Traditional healers, faith healers and medical practitioners: the contribution of medical pluralism to bottlenecks along the cascade of care for HIV/AIDS in Eastern and Southern Africa

Moshabela, Mosa; Bukenya, Dominic; Darong, Gabriel; Wamoyi, Joyce; McLean, Estelle; Skovdal, Morten; Ddaaki, William; Ondenge, Kenneth; Bonnington, Oliver; Seeley, Janet; Hosegood, Victoria; Wringe, Alison

doi:10.1136/sextrans-2016-052974

Cited by 74 publications

(89 citation statements)

References 27 publications

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“…22,14,60 Various participants described healthcare providers as disapproving and rude and they also felt mistreated by them. A study by Govender et al 14 In South Africa, attention has recently focused on the concept of medical pluralism 70 which occurs when individuals utilise more than one medical system when seeking healthcare. 70 Such healthcare systems include traditional and faith-based systems.…”

Section: Discussionmentioning

confidence: 99%

“…A study by Govender et al 14 In South Africa, attention has recently focused on the concept of medical pluralism 70 which occurs when individuals utilise more than one medical system when seeking healthcare. 70 Such healthcare systems include traditional and faith-based systems. It was evident in this study that many participants had been consulting traditional healers and using or contemplated using traditional medication.…”

Section: Discussionmentioning

confidence: 99%

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“I have to provide for another life emotionally, physically and financially”: Understanding pregnancy, motherhood and the future aspirations of adolescent mothers in KwaZulu-Natal, South Africa

Govender¹,

Naidoo²,

Taylor³

2019

Preprint

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Background Adolescent pregnancy and adolescent parenting have been controversial and much disputed subjects in the field of public health. There are increasing concerns that the psychosocial challenges that adolescent mothers face may remain in the background because research in this field has mainly focused on the medical complications of early childbearing. Aim The aim of this qualitative study was to explore adolescent pregnancy and motherhood in order to understand this phenomenon from the perspective of adolescent mothers and to gain insight into their future aspirations. Methods This descriptive qualitative study utilised data that were generated from focus group discussions with adolescent mothers who utilised healthcare services at a hospital in the Ugu district in KwaZulu-Natal, South Africa. The data were analysed using thematic analysis. Results Adolescent mothers reported a range of positive and negative experiences. Some adolescent mothers’ partners were in denial and rejected them and the child, while others’ partners were happy and supported them during their pregnancy. Families’ reactions to the pregnancies ranged between anger and disappointment to abandonment, the “silent treatment”, and acceptance and forgiveness. The psychological issues experienced by some of the adolescent mothers included suicidal ideation, guilt, loneliness, anxiety, and stress. They also experienced financial constraints, difficulty in returning to school, and stigmatisation by society. The participants envisioned completing their education, focusing on their dream careers, and contributing positively to society. Conclusion Experiences of adolescent pregnancy and parenting are multifaceted and the healthcare needs of pregnant and parenting adolescents extend beyond information and knowledge. A multidisciplinary approach is required in the care of adolescent mothers. A key policy priority should encompass the collaboration of different professionals from various healthcare sectors to assist adolescent mothers in achieving better health and psychosocial and socio-economic outcomes as steps to securing a better future for themselves and their children.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“I have to provide for another life emotionally, physically and financially”: Understanding pregnancy, motherhood and the future aspirations of adolescent mothers in KwaZulu-Natal, South Africa

Govender¹,

Naidoo²,

Taylor³

2019

Preprint

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“…They "provide health care by using plant, animal and mineral substances, and other methods based on social, cultural, and religious practices" [12]. Prior work in medically pluralistic contexts shows that initial choice of therapeutic modality is driven by patients' perceived etiology of illness, and provider trustworthiness [13][14][15][16]. Patients may switch modalities in the setting of treatment "failure", when symptoms worsen or persist despite treatment [13,17].…”

Section: Introductionmentioning

confidence: 99%

“…Medical pluralism has been characterized as a central factor contributing to poor health outcomes. For example, researchers have shown that use of traditional medicine delays HIV testing and ART initiation [18], and interrupts HIV treatment [13], for people living with HIV (PLHIV) . In Mozambique, PLHIV initially seeking care from traditional healers experienced significantly longer delays to diagnosis compared with those who did not utilize healers; this delay exponentially increased with corresponding increases in the number of healers consulted prior to receiving HIV testing [18].…”

Section: Introductionmentioning

confidence: 99%

A conceptual model for pluralistic healthcare behavior: results from a qualitative study in southwestern Uganda

Sundararajan

Mwanga-Amumpaire

King

et al. 2019

Preprint

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Introduction: Medical pluralism, or concurrent utilization of multiple therapeutic modalities, is common in various international contexts, and has been characterized 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. It is not well understood why patients in pluralistic settings continue to engage with both therapeutic healthcare modalities, rather than simply selecting one or the other. The goal of this study was to identify factors that motivate pluralistic healthcare utilization, and create a general, conceptual framework of pluralistic health behavior. Methods: In-depth interviews were conducted between September 2017 and 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-utilizing communities. Inclusion criteria included age 18 years or older, and ability to provide informed consent. Participants were recruited from healer practices representing the range of healer specialties. Following an inductive approach, interview transcripts were reviewed and coded to identify conceptual categories explaining healthcare utilization. Results: We identified three broad categories relevant to healthcare utilization among study participants: 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 recognizing traditional healers as important stakeholders in community health.

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“…Over the last 15 years, there has been a steady flow of peer reviewed reports relating to the unintended health-related consequences associated with medical pluralism in eastern and southern Africa. In the context of HIV, medical pluralism is primarily associated with delays in testing and treatment interruption (for one of many examples, see Moshabela et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Re-Contextualizing Medical Pluralism in South Africa: a Research Schema for Indigenous Decision Making

Burman

2018

Syst Pract Action Res

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The purpose of this article is to explain the rationale and development of a research schema that focuses on reducing the unintended consequences of medical pluralism in the context of communicable and non-communicable diseases in eastern and southern Africa. The research schema represents a contribution to the field of action-oriented research relating to the unintended consequences associated with medical pluralism that will be piloted in South Africa. The principle consequences of the unintended consequences of medically pluralism are delays in testing and treatment interruption. The research schema is framed through a resilience lens because the unintended consequences of medical pluralism bear the hallmarks of a complex 'wicked problem'. The resilience perspective will use grassroots agency as the initial referential axis of enquiry. From this start point, broader systemic influences will be contextualized from a realist perspective using the 'AART' model of enquiry as a guiding heuristic ('abduction, abstraction, retroduction and testing'). The 'abductive' component of the 'AART' model will facilitate a re-interrogation of broader systemic influences that sustain contemporary forms of medical pluralism as a precursor to the action-oriented phases. The methodological approach will include the application of proprietary software called SenseMaker® which was designed to enable research into complex anthropogenic phenomena. Analytically the re-interrogation aims to 'empower indigenous decision making alongside scientific data' as a mechanism to develop novel social practices that can reduce the unintended consequences associated with medical pluralism. The forthcoming pilot will ultimately be the judge of this theoretical contribution.

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Traditional healers, faith healers and medical practitioners: the contribution of medical pluralism to bottlenecks along the cascade of care for HIV/AIDS in Eastern and Southern Africa

Cited by 74 publications

References 27 publications

“I have to provide for another life emotionally, physically and financially”: Understanding pregnancy, motherhood and the future aspirations of adolescent mothers in KwaZulu-Natal, South Africa

“I have to provide for another life emotionally, physically and financially”: Understanding pregnancy, motherhood and the future aspirations of adolescent mothers in KwaZulu-Natal, South Africa

A conceptual model for pluralistic healthcare behavior: results from a qualitative study in southwestern Uganda

Re-Contextualizing Medical Pluralism in South Africa: a Research Schema for Indigenous Decision Making

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