2022; 348:771-785. [PMID: 35738464 DOI: 10.1016/j.jconrel.2022.06.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/31/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
Hydrogel-forming microarray patches (HF-MAPs) offer minimally invasive, pain-free and prolonged drug delivery. These devices are designed to be self-administered and self-disabling, avoiding contaminated sharps waste generation. Cabotegravir sodium (CAB-Na) is a poorly soluble anti- human immunodeficiency virus (HIV) drug for the treatment and pre-exposure prophylaxis of HIV infection that lends itself to depot formation following intradermal delivery but presents significant challenges when delivered via HF-MAPs, whose nature is aqueous. Herein, we have investigated, for the first time, the use of hydroxypropyl-β-cyclodextrin (HP-β-CD) to enhance the solubility of CAB-Na, and its effect on intradermal delivery via HF-MAPs. Accordingly, tablet reservoirs containing CAB-Na and HP-β-CD were formulated. These novel reservoirs were combined with two different HF-MAP formulations (MAP1 (Gantrez S97® + poly (ethylene glycol) 10,000 + Na2CO3) and MAP2 (poly (vinyl pyrrolidone) 58 kDa + poly (vinyl alcohol) 85-120 kDa + citric acid)) to form fully integrated MAP devices which were tested in both ex vivo and in vivo settings. Ex vivo skin deposition results for MAP1 and MAP2 showed that 141 ± 40 μg and 342 ± 34 μg of CAB-Na was deposited into 0.5 cm2 of excised neonatal porcine skin after 24 h, respectively. Based on these findings, the in vivo pharmacokinetics of MAP2 were investigated over 28 days using a Sprague-Dawley rat model. After 24 h patch application, MAP2 demonstrated an extended drug release profile and an observed Cmax of 53.4 ± 10.16 μg/mL, superior to that of an FDA-approved CAB-nanosuspension administered via intramuscular application (Cmax of 43.6 ± 5.3 μg/mL). Consequently, this tablet integrated MAP device is considered to be a viable option for the intradermal delivery of hydrophobic anti-HIV drugs.
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Affiliation(s)
- Fabiana Volpe-Zanutto
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; Faculty of Pharmaceutical Sciences, R. Cândido Portinari, 200 - Cidade Universitária, Campinas - SP, 13083-871, University of Campinas, Brazil
| | - Lalitkumar K Vora
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Ismaiel A Tekko
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; Faculty of Pharmacy, Aleppo University, Syria
| | - Peter E McKenna
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Andi Dian Permana
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; Department of Pharmaceutics, Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia
| | - Akmal H Sabri
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Qonita K Anjani
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Helen O McCarthy
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Alejandro J Paredes
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK.
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Muniroh L, Mahmudah, Solfaine R. Effect of Tithonia diversifolia Leaf Extract on Leptin, Adiponectin, and Insulin Receptor Levels in Diabetic Rats. Prev Nutr Food Sci 2022; 27:63-69. [PMID: 35465110 PMCID: PMC9007713 DOI: 10.3746/pnf.2022.27.1.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 12/02/2022] Open
Abstract
This study aimed to evaluate the effect of Tithonia diversifolia extract (TDE) on leptin, adiponectin, and insulin receptor (IR) concentrations in diabetic rats. Twenty-four Wistar rats were divided into a control and treatment groups (n=6 per group). The control group received normal saline, and the treatment groups received 0.25% sodium carboxymethyl cellulose, TDE at 100 mg/kg body weight (bw), and catechin at 10 mg/kg bw for 7 days. On day 8, the rats were sacrificed, blood samples were obtained, and leptin, adiponectin, and insulin concentrations were measured using avidinhorseradish peroxidase sandwich-enzyme-linked immunosorbent assay. A calorimetric method was used to measure blood glucose (BG) and total serum cholesterol concentrations. The pancreas and kidneys were collected for the measurement of renal IR and macrophage cluster of differentiation (CD)14 levels using immunohistochemical staining. Acute type 2 diabetes mellitus (T2DM) with elevated BG and total serum cholesterol concentrations was observed in the treatment groups administered streptozotocin. The administration of TDE at 100 mg/kg bw significantly decreased leptin and increased adiponectin concentrations (P≤0.05). Furthermore, TDE treatment significantly increased renal IR and decreased macrophage CD14 levels (P<0.05). Therefore, TDE decreased leptin and BG concentrations by increasing IR levels. TDE also suppressed the necrosis of pancreatic tissues by inhibiting macrophage CD14 expression in diabetic rats. However, further research is necessary to determine the effect of TDE on interleukin and IR levels in the related tissues of patients with T2DM.
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Affiliation(s)
- Lailatul Muniroh
- Department of Nutrition, Biostatistics, Population, and Health Promotion, Faculty of Public Health, Universitas Airlangga, Kampus C UNAIR, Surabaya 60115, Indonesia
| | - Mahmudah
- Department of Epidemiology, Biostatistics, Population, and Health Promotion, Faculty of Public Health, Universitas Airlangga, Kampus C UNAIR, Surabaya 60115, Indonesia
| | - Rondius Solfaine
- Department of Pathology, Faculty of Veterinary Medicine, University of Wijaya Kusuma Surabaya, Surabaya 60225, Indonesia
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Sundararajan R, Langa PV, Morshed T, Manuel S. Traditional healers as client advocates in the HIV-endemic region of Maputo, Mozambique: results from a qualitative study. SAHARA J 2021; 18:77-85. [PMID: 33902401 PMCID: PMC8081305 DOI: 10.1080/17290376.2021.1909492] [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] [Indexed: 01/19/2023] Open
Abstract
Traditional healers are commonly utilised throughout sub-Saharan Africa instead of - and in concert with - biomedical facilities. Traditional healers are trusted providers and prominent community members and could be important partners in improving engagement with HIV services in endemic contexts. Our study sought to understand the roles of healers in the urban setting of Maputo, Mozambique, where HIV prevalence is high and testing rates are low. Qualitative data were gathered through minimally structured interviews with 36 healers. Analysis followed an inductive, grounded theory approach. Data reveal three themes relevant to improving engagement with HIV services in this endemic region: (1) healers have positive attitudes towards biomedicine; (2) healers advocate for their sick clients and (3) clients are reticent to present to biomedical facilities. Healers describe their roles as 'cooperative' with biomedical providers to provide healthcare for their clients. Results suggest that healers could be considered critical enablers to effective HIV programmes in communities. They have social and symbolic capital that positions them to beneficially influence clients and are natural partners for interventions to improve uptake of HIV services.
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Affiliation(s)
| | - Patricio V. Langa
- Faculty of Arts and Social Sciences, Universidade Eduardo Mondlane, Maputo City, Mozambique
| | - Trisha Morshed
- Emergency Medicine, Banner Medical Center, Vituity Physician Group, Sun City, AZ, USA
| | - Sandra Manuel
- Faculty of Education, Universidade Eduardo Mondlane, Maputo City, Mozambique
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Taneri PE, Akis N, Karaalp A. Herbal product use patterns and possible herb-drug interactions among older adults in Turkey. J Herb Med 2021. [DOI: 10.1016/j.hermed.2021.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hughes GD, Aboyade OM, Okonji CO, Clark B, Mabweazara SZ. Comparison of the prevalence of non-communicable diseases and traditional herbal medicine use in urban and rural communities in South Africa. ADVANCES IN INTEGRATIVE MEDICINE 2021. [DOI: 10.1016/j.aimed.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Matyanga CMJ, Morse GD, Gundidza M, Ndawana B, Reid A, Chitsike I, Nhachi CFB. Impact of acute, oral ingestion of hypoxoside from African potato on hepatic and renal function tests in HIV infected patients on combination antiretroviral therapy. J Herb Med 2021; 26. [PMID: 33585170 DOI: 10.1016/j.hermed.2021.100427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives African potato (hypoxis hemerocallidea) is used against HIV to enhance immune-function, although no studies have evaluated its use in HIV infected individuals on combination antiretroviral therapy. The study aimed to evaluate the acute effects of orally administered hypoxoside, a constituent of African potato, on the hepatic and renal function in HIV infected individuals on tenofovir disoproxil fumarate/ lamivudine/ efavirenz regimen. Methods This was an open-label, two-period, fixed-sequence, pre-post test study, pilot design. Ethical approval was obtained from Medical Research Council of Zimbabwe (MRCZ A/2045) and Medicines Control Authority of Zimbabwe (MCAZ CT134/2016). Blood samples were collected before and after administration of African potato tablets. Tablets were administered orally once daily at 15mg/ kg hypoxoside for 10 days. Hepatic function tests (ALT, AST, ALP, GGT, albumin, total/ direct bilirubin); renal function tests (eGFR, blood urea nitrogen, creatinine), serum electrolytes (sodium, potassium, chloride) were assayed. STATA was used for statistical analysis. Results Twenty-six participants were enrolled (85% female). Median age (range) was 43 (28-52) years. Most had overweight Body Mass Index (46%) and were married (54%). No statistical difference was noted during hypoxoside for AST/ ALT/ ALP/ GGT/ albumin/ bilirubin. There were no changes in creatinine/ eGFR/ electrolytes. A mean significant increase in total protein (p=0.04) and decrease in blood urea nitrogen (p=0.04) were noted. Conclusion Short-term exposure to hypoxoside from African potato appeared safe and was not associated with clinically significant changes in hepatic, renal function tests/electrolytes. There is further need to evaluate extent of systemic exposure during long-term use in a larger population.
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Affiliation(s)
- Celia M J Matyanga
- Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Gene D Morse
- Center for Integrated Global Biomedical Sciences; School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, New York, United States
| | - Mazuru Gundidza
- Department of Pharmaceutical Technology, School of Industrial Sciences and Technology, Harare Institute of Technology, Belvedere, Harare, Zimbabwe
| | - Billy Ndawana
- Harare Municipality Medical Aid Laboratories (HMMI), 133 Nelson Mandela, Corner 6th Street, Harare, Zimbabwe
| | - Andrew Reid
- Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Inam Chitsike
- Department of Pediatrics, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Charles F B Nhachi
- Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Sundararajan R, Mwanga-Amumpaire J, King R, Ware NC. Conceptual model for pluralistic healthcare behaviour: results from a qualitative study in southwestern Uganda. BMJ Open 2020; 10:e033410. [PMID: 32317259 PMCID: PMC7204928 DOI: 10.1136/bmjopen-2019-033410] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Medical pluralism, or concurrent utilisation of multiple therapeutic modalities, is common in various international contexts, and has been characterised as a factor contributing to poor health outcomes in low-resource settings. Traditional healers are ubiquitous providers in most regions, including the study site of southwestern Uganda. Where both informal and formal healthcare services are both available, patients do not engage with both options equally. It is not well understood why patients choose to engage with one healthcare modality over the other. The goal of this study was to explain therapeutic itineraries and create a conceptual framework of pluralistic health behaviour. METHODS In-depth interviews were conducted from September 2017 to February 2018 with patients seeking care at traditional healers (n=30) and at an outpatient medicine clinic (n=30) in Mbarara, Uganda; the study is nested within a longitudinal project examining HIV testing engagement among traditional healer-using communities. Inclusion criteria included age ≥18 years, and ability to provide informed consent. Participants were recruited from practices representing the range of healer specialties. Following an inductive approach, interview transcripts were reviewed and coded to identify conceptual categories explaining healthcare utilisation. RESULTS We identified three broad categories relevant to healthcare utilisation: (1) traditional healers treat patients with 'care'; (2) biomedicine uses 'modern' technologies and (3) peer 'testimony' influences healthcare engagement. These categories describe variables at the healthcare provider, healthcare system and peer levels that interrelate to motivate individual engagement in pluralistic health resources. CONCLUSIONS Patients perceive clear advantages and disadvantages to biomedical and traditional care in medically pluralistic settings. We identified factors at the healthcare provider, healthcare system and peer levels which influence patients' therapeutic itineraries. Our findings provide a basis to improve health outcomes in medically pluralistic settings, and underscore the importance of recognising traditional healers as important stakeholders in community health.
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Affiliation(s)
- Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Rachel King
- Global Health Sciences, UCSF Medical Center, San Francisco, California, USA
| | - Norma C Ware
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Torgersen J, Bellamy SL, Ratshaa B, Han X, Mosepele M, Zuppa AF, Vujkovic M, Steenhoff A, Bisson GP, Gross R. Impact of Efavirenz Metabolism on Loss to Care in Older HIV+ Africans. Eur J Drug Metab Pharmacokinet 2019; 44:179-187. [PMID: 30168000 PMCID: PMC6420397 DOI: 10.1007/s13318-018-0507-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE: Efavirenz is commonly used in Africa and is frequently associated with neurocognitive toxicity, which may compromise clinical outcomes. Older individuals are at increased risk for drug toxicity and clinical outcomes may be worse in older age, particularly among those individuals with cytochrome P450 (CYP) 2B6 polymorphisms associated with slower efavirenz metabolism. The aim of this study was to determine if the CYP2B6 polymorphisms differentially impacts loss to care in older people. METHODS We conducted a prospective cohort study of 914 treatment-naïve HIV+ adults initiating efavirenz-based antiretroviral treatment at public HIV clinics in Gaborone, Botswana between 2009 and 2013. Older age, defined as age ≥ 50 years, was the primary exposure and loss to care at 6 months was the primary outcome. Interaction between age and CYP2B6 516G>T and 983T>C polymorphisms, defined as extensive, intermediate, and slow metabolism, was assessed. Neurocognitive toxicity was measured using a symptom questionnaire. Age-stratified logistic regression was performed to identify factors associated with loss to care. RESULTS Older age was associated with loss to care (OR 1.95, 95% CI 1.30-2.92). Age modified the effect of CYP2B6 genotype on loss to care with older, slow metabolizers at over four-fold higher risk when compared to older, intermediate metabolizers (OR 4.06 95% CI 1.38-11.89); neurocognitive toxicity did not mediate this risk. CYP2B6 metabolism genotype did not increase risk of loss to care in younger participants. CONCLUSION Older age was associated with loss to care, especially among those with slow efavirenz metabolism. Understanding the relationship between older age and CYP2B6 genotype will be important to improving outcomes in an aging population initiating efavirenz-based ART in similar settings.
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Affiliation(s)
- Jessie Torgersen
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Scarlett L. Bellamy
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | | | - Xiaoyan Han
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Athena F Zuppa
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marijana Vujkovic
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrew Steenhoff
- Botswana UPenn Partnership, Gaborone, Botswana
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gregory P. Bisson
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Gross
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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James PB, Kaikai AI, Bah AJ, Steel A, Wardle J. Herbal medicine use during breastfeeding: a cross-sectional study among mothers visiting public health facilities in the Western area of Sierra Leone. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:66. [PMID: 30876454 PMCID: PMC6420723 DOI: 10.1186/s12906-019-2479-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 03/11/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The use of medications, including herbal medicines during breastfeeding is always a concern among women. Currently, there is no published evidence on whether Sierra Leonean women use herbal medicine during breastfeeding. This study investigates the prevalence, correlates and pattern of herbal medicine use during breastfeeding. METHODOLOGY We conducted a cross-sectional study among 378 current breastfeeding mothers visiting public healthcare facilities within the Western area of Sierra Leone. Descriptive statistics and logistic regression analysis were used for data analysis. RESULTS Over a third of mothers (n = 140, 37.0%) used herbal medicine during breastfeeding. However, very few herbal medicine users (2.1%, n = 3) used herbal medicine to augment breastfeeding. Dietary changes were the most common method used to increase breast milk supply (93.9%, n = 355) with cassava leaves sauce and tubers being the most common dietary addition. Mothers with children more than six months old were more likely to use herbal medicine than mothers with younger children (OR:1.8; CI:1.13-2.85,p = 0.013). Among herbal medicine users, only 11.4% (n = 16) disclosed their herbal medicine use to their conventional healthcare providers. CONCLUSION The use of herbal medicine among breastfeeding mothers attending public health facilities in the Western area of Sierra Leone is common. Whilst this use is not usually specific to increasing breast milk supply, our study indicates that herbal medicines may be used to 'cleanse' initial breast milk.
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Affiliation(s)
- Peter Bai James
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007 Australia
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Angela Isata Kaikai
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007 Australia
- Endeavour College of Natural Health, 269 Wickham St, Fortitude Valley, QLD 4006 Australia
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007 Australia
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James PB, Wardle J, Steel A, Adams J. Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review. BMJ Glob Health 2018; 3:e000895. [PMID: 30483405 PMCID: PMC6231111 DOI: 10.1136/bmjgh-2018-000895] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 12/31/2022] Open
Abstract
Background The WHO estimates that a considerable number of people in Sub-Saharan Africa (SSA) rely on traditional, complementary and alternative medicine (TCAM) to meet their primary healthcare needs, yet there remains a dearth of research evidence on the overall picture of TCAM utilisation in the region. Methods We conducted a literature search of original articles examining TCAM use in SSA between 1 January 2006 and 28 February 2017, employing Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Scopus, ProQuest, PubMed, Embase and African Journals Online databases. A critical appraisal of relevant articles reporting a quantitative or mixed-method design was undertaken. Results Despite the heterogeneity and general low quality of the identified literature, the review highlights a relatively high use of TCAM alone or in combination with orthodox medicine, in both general population and in specific health conditions in SSA. TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, while there were inconsistencies in age, sex, spatial location and religious affiliation between TCAM users and non-TCAM users. Most TCAM users (55.8%–100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for non-disclosure being fear of receiving improper care, healthcare providers’ negative attitude and a lack of enquiry about TCAM use from healthcare providers. Conclusion TCAM use in SSA is significant, although most studies emerge from a few countries. Factors associated with TCAM use in SSA are similar to those observed in other regions, but further research may be required to further elucidate challenges and opportunities related to TCAM use specific to SSA.
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Affiliation(s)
- Peter Bai James
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Office of Research, Endeavour College of Natural Health, Brisbane, Queensland, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Zuma T, Wight D, Rochat T, Moshabela M. Navigating Multiple Sources of Healing in the Context of HIV/AIDS and Wide Availability of Antiretroviral Treatment: A Qualitative Study of Community Participants' Perceptions and Experiences in Rural South Africa. Front Public Health 2018; 6:73. [PMID: 29594094 PMCID: PMC5857548 DOI: 10.3389/fpubh.2018.00073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/22/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND South Africa introduced the world's largest antiretroviral treatment (ART) program in 2004 and since 2016 the Department of Health implemented a universal Treatment as Prevention (TasP) strategy. However, some studies have shown that increasing the availability of ART is insufficient for the comprehensive treatment of HIV, since many people still use traditional health practitioners (THPs) to avoid being identified as HIV positive, and for reasons unrelated to HIV/AIDS. This qualitative study explored the factors influencing how both HIV-negative and HIV-positive people choose amongst multiple sources of healing and how they engage with them, in the context of HIV/AIDS and wide availability of ART. METHODS Data were collected as part of a larger TasP trial at the Africa Health Research Institute, KwaZulu-Natal. Repeat in-depth individual interviews were conducted with 10 participants. Repeat group discussions were conducted with 42 participants. Group discussion data were triangulated using community walks and photo-voice techniques to give more insight into the perceptions of community members. All data were collected over 18 months. Thematic analysis was used to analyze participants' narratives from both individual interviews and group discussions. FINDINGS In the context of HIV/AIDS and wide availability of ART, use of biomedical and traditional healing systems seemed to be common in this locality. People used THPs to meet family expectations, particularly those of authoritative heads of households such as parents or grandparents. Most participants believed that THPs could address specific types of illnesses, especially those understood to be spiritually caused and which could not be addressed or cured by biomedical practitioners. However, it was not easy for participants to separate some spiritually caused illnesses from biological illnesses in the context of HIV/AIDS. These data demonstrate that in this context, the use of THPs continues regardless of the wide availability of ART. To meet the health care needs of those patients requiring a health care system which combines biomedical and traditional approaches, collaboration and integration of biomedical and traditional health care should be considered.
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Affiliation(s)
- Thembelihle Zuma
- Africa Health Research Institute, Mtubatuba, South Africa
- School of Nursing and Public Health University of KwaZulu-Natal, Durban, South Africa
| | - Daniel Wight
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Tamsen Rochat
- Human Sciences Research Council/Human and Social Development (HSD), MRC Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of Witwatersrand, Durban, South Africa
| | - Mosa Moshabela
- Africa Health Research Institute, Mtubatuba, South Africa
- Discipline of Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Weintraub A, Mantell JE, Holt K, Street RA, Wilkey C, Dawad S, Masvawure TB, Hoffman S. 'These people who dig roots in the forests cannot treat HIV': Women and men in Durban, South Africa, reflect on traditional medicine and antiretroviral drugs. Glob Public Health 2018; 13:115-127. [PMID: 28793809 PMCID: PMC5698148 DOI: 10.1080/17441692.2017.1359326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Relatively few empirical investigations of the intersection of HIV biomedical and traditional medicine have been undertaken. As part of preliminary work for a longitudinal study investigating health-seeking behaviours among newly diagnosed individuals living with HIV, we conducted semi-structured interviews with 24 urban South Africans presenting for HIV testing or newly enrolled in HIV care; here we explored participants' views on African traditional medicine (TM) and biomedical HIV treatment. Notions of acceptance/non-acceptance were more nuanced than dichotomous, with participants expressing views ranging from favourable to reproachful, often referring to stories they had heard from others rather than drawing from personal experience. Respect for antiretrovirals and biomedicine was evident, but indigenous beliefs, particularly about the role of ancestors in healing, were common. Many endorsed the use of herbal remedies, which often were not considered TM. Given people's diverse health-seeking practices, biomedical providers need to recognise the cultural importance of traditional health practices and routinely initiate respectful discussion of TM use with patients.
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Affiliation(s)
- Amy Weintraub
- a HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health , New York State Psychiatric Institute and Columbia University , New York , NY , USA
| | - Joanne E Mantell
- a HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health , New York State Psychiatric Institute and Columbia University , New York , NY , USA
| | - Kelsey Holt
- b Women and Health Initiative , Harvard T.H. Chan School of Public Health , Boston , MA , USA
- c Ibis Reproductive Health , Cambridge , MA , USA
| | - Renée A Street
- d South African Medical Research Council , HIV Prevention Research Unit , Durban , South Africa
| | - Catriona Wilkey
- e Hornby Zeller Associates , Inc. , South Portland , ME , USA
| | - Suraya Dawad
- f The Presidency Republic of South Africa , Pretoria , South Africa
| | - Tsitsi B Masvawure
- g Department of Sociology and Anthropology , College of the Holy Cross , Worcester , MA , USA
| | - Susie Hoffman
- a HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Division of Gender, Sexuality and Health , New York State Psychiatric Institute and Columbia University , New York , NY , USA
- h Joseph Mailman School of Public Health, Department of Epidemiology , Columbia University , New York , NY , USA
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Moshabela M, Bukenya D, Darong G, Wamoyi J, McLean E, Skovdal M, Ddaaki W, Ondeng'e K, Bonnington O, Seeley J, Hosegood V, Wringe A. Traditional healers, faith healers and medical practitioners: the contribution of medical pluralism to bottlenecks along the cascade of care for HIV/AIDS in Eastern and Southern Africa. Sex Transm Infect 2017; 93:sextrans-2016-052974. [PMID: 28736393 PMCID: PMC5739844 DOI: 10.1136/sextrans-2016-052974] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/03/2017] [Accepted: 05/06/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES There are concerns that medical pluralism may delay patients' progression through the HIV cascade-of-care. However, the pathways of impact through which medical pluralism influence the care of people living with HIV (PLHIV) in African settings remain unclear. We sought to establish the manifestation of medical pluralism among PLHIV, and explore mechanisms through which medical pluralism contributes bottlenecks along the HIV care cascade. METHODS We conducted a multicountry exploratory qualitative study in seven health and demographic surveillance sites in six eastern and southern African countries: Uganda, Kenya, Tanzania, Malawi, Zimbabwe and South Africa. We interviewed 258 PLHIV at different stages of the HIV cascade-of-care, 48 family members of deceased PLHIV and 53 HIV healthcare workers. Interviews were conducted using shared standardised topic guides, and data managed through NVIVO 8/10/11. We conducted a thematic analysis of healthcare pathways and bottlenecks related to medical pluralism. RESULTS Medical pluralism, manifesting across traditional, faith-based and biomedical health-worlds, contributed to the care cascade bottlenecks for PLHIV through three pathways of impact. First, access to HIV treatment was delayed through the nature of health-related beliefs, knowledge and patient journeys. Second, HIV treatment was interrupted by availability of alternative options, perceived failed treatment and exploitation of PLHIV by opportunistic traders and healers. Lastly, the mixing of biomedical healthcare providers and treatment with traditional and faith-based options fuelled tensions driven by fear of drug-to-drug interactions and mistrust between providers operating in different health-worlds. CONCLUSION Medical pluralism contributes to delays and interruptions of care along the HIV cascade, and mistrust between health providers. Region-wide interventions and policies are urgently needed in sub-Saharan Africa to minimise potential harm and consequences of medical pluralism for PLHIV. The role of sociocultural beliefs in mediating bottlenecks necessitate adoption of culture-sensitive approaches intervention designs and policy reforms appropriate to the context of sub-Saharan Africa.
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Affiliation(s)
- Mosa Moshabela
- Department of Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Gabriel Darong
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Joyce Wamoyi
- Tanzanian National Institute of Medical Research, Mwanza, Tanzania
| | - Estelle McLean
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi.,London School of Hygiene and Tropical Medicine, London, UK
| | - Morten Skovdal
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Kenneth Ondeng'e
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | | | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - Victoria Hosegood
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,University of Southampton, Southampton, UK
| | - Alison Wringe
- London School of Hygiene and Tropical Medicine, London, UK
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Ilomuanya MO, Okubanjo OO, Azubuike C, Oguntibeju A, Ajiboye D, Maduka C. Evaluation of the frequency of use of herbal drugs with concomitant administration of highly active antiretroviral therapy and its effect on medication adherence in two health care facilities in south western Nigeria. ACTA ACUST UNITED AC 2017. [DOI: 10.5897/jahr2016.0399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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19
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Zuma T, Wight D, Rochat T, Moshabela M. Traditional health practitioners' management of HIV/AIDS in rural South Africa in the era of widespread antiretroviral therapy. Glob Health Action 2017; 10:1352210. [PMID: 28771116 PMCID: PMC5645651 DOI: 10.1080/16549716.2017.1352210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 07/05/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Traditional health practitioners (THPs) have been identified as a key local resource in the fight against human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in South Africa. However, their approaches to the treatment of people living with HIV (PLHIV) have been met with scepticism by some biomedical practitioners amid increasing access to antiretroviral therapy (ART). OBJECTIVE In light of this ambivalence, this study aims to document and identify treatment approaches of THPs to the management of illness among PLHIV in the current era of widespread access to ART. METHODS The study was conducted as part of a larger trial of Treatment as Prevention (TasP) in rural northern Kwa-Zulu Natal, intended to treat PLHIV regardless of CD4 count. Nine THPs were enrolled using purposive and snowballing techniques. Repeat group discussions, triangulated with community walks and photovoice techniques, were conducted. A thematic analysis approach was used to analyse the data. RESULTS Eight of the nine THPs had received training in biomedical aspects of HIV. THPs showed a multilayered decision-making process in managing illness among PLHIV, influenced by the attributes and choices of the THPs. THPs assessed and managed illness among PLHIV based on THP training in HIV/AIDS, THP type, as well as knowledge and experience in the traditional healing practice. Management of illness depended on the patients' report of their HIV status or willingness to test for HIV. CONCLUSIONS THPs' approaches to illness in PLHIV appear to be shifting in light of increasing exposure to HIV/AIDS-related information. Importantly, disclosure of HIV status plays a major role in THPs' management of illness among PLHIV, as well as linkage to HIV testing and care for their patients. Therefore, THPs can potentially enhance the success of ART for PLHIV when HIV status is known.
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Affiliation(s)
- Thembelihle Zuma
- Africa Health Research Institute, Mtubatuba, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Daniel Wight
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Tamsen Rochat
- Human Sciences Research Council/Human and Social Development (HSD) and MRC Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Mosa Moshabela
- Africa Health Research Institute, Mtubatuba, South Africa
- Discipline of Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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20
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Mncengeli S, Manimbulu NM, Panjasaram N. Concurrent use of Antiretroviral and African traditional medicines amongst people living with HIV/AIDS (PLWA) in the eThekwini Metropolitan area of KwaZulu Natal. Afr Health Sci 2016; 16:1118-1130. [PMID: 28479905 PMCID: PMC5398459 DOI: 10.4314/ahs.v16i4.30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND People living with HIV/AIDS (PLWA) often use African Traditional Medicines (ATM) either alone or in combination with Western medicines including Antiretrovirals (ARV). OBJECTIVES To explore the prevalence of concurrent Antiretrovirals (ARV) and African Traditional medicines (ATM) use and determine the effects of any concurrent use on the CD4+ Lymphocyte count and Viral Load (VL) of PLWA in the eThekwini Metropolitan area. METHODS A descriptive and exploratory study was carried out on 360 patients. Information was gathered on patients socioeconomic characteristics, ATM usage, outcome measures of HIV disease progression (CD4+ Count, VL). The data was analysed using descriptive statistics, univariate and multivariate analyses. RESULTS 4.98% (14/281) of the patients used ATM and ARV concurrently during the study period. Over 65% (185/281) reported ATM use before diagnosis with HIV whilst 77.6% (218/281) reported previous ATM use after their HIV diagnosis but before initiation with ARV. Place of residence (p=0.004), age (p<0.001) and education level (P=0.041) were found to be significantly and positively correlated with ATM use. There were no statistically significant changes in mean plasma CD4+ Count and inconclusive effects on VL during the period of the study in the group taking ARV alone when compared with the group using ARV and ATM concomitantly. CONCLUSION Concurrent ARV and ATM use is quite low (4.98%) when compared to ATM use before HIV diagnosis and after HIV diagnosis but before initiation with ARV. This may point to efficient pre-counselling efforts before ARV initiation by health care professionals. This study also demonstrated that there were no significant differences in the CD4+ and inconclusive effects on VL, between patients taking both ARV and ATM concomitantly and those using ARV alone.
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Affiliation(s)
- Sibanda Mncengeli
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal (Westville Campus), Private Bag X54001, Durban 4000. South Africa
| | - Nlooto M Manimbulu
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal (Westville Campus), Private Bag X54001, Durban 4000. South Africa
| | - Naidoo Panjasaram
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal (Westville Campus), Private Bag X54001, Durban 4000. South Africa
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Aboyade OM, Beauclair R, Mbamalu ON, Puoane TR, Hughes GD. Health-seeking behaviours of older black women living with non-communicable diseases in an urban township in South Africa. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:410. [PMID: 27776505 PMCID: PMC5078908 DOI: 10.1186/s12906-016-1378-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 10/06/2016] [Indexed: 12/25/2022]
Abstract
Background Various studies have shown that non-communicable diseases (NCDs) especially diabetes and hypertension are prevalent among older women living in South African urban areas, placing a heavy burden on the healthcare system. This study aimed to understand the health-seeking behaviour, healthcare practices and prevalence of traditional herbal medicine (THM) use among older women self-reporting NCDs from the Prospective Urban Rural Epidemiology study (PURE). Method A homogenous purposive sampling of PURE participants was used to recruit women who were 50 years or older (n = 250). Descriptive statistics were used to examine the number of NCDs reported by the study sample, health seeking behaviour and practices as well as THM use. Logistic regression was also employed to investigate possible associations between reported conditions and THM use or medical pluralism. Results Within the study sample, 72 % self-reported an NCD. Of those with self-reported NCDs, 46 % had one, and 54 % had two or more NCDs. Those with NCDs usually visited public clinics (80 %), relied on doctors (90 %) and nurses (85 %) for health information, and mostly used conventional medicine (CM) to manage high blood pressure (81 %). About 30 % of those with NCDs indicated using THM, of whom 29 (53 %) reported practicing medical pluralism. Participants with dental problems (OR: 3.24, 95 % CI: 1.30–8.20), headaches (OR: 2.42, 95 % CI: 1.24–4.94), heart burn (OR: 2.30, 95 % CI: 1.18–4.48) and severe tiredness (OR: 2.05, 95 % CI: 1.08–3.99) were more likely to use THM. Anxiety and allergies increased the likelihood to practise medical pluralism by five and 20 times, respectively. Conclusion Self-reported NCD with co-morbidities was prevalent among the participants in the study. Most of the study participants utilized state-owned clinics and hospitals for the management of their chronic conditions. THM use was not very common. However, among those who used THM, medical pluralism was prevalent. Family history was the most common reason for THM use, with many THM patrons utilizing these for treatment of a health condition. Older black women with anxiety and allergies were more likely to practise medical pluralism.
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Nlooto M, Naidoo P. Traditional, complementary and alternative medicine use by HIV patients a decade after public sector antiretroviral therapy roll out in South Africa: a cross sectional study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:128. [PMID: 27189225 PMCID: PMC4869398 DOI: 10.1186/s12906-016-1101-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 04/21/2016] [Indexed: 11/16/2022]
Abstract
Background The roll out of antiretroviral therapy in the South African public health sector in 2004 was preceded by the politicisation of HIV-infection which was used to promote traditional medicine for the management of HIV/AIDS. One decade has passed since; however, questions remain on the extent of the use of traditional, complementary and alternative medicine (TCAM) by HIV-infected patients. This study therefore aimed at investigating the prevalence of the use of African traditional medicine (ATM), complementary and alternative medicines (CAM) by adult patients in the eThekwini and UThukela Health Districts, South Africa. Methods A cross- sectional study was carried out at 8 public health sector antiretroviral clinics using interviewer-administered semi-structured questionnaires. These were completed from April to October 2014 by adult patients who had been on antiretroviral therapy (ART) for at least three months. Use of TCAM by patients was analysed by descriptive statistics using frequency and percentages with standard error. Where the associated relative error was equal or greater to 0.50, the percentage was rejected as unstable. A p-value <0.05 was estimated as statistically significant. Results The majority of the 1748 participants were Black Africans (1685/1748, 96.40 %, SE: 0.00045), followed by Coloured (39/1748, 2.23 %, SE: 0.02364), Indian (17/1748, 0.97 %, SE: 0.02377), and Whites (4/1748, 0.23 %, SE: 0.02324), p < 0.05. The prevalence of ATM use varied prior to (382/1748, 21.85 %) and after ART initiation (142/1748, 8.12 %), p <0.05, specifically by Black African females both before (14.41 %) and after uptake (5.49 %), p < 0.05. Overall, 35 Black Africans, one Coloured and one Indian (37/1748, 2.12 %) reported visiting CAM practitioners for their HIV condition and related symptoms post ART. Conclusion Despite a progressive implementation of a successful antiretroviral programme over the first decade of free antiretroviral therapy in the South African public health sector, the use of TCAM is still prevalent amongst a small percentage of HIV infected patients attending public healthcare sector antiretroviral clinics. Further research is needed to explore reasons for use and health benefits or risks experienced by the minority that uses both conventional antiretroviral therapy with TCAM.
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Tran BX, Nguyen NK, Nguyen LP, Nguyen CT, Nong VM, Nguyen LH. Preference and willingness to pay for traditional medicine services in rural ethnic minority community in Vietnam. Altern Ther Health Med 2016; 16:48. [PMID: 26841925 PMCID: PMC4739329 DOI: 10.1186/s12906-016-1010-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 01/22/2016] [Indexed: 11/26/2022]
Abstract
Background Traditional medicine (TM) still plays an important role in a number of health care systems around the world, especially across Asian and African countries. In Vietnam, however, little is known about preference for traditional medicine use. This study assessed the prevalence of use, preference, satisfaction, and willingness to pay for TM services amongst rural ethnic minority community. Methods A cross-sectional survey in three provinces in the North and South of Vietnam. Results The results showed a high level of satisfaction with TM services, with more than 90 % of respondents reporting improved health status given the use of TM. Indicators for preference of TM over modern medicine are a longer distance to health station; being in an ethnic minority; being female; and having had higher service satisfaction. Although we did not have a comparison group, the high level of satisfaction with TM services is likely the result of a project targeting community health workers and the public regarding TM education and access promotion. Indeed, the community health workers are credited with relaying the information about TM more than any other sources. This suggests the importance of community health workers and community health centers in the promotion of TM use. Conclusions Ethnic minority people prefer the use of traditional medicine services that supports the expansion of national programs and promotion of traditional medications.
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Hughes GD, Aboyade OM, Beauclair R, Mbamalu ON, Puoane TR. Characterizing Herbal Medicine Use for Noncommunicable Diseases in Urban South Africa. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:736074. [PMID: 26557865 PMCID: PMC4629029 DOI: 10.1155/2015/736074] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/16/2015] [Indexed: 01/10/2023]
Abstract
Economic challenges associated with noncommunicable diseases (NCDs) and the sociocultural outlook of many patients especially in Africa have increased dependence on traditional herbal medicines (THMs) for these diseases. A cross-sectional descriptive study designed to determine the prevalence of and reasons for THM use in the management of NCDs among South African adults was conducted in an urban, economically disadvantaged area of Cape Town, South Africa. In a cohort of 1030 participants recruited as part of the existing Prospective Urban and Rural Epidemiological (PURE) study, 456 individuals were identified. The overall prevalence of THM use was 27%, of which 61% was for NCDs. Participants used THM because of a family history (49%) and sociocultural beliefs (33%). Hypertensive medication was most commonly used concurrently with THM. Healthcare professionals need to be aware of the potential dualistic use of THM and conventional drugs by patients, as this could significantly influence health outcomes. Efforts should be made to educate patients on the potential for drug/herb interactions.
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Affiliation(s)
- Gail D. Hughes
- South African Herbal Science and Medicine Institute (SAHSMI), Faculty of Natural Sciences, University of the Western Cape, Private Bag X17, Bellville 7535, South Africa
| | - Oluwaseyi M. Aboyade
- South African Herbal Science and Medicine Institute, University of the Western Cape, Bellville 7535, South Africa
| | - Roxanne Beauclair
- The South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch 7602, South Africa
- International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP114, 9000 Gent, Belgium
| | - Oluchi N. Mbamalu
- School of Pharmacy, University of the Western Cape, Bellville 7535, South Africa
| | - Thandi R. Puoane
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa
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Nlooto M. Views and experiences of healthcare professionals towards the use of African traditional, complementary and alternative medicines among patients with HIV infection: the case of eThekwini health district, South Africa. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:170. [PMID: 26047941 PMCID: PMC4458021 DOI: 10.1186/s12906-015-0687-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 05/21/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many patients with human immunodeficiency virus infection use traditional, complementary, and alternative medicines and other practices to combat the disease, with some also using prescribed antiretroviral therapy provided by the public health sector. This study aimed to establish the awareness of public sector biomedical health care providers on the use of traditional, complementary and alternative medicines by HIV-infected patients who also used highly active antiretroviral therapy, and to determine whether this was based on patients seen or cases being reported to them. Potential risks of interactions between the prescribed antiretroviral and non-prescribed medication therapies may pose safety and effectiveness issues in patients using both types of treatment. METHODS A descriptive cross-sectional study, using a researcher administered semi-structured questionnaire, was conducted from June to August 2013 at ten public sector antiretroviral clinics in five regional, three specialised and two district hospitals in eThekwini Health District, South Africa. Questionnaires were administered through face-to face interview to 120 eligible participants consisting of doctors, nurses, pharmacists and post-basic pharmacist assistants in HIV clinical practice. The results are presented as percent or proportion with standard error (SE), or as frequency. RESULTS Ninety-four respondents completed the questionnaire, yielding a response rate of 78.3 %. Almost half (48/94) were aware of patients using African traditional herbal medicines, over-the-counter supplements, unnamed complementary Ayurveda medicines and acupuncture. Twenty-three of the 94 respondents (24.4 %) said they had consulted patients who were using both antiretroviral therapy and certain types of non-prescribed medication in the previous three months. CONCLUSIONS Awareness among healthcare providers on patient use of traditional, complementary and alternative medicines was relatively high. Few respondents had seen patients who used mostly African traditional medicines, over-the counter supplements, and negligible complementary Ayurveda medicines and acupuncture, with caution being advised in the interpretation of the former. Further research is needed to investigate communication between healthcare providers and patients in this regard, and levels of acceptance of traditional, complementary and alternative medicines by biomedical health care workers in HIV public sector practice.
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Affiliation(s)
- Manimbulu Nlooto
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa.
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Mee P, Wagner RG, Gómez-Olivé FX, Kabudula C, Kahn K, Madhavan S, Collinson M, Byass P, Tollman SM. Changing use of traditional healthcare amongst those dying of HIV related disease and TB in rural South Africa from 2003 - 2011: a retrospective cohort study. Altern Ther Health Med 2014; 14:504. [PMID: 25515165 PMCID: PMC4325963 DOI: 10.1186/1472-6882-14-504] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/20/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND In 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. The effective integration of traditional medical practitioners and biomedical providers in HIV prevention and care has been demonstrated. However concerns remain that the use of traditional treatments for HIV-related disease may lead to pharmacokinetic interactions between herbal remedies and ART drugs and delay ART initiation. Here we analyse the changing prevalence and determinants of traditional healthcare use amongst those dying of HIV-related disease, pulmonary tuberculosis and other causes in a rural South African community between 2003 and 2011. ART was made available in this area in the latter part of this period. METHODS Data was collected during household visits and verbal autopsy interviews. InterVA-4 was used to assign causes of death. Spatial analyses of the distribution of traditional healthcare use were performed. Logistic regression models were developed to test associations of determinants with traditional healthcare use. RESULTS There were 5929 deaths in the study population of which 47.7% were caused by HIV-related disease or pulmonary tuberculosis (HIV/AIDS and TB). Traditional healthcare use declined for all deaths, with higher levels throughout for those dying of HIV/AIDS and TB than for those dying of other causes. In 2003-2005, sole use of biomedical treatment was reported for 18.2% of HIV/AIDS and TB deaths and 27.2% of other deaths, by 2008-2011 the figures were 49.9% and 45.3% respectively. In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003-2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality. In the multivariate model only country of origin, time period and illness duration remained associated. CONCLUSIONS There were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB. No associations between socio-economic position, age or gender and the likelihood of traditional healthcare use were seen. Further qualitative and quantitative studies are needed to assess whether these figures reflect trends in healthcare use amongst the entire population and the reasons for the temporal changes identified.
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Davids D, Blouws T, Aboyade O, Gibson D, De Jong JT, Van't Klooster C, Hughes G. Traditional health practitioners' perceptions, herbal treatment and management of HIV and related opportunistic infections. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2014; 10:77. [PMID: 25480758 PMCID: PMC4414384 DOI: 10.1186/1746-4269-10-77] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 11/27/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND In South Africa, traditional health practitioners' (THPs) explanatory frameworks concerning illness aetiologies are much researched. However there is a gap in the literature on how THPs understand HIV-related opportunistic infections (OIs), i.e. tuberculosis, candidiasis and herpes zoster. This study aimed to comprehend THPs' understandings of the aforementioned; to ascertain and better understand the treatment methods used by THPs for HIV and OIs, while also contributing to the documentation of South African medicinal plants for future conservation. METHODS The study was conducted in two locations: Strand, Western Cape where THPs are trained and Mpoza village, Mount Frere, Eastern Cape from where medicinal plants are ordered or collected. Semi-structured interviews were conducted with 53 THPs of whom 36 were diviners (amagrirha: isangoma) and 17 herbalists (inyanga). THPs were selected through a non-probability "snowball" method. Data were analysed using a thematic content analysis approach. An ethnobotanical survey was conducted and plants used to manage HIV and OIs were collected. A complete set of voucher specimens was deposited at the University of the Western Cape Herbarium for identification. Plant names were checked and updated with Kew's online website http://www.theplantlist.org . RESULTS THPs conceptualise the aetiology of HIV and OIs at two related levels. The first involves the immediate manifestation of the illness/condition because of a viral infection in the blood (HIV), the presence of bacteria in the lungs (tuberculosis), or weakened state of the body making it susceptible to OIs. The presence of OIs is indicative of the probable presence of HIV. The second level of causation affects the first, which includes pollution, changes in cultural sexual norms, witchcraft, environmental factors, and lack of adherence to ancestral rituals. THPs reported using 17 plants belonging to 12 families. Remedies included mixes of up to five plants. CONCLUSION This study explored the THPs' perspectives on HIV and commonly associated OIs and their herbal treatment methods. THPs generally rely on biomedical diagnosis before treating a client. They also seek guidance from the ancestors for a particular diagnosis, the plants to use for a specific treatment, when to harvest, and how to administer herbal remedies.
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Affiliation(s)
- Denver Davids
- Department of Anthropology and Sociology, University of the Western Cape, Bellville, South Africa.
| | - Tarryn Blouws
- South African Herbal Science and Medicine Institute, University of the Western Cape, Bellville, South Africa.
| | - Oluwaseyi Aboyade
- South African Herbal Science and Medicine Institute, University of the Western Cape, Bellville, South Africa.
| | - Diana Gibson
- Department of Anthropology and Sociology, University of the Western Cape, Bellville, South Africa.
| | - Joop T De Jong
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, The Netherlands.
| | - Charlotte Van't Klooster
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, The Netherlands.
| | - Gail Hughes
- South African Herbal Science and Medicine Institute, University of the Western Cape, Bellville, South Africa.
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Hughes GD, Aboyade OM, Clark BL, Puoane TR. The prevalence of traditional herbal medicine use among hypertensives living in South African communities. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 13:38. [PMID: 23414344 PMCID: PMC3598715 DOI: 10.1186/1472-6882-13-38] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 02/05/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND In South Africa, over 6 million people are hypertensive and the burden of disease shows that cardiovascular diseases (CVDs) are the leading cause of death among adults. Although treatments exist, few people comply or adhere to recommended treatment due to side effects or costs of the drugs, hence the reliance on alternative forms of treatment. Traditional herbal medicines (THM) are used for the management of hypertension but the prevalence of its use among hypertensive patients living in South African communities is not sufficiently known. METHODS This was a cross-sectional descriptive study to determine the prevalence of THM use for hypertension, among 135 purposefully selected South African participants of the Prospective Urban and Rural Epidemiological (PURE) study, who are THM users. Data on THM use were collected by way of face to face interviews using structured questionnaires administered by trained field workers. Standard descriptive measures were used to characterize the study sample and responses to the questionnaire. Chi-square test was used when making comparisons between groups. RESULTS There were 135 THM users, 21% of whom used THM to treat hypertension. Majority (82.1%) of the hypertensive THM users were females, only 29% were married or co-habitating, virtually all (96%) were unemployed and 86% were Christians. More than half (56%) of the respondents were aged between 55 and 64 years. THM was occasionally used (51.9%) as a combination of tea and other mixtures (63%) and prescribed by family/ friends/self-administered. There was a significant difference in the age, marital and employment status, as well as the form and frequency of THM use of hypertensive THM users compared to other THM users. CONCLUSIONS The study gives an insight into the prevalence of THM use by hypertensive patients in selected South African communities. The practice of self-medication was also observed which raises concern regarding the safety of medications taken by the participants. Health care providers should however be more aware of THM use and counsel patients regarding the combination of prescribed treatment regimen and herbal medicines and the potential of herb-drug interactions.
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Affiliation(s)
- Gail D Hughes
- South African Herbal Science and Medicine Institute, University of the Western Cape, Bellville 7535, South Africa
| | - Oluwaseyi M Aboyade
- South African Herbal Science and Medicine Institute, University of the Western Cape, Bellville 7535, South Africa
| | - Bobby L Clark
- Clark & Associates Statistical Consulting, Nolensville, TN, USA
| | - Thandi R Puoane
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa
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