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Background: Ethnobotanical knowledge on four herbaceous species, Acmella uliginosa (Sw.) Cass., Momordica charantia L., Phyllanthus amarus Schumach. & Thonn., and Scoparia dulcis L., in Benin was investigated., Methods: Herbal medicine traders in six different markets were interviewed using a semi-structured questionnaire. The linear regression test was performed to check for the influence of respondent's age on ethnobotanical uses they hold. Relative frequency citation, fidelity level, use value, and Rahman similarity index were calculated to assess the diversity of medico-magic knowledge. The Informant Consensus Factor is not applicable in this study since we are dealing neither with the diversity of medicinal plants used by a community of people nor with a great number of plant species used for medicinal purposes, nor the diversity of plant species used in the treatment of a specific or group of ailments., Results: The respondent's age did not influence the ethnobotanical uses they hold on the species. All thirty-six informants surveyed traded Phyllanthus amarus Schumach. & Thonn., Momordica charantia L., and Scoparia dulcis L., and the majority traded Acmella uliginosa (Sw.) Cass. The respondent's age does not influence the diversity of ethnobotanical uses they hold on the study species. Purchase in traders' own markets was the predominant source of Phyllanthus amarus Schumach. & Thonn., Momordica charantia L., and Scoparia dulcis L. while Acmella uliginosa (Sw.) Cass. was mostly purchased in other more distant markets. A noticeable proportion of traders also collect Phyllanthus amarus Schumach. & Thonn. and Momordica charantia L. from wild populations. Phyllanthus amarus Schumach. & Thonn. was the species most demanded by customers followed by Momordica charantia L. Traders confirmed the scarcity of all species in recent years and climate change and destruction of natural habitats for logging were the most cited causes. The entire plant of Phyllanthus amarus Schumach. & Thonn. was used mainly to treat malaria, diabetes, and constipation, and decoction with oral administration was the most frequent preparation for malaria treatment. To treat diabetes, informants mixed Phyllanthus amarus Schumach. & Thonn. with Momordica charantia L. used as a decoction with oral administration. Momordica charantia L. was also used to treat measles and chicken pox. Acmella uliginosa (Sw.) Cass. and Scoparia dulcis L. were mostly used for their spiritual use for luck, predominantly by chewing fresh leaves or flowers, and by bathing with the ground plant mixed with soap, respectively. Overall, Momordica charantia L. had the greatest use value followed by Phyllanthus amarus Schumach. & Thonn. The majority of traders do not plant the species., Conclusions: The harvesting and trade of the species threaten their natural populations and urgent tools, including in situ and ex situ conservation, are needed to ensure their long-term sustainable exploitation., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2021 Hubert Olivier Dossou-Yovo et al.)

Background: About 70% of Ghanaians depend on traditional, complementary and integrative medicine (TCIM) practices for primary healthcare needs. It was therefore integrated into mainstream healthcare delivery system by the Ministry of Health in September 2012. LEKMA hospital was one of the institutions for piloting TCIM services. We assessed factors that promote the usage and sustainability of TCIM services within the formal healthcare system., Methods: We conducted a cross-sectional study from April-June 2017 at the LEKMA hospital, Accra, Ghana. Patients and managers of TCIM clinic were interviewed. Data was collected through qualitative and quantitative approaches. We defined usage of TCIM as its current use, and sustainability as structures in place to run TCIM services. For assessing usage, a five-point Likert scale was used to assess five domain areas via exit interviews. Managers were assessed on the sustainability of TCIM services through in-depth interviews. Likert scales responses were analysed quantitatively using descriptive tertile statistics. Thematic analysis was used for qualitative analysis., Results: Overall, 72.7% (40/55) of the clients showed a high preference for TCIM usage and 80.0% (4/5) of the managers valued it as partially sustainable. Eighty per cent (44/55) of patients indicated that the location of TCIM services and availability of visible directional signs influenced the good usage; 84% (46/55) of the patients agreed that the usage of TCIM was influenced by their perceived effectiveness. Managers indicated that human resources for providing services was a challenge and TCIM integration into the operations of the hospital needed to be improved., Conclusion: We observed a high preference for usage of TCIM among users at LEKMA hospital. The general belief in the potency, perceived effectiveness, location and availability of TCIM services are key determinants of the high preference for usage of TCIM. Provision of TCIM services in its current form is partially sustainable from the managers' perspective. We recommend that the Ministry of Health ensures the availability of staff and create awareness of TCIM services among the general populace.

The World Health Organization (WHO) estimates that about 50 million people of all ages have epilepsy and nearly 85% of whom live in low- and middle-income (LMICs) countries. In Morocco, epilepsy is one of the major neurological health conditions, with an estimated prevalence of 1.1%. The management of patients is difficult due to multiple factors. The lack of neurologists whose number is currently 180, the uneven distribution of neurologists who are concentrated in large cities, 43% of whom are in Rabat and Casablanca alone; the low involvement of general practitioners in the management of epilepsy; the frequent consultation of traditional healers; and the low coverage of social security all contribute to the treatment gap. The management of epilepsy has advanced considerably since the early nineties. Several factors contributed to this progress: the increasing number of neurologists compared to previous years, the creation of well-equipped new academic centers, and small units of general neurology, in addition to the disuse of several antiepileptic drugs. However, much work remains to be done against the use of many forms of traditional practices and the low involvement of general practitioners in the management of epilepsy. This is the first study on epilepsy conducted in Morocco., Competing Interests: None of the authors has any conflict of interest to disclose. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines., (© 2020 The Authors. Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)

Introduction: Medical pluralism , or concurrent utilisation of multiple therapeutic modalities, is common in various international contexts, and has been characterised as a factor contributing to poor health outcomes in low-resource settings. Traditional healers are ubiquitous providers in most regions, including the study site of southwestern Uganda. Where both informal and formal healthcare services are both available, patients do not engage with both options equally. It is not well understood why patients choose to engage with one healthcare modality over the other. The goal of this study was to explain therapeutic itineraries and create a conceptual framework of pluralistic health behaviour., Methods: In-depth interviews were conducted from September 2017 to February 2018 with patients seeking care at traditional healers (n=30) and at an outpatient medicine clinic (n=30) in Mbarara, Uganda; the study is nested within a longitudinal project examining HIV testing engagement among traditional healer-using communities. Inclusion criteria included age ≥18 years, and ability to provide informed consent. Participants were recruited from practices representing the range of healer specialties. Following an inductive approach, interview transcripts were reviewed and coded to identify conceptual categories explaining healthcare utilisation., Results: We identified three broad categories relevant to healthcare utilisation: (1) traditional healers treat patients with 'care'; (2) biomedicine uses 'modern' technologies and (3) peer 'testimony' influences healthcare engagement. These categories describe variables at the healthcare provider , healthcare system and peer levels that interrelate to motivate individual engagement in pluralistic health resources., Conclusions: Patients perceive clear advantages and disadvantages to biomedical and traditional care in medically pluralistic settings. We identified factors at the healthcare provider, healthcare system and peer levels which influence patients' therapeutic itineraries. Our findings provide a basis to improve health outcomes in medically pluralistic settings, and underscore the importance of recognising traditional healers as important stakeholders in community health., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Peritonitis is an emergency which frequently requires surgical intervention. The aim of this study was to describe factors influencing seeking and reaching care for patients with peritonitis presenting to a tertiary referral hospital in Rwanda., Methods: This was a cross-sectional study of patients with peritonitis admitted to University Teaching Hospital of Kigali. Data were collected on demographics, prehospital course, and in-hospital management. Delays were classified according to the Three Delays Model as delays in seeking or reaching care. Chi square test and logistic regression were used to determine associations between delayed presentation and various factors., Results: Over a 9-month period, 54 patients with peritonitis were admitted. Twenty (37%) patients attended only primary school and 15 (28%) never went to school. A large number (n = 26, 48%) of patients were unemployed and most (n = 45, 83%) used a community-based health insurance. For most patients (n = 44, 81%), the monthly income was less than 10,000 Rwandan francs (RWF) (11.90 U.S. Dollars [USD]). Most (n = 51, 94%) patients presented to the referral hospital with more than 24 h of symptoms. More than half (n = 31, 60%) of patients had more than 4 d of symptoms on presentation. Most (n = 37, 69%) patients consulted a traditional healer before presentation at the health care system. Consultation with a traditional healer was associated with delayed presentation at the referral hospital (P < 0.001). Most (n = 29, 53%) patients traveled more than 2 h to reach a health facility and this was associated with delayed presentation (P = 0.019). The cost of transportation ranged between 5000 and 1000 RWF (5.95-11.90 USD) for most patients and was not associated with delayed presentation (P = 0.449)., Conclusions: In this study, most patients with peritonitis present in a delayed fashion to the referral hospital. Factors associated with seeking and reaching care included sociodemographic characteristics, health-seeking behaviors, cost of care, and travel time. These findings highlight factors associated with delays in seeking and reaching care for patients with peritonitis., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Aim: This study aims to explore the experiences of carers of children with cerebral palsy living in rural areas of Ghana who have received no rehabilitation services., Background: Cerebral palsy is the most common chronic disability from childhood, which needs lifelong rehabilitation. Most of the population living in rural communities in Ghana have virtually no form of rehabilitation services for their chronic disabling conditions. Caring for children with disability are known to be challenging especially when coupled with environmental challenges in rural communities., Results: Purposive and snowball techniques were used to recruit 12 carers, age 22 to 68 years, of children with cerebral palsy aged 7 to 15 years. Two main themes, developing personal beliefs to support the caregiving role and the demands that shape the experience of caring, emerged from six subthemes and 25 theme clusters of the narratives of the carers. The essential structure of the phenomenon demonstrated the complex interaction of personal and environmental factors in harmony with the actual demands to influence the experiences of participants positively or negatively. Positively, carers achieved coping, committed to caring, hoped for the future, and accepted the condition. However, negatively, carers described the triggering factors of feeling of despair and sorrow as frustration and lack of understanding of the condition, felt stigmatized, and perceived the child was going through pain and suffering., Conclusions: Carers derived strength from their religious and spiritual beliefs to balance the demands of caregiving. Findings could be used as basis for developing interventions to support carers and inform new strategies for rehabilitation service and sensitization of community members about inclusion of children with disabilities., (© 2019 John Wiley & Sons Ltd.)

Aim: This paper examined the association between wealth and health insurance status and the use of traditional medicine (TM) among older persons in Ghana., Background: There have been considerable efforts by sub-Saharan African countries to improve access to primary health care services, partly through the implementation of risk-pooling community or national health insurance schemes. The use of TM, which is often not covered under these insurance schemes, remains common in many countries, including Ghana. Understanding how health insurance and wealth influence the use of TM, or otherwise, is essential to the development of equitable health care policies., Methods: The study used data from the first wave of the World Health Organisation's Study of Global Ageing and Adult Health conducted in Ghana in 2008. Descriptive statistics and negative loglog regression models were fitted to the data to examine the influence of insurance and wealth status on the use of TM, controlling for theoretically relevant factors., Findings: Seniors who had health insurance coverage were also 17% less likely to frequently seek treatment from a TM healer relative to the uninsured. For older persons in the poorest income quintile, the odds of frequently seeking treatment from TM increased by 61% when compared to those in the richest quintile. This figure was 46%, 62% and 40% for older persons in poorer, middle and richer income quintiles, respectively, compared to their counterparts in the richest income quintile., Conclusion: The findings indicate that TM was primarily used by the poor and persons who were not enrolled in the National Health Insurance Scheme. TM continues to be a vital health care resource for the poor and uninsured older adults in Ghana.

Background:  Medical male circumcision (MMC) and traditional male circumcision (TMC) are reportedly having negative and positive outcomes in the Eastern Cape province. Researchers show contradictory remedies; some advocate for abolishment of TMC and others call for the integration of both methods., Aim:  This study aimed to explore factors influencing the integration of TMC and MMC at different socio-ecological levels., Setting:  The study was conducted at Ingquza Hill Local Municipality in the Eastern Cape province., Methods:  An explorative qualitative study design, using in-depth interviews (IDIs) and focus group discussions (FGDs), was employed in this study. Purposive sampling was used to select the participants. A framework analysis approach was used to analyse the data, and the themes were developed in line with the socio-ecological model., Results:  Four main themes emerged from the data as important in influencing the integration of TMC and MMC methods. These included: (1) individual factors, related to circumcision age eligibility and post-circumcision behaviour; (2) microsystem factors, related to alcohol and drug abuse, peer pressure, abuse of initiates, and family influence; (3) exosystem factors, related to financial gains associated with circumcision and the role of community forums; and (4) macrosystem factors, related to stigma and discrimination, and male youth dominance in circumcision practices., Conclusion:  Male circumcision in this area is influenced by complex factors at multiple social levels. Interventions directed at all of these levels are urgently needed to facilitate integration of the TMC and MMC methods.

Background: Over 75% of people with mental neurological and substance use disorders (MNSD) live in low and middle-income countries with limited access to specialized care. The World Health Organization's Mental Health Gap Action Program (mhGAP) aims to address the human resource gap but it requires contextualization., Aims: We conducted a qualitative study in rural coastal Kenya to explore the local terms, perceived causes and management modalities of priority MNSD listed in the mhGAP, to inform implementation in this setting., Methods: We conducted 8 focus group discussions with primary health care providers and traditional health practitioners and used the framework method to conduct thematic analysis. We identified local terms, perceived causes and treatment options for MNSD. We also explored possibilities for collaboration between the traditional health practitioners and primary health care providers., Results: We found local terms for depression, psychoses, epilepsy, disorders due to substance use and self-harm/ suicide but none for dementia. Child and adolescent mental and behavioral problems were not regarded as MNSD but consequences of poor parenting. Self-harm/suicide was recognized in the context of other MNSD. Causes of MNSD were broadly either biological or supernatural. Treatment options were dependent on perceived cause of illness. Most traditional health practitioners were willing to collaborate with primary health care providers mainly through referring cases. Primary health care providers were unwilling to collaborate with traditional health practitioners because they perceived them to contribute to worsening of patients' prognoses., Conclusions: Local terms and management modalities are available for some priority MNSD in this setting. Community level case detection and referral may be hindered by lack of collaboration between traditional health practitioners and primary health care providers. There is need for training on the recognition and management of all priority MNSD., Competing Interests: The authors have declared that no competing interests exist.

Background: Tuberculosis (TB) remains the prime killer disease among infectious diseases. TB control depends on early case detection and treatment in a directly observed treatment short course (DOTS) programme. The success of DOTS depends on the ability of the health care system to identify and properly manage TB cases. The present study aims to assess healthcare provider (HCP) knowledge, attitude and perceived stigma regarding TB and perception about traditional healers., Methods: A descriptive cross sectional study was conducted among 108 HCPs using a semi-structured, self-administered questionnaire from September 2014 to January 2015. The study district has a high TB burden area with one district hospital, 4 health centres, and 18 health posts. All health facilities and HCPs available during the study period in the district were included in the study. Statistical software for social science (SPSS) version 22 and STATA version 14 were used to enter and analyse data, respectively., Results: The majority (64%) of the HCPs had poor overall knowledge regarding TB, and 67.6 and 57.6% had poor knowledge regarding TB diagnosis and nature of the disease, respectively. Moreover, most 66.7 and 55.6% of the HCPs had an unfavourable attitude towards TB and TB control systems, respectively. Slightly under half (49.1%) of the HCPs had a favourable attitude towards TB patients, and the majority (88.9%) had low perceived stigma. The majority (87.0%) of the HCPs indicated the importance of community involvement in TB control activity. Moreover, most (60.2%) of the HCPs showed willingness to collaborate with traditional healers (THs) on TB control activity., Conclusions: Healthcare workers' knowledge gap and unfavourable attitude towards TB control systems reported in this study may cause poor TB care delivery. HCPs' perception of the importance of community involvement in TB control and willingness to collaborate with THs on TB management could be an opportunity to strengthen the World Health Organization's (WHO's) component of End TB strategy through community engagement. Training and workshops could be used to address the knowledge gap and the unfavourable attitude regarding TB among HCPs.

Background: Involvement of traditional health practitioners (THPs) in the form of collaboration with the formal health care system is suggested to improve the pathways to mental health care in Kenya, yet understanding of the current traditional practice and THPs' perspectives is lacking. The aim of this study was to explore the views of THPs with respect to their mental health practice., Methods: This study qualitatively explored the views of THPs, using four focus group discussions (FDGs) each consisting of 8-10 traditional and faith healers, resulting in a total of 36 participants. Thematic content analysis using a grounded theory approach was performed using QSR NVivo 10. Emerging topics were identified and examined by re-reading the transcripts several times and constantly re-sorting the material., Results: Four themes that reflect THPs' mental health practice perspectives emerged as follows: 1) Categorization of mental illness; 2) Diagnostics in traditional mental health practice; 3) Treatments and challenges in current traditional mental health practice; and 4) Solutions to improve traditional mental health practice., Conclusions: These themes provide insight into the perspectives of Kenyan traditional and faith healers on their mental health practice, in an attempt to offer a meaningful contribution to the debate on collaboration between informal and formal health care providers in improving mental health services in Kenya. Furthermore, the presented challenges and solutions can inform policy makers in their task to improve and scale up mental health services in resource-poor areas in Kenya. Addressing these issues would be a first step towards understanding the solid foundation of traditional medicine that is necessary before collaboration can be successfully attempted. Further research is also recommended to assess patients' needs and explore potential forms of collaboration, in order to achieve sustainable improvement in the mental health care pathways for patients.

In the past four decades, there has been an increase in the occurrence of zoonotic diseases. Some outbreaks have been devastating because of the inability of individuals and health workers to identify the diseases early. Generally, most zoonotic diseases are heralded by a fever. While fevers are common, they are often the symptoms of different diseases. This paper explores how a population at potential risk of zoonotic diseases identify fevers, and what treatments they seek when they develop fevers. The data are from focus group discussions and a survey of three communities in the Brong Ahafo, Volta and Greater Accra regions in Ghana. The quantitative data were analysed using descriptive statistics while the qualitative data were analysed using thematic analysis. The findings indicate that the perceived causes of fever differ from the traditional biomedical view. While orthodox treatment was the preferred choice for most participants, rural dwellers utilised traditional medicine more than their urban counterparts. Though there is no record of bat-borne zoonotic disease in Ghana, our findings could be used as a proxy to indicate how populations at risk of exposure might respond in the event of a spillover event from a zoonosis. We recommend that educational campaigns on zoonotic diseases should target rural dwellers, especially farmers, who may be most at risk of zoonoses., Competing Interests: The authors have declared that no competing interests exist.

Background: Canine Bud Extraction (CBE) is a process of removing or gouging children's healthy canine tooth buds embedded underneath the gum using traditional unsterilized tools. The practice of CBE commonly known as false teeth removal continues to be an adopted cultural intervention of choice, in the prevention of morbidity and mortality from common childhood illnesses. However, it is a practice against the rights of the children with serious consequences. While CBE is associated with the perceived myth of curative gains, the agony emanating from the cultural practice exposes children to ill-health conditions such as dehydration, malnutrition, blood-borne diseases like HIV/AIDs, septicemia, fever and death. This research sought to understand the factors underpinning the practice of CBE among urban slum dwellers., Method: A cross-sectional study was conducted from five randomly selected slums in Makindye division; 298 household heads or guardians with children below 5 years, who had ever suffered from false teeth were interviewed. The variables measured included guardians' socio-demographic profiles, determinants of CBE, common childhood illnesses assumed to be treated with CBE and the reported side-effects associated with the practice., Results: Of the 298 respondents with children who had ever suffered from "false teeth" interviewed, 56.7% had two or more children below 5 years and 31.9% were from the central region. The proportion of households practicing CBE was 90.3%; 69.8% of the caretakers mentioned that it was done by traditional healers and for 12.1% by trained health workers (dentists). Number of children (OR = 2.8, 95% CI: 1.1-7.2) and the belief that CBE is bad (OR = 0.1, 95% CI: < 0.001, p < 0.001) had a statistically significant association with CBE. Additionally, number of children (χ2 = 4.9, p = 0.027) and 2 sets of beliefs (CBE treats diarrhea (χ2 = 12.8, p = 0.0017) and CBE treats fever (χ2 = 15.1, p = 0.0005) were independent predictors of CBE practice. A total of 55.7% respondents knew that there were side effects to CBE and 31% mentioned death as one of them., Conclusion: The high proportion of households practicing CBE from this study ought to awaken the perception that the practice is ancient. CBE in this community as the study suggests was strongly driven by myths. The strong belief that CBE is bad provides an opportunity for concerted effort by primary health care providers, policy makers and the community to demystify the myths associated with false teeth and the gains of CBE.

Background: Prior to the advent of modern obstetric services, traditional birth attendants (TBAs) have rendered services to pregnant women and women in labour for a long time. Although it is anticipated that women in contemporary societies will give birth in hospitals and clinics, some women still patronize the services of TBAs. The study therefore sought to gain an in-depth understanding of the initiation of TBAs and their traditional and spiritual practices employed during pregnancy and childbirth in Ghana., Methods: The design was an exploratory qualitative one using in-depth individual interviews. Data saturation was reached with 16 participants who were all of Christian faith. Interviews were conducted with a semi-structured interview guide, audiotaped and transcribed verbatim. Content analysis was employed to generate findings., Results: The findings showed that TBAs were initiated through apprenticeship from family members who were TBAs and other non-family TBAs as well as through dreams and revelations. They practice using both spiritual and physical methods and their work was founded on spiritual directions, use of spiritual artefacts, herbs and physical examination. TBAs delay cutting of the cord and disposal of the placenta was associated with beliefs which indicated that when not properly disposed, it will have negative consequences on the child during adulthood., Conclusion: Although, TBAs like maternal health professionals operate to improve maternal health care, some of their spiritual practices and beliefs may pose threats to their clients. Nonetheless, with appropriate initiation and training, they can become useful.

We examined the scope of collaborative care for persons with mental illness as implemented by traditional healers, faith healers, and biomedical care providers. We conducted semistructured focus group discussions in Ghana, Kenya, and Nigeria with traditional healers, faith healers, biomedical care providers, patients, and their caregivers. Transcribed data were thematically analyzed. A barrier to collaboration was distrust, influenced by factionalism, charlatanism, perceptions of superiority, limited roles, and responsibilities. Pathways to better collaboration were education, formal policy recognition and regulation, and acceptance of mutual responsibility. This study provides a novel cross-national insight into the perspectives of collaboration from four stakeholder groups. Collaboration was viewed as a means to reach their own goals, rooted in a deep sense of distrust and superiority. In the absence of openness, understanding, and respect for each other, efficient collaboration remains remote. The strongest foundation for mutual collaboration is a shared sense of responsibility for patient well-being.

Background: Human immunodeficiency virus (HIV) substantially contributes to the burden of disease and health care provision in sub-Saharan Africa, where traditional healers play a major role in care, due to both their accessibility and acceptability. In rural, northeastern South Africa, people living with HIV often ping-pong between traditional healers and allopathic providers., Methods: We conducted 27 in-depth interviews and 133 surveys with a random sample of traditional healers living in Bushbuckridge, South Africa, where anti-retroviral therapy (ART) is publicly available, to learn: (1) healer perspectives about which HIV patients they choose to treat; (2) the type of treatment offered; (3) outcomes expected, and; (4) the cost of delivering treatment., Results: Healers were mostly female (77%), older (median: 58.0 years; interquartile range [IQR]: 50-67), with low levels of formal education (median: 3.7 years; IQR: 3.2-4.2). Thirty-nine healers (30%) reported being able to cure HIV in an adult patients whose (CD4) count was >350cells/mm 3 . If an HIV-infected patient preferred traditional treatment, healers differentiated two categories of known HIV-infected patients, CD4+ cell counts <350 or ≥350 cells/mm 3 . Patients with low CD4 counts were routinely referred back to the health facility. Healers who reported offering/performing a traditional cure for HIV had practiced for less time (mean = 16.9 vs. 22.8 years; p = 0.03), treated more patients (mean 8.7 vs. 4.8 per month; p = 0.03), and had lower levels of education (mean = 2.8 vs. 4.1 years; p = 0.017) when compared to healers who reported not treating HIV-infected patients. Healers charged a median of 92 USD to treat patients with HIV., Conclusion: Traditional healers referred suspected HIV-infected patients to standard allopathic care, yet continued to treat HIV-infected patients with higher CD4 counts. A greater emphasis on patient education and healer engagement is warranted.

AbstractPatients' delay in seeking diagnosis is a major problem in the management of tuberculosis (TB). Relative to the burden of TB, there is lack of data on the magnitude of delays in seeking care and why patients fail to seek early care at health facilities in Ethiopia. A facility-based cross-sectional study was conducted from April to July 2013 in East Gojjam Zone, Amhara, Ethiopia, to assess patients' delays and associated factors in TB patients. Using simple random sampling, 605 (327 male and 278 female) participants were recruited. Of the total, 323 (53.4%) TB patients were delayed in seeking health care (median = 45 days; mean = 78.5 days). The following independent variables were associated with patient delays: age ≥ 45 years (adjusted odds ratio [AOR] = 8.74, 95% confidence interval [CI] = 4.71-16.23, P < 0.001); working as a farmer (AOR = 4.18, 95% CI = 1.44-12.11, P = 0.009); prior visit to holy water sites, traditional healers, and/or private drug shops (AOR = 69.11, 95% CI =13.91-343.29, P < 0.001; AOR = 14.74, 95% CI = 1.43-152.31, P = 0.024; AOR = 2.10, 95% CI = 1.22-3.59, P = 0.007, respectively); poor knowledge about TB (AOR = 2.79, 95% CI = 1.74-4.92, P = 0.006), and extrapulmonary TB (AOR = 14.69, 95% CI = 8.21-26.26, P < 0.001). Generally, patients' delay in seeking care at health facilities was high (53.4%). Most of TB patients getting treatment from holy water (95.3%; 101/106) and traditional healers (84.6%; 11/13) were delayed. Therefore, for early seeking in modern health care, a combination of interventions is required to encourage TB patients.

The paper introduces the Baanashada Dumarka, a Somali fertility therapy carried out by a spirit medium, known locally as 'Alaqad. Baanashada is aimed at women whose fertility issues are believed to be caused by spirits. The study also explores a component of the Baanashada, namely, the use of tiire (Rotheca myricoides), or the butterfly bush. Although Rotheca myricoides is known to possess a number of medicinal components as confirmed by studies of modern science, so far, there exist no studies on its potential (or lack of) fertility effects. Hence, the alleged fertility benefits of the butterfly bush need examining. In 2008 a British Somali woman died of herbs placed in her cervix by a traditional healer in Somaliland. This piece of information indicated not only the role of herbal medicine in fertility practices, but also the popularity of traditional reproductive medicine beyond border, class or educational background. Yet, current research into Somali women's health focuses mainly on Female Genital Mutilation (FGM), examined often without the context of wider cultural practices. This paper, however, suggests that rituals, beliefs and material culture play a paramount role in women's practices. For example, as explored elsewhere, the wagar, a wooden and sacred object made of the African olive, is critical for fertility practices. The current paper illuminates further the significance of reproduction practices in Somali society and the potential continuity of traditions associated with the perpetuation of kinship. It concludes that fertility rituals are part of a wider context of interaction with sacred landscapes, objects and archaeological sites, often associated with past legends in the Horn of Africa.

Background: Female Circumcision (FC) is a harmful traditional practice and remains a public health problem particularly in the era of HIV/AIDS. Aside its numerous health implications, it can cause infertility, complications in childbirth and increased risk of newborn deaths. FC is widely practised in Nigeria., Objective: The study assessed the level of FC, daughters' circumcision and attitude towards discontinuation of the practice among women of reproductive age., Methods: Data were extracted from the 2008 Nigeria Demographic Health and Survey. Data were analysed using Chi-square and binary logistic regression models (á = 0.05)., Results: Among the respondents, prevalence of FC was 49.2% with 30.6% having circumcised their daughters and 25.8% wishing the practice to continue. About 56% of circumcised women also circumcised their daughters whereas only 2.9% of uncircumcised women circumcised their daughters. Approximately 69.8% of women who had circumcised their daughters would like FC to continue compared to 8.8% of those who never circumcised any of their daughters. The likelihood of FC was higher (OR = 2.07; C.I = 1.85-2.30) among Moslems compare to Christians. Igbo women were less likely to discontinue FC compared to women of Hausa/Fulani ethnic group despite controlling for the confounding variables (OR = 0.57; C.I = 0.35-0.91)., Conclusion: Female circumcision is still practiced in all parts of Nigeria and a high proportion of women reported that the practice should continue. There is need to intensify efforts on the campaign against female circumcision in Nigeria.

Previous research suggests that care-seeking in rural northern Ghana is often governed by a woman's husband or compound head. This study was designed to explore the role grandmothers (typically a woman's mother-in-law) play in influencing maternal and newborn healthcare decisions. In-depth interviews were conducted with 35 mothers of newborns, 8 traditional birth attendants and local healers, 16 community leaders and 13 healthcare practitioners. An additional 18 focus groups were conducted with stakeholders such as household heads, compound leaders and grandmothers. In this region, grandmothers play many roles. They may act as primary support providers to pregnant mothers, care for newborns following delivery, preserve cultural traditions and serve as repositories of knowledge on local medicine. Grandmothers may also serve as gatekeepers for health-seeking behaviour, especially with regard to their daughters and daughters-in-law. This research also sheds light on the potential gap between health education campaigns that target mothers as autonomous decision-makers, and the reality of a more collectivist community structure in which mothers rarely make such decisions without the support of other community members.

Background: Mercury is a toxic metal however its use in traditional healthcare systems remains widespread. The aim of this study was to determine the prevalence of mercury use by South African Traditional Health Practitioners (THP) and to document reasons for use and administration methods., Methods: A cross-sectional study design was employed. A total of 201 THPs were enrolled from two main metropolitan areas of KwaZulu-Natal (South Africa), and 198 were included in the final analysis. Information on demographic characteristics, reasons for using or not using mercury as well as mercury administration methods were collected., Results: Of the 198 THPs, 78 (39%) used mercury for healing purposes and 74 (95%) of the mercury users stated that they were taught to use it by another THP. The two main routes of administration were oral and sub-cutaneous implantations (ukugcaba) at 85% (n = 66) and 59% (n = 46), respectively. The most common responses for mercury administration were for child birth (n = 70; 90%) and protection against guns (n = 39; 50%)., Conclusion: This is the first study to describe the prevalence and practice of mercury use in South African traditional medicine. Socio-cultural mercury use is a potential source of exposure to both THPs and their patients. In light of such findings, public education messages and regulatory measures need to be effected.

Use of traditional medicines for treatment of cancers has increased worldwide. We used a qualitative approach to explore barriers to biomedical care and reasons for use of traditional medicines for the treatment of cervical cancer in Gulu, northern Uganda. We carried out 24 focus group discussions involving men and women aged 18-59 years. We employed content analyses technique in data analysis. Traditional medicines were used mainly due to barriers to biomedical care for cervical cancer. The barriers included health system factors, for example long distances to health facilities and unavailability of medicines; health workers' factors, for example negative attitudes towards patients and demands for bribes; individual patient's factors, for example inability to pay for medical care; and socio-cultural beliefs about superiority of traditional medicines and perceived greater privacy in accessing traditional healers. Barriers to biomedical care and community beliefs in the effectiveness of traditional medicines encourage use of traditional medicines for treatment of cervical cancer but might hinder help-seeking at biomedical facilities. There is need for targeted culturally sensitive awareness campaign to promote effectiveness of modern medicine and to encourage cautious use of traditional medicines in the treatment of cervical cancer., (© 2014 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd.)

Old age is usually accompanied with numerous health challenges compared with the other stages of life. By 60 years, many people experience chronic diseases, deterioration in the function of their body organs, and a host of other health problems. Yet, many aged people are reluctant to utilise health care services even when they need them, because of apprehensions they have about the forms of health care. This article examines the perceptions of the aged about traditional and modern medicines using Yamoransa as the study setting. Cross-sectional survey was conducted to assess the perceptions of the aged, and using interview schedules, 311 aged people responded to questions which were primarily used as the bases for the analyses. The study employed modernisation theory, theory of planned behaviour and health belief model to explain the perceptions of the aged about traditional and orthodox medicines. It was found that the aged preferred modern medicine because of the perception that modern health facilities are endowed with professionals in health care and also boasts of medical resources/apparatus which are very effective in the treatment of diseases and ailments. However, the difference in preference was infinitesimal; pointing that, an integrated form of health care would be quite helpful for the aged.

Introduction: Studies in different parts of the world indicate that there is high level use of self medication among pregnant women. But there are no scientific evidences on it and factors associated with it in Bahir Dar city administration. The aim of this study was therefore to assess level of self medication and identify factors associated with it among pregnant women attending ANC service at governmental health centers in Bahir Dar city administration., Methods: Institution based cross-sectional study was conducted from June 20-July 10, 2013. Data were collected using structured questionnaire and analyzed using SPSS version 16.0. Back ward logistic regression model was used to assess level of association with self medication practice., Results: A total of 510 pregnant women were included in the study. Of these, 25.1% reported self-medication during the current pregnancy. Self medication during pregnancy was significantly associated with gravida (AOR = 2.1, 95% CI: 1.3-3.4), maternal illness on the date of interview (AOR = 4.8, 95% CI: 2.9-8.0) and location of health facility (AOR = 4.6; 95% CI: 2.9-7.4)., Conclusion: A considerable proportion of pregnant women practiced self-medication during their pregnancy with modern medications or traditional herbs. Mothers who were multi gravida, who had maternal illness on the date of interview and who were attending antenatal care were more likely to practice self medication.

Introduction: This article draws on selected palliative care providers' views and experiences to reflect on the potential benefits and possible challenges of involving traditional healers in palliative care in rural areas of South Africa. There is increasing consensus that palliative care should be offered by a range of professional and non-professional healthcare givers. Including non-professionals such as traditional healers in a palliative care team may strengthen care provisioning as they have intimate knowledge of patients' local culture and spiritual beliefs., Methods: Employing the qualitative method of photo-elicitation, one-on-one discussions about the photographs taken by participants were conducted. The participants - 4 palliative care nurses and 17 home-based care workers - were purposively selected to provide in-depth information about their experiences as palliative caregivers in rural homes., Results: Healthcare workers' experiences revealed that the patients they cared for valued traditional rituals connected to illness, dying, death and bereavement. Participants suggested that traditional healers should be included in palliative care training programs as they could offer appropriate psychological, cultural and spiritual care. A challenge identified by participants was the potential of traditional healers to foster a false sense of longevity in patients facing death., Discussion: The importance of recognising the value of traditional practices in palliative care should not be underrated in rural South Africa. Traditional healers could enhance palliative care services as they have deep, insider knowledge of patients' spiritual needs and awareness of cultural practices relating to illness, death, dying and bereavement. Incorporating traditional healers into healthcare services where there are differences in the worldviews of healthcare providers and patients, and a sensitivity to mediate cultural differences between caregivers and patients, could have the benefit of providing appropriate care in rural spaces., Conclusions: Considering the influences of cultural and spiritual beliefs on the wellbeing of patients living in rural areas, the inclusion of traditional healers in a palliative care team is a sensible move. It is, nevertheless, important to note that unanticipated challenges may arise with respect to power differentials within the palliative care team and to beliefs that contradict medical prognosis.

Background: It was the aim of the current research to investigate perceived service quality rendered by traditional medical practitioners and the role of socio-psychological factors in the perception., Methods: The first part, a quantitative cross-sectional survey utilized a 93-item questionnaire to examine the influence of quality of life, general health perception, socio-economic status and personality factors on perceived service quality. The second part, a qualitative study utilized 5 FGDs and 2 KIIs to explore consumers' evaluation of perceived service quality. Five research questions were raised. The 336 purposively-selected participants were attendees of traditional-health clinics/centers in Ibadan with a mean age of x(-)=30.60±9.97., Findings: The FGD respondents opined that the scope of orthodox-medicine does not cover certain illnesses. 77.8% of the participants attested to the affordability and promptness of services in traditional hospitals; acknowledging that its perceived efficacy (i.e. 56.8%) motivate patronage of traditional-health service. The 2x2x3 ANOVA revealed significant main effect of quality of life (F[1,270]=41.05, p<.001) and socio-economic status (F[2,270]=36.34; p<.001); as well as interaction effect of quality of life, general health and socio-economic status (F[1,270]=9.624, p<.002); while the regression analysis showed independent influence of extraversion (B= 0.31; p<.001), agreeableness (B=0.303; p<.001) and openness to experience (B=0.166; p<.01)., Conclusion: This sample acknowledged that traditional health care met quality standards. The role of socio-psychological factors in the quality appraisal was established. The need for better regulation and validation of traditional health care in assuring evidence based care was suggested.

A review of the international medical literature was undertaken on the role of spirituality in the discipline of psychiatry, within the context that a perceived change is taking place in the health care environment in South Africa. Revitalized interest in spirituality was evident from the literature partly because Western societies have, through the migration of people, become more heterogeneous in recent years. The literature concurred that spirituality must be incorporated into the current approach to the practice and training of psychiatry, but within the professional scope of the discipline, while all faith traditions and belief systems should be regarded equally. Beyond South Africa, it is envisaged that the review has implications for the practice of psychiatry in Africa.

Background: While there are biomedical drugs for managing diabetes mellitus, some patients with diabetes use traditional medicine. The aim of the study was to explore why patients with diabetes use traditional medicine for the treatment of diabetes., Methods: The study was conducted in Iganga and Bugiri districts in Eastern Uganda using four focus group discussions (FGDs) with patients with diabetes; two with female patients and two with male patients, thirteen key informant interviews (KIIs); nine with health workers working with patients with diabetes and four with herbalists. FGDs and KIIs focused on what respondents perceived as reasons for patients with diabetes taking traditional medicine. Analysis was done using content analysis., Results: Reasons for taking traditional medicine included finding difficulties accessing hospitals, diabetic drugs being out of stock, traditional medicine being acceptable and available within community, as well as being supplied in big quantities. Others were traditional medicine being cheaper than biomedical treatment and payment for it being done in installments. Traditional medicine was also more convenient to take and was marketed aggressively by the herbalists. Influence of family and friends as well as traditional healers contributed to use of traditional medicine., Conclusions: Possibilities of putting diabetic drugs at facilities closer to patients need to be considered and health facilities should have a constant supply of diabetic drugs. Community members need to be sensitized on the proper treatment for diabetes mellitus and on the dangers of taking traditional medicine.

Background: Acceptability is a poorly conceptualized dimension of access to health care. Using a study on childhood convulsion in rural Tanzania, we examined social acceptability from a user perspective. The study design is based on the premise that a match between health providers' and clients' understanding of disease is an important dimension of social acceptability, especially in trans-cultural communication, for example if childhood convulsions are not linked with malaria and local treatment practices are mostly preferred. The study was linked to health interventions with the objective of bridging the gap between local and biomedical understanding of convulsions., Methods: The study combined classical ethnography with the cultural epidemiology approach using EMIC (Explanatory Model Interview Catalogue) tool. EMIC interviews were conducted in a 2007/08 convulsion study (n = 88) and results were compared with those of an earlier 2004/06 convulsion study (n = 135). Earlier studies on convulsion in the area were also examined to explore longer-term changes in treatment practices., Results: The match between local and biomedical understanding of convulsions was already high in the 2004/06 study. Specific improvements were noted in form of (1) 46% point increase among those who reported use of mosquito nets to prevent convulsion (2) 13% point decrease among caregivers who associated convulsion with 'evil eye and sorcery', 3) 14% point increase in prompt use of health facility and 4)16% point decrease among those who did not use health facility at all. Such changes can be partly attributed to interventions which explicitly aimed at increasing the match between local and biomedical understanding of malaria. Caregivers, mostly mothers, did not seek advice on where to take an ill child. This indicates that treatment at health facility has become socially acceptable for severe febrile with convulsion., Conclusion: As an important dimension of access to health care 'social acceptability' seems relevant in studying illnesses that are perceived not to belong to the biomedical field, specifically in trans-cultural societies. Understanding the match between local and biomedical understanding of disease is fundamental to ensure acceptability of health care services, successful control and management of health problems. Our study noted some positive changes in community knowledge and management of convulsion episodes, changes which might be accredited to extensive health education campaigns in the study area. On the other hand it is difficult to make inference out of the findings as a result of small sample size involved. In return, it is clear that well ingrained traditional beliefs can be modified with communication campaigns, provided that this change resonates with the beneficiaries.

Traditional healers are the first to be called for help when illness strikes the majority of South Africans. Their communities have faith in their ability to cure or alleviate conditions managed by doctors, and much more. A visit to such practitioners' websites (they are up with the latest advertising technology!) shows that they promise help with providing more power, love, security or money, protection from evil people and spirits, enhancing one's sex life with penis enlargement and vagina tightening spells, etc. Contemplating such claims, it is easy to be dismissive of traditional healers. But in this issue of the SAMJ Nompumelelo Mbatha and colleagues1 argue that the traditional healers' regulatory council, promised by an Act of Parliament, should be established, followed by (or preferably preceded by) formal recognition by employers of sick certificates issued by traditional healers. Can matters be so simply resolved? What does this mean for doctors and other formally recognised healthcare professionals, and how to respond to such claims and social pressures?

In treating illness and suffering, the Akan anti-witchcraft shrine is often presented as a model of unchanging, tightly bounded and antiquated ideals. This fails to acknowledge the extensive repertoire of Ghanaian witchcraft discourses and contemporary divinatory practices uncovered at Akan anti-witchcraft shrines. This paper analyses how one of the most popular Akan anti-witchcraft shrine in Europe, in an eastern banlieue of Paris, diagnoses the seemingly common and innocuous coughs and colds suffered by recently arrived, unskilled female Ghanaian migrants as something more socially and economically malignant, witchcraft. Successful treatment combines divinatory techniques, paracetamol medicines and positive thinking in order to empower clients and present them with the possibility of new social and gainful employment prospects.

Traditional medicine is believed to constitute a crucial healthcare option for poor or remote households in developing countries that have limited access to allopathic medicine and/or a strong cultural attachment to traditional medicine. However, little research has been performed on medicinal plant reliance in developing countries, and the determinants of medicinal plant consumption at the household level in these countries have not been empirically studied. Quantifying the use of traditional medicine at the household level is, therefore, essential to the development of sustainable healthcare policies in the developing world. This paper quantifies household-level use of traditional medicine and identifies determinants of the choice of traditional treatment in the south central region of Burkina Faso. Structured household interviews (n = 205) were conducted in nine villages of rural Burkina Faso from November 2007 to November 2008 and in November 2009 to collect data on household characteristics (e.g., income, education, demographics), illness frequencies, illness types, and treatment strategies employed. Comprehensive analysis of treatment choice was performed through bivariate analyses. Results indicate that traditional medicine was primarily relied on by middle-aged individuals from relatively uneducated households who were living in villages with limited allopathic medicine service provision. Moreover, a differential approach to medicinal plant consumption was used to distinguish between patients using traditional medicine as a self-care treatment and those visiting a traditional healer. Although poorer households were shown to use traditional medicine as a self-treatment, traditional healers' services were relied on by wealthier households., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The paper describes, for the Hausa farmers of Gidan Jatau in northern Nigeria, the distinct ways in which they see and understand (a) their close and distant environment and (b) their bodies' anatomy and physiology. These ways result in 'another geography' - of both space and being - which, however, may no longer now have the resonance it had in the early 1970s when the author lived in Gidan Jatau for two years as a guest. At that time, the spiritual dimensions of daily life were deemed important to the health and prosperity of each person and to the farmstead as a whole. The argument is made that the urban-centred literature on the bori possession-cult neglects the ordinary, anonymous spirits of house and field. Any serious archaeology of the landscape will need insights into this 'alternative geography' if it is truly to 'read' a lost countryside from the traces left by its religious past; the paper also explains why some traces, such as shrines, may not be where they are expected to be.

This study investigated the extent to which recourse to traditional healers depended on biometric variables; ways of knowing in good time what ailments were more likely to be better handled by traditional healers; rationale behind traditional healing methodologies. On the whole, four research questions were engaged. The sample for the study included residents in urban (Benin City) and rural (Ehime Mbano) communities in Nigeria. The instruments comprised of two questionnaires. The traditional healers were also interviewed in addition. The findings of the research included the following: in both rural and urban areas, women and more elderly persons had more recourse than other groups to traditional medicine; Christians, less educated persons, self-employed persons and women affirmed most strongly to the efficacy of traditional medicine over Western medicine with respect to certain ailments; ways for averting spiritual illnesses included obeying instructions from ancestors and offering regular sacrifices to the gods; methods used by traditional healers to determine whether an ailment was "spiritual" or as a result of home problems included diagnosis linked to divination, interpretation of dreams particularly those involving visits by ancestors, interpretation of nightmares and omens such as the appearance of owls; methods for curing patients included use of herbs particularly those believed to have magical powers, offering of sacrifices, use of incantations and wearing of protective medicine.

This study aimed at ascertaining the connection between disease aetiology of the autochthonous psychiatric health system and the current mental health-seeking behaviors of the Nsukka people. Structured participant observation was the principal method of collecting data. In-depth interview sessions were also held with elders in the communities. It was found that although there has been social contact and change among the Nsukka, the personalistic elements in the aetiology of their traditional psychiatric system still largely determined their mental health-seeking behaviors. Thus, they were found to be more at home with traditional healers and syncretic churches than orthodox mental healthcare. To be successful, any mental healthcare program in Nsukka ought to consider how orthodox mental health practitioners, traditional healers, and those who run prayer houses could be incorporated in a comprehensive community mental healthcare program.

Drawing on data collected from 3 focus groups with 24 traditional healers, the aim of this qualitative study was to use the constructs of the Theory of Planned Behaviour (TPB) to gain an understanding of traditional healer referral practices of their patients with a mental illness. Results indicated that traditional healers possess a concept of mental illness, mainly referring to a patient behaving abnormally. They often report regularly treating patients with these behaviours. Traditional healer referral to Western care is considered a temporary measure or a last resort. A majority of healers feel that allopathic physicians do not treat them with the respect that they feel their contribution to the health of the community warrants. Recommendations include the need for traditional healers to be trained to identify potential cases of mental illness in their communities and for dialogue between traditional and allopathic physicians in regard to mental health care.

Objective: To compare traditional healers (TH) and Cameroonian representatives of Western medicine (Western providers (WP)) in terms of patient characteristics and communication patterns during the consultation in rural Cameroon., Methods: A facility-based comparative study was conducted. Seven TH were compared to eight WP in the same district. Patients (five per provider) provided detailed socio-demographic data. Recorded consultations were analysed with the Roter Interaction Analysis System (RIAS)., Results: Patients were similar in socio-demographic characteristics except for age, where TH patients were on average 9 years younger (P < 0.05). Patients of TH travelled 2.5 times as far to their provider as did patients in the WP group (79 vs. 31 km; P < 0.05) and paid 12 times more for their treatment (123 vs. 10 Euros; P < 0.05). Consultations of TH were shorter (5.6 vs. 10.3 min, P < 0.01), had fewer utterances (100 vs. 166, P < 0.05) and the patient's share in the communication was smaller (P < 0.01). TH had a higher percentage of lifestyle and psychosocial information at the expense of medical information (P < 0.05) and communicated more emotionally (P < 0.001). They asked more frequently for their patients' opinion (P < 0.01) and explicitly discussed their patients' concept of illness (P < 0.001). Patients of TH responded with a higher percentage of active communication (P < 0.05) i.e. question asking (P < 0.01)., Conclusions: Our data contradict the idea that the lack of money or geographical access to Western health care in rural Africa is the main reason for people to consult traditional healers. Compared to WP, TH interacted very differently with their clients, using a more patient-centred communication style, to seek common ground with patients. This different type of interaction could be a relevant factor contributing to the popularity of traditional healers in Cameroon., (© 2010 Blackwell Publishing Ltd.)

Objective: In many traditional belief systems in Africa, including South Africa, mental health problems may be attributed to the influence of ancestors or to bewitchment. Traditional healers are viewed as having the expertise to address these causes. However, there is limited information on their explanatory models and consequent treatment practices. The present study examines traditional healers' explanatory models (EMs) and treatment practices for psychotic and non-psychotic mental illnesses., Method: 4 focus group discussions (8 healers in each group) and 18 in-depth interviews were conducted. Four vignettes were presented (schizophrenia, depression, panic and somatisation) and traditional healers' views on the nature of the problem, cause, consequence, treatment and patient expectations were elicited., Results: Traditional healers held multiple explanatory models for psychotic and non-psychotic disorders. Psychotic illnesses appear to be the main exemplar of mental illness and were treated with traditional medicine, while nonpsychotic illnesses were not viewed as a mental illness at all. Additionally, traditional healers do not only use herbs and substances solely from "traditional" sources but rather have incorporated into their treatment practices modern ingredients that are potentially toxic., Conclusion: Interventions aimed at increasing the mental health literacy of traditional healers are essential. In addition, investigations of the effectiveness of traditional healer treatment for psychiatric disorders should be conducted.

Background: The role of religious beliefs in the prevention of HIV and attitudes towards the infected has received considerable attention. However, little research has been conducted on Faith Leaders' (FLs) perceptions of antiretroviral therapy (ART) in the developing world. This study investigated FLs' attitudes towards different HIV treatment options (traditional, medical and spiritual) available in a rural Tanzanian ward., Methods: Qualitative interviews were conducted with 25 FLs purposively selected to account for all the denominations present in the area. Data was organised into themes using the software package NVIVO-7. The field work guidelines were tailored as new topics emerged and additional codes progressively added to the coding frame., Results: Traditional healers (THs) and FLs were often reported as antagonists but duality prevailed and many FLs simultaneously believed in traditional healing. Inter-denomination mobility was high and guided by pragmatism.Praying for the sick was a common practice and over one third of respondents said that prayer could cure HIV. Being HIV-positive was often seen as "a punishment from God" and a consequence of sin. As sinning could result from "the work of Satan", forgiveness was possible, and a "reconciliation with God" deemed as essential for a favourable remission of the disease. Several FLs believed that "evil spirits" inflicted through witchcraft could cause the disease and claimed that they could cast "demons" away.While prayers could potentially cure HIV "completely", ART use was generally not discouraged because God had "only a part to play". The perceived potential superiority of spiritual options could however lead some users to interrupt treatment., Conclusions: The roll-out of ART is taking place in a context in which the new drugs are competing with a diversity of existing options. As long as the complementarities of prayers and ART are not clearly and explicitly stated by FLs, spiritual options may be interpreted as a superior alternative and contribute to hampering adherence to ART. In contexts where ambivalent attitudes towards the new drugs prevail, enhancing FLs understanding of ART's strengths and pitfalls is an essential step to engage them as active partners in ART scale-up programs.

Agrarian rural dwellers in Nigeria produce about 95% of locally grown food commodities. The low accessibility to and affordability of orthodox medicine by rural dwellers and their need to keep healthy to be economically productive, have led to their dependence on traditional medicine. This paper posits an increasing acceptance of traditional medicine country-wide and advanced reasons for this trend. The fact that traditional medicine practitioners' concept of disease is on a wider plane vis-à-vis orthodox medicine practitioners' has culminated in some socio-cultural and magico-religious practices observed in preparation and use of plant medicines for farmers' health management. Possible scientific reasons were advanced for some of these practices to show the nexus between traditional medicine and orthodox medicine. The paper concludes that the psychological aspect of traditional medicine are reflected in its socio-cultural and magico-religious practices and suggests that government should fund research into traditional medicine to identify components of it that can be integrated into the national health system.

Objective: The purpose of this study was to gain an understanding of the approach of traditional healers to epilepsy care, in order to develop a community-based epilepsy care program in Batibo Health District., Methods: With an 18-item questionnaire, interviews were carried out with 102 traditional healers randomly selected from two associations of traditional healers in the Batibo Health District., Results: Most traditional healers had heard about epilepsy (98.0%), knew someone with epilepsy (97.8%), or had witnessed a seizure (92.2%). About 40% would object to their children associating with people with epilepsy (PWE), 46.1% would object to their children marrying PWE, and 51% linked the disease to insanity. Though 61.8% of the traditional healers could not offer any treatment for epilepsy, most of them thought it was treatable (74.5%) and would readily refer a patient to the hospital (95.1%). The independent predictors of attitudes were: middle age (30-49 years), P=0.00003; female gender, P=0.007; correct knowledge of the cause(s) of epilepsy, P=0.001; and the misconceptions that epilepsy is contagious and that epilepsy is a form of insanity, P=0.003 and 0.019, respectively., Conclusion: Traditional healers constituted the focus group studied so far in Cameroon that is most familiar with epilepsy. Although they still have some negative practices, the attitudes of traditional healers toward PWE in Batibo Health District are satisfactory, compared with those of the general public and students in the same community. These findings provide evidence for the first time in Cameroon suggesting that collaboration between the modern and traditional health systems with the view of bridging the epilepsy treatment gap is possible. There is a need to train traditional healers in epilepsy care in our context., (2009 Elsevier Inc. All rights reserved.)

Limited research has been conducted to explore the factors that support or obstruct collaboration between traditional healers and public sector mental health services. The first aim of this study was to explore the reasons underpinning the widespread appeal of traditional/faith healers in Ghana. This formed a backdrop for the second objective, to identify what barriers or enabling factors may exist for forming bi-sectoral partnerships. Eighty-one semi-structured interviews and seven focus group discussions were conducted with 120 key stakeholders drawn from five of the ten regions in Ghana. The results were analysed through a framework approach. Respondents indicated many reasons for the appeal of traditional and faith healers, including cultural perceptions of mental disorders, the psychosocial support afforded by such healers, as well as their availability, accessibility and affordability. A number of barriers hindering collaboration, including human rights and safety concerns, scepticism around the effectiveness of 'conventional' treatments, and traditional healer solidarity were identified. Mutual respect and bi-directional conversations surfaced as the key ingredients for successful partnerships. Collaboration is not as easy as commonly assumed, given paradigmatic disjunctures and widespread scepticism between different treatment modalities. Promoting greater understanding, rather than maintaining indifferent distances may lead to more successful co-operation in future.

The research study done at the Kanye village of Botswana was qualitative in design and exploratory in nature. While the broad goal aimed at assessing the contributions of caregivers in the Kanye CHBC programme, this article aims at evaluating the traditional Healers' contribution as providers of care to HIV/AIDS patients and other chronically ill persons. The study conveniently involved all the 140 registered caregivers in the Kanye programme, but with only 82 caregivers turning up for focus group discussions. The caregivers were grouped in 10 focus group discussions, and all of the 5 CHBC nurses were subjected to one-on-one interviews. Both the focus group discussions and one-on-one interviews with the nurses used two slightly different interview schedules as data collection instruments. The study findings revealed that traditional healers are important players in caregiving of persons with various ailments but their role, position and contribution in the battle against HIV/AIDS is fast waning with time. The government has been challenged to map out strategies of collaboration between the two systems as traditional healers can complement the services of biomedical practitioners in this era of HIV/AIDS.

HIV/AIDS has had a devastating impact at individual, household and community levels. This qualitative research investigates the role of HIV voluntary counselling and testing (VCT) and treatment in enabling HIV-positive Ugandans to cope with this disease. Twelve predetermined focus group discussions (FGDs) were conducted; six with men and six with women. Half of the men and women's groups were receiving antiretroviral therapy (ART) and half were not. An FGD was held with the health care providers administering ART. Testing for HIV was perceived as soliciting a death warrant. Participants affirmed that the incentive for testing was the possibility of accessing free ART. They described experiencing gender-variant stigma and depression on confirming their HIV status and commended the role of counselling in supporting them to adopt positive living. For those receiving ART, counselling reinforced treatment adherence. The findings also revealed gender differences in treatment adherence strategies. ART was described to reduce disease symptoms and restore physical health allowing them to resume their daily activities. Additionally, ART was preferred over traditional herbal treatment because it had clear dosages, expiry dates and was scientifically manufactured. Those that were not receiving ART bore myths and misconceptions about the effectiveness and side effects of ART, delaying the decision to seek treatment. Stigma and the attached concern of HIV/AIDS-related swift death, is a major barrier for VCT. Based on this study's findings, ensuring the provision of quality assured and gender conscious VCT and ART delivery services will enhance positive living and enforce compliance to ART programmes.