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Mwamba M, Lombe DC, Msadabwe S, Bond V, Simwinga M, Sentoogo Ssemata A, Muhumuza R, Seeley J, Mwaka AD, Aggarwal A. A Narrative Synthesis of Literature on the Barriers to Timely Diagnosis and Treatment of Cancer in Sub-Saharan Africa. Clin Oncol (R Coll Radiol) 2023; 35:e537-e548. [PMID: 37302880 DOI: 10.1016/j.clon.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/13/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
Poor cancer survival outcomes in sub-Saharan Africa (SSA) have been linked to delays in diagnosis and treatment. Here we present a detailed overview of the qualitative literature evaluating the barriers to receiving timely diagnosis and treatment of cancer in SSA. The PubMed, EMBASE, CINAHL, PsycINFO databases were searched to identify qualitative studies reporting on barriers to timely diagnosis of cancer in SSA published between 1995 and 2020. A systematic review methodology was applied, including quality assessment and narrative data synthesis. We identified 39 studies, of which 24 focused on breast or cervical cancer. Only one study focused on prostate cancer and one on lung cancer. When exploring factors contributing to delays, six key themes emerged from the data. The first theme was health service barriers, which included: (i) inadequate numbers of trained specialists; (ii) limited knowledge of cancer among healthcare providers; (iii) poor co-ordination of care; (iv) inadequately resourced health facilities; (v) negative attitudes of healthcare providers towards patients; (vi) high cost of diagnostic and treatment services. The second key theme was patient preference for complementary and alternative medicine; the third was the limited understanding of cancer among the population. The fourth barrier was a patient's personal and family obligations; the fifth was the perceived impact of cancer and its treatment on sexuality, body image and relationships. Finally, the sixth was the stigma and discrimination faced by patients following a diagnosis of cancer. In conclusion, health system, patient level and societal factors all influence the likelihood of timely diagnosis and treatment for cancer in SSA. The results provide a focus for targeting health system interventions, particular with regards to awareness and understanding of cancer in the region.
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Affiliation(s)
- M Mwamba
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia.
| | - D C Lombe
- Regional Cancer Treatment Services MidCentral District Health Board, New Zealand
| | - S Msadabwe
- Cancer Diseases Hospital, Lusaka, Zambia
| | - V Bond
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia; London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - M Simwinga
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - A Sentoogo Ssemata
- The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - R Muhumuza
- The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - J Seeley
- The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - A D Mwaka
- Department of Medicine, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - A Aggarwal
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK; Institute of Cancer Policy, King's College London, London, UK
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Asiimwe JB, Nagendrappa PB, Atukunda EC, Nambozi G, Tolo CU, Ogwang PE, Kamatenesi MM. The meaning of caring for patients with cancer among traditional medicine practitioners in Uganda: A grounded theory approach. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001764. [PMID: 37459297 PMCID: PMC10351711 DOI: 10.1371/journal.pgph.0001764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
Traditional medicine practitioners (TMPs) are a critical part of healthcare systems in many sub-Saharan African countries and play vital roles in caring for patients with cancer. Despite some progress in describing TMPs' caring experiences in abstract terms, literature about practice models in Africa remains limited. This study aimed to develop a substantive theory to clarify the care provided by TMPs to patients with cancer in Uganda. This study adhered to the principal features of the modified Straussian grounded theory design. Participants were 18 TMPs caring for patients with cancer from 10 districts in Uganda, selected by purposive and theoretical sampling methods. Researcher-administered in-depth interviews were conducted, along with three focus group discussions. Data were analyzed using constant comparative analysis. The core category that represented TMPs' meaning of caring for patients with cancer was "Restoring patients' hope in life through individualizing care." TMPs restored patients' hope through five main processes: 1) ensuring continuity in the predecessors' role; 2) having full knowledge of a patient's cancer disease; 3) restoring hope in life; 4) customizing or individualizing care, and 5) improving the patient's condition/health. Despite practice challenges, the substantive theory suggests that TMPs restore hope for patients with cancer in a culturally sensitive manner, which may partly explain why patients with cancer continue to seek their services. The findings of this study may guide research, education, and public health policy to advance traditional medicine in sub-Saharan Africa.
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Affiliation(s)
- John Baptist Asiimwe
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- Aga Khan University, Uganda Campus, Kampala, Uganda
| | | | - Esther C. Atukunda
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Grace Nambozi
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Casim Umba Tolo
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Patrick E. Ogwang
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
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Mwaka AD, Achan J, Adoch W, Wabinga H. From their own perspectives: a qualitative study exploring the perceptions of traditional health practitioners in northern Uganda regarding cancers, their causes and treatments. BMC FAMILY PRACTICE 2021; 22:155. [PMID: 34275446 PMCID: PMC8287672 DOI: 10.1186/s12875-021-01505-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/01/2021] [Indexed: 12/13/2022]
Abstract
Background Many cancer patients in the low- and middle-income countries seek care with traditional health practitioners (THPs) and use traditional and complementary medicines (T&CMs) for treatment of cancers. Little is known about the perceptions and influence of THPs on cancer patients’ help-seeking and treatment decisions. We aimed to explore perceptions of THPs regarding cancers, cancer causes, and preferred treatments for cancers, in order to identify aspects that can inform interventions to improve cancer outcomes in Uganda. Methods We conducted this ethnographic study in northern Uganda. In-depth interviews were conducted at the respondents’ homes in quiet, open places, and in the absence of none- respondents. Interviews were audio-recorded and transcribed verbatim within a week of the interviews. Thematic qualitative analysis approaches were used to identify themes and subthemes. Results We included 21 respondents in the study; most were male (16/21), married, with median age of 59 years (range 39 – 80). Most respondents perceived cancer as a new and challenging disease, while one respondent thought of cancer as a result of an imbalance within the body. Most confessed unawareness of the causes of cancers, but believed that cancer could result from the interplay of a number of factors including poor diets, ingestions of chemical agents, and assaults by the spirits of the dead. Some reported that cancers (especially of women’s genital tracts) were sexually transmitted, or caused by accumulation of dirt. Only few healers treated cancers. Most respondents reported that they referred cancer patients to biomedical facilities, sometimes after they have first used their medicines. Most respondents hoped that collaborative research with scientists could help them identify potent T&CMs that cure cancers. Conclusion Traditional health practitioners require training on cancer causes, symptoms and signs, and the necessity for prompt initiation of effective treatments in order to improve cancer outcomes. The predisposition of the majority of respondents to refer cancer patients to biomedical services sets a fertile ground for meaningful cooperation between biomedical and traditional health practices. The national health system in the low- and middle-income countries could formally recognize traditional health practices as a component of the national healthcare system, and encourage the two to practice side by side. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01505-w.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Jennifer Achan
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Winnie Adoch
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Wabinga
- Kampala Cancer Registry, Department of Pathology, School of Biomedical Sciences, Makerere University, Kampala, Uganda
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Vhavenda Herbal Remedies as Sources of Antihypertensive Drugs: Ethnobotanical and Ethnopharmacological Studies. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2020:6636766. [PMID: 33381266 PMCID: PMC7748911 DOI: 10.1155/2020/6636766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/11/2020] [Accepted: 11/30/2020] [Indexed: 12/16/2022]
Abstract
Hypertension is a dominant risk factor for the development of cardiovascular, kidney, and eye diseases. In Africa, it increasingly leads to hospitalisation and a strain on the public health system. However, rather than modern medicine, African traditional healers are the first choice for most South Africans. Therefore, this study is aimed at gathering information on herbal remedies traditionally used for the treatment of high blood pressure in Vhavenda, South Africa, and comparing this information with reports in the literature regarding plants used to manage high blood pressure. An ethnobotanical survey was carried out in Vhembe district and its environs with 53 herbalists and indigenous people aged between 36 and 66 years from January to October 2019 using a semistructured questionnaire. The plants were collected with each respondent; they were authenticated and kept in herbarium. A total of 51 different plants were mentioned as being most commonly used for hypertension treatment. Of these, 44 plants were identified, with those from the Fabaceae family followed by plants from the Celastraceae family being commonly mentioned. Of these, the Elaeodendron transvaalense, Tabernaemontana elegans, Elephantorrhiza elephantina, and Aloe vossii were commonly cited species. According to the literature data, most of the identified plants are yet to be scientifically investigated for the treatment of hypertension, whereas only preliminary investigations have been carried out on other plants, suggesting that these preliminary investigations may have highlight promising antihypertensive activities in vitro that are indicative of their potential as antihypertensive drugs. Therefore, there is a need to scientifically investigate the antihypertensive potentials of these plants as a potential source of antihypertensive treatment and compounds.
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Fapohunda A, Fakolade A, Omiye J, Afolaranmi O, Arowojolu O, Oyebamiji T, Nwogu C, Olawaiye A, Mutiu J. Cancer presentation patterns in Lagos, Nigeria: Experience from a private cancer center. J Public Health Afr 2020; 11:1138. [PMID: 33623651 PMCID: PMC7893315 DOI: 10.4081/jphia.2020.1138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/02/2021] [Indexed: 12/24/2022] Open
Abstract
Background Cancer incidence and mortality is increasing worldwide. In 2018, there were an estimated 18.1 million new cancer cases and 9.6 million cancer deaths. In Nigeria, it is estimated that 100,000 new cases occur annually, with a high case fatality ratio. The burden of cancer in Nigeria is significant, as the country still grapples with infectious diseases and has limited data on cancer epidemiology. Our study is descriptive using data from a hospital-based registry. Objectives This retrospective study assesses the characteristics of patients that presented to a private cancer center in Lagos, Nigeria. We aimed to update knowledge on the current trends of cancer in Nigeria as exemplified by the experience of this cancer center and set a foundation for guiding future research and policy efforts in cancer screening, prevention, and control. Methods The records of all the 548 oncology patients registered at the Lakeshore Cancer Center (LCC) cancer registry from January 2015 to June 2018 were reviewed for this study. Results Most common cancer types were breast cancer for females (46%) and prostate cancer for males (32%). 92% of the tumors were malignant and 97% of the patients were symptomatic. Among patients diagnosed with cancer, 49% were ≤ 50 years old, 90% paid for their healthcare out of pocket, and 67% did not complete treatment. Conclusions This study highlights the state of cancer care in Nigeria and should guide future research, with a focus on public awareness, screening programs and implementation of novel cancer control policies and infrastructure that supports early detection.
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Mwaka AD, Abbo C, Kinengyere AA. Traditional and Complementary Medicine Use Among Adult Cancer Patients Undergoing Conventional Treatment in Sub-Saharan Africa: A Scoping Review on the Use, Safety and Risks. Cancer Manag Res 2020; 12:3699-3712. [PMID: 32547206 PMCID: PMC7246319 DOI: 10.2147/cmar.s251975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/29/2020] [Indexed: 12/30/2022] Open
Abstract
Background Use of traditional and complementary medicine (T&CM) is very common among patients in sub-Saharan Africa (SSA). However, there are limited data on concurrent use of T&CM with conventional cancer therapies. In this scoping review, we sought to describe the (i) prevalence of use, (ii) types of medicine, (iii) reasons for taking T&CM, (iv) current knowledge on safety and risks, (v) characteristics of adult cancer patients who use T&CM, and (vi) perceived treatment outcomes among cancer patients undergoing conventional cancer treatment in SSA. Methods We conducted a systematic literature search for articles published in the English language in three scientific databases (PubMed, Embase and Web of Science). We used a scoping review approach to map relevant literature on T&CM use among cancer patients undergoing conventional cancer treatments. We assessed 96 articles based on titles and abstracts, and 23 articles based on full text. Twelve articles fulfilled preset eligibility criteria. Results More than half of the included articles were from only two countries in SSA: Nigeria and Uganda. Median prevalence of use of T&CM was 60.0% (range: 14.1-79.0%). Median percent disclosure of use of T&CM to attending healthcare professionals was low at 32% (range: 15.3-85.7%). The most common reasons for non-disclosure were: the doctor did not ask, the doctor would rebuke them for using T&CM, and the doctors do not know much about T&CM and so there is no need to share the issue of use with them. T&CM used by cancer patients included herbs, healing prayers and massage. Reported reasons for use of T&CM in 8 of 12 articles included the wish to get rid of cancer symptoms, especially pain, cure cancer, improve physical and psychological well-being, treat toxicity of conventional cancer therapies and improve immunity. There were limited data on safety and risk profiles of T&CM among cancer patients in SSA. Conclusion Use of traditional and complementary medicines is common among cancer patients undergoing conventional cancer treatments. Healthcare professionals caring for cancer patients ought to inquire and communicate effectively regarding the use of T&CM in order to minimize the risks of side effects from concurrent use of T&CM and biomedicines.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Catherine Abbo
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alison Annet Kinengyere
- Albert Cook Medical Library, College of Health Sciences, Makerere University, Kampala, Uganda
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Li S, Odedina S, Agwai I, Ojengbede O, Huo D, Olopade OI. Traditional medicine usage among adult women in Ibadan, Nigeria: a cross-sectional study. BMC Complement Med Ther 2020; 20:93. [PMID: 32192455 PMCID: PMC7083039 DOI: 10.1186/s12906-020-02881-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 03/05/2020] [Indexed: 12/24/2022] Open
Abstract
Background Previous research has revealed high rates of traditional medicine usage in Nigeria. Reports of widespread contamination of herbal medicine products and higher rates of noncompliance with Western medications among traditional medicine users have raised concerns about the safety of traditional medicine use. Few studies have explored how demographic factors predict rates of traditional medicine use in the general population. Methods We conducted interviews of 748 adult women recruited from the communities in the city of Ibadan, Nigeria from 2013 to 2015. A structured questionnaire was created to collect data on rates of traditional medicine use and demographic factors such as age, education, ethnicity, and occupation. Multivariate logistic regressions were run to examine factors related to traditional medicine use, and the effects were measured with odds ratios (OR) along with 95% confidence interval (95%CI). Results The overall proportion of traditional medicine use was 81.6%. Women from the Ibo and Hausa ethnic groups were significantly less likely to use traditional medicine than the majority Yoruba group (OR 0.25, 95%CI 0.10–0.63;, OR 0.43, 95%CI 0.24–0.76) respectively). In addition, educated women were less likely than their non-educated counterparts to have used traditional medicine, with the biggest effect seen in women with a secondary education (OR 0.42, 95%CI 0.21–0.85). Conclusions We found a high rate of traditional medicine usage, consistent with that found in prior research. A novel finding was the significance of ethnicity as a predictor for usage rates.
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Affiliation(s)
- Suellen Li
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Stella Odedina
- Center for Population and Reproductive Health, College of Medicine, University of Ibadan, UCH, Ibadan, Nigeria
| | - Imaria Agwai
- Center for Population and Reproductive Health, College of Medicine, University of Ibadan, UCH, Ibadan, Nigeria
| | - Oladosu Ojengbede
- Center for Population and Reproductive Health, College of Medicine, University of Ibadan, UCH, Ibadan, Nigeria
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
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Mwaka AD, Mangi SP, Okuku FM. Use of traditional and complementary medicines by cancer patients at a national cancer referral facility in a low-income country. Eur J Cancer Care (Engl) 2019; 28:e13158. [PMID: 31441575 DOI: 10.1111/ecc.13158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/28/2019] [Accepted: 08/01/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this study was to describe use of traditional and complementary medicines (T&CM) and associated factors among patients with cancer. METHODS We conducted a cross-sectional study at the Uganda Cancer Institute (UCI) involving patients with selected solid tumours. Independent variables included age, sex, marital status, cancer site and stage. Main outcome variables were use and disclosure of use of T&CM. RESULTS The majority of participants were women (n = 352; 81.9%). Breast cancer (n = 312; 71.9%) was the predominant cancer type. 55.4% of participants (n = 240) self-reported use of T&CM. Among them, 68.3% (140/205) reported using them to treat/cure cancer, 35.6% (72/202) for strengthening the immune system and 31.2% (63/202) for management of pain. Patients with advanced stage cancers were more likely to be users compared with those in stage one. The majority (81.9%, 195/238) of T&CM users did not disclose use to their healthcare professionals. The main reasons for nondisclosure included lack of inquiry by clinicians (79.6%, 117/147) and fear of disapproval and/or rebuke (11.6%, 17/147). CONCLUSION Use of T&CM by patients with cancer under biomedical care is common but often undisclosed to the healthcare professionals.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.,Cancer Awareness and Early Detection Coalition (CAEDCO), Kampala, Uganda
| | - Sabina Patrick Mangi
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda.,Tosamaganga Council Designated Hospital, Iringa, Tanzania
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Knowledge and Health Seeking Behaviour of Breast Cancer Patients in Ghana. Int J Breast Cancer 2019; 2019:5239840. [PMID: 31057972 PMCID: PMC6463645 DOI: 10.1155/2019/5239840] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/17/2019] [Indexed: 10/27/2022] Open
Abstract
Background Breast cancer is a major contributor to cancer-related deaths among women worldwide, despite the numerous measures employed to prevent and manage the disease. This study explored the knowledge and health seeking behaviour of breast cancer patients at the Komfo Anokye Teaching Hospital. Methods A descriptive cross-sectional study was conducted at Komfo Anokye Teaching Hospital in Kumasi, Ghana, from June 2014 to July 2014. Thirty-five participants were purposively selected. The responses to questions about their experiences with breast cancer were determined using indepth interviews. Transcripts were coded and analysed using NVIVO version 10.0. Results Participants' knowledge about signs and symptoms of breast cancer after their diagnosis was high but low for risk factors. Screening for breast cancer through self-breast examination was infrequently performed prior to their diagnosis. The patients' first point of care was generally health facilities. Some patients reported late due to misinterpretation of signs and symptoms, cultural influences and fear of losing their breast to surgery, physician delay, health providers' laxity, and disinterest in breast cancer. Men, for example, husbands, decide on where and when breast cancer patients go for treatment. Conclusion There is poor knowledge of the risk factors for developing breast cancer. Patients resorted to the hospital as first options for cure but were generally delayed in doing so. There is the need to create awareness about breast cancer among the general population.
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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: 158] [Impact Index Per Article: 26.3] [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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Hill J, Mills C, Li Q, Smith JS. Prevalence of traditional, complementary, and alternative medicine use by cancer patients in low income and lower-middle income countries. Glob Public Health 2018; 14:418-430. [PMID: 30325704 DOI: 10.1080/17441692.2018.1534254] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The use of traditional, complementary, and alternative medicine (TCAM) for cancer may influence the delivery or effectiveness of conventional cancer treatment. In this systematic review, we aimed to (1) summarise the available prevalence data on traditional medicine use by cancer patients in less developed countries (LDCs), and (2) stratify the prevalence data by world region and country income level. A literature search for cancer, TCAM, and low income (LI) and lower-middle income (LMI) countries was conducted across 5 databases. A total of 2,365 publications were reviewed for eligibility, of which 25 studies met inclusion criteria. The combined sample size was 6,878 cancer patients, with a median of 54.5% reporting the use of TCAM for cancer care. Of the studies providing data on the concomitant use of TCAM and conventional cancer treatment (n = 4,872 cancer patients), a median of 26.7% of participants reported combining the two systems of medicine. From the data available, it is apparent that TCAM use among cancer patients in less developed countries is common; however, additional studies are needed to support the safe and effective management of cancer for patients in LI and LMI countries.
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Affiliation(s)
- Jacob Hill
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina, Chapel Hill, USA
| | - Coleman Mills
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Quefeng Li
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
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Travado L, Bultz BD, Ullrich A, Asuzu CC, Turner J, Grassi L, Jacobsen P. 2016 President's Plenary International Psycho-Oncology Society: challenges and opportunities for growing and developing psychosocial oncology programmes worldwide. Psychooncology 2017; 26:1231-1238. [PMID: 28599340 DOI: 10.1002/pon.4471] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 01/02/2023]
Abstract
Consistent with the International Psycho-Oncology Society's (IPOS) vision and goals, we are committed to improving quality cancer care and cancer policies through psychosocial care globally. As part of IPOS's mission, upon entering "Official Relations" for a second term with the World Health Organization (WHO), IPOS has dedicated much attention to reaching out to countries, which lack formalized psychosocial care programmes. One of IPOS's strategies to accomplish this goal has been to bring psycho-oncology training programmes to low- and middle-income countries and regions. To this end, the IPOS Board approved a new position on the Board of Directors for a member from a low- to middle-income country (LMIC). The IPOS 2016 President's Plenary focused on challenges and opportunities that exist in growing and developing psychosocial oncology programmes worldwide. The plenary presentations highlight how IPOS and WHO have aligned their goals to help LMICs support cancer patients as an essential element of cancer and palliative care. IPOS country representatives are strongly supported in liaising with national health authorities and with WHO Country Representatives in LMICs. The plenary speakers discussed the role IPOS Federation has taken in building a global network of psychosocial leaders and the impact this had in assisting LMICs in meeting IPOS's psychosocial care objectives. The plenary highlighted the challenges of expanding psychosocial reach into these countries. One significant question remains: Can psychosocial guidelines be adapted to LMICs and regions?
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Affiliation(s)
- Luzia Travado
- Psycho-oncology Service, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Barry D Bultz
- Daniel Family Leadership Chair in Psychosocial Oncology, Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Psychosocial and Rehabilitation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Andreas Ullrich
- World Health Organization, Noncommunicable Diseases and Mental Health Cluster, Switzerland
| | - Chioma C Asuzu
- Department of Counselling and Human Development Studies and Unit of Psycho-Oncology, Department of Radiation Oncology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jane Turner
- Faculty of Medicine, The University of Queensland, St Lucia, Australia
| | - Luigi Grassi
- Institute of Psychiatry, Section of Neurology, Psychiatry and Psychology, Department of Biomedical and Speciality Surgical Sciences, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Department of Mental Health and Addictive Behavior, S. Anna University Hospital and Health Authorities, Ferrara, Italy
| | - Paul Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
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13
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Anakwenze CP, Ntekim A, Trock B, Uwadiae IB, Page BR. Barriers to radiotherapy access at the University College Hospital in Ibadan, Nigeria. Clin Transl Radiat Oncol 2017; 5:1-5. [PMID: 29594210 PMCID: PMC5833915 DOI: 10.1016/j.ctro.2017.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/20/2017] [Accepted: 05/28/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction Nigeria has the biggest gap between radiotherapy availability and need, with one machine per 19.4 million people, compared to one machine per 250,000 people in high-income countries. This study aims to identify its patient-level barriers to radiotherapy access. Material and methods This was a cross sectional study consisting of patient questionnaires (n = 50) conducted in January 2016 to assess patient demographics, types of cancers seen, barriers to receiving radiotherapy, health beliefs and practices, and factors leading to treatment delay. Results Eighty percent of patients could not afford radiotherapy without financial assistance and only 6% of the patients had federal insurance, which did not cover radiotherapy services. Of the patients who had completed radiotherapy treatment, 91.3% had experienced treatment delay or often cancellation due to healthcare worker strike, power failure, machine breakdown, or prolonged wait time. The timeliness of a patient’s radiotherapy care correlated with their employment status and distance from radiotherapy center (p < 0.05). Conclusions Barriers to care at a radiotherapy center in a low- and middle-income country (LMIC) have previously not been well characterized. These findings can be used to inform efforts to expand the availability of radiotherapy and improve current treatment capacity in Nigeria and in other LMICs.
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Affiliation(s)
- Chidinma P Anakwenze
- University of Alabama Birmingham School of Medicine, Birmingham, AL, United States.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Atara Ntekim
- College of Medicine, University of Ibadan, Ibadan, Nigeria.,University College Hospital, Ibadan, Nigeria
| | - Bruce Trock
- James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, United States
| | | | - Brandi R Page
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
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