Participation of traditional, complementary and alternative health practitioners in conventional health systems in low- and middle-income countries

Street, Renée; Falkenberg, Torkel; Sundberg, Tobias; Balakrishna, Yusentha; Abrams, Amber; Kredo, Tamara

doi:10.1002/14651858.cd013391

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…Indeed, traditional medicine use is prevalent in LMICs as well as in HICs, with 80% of people in the world utilizing traditional medicine ( 91 ). However, health-seeking behaviors regarding traditional medicine use differ between HICs and LMICs ( 92 , 93 ). In HICs, traditional medicines are utilized as a supplemental therapy to conventional medicine, whereas in LMICs, traditional medicines are often the primary treatment ( 94 ).…”

Section: Discussionmentioning

confidence: 99%

Self-reported medication adherence instruments and their applicability in low-middle income countries: a scoping review

Khoiry

Alfian

Boven

et al. 2023

Front. Public Health

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IntroductionMedication non-adherence is an important public health issue, associated with poor clinical and economic outcomes. Globally, self-reported instruments are the most widely used method to assess medication adherence. However, the majority of these were developed in high-income countries (HICs) with a well-established health care system. Their applicability in low- and middle-income countries (LMICs) remains unclear. The objective of this study is to systematically review the applicability of content and use of self-reported adherence instruments in LMICs.MethodA scoping review informed by a literature search in Pubmed, EBSCO, and Cochrane databases was conducted to identify studies assessing medication adherence using self-reported instruments for patients with five common chronic diseases [hypertension, diabetes, dyslipidemia, asthma, or Chronic Obstructive Pulmonary Disease (COPD)] in LMICs up to January 2022 with no constraints on publication year. Two reviewers performed the study selection process, data extraction and outcomes assessment independently. Outcomes focused on LMIC applicability of the self-reported adherence instruments assessed by (i) containing LMIC relevant adherence content; (ii) methodological quality and (iii) fees for use.FindingsWe identified 181 studies that used self-reported instruments for assessing medication adherence in LMICs. A total of 32 distinct types of self-reported instruments to assess medication adherence were identified. Of these, 14 self-reported instruments were developed in LMICs, while the remaining ones were adapted from self-reported instruments originally developed in HICs. All self-reported adherence instruments in studies included presented diverse potential challenges regarding their applicability in LMICs, included an underrepresentation of LMIC relevant non-adherence reasons, such as financial issues, use of traditional medicines, religious beliefs, lack of communication with healthcare provider, running out of medicine, and access to care. Almost half of included studies showed that the existing self-reported adherence instruments lack sufficient evidence regarding cross cultural validation and internal consistency. In 70% of the studies, fees applied for using the self-reported instruments in LMICs.ConclusionThere seems insufficient emphasis on applicability and methodological rigor of self-reported medication adherence instruments used in LMICs. This presents an opportunity for developing a self-reported adherence instrument that is suitable to health systems and resources in LMICs.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022302215.

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Section: Discussionmentioning

confidence: 99%

Self-reported medication adherence instruments and their applicability in low-middle income countries: a scoping review

Khoiry

Alfian

Boven

et al. 2023

Front. Public Health

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“…The use of traditional medicine has continued across the world, and the World Health Organisation (WHO) estimates that 80% of the world's population uses traditional medicine [9]. The use of traditional medicine has become inseparable from some nation's public health systems [10] and while the success of ancient remedies may have relied on trial and error, the inclusion of natural products in modern medicine has been validated by extensive scientific research and empirical data. The use of natural products in modern medicine continues with 64% of all drugs originating from a diverse range of natural sources or their derivatives [11,12].…”

Section: Introductionmentioning

confidence: 99%

Galleria mellonella as a Novel In Vivo Model to Screen Natural Product-Derived Modulators of Innate Immunity

Wright

Kavanagh

2022

Applied Sciences

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Immunomodulators are drugs that either stimulate or suppress the immune system in response to an immunopathological disease or cancer. The majority of clinically approved immunomodulators are either chemically synthesised (e.g., dexamethasone) or protein-based (e.g., monoclonal antibodies), whose uses are limited due to toxicity issues, poor bioavailability, or prohibitive cost. Nature is an excellent source of novel compounds, as it is estimated that almost half of all licenced medicines are derived from nature or inspired by natural product (NP) structures. The clinical success of the fungal-derived immunosuppressant cyclosporin A demonstrates the potential of natural products as immunomodulators. Conventionally, the screening of NP molecules for immunomodulation is performed in small animal models; however, there is a growing impetus to replace animal models with more ethical alternatives. One novel approach is the use of Galleria melonella larvae as an in vivo model of immunity. Despite lacking adaptive antigen-specific immunity, this insect possesses an innate immune system comparable to mammals. In this review, we will describe studies that have used this alternative in vivo model to assess the immunomodulating activity of synthetic and NP-derived compounds, outline the array of bioassays employed, and suggest strategies to enhance the use of this model in future research.

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Systematic review of lay consultation in symptoms and illness experiences in informal urban settlements of low-income and middle-income countries

et al. 2021

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ObjectivesLay consultation is the process of discussing a symptom or an illness with lay social network members. This can have positive or negative consequences on health-seeking behaviours. Understanding how consultation with lay social networks works in informal urban settlements of low-income and middle-income countries (LMICs) is important to enable health and policy-makers to maximise its potential to aid healthcare delivery and minimise its negative impacts. This study explored the composition, content and consequences of lay consultation in informal urban settlements of LMICs.DesignMixed-method systematic review.Data sourcesSix key public health and social science databases, Google Scholar and reference lists of included studies were searched for potential articles.Eligibility criteriaPapers that described discussions with lay informal social network members during symptoms or illness experiences.Data analysis and synthesisQuality assessment was done using the Mixed Methods Appraisal Tool. Data were analysed and synthesised using a stepwise thematic synthesis approach involving two steps: identifying themes within individual studies and synthesising themes across studies.Results13 studies were included in the synthesis. Across the studies, three main categories of networks consulted during illness: kin, non-kin associates and significant community groups. Of these, kin networks were the most commonly consulted. The content of lay consultations were: asking for suggestions, negotiating care-seeking decisions, seeking resources and non-disclosure due to personal or social reasons. Lay consultations positively and negatively impacted access to formal healthcare and adherence to medical advice.ConclusionLay consultation is mainly sought from social networks in immediate environments in informal urban settlements of LMICs. Policy-makers and practitioners need to utilise these networks as mediators of healthcare-seeking behaviours.PROSPERO registration numberCRD42020205196.

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Participation of traditional, complementary and alternative health practitioners in conventional health systems in low- and middle-income countries

Cited by 3 publications

References 19 publications

Self-reported medication adherence instruments and their applicability in low-middle income countries: a scoping review

Self-reported medication adherence instruments and their applicability in low-middle income countries: a scoping review

Galleria mellonella as a Novel In Vivo Model to Screen Natural Product-Derived Modulators of Innate Immunity

Systematic review of lay consultation in symptoms and illness experiences in informal urban settlements of low-income and middle-income countries

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