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Kissani N, Cherkaoui Rhazouani O, Souirti Z, Khramaz M, Meryem C, Mebrouk Y, Ouazzani R. Epilepsy in Morocco: Realities, pitfalls and prospects. Epilepsia Open 2021; 6:13-21. [PMID: 33681643 PMCID: PMC7918313 DOI: 10.1002/epi4.12440] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/01/2020] [Accepted: 10/12/2020] [Indexed: 12/04/2022] Open
Abstract
The World Health Organization (WHO) estimates that about 50 million people of all ages have epilepsy and nearly 85% of whom live in low- and middle-income (LMICs) countries. In Morocco, epilepsy is one of the major neurological health conditions, with an estimated prevalence of 1.1%. The management of patients is difficult due to multiple factors. The lack of neurologists whose number is currently 180, the uneven distribution of neurologists who are concentrated in large cities, 43% of whom are in Rabat and Casablanca alone; the low involvement of general practitioners in the management of epilepsy; the frequent consultation of traditional healers; and the low coverage of social security all contribute to the treatment gap. The management of epilepsy has advanced considerably since the early nineties. Several factors contributed to this progress: the increasing number of neurologists compared to previous years, the creation of well-equipped new academic centers, and small units of general neurology, in addition to the disuse of several antiepileptic drugs. However, much work remains to be done against the use of many forms of traditional practices and the low involvement of general practitioners in the management of epilepsy. This is the first study on epilepsy conducted in Morocco.
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Affiliation(s)
- Najib Kissani
- Laboratory of Clinical and Experimental NeuroscienceFaculty of MedicineCadi Ayyad UniversityMarrakechMorocco
- Department of NeurologyMohammed VI University HospitalMarrakechMorocco
| | - Oussama Cherkaoui Rhazouani
- Laboratory of Clinical and Experimental NeuroscienceFaculty of MedicineCadi Ayyad UniversityMarrakechMorocco
| | - Zouhayr Souirti
- Department of NeurologyCHU Hassan II of FezFezMorocco
- Center of sleep medicineCHU Hassan II of FezFezMorocco
| | - Mounia Khramaz
- Laboratory of Clinical and Experimental NeuroscienceFaculty of MedicineCadi Ayyad UniversityMarrakechMorocco
| | - Chettati Meryem
- Laboratory of Clinical and Experimental NeuroscienceFaculty of MedicineCadi Ayyad UniversityMarrakechMorocco
| | - Yassine Mebrouk
- Department of NeurologyMohammed VI Oujda University HospitalOujdaMorocco
| | - Reda Ouazzani
- Department of Clinical NeurophysiologySpecialty Hospital ONO CHU Ibn Sina RabatRabatMorocco
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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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Munyaneza M, Jayaraman S, Ntirenganya F, Rickard J. Factors Influencing Seeking and Reaching Care in Patients With Peritonitis in Rwanda. J Surg Res 2019; 246:236-242. [PMID: 31610351 DOI: 10.1016/j.jss.2019.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/29/2019] [Accepted: 09/13/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Peritonitis is an emergency which frequently requires surgical intervention. The aim of this study was to describe factors influencing seeking and reaching care for patients with peritonitis presenting to a tertiary referral hospital in Rwanda. METHODS This was a cross-sectional study of patients with peritonitis admitted to University Teaching Hospital of Kigali. Data were collected on demographics, prehospital course, and in-hospital management. Delays were classified according to the Three Delays Model as delays in seeking or reaching care. Chi square test and logistic regression were used to determine associations between delayed presentation and various factors. RESULTS Over a 9-month period, 54 patients with peritonitis were admitted. Twenty (37%) patients attended only primary school and 15 (28%) never went to school. A large number (n = 26, 48%) of patients were unemployed and most (n = 45, 83%) used a community-based health insurance. For most patients (n = 44, 81%), the monthly income was less than 10,000 Rwandan francs (RWF) (11.90 U.S. Dollars [USD]). Most (n = 51, 94%) patients presented to the referral hospital with more than 24 h of symptoms. More than half (n = 31, 60%) of patients had more than 4 d of symptoms on presentation. Most (n = 37, 69%) patients consulted a traditional healer before presentation at the health care system. Consultation with a traditional healer was associated with delayed presentation at the referral hospital (P < 0.001). Most (n = 29, 53%) patients traveled more than 2 h to reach a health facility and this was associated with delayed presentation (P = 0.019). The cost of transportation ranged between 5000 and 1000 RWF (5.95-11.90 USD) for most patients and was not associated with delayed presentation (P = 0.449). CONCLUSIONS In this study, most patients with peritonitis present in a delayed fashion to the referral hospital. Factors associated with seeking and reaching care included sociodemographic characteristics, health-seeking behaviors, cost of care, and travel time. These findings highlight factors associated with delays in seeking and reaching care for patients with peritonitis.
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Affiliation(s)
- Martin Munyaneza
- Department of Surgery, University of Rwanda, Kigali, Rwanda; Department of Surgery, University Teaching Hospital of Butare, Butare, Rwanda
| | - Sudha Jayaraman
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Faustin Ntirenganya
- Department of Surgery, University of Rwanda, Kigali, Rwanda; Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jennifer Rickard
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
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Bitta MA, Kariuki SM, Gona J, Abubakar A, Newton CRJC. Priority mental, neurological and substance use disorders in rural Kenya: Traditional health practitioners' and primary health care workers' perspectives. PLoS One 2019; 14:e0220034. [PMID: 31335915 PMCID: PMC6650073 DOI: 10.1371/journal.pone.0220034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 07/07/2019] [Indexed: 11/21/2022] Open
Abstract
Background Over 75% of people with mental neurological and substance use disorders (MNSD) live in low and middle-income countries with limited access to specialized care. The World Health Organization’s Mental Health Gap Action Program (mhGAP) aims to address the human resource gap but it requires contextualization. Aims We conducted a qualitative study in rural coastal Kenya to explore the local terms, perceived causes and management modalities of priority MNSD listed in the mhGAP, to inform implementation in this setting. Methods We conducted 8 focus group discussions with primary health care providers and traditional health practitioners and used the framework method to conduct thematic analysis. We identified local terms, perceived causes and treatment options for MNSD. We also explored possibilities for collaboration between the traditional health practitioners and primary health care providers. Results We found local terms for depression, psychoses, epilepsy, disorders due to substance use and self-harm/ suicide but none for dementia. Child and adolescent mental and behavioral problems were not regarded as MNSD but consequences of poor parenting. Self-harm/suicide was recognized in the context of other MNSD. Causes of MNSD were broadly either biological or supernatural. Treatment options were dependent on perceived cause of illness. Most traditional health practitioners were willing to collaborate with primary health care providers mainly through referring cases. Primary health care providers were unwilling to collaborate with traditional health practitioners because they perceived them to contribute to worsening of patients’ prognoses. Conclusions Local terms and management modalities are available for some priority MNSD in this setting. Community level case detection and referral may be hindered by lack of collaboration between traditional health practitioners and primary health care providers. There is need for training on the recognition and management of all priority MNSD.
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Affiliation(s)
- Mary A. Bitta
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Symon M. Kariuki
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Joseph Gona
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Amina Abubakar
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Aga Khan University, Nairobi, Kenya
| | - Charles R. J. C. Newton
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Musyimi CW, Mutiso VN, Loeffen L, Krumeich A, Ndetei DM. Exploring mental health practice among Traditional health practitioners: a qualitative study in rural Kenya. BMC Complement Altern Med 2018; 18:334. [PMID: 30547778 PMCID: PMC6295025 DOI: 10.1186/s12906-018-2393-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/28/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Involvement of traditional health practitioners (THPs) in the form of collaboration with the formal health care system is suggested to improve the pathways to mental health care in Kenya, yet understanding of the current traditional practice and THPs' perspectives is lacking. The aim of this study was to explore the views of THPs with respect to their mental health practice. METHODS This study qualitatively explored the views of THPs, using four focus group discussions (FDGs) each consisting of 8-10 traditional and faith healers, resulting in a total of 36 participants. Thematic content analysis using a grounded theory approach was performed using QSR NVivo 10. Emerging topics were identified and examined by re-reading the transcripts several times and constantly re-sorting the material. RESULTS Four themes that reflect THPs' mental health practice perspectives emerged as follows: 1) Categorization of mental illness; 2) Diagnostics in traditional mental health practice; 3) Treatments and challenges in current traditional mental health practice; and 4) Solutions to improve traditional mental health practice. CONCLUSIONS These themes provide insight into the perspectives of Kenyan traditional and faith healers on their mental health practice, in an attempt to offer a meaningful contribution to the debate on collaboration between informal and formal health care providers in improving mental health services in Kenya. Furthermore, the presented challenges and solutions can inform policy makers in their task to improve and scale up mental health services in resource-poor areas in Kenya. Addressing these issues would be a first step towards understanding the solid foundation of traditional medicine that is necessary before collaboration can be successfully attempted. Further research is also recommended to assess patients' needs and explore potential forms of collaboration, in order to achieve sustainable improvement in the mental health care pathways for patients.
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Affiliation(s)
- Christine W. Musyimi
- Africa Mental Health Foundation and Department of Psychiatry, University of Nairobi, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. BOX 48423-00100, Nairobi, Kenya
- Vrije Universiteit, 1081 HV Amsterdam, Netherlands
| | - Victoria N. Mutiso
- Africa Mental Health Foundation and Department of Psychiatry, University of Nairobi, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. BOX 48423-00100, Nairobi, Kenya
| | - Lianne Loeffen
- Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands
| | - Anja Krumeich
- Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands
| | - David M. Ndetei
- Africa Mental Health Foundation and Department of Psychiatry, University of Nairobi, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. BOX 48423-00100, Nairobi, Kenya
- University of Nairobi, P. O. Box 30197 00100, Nairobi, Kenya
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van der Watt ASJ, Nortje G, Kola L, Appiah-Poku J, Othieno C, Harris B, Oladeji BD, Esan O, Makanjuola V, Price LN, Seedat S, Gureje O. Collaboration Between Biomedical and Complementary and Alternative Care Providers: Barriers and Pathways. Qual Health Res 2017; 27:2177-2188. [PMID: 28901831 DOI: 10.1177/1049732317729342] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
We examined the scope of collaborative care for persons with mental illness as implemented by traditional healers, faith healers, and biomedical care providers. We conducted semistructured focus group discussions in Ghana, Kenya, and Nigeria with traditional healers, faith healers, biomedical care providers, patients, and their caregivers. Transcribed data were thematically analyzed. A barrier to collaboration was distrust, influenced by factionalism, charlatanism, perceptions of superiority, limited roles, and responsibilities. Pathways to better collaboration were education, formal policy recognition and regulation, and acceptance of mutual responsibility. This study provides a novel cross-national insight into the perspectives of collaboration from four stakeholder groups. Collaboration was viewed as a means to reach their own goals, rooted in a deep sense of distrust and superiority. In the absence of openness, understanding, and respect for each other, efficient collaboration remains remote. The strongest foundation for mutual collaboration is a shared sense of responsibility for patient well-being.
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Affiliation(s)
| | | | - Lola Kola
- 2 University of Ibadan, Ibadan, Nigeria
| | - John Appiah-Poku
- 3 Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | | | - LeShawndra N Price
- 6 National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
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Asres M, Gedefaw M, Kahsay A, Weldu Y. Patients' Delay in Seeking Health Care for Tuberculosis Diagnosis in East Gojjam Zone, Northwest Ethiopia. Am J Trop Med Hyg 2017; 96:1071-1075. [PMID: 28500803 PMCID: PMC5417197 DOI: 10.4269/ajtmh.16-0892] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/21/2017] [Indexed: 11/07/2022] Open
Abstract
AbstractPatients' delay in seeking diagnosis is a major problem in the management of tuberculosis (TB). Relative to the burden of TB, there is lack of data on the magnitude of delays in seeking care and why patients fail to seek early care at health facilities in Ethiopia. A facility-based cross-sectional study was conducted from April to July 2013 in East Gojjam Zone, Amhara, Ethiopia, to assess patients' delays and associated factors in TB patients. Using simple random sampling, 605 (327 male and 278 female) participants were recruited. Of the total, 323 (53.4%) TB patients were delayed in seeking health care (median = 45 days; mean = 78.5 days). The following independent variables were associated with patient delays: age ≥ 45 years (adjusted odds ratio [AOR] = 8.74, 95% confidence interval [CI] = 4.71-16.23, P < 0.001); working as a farmer (AOR = 4.18, 95% CI = 1.44-12.11, P = 0.009); prior visit to holy water sites, traditional healers, and/or private drug shops (AOR = 69.11, 95% CI =13.91-343.29, P < 0.001; AOR = 14.74, 95% CI = 1.43-152.31, P = 0.024; AOR = 2.10, 95% CI = 1.22-3.59, P = 0.007, respectively); poor knowledge about TB (AOR = 2.79, 95% CI = 1.74-4.92, P = 0.006), and extrapulmonary TB (AOR = 14.69, 95% CI = 8.21-26.26, P < 0.001). Generally, patients' delay in seeking care at health facilities was high (53.4%). Most of TB patients getting treatment from holy water (95.3%; 101/106) and traditional healers (84.6%; 11/13) were delayed. Therefore, for early seeking in modern health care, a combination of interventions is required to encourage TB patients.
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Affiliation(s)
- Mihret Asres
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Molla Gedefaw
- GAMBY College of Medicine and Health Sciences, Bahir Dar, Ethiopia
| | - Amlsha Kahsay
- School of Medicine, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Department of Medical Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Yemane Weldu
- School of Medicine, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Department of Medical Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Gbadebo BM, Afolabi RF, Adebowale AS. Female circumcision in Nigeria and attitudes towards its discontinuation. Afr J Med Med Sci 2015; 44:343-354. [PMID: 27462697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Female Circumcision (FC) is a harmful traditional practice and remains a public health problem particularly in the era of HIV/AIDS. Aside its numerous health implications, it can cause infertility, complications in childbirth and increased risk of newborn deaths. FC is widely practised in Nigeria. OBJECTIVE The study assessed the level of FC, daughters' circumcision and attitude towards discontinuation of the practice among women of reproductive age. METHODS Data were extracted from the 2008 Nigeria Demographic Health and Survey. Data were analysed using Chi-square and binary logistic regression models (á = 0.05). RESULTS Among the respondents, prevalence of FC was 49.2% with 30.6% having circumcised their daughters and 25.8% wishing the practice to continue. About 56% of circumcised women also circumcised their daughters whereas only 2.9% of uncircumcised women circumcised their daughters. Approximately 69.8% of women who had circumcised their daughters would like FC to continue compared to 8.8% of those who never circumcised any of their daughters. The likelihood of FC was higher (OR = 2.07; C.I = 1.85-2.30) among Moslems compare to Christians. Igbo women were less likely to discontinue FC compared to women of Hausa/Fulani ethnic group despite controlling for the confounding variables (OR = 0.57; C.I = 0.35-0.91). CONCLUSION Female circumcision is still practiced in all parts of Nigeria and a high proportion of women reported that the practice should continue. There is need to intensify efforts on the campaign against female circumcision in Nigeria.
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Street RA, Kabera GM, Connolly C. Metallic mercury use by South African traditional health practitioners: perceptions and practices. Environ Health 2015; 14:67. [PMID: 26276298 PMCID: PMC4537568 DOI: 10.1186/s12940-015-0053-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/05/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Mercury is a toxic metal however its use in traditional healthcare systems remains widespread. The aim of this study was to determine the prevalence of mercury use by South African Traditional Health Practitioners (THP) and to document reasons for use and administration methods. METHODS A cross-sectional study design was employed. A total of 201 THPs were enrolled from two main metropolitan areas of KwaZulu-Natal (South Africa), and 198 were included in the final analysis. Information on demographic characteristics, reasons for using or not using mercury as well as mercury administration methods were collected. RESULTS Of the 198 THPs, 78 (39%) used mercury for healing purposes and 74 (95%) of the mercury users stated that they were taught to use it by another THP. The two main routes of administration were oral and sub-cutaneous implantations (ukugcaba) at 85% (n = 66) and 59% (n = 46), respectively. The most common responses for mercury administration were for child birth (n = 70; 90%) and protection against guns (n = 39; 50%). CONCLUSION This is the first study to describe the prevalence and practice of mercury use in South African traditional medicine. Socio-cultural mercury use is a potential source of exposure to both THPs and their patients. In light of such findings, public education messages and regulatory measures need to be effected.
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Affiliation(s)
- Renée A Street
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa.
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Gaëtan M Kabera
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa.
| | - Catherine Connolly
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa.
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Campbell LM, Amin NN. A qualitative study: potential benefits and challenges of traditional healers in providing aspects of palliative care in rural South Africa. Rural Remote Health 2014; 14:2378. [PMID: 24815856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION This article draws on selected palliative care providers' views and experiences to reflect on the potential benefits and possible challenges of involving traditional healers in palliative care in rural areas of South Africa. There is increasing consensus that palliative care should be offered by a range of professional and non-professional healthcare givers. Including non-professionals such as traditional healers in a palliative care team may strengthen care provisioning as they have intimate knowledge of patients' local culture and spiritual beliefs. METHODS Employing the qualitative method of photo-elicitation, one-on-one discussions about the photographs taken by participants were conducted. The participants - 4 palliative care nurses and 17 home-based care workers - were purposively selected to provide in-depth information about their experiences as palliative caregivers in rural homes. RESULTS Healthcare workers' experiences revealed that the patients they cared for valued traditional rituals connected to illness, dying, death and bereavement. Participants suggested that traditional healers should be included in palliative care training programs as they could offer appropriate psychological, cultural and spiritual care. A challenge identified by participants was the potential of traditional healers to foster a false sense of longevity in patients facing death. DISCUSSION The importance of recognising the value of traditional practices in palliative care should not be underrated in rural South Africa. Traditional healers could enhance palliative care services as they have deep, insider knowledge of patients' spiritual needs and awareness of cultural practices relating to illness, death, dying and bereavement. Incorporating traditional healers into healthcare services where there are differences in the worldviews of healthcare providers and patients, and a sensitivity to mediate cultural differences between caregivers and patients, could have the benefit of providing appropriate care in rural spaces. CONCLUSIONS Considering the influences of cultural and spiritual beliefs on the wellbeing of patients living in rural areas, the inclusion of traditional healers in a palliative care team is a sensible move. It is, nevertheless, important to note that unanticipated challenges may arise with respect to power differentials within the palliative care team and to beliefs that contradict medical prognosis.
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Affiliation(s)
- L M Campbell
- Edgewood College, School of Education, University of KwaZulu-Natal, Durban, South Africa.
| | - N N Amin
- Edgewood College, School of Education, University of KwaZulu-Natal, Durban, South Africa.
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Bourassa J. [Mahdi the medium: chronicles of a nurse in Ethiopia]. Perspect Infirm 2013; 10:65. [PMID: 24358683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Adejumo A, Faluyi M, Adejuwon A. Role of socio-psychological factors in perceived quality of care rendered by traditional medical practitioners in Ibadan, Nigeria. Glob J Health Sci 2013; 5:186-96. [PMID: 24171887 PMCID: PMC4776887 DOI: 10.5539/gjhs.v5n6p186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 08/19/2013] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It was the aim of the current research to investigate perceived service quality rendered by traditional medical practitioners and the role of socio-psychological factors in the perception. METHODS The first part, a quantitative cross-sectional survey utilized a 93-item questionnaire to examine the influence of quality of life, general health perception, socio-economic status and personality factors on perceived service quality. The second part, a qualitative study utilized 5 FGDs and 2 KIIs to explore consumers' evaluation of perceived service quality. Five research questions were raised. The 336 purposively-selected participants were attendees of traditional-health clinics/centers in Ibadan with a mean age of x(-)=30.60±9.97. FINDINGS The FGD respondents opined that the scope of orthodox-medicine does not cover certain illnesses. 77.8% of the participants attested to the affordability and promptness of services in traditional hospitals; acknowledging that its perceived efficacy (i.e. 56.8%) motivate patronage of traditional-health service. The 2x2x3 ANOVA revealed significant main effect of quality of life (F[1,270]=41.05, p<.001) and socio-economic status (F[2,270]=36.34; p<.001); as well as interaction effect of quality of life, general health and socio-economic status (F[1,270]=9.624, p<.002); while the regression analysis showed independent influence of extraversion (B= 0.31; p<.001), agreeableness (B=0.303; p<.001) and openness to experience (B=0.166; p<.01). CONCLUSION This sample acknowledged that traditional health care met quality standards. The role of socio-psychological factors in the quality appraisal was established. The need for better regulation and validation of traditional health care in assuring evidence based care was suggested.
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Roura M, Nsigaye R, Nhandi B, Wamoyi J, Busza J, Urassa M, Todd J, Zaba B. "Driving the devil away": qualitative insights into miraculous cures for AIDS in a rural Tanzanian ward. BMC Public Health 2010; 10:427. [PMID: 20646300 PMCID: PMC2916904 DOI: 10.1186/1471-2458-10-427] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 07/20/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The role of religious beliefs in the prevention of HIV and attitudes towards the infected has received considerable attention. However, little research has been conducted on Faith Leaders' (FLs) perceptions of antiretroviral therapy (ART) in the developing world. This study investigated FLs' attitudes towards different HIV treatment options (traditional, medical and spiritual) available in a rural Tanzanian ward. METHODS Qualitative interviews were conducted with 25 FLs purposively selected to account for all the denominations present in the area. Data was organised into themes using the software package NVIVO-7. The field work guidelines were tailored as new topics emerged and additional codes progressively added to the coding frame. RESULTS Traditional healers (THs) and FLs were often reported as antagonists but duality prevailed and many FLs simultaneously believed in traditional healing. Inter-denomination mobility was high and guided by pragmatism.Praying for the sick was a common practice and over one third of respondents said that prayer could cure HIV. Being HIV-positive was often seen as "a punishment from God" and a consequence of sin. As sinning could result from "the work of Satan", forgiveness was possible, and a "reconciliation with God" deemed as essential for a favourable remission of the disease. Several FLs believed that "evil spirits" inflicted through witchcraft could cause the disease and claimed that they could cast "demons" away.While prayers could potentially cure HIV "completely", ART use was generally not discouraged because God had "only a part to play". The perceived potential superiority of spiritual options could however lead some users to interrupt treatment. CONCLUSIONS The roll-out of ART is taking place in a context in which the new drugs are competing with a diversity of existing options. As long as the complementarities of prayers and ART are not clearly and explicitly stated by FLs, spiritual options may be interpreted as a superior alternative and contribute to hampering adherence to ART. In contexts where ambivalent attitudes towards the new drugs prevail, enhancing FLs understanding of ART's strengths and pitfalls is an essential step to engage them as active partners in ART scale-up programs.
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Affiliation(s)
- Maria Roura
- Centre for Population Studies, Department of Epidemiology and Population Health, 49-51 Bedford Square, London School of Hygiene and Tropical Medicine, London, WC 1B 3DP, UK
- The TAZAMA Project, NIMR, The Tanzanian National Institute for Medical Research, PO Box 1462, Isamilo, Mwanza, Tanzania
| | - Ray Nsigaye
- The TAZAMA Project, NIMR, The Tanzanian National Institute for Medical Research, PO Box 1462, Isamilo, Mwanza, Tanzania
| | - Benjamin Nhandi
- The TAZAMA Project, NIMR, The Tanzanian National Institute for Medical Research, PO Box 1462, Isamilo, Mwanza, Tanzania
| | - Joyce Wamoyi
- Centre for Population Studies, Department of Epidemiology and Population Health, 49-51 Bedford Square, London School of Hygiene and Tropical Medicine, London, WC 1B 3DP, UK
| | - Joanna Busza
- Centre for Population Studies, Department of Epidemiology and Population Health, 49-51 Bedford Square, London School of Hygiene and Tropical Medicine, London, WC 1B 3DP, UK
| | - Mark Urassa
- The TAZAMA Project, NIMR, The Tanzanian National Institute for Medical Research, PO Box 1462, Isamilo, Mwanza, Tanzania
| | - Jim Todd
- Centre for Population Studies, Department of Epidemiology and Population Health, 49-51 Bedford Square, London School of Hygiene and Tropical Medicine, London, WC 1B 3DP, UK
| | - Basia Zaba
- Centre for Population Studies, Department of Epidemiology and Population Health, 49-51 Bedford Square, London School of Hygiene and Tropical Medicine, London, WC 1B 3DP, UK
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Mafimisebi TE, Oguntade AE. Preparation and use of plant medicines for farmers' health in Southwest Nigeria: socio-cultural, magico-religious and economic aspects. J Ethnobiol Ethnomed 2010; 6:1. [PMID: 20346120 PMCID: PMC2821299 DOI: 10.1186/1746-4269-6-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 01/20/2010] [Indexed: 05/05/2023]
Abstract
Agrarian rural dwellers in Nigeria produce about 95% of locally grown food commodities. The low accessibility to and affordability of orthodox medicine by rural dwellers and their need to keep healthy to be economically productive, have led to their dependence on traditional medicine. This paper posits an increasing acceptance of traditional medicine country-wide and advanced reasons for this trend. The fact that traditional medicine practitioners' concept of disease is on a wider plane vis-à-vis orthodox medicine practitioners' has culminated in some socio-cultural and magico-religious practices observed in preparation and use of plant medicines for farmers' health management. Possible scientific reasons were advanced for some of these practices to show the nexus between traditional medicine and orthodox medicine. The paper concludes that the psychological aspect of traditional medicine are reflected in its socio-cultural and magico-religious practices and suggests that government should fund research into traditional medicine to identify components of it that can be integrated into the national health system.
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Affiliation(s)
- Taiwo E Mafimisebi
- Department of Agricultural Economics and Extension, School of Agriculture and Agricultural Technology, The Federal University of Technology, Akure, Nigeria
| | - Adegboyega E Oguntade
- Department of Agricultural Economics and Extension, School of Agriculture and Agricultural Technology, The Federal University of Technology, Akure, Nigeria
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