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Schedwin M, Furaha AB, Hildenwall H, Elimian K, Malembaka EB, Yambayamba MK, Forsberg BC, Van Damme W, Alfvén T, Carter SE, Okitayemba PW, Mapatano MA, King C. Exploring different health care providers´ perceptions on the management of diarrhoea in cholera hotspots in the Democratic Republic of Congo: A qualitative content analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002896. [PMID: 38502678 PMCID: PMC10950234 DOI: 10.1371/journal.pgph.0002896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Abstract
Global cholera guidelines support wider healthcare system strengthening interventions, alongside vertical outbreak responses, to end cholera. Well-trained healthcare providers are essential for a resilient health system and can create synergies with childhood diarrhoea, which has higher mortality. We explored how the main provider groups for diarrhoea in cholera hotspots interact, decide on treatment, and reflect on possible limiting factors and opportunities to improve prevention and treatment. We conducted focus group discussions in September 2022 with different healthcare provider types in two urban and two rural cholera hotspots in the North Kivu and Tanganyika provinces in the Eastern Democratic Republic of Congo. Content analysis was used with the same coding applied to all providers. In total 15 focus group discussions with medical doctors (n = 3), nurses (n = 4), drug shop vendors (n = 4), and traditional health practitioners (n = 4) were performed. Four categories were derived from the analysis. (i) Provider dynamics: scepticism between all cadres was prominent, whilst also acknowledging the important role all provider groups have in current case management. (ii) Choice of treatment: affordability and strong caregiver demands shaped by cultural beliefs strongly affected choice. (iii) Financial consideration on access: empathy was strong, with providers finding innovative ways to create access to treatment. Concurrently, financial incentives were important, and providers asked for this to be considered when subsiding treatment. (iv) How to improve: the current cholera outbreak response approach was appreciated however there was a strong wish for broader long-term interventions targeting root causes, particularly community access to potable water. Drug shops and traditional health practitioners should be considered for inclusion in health policies for cholera and other diarrhoeal diseases. Financial incentives for the provider to improve access to low-cost treatment and investment in access to potable water should furthermore be considered.
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Affiliation(s)
- Mattias Schedwin
- Department of Global Public Health, Stockholm, Sweden
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Aurélie Bisumba Furaha
- Paediatric Department, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Helena Hildenwall
- Department of Global Public Health, Stockholm, Sweden
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Karolinska Institutet, Intervention and Technology, Stockholm, Sweden
| | - Kelly Elimian
- Department of Global Public Health, Stockholm, Sweden
- Exhale Health Foundation, Abuja, Nigeria
| | - Espoir Bwenge Malembaka
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Tropical Diseases and Global Health, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Marc K. Yambayamba
- Vetsuisse Faculty, Section Epidemiology, University of Zurich, Zurich, Switzerland
- Department of Epidemiology and Biostatistics, Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tobias Alfvén
- Department of Global Public Health, Stockholm, Sweden
- Sach’s Children and Youth Hospital, Stockholm, Sweden
| | - Simone E. Carter
- Public Health Emergencies, UNICEF, Kinshasa, Democratic Republic of Congo
| | - Placide Welo Okitayemba
- Programme National d’Elimination du Choléra et de Lutte Contre les Autres Maladies Diarrhéiques, Kinshasa, Democratic Republic of Congo
| | - Mala Ali Mapatano
- Department of Nutrition, Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Carina King
- Department of Global Public Health, Stockholm, Sweden
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Plaatjie MTA, Onyiche TE, Ramatla T, Bezuidenhout JJ, Legoabe L, Nyembe NI, Thekisoe O. A scoping review on efficacy and safety of medicinal plants used for the treatment of diarrhea in sub-Saharan Africa. Trop Med Health 2024; 52:6. [PMID: 38173018 PMCID: PMC10763068 DOI: 10.1186/s41182-023-00569-x] [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] [Received: 10/21/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In sub-Saharan Africa (SSA), significant morbidity and mortality have been linked to diarrhea, which is frequently caused by microorganisms. A rise in antimicrobial-resistant pathogens has reignited the search for alternative therapies. This scoping review aims to map the literature on medicinal plants in relation to their anti-diarrheal potential from SSA. METHODS Studies published from 1990 until April 2022 on medicinal plants used for the treatment of diarrhea from each country in SSA were searched on Scopus, Web of Science, Science Direct and PubMed. The selection of articles was based on the availability of data on the in vitro and/or in vivo, ethnobotanical, and cross-sectional studies on the efficacy of medicinal plants against diarrhea. A total of 67 articles (ethnobotanical (n = 40); in vitro (n = 11), in vivo (n = 7), cross-sectional (n = 3), in vitro and in vivo (n = 2) and ethnobotanical and in vitro (n = 2), were considered for the descriptive analysis, which addressed study characteristics, herbal intervention information, phytochemistry, outcome measures, and toxicity findings. RESULTS A total of 587 different plant species (from 123 families) used for diarrhea treatment were identified. Most studies were conducted on plants from the Fabaceae family. The plants with the strongest antimicrobial activity were Indigofera daleoides and Punica granatum. Chromatographic methods were used to isolate six pure compounds from ethyl acetate extract of Hydnora johannis, and spectroscopic methods were used to determine their structures. The majority of anti-diarrheal plants were from South Africa (23.9%), Ethiopia (16.4%), and Uganda (9%). This study highlights the value of traditional remedies in treating common human diseases such as diarrhea in SSA. CONCLUSION Baseline knowledge gaps were identified in various parts of SSA. It is therefore recommended that future ethnobotanical studies document the knowledge held by other countries in SSA that have so far received less attention. Additionally, we recommend that future studies conduct phytochemical investigations, particularly on the widely used medicinal plants for the treatment of diarrheal illnesses, which can serve as a foundation for future research into the development of contemporary drugs.
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Affiliation(s)
- Moitshepi T A Plaatjie
- Unit for Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
| | - ThankGod E Onyiche
- Department of Veterinary Parasitology and Entomology, University of Maiduguri, Maiduguri, 600230, Nigeria
| | - Tsepo Ramatla
- Unit for Environmental Sciences and Management, North-West University, Potchefstroom, South Africa.
- Gastrointestinal Research Unit, Department of Surgery, School of Clinical Medicine, University of the Free State, Bloemfontein, 9300, South Africa.
| | - Johannes J Bezuidenhout
- Unit for Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
| | - Lesetja Legoabe
- Pharmaceutical Chemistry, School of Pharmacy, North-West University, Potchefstroom, 2520, South Africa
| | - Nthatisi I Nyembe
- Department of Zoology and Entomology, University of the Free State, Phuthaditjhaba, South Africa
| | - Oriel Thekisoe
- Unit for Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
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Guad RM, Carandang RR, Solidum JN, W. Taylor-Robinson A, Wu YS, Aung YN, Low WY, Sim MS, Sekaran SD, Azizan N. Different domains of dengue research in the Philippines: A systematic review and meta-analysis of questionnaire-based studies. PLoS One 2021; 16:e0261412. [PMID: 34929011 PMCID: PMC8687574 DOI: 10.1371/journal.pone.0261412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background
Dengue is the most rapidly spreading mosquito-borne viral disease of humans worldwide, including southeast Asia region. This review provides a comprehensive overview of questionnaire-related dengue studies conducted in the Philippines and evaluates their reliability and validity in these surveys.
Methods
A review protocol constructed by a panel of experienced academic reviewers was used to formulate the methodology, research design, search strategy and selection criteria. An extensive literature search was conducted between March–June 2020 in various major electronic biomedical databases including PubMed, EMBASE, MEDLINE and ScienceDirect. A systematic review and meta-analysis (PRISMA) were selected as the preferred item reporting method.
Results
Out of a total of 34 peer-reviewed dengue-related KAP studies that were identified, 15 published from 2000 to April 2020 met the inclusion criteria. Based on the meta-analysis, a poor mean score was obtained for each of knowledge (68.89), attitude (49.86) and preventive practice (64.69). Most respondents were equipped with a good knowledge of the major clinical signs of dengue. Worryingly, 95% of respondents showed several negative attitudes towards dengue prevention, claiming that this was not possible and that enacting preventive practices was not their responsibility. Interestingly, television or radio was claimed as the main source of gaining dengue information (range 50–95%). Lastly, only five articles (33.3%) piloted or pretested their questionnaire before surveying, of which three reported Cronbach’s alpha coefficient (range 0.70 to 0.90).
Conclusion
This review indicates that to combat the growing public health threat of dengue to the Philippines, we need the active participation of resident communities, full engagement of healthcare personnel, promotion of awareness campaigns, and access to safe complementary and alternative medicines. Importantly, the psychometric properties of each questionnaire should be assessed rigorously.
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Affiliation(s)
- Rhanye Mac Guad
- Faculty of Pharmacy, Department of Pharmaceutical Life Sciences, Universiti Malaya, Kuala Lumpur, Malaysia
- Faculty of Medicine and Health Science, Department of Biomedical Science and Therapeutics, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Rogie Royce Carandang
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Andrew W. Taylor-Robinson
- School of Health, Medical & Applied Sciences, Central Queensland University, Brisbane, QLD, Australia
- College of Health & Human Sciences, Charles Darwin University, Casuarina, NT, Australia
- College of Health Sciences, Vin University, Gia Lam District, Hanoi, Vietnam
| | - Yuan Seng Wu
- Centre for Virus and Vaccine Research, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
| | - Yin Nwe Aung
- Faculty of Medicine & Health Sciences, UCSI University, Port Dickson, Negeri Sembilan, Malaysia
| | - Wah Yun Low
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Asia-Europe Institute, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Maw Shin Sim
- Faculty of Pharmacy, Department of Pharmaceutical Life Sciences, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shamala Devi Sekaran
- Faculty of Medicine & Health Sciences, UCSI University, Port Dickson, Negeri Sembilan, Malaysia
| | - Nornazirah Azizan
- Department of Pathology and Microbiology, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
- * E-mail:
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Carè J, Steel A, Wardle J. Stakeholder attitudes to the regulation of traditional and complementary medicine professions: a systematic review. HUMAN RESOURCES FOR HEALTH 2021; 19:42. [PMID: 33781297 PMCID: PMC8008552 DOI: 10.1186/s12960-021-00579-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/01/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND There has been a considerable increase in the number of traditional and complementary medicine (T&CM) practitioners over the past 20 years and in some jurisdictions are estimated to outnumber general practitioners. Despite this globally significant role, it is apparent that worldwide not all T&CM professions operate under adequate accountability and regulatory oversight for maintaining public protection. To date there has been no published systematic examination of stakeholder opinions regarding regulated and unregulated T&CM occupations. In response, this review aims to investigate, describe, and analyse attitudes held by a range of stakeholder groups towards the regulation of T&CM professions. METHODS A database search of AMED, CINAHL, Embase, Ovid MEDLINE, ProQuest, PsycINFO, PubMed, Scopus, and Google Scholar was conducted for original research published between 2000 and 2020 on stakeholder opinions regarding the regulation of T&CM professions. RESULTS Sixty studies across 15 countries reported on the views of six health care stakeholder groups: consumers, T&CM practitioners, conventional medicine practitioners, professional associations, education providers, and policy-makers. Across all stakeholder groups there was between 15% and 95% (median 61%) support for, and 1% to 57% (median 14%) opposition to the regulation of various T&CM professions. The main reasons for supporting regulation included providing greater public protection, raising training and practice standards, establishing title protection, and gaining acceptance from conventional medicine providers. Concerns regarding regulation included potential restrictions to practice, misappropriation of practice, and medical oversight of T&CM practitioners. Few studies canvassed the views of professional associations (n = 6), education providers (n = 2), and policy-makers (n = 2). CONCLUSIONS There appears to be broad support for the regulation of T&CM professions, although there was wide variation in attitudes as to how this should be applied. Further research, with a particular focus on policy-makers, education providers, and professional associations, is critical to inform appropriate health policy and practice recommendations relating to T&CM professional regulation across jurisdictions. Systematic review registration: the a priori protocol for this systematic review was registered in PROSPERO and is available at: www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42020198767 .
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Affiliation(s)
- Jenny Carè
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW, 2007, Australia.
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW, 2007, Australia
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, 2480, Australia
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