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Ngubane NP, Mabandla MV, De Gama BZ. Global perspectives on the traditional approaches used in the treatment of schizophrenia: A systematic review. Asian J Psychiatr 2024; 97:104081. [PMID: 38797088 DOI: 10.1016/j.ajp.2024.104081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/01/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Traditional healing considers a holistic approach when diagnosing and treating patients for mental ailments, and is the preferred approach globally. OBJECTIVE This review documented traditional healing approaches for treatment of schizophrenia used in different regions globally. METHODS PICO framework was used to facilitate literature search from Google Scholar, PubMed, Medline, Cochrane, Scopus, APA PsycINFO, and Web search. Studies documenting methods of treatment from the perspective of traditional healers, patients and/or caregivers were included and also studies which investigated herbal plants used in traditional healing in vitro and in vivo were included. Review articles, magazine/newspaper articles, editorials, letters, comments/opinion articles, and articles with inaccessible full text were excluded. The risk of bias was assessed using MMAT and SYRCLE tools. University Capacity Development Programme funded this review. RESULTS 74 articles were included, these documented traditional healing practices used in Africa, Asia, America, Europe, and Oceania. Common approach globally was herbal medicine. Other reported methods included faith-based healing, consultation with the ancestors, performing rituals, acupuncture, and music and yoga therapies. Inhumane approaches included starving, beating, cutting and confining patients. In some cases, traditional healing was used as adjunctive treatment. The overall risk of bias for studies in this review was low. CONCLUSION Traditional healing contributes in bridging the treatment gap for schizophrenia in developing countries. However, there is a lack of standardisation of the approaches employed in the different regions, and the safety and effectiveness of some of these approaches remain questionable.
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Affiliation(s)
- Ntombifuthi P Ngubane
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000, South Africa.
| | - Musa V Mabandla
- Discipline of Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000, South Africa
| | - Brenda Z De Gama
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000, South Africa
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Galvin M, Chiwaye L, Moolla A. Religious and Medical Pluralism Among Traditional Healers in Johannesburg, South Africa. JOURNAL OF RELIGION AND HEALTH 2024; 63:907-923. [PMID: 36971902 PMCID: PMC10040931 DOI: 10.1007/s10943-023-01795-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
Religion and spirituality are powerful social forces in contemporary South Africa. Traditional Health Practitioners (THPs) are commonly consulted for both spiritual and medical ailments as a first line of care. Many studies have assessed African traditional health seeking behaviors but few have examined beliefs, practices, and behaviors of THPs themselves. This study sought to explore spiritual worldviews among South African THPs. Semi-structured in-depth interviews were conducted with 18 THPs in Johannesburg, South Africa between January and May, 2022. Interviews were transcribed and translated into English. Data were managed using NVivo 12 software and thematically analyzed. The majority of THPs interviewed indicated that initiation as a THP was almost always preceded by a sickness accompanied by dreams/visions that represented an "ancestral calling" to become a healer. Most THPs also trained as both sangomas-who healed according to traditional beliefs-and prophets-who healed according to Christian beliefs. This reflects a syncretic relationship between traditional African beliefs and Christianity. However, not all churches are accepting of traditional beliefs and subsequently these THPs are members only at non-Pentecostal AIC churches who blend both African and Christian practices. Similar to these forms of religious pluralism melding Christianity and traditional beliefs, many THPs also often practice medical pluralism, mixing Western treatments with traditional practices/medicines. THPs are able to adapt elements of Western and African beliefs into healing practices that span multiple religious and medical fields. Thus, collaborative and decentralized healthcare services may be highly acceptable among such a pluralistic community.
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Affiliation(s)
- Michael Galvin
- Health Economics and Epidemiology Research Office (HE2RO), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Psychiatry, Boston Medical Center (BMC), Boston, USA.
- Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Lesley Chiwaye
- Health Economics and Epidemiology Research Office (HE2RO), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aneesa Moolla
- Health Economics and Epidemiology Research Office (HE2RO), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Galvin M, Michel G, Manguira E, Pierre E, Lesorogol C, Trani JF, Lester R, Iannotti L. Examining the Etiology and Treatment of Mental Illness Among Vodou Priests in Northern Haiti. Cult Med Psychiatry 2023; 47:647-668. [PMID: 35753013 PMCID: PMC9244373 DOI: 10.1007/s11013-022-09791-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 11/17/2022]
Abstract
This study assesses the perspectives and experiences of Vodou priests (ougan) in the treatment of mental illness in northern Haiti. Our goal is to explore the etiology and popular nosologies of mental illness in the context of Haitian Vodou, through understandings of illness and misfortune which are often viewed as a result of sent spirits-or spirits sent supernaturally by others with the intent to cause harm. Using a qualitative approach, this study conducted semi-structured in-depth interviews with 20 ougan living near the city of Cap-Haïtien. Interviews highlight a sample of healers with little formal training who maintain beliefs and practices that differ significantly from current biomedical models. Ougan treat mental illness through a variety of means including prayer and conjuring of spirits, leaves for teas and baths, as well as combinations of perfumes, rum, human remains, and other powdered concoctions that are either imbibed or rubbed on the skin. The primary purpose of these treatments is to expel the spirit causing harm, yet they can often result in additional harm to the patient. Findings suggest that while ougan are willing to collaborate with biomedical practitioners, significant barriers remain preventing cooperation between these two groups.
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Affiliation(s)
- Michael Galvin
- Fogarty Global Health Fellow (NIH), Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | - Guesly Michel
- Mental Health Center at Morne Pelé, Quartier Morin, Nord, Haiti
| | - Eurine Manguira
- Mental Health Center at Morne Pelé, Quartier Morin, Nord, Haiti
| | - Edny Pierre
- Mental Health Center at Morne Pelé, Quartier Morin, Nord, Haiti
| | - Carolyn Lesorogol
- Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO 63130 USA
| | - Jean-François Trani
- Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO 63130 USA
| | - Rebecca Lester
- Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO 63130 USA
| | - Lora Iannotti
- Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO 63130 USA
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Galvin M, Chiwaye L, Moolla A. Perceptions of causes and treatment of mental illness among traditional health practitioners in Johannesburg, South Africa. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2023; 53:403-415. [PMID: 38037643 PMCID: PMC10688254 DOI: 10.1177/00812463231186264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Mental disorders are among the most poorly treated illnesses in sub-Saharan Africa. It is estimated that 70%-80% of South Africans consult traditional health practitioners for the treatment of psychological ailments. As traditional health practitioners maintain a strong role in assessing and treating patients with mental illness in this context, this study contributes to the burgeoning research literature on the topic. Semi-structured in-depth interviews were conducted with 18 traditional health practitioners in Johannesburg, South Africa, between January and May 2022. Interviews were transcribed and translated into English. The data were managed using NVivo 12 software and thematically analysed. Traditional health practitioners interviewed generally perceived mental illness to be of supernatural causation, either as a result of bewitchment, a calling for patients to become THPs themselves, due to displeased ancestors, or due to natural causes. Traditional health practitioners identified eight primary treatments that they use for treating mental illness. Among these were throwing of bones (tinhlolo) to start communicating with ancestors, steaming (ukufutha) to start a cleansing process, sneezing (umbhemiso) to forcefully dispel the spirit causing the illness, induced vomiting (phalaza), and the administration of laxatives (mahlabekufeni) to remove the spirits poisoning the body as well as animal sacrifice to purge spirits and communicate with ancestors. This is all followed by cutting (ukucaba), which is the final part of the treatment and ensures that the evil spirit cannot return. Due to the ubiquity of traditional health practitioner usage for mental illness in sub-Saharan Africa, it is essential to understand what conceptions traditional health practitioners have of the aetiology of these disorders as well as their modalities for administering treatment.
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Affiliation(s)
- Michael Galvin
- Health Economics and Epidemiology Research Office (HERO), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Psychiatry, Boston Medical Center (BMC), USA
- Harvard T.H. Chan School of Public Health, USA
| | - Lesley Chiwaye
- Health Economics and Epidemiology Research Office (HERO), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aneesa Moolla
- Health Economics and Epidemiology Research Office (HERO), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Muswerakuenda FF, Mundagowa PT, Madziwa C, Mukora-Mutseyekwa F. Access to psychosocial support for church-going young people recovering from drug and substance abuse in Zimbabwe: a qualitative study. BMC Public Health 2023; 23:723. [PMID: 37081488 PMCID: PMC10117257 DOI: 10.1186/s12889-023-15633-8] [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: 01/07/2023] [Accepted: 04/08/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The church and other religious-affiliated organizations have promising yet underexplored potential to provide social support services for young people recovering from substance abuse in communities where drug and substance rehabilitation services are limited. This study aimed to establish the barriers and facilitators of accessing psychosocial support, the role of the church, and strategies to promote access to psychosocial support for youths recovering from drug and substance abuse. METHODS This was a qualitative cross-sectional study, and semi-structured interviews of 18 church-going youths and three youth pastors were conducted in eastern Zimbabwe. Data were collected using recorded telephone interviews. Data were transcribed and analyzed using the thematic network analysis technique of producing basic themes, which build into organizing themes. Organizing themes produces one overarching global theme. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for reporting on qualitative research were used in reporting the study findings. RESULTS The interviews produced the following basic themes under organizing theme barriers: stigma and discrimination, parental/guardian denial, radical religious beliefs, and negative role models. Under the organizing theme facilitators, the basic themes were acceptance, confidentiality, peer and parental support, and an organized support program. The church acted as the bridge between the barriers to access to services and support seeking through innovative, inclusive projects and activities, as well as a pillar of social support. CONCLUSIONS Acceptance of one's addiction problem is critical to initiate seeking psychosocial support. Confidentiality, support from trustworthy relationships, and the availability of a well-coordinated recovery program enable young people to seek support. We recommend formal training church-based counselors in the ethical aspects of psychotherapy to reduce the preconceived social stigma associated with drug and substance abuse.
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Affiliation(s)
| | - Paddington T Mundagowa
- Clinical Research Center, Africa University, Mutare, Zimbabwe.
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, USA.
| | - Clara Madziwa
- College of Social Sciences, Theology and Education, Africa University, Mutare, Zimbabwe
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Liao Y, Ameyaw MA, Liang C, Li W. Research on the Effect of Evidence-Based Intervention on Improving Students' Mental Health Literacy Led by Ordinary Teachers: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:949. [PMID: 36673704 PMCID: PMC9859505 DOI: 10.3390/ijerph20020949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND the purpose of this study was to systematically review the effects of intervention experiments led by ordinary teachers to improve students' mental health literacy and to provide evidence-based research and new ideas for improving students' mental health literacy. METHODS A systematic search using 5 English (Web of Science, PubMed, ProQuest, EBSCO, Springer Link) and 3 Chinese (CNKI, WanFang, and VIP) databases was initiated to identify controlled trials assessing the immediate effect and delay effect of the intervention experiment led by ordinary teachers on improving students' mental health knowledge, anti-stigma, willingness, or behavior to seek-help. RESULTS a total of 14 experiments with 7873 subjects were included. The results showed that the immediate effect of the intervention on promoting students' mental health knowledge [g = 0.622, 95% CI (0.395, 0.849)] and anti-stigma [g = 0.262, 95% CI (0.170, 0.354)] was significant, but the amount of delay effect is not significant. CONCLUSIONS the results of this review show that ordinary classroom teachers can effectively participate in projects to improve students' mental health literacy, significantly improve students' mental health knowledge and attitudes towards psychological problems, and make up for the shortage of full-time mental health teachers in schools. In future, more attention should be paid to students' mental health literacy, and evidence-based intervention research should be strengthened. Furthermore, we can improve students' mental health literacy and avoid poor mental health by addressing delays in early intervention, as well as improve experimental design, prolong the intervention time, and improve the effectiveness of the intervention.
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Sichimba F, Janlöv AC, Khalaf A. Family caregivers' perspectives of cultural beliefs and practices towards mental illness in Zambia: an interview-based qualitative study. Sci Rep 2022; 12:21388. [PMID: 36496509 PMCID: PMC9736699 DOI: 10.1038/s41598-022-25985-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
Many elements of mental illness, including accessibility and utilization of mental health care, are influenced by societal cultural ideas. In Zambia, for example, traditional healers are not recognized, yet a large segment of the population continues to use their services due to their conviction. Despite this, studies on cultural beliefs and practices regarding mental illness in Zambia are scarce. Thus, this study is contextualized in Lusaka, Zambia, with the goal of filling a gap in the knowledge by exploring the cultural beliefs and practices surrounding mental illness as experienced by family caregivers caring for a next-of-kin with mental illness. Using a qualitative exploratory design, a purposeful sample of 15 family caregivers of next-of-kins diagnosed with mental illness were recruited. Data were collected via individual interviews, and analyzed using qualitative thematic analysis. The analysis revealed four main themes: (1) prevailing beliefs on cause of mental illness; (2) encountering social support and neglect; (3) recognizing the need of professional help; and (4) seeking culturally influenced help. Findings show that traditional attributions (for example, being bewitched, demon possession and sexual relations with uncleansed widows) are deeply embedded in beliefs and descriptions of what causes mental illness. These beliefs were found to influence not only help-seeking practices but also how people perceived and related to families. Given that beliefs influence caregiver help-seeking, these findings have implications for culturally sensitive practice. The study recommends that public health practitioners consider cultural beliefs and practices when developing health promotion programs, and public health messages.
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Affiliation(s)
- F Sichimba
- Department of Psychology, University of Zambia, P.O. Box 32379, Lusaka, Zambia
| | - A-C Janlöv
- Faculty of Health Sciences, Kristianstad University, Elmetorpsvägen 15, 291 88, Kristianstad, Sweden
| | - A Khalaf
- Faculty of Health Sciences, Kristianstad University, Elmetorpsvägen 15, 291 88, Kristianstad, Sweden.
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Pham TV, Koirala R, Wainberg ML, Kohrt BA. Reassessing the Mental Health Treatment Gap: What Happens if We Include the Impact of Traditional Healing on Mental Illness? Community Ment Health J 2021; 57:777-791. [PMID: 32894398 PMCID: PMC7936992 DOI: 10.1007/s10597-020-00705-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
In this Fresh Focus, we reassess what the mental health treatment gap may mean if we consider the role of traditional healing. Based on systematic reviews, patients can use traditional healers and qualitatively report improvement from general psychological distress and symptom reduction for common mental disorders. Given these clinical implications, some high-income countries have scaled up research into traditional healing practices, while at the same time in low-and middle-income countries, where the use of traditional healers is nearly ubiquitous, considerably less research funding has studied or capitalized on this phenomena. The World Health Organization 2003-2020 Mental Health Action Plan called for government health programs to include traditional and faith healers as treatment resources to combat the low- and middle-income country treatment gap. Reflection on the work which emerged during the course of this Mental Health Action Plan revealed areas for improvement. As we embark on the next Mental Health Action Plan, we offer lessons-learned for exploring potential relationships and collaborations between traditional healing and biomedicine.
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Affiliation(s)
- Tony V Pham
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2213 Elba Street, Durham, NC, 27705, USA.
- Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal.
| | - Rishav Koirala
- University of Oslo, Problemveien 7, 0315, Oslo, Norway
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal
- Brain and Neuroscience Center Nepal, Krishna Dhara Marg, Kathmandu, 44600, Nepal
| | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Brandon A Kohrt
- Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal
- George Washington University School of Medicine and Health Sciences, 2120 L Street, NW, Suite 600, Washington, DC, 20037, USA
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Why Do Patients with Mental Disorders Default Treatment? A Qualitative Enquiry in Rural Kwazulu-Natal, South Africa. Healthcare (Basel) 2021; 9:healthcare9040461. [PMID: 33919729 PMCID: PMC8070736 DOI: 10.3390/healthcare9040461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
Although treatment default by psychiatric patients or mental health care users is a global challenge, this behavior is reported to be higher in South Africa. The Manguzi District Hospital in rural Kwa-Zulu Natal Province, South Africa, experiences high rates of treatment default by psychiatric patients. The objective of this study was to determine the reasons for treatment defaulting at Manguzi Hospital, KwaZulu-Natal Province, South Africa. An explorative qualitative design, using in-depth interviews, was conducted with mental health care users who had defaulted out-patient psychiatric treatment. Twenty-one mental health care users were interviewed before data saturation was reached. Nvivo version 11 was used to analyze the qualitative data. Major themes that emerged confirmed that social factors are key contributions to treatment defaulting, and these include denial of the mental disorders; belief that they are cured; lack of, or disintegration of social support; preference for traditional medicine; and flaws in the health care system. Social determinants of treatment outcomes for mental disorders require tailor-made support systems for patients in these rural communities, which include increase in health literacy and attention to the cultural understanding of mental disorders.
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Chidarikire S, Cross M, Skinner I, Cleary M. Ethnographic Insights into the Quality of Life and Experiences of People Living with Schizophrenia in Harare, Zimbabwe. Issues Ment Health Nurs 2021; 42:65-78. [PMID: 32633167 DOI: 10.1080/01612840.2020.1770385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Schizophrenia is a complex and severe mental disorder affecting more than 20 million people worldwide. This study used focused ethnography to explore the everyday lives of 18 people living with schizophrenia in Zimbabwe and its impact on their quality of life (QOL). Data were collected using semi-structured interviews, observational fieldwork, and the short form of the World Health Organization QOL-BREF questionnaire. Those aged 20-40 years experienced poorer QOL than older people. Family dislocation, living with stigma and discrimination, cost of medications and limited and variable access to treatment and support disrupted participants' ability to enjoy life and function socially.
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Affiliation(s)
| | - Merylin Cross
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Isabelle Skinner
- Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
| | - Michelle Cleary
- School of Nursing, University of Tasmania, Sydney, New South Wales, Australia
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Kpobi L, Swartz L. Indigenous and faith healing for mental health in Ghana: An examination of the literature on reported beliefs, practices and use of alternative mental health care in Ghana. Afr J Prim Health Care Fam Med 2019; 11:e1-e5. [PMID: 31368321 PMCID: PMC6676964 DOI: 10.4102/phcfm.v11i1.1941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/16/2018] [Accepted: 01/24/2019] [Indexed: 11/25/2022] Open
Abstract
Background For many people in African countries, various forms of health care are utilised for the treatment of illness. This pluralistic nature of health seeking includes the use of indigenous, faith and allopathic medicines for care. Aim In this article, our aim was to gain insight into the existing knowledge on indigenous and faith healing in Ghana, with a particular focus on mental health care. We first examine the reported mental health beliefs and practices of Ghanaian alternative healers. Following this, we look at the use and purported preference for non-biomedical mental health care by patients. Methods Relevant literature was examined to explore the beliefs, practices and use of non-biomedical mental health care systems in Ghana Results Evidence for the use and preference for non-biomedical mental health care is largely anecdotal. Similarly, the mental health beliefs of alternative healers have been documented in various small-scale studies. However, such information is important if mental health services in Ghana are to be improved. Conclusion Integration of the different healthcare systems must be built on knowledge of beliefs and methods. A clearer understanding of the work of non-biomedical healers is important if appropriate recommendations are to be made for collaboration between biomedical and non-biomedical systems in Ghana.
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Affiliation(s)
- Lily Kpobi
- Department of Psychology, Stellenbosch University, Stellenbosch.
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Kpobi LNA, Swartz L, Omenyo CN. Traditional herbalists' methods of treating mental disorders in Ghana. Transcult Psychiatry 2019; 56:250-266. [PMID: 30284964 DOI: 10.1177/1363461518802981] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of traditional medicine for the treatment of various disorders is not a new practice. Indeed, various categories of traditional healers form a large part of the healthcare workforce in many low- and middle-income countries, and given the paucity of mental health professionals in these countries, traditional and complementary medicine practitioners are utilised even more so for mental disorders. In Ghana, efforts have been made to formalise and standardise the work of traditional medicine practitioners. This goal is still mostly unmet, partly due to the lack of scientific knowledge of their beliefs, methods, and practices in mental healthcare. Very few studies have documented this knowledge. In this article, we report on some of the methods that are used by traditional Ghanaian herbalists in treating mental disorders. Eight herbalists working within the Greater Accra Region, who specialised in mental health, were interviewed through individual semi-structured interviews. Thematic analysis showed that traditional herbalists' work in treating mental disorders revolved around four key themes: the method of diagnosis; the treatment methods used; the mode of administering the treatment; and the purpose of the specific treatment. These themes are discussed with reference to their potential implications for patients' care and outcomes.
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Abstract
In November 2017, following a military intervention, Robert Mugabe was forced to resign as president of Zimbabwe – where he had ruthlessly ruled since 1980. Mugabe’s regime was responsible for destroying the country’s excellent health system. I argue that this is a unique moment for health reform in Zimbabwe. This reform should focus on three areas: (1) repairing relationships with the international community by focusing on human rights and eliminating corruption, (2) strengthening the health workforce through retention strategies, training, and non-specialist providers, and (3) community engagement. The future of Zimbabwe’s health system is in limbo, and now is a unique opportunity to make positive change.
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14
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Kpobi L, Swartz L. Implications of healing power and positioning for collaboration between formal mental health services and traditional/alternative medicine: the case of Ghana. Glob Health Action 2018. [PMID: 29529937 PMCID: PMC5912442 DOI: 10.1080/16549716.2018.1445333] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Many current debates about global mental health have increasingly called for collaboration between biomedical and traditional medical health systems. Despite these calls, not much has been written about the variables that would influence such collaboration. To a large extent, collaboration dialogues have considered biomedicine on the one hand, and a wide range of traditional and faith-based treatments on the other hand. However, this dualistic bifurcation does not reflect the plurality of healing systems in operation in many contexts, and the diverse investments that different non-biomedical healing approaches may have in their own power to heal. OBJECTIVE We set out to explore the diversity of different healers' perceptions of power, and the relationship between that power and the perceived power of biomedical approaches. METHODS Through a qualitative design, and using the case of medical pluralism in urban Ghana as an example, we conducted interviews among different categories of traditional and alternative medicine (TAM) practitioners living and/or working in the Greater Accra Region of Ghana. RESULTS Through thematic analyses, differences in the notions about collaboration between the different categories of healers were identified. Their perceptions of whether collaboration would be beneficial seemed, from this study, to co-occur with their perceptions of their own power. CONCLUSIONS We suggest that an important way to move debates forward about collaboration amongst different sectors is to examine the notions of power and positioning of different categories of TAM healers in relation to biomedicine, and the attendant implications of those notions for integrative mental healthcare.
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Affiliation(s)
- Lily Kpobi
- a Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
| | - Leslie Swartz
- a Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
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15
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January J, Chimbari MJ. Opportunities and obstacles to screening for perinatal depression among women in Zimbabwe: A narrative review of literature. S Afr J Psychiatr 2018; 24:1127. [PMID: 30263213 PMCID: PMC6138181 DOI: 10.4102/sajpsychiatry.v24i0.1127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 07/11/2018] [Indexed: 11/28/2022] Open
Abstract
Background The perinatal period provides an opportune time for health care providers to screen for and proffer interventions for women suffering from depression. However, routine screening for depression is not done in primary care settings in Zimbabwe. Aim This narrative review discusses opportunities and obstacles surrounding screening for perinatal depression in primary care settings in Zimbabwe, with a view to stress the importance of routine screening to policy-makers. Methods Both electronic and manual searches were done on PubMed, PubMed Central, African Journals Online, Google Scholar and the University of Zimbabwe Institutional Repository (UZIR) using the following key terms: ‘women and antenatal depression’, ‘prenatal depression’, ‘postnatal depression’, ‘postpartum depression’, ‘depressive disorder’, or ‘common mental disorder’ and ‘screening and Zimbabwe’. Results Although opportunities for depression screening are possible because of the high antenatal and postnatal service coverage, the potential for universal screening is fraught with human and financial resource constraints, lack of training in mental health care among primary health care providers and lack of locally validated screening tools for depression. Conclusion There is a need to channel resources into the training of midwives and other primary health care providers on mental health issues affecting women perinatally.
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Affiliation(s)
- James January
- Department of Psychiatry, University of KwaZulu-Natal, South Africa
| | - Moses J Chimbari
- School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
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Kpobi L, Swartz L. 'That is how the real mad people behave': Beliefs about and treatment of mental disorders by traditional medicine-men in Accra, Ghana. Int J Soc Psychiatry 2018. [PMID: 29529921 DOI: 10.1177/0020764018763705] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traditional healing methods are considered central to mental health care in low-income countries such as Ghana, because they are perceived to be more easily accessible, more affordable and generally ascribe similar causal beliefs to those of the patients. However, not much is known about the work of traditional healers largely because their methods are shrouded in mysticism and secrecy. There is a need to understand the ideology and beliefs of traditional healers surrounding mental disorders, including knowledge about their practices in mental health care. AIMS In this article, we discuss the causal beliefs and treatment methods of traditional medicine-men from Accra, Ghana. We also describe their diagnostic and treatment methods for mental disorders. METHODS Eight medicine-men, indigenous to the Greater Accra Region, were interviewed through individual semi-structured interviews. The data were analysed through thematic analysis. RESULTS The medicine-men's beliefs about mental illness were dominated by supernatural ideas. Mental illness was also seen as a form of punishment or resulting from envy, and there was a strong reliance on spiritual direction from the gods for diagnosis and treatment. CONCLUSION These themes are discussed with emphasis on their potential implications for patients, as well as for collaborative efforts.
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Affiliation(s)
- Lily Kpobi
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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17
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Kidia K, Machando D, Mangezi W, Hendler R, Crooks M, Abas M, Chibanda D, Thornicroft G, Semrau M, Jack H. Mental health in Zimbabwe: a health systems analysis. Lancet Psychiatry 2017. [PMID: 28625876 DOI: 10.1016/s2215-0366(17)30128-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There has been little external analysis of Zimbabwe's mental health system. We did a systems analysis to identify bottlenecks and opportunities for mental health service improvement in Zimbabwe and to generate cost-effective, policy-relevant solutions. We combined in-depth interviews with a range of key stakeholders in health and mental health, analysis of mental health laws and policies, and publicly available data about mental health. Five themes are key to mental health service delivery in Zimbabwe: policy and law; financing and resources; criminal justice; workforce, training, and research; and beliefs about mental illness. We identified human resources, rehabilitation facilities, psychotropic medication, and community mental health as funding priorities. Moreover, we found that researchers should prioritise measuring the economic impact of mental health and exploring substance use, forensic care, and mental health integration. Our study highlights forensic services as a central component of the mental health system, which has been a neglected concept. We also describe a tailored process for mental health systems that is transferable to other low-income settings and that garners political will, builds capacity, and raises the profile of mental health.
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Affiliation(s)
- Khameer Kidia
- Kushinga, Harare, Zimbabwe; Arnhold Institute for Global Health, Icahn School of Medicine, New York, NY, USA.
| | | | - Walter Mangezi
- Department of Psychiatry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Reuben Hendler
- Kushinga, Harare, Zimbabwe; Arnhold Institute for Global Health, Icahn School of Medicine, New York, NY, USA
| | - Megan Crooks
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Melanie Abas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maya Semrau
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Helen Jack
- Kushinga, Harare, Zimbabwe; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Harvard Medical School, Boston, MA, USA
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Kutcher S, Wei Y, Gilberds H, Ubuguyu O, Njau T, Brown A, Sabuni N, Magimba A, Perkins K. A school mental health literacy curriculum resource training approach: effects on Tanzanian teachers' mental health knowledge, stigma and help-seeking efficacy. Int J Ment Health Syst 2016; 10:50. [PMID: 27493684 PMCID: PMC4973111 DOI: 10.1186/s13033-016-0082-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/19/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mental health literacy (MHL) is foundational for mental health promotion, prevention, stigma reduction, and care; School supported information pertaining to MHL in sub-Saharan Africa is extremely limited, including in Tanzania. Successful application of a school MHL curriculum resource may be an effective way to increase teacher MHL and therefore help to improve mental health outcomes for students. METHODS Secondary school teachers in Tanzania were trained on the African Guide (AG) a school MHL curriculum resource culturally adapted from a Canadian MHL resource (The Guide) for use in Africa. Teacher training workshops on the classroom application of the AG were used to evaluate its impact on mental health literacy in a sample of Tanzanian Secondary school teachers. Pre-post training assessment of participant knowledge and attitudes was conducted. Help-seeking efficacy for teachers themselves and their interventions for students, friends, family members and peers were determined. RESULTS Paired t test (n = 37) results demonstrate highly significant improvements in teacher's overall knowledge (p < 0.001; d = 1.14), including mental health knowledge, (p < 0.001; d = 1.14) and curriculum specific knowledge (p < 0.01; d = 0.63). Teachers' stigma against mental illness decreased significantly following the training (p < 0.001; d = 0.61). Independent t tests comparing the paired sample against unpaired sample also demonstrated significant differences between the groups for teacher's overall knowledge (p < 0.001). Teachers also reported high rates (greater than ¾ of the sample) of positive help-seeking efficacy for themselves as well as for their students, friends, family members and peers. As a result of the training, the number of students teachers identified for potential mental health care totaled over 200. CONCLUSIONS These positive results, when taken together with other research, suggest that the use of a classroom-based resource (the AG) that integrates MHL into existing school curriculum through training teachers may be an effective and sustainable way to increase the MHL (improved knowledge, decreased stigma and positive help-seeking efficacy) of teachers in Tanzania. As this study replicated the results of a previous intervention in Malawi, consideration could be given to scaling up this intervention in both countries and applying this resource and approach in other countries in East Africa.
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Affiliation(s)
- Stan Kutcher
- Dalhousie University and the Izaak Walton Killam (IWK) Health Centre, 5850 University Avenue, PO Box 9700, Halifax, NS B3K 6R8 Canada
| | - Yifeng Wei
- Sun Life Financial Chair in Adolescent Mental Health team, Dalhousie University and IWK Health Centre, Halifax, Canada
| | | | - Omary Ubuguyu
- Muhimbili National Hospital, Kalenga Street, PO Box 65000, Dar es Salaam, Tanzania
| | - Tasiana Njau
- Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Adena Brown
- Sun Life Financial Chair in Adolescent Mental Health team, IWK Health Centre, Halifax, Canada
| | - Norman Sabuni
- Mental Health and Substance Abuse, Ministry of Health, PO Box 9083, Dar es Salaam, Tanzania
| | - Ayoub Magimba
- Non Communicable Disease, Ministry of Health, PO Box 9083, Dar es Salaam, Tanzania
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