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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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Audet CM, Seabi T, Oyekunle T, Hove J, Wagner RG. A individually randomized controlled trial comparing Healer-led vs. clinician- led training to improve personal protective equipment use among traditional healers in South Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002945. [PMID: 38394119 PMCID: PMC10889871 DOI: 10.1371/journal.pgph.0002945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
Like allopathic healthcare workers, healers are also exposed to patients' blood and body fluids. A widespread practice is the traditional "injection," in which the healer performs subcutaneous incisions to rub herbs directly into the bloodied skin, resulting in 1,500 blood exposures over their lifetime. We tested the impact of healer-led PPE training, staffed by trained traditional healers who reported using PPE during each risky clinical encounter vs. healthcare worker (HCW)-led PPE training sessions. We randomized 136 healers into one of the two study arms (67 in the healer-led group, 69 in the HCW-led group) and assessed the impact of trainer on PPE skills and use over a six-month period. All healers received one in-person day of didactic and practical training followed by three sessions at the healers' home. Participants were largely female (80%), averaged 51 years old, and practiced as a healer for an average of 17 years. Almost 44% either disclosed themselves as HIV+ or received a positive HIV test result at study initiation. Healers in the HCW arm showed equivalent PPE scores as those trained by traditional healers at baseline and at seven months. Healers in both arms self-reported high levels of glove use during"injections," with no statistical difference of use by study arm. When we assessed actual gloves and razor blades disposed of each month, a similar trend emerged. No one seroconverted during the study period. The need for PPE support among traditional healers cannot be ignored. Traditional healers can be trained to effectively disseminate PPE knowledge and skills to other traditional healers. With an estimated 200,000 traditional healers in South Africa, it is imperative that all of them have access to PPE training and supplies to prevent HIV, HCV, or HBV infections. Trial registration: ClinicalTrials.gov, NCT04440813. Registered 17 June 2020, https://clinicaltrials.gov/ct2/show/NCT04440813.
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Affiliation(s)
- Carolyn M. Audet
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, United States of America
| | - Tshegofatso Seabi
- MRC/Wits Agincourt Research Unit, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Taofik Oyekunle
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, United States of America
| | - Jennifer Hove
- MRC/Wits Agincourt Research Unit, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ryan G. Wagner
- MRC/Wits Agincourt Research Unit, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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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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Dean L, Buechner H, Moffett B, Maritze M, Dalton LJ, Hanna JR, Rapa E, Stein A, Tollman S, Kahn K. Obstacles and facilitators to communicating with children about their parents' mental illness: a qualitative study in a sub-district of Mpumalanga, South Africa. BMC Psychiatry 2023; 23:78. [PMID: 36707793 PMCID: PMC9883085 DOI: 10.1186/s12888-023-04569-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Given that common mental disorders are one of the leading causes of disease burden worldwide, it is likely that many children are growing up with a parent or other adult within their family who has anxiety or depression. Parents with a mental illness may not consider it appropriate to discuss their illness with their child, and consequently an absence of communication may lead to stigmatization, shame, misunderstanding their parents' symptoms, and even blaming themselves. There is a scarcity of research exploring the experiences and perceptions of healthcare professionals about communication with children of parents with mental illness in low-resource and African contexts. METHODS A qualitative study using semi-structured interviews with healthcare professionals (n = 15) was conducted within the Bushbuckridge sub-district of Mpumalanga Province, South Africa. Data were analysed using Thematic Analysis. RESULTS Four themes were identified relating to the obstacles around communication with children. These included: (1) finding an appropriate language to describe mental illness, as well as the prevailing cultural explanations of mental illness (2) the stigma associated with mental illness (3) the perceived role of children in society and (4) mental health services and staff skills. Two themes that addressed facilitators of communication about parental mental illness were identified: (1) the potential to increase mental health awareness amongst the broader community through social media, the internet, and general psychoeducation (2) healthcare professionals' concerns for the wellbeing and future mental health of patients' children, as well as their hopes for increased mental health awareness amongst future generations. CONCLUSIONS This study provides insight into healthcare professionals' attitudes and perceptions about talking to patients and families within their community about mental illness. The results provide recommendations about possible ways to promote sharing information about a parent's mental illness with children at an individual and community level. Future research should focus on the collaborative creation of culturally sensitive psychoeducational resources and evidence-based guidelines. This must be supported by systemic and organisational change in order for professionals to successfully facilitate conversations with patients who are parents, and their children.
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Affiliation(s)
- Lucy Dean
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Hadassah Buechner
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Bianca Moffett
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Meriam Maritze
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise J. Dalton
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jeffrey R. Hanna
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK ,grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Alan Stein
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK ,grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Lima-Smit B, Nel K, Setwaba M. Cultural knowledge and perceptions of students towards mental illness in South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2022. [DOI: 10.1080/14330237.2022.2066367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Bianca Lima-Smit
- Department of Psychology, University of Limpopo, Polokwane, South Africa
| | - Kathryn Nel
- Research Administration and Development, University of Limpopo, Polokwane, South Africa
| | - Mokgadi Setwaba
- Department of Psychology, University of Limpopo, Polokwane, South Africa
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Mkabile S, Swartz L. Traditional healers' explanatory models of intellectual disability in Cape Town. Transcult Psychiatry 2022; 59:263-273. [PMID: 35225090 DOI: 10.1177/13634615211055967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While intellectual disability is experienced worldwide, with much greater rates in contexts of poverty, relatively few studies on intellectual disability have been conducted in low- and middle-income countries. High levels of intellectual disability in South Africa exist alongside high levels of poverty, malnutrition and poor or inaccessible healthcare services. The lack of access to services partly explains why many turn to traditional healers. Within this context there is very limited research on the role that traditional healers play in relation to intellectual disability in South Africa. The current study investigated traditional healers' understanding and beliefs about intellectual disabilities and the treatment modalities that they use. An exploratory qualitative research design was used to examine the views and perspectives of traditional healers on intellectual disability. Fifteen traditional healers participated in the study. Key findings show that the naming of and the terminology used to describe and identify intellectual disability are very much similar to what has been observed in African cultures in general where intellectual disability is identified as an abnormality. Some traditional healers located the presentation of intellectual disability within the biomedical sphere while others gave supernatural explanations for how intellectual disability presents in children and for its causes. All traditional healers expressed a willingness to work with the Western formal healthcare system. Findings on traditional healers' views on future collaborations with the formal health system provide opportunities for these two forms of healthcare services to be synergised for the strengthening and improvement of services provided to children with intellectual disability and their families.
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Affiliation(s)
- Siyabulela Mkabile
- Department of Psychology, 26697Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, 26697Stellenbosch University, Stellenbosch, South Africa
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Shange S, Ross E. “The Question Is Not How but Why Things Happen comes from Mkize, 2003, p.4)”: South African Traditional Healers’ Explanatory Model of Mental Illness, Its Diagnosis and Treatment. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2022. [DOI: 10.1177/00220221221077361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While there is relatively high patronage of traditional healers in South Africa, their approaches toward mental illness remain shrouded in mystery. The research therefore explored the beliefs and practices of traditional healers at Dube Village, Soweto, South Africa regarding the reasons for and treatment of mental illness and was guided by an Afrocentric theoretical perspective. Qualitative interviews with 14 traditional healers revealed that mental illness could be identified by throwing the bones, observations, and history-taking. They attributed mental illness to spiritual, socio-cultural, psychosocial, and physical factors. Methods used to treat mental illness included removing evil spirits through washing, steaming, induced vomiting, and administering herbal remedies. Findings suggest that while there are many similarities with biomedicine, traditional healing differs in terms of its links with spirituality and the efforts of healers to answer the question why things happen from a collectivist perspective.
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Affiliation(s)
- Sinethemba Shange
- University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Eleanor Ross
- University of Johannesburg Centre for Social Development in Africa, Faculty of Humanities, Auckland Park, Johannesburg, South Africa
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Nann S. How beliefs in traditional healers impact on the use of allopathic medicine: In the case of indigenous snakebite in Eswatini. PLoS Negl Trop Dis 2021; 15:e0009731. [PMID: 34499648 PMCID: PMC8428564 DOI: 10.1371/journal.pntd.0009731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/13/2021] [Indexed: 11/19/2022] Open
Abstract
Snakebite is a major public health problem in Eswatini and serious envenomations can be responsible for considerable morbidity and mortality if not treated correctly. Antivenom should be administered in hospital in case of adverse reactions and any delays due to distance, transport, costs, antivenom availability and cultural beliefs can be critical. Myths and superstition surround snakes, with illness from snakebite considered a supernatural phenomenon best treated by traditional medicine since healers can explore causes through communication with the ancestors. Traditional consultations can cause significant delays and the remedies may cause further complications. Four rural focus group discussions were held in varying geographical regions to establish why people may choose traditional medicine following snakebite. The study revealed four themes, with no apparent gender bias. These were 'beliefs and traditions', 'logistical issues', 'lack of knowledge' and 'parallel systems'. All snakes are feared, regardless of geographical variations in species distribution. Deep-seated cultural beliefs were the most important reason for choosing traditional medicine, the success of which is largely attributed to the 'placebo effect' and positive expectations. Collaboration and integration of the allopathic and traditional systems assisted by the regulation of healers and their methods could improve future treatment success. The plight of victims could be further improved with more education, lower costs and improved allopathic facilities.
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Affiliation(s)
- Sarah Nann
- Manchester Metropolitan University, Manchester, United Kingdom
- * E-mail:
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Adjorlolo S, Setordzi M. Psychosis in adolescents in Africa: A scoping review for current understanding and future directions. COGENT PSYCHOLOGY 2021. [DOI: 10.1080/23311908.2021.1949173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Samuel Adjorlolo
- Department of Mental Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- Research and Grant Institute of Ghana, Accra, Ghana
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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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Ginsburg C, Collinson MA, Gómez-Olivé FX, Gross M, Harawa S, Lurie MN, Mukondwa K, Pheiffer CF, Tollman S, Wang R, White MJ. Internal migration and health in South Africa: determinants of healthcare utilisation in a young adult cohort. BMC Public Health 2021; 21:554. [PMID: 33743663 PMCID: PMC7981972 DOI: 10.1186/s12889-021-10590-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/08/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In South Africa, human geographic mobility is high as people engage in both permanent and temporary relocation, predominantly from rural to urban areas. Such mobility can compromise healthcare access and utilisation. The objective of this paper is to explore healthcare utilisation and its determinants in a cohort of internal migrants and permanent residents (non-migrants) originating from the Agincourt sub-district in South Africa's rural northeast. METHODS A 5-year cohort study of 3800 individuals aged 18 to 40 commenced in 2017. Baseline data have been collected from 1764 Agincourt residents and 1334 temporary, mostly urban-based, migrants, and are analysed using bivariate analyses, logistic and multinomial regression models, and propensity score matching analysis. RESULTS Health service utilisation differs sharply by migrant status and sex. Among those with a chronic condition, migrants had 0.33 times the odds of non-migrants to have consulted a health service in the preceding year, and males had 0.32 times the odds of females of having used health services. Of those who utilised services, migration status was further associated with the type of healthcare utilised, with 97% of non-migrant rural residents having accessed government facilities, while large proportions of migrants (31%) utilised private health services or consulted traditional healers (25%) in migrant destinations. The multinomial logistic regression analysis indicated that, in the presence of controls, migrants had 8.12 the relative risk of non-migrants for utilising private healthcare (versus the government-services-only reference category), and 2.40 the relative risk of non-migrants for using a combination of public and private sector facilities. These findings of differential utilisation hold under statistical adjustment for relevant controls and for underlying propensity to migrate. CONCLUSIONS Migrants and non-migrants in the study population in South Africa were found to utilise health services differently, both in overall use and in the type of healthcare consulted. The study helps improve upon the limited stock of knowledge on how migrants interface with healthcare systems in low and middle-income country settings. Findings can assist in guiding policies and programmes to be directed more effectively to the populations most in need, and to drive locally adapted approaches to universal health coverage.
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Affiliation(s)
- Carren Ginsburg
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
| | - Mark A. Collinson
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
- Department of Science and Innovation/ Medical Research Council, South African Population Research Infrastructure Network, Johannesburg, South Africa
| | - F. Xavier Gómez-Olivé
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
| | - Mark Gross
- Population Studies and Training Centre, Brown University, Providence, RI, USA
| | - Sadson Harawa
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
| | - Mark N. Lurie
- Population Studies and Training Centre, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University, School of Public Health, Providence, RI, USA
| | - Keith Mukondwa
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
| | - Chantel F. Pheiffer
- Population Studies and Training Centre, Brown University, Providence, RI, USA
| | - Stephen Tollman
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
- Department of Science and Innovation/ Medical Research Council, South African Population Research Infrastructure Network, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Rebecca Wang
- Population Studies and Training Centre, Brown University, Providence, RI, USA
| | - Michael J. White
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
- Population Studies and Training Centre, Brown University, Providence, RI, USA
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van der Watt ASJ, Biederman SV, Abdulmalik JO, Mbanga I, Das-Brailsford P, Seedat S. Becoming a Xhosa traditional healer: The calling, illness, conflict and belonging. S Afr J Psychiatr 2021; 27:1528. [PMID: 33824752 DOI: 10.4102/sajpsychiatry.v27i0.1528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 11/16/2020] [Indexed: 11/01/2022] Open
Abstract
Background Traditional healers (THs) are an important part of the healthcare system in sub-Saharan Africa. Understanding their training, experiences of becoming healers and their perceived roles in society is critical. Aim This study aimed to explore the experience of becoming a TH, including accepting the calling, and sheds light on how the experience is conceptualised within the cultural and communitarian context of THs. Setting This study was conducted amongst Xhosa THs in the Western Cape, South Africa. Methods In-depth phenomenological interviews (n = 4) were conducted with Xhosa THs and analysed using Giorgi's descriptive pre-transcendental Husserlian phenomenological analysis. Results The experience of becoming a TH can be summarised in the context of three units of significance: (1) the gift of healing as an illness; (2) the experience of conflict (including with their families, the church and self-conflict); and (3) the experience of belonging. Familial conflict, specifically, was fuelled by the financial burden of becoming a TH and a lack of understanding of the process. Conclusion To develop a workable model of collaboration in the future, it is crucial that mental healthcare providers develop a better understanding of the experiences of THs in becoming care providers. The findings highlight an appreciation of the challenging process of becoming a TH. Finally, further research and culturally appropriate psychoeducation can provide trainee THs and their family members with the skills and knowledge to support each other through a difficult process.
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Affiliation(s)
- Alberta S J van der Watt
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sarah V Biederman
- Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jibril O Abdulmalik
- Department of Psychiatry, Faculty College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Irene Mbanga
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Pricilla Das-Brailsford
- Department of Clinical Psychology, The Chicago School of Professional Psychology, Washington, DC, United States of America
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Audet CM, Shepherd BE, Aliyu MH, Moshabela M, Pettapiece-Phillips MJ, Wagner RG. Healer-led vs. clinician-led training to improve personal protective equipment use among traditional healers in South Africa: a randomized controlled trial protocol. Glob Health Action 2021; 14:1898131. [PMID: 33797347 PMCID: PMC8023590 DOI: 10.1080/16549716.2021.1898131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/01/2021] [Indexed: 11/30/2022] Open
Abstract
There are estimated two million traditional healers in sub-Saharan Africa (SSA), with more than 10% (200,000) working in South Africa. Traditional healers in SSA are frequently exposed to bloodborne pathogens through the widespread practice of traditional 'injections', in which the healers perform dozens of subcutaneous incisions to rub herbs directly into the bloodied tissue with their hands. Healers who report exposure to patient blood have a 2.2-fold higher risk of being HIV-positive than those who do not report exposure. We propose a randomized controlled trial (61 healers in the intervention group and 61 healers in the control group) in Mpumalanga Province. Healers will receive personal protective equipment (PPE) education and training, general HIV prevention education, and three educational outreach visits at the healer's place of practice to provide advice and support for PPE use and disposal. Healers in the control arm will be trained by health care providers, while participants in the intervention arm will receive training and outreach from a team of healers who were early adopters of PPE. We will evaluate intervention implementation using data from surveys, observation, and educational assessments. Implementation outcomes of interest include acceptability and feasibility of PPE use during clinical encounters and fidelity of PPE use during treatments that involve blood exposure. We will test our two intervention strategies to identify an optimal strategy for PPE education in a region with high HIV prevalence.
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Affiliation(s)
- Carolyn M. Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Muktar H. Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mosa Moshabela
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | | | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
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Kaddumukasa M, Smith PJ, Kaddumukasa MN, Kajumba M, Almojuela A, Bobholz S, Chakraborty P, Sinha DD, Nakasujja N, Kakooza-Mwesige A, Gualtieri A, Onuoha E, Nakku J, Sanchez N, Muhumuza C, Fuller AT, Haglund MM, Koltai DC. Epilepsy beliefs and misconceptions among patient and community samples in Uganda. Epilepsy Behav 2021; 114:107300. [PMID: 32758405 DOI: 10.1016/j.yebeh.2020.107300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of the study was to characterize and compare the attitudes, beliefs, and perceptions about epilepsy across community and patient cohorts in Uganda. METHODS This was a descriptive study utilizing two samples: a randomly selected, national survey community sample and a hospital-based patient sample of people with epilepsy (PWE) and their caregivers attending clinic settings in Kampala and Mbarara, Uganda for epilepsy care. Both samples were surveyed about their beliefs about epilepsy, its treatment, and people who have the illness. Multivariate linear regression was used to examine group differences and variables associated with specific beliefs. RESULTS Among the 15,818 community survey participants who participated in this study, 435 study participants reported symptoms suggestive of recurrent seizures, and all 626 subjects in the hospital-based sample had confirmed epilepsy. Results revealed significant differences across groups in their endorsement of epilepsy as a contagion; 37% of people in the community unaffected by epilepsy, and 39% of people with suspected epilepsy who did not seek care believed that epilepsy was contagious by touch, in contrast to 8% of PWE or their caregivers attending regular hospital-based care. Higher educational attainment and income, and seeking regular hospital-based medical care were associated with less endorsement of epilepsy as a contagion, while age, education, income, area of residence, and presence of seizure symptoms, were significant predictors of support or belief in the basic rights of PWE. Study participants within the community who screened negative for seizures placed the most restrictions on rights for PWE. To varying degrees, the samples all endorsed the effectiveness of allopathic, traditional, and religious providers, and the use of pharmaceutical drugs, traditional rituals and herbs, and prayer. CONCLUSIONS People with epilepsy who are attending biomedical care for routine epilepsy care think differently about epilepsy, its treatment, and the rights of those with the disease than the general population. Within the community setting, more erroneous beliefs and negative attitudes about epilepsy and PWE persist, and they not only contribute to stigma but also interfere with the patients' health-seeking behavior. Further confounding the care of PWE, the pluralistic healthcare system in Uganda is evident in endorsements spanning biomedical, traditional, and religious treatment methods. Focused awareness campaigns utilizing local epilepsy societies are needed to promote epilepsy health literacy, to favorably impact acceptance and opportunities for PWE in Uganda, and to facilitate efficient uptake of biomedical care. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
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Affiliation(s)
- Mark Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Patrick J Smith
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119; Trent Drive, Durham, NC, USA
| | - Martin N Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda; Department of Medicine, Mulago National Referral Hospital, Neurology Unit, Kampala, Uganda
| | - Mayanja Kajumba
- Department of Mental Health and Community Psychology, Makerere University School of Psychology, P.O. Box 7062, Kampala, Uganda
| | - Alysa Almojuela
- Section of Neurosurgery, Rady Faculty of Health Sciences, University of Manitoba, GB1-820 Sherbrook Street, Health Sciences Centre, Winnipeg, MB R3A 1R9, Canada
| | - Samuel Bobholz
- University of Wisconsin - Madison, Department of Neurology, 1685 Highland Avenue, Madison, WI 53705-2281, USA
| | - Payal Chakraborty
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Drishti D Sinha
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Mulago Hill Road, P.O.Box 7072, Kampala, Uganda; Department of Paediatrics and Child Health, Mulago National Referral Hospital, Pediatric Neurology Unit, Kampala, Uganda
| | - Alex Gualtieri
- Duke University Medical Center, Clinical Neuropsychology Service, Box 3333, Durham, NC, USA
| | - Erica Onuoha
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Juliet Nakku
- Butabika National Referral Mental Hospital, P.O.Box 7017, Kampala, Uganda
| | - Nadine Sanchez
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Christine Muhumuza
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Makerere University School of Public Health, Department of Epidemiology and Biostatistics, New Mulago Complex, P.O. Box 7072, Kampala, Uganda
| | - Anthony T Fuller
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, 3100 Tower Blvd, Durham, NC 27707, USA
| | - Michael M Haglund
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, 3100 Tower Blvd, Durham, NC 27707, USA
| | - Deborah C Koltai
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119; Trent Drive, Durham, NC, USA; Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA.
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An unrecognized key population? Traditional treatment practices associated with HIV risk among traditional healers in rural South Africa. AIDS 2020; 34:2313-2317. [PMID: 33048882 DOI: 10.1097/qad.0000000000002710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To understand the risk of HIV acquisition through occupational exposure among rural South African traditional healers, notably via the practice of traditional skin incisions with razors. DESIGN A random sample of traditional healers living in South Africa participated in a cross-sectional survey that included a rapid HIV test. SETTING Rural Bushbuckridge district of Mpumalanga, South Africa. PARTICIPANTS Traditional healers. INTERVENTION Pretest counseling, posttest counseling, and referral to care if HIV seropositive. MAIN OUTCOME MEASURE(S) HIV infection. RESULTS Among healers who reported a previous positive test result or accepted an HIV test (96%), HIV prevalence was 30% (95% confidence interval: 23-37%). During their careers, 98% of healers reported conducting at least one 'vaccination' (as traditional incisions are called), 32% reported always using gloves when conducting these procedures, 29 (14%) reported patient blood touching their bare skin. Healers who reported exposure to patient blood had a higher HIV prevalence than their nonexposed colleagues (adjusted risk ratio: 2.35, 95% confidence interval: 1.55-3.56, P = 0.001). CONCLUSION Nearly all traditional healers are routinely performing minimally invasive skin incisions that could expose them to patient blood. The lack of training and access to personal protective equipment increase their risk of acquisition of blood-borne pathogens, including HIV. Given the widespread practice of traditional skin incisions across southern Africa, and the higher levels of HIV among traditional healers exposed to patient blood, it is likely that traditional healers are a hitherto unrecognized key population at disproportionate risk of acquiring HIV.
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Audet CM, Clemens EM, Ngobeni S, Mkansi M, Sack DE, Wagner RG. Throwing the bones to diagnose HIV: Views of rural South African traditional healers on undertaking HIV counselling and testing. AIDS Care 2020; 33:1316-1320. [PMID: 32799661 DOI: 10.1080/09540121.2020.1808568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In 2018, nearly 800,000 HIV positive individuals in South Africa were unaware of their status. Traditional healers see patients who avoid health clinics, including those who refuse HIV testing. This manuscript details the results of a qualitative study to understand traditional healer perspectives on performing healer-initiated HIV counseling and testing HIV in rural South Africa. We conducted 30 structured in-depth interviews between April and June 2019 to elicit traditional healer attitudes towards partnering with local health services to perform HIV counseling and testing with their patients. Healers reported that while some patients are open about their HIV status, others lie about it due to stigma. This creates challenges with concurrent treatment, which healers believe leads to allopathic and/or traditional medication treatment failure. Most healers expressed both an interest and a willingness to perform HIV counseling and testing. Healers felt that by performing testing in the community, it would overcome issues related to HIV stigma, as well as a lack of confidentiality and trust with health care workers at the clinic. Trained traditional healers may be able to bridge the testing gap between "non-testers" and the allopathic health system, essentially "opening" thousands of new testing locations with little financial investment.
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Affiliation(s)
- Carolyn M Audet
- Department of Health Policy, Vanderbilt University Medical Center, School of Medicine, Vanderbilt University, Nashville, USA
| | - Elise M Clemens
- Department of Health Policy, Vanderbilt University Medical Center, School of Medicine, Vanderbilt University, Nashville, USA
| | - Sizzy Ngobeni
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mevian Mkansi
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel E Sack
- Department of Health Policy, Vanderbilt University Medical Center, School of Medicine, Vanderbilt University, Nashville, USA
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Maina BW, Orindi BO, Osindo J, Ziraba AK. Depressive symptoms as predictors of sexual experiences among very young adolescent girls in slum communities in Nairobi, Kenya. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2020; 25:836-848. [PMID: 32537261 PMCID: PMC7254498 DOI: 10.1080/02673843.2020.1756861] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/14/2020] [Indexed: 12/03/2022] Open
Abstract
Mental health issues are a predisposing factor for HIV acquisition. We examined the association between depressive symptoms and patterns of sexual experience among girls aged 10–14 years living in Korogocho and Viwandani slums in Nairobi, Kenya. We analysed data collected in 2017 from a random sample of 606 girls. Using Latent Class Analysis, we modelled patterns of sexual experiences and used multivariable regression analysis to determine the association between self-reported depressive symptoms and sexual experiences. Seven in ten girls reported at least one symptom of self-reported depression in the past 12 months. About 13% of girls had had a sexual experience, resulting in two patterns of sexual experience – naïve and experienced. Girls reporting depressive symptoms were more likely to be sexually experienced. Sexual and reproductive health programs targeting adolescent girls should consider including intervention packages that address mental health conditions such as depression.
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Affiliation(s)
- Beatrice W Maina
- African Population and Health Research Center, Nairobi, Kenya.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Benedict O Orindi
- African Population and Health Research Center, Nairobi, Kenya.,Department of Public Health and Primary Care, Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, Leuven, Belgium
| | - Jane Osindo
- African Population and Health Research Center, Nairobi, Kenya
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Wagner RG, Kabudula CW, Forsgren L, Ibinda F, Lindholm L, Kahn K, Tollman S, Newton CR. Epilepsy care cascade, treatment gap and its determinants in rural South Africa. Seizure 2020; 80:175-180. [PMID: 32593141 PMCID: PMC7443697 DOI: 10.1016/j.seizure.2020.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/14/2020] [Accepted: 06/06/2020] [Indexed: 12/20/2022] Open
Abstract
Most people with active convulsive epilepsy in rural South Africa are diagnosed. Most individuals diagnosed have some blood level of anti-seizure medication. Most individuals do not have optimal levels of medication. The epilepsy treatment gap is high in rural South Africa, especially in children. Identifying the epilepsy care cascade may better allow for targeting of interventions.
Purpose The percentage of people who are diagnosed with epilepsy (diagnostic gap), access, receive and adhere (treatment gap) to anti-seizure medication (ASM) in low- and middle- income countries remains low. We explored the epilepsy care cascade, measured the diagnostic and treatment gaps, and examined socio-demographic factors associated with adherence to ASMs in rural South Africa. Methods Utilizing a population-based cohort of 311 people with active convulsive epilepsy (ACE) residing in rural northeastern South Africa, a questionnaire was administered to examine associations between demographic and socioeconomic factors and the epilepsy treatment gap. Blood was taken to measure levels of ASMs. Results Of the 311 individuals diagnosed, 93 % of individuals reported being previously told they had epilepsy and 94 % reported previously attending a health facility for their epilepsy. ASMs were detected in 138 individuals (76 %) and optimal levels were detected in 67 individuals, resulting in a treatment gap of 63 % (95 % confidence interval [95 %CI]: 56 %–70 %). Self-reported specificity of ASM use was 23 % (95 %CI: 12–39 %) and individuals ≥18 years were significantly more likely to report taking ASM than children and were significantly (p = 0.011) more likely to be adherent. Conclusion Most people with epilepsy in rural South Africa had been previously diagnosed with epilepsy and had accessed care for epilepsy, yet the level of ASM adherence remained low, significantly lower amongst children. Understanding ways of improving knowledge of and adherence to ASM in rural South Africa is necessary, especially amongst children. The epilepsy care cascade can be useful in identifying gaps in care and targeting interventions to reduce these gaps.
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Affiliation(s)
- Ryan G Wagner
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS) - INDEPTH Network, Accra, Ghana; MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden; Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden.
| | - Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lars Forsgren
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Fredrick Ibinda
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, Kilifi, Kenya
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana
| | - Stephen Tollman
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana
| | - Charles R Newton
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS) - INDEPTH Network, Accra, Ghana; MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, Kilifi, Kenya; Neurosciences Unit, UCL Institute of Child Health, London, United Kingdom; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Rutebemberwa E, Ssemugabo C, Tweheyo R, Turyagaruka J, Pariyo GW. Biomedical drugs and traditional treatment in care seeking pathways for adults with epilepsy in Masindi district, Western Uganda: a household survey. BMC Health Serv Res 2020; 20:17. [PMID: 31907036 PMCID: PMC6945646 DOI: 10.1186/s12913-019-4879-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/27/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many patients with epilepsy in sub-Saharan Africa do not receive adequate treatment. The purpose of the study was to identify the health care providers where patients with epilepsy sought care and what treatment they received. METHODS A cross sectional study was conducted across 87 out of 312 villages in Masindi district. A total of 305 households having patients with epilepsy were surveyed using an interviewer administered questionnaire. Data was entered and analysed in Epi-info ver 7 for univariate and bivariate analysis, and in Stata SE ver 15.0 for multivariable analysis. Sequences of health providers consulted in care seeking, rationale and drugs used, and factors associated with choice of provider were assessed. RESULTS A total of 139 out of 305 (45.6%) households offered some treatment regimen at home when patients got symptoms of epilepsy with 44.6% (62/139) giving herbs and 18.0% (25/139) offering prayers. Eight different types of providers were consulted as first contact providers for treatment of epilepsy. Health centres received the highest percentage 35.4% (108/305) followed by hospitals 20.9% (64/305). A total of 192 of 305 (63.0%) households received anti-epileptic drugs, 13.1% (40/305) received prayers and 21.6% (66/305) received herbs at the first contact care seeking. Compared to a health centre as the first choice provider, other facilities more significantly visited were; hospitals if they were perceived as nearer (adj. Coeff 2.16, 95%CI 0.74, 3.59, p = 0.003), churches / mosques if cure for epilepsy was expected (adj. Coeff 1.91, 95%CI 0.38, 3.48, p = 0.014), and traditional healer for those aged ≥46 years (adj. Coeff 5.83, 95%CI 0.67, 10.99, p = 0.027), and friends/neighbour for traders (adj. Coeff 2.87, 95%CI 0.71, 5.04, p = 0.009). CONCLUSION Patients with epilepsy seek treatment from multiple providers with the public sector attending to the biggest proportion of patients. Engaging the private sector and community health workers, conducting community outreaches and community sensitization with messages tailored for audiences including the young, older epileptics, traditional healers as stakeholders, and traders could increase access to appropriate treatment for epilepsy.
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Affiliation(s)
- Elizeus Rutebemberwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda. .,African Centre for Health and Environmental Studies, Kampala, Uganda.
| | - Charles Ssemugabo
- Department of Disease Control and Environmental Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Raymond Tweheyo
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.,Department of Public Health, Lira University, Lira, Uganda
| | - John Turyagaruka
- District Health Office, Masindi District Local Government, Masindi, Uganda
| | - George William Pariyo
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA
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21
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Price J, Willcox M, Kabudula CW, Herbst K, Hinton L, Kahn K, Harnden A. Care pathways during a child's final illness in rural South Africa: Findings from a social autopsy study. PLoS One 2019; 14:e0224284. [PMID: 31639177 PMCID: PMC6804973 DOI: 10.1371/journal.pone.0224284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/09/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Half of under-5 deaths in South Africa occur at home, however the reasons remain poorly described and data on the care pathways during fatal childhood illness is limited. This study aimed to better describe care-seeking behavior in fatal childhood illness and to assess barriers to healthcare and modifiable factors that contribute to under-5 deaths in rural South Africa. METHODS We conducted a social autopsy study on all under-5 deaths in two rural South African health and demographic surveillance system sites. Descriptive analyses based on the Pathways to Survival Framework were used to characterise how caregivers move through the stages of seeking and providing care for children during their final illness and to identify modifiable factors that contributed to death. FINDINGS Of 53 deaths, 40% occurred outside health facilities. Rates of antenatal and perinatal preventative care-seeking were high: over 70% of mothers had tested for HIV, 93% received professional assistance during delivery and 79% of children were reportedly immunised appropriately for age. Of the 48 deaths tracked through the stages of the Pathways to Survival Framework, 10% died suddenly without any care, 23% received home care of whom 80% had signs of severe or possibly severe illness, and 85% sought or attempted to seek formal care outside the home. Although half of all children left the first facility alive, only 27% were referred for further care. CONCLUSIONS Modifiable factors for preventing deaths during a child's final illness occur both inside and outside the home. The most important modifiable factors occurring inside the home relate to caregivers' recognition of illness and appreciation of urgency in response to the severity of the child's symptoms and signs. Outside the home, modifiable factors relate to inadequate referral and follow-up by health professionals. Further research should focus on identifying and overcoming barriers to referral.
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Affiliation(s)
- Jessica Price
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, United Kingdom
| | - Merlin Willcox
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, England, United Kingdom
| | - Chodziwadziwa Whiteson Kabudula
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, United Kingdom
| | - Kathleen Kahn
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anthony Harnden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, United Kingdom
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A survey of traditional and faith healers providing mental health care in three sub-Saharan African countries. Soc Psychiatry Psychiatr Epidemiol 2019; 54:395-403. [PMID: 30456425 DOI: 10.1007/s00127-018-1630-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Traditional and faith healers constitute an important group of complementary and alternative mental health service providers (CAPs) in sub-Sahara Africa. Governments in the region commonly express a desire to integrate them into the public health system. The aim of the study was to describe the profile, practices and distribution of traditional and faith healers in three sub-Saharan African countries in great need for major improvements in their mental health systems namely Ghana, Kenya and Nigeria. MATERIALS AND METHODS A mapping exercise of CAPs who provide mental health care was conducted in selected catchment areas in the three countries through a combination of desk review of existing registers, engagement activities with community leaders and a snowballing technique. Information was collected on the type of practice, the methods of diagnosis and the forms of treatment using a specially designed proforma. RESULTS We identified 205 CAPs in Ghana, 406 in Kenya and 82 in Nigeria. Most (> 70%) of the CAPs treat both physical and mental illnesses. CAPs receive training through long years of apprenticeship. They use a combination of herbs, various forms of divination and rituals in the treatment of mental disorders. The use of physical restraints by CAPs to manage patients was relatively uncommon in Kenya (4%) compared to Nigeria (63.4%) and Ghana (21%). CAPs often have between 2- to 10-fold capacity for patient admission compared to conventional mental health facilities. The profile of CAPs in Kenya stands out from those of Ghana and Nigeria in many respects. CONCLUSION CAPs are an important group of providers of mental health care in sub-Saharan Africa, but attempts to integrate them into the public health system must address the common use of harmful treatment practices.
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Das Neves Martins Pires PH, Marega A, Creagh JM. Contributions des tradipraticiens de santé au traitement antirétroviral : Étude de cas à Nampula, Mozambique. Afr J Prim Health Care Fam Med 2018; 10:e1-e6. [PMID: 30456971 PMCID: PMC6244362 DOI: 10.4102/phcfm.v10i1.1031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 07/03/2018] [Accepted: 07/03/2018] [Indexed: 11/13/2022] Open
Abstract
Contexte L’épidémie du virus de l’immunodéficience humaine au Mozambique est un problème grave de santé publique et le Ministère de la Santé a étendu le traitement antirétroviral à tous les districts du pays. Cependant, on constate un nombre élevé d’abandon du traitement encore insuffisamment évalué. L’Organisation Mondiale de la Santé recommande que les tradipraticiens de santé collaborent avec les systèmes nationaux de santé dans les pays en développement, pour combattre cette épidémie, mais il existe peu d’actions dans ce domaine à ce jour. Objectif Évaluer la connaissance des tradipraticiens sur l’infection et leur disponibilité à coopérer avec les services de santé dans la Province de Nampula au Mozambique, pour améliorer les résultats du traitement antirétroviral. Lieux Cinq centres de santé des districts de la Province de Nampula, au Nord du Mozambique, avec des taux élevés d’incidence du virus d’immunodéficience humaine et d’abandon du traitement. Méthodes Une étude mixte transversale, utilisant des interviews ciblés et des discussions de groupes focaux. Les données quantitatives étaient traitées par fréquence et les données qualitatives par analyse de discours et ethnographie locale. Résultats Nous avons interviewé 79 tradipraticiens de santé. La perte de poids était souvent considérée comme le signal principal de suspicion d’infection par le virus d’immunodéficience humaine et certains tradipraticiens ne pas les signes de la maladie ; la majorité pensait que les antirétroviraux améliorent la qualité de vie des patients, ne prétendait pas traiter l’infection, savait qu’elle n’est pas curable, avait une idée sur le concept de bonne adhésion au traitement et référait les cas compliqués au centre de santé. En ce qui concerne l’alimentation, la moitié considérait exclusivement les céréales comme l’aliment principal ; les fruits étaient importants pour un quart ; l’eau potable est ignorée. La majorité était prête à collaborer avec le système de santé et avait des propositions de coopération pratique : la qualification et la reconnaissance individuelle et la formation intégrée avec les professionnels de santé. Conclusion Les tradipraticiens connaissaient l’infection par le virus d’immunodéficience humaine et les facteurs associés, mais il y a des lacunes. Ils ont signalé qu’ils utilisaient principalement les plantes médicinales, ce qui peut contribuer au traitement des infections opportunistes et la majorité référait déjà des patients au centre de santé ; mais la collaboration nécessite une procédure éducative et une articulation structurée. Les lacunes de connaissance empêchent une coopération efficace dans le combat contre l’épidémie. Le groupe est disponible pour coopérer avec le système de santé pour améliorer les résultats du traitement antirétroviral, mais pour ça il est nécessaire d’informer et former les tradipraticiens dans un processus intégré de collaboration avec les professionnels de santé conventionnels.
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du Toit A, Pretorius C. Seizures in Namibia: A study of traditional health practitioners. Epilepsia Open 2018; 3:374-382. [PMID: 30187008 PMCID: PMC6119750 DOI: 10.1002/epi4.12240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Countries in sub-Saharan Africa are plagued by poor healthcare facilities, lack of specialist care, and limited financial resources. People with seizures often rely on the help of traditional health practitioners (THPs). Traditional health practices are not acknowledged in Namibia and remain unregulated and open to exploitation. We conducted a qualitative study to gain an understanding of THPs' perceptions and experiences in delivering seizure care in Namibia. METHODS This study formed part of a larger mixed-method study that explored seizure care among healthcare providers (HCPs) in Namibia. Semi-structured interviews were conducted with 11 THPs in Namibia. Thematic analysis was used to identify themes and subthemes in the data. Themes were interpreted using the different levels of Bronfenbrenner's Ecological Systems Theory to illustrate the perceptions and experiences of THPs in the management of seizures. RESULTS THPs distinguish between seizures with physical causes and those caused by witchcraft, evil spirits, and supernatural forces. THPs acknowledge the role of Western medicine in the treatment of medically explained seizures (physical causes). Seizures as a result of medically unexplained symptoms (spiritual) are deemed best treated by traditional medicine (TM). Diagnostic and treatment practices are person-specific and are guided by divination and the use of plant and animal material. Treatment success is measured by the complete absence of seizures. Biomedical treatment is seen as lacking due to its focus on seizure control and failure to provide a permanent cure. SIGNIFICANCE In countries with limited healthcare resources, the untapped potential of THPs may play a valuable role in bridging the treatment gap for seizures. Incorporating THPs into the healthcare system depends on proper regulation and clear demarcation of roles between service providers. Improved referral practices and collaboration between service providers will be of benefit for people with seizures who are often exposed to stigma and discrimination.
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Affiliation(s)
- Anina du Toit
- Department of PsychologyStellenbosch UniversityStellenboschSouth Africa
| | - Chrisma Pretorius
- Department of PsychologyStellenbosch UniversityStellenboschSouth Africa
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Enogieru AB, Omoruyi SI, Hiss DC, Ekpo OE. Potential antiparkinsonian agents derived from South African medicinal plants. J Herb Med 2018. [DOI: 10.1016/j.hermed.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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