Occupational hazards of traditional healers: repeated unprotected blood exposures risk infectious disease transmission.

OBJECTIVE: Healers provide support for acute and chronic illnesses in rural Mozambique, such as socially acceptable traditional 'vaccinations' (subcutaneous cuts in the skin to rub herbs directly into the bloody lesion). We aimed to document the frequency of blood exposure by traditional practitioners in Mozambique. METHODS: We conducted surveys with a simple random sample of 236 traditional healers in Zambézia province. Chi-square and Wilcoxon rank-sum tests were used to compare 'injection' behaviours across districts. RESULTS: Healers treated a median of eight patients in the past month (IQR: 4-15). About 75% conducted 'injections'. These healers 'injected' a median of four patients (IQR: 1-8), used a new razor a median of three times (IQR: 1-8), and almost never used gloves. Lifetime blood exposures among those who provided 'injections' during treatments were estimated to be 1758 over a healer's career. CONCLUSION: The majority of healers are exposed repeatedly to patient blood. Given the high prevalence of HIV, hepatitis B and C virus, and other blood-borne agents, specific healer practices are an occupational hazard and reuse of razors is risky for their clients.

Práticas Tradicionais de Nutrição na Província de Cabo Delgado / Traditional Nutrition Practices in Cabo Delgado Province

A ideia de realizar o presente estudo surge a partir da altura que constatou-se que em Moçambique há muito esforço com vista a mitigação do problema da desnutrição, mas a desnutrição ainda prevalece nas Comunidades. De referir que trata-se de um fenómeno que não afecta intensivamente apenas Moçambique, mas sim toda região da África Subsaariana e Ásia. Neste contexto, o Ministério da Saúde, através do Instituto de Medicina Tradicional, em colaboração com o Departamento de Nutrição, DPS Cabo Delgado, Centro de Investigação de Saúde da Manhiça (CISM), Secretariado Técnico para a Segurança Alimentar (SETSAN) e Ministério da Indústria e Comércio (MIC), realizou um Estudo do âmbito Socioantropológico para captar as Percepções Socioculturais e práticas da Nutrição que podem constituir barreiras ou vantagens, para alimentar estratégias de intervenção comunitária baseadas numa abordagem sociocultural viável no âmbito de combate a desnutrição crónica. Referir que visitou-se outros Estudos socioculturais no âmbito da nutrição onde constatou-se uma exploração superficial da nutrição enquanto um fenómeno complexo e que havia necessidade de mergulhar mais ao fundo das percepções e estabelecer a correlação existente entre as diferentes práticas que de algum modo exercem influência para a prevalência de altos índices de desnutrição no país. Para o efeito, escolheu-se a província de Cabo Delgado como local de Estudo, pelo facto desta apresentar altos índices de baixo peso a nascença. Foram seleccionados três distritos, sendo Quissanga, Chiúre e Nangade; e Postos Administrativos de Bilibiza, Chiúre Velho e Ntamba respectivamente. O estudo decorreu de 3 a 17 de Novembro de 2014. Quanto a metodologia, é um estudo de carácter qualitativo que visa explorar as percepções que determinam as diferentes práticas de nutrição. Para a recolha de dados foram usadas as técnicas de discussão em grupo focal com Praticantes de Medicina Tradicional e Parteiras Tradicionais, Líderes Comunitários, Padrinhos e Madrinhas dos Ritos de Iniciação, Líderes Religiosos, professores, Mães de Crianças Menores de 5 anos, APES e outros Voluntários, Alunos/Estudantes, representantes de ONG's, Tias/os, avôs e sogras/os, Pais, Mulheres Grávidas Jovens e Adolescentes. Foram igualmente aplicadas entrevistas individuais com informantes-chave, tais como Directores Distritais e Provinciais (Saúde, Unidade Sanitária, Educação e Cultura, Indústria, Mulher e Acção Social e Comércio, Actividades Económicas). As discussões em grupos focais eram moderadas por facilitadores formados e em línguas locais (macua, maconde) e Português. Os dados simultaneamente manuscritos e gravados. As notas e cartões de memórias foram transcritos e 5 analisados com recurso ao programa informático NVivo. Para melhor seguimento em termos de aplicação dos resultados do estudo, estiveram envolvidos na equipe de recolha de dados os técnicos provinciais e distritais de SMI, IMT, Nutrição, envolvimento comunitário e SETSAN. No estudo foram constatadas de forma generalizada barreiras culturas para o alcance de alimentação adequada, que são práticas alimentares que se fundam na tradição e que tem uma ligação com os aspectos de Género, Sexualidade, Religião (Islâmica) e Poder resultantes de um processo de Socialização. Também foram constatados alguns pontos positivos, o facto de a alimentação ser interpretada como útil a vida é um ponto forte que pode ser capitalizado no âmbito de combate a desnutrição

Educational intervention increased referrals to allopathic care by traditional healers in three high HIV-prevalence rural districts in Mozambique.

INTRODUCTION: Delayed uptake of clinical services impedes favorable clinical outcomes in Mozambique. Care is delayed among patients who initiate care with traditional healers; patients with conditions like human immunodeficiency virus (HIV) or tuberculosis are rarely referred to the health system in a timely fashion. METHODS: We conducted a pre-post educational intervention with traditional healers, assessing healer referral rates and HIV knowledge in three rural districts in Zambézia Province. RESULTS: The median monthly referral rate prior to the intervention was 0.25 patients (interquartile range [IQR]: 0-0.54) compared with a post-intervention rate of 0.34 patients (IQR: 0-0.71), a 35% increase (p=0.046). A median HIV knowledge score of 67% (IQR: 59-78) was noted 4-months pre-intervention and a median score of 81% (IQR: 74-89) was recorded 2½ months post-intervention (p<0.001). One hundred and eleven healers referred 127 adults, 36 pregnant women, and 188 children to health facilities. Referred patients were most likely to be diagnosed with bronchopneumonia (20% adults; 13% children) and/or malaria (15% adults; 37% children). Of 315 non-pregnant persons referred, 3.5% were tested for HIV and 2.5% were tested for tuberculosis. DISCUSSION: We engaged traditional healers with some success; referral rates were low, but increased post-intervention. Once seen in the clinics, patients were rarely tested for HIV or tuberculosis, though symptoms suggested screening was indicated. We found increased referral rates through an inexpensive intervention with traditional healers, a viable, cost-effective method of directing patients to health facilities. However, quality improvement within the clinics is necessary before a substantial impact can be expected.

Educational Intervention Increased Referrals to Allopathic Care by Traditional Healers in Three High HIV-Prevalence Rural Districts in Mozambique

Introduction: Delayed uptake of clinical services impedes favorable clinical outcomes in Mozambique. Care is delayed among patients who initiate care with traditional healers; patients with conditions like human immunodeficiency virus (HIV) or tuberculosis are rarely referred to the health system in a timely fashion. Methods: We conducted a pre-post educational intervention with traditional healers, assessing healer referral rates and HIV knowledge in three rural districts in Zambézia Province. Results: The median monthly referral rate prior to the intervention was 0.25 patients (interquartile range [IQR]: 0-0.54) compared with a post-intervention rate of 0.34 patients (IQR: 0-0.71), a 35% increase (p=0.046). A median HIV knowledge score of 67% (IQR: 59-78) was noted 4-months pre-intervention and a median score of 81% (IQR: 74-89) was recorded 2½ months post-intervention (p<0.001). One hundred and eleven healers referred 127 adults, 36 pregnant women, and 188 children to health facilities. Referred patients were most likely to be diagnosed with bronchopneumonia (20% adults; 13% children) and/or malaria (15% adults; 37% children). Of 315 non-pregnant persons referred, 3.5% were tested for HIV and 2.5% were tested for tuberculosis. Discussion: We engaged traditional healers with some success; referral rates were low, but increased post-intervention. Once seen in the clinics, patients were rarely tested for HIV or tuberculosis, though symptoms suggested screening was indicated. We found increased referral rates through an inexpensive intervention with traditional healers, a viable, cost-effective method of directing patients to health facilities. However, quality improvement within the clinics is necessary before a substantial impact can be expected.