Help-seeking from traditional healers in patients with severe mental illness and its relationship with internalized stigma.

BACKGROUND: Help-seeking from traditional healers (TH) is common in patients with severe mental illness. However, the differences between patients with schizophrenia and bipolar disorder are not well-known. Although internalized stigma is also common in patients with severe mental illness, its impact on help-seeking from TH is not studied. AIM: To investigate help-seeking from TH and the relationship between help-seeking from TH and internalized stigma in patients with schizophrenia and bipolar disorder. METHODS: In this cross-sectional study, we collected information about help-seeking from TH and clinical characteristics by using a semi-structured interview form from 310 patients with schizophrenia and bipolar disorder in two sites with different socio-cultural backgrounds. We measured internalized stigma by using The Internalized Stigma of Mental Illness (ISMI) scale. RESULTS: We found that 47% of the patients visited TH in any phase of their illness, and 46% of them sought help from TH before their first contact with a psychiatrist. Those who grew up in rural areas, were less educated, who attempted suicide before, with resistance to treatment, and with a family member who also admitted to TH were more frequent among the help-seekers from TH. This group also had more hospitalizations and higher Clinical Global Impression scores. Internalized stigma was found to be higher in the schizophrenia group, and it was related to help-seeking from TH and delay in admission to psychiatric facilities. CONCLUSION: Our findings suggest that help-seeking from TH is common both in patients with schizophrenia and bipolar disorder, and it has socio-cultural, illness-related, and stigma-related predictors.

Mental health literacy and associated factors among traditional healers of Jimma town, southwest, Ethiopia 2020: a community based, cross-sectional study.

Background: Traditional healers are in the front line to give the mental healthcare service in developing countries like Ethiopia. In Ethiopia, different studies were done focusing on the role of traditional medicine and perception of the community toward traditional medicine. However, there is paucity of studies, which shows the level of mental health literacy among traditional healers. Therefore, this study intended to mental health literacy level of traditional healers in Jimma town, Ethiopia. Method: A community-based cross-sectional study design was employed among 310 participants. To select the participants from Jimma town, a stratified random sampling method was utilized from August 1 to September 30, 2020. The Mental Health Literacy Questionnaire was used to assess mental health literacy for assessment of mental health literacy among traditional healers. The collected data were coded and entered into EpiData version 4.6 and exported to SPSS version 25.0 for analysis. Bivariate and multivariable linear regression was used for data analysis. Result: The finding of this study showed that the samples of traditional healers found in Jimma town scored a total mean of 95.91 ± 3.0025 for mental health literacy. Age [ß = -0.052 (95% CI: -0.078, -0.026)], year of experience [ß = 0.095 (95% CI: 0.067, 0.123)], family history of mental illness [ß = 1.709 (95% CI: 0.543, 2.360)], history of professional help seeking on mental illness [ß = 0.501 (95% CI: 0.715, 2.288)], history of getting information of mental illness on media [ß = 0.941 (95% CI: 0.345, 1.538)], training on mental health [ß = 2.213 (995% CI: 1.520, 2.906)], history of treating mental illness [ß = 1.676 (95% CI: 0.808, 2.544)], and informal education [ß = -1.664 (95% CI: -2.081, -1.247)] were factors significantly associated with MHL. Conclusion: The mental health literacy of traditional healers mean score is lower than the mean score of other studies. Age, year of experience, training on mental illness, family history, history of professional help seeking, history of treating mental illness, information on mental illness, and informal education are significantly associated with mental health literacy. Therefore, structured training is very important to improve their level of mental health literacy.

Polycyclic aromatic hydrocarbon (PAH) accumulation in selected medicinal plants: a mini review.

The use of plant-based products in healthcare systems has experienced a tremendous rise leading to a substantial increase in global demand. However, the quality and effectiveness of such plant-based treatments are often affected due to contamination of various pollutants including polycyclic aromatic hydrocarbons (PAHs). Like other plants, medicinal plants also uptake and accumulate PAHs when exposed to a contaminated environment. The consumption of such medicinal plants and/or plant-based products causes negative effects on health rather than providing any therapeutic advantages. Unfortunately, research focusing on PAH accumulation in medicinal plants has received very limited attention. This review discusses a sizable number of literature regarding the concentration of sixteen priority PAH pollutants as recognised by the US Environmental Protection Agency (USEPA) in different medicinal plants. The review also highlights the risk assessment of cancer associated with some medicinal plants in terms of benzo[a]pyrene (BaP) equivalent concentrations.

Traditional eye medicine practice and its determinant factors among ophthalmic patients in the West Bank.

Background: Traditional eye medicine (TEM) is becoming more widely used across the world. Depending on the drugs used, TEM usage can be considered harmful or innocuous. The therapy may induce infection or irreparable blindness in the already injured eye.The aim of the study was to determine the proportion of traditional eye medicine practices and associated factors among adult ophthalmic patients attending ophthalmic clinics in the governmental hospitals in the West Bank. Design and methods: A cross-sectional study conducted on 300 patients. The data was collected using a structured, self-administered questionnaire. Results: The results of the study revealed that 65.7% of people use TEM. The most common symptoms that necessitated the use of traditional eye practice were inflammatory symptoms of the eye (49.2%), blurred vision (15.7%), and allergic conjunctivitis (10.7%). The most common TEM used was tea (34.0%), followed by herbal products (25.4%) and vegetable slices (potato, cucumber, and onion) (14.7%). The most traditional eye treatment was the topical route (92.9%). The majority of prescribers of traditional eye practice were traditional healers (48.7%). Furthermore, the current study found that occupation and the income were predictors of using traditional eye practice among ophthalmic patients attending ophthalmic clinics in selected West Bank hospitals. Conclusion: The proportion of traditional eye medicine practice was high among ophthalmic patients in the West Bank. The predictors of using traditional eye treatment were occupation and the income. The most common TEM used was tea, followed by herbal products and vegetable slices (potato, cucumber, and onion).

Ethnobotanical study of traditional medicinal plants in Kebridehar and Shekosh districts, Korahi zone, Somali Region, Ethiopia.

This study was conducted in Kebridehar and Shekosh districts, Ethiopia, to investigate an ethnobotanical study on traditional medicinal plants. Systematic random sampling techniques were used for data collection. Preference ranking, paired comparison, informant consensus factor, direct matrix ranking, and jaccard comparison were used for data analysis. A total of 44 medicinal plant species from 34 genera and 23 families have been documented as being used to treat 38 human, 5 livestock, and 1 both human and livestock ailment. The shrub category was the dominant growth form in the study area. The study showed that the most frequently used plant parts for the preparation of traditional medicine were roots (45.45 %), followed by leaves, glue, and liquid (11.36 % each). The most common route of administration was oral (30.77 %), followed by dermal (20.51 %). Jaccard's Coefficient of Similarity for Kebridehar and Shekosh for the reported traditional medicinal plants were 0.21, indicating some trend towards using common plants. Methanol extracts were more effective than ethanol extracts. The results of this study provide an insight into the anti-bacterial properties of the extracts of Aloe megalacantha, Ephorbiarobecchi, and Oppiliacampestris. This in vitro study demonstrated that these three folklore medicinal plants have good potential. In conclusion, the main threat to medicinal plants in the study area was drought. Therefore, it is recommended that the cultivation of medicinal plants be encouraged in home gardens.

Treatment-seeking behaviour among infertile tribal women of Palghar district in India.

Background: The tribal culture views health care practices differently from the mainstream. Infertile tribal women practice treatment-seeking behaviour that reflects the community's cultural access to and availability of treatment as well as customs to meet their health care needs. In the environment of rising awareness of infertility and numerous treatment options, this study aims to highlight the infertility treatment-seeking behaviour of tribal communities. Data and methods: The study employed a mix methods approach to collect data from 153 tribal couples suffering with infertility (interview schedule) and the community (in-depth interviews-14 and focus group discussions-12). The data was analyzed using Stata 13.0, and NVivo 10. Results of the quantitative data were triangulated with qualitative data for writing. Results: Many treatment options were available for infertility in the community. Generally, traditional healers (98.7%) were preferred over modern healthcare practitioners (35%). Community members usually guided infertile couples for choosing providers. Treatment practices were very different among primary infertile women than sub-fertile. Women frequently discontinued treatment and switched between providers because of unaffordability, poor connectivity, distance, travel time, time constraints, and non-supportive circumstances. The couples were advised to consume herbs, and eat or avoid certain food items, were given massage, burns on the abdomen (dagani), removed black blood (phasani) and other various rituals to appease spirits, get rid of ghosts while offering animal sacrifice, and conducting shidwa ritual. The mean expenditure on treatment was INR 18,374. If treatment did not yield any result, couple resorted to add another wife, divorce, accept childlessness and foster a child. Conclusion: Local authorities should strive to work towards the socio-economic development of the tribal communities and provide good healthcare services at their doorstep. The infertility problem needs to be understood in the context of poverty, tribal beliefs, and unequal access to healthcare resources.

Preferences for Health Care and Its Determinants Among Mentally Ill Patients of the West Shoa Zone Community, Oromia, Ethiopia.

Background: Over 9 million people die from mental diseases each year, making them the second highest cause of mortality and the primary cause of disability worldwide. Objective: To explore the preferences for health care and its determinants among mentally ill patients in the West Shoa Zone Community in Oromia, Ethiopia, from July 11-September 20, 2022. Methods: The preference for health care and its determinants among mentally ill patients in the West Shoa Zone community were explored using an ethnographical study. Purposefully, a total of 16 FGD participants and 10 unstructured interview subjects, who had pertinent experiences and perspectives, were carefully selected from the urban and district levels. Data was collected utilizing two approaches in a triangulated manner and then coded, findings were contextualized, and a thematic plot was developed for thematic analysis. Results: In this study, in response to the questions, three main findings were thematized according to the causes, and six sub-themes were framed under the themes according to the preferences for treatment among mentally ill patients. The themes that emerged from the data were; 1. Supernatural causes, 2. Traditional non-spiritual beliefs and practices; and 3. Medico-surgical problems. The majority of the participants responded that residents preferred religious spiritualists the most (46%), followed by traditional counselors (Wabeka) (19%), traditional spiritualists (15%), institutional care (12%), herbalists (4%), and psychologists (4%). Conclusions and Recommendations: In this study, the most commonly perceived causes of mental illnesses were bad spirits, devilish activity, and engaging in actions that violated social norms and regulations. Religious spiritualists were the study's first choice for mental health care. This study advises collaboration and a shared strategy between health care professionals and traditional and religious stakeholders.

A prospective study of snakebite in a tertiary care hospital in south-western Nepal.

BACKGROUND: Snakebite is a neglected public health issue in Nepal. We aimed to characterize patients with snake envenoming admitted to hospital in south-western Nepal. METHODS: This was a prospective cohort study of 476 snakebite patients admitted to Bheri Hospital from May to December 2017. Data were collected on patient demographics, bite circumstances, snake type, treatment-seeking behavior, clinical effects, complications and treatment. RESULTS: There were 139/476 (29%) patients with clinical features of envenomation and 10 deaths (8%), of which six were prehospital deaths; 325/476 (68%) patients used non-recommended prehospital first aid, including 278 (58%) who applied a tourniquet and 43 (9%) consulting traditional healers. Median time to hospital arrival was 1.5 (IQR: 0.8-4) h. Also, 127 envenomated patients (91%) developed neurotoxicity and 12 (9%) hemotoxicity, while 124 patients (89%) received antivenom, with a median dose of 10 (4-30) vials. Three patients developed anaphylaxis following antivenom administration; 111 of 139 (80%) cases were admitted to the ICU and 48 (35%) were intubated. Median length of hospital stay for all cases was 0.5 (IQR: 0.5-1.2) d, but it was 2.2 (IQR: 1.5-3.8) d for envenomated cases. CONCLUSIONS: The majority of snakebite patients used non-recommended first aid or attended traditional healers. Almost one-third of patients developed systemic envenomation and required antivenom. The case fatality rate was high, but many died prior to arriving in hospital.

Treatment-seeking behavior and barriers to mental health service utilization for depressive symptoms and hazardous drinking: The role of religious and traditional healers in mental healthcare of Northwest Ethiopia.

Understanding mental healthcare seeking and associated factors is essential for planning mental health services. This study aimed to assess treatment seeking and barriers to care for depressive symptoms and hazardous drinking in a community sample of Northwest Ethiopia. A cross-sectional study was conducted to screen 1,728 participants for depressive symptoms (n = 414) and hazardous drinking (n = 155). Participants were asked whether they had sought mental healthcare. We also assessed the barriers to seeking mental healthcare. Logistic regression was used to identify associated factors. Among people with depressive symptoms, 14.3%, 15.5%, and 19.6% sought treatment from healthcare settings, non-healthcare settings, or any sources, respectively. Religious places (39.5%) were the most helpful treatment sources. People with low levels of internalized stigma (adj OR = 3.00 [1.41, 6.42]) and positive attitudes towards mental illness (adj OR = 2.84 [1.33, 6.07]) were nearly threefold more likely to seek depression treatment. No participants with hazardous drinking sought treatment from healthcare settings, and only 1.3% had sought help from families/friends. Over 97% of participants with depressive symptoms and hazardous drinking reported at least one barrier to treatment-seeking from a healthcare setting. Religious and traditional healers were as important as healthcare settings for treatment-seeking.

Rare causes of genital fistula in nine African countries: a retrospective review.

BACKGROUND: Most genital fistulas result from prolonged, obstructed labor or surgical complications. Other causes include trauma (from accidents, traditional healers, or sexual violence), radiation, carcinoma, infection, unsafe abortion, and congenital malformation. METHODS: This retrospective records review focuses on rare fistula causes among 6,787 women who developed fistula after 1980 and sought treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Zambia, Rwanda, Ethiopia, Somalia, and South Sudan. We compare fistula etiologies across countries and assess associations between rare causes and type of incontinence (urine, feces, or both). RESULTS: Rare fistula accounted for 1.12% (76/6,787) of all fistulas, including traumatic accidents (19/6,787, 0.28%), traumatic sexual violence (15/6,787, 0.22%), traumatic injuries caused by traditional healers (13/6,787, 0.19%), unsafe abortion (10/6,791, 0.15%), radiation (8/6,787, 0.12%), complications of HIV infection (6/6,787, 0.09%), and congenital abnormality (5/6,787, 0.07%). Trauma caused by traditional healers was a particular problem among Somali women. CONCLUSION: Fistulas attributable to rare causes illuminate a variety of risks confronting women. Fistula repair training materials should distinguish trauma caused by traditional healers as a distinct fistula etiology. Diverse causes of fistula call for multi-pronged strategies to reduce fistula incidence.

The effects of traditional healing on HIV and AIDS management: An ethnographic study.

BACKGROUND: This article presents the effects of traditional healing on the management of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the Vhembe district, South Africa. The Vhembe district is one of the rural districts in Limpopo Province, South Africa, in which traditional healers are used as the first point of consultation for most ailments, regardless of their causes. METHODS: This ethnographic study was based on Leininger's theory of culture care diversity and universality. It was carried out in selected villages in the Vhembe district. Observation and interviews with 15 purposively selected key informants, who are traditional healers, were used to collect data. Interviews were tape-recorded and field notes were also taken. The data were analysed using the ethnographic content analysis method. RESULTS: The results suggest that traditional healing has both negative and positive effects on HIV and AIDS management. The positive effects are the effective treatment of some opportunistic infections, such as diarrhoea, skin lesions and childhood diseases. Negative effects, however, include incisions to let the 'dirty blood flow out' and inducing of vomiting and diarrhoea, which may lead to anaemia, dehydration and electrolyte imbalances. Some traditional healers are of the view that HIV does not exist and that people either have an ancestral calling or are bewitched. Even though their claims have not been scientifically proven, some traditional healers stated that they can heal HIV and AIDS. CONCLUSION: The research brings insight as to whether Vhavenda traditional healing has a favourable or unfavourable impact on HIV and AIDS management. Using Leininger's steps for adaptation for culture care diversity and universality will help with re-Africanisation of HIV management. The researcher recommend the modification of practices with a high risk of HIV infection to reduce this risk, whilst also supporting the continuation of beneficial practices that reduce HIV mortality, such as diarrhoea management.

Bilateral house advancement flap anoplasty for severe anal stenosis secondary to traditional medicine application with excellent outcome: "Case report".

INTRODUCTION AND IMPORTANCE: Anal stenosis is narrowing of anal canal that may result from true anatomic stricture or functional stenosis. Anal stenosis from irritant chemical application for hemorrhoid is rare and tends to be more severe. There is scarcity of data in the literature regarding anal stenosis secondary to traditional medicine application for the treatment of hemorrhoid. This case report can create awareness to promote health education and health advancement, especially in areas with wide spread use of traditional medicine. In addition, it can motivate general surgeons to prepare themselves to handle such cases in the absence of colorectal surgeons. PRESENTATION OF THE CASE: A 75 years old male farmer presented with worsening of difficulty of passing feces and flatus and intermittent abdominal distention of 3 months. The patient has history of application of irritant chemical by traditional healer for treatment of hemorrhoid. Physical examination led to diagnosis of severe anal stenosis. Bilateral house advancement flap anoplasty done by a general surgeon with excellent result. DISCUSSION: The commonest cause of anal stenosis is hemorrhoidectomy. Other causes include other anorectal surgeries, anorectal diseases, and radiotherapy. Diagnosis of anal stenosis is by physical examination. Treatment is conservative for mild cases and advancement flap anoplasty for moderate to severe cases. CONCLUSION: Health education and health advancement can create awareness, hence preventing people from having wrong treatments. House advancement flap anoplasty is a good option for the treatment of anal stenosis in resource limited setup, as it is easy to do and has good outcome.

Views and experiences of traditional and Western medicine practitioners on potential collaboration in the care of people living with mental illness in Malawi.

Introduction: Collaboration between traditional and biomedical medicine can lead to holistic care and improved health outcomes for people with mental illnesses. The current study aimed to explore the views and experiences of traditional and western medicine practitioners on potential collaboration in the care of people living with mental illness in Blantyre, Malawi. Method: A phenomenological qualitative research design was used. Data were collected using both one-on-one in-depth interviews (IDIs) and focus group discussions (FGDs). Participants were traditional healers and western medicine practitioners in Blantyre, Malawi. We conducted 10 in-depth interviews with traditional healers, 4 focus group discussions (2 for traditional healers and 2 for western medicine practitioners) and 6 key informant interviews with leaders of the two groups. The sample was determined based on data saturation. Thematic analysis was used to analyse the data. We used a combination of deductive and inductive coding. Results: Five broad themes were identified from the data: experiences with collaboration, views on collaboration, models of collaboration, barriers to collaboration, and factors that can facilitate collaboration. participants had no experience of formal collaboration between traditional healers and western healthcare workers in the management of mental illness. However, some reported experience of successful collaborations in other health areas such as safe motherhood, tuberculosis and HIV/AIDS. Many participants showed a positive attitude toward collaboration and were in support of it. Barriers to collaboration included negative attitudes and a lack of resources. Factors that can facilitate collaboration were dialogue, training and respect. Referral and training were the preferred forms of collaboration. Conclusion: With proper structures and respectful dialogue, a collaboration between traditional and western medicine practitioners is possible in Blantyre, Malawi.

Attitude Towards Traditional Eye Medicine and Associated Factors Among Adult Ophthalmic Patients Attending University of Gondar Comprehensive Specialized Hospital-Tertiary Eye Care and Training Center, Northwest Ethiopia.

BACKGROUND: Traditional eye medicine is a form of biologically based therapies, practices, or partially processed organic or inorganic agents that can be applied to the eye and lead to a blinding complication. Attitude towards those medicines plays a pertinent role in the practice of those traditional eye medicines. OBJECTIVE: To determine attitude towards traditional eye medicine and associated factors among adult ophthalmic patients attending University of Gondar Comprehensive Specialized Hospital-Tertiary Eye Care and Training Center, Northwest Ethiopia, 2020. METHODS: A hospital-based cross-sectional study was conducted on 417 newly presenting adult ophthalmic patients who were selected by using a systematic random sampling method from June 22 to August 11, 2020. The data from the interview-based structured questionnaire were entered into Epi Info 7 and analyzed by SPSS 20. Frequency and cross-tabulations were used for descriptive analysis. Association between variables was analyzed using binary logistic regression through the enter method with a 95% confidence interval. RESULTS: A total of 417 subjects with a 98.8% response rate have participated in the study. Of the total study subjects, 60.7% (253) (95% CI: 19-26%) had a positive attitude towards traditional eye medicine. Residing in a rural area (AOR=6.46 (95% CI: 2.89-14.45)), positive family history of traditional eye medicine use (AOR=8.01 (95% CI: 4.17-15.37)) and availability of traditional healer (AOR=19.43 (95% CI: 12.06-31.64)) were significantly associated with a positive attitude towards traditional eye medicine. CONCLUSION AND RECOMMENDATION: Most adult ophthalmic patients had a positive attitude towards traditional eye medicine. Residing in a rural, availability of a traditional healer, and positive family history of traditional eye medicine use had a significant positive association with a positive attitude. Educating the traditional healers on safe practices is crucial in reducing the burden.

Utilization of complementary and traditional medicine practitioners among middle-aged and older adults in India: results of a national survey in 2017-2018.

BACKGROUND: Lack of information exists about the use of traditional and complementary medicine (TCM) use among middle-aged and older adults in India, which led to studying the estimates of past-12-month Ayurveda/Yoga/Naturopathy/Unani/Siddha/Homeopathy (AYUSH) practitioner and traditional health practitioner (THP) utilization in India. METHODS: The study included 72,262 individuals (45 years and older) from the cross-sectional 2017-2018 Longitudinal Ageing Study in India (LASI) Wave 1. RESULTS: The prevalence of past 12-month AYUSH practitioner utilization was 6.5%, THP use 7.0%, and AYUSH or THP use 13.0%. The rate of AYUSH practitioner utilization was determined by older age (≥60 years) (Adjusted Odds Ratio-AOR: 1.20, 95% Confidence Interval-CI: 1.07-1.34), having pain (AOR: 1.48, 95% CI: 1.29-1.69), any bone or joint diseases (AOR: 1.57, 95% CI: 1.35-1.82), current tobacco use (AOR: 1.30, 95% CI: 1.12-1.50), male sex (AOR: 0.76, 95% CI: 0.68-0.85), high subjective socioeconomic status (AOR: 0.72, 95% CI: 0.60-0.87), urban residence (AOR: 0.71, 95% CI: 0.57-0.88), diabetes (AOR: 0.66, 95% CI: 0.55-0.81), chronic heart disease (AOR: 0.52, 95% CI: 0.37-0.73), and having a health insurance cover (AOR: 0.36, 95% CI: 0.30-0.44). The rate of THP utilization was determined by depressive symptoms (AOR: 1.17, 95% CI: 1.01-1.35), sleep problems (AOR: 1.28, 95% CI: 1.08-1.51), having pain (AOR: 1.82, 95% CI: 1.55-2.15), current tobacco use (AOR: 1.35, 95% CI: 1.22-1.51), having health insurance cover (AOR: 0.41, 95% CI: 0.33-0.51), hypertension (AOR: 0.82, 95% CI: 0.71-0.95), diabetes (AOR: 0.50, 95% CI: 0.39-0.65), urban residence (AOR: 0.25, 95% CI: 0.19-0.34), and high subjective socioeconomic status (AOR: 0.70, 95% CI: 0.58-0.85). CONCLUSION: A moderate prevalence of AYUSH practitioner and THP use among middle-aged and older adults in India was found and several factors associated with AYUSH practitioner and THP use were identified.

Dealing with snakebite in rural Cameroon: A qualitative investigation among victims and traditional healers.

BACKGROUND: Snakebite is a neglected tropical disease (NTD) affecting rural and remote populations globally, who are additionally burdened by poverty and the lack of effective healthcare systems. Delayed healthcare and use of traditional treatments are very frequent. The purpose of our study was to explore perceptions of snakes, impact of snakebite, and knowledge and opinions of different snakebite treatments with the aim of identifying opportunities for improving snakebite management. METHODS: This is a qualitative descriptive study based on semi-structured interviews with 21 snakebite victims and 4 traditional healers in 4 villages of Akonolinga health district, Center Region, Cameroon. Analysis focused on describing participants' perceptions of snakes, the impact of snakebite on the victims' lives, and their opinions of different treatment options. RESULTS: Respondents were fearful of snakes and knowledgeable about envenoming symptoms and treatments. The experience of snakebite led to increased vigilance and avoidance behaviours, which sometimes resulted in financial loss for the victims. A range of traditional treatments were described, including tourniquets, black-stone application and medicinal plant decoctions. However, opinions were ambivalent regarding their efficacy, depending especially on previous personal experiences. Still, traditional treatments were said to be more available and cheaper than hospital care, and in particular, than antivenom. Nevertheless, most victims preferred hospital treatment if the financial and transportation barriers were lifted. Both snakebite victims and traditional healers were of the opinion that collaboration between health services and traditional healers could help to improve snakebite management and outcomes. CONCLUSION: Our study shows that snakebite victims are in favour of using antivenom for the treatment of snakebite and would welcome better access to it. However, its current unavailability and high cost pushes them to turn to traditional treatments. On the other hand, traditional healers are in favour of collaborating with health facilities. These results are very encouraging for the improvement of snakebite management in Cameroon along the lines of the WHO Snakebite Envenoming Strategy for Prevention and Control: ensuring access to safe and effective treatment, and increasing partnership and coordination between communities, traditional healers, and conventional caregivers.

Local experience of using traditional medicine in northern Rwanda: a qualitative study.

BACKGROUND: The popular use of traditional medicine in low-income settings has previously been attributed to poverty, lack of education, and insufficient accessibility to conventional health service. However, in many countries, including in Rwanda, the use of traditional medicine is still popular despite the good accessibility and availability of conventional health services. This study aims to explore why traditional medicine is popularly used in Rwanda where it has achieved universal health coverage. METHODS: The qualitative study, which included in-depth interviews and participant observations, investigated the experience of using traditional medicine as well as the perceived needs and reasons for its use in the Musanze district of northern Rwanda. We recruited 21 participants (15 community members and 6 traditional healers) for in-depth interviews. Thematic analysis was conducted to generate common themes and coding schemes. RESULTS: Our findings suggest that the characteristics of traditional medicine are responding to community members' health, social and financial needs which are insufficiently met by the current conventional health services. Participants used traditional medicine particularly to deal with culture-specific illness - uburozi. To treat uburozi appropriately, referrals from hospitals to traditional healers took place spontaneously. CONCLUSIONS: In Rwanda, conventional health services universally cover diseases that are diagnosed by the standard of conventional medicine. However, this universal health coverage may not sufficiently respond patients' social and financial needs arising from the health needs. Given this, integrating traditional medicine into national health systems, with adequate regulatory framework for quality control, would be beneficial to meet patients' needs.

First recourse for care-seeking and associated factors among rural populations in the eastern Democratic Republic of the Congo.

BACKGROUND: Access to quality healthcare is a global fundamental human right. However, in the Democratic Republic of the Congo, several parameters affect the choices of health service users in fragile, rural contexts (zones). The overarching aim of this study was to identify the first recourse of healthcare-seeking and the determinants of utilization of health centers (primary health care structures) in the rural health zones of Katana and Walungu. METHODS: A cross-sectional survey was conducted from June to September 2017. Consenting respondents comprised 1751 adults. Continuous data were summarized using means (standard deviation) and medians (interquartile range). We used Pearson's chi-square test and Fisher exact test to compare proportions. Logistic regression was run to assess socio-determinants of health center utilization. RESULTS: The morbidity rate of the sample population for the previous month was 86.4% (n = 1501) of which 60% used health centers for their last morbid episode and 20% did not. 5.3% of the respondents patronized prayer rooms and 7.9% resorted to self-medication principally because the cost was low, or the services were fast. Being female (OR: 1.51; p = 0.005) and a higher level of education (OR: 1.79; p = 0.032) were determinants of the use of health centers in Walungu. Only the level of education was associated with the use of health centers in Katana (OR: 2.78; p = 0.045). CONCLUSION: Our findings suggest that health centers are the first recourse for the majority of the population during an illness. However, a significant percentage of patients are still using traditional healers or prayer rooms because the cost is low. Our results suggest that future interventions to encourage integrated health service use should target those with lower levels of education.

Management of epilepsy in Laos: Perceptions of healthcare professionals from Vientiane Capital province and traditional healers in Southern Laos.

BACKGROUND AND AIM: Traditional practices are deeply rooted in Lao people's perceptions and beliefs about health and illness.The objective of the study was to understand the perceptions of healthcare professionals and traditional healers regarding the management of epilepsy in Laos, and their reciprocal views. EXPERIMENTAL PROCEDURE: An observational study was carried out in two areas of Laos from February to May 2017. Semi directive questionnaires were used to collect quantitative and qualitative data. Semiotic square was carried out to highlight relationships between attitudes of traditional healers and healthcare professionals. For quantitative approach, the proportions were reported, and the test used was Fisher's test for nominal variables. The mean and standard deviation expressed the continuous variables and the Student's t-test was used. RESULTS AND CONCLUSION: Epilepsy was cited by 90.9% of traditional healers as a convulsive disease with saliva or urine, and herbal medicines were predominantly used (86.4%) to treat it. Few healthcare professionals (26.5%) pointed out that they knew remedies to treat epilepsy other than antiepileptic drugs (AEDs), and 76.5% of healthcare professionals mentioned that epilepsy was a disease which only AEDs could treat. On the other hand, 54.5% of traditional healers confirmed a traditional remedy could cure completely epilepsy through long-term use. Ninety percent of traditional healers said the collaboration with healthcare professionals was a good idea and 44.1% of the healthcare professionals group said was complicated.The combination of these medicines for the management of epilepsy needs to be adapted to Lao's medical context.

Towards a better understanding of attitudes and beliefs held by traditional healers and recipients of traditional medicine concerning mental health conditions in post-conflict Liberia: a qualitative investigation.

BACKGROUND: A better understanding of attitudes and beliefs held by traditional healers and utilizers of traditional medicine concerning mental health conditions in Liberia is important as Liberia seeks to improve its delivery of mental healthcare in the context of scarce resources and recovery from civil war. METHODS: A qualitative research design was used to collect data from 24 Liberian traditional healers, and 11 utilizers of Liberian traditional medicine. Participants were queried about mental health problems in Liberia, treatments, and attitudes towards modern healthcare. Qualitative data were probed and aggregated using content analysis. RESULTS: Mental health problems described by study participants included: Open Mole, African Science, Epilepsy, Depression and Mental Illness (trauma/substance use). Mental health problems were often associated with socioeconomic distress, and participants described their attitudes and beliefs concerning mental healthcare, traditional medicine, and modern healthcare. CONCLUSION: Traditional medicine is an important part of mental healthcare in Africa. Mental illness, social factors, and healthcare access were important problems in Liberia. Mental health problems blended local cultural beliefs with Westernized nosology and social factors. Traditional healer's attitudes towards Western medicine reflected ambivalence. There is a desire for collaboration with 'modern' health care providers, but this will require reciprocal trust-building.