Communication Between Traditional Medical Practitioners and Western Medical Professionals

Where do traditional healers fit in the dentist-centred oral health system? An ethnography inquiry among the indigenous communities in Gudalur, South India

Background

Adivasi (Indigenous) communities in Gudalur, Tamil Nadu, India, face significant challenges in accessing equitable oral health care, influenced by cultural and socio-political factors. This study examines the role of traditional herbal medicine healers in delivering oral health services within these communities.

Methods

Guided by the Socio-Ecological Framework, the data were collected between April 2015 and July 2018, employing ethnography tools such as participant observation, focus group discussions, and semi-structured interviews. A total of twenty-four healers took part, offering insights into how Adivasi healers perceive and treat oral health issues. The study also incorporated perspectives from community members, dentists, and doctors to provide a broader understanding of oral healthcare within the community.

Results

Adivasi healers identified overlapping oral health symptoms and provided local care that fills gaps in the formal health system. Challenges such as resource limitations and competition with Western biomedicine affect the continuity of their practices. Oral health among Adivasis is deeply intertwined with cultural and structural determinants, exacerbated by marginalisation within the mainstream public healthcare system.

Conclusion

Local health traditions, particularly those practised by Adivasi healers, play a crucial role in primary oral health care where formal dental services are inadequate. Addressing oral health disparities requires a shift towards inclusive, community-oriented health systems that recognise and integrate local healing practices.

Health Professionals' Attitudes Towards Traditional Healing for Mental Illness: A Systematic Review

Combining modern treatments with traditional healing approaches has been proposed as one way to address mental health problems, especially in low-income countries where the costs of pharmaceuticals often prevent or reduce their use. Despite health professionals' involvement being crucial for the integration of this approach, their involvement has been limited to date. This systematic review is designed to explore the attitudes of health professionals towards traditional healing practices for mental illness. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines were followed. The studies were identified from Scopus, EMBASE, PubMed, PsycINFO, and the Web of Sciences. The qualities of the included articles were assessed using the Mixed Method Appraisal Tool (MMAT) Version 2018, and mixed-method synthesis was used to narrate the results. Of the 2115 identified articles, 36 were included in the data synthesis. From the extracted data, health professionals had negative, mixed, and positive views towards traditional healing approaches for mental illness. Their negative attitude towards traditional healing approaches were due to their concerns that traditional healing may cause harm to service users, and they have no trust in the scientific basis, education, or practices of healers. Despite the fact that it is crucial for healthcare professionals to comprehend the cultural backgrounds of those receiving mental health services in order to offer care appropriately, health professionals' negative and mixed attitudinal expressions towards traditional healing approaches limit their involvement. This might be improved by identifying barriers from the perspective of practitioners and creating culturally appropriate guidelines for communication and referral between traditional healing approaches and biomedical care.

Challenges and Issues in Acupuncture Education in Malaysia

Background

Acupuncture, a traditional Chinese medicine (TCM) practice, has become globally recognized as a complementary therapeutic approach for various health conditions. In Malaysia, acupuncture occupies a significant role in the country's diverse healthcare system, reflecting its cultural heritage. However, the education and training of acupuncture practitioners face numerous challenges, including variability in educational approaches, accreditation, and integration with conventional medical practices.

Objective

This article aims to explore the complexities of acupuncture education in Malaysia, providing an overview of the current landscape. It addresses the regulatory frameworks, educational challenges, and the implications these have on professional standards and patient care. The article also highlights potential solutions for improving acupuncture education in the country.

Methods

A comprehensive review of existing literature, regulatory frameworks, and educational practices related to acupuncture in Malaysia is presented. The article examines the variability in training programs, accreditation standards, and the integration of acupuncture with conventional healthcare models.

Results

The education and training of acupuncture practitioners in Malaysia are hindered by inconsistent curricula, lack of standardized guidelines, and differing levels of accreditation. These challenges contribute to variations in educational quality across institutions, complicating efforts to ensure competent practitioners. Furthermore, acupuncture's integration with mainstream medical practices remains unclear, affecting its overall acceptance and effectiveness within the broader healthcare system.

Conclusion

Addressing the challenges in acupuncture education is crucial for enhancing the competence of practitioners and ensuring quality patient care. Key areas for improvement include the standardization of curricula, strengthening accreditation processes, promoting interdisciplinary collaboration, and increasing public awareness. Proactive efforts in these areas can enhance the quality of acupuncture education in Malaysia and foster better integration of acupuncture into the national healthcare framework.

Perspectives of traditional healers, faith healers, and biomedical providers about mental illness treatment: qualitative study from rural Uganda

Most people with mental illness in low and middle-income countries (LMICs) do not receive biomedical treatment, though many seek care from traditional healers and faith healers. We conducted a qualitative study in Buyende District, Uganda, using framework analysis. Data collection included interviews with 24 traditional healers, 20 faith healers, and 23 biomedical providers, plus 4 focus group discussions. Interviews explored treatment approaches, provider relationships, and collaboration potential until theoretical saturation was reached. Three main themes emerged: (1) Biomedical providers' perspectives on traditional and faith healers; (2) Traditional and faith healers' views on biomedical providers; and (3) Collaboration opportunities and barriers. Biomedical providers viewed faith healers positively but traditional healers as potentially harmful. Traditional and faith healers valued biomedical approaches while feeling variably accepted. Interest in collaboration existed across groups but was complicated by power dynamics, economic concerns, and differing mental illness conceptualizations. Traditional healers and faith healers routinely referred patients to biomedical providers, though reciprocal referrals were rare. The study reveals distinct dynamics among providers in rural Uganda, with historical colonial influences continuing to shape relationships and highlighting the need for integrated, contextually appropriate mental healthcare systems.

Community perspectives on barriers to injury care in Northern Malawi: a three delays framed assessment using focus groups and photovoice

INTRODUCTION

The global burden of injury is huge, falling disproportionately on poorer populations. The benefits of qualitative research in injury care are recognised and its application is growing. We used a novel application of focus group discussions with photovoice to rapidly assess barriers at each of three delay stages; seeking (delay-1), reaching (delay-2) or receiving (delay-3) injury care in Northern Malawi.

METHODS

Three community Focus Group Discussions (FGDs) of individuals with (FGD1) and without (FGD2) recent injury experience and community leaders (FGD3) discussed barriers to seeking, reaching or receiving care following injury. Participants from FGD1 subsequently used a digital camera and, following training in photovoice, took photographs illustrating barriers to injury care. Participants reconvened to discuss images which they believed illustrated important barriers. A framework method analysis compared barriers generated to those identified by an earlier Delphi study.

RESULTS

Seven of eight invited adult community members attended each discussion group. Within the FGDs, all prior Delphi derived delay 1 barriers were described. Within delay 2, all but three were discussed by community participants. Those not covered were: 1) "communication" ;2) "prehospital care"; 3) "coordination". Within Delay 3, only "capacity"was not highlighted by participants during the study. Additional health system barriers not identified in the Delphi were inductively derived. Within Delay 1, these were labelled; "religious or other beliefs"; "indecision"; "fear or lacking courage"; and "community/bystander engagement". Within Delay 2, "lack of assistance" was derived. Within Delay 3; "alleged corruption"; "interfacility transfer"; and "police processes" were all identified during analysis. The photovoice group provided 21 photographs evidencing 15 barriers. Delay 1 was the most frequently captured by images (12/21).The individual barriers most frequently described were "transport" and "roads" (6/21 and 5/21, respectively). The photovoice group did not describe any additional barriers not covered in the prior FGDs.

CONCLUSION

We identified several barriers within this health system. Participants illustrated how some barriers impact on multiple phases of delay. The method was quick, low cost and participants grasped the technique and research question effectively. We recommend this approach for future health system assessments.

Exploring the experiences of traditional practitioners while managing hypertension in Rwanda

BACKGROUND

Hypertension (HTN) is a major global health concern, affecting approximately 1.28 billion adults worldwide. In Rwanda, hypertension contribute to 2.81 of the disability adjusted life years (DALYs) and 1.87% of hypertensive heart disease mortality. Traditional medicine remains popular in Africa with some herbal remedies which have shown antihypertensive properties. However, no study was done to explore traditional Practitioners' approach to hypertension in Rwanda.

OBJECTIVE

To explore the experience of traditional Practitioners while managing hypertension in Rwanda.

METHODOLOGY

This qualitative study utilized an ethnographic approach to explore the experience of traditional Practitioners (TPs) while managing HTN in Rwanda. Semi- structure interviews were conducted with 20 traditional Practitioners from three districts known for their popular use of traditional medicine in Rwanda. Participants were purposively selected, and interviews were guided by a pretested semi-structured interview guide in local language. Thematic analysis was used to generate the key themes.

RESULTS

Three main themes emerged from analysis: first, traditional medicine is often undervalued by modern medical providers, resulting in limited collaboration and communication between traditional Practitioners and modern medical providers. Despite this, TPs are trusted by the community, often receiving referrals from patients dissatisfied with modern treatment. Second, TPs face challenges in diagnosing HTN due to lack of diagnostic tools, often relying on their observation, patients' description of symptoms and patient's response to treatment. TPs expressed desire for collaboration with modern medicine and access to diagnostic tools. Third, lack of legal framework and standardized practices for traditional medicine remains a challenge.

CONCLUSION

The study highlights the need to promote collaboration between traditional and modern medicine in Rwanda. To enhance HTN management, we recommend training of traditional Practitioners, setting standardized practice and legal framework to guide traditional Practitioners in Rwanda as well as improving their access to HTN diagnostic tools.

Evaluation of clinical effectiveness of blood stasis leaflet in patients with blood stasis: A prospective, randomized, and crossover trial

BACKGROUND

Blood stasis (BS) refers to a pattern of symptoms resulting from circulatory dysfunction or stagnation in the human body. Due to its historical origin and diverse interpretations, communication between patients and doctors of traditional Korean medicine (DKMs) presents challenges. Efforts to improve patients understanding in traditional Korean medicine (TKM) have led to the development of disease-specific standard clinical practice guidelines. However, there is a limited focus on creating clinical practice guidelines or informative leaflet specifically addressing BS, which is a frequently encountered pattern of symptoms in TKM.

METHODS

This study aimed to bridge the gap between patients and DKMs by developing an informative leaflet focusing on BS for metabolic diseases. We assessed its appropriateness through expert advisory meetings and the Delphi process, and evaluated its clinical effectiveness. We conducted a prospective, randomized, crossover trial to compare the clinical effectiveness of using BS leaflets in TKM treatment. The hypothesis investigated whether the leaflet group would show higher scores in satisfaction of DKMs' explanations, understanding of DKMs' explanations, improving the reliability of TKM, satisfaction with treatment time, improvement in explanations compared to previous TKM experiences, and necessity of managing BS treatment, compared to the no-leaflet group.

RESULTS

In a study involving 40 patients (mean age: 62.3 ± 7.8 years), symptoms persisted for an average of 16.75 ± 9.3 hours daily, with a severity rating of 2.53. The leaflet group exhibited significantly higher satisfaction scores than the no-leaflet group in all aspects (all P < .0001). After confirming the absence of sequence and period effects using a linear-mixed effect model, we were able to ascertain the presence of a treatment effect, as evidenced by statistically significant higher scores across all survey items in the leaflet group compared to the no-leaflet group (all P < .0001).

CONCLUSION

Expert consensus on symptoms aligning with the BS pattern resulted in the development of an informative leaflet. Its utilization notably improved patient satisfaction, comprehension, and trust in TKM treatment, unaffected by temporal influences, thus demonstrating its clinical effectiveness. In summary, the BS leaflet significantly enhanced patient understanding and optimized treatment procedures.

Integrating traditional medicine into the African healthcare system post-Traditional Medicine Global Summit: challenges and recommendations

The World Health Organization (WHO) held the inaugural Traditional Medicine Global Summit in India in 2023 to promote the evidence-based integration of traditional medicine (TM) into the global healthcare system. This summit offers many opportunities for Africa, where most people rely on TM for health care. TM is widely accepted and affordable in the region but faces many challenges that limit its potential. This article identifies some of the most pressing challenges to incorporating TM into standard healthcare in Africa. It also proffers useful recommendations on how these issues may be addressed while identifying key stakeholders whose contributions may hamper or enhance the realization of WHO´s goals for TM in the continent.

Allopathic medicine practitioners' experiences with non-disclosure of traditional medicine use

Background

A pertinent issue impacting patient treatment outcomes is the nondisclosure of traditional medicine (TM) use to Allopathic medicine practitioners (AMPs). For years, TM has been a controversial practice, with patients often using it alongside allopathic medicine without disclosing their use. It is imperitive to learn and understand the experiences of AMPs regarding the disclosure of TM use in Gauteng province to enable them to provide the best possible treatment outcomes for patients who use TM.

Aim

This study aimed to explore the experiences of AMPs regarding non-disclosure of TM use in Gauteng province.

Setting

This study was conducted in four district hospitals where outpatient care and services are rendered in Gauteng Province.

Methods

An interpretive phenomenological analysis (IPA) design was followed. Fourteen purposefully sampled AMPs participated in face-to-face, one-on-one, and semi-structured interviews. Interpretive phenomenological analysis in Atlas.ti was conducted.

Results

Three themes emerged: bedside manner of AMPs; stigmatising TM use; and individual belief systems. The belief of patients' disclosure hesitancy because of fear of judgment by the AMPs underpinned these themes.

Conclusion

Allopathic medicine practitioners are aware that patients who use TM could feel guilty and stigmatised. They acknowledged that patients use TM because of cultural and ethnic reasons, which should not be disregarded.

Contribution

The study highlighted that patients do not disclose their TM use because of AMPs' attitudes, stigmatising TM use, and their prejudices against the cultural beliefs of patients. Allopathic medicine practitioners should establish good communication with patients by providing patient-centred communication to facilitate disclosure of TM use.

Traditional health practitioners' training needs on biomedical knowledge and skills in a South African township

BACKGROUND

Traditional health practitioners (THPs) play an important role in communities by providing necessary health services for a variety of health problems. Possessing complementary biomedical knowledge and skills is vital in saving lives of patients. However, less is known about biomedical knowledge and skills among THPs.

AIM

This study aimed to explore and describe the training needs of THPs on biomedical knowledge and skills in urban townships in South Africa.

SETTING

The study was conducted in a township in the City of Tshwane Metropolitan Municipality of Gauteng province, South Africa.

METHODS

A qualitative, explorative, descriptive design with 18 THPs was employed through snowballing sampling. Data were collected through a lekgotla group discussion and thematic content analysis undertaken.

RESULTS

Themes that emanated include knowledge of the basic physiological functioning of the human body; biomedical knowledge and skills required for the assessment of patients; managing emergency health conditions and understanding diagnostic concepts used in traditional health practice versus biomedical systems.

CONCLUSION

Traditional health practitioners have demonstrated interest in being trained on certain skills used within the biomedical system to care for patients. Performing the necessary first-aid skills by THPs will assist patients in the communities while waiting for emergency services or referrals. Provision of training programmes for THPs on first aid interventions during emergencies is therefore recommended.Contribution: The study revealed that capacitating THPs with biomedical knowledge and skills can improve their ability to promote healthy living and prevent health problems in communities where access to resources is limited.

A qualitative study on traditional healers' perceptions and management of epidermolysis bullosa

Background

Epidermolysis bullosa (EB) is a rare, incurable genodermatosis causing blisters that can result in multisystemic complications and death. Limited data exists on EB in South Africa. Research indicates that the majority of African patients consult traditional health practitioners (THPs) before seeking allopathic healthcare.

Aim

This study aims to understand THPs belief systems, experiences, perceptions and management of EB patients and their families in the social and cultural context to improve the healthcare of EB patients.

Setting

The study setting is Nelson Mandela School of Medicine, Durban, and Grey's hospital, Pietermaritzburg, KwaZulu-Natal.

Methods

Qualitative in-depth interviews were conducted with 10 THPs. A non-probability, purposive sampling method was used. A two-site qualitative study was guided by interpretative phenomenological analysis. Guba's trustworthiness framework was used to ensure rigour.

Results

Three male and seven female THPs were interviewed, including sangoma, inyanga and umthandazi. The integration presented five global themes: (1) THP practices, (2) perceptions of THP, (3) experiences of THP with patients with EB, (4) diagnosis and management plans of THP and (5) vision and role of THPs. There were multiple divergent perspectives among the THPs with the shared African worldview.

Conclusion

Understanding THPs belief systems and therapeutic options is crucial for holistic patient management. Knowledge exchange can promote safe healthcare practices and facilitate collaboration between traditional and allopathic health practitioners.

Contribution

This is the first study to explore THPs perceptions and practices regarding EB, a rare disease.

Novel application of multi-facility process map analysis for rapid injury care health system assessment in Northern Malawi

OBJECTIVES

We used the process mapping method and Three Delays framework, to identify and visually represent the relationship between critical actions, decisions and barriers to access to care following injury in the Karonga health system, Northern Malawi.

DESIGN

Facilitated group process mapping workshops with summary process mapping synthesis.

SETTING

Process mapping workshops took place in 11 identified health system facilities (one per facility) providing injury care for a population in Karonga, Northern Malawi.

PARTICIPANTS

Fifty-four healthcare workers from various cadres took part.

RESULTS

An overall injury health system summary map was created using those categories of action, decision and barrier that were sometimes or frequently reported. This provided a visual summary of the process following injury within the health system. For Delay 1 (seeking care) four barriers were most commonly described (by 8 of 11 facilities) these were 'cultural norms', 'healthcare literacy', 'traditional healers' and 'police processes'. For Delay 2 (reaching care) the barrier most frequently described was 'transport'-a lack of timely affordable emergency transport (formal or informal) described by all 11 facilities. For Delay 3 (receiving quality care) the most commonly reported barrier was that of 'physical resources' (9 of 11 facilities).

CONCLUSIONS

We found our novel approach combining several process mapping exercises to produce a summary map to be highly suited to rapid health system assessment identifying barriers to injury care, within a Three Delays framework. We commend the approach to others wishing to conduct rapid health system assessments in similar contexts.

Use of home remedies for the treatment and prevention of coronavirus disease: An integrative review

Background and Aims

Home remedies are understood to mean medications or tonics prepared at home to treat certain ailments without any prescription or professional supervision. Reliance on home remedies increased during coronavirus disease 2019 (COVID-19). The aim of this integrative review was to identify home remedies used to treat and prevent COVID-19 and discuss implications for nursing practice and health related to the safety and efficacy of home remedies.

Methods

Cooper's integrative review method guided this study to identify home remedies used to prevent and treat COVID-19. Google Scholar, BMC, EBSCOhost, Medline, Academic Search Ultimate, Web of Science Core Collections, Science Direct and Global Health were used to search for relevant information on the use of COVID-19 home remedies from 2019 to 2022. The Critical Appraisal Skills Program (CASP) checklist was used to select studies that had to be included. The eligibility criteria included studies on home remedies, written in English from 2019 to 2022. Findings of qualitative, quantitative and mixed-methods research were extracted, and narrative thematic data synthesis was applied.

Results

Eleven articles which met the inclusion criteria were found in nine countries: Ghana (1), South Africa (1), Tanzania (1), Togo (1) and Zimbabwe (1), Bangladesh (1), Hong Kong (1), India (2), Iran (1), and Pakistan (1). Findings showed that home remedies are used for the prevention of COVID-19 infection, treatment of COVID-19, and boosting immunity.

Conclusions

Home remedies have been found to be more pronounced across all sectors and social strata. More research is needed on the use of home remedies for life-threatening outbreaks. Policymakers and healthcare workers are challenged to encourage the use of home remedies in the prevention of other ailments and epidemics that might occur in the future.

The Roles and Challenges of Traditional Health Practitioners in Maternal Health Services in Rural Communities of Mthatha, South Africa

Traditional health practitioners (THPs) are considered as the entry level of care in African societies and play an important role in the delivery of health services to the population. A phenomenological qualitative study was carried out among purposefully selected THPs in Mthatha to understand their roles and the challenges they face in providing maternal health services. The study included a focus group discussion with seven participants which yielded three themes and seven subthemes. The content analysis of descriptive data from the focus group discussion revealed threats posed by unregistered and counterfeit THPs to the lives of pregnant women in rural settings. The THPs' wide range of services allowed pregnant women to receive prenatal, antenatal, and postnatal care in proximity. However, this community level of care was marked by high levels of secrecy and counterfeit practitioners who used human body parts, which compromised the practice and rendered it unpopular. The South African government recommended the establishment of a register for THPs in order to protect the public, including the clarification of functional referral pathways between THPs and conventional health services.

Factors limiting traditional medicine integration into modern health systems in Africa: protocol for a systematic review of qualitative studies

OBJECTIVES

It was recognised in the 1978 Alma-Ata Declaration that the integration of traditional medicine into modern health systems is a major lever for achieving universal health coverage. In several African countries, the integration of traditional medicine still faces constraints, despite the development of policies and regulations in favour of this integration. The objective of this study is to conduct a systematic review of the limitations of integrating traditional medicine in Africa.

STUDY DESIGN

This is a systematic review protocol for qualitative studies.

METHODS

The aim will be to conduct a systematic review of qualitative studies according to PRISMA guidelines. Given the qualitative nature of the primary studies, the COREQ guidelines will also be used to complement PRISMA. The search for primary studies will be conducted in Medline, Science Direct, Hinari and Google Scholar databases, using search equations designed based on the keywords constituting the thesauri of the search question. This will be done independently by two authors. The screening steps of the identified articles will be presented in PRISMA 2009 flowchart. The assessment of the risk of bias of the primary studies and the strength of the conclusions or recommendations will be performed by the GRADE tool.

RESULTS

The results of this systematic review will consist of the primary qualitative studies on the limitations of integrating traditional medicine into conventional health systems in African countries. These will be categorised into policy, legal, organisational and sociocultural limitations. They will be reported in accordance with the PRISMA and COREQ guidelines.

CONCLUSION

A systematic qualitative study of the limitations of effective integration of traditional medicine into conventional health systems in Africa is needed to guide national policies and regulations on traditional medicine. The application of PRISMA and COREQ standards to this review will ensure its quality and reproducibility.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO ID: CRD42022318699.

Patients’ Experience on Practice and Applicability of Informed Consent in Traditional Medical Practice in KwaZulu-Natal Province, South Africa

Background

Informed consent (IC) is constitutionally protected in South Africa based on individual rights to bodily integrity and well-being. In terms of the law, patients cannot be involved in medical treatment or research without IC. This study explored patients' experience on practice and applicability of IC in African traditional medicine (ATM) in Msunduzi and eThekwini municipalities, KwaZulu-Natal province, South Africa, to evaluate whether important elements of IC such as full information disclosure, capacity, understanding, and volition are considered or being applied during ATM.

Methods

This cross-sectional quantitative study was conducted using semistructured questionnaires administered to patients attending traditional health practitioners' (THPs') treatment centres. Stata V15.1 was used to analyse variables including descriptive and inferential data analysis.

Results

One hundred and twenty-nine (129) participants completed this study, of which 62% were females. Most participants were in the age range of 26–35 (38.8%). All respondents were IsiZulu home-language speakers, single (62.8%), employed (48%), and with some tertiary education (48.8%). Most patients were informed about their diagnosis (58.9%), treatment benefits (79.8%), and recommended treatment (79.8%). Fewer were informed about risks of treatment (36.4%), right of refusal (3.1%), and risks of refusing recommended treatment (0.8%). All participants reported satisfaction with information disclosed by the THPs and did not feel coerced to accept treatment. Consent was obtained verbally in all cases. The majority of participants (76.7%) sought surrogate assistance when consulting THPS, and 81.4% preferred being informed about all treatment risks. Most respondents also preferred involvement in healthcare decision-making during ATM.

Conclusion

This study reveals that most patients consulting THPs in the KwaZulu-Natal province for treatment are aware of their right to information disclosure and the need to reach agreement before involvement in ATM treatment procedures. The study also showed that some key elements of IC are currently being applied during ATM practice in South Africa.

The Two Great Healing Traditions: Issues, Opportunities, and Recommendations for an Integrated First Nations Healthcare System in Canada

The First Nations in Manitoba, Canada, are calling for active recognition and incorporation of holistic traditional healing and medicine ways and approaches by the mainstream healthcare system that has hitherto tended to ignore all but biomedical approaches. This request for recognition requires elaboration on areas of opportunity for collaboration that could positively influence both Indigenous and allopathic medicine. We discuss pathways to an integrated healthcare system as community-based primary healthcare transformation. A community-based participatory research approach was used to engage eight Manitoba First Nations communities. One hundred and eighty-three (183) in-depth, semi-structured key informant interviews were completed in all communities. Grounded theory guided data analysis using NVivo 10 software. We learned that increased recognition and incorporation of traditional healing and medical methods would enhance a newly envisioned funded health system. Elders and healers will be meaningfully involved in the delivery of community-based primary health care. Funding for traditional healing and medicines are necessary components of primary health care. An overall respect for Indigenous health knowledge would aid transformation in community-based primary health care. Recognition of and respect for traditional healing, healers, medicines, therapies, and approaches is also recommended as part of addressing the legacy and intergenerational impact of assimilative policies including Indian residential schools as the Truth and Reconciliation Commission of Canada has stated in its Calls to Action.

Using locational data in a novel mixed-methods sequence design: Identifying critical health care barriers for people with disabilities in Malawi

The primary aim of this study was to determine which health care barriers were most important for people with disabilities in Malawi. To accomplish this, we devised a sequential mixed-methods research design that integrated locational survey data and qualitative data from field studies. Our secondary aim was to evaluate this research design not only as a design-solution to our particular research objective, but as a tool with more general applicability within social sciences. Malawi has one of the most underserved health service populations in the world with chronic resource shortages and long travel distances where people with disabilities are at a particular disadvantage. Nevertheless, our results show that even in a resource scarce society such as Malawi it is the interpersonal relationships between patients and health service providers that has the largest impact on the perception of access among patients. Our results also suggest that the sequential mixed-methods design is effective in guiding researchers towards models with strong specifications.

Integration of Traditional Healers in Human African Trypanosomiasis Case Finding in Central Africa: A Quasi-Experimental Study

BACKGROUND

Based on the premise that Africans in rural areas seek health care from traditional healers, this study investigated a collaborative model between traditional healers and the national Human African Trypanosomiasis (HAT) programs across seven endemic foci in seven central African countries by measuring the model's contribution to HAT case finding.

METHOD

Traditional healers were recruited and trained by health professionals to identify HAT suspects based on its basics signs and symptoms and to refer them to the National Sleeping Sickness Control Program (NSSCP) for testing and confirmatory diagnosis.

RESULTS

35 traditional healers were recruited and trained, 28 finally participated in this study (80%) and referred 278 HAT suspects, of which 20 (7.19%) were CATT positive for the disease. Most cases originated from Bandundu (45%) in the Democratic Republic of Congo and from Ngabe (35%) in Congo. Twelve (4.32%) patients had confirmatory diagnosis. Although a statistically significant difference was not shown in terms of case finding (p = 0.56), traditional healers were able to refer confirmed HAT cases that were ultimately cared for by NCSSPs.

CONCLUSION

Integrating traditional healers in the control program of HAT will likely enhance the detection of cases, thereby, eventually contributing to the elimination of HAT in the most affected communities.

The governance of traditional medicine and herbal remedies in the selected local markets of Western Kenya

BACKGROUND

A lot of emphasis is often placed on modern governance systems and little or no attention is given to traditional governance practices which remain largely undocumented. The study aimed at finding out important traditional and modern governance practices that regulate traditional medicine sector in Western Kenya.

MATERIALS AND METHODS

The study was carried out in selected market centres of Western Kenya where the identified traditional medicine practitioners (TMPs) sell their traditional medicine. All consenting TMPs and professional experts were interviewed with the aid of a semi-structured questionnaire. Purposive sampling design with elements of snowball techniques was employed in tracing competent traditional medicine (TM) experts and relevant professional experts. The data collected was processed in Microsoft Excel and descriptive statistics performed. Pearson's chi-square statistics was carried out to determine the significance of the traditional and modern governance data sets using the STATA software.

RESULTS

Modern governance practices were not significantly different in all the market centres surveyed (p = 0.080). Equally, the traditional governance practices were also not significantly different in all the selected market centres (p = 1.000).

CONCLUSIONS

Traditional governance practices play an important role in the governance of traditional medicine and are shaped by the socio-cultural beliefs of the local communities. Modern governance practices, on the other hand, are widely perceived as top downregulation of the traditional medicine growing industry.