The Determinants of Traditional Medicine Use in Northern Tanzania: A Mixed-Methods Study
Identifieur interne : 000147 ( Pmc/Curation ); précédent : 000146; suivant : 000148The Determinants of Traditional Medicine Use in Northern Tanzania: A Mixed-Methods Study
Auteurs : John W. Stanifer [États-Unis] ; Uptal D. Patel [États-Unis] ; Francis Karia [Tanzanie] ; Nathan Thielman [États-Unis] ; Venance Maro [Tanzanie] ; Dionis Shimbi [Tanzanie] ; Humphrey Kilaweh [Tanzanie] ; Matayo Lazaro [Tanzanie] ; Oliver Matemu [Tanzanie] ; Justin Omolo [Tanzanie] ; David Boyd [États-Unis]Source :
- PLoS ONE [ 1932-6203 ] ; 2015.
Abstract
Traditional medicines are an important part of healthcare in sub-Saharan Africa, and building successful disease treatment programs that are sensitive to traditional medicine practices will require an understanding of their current use and roles, including from a biomedical perspective. Therefore, we conducted a mixed-method study in Northern Tanzania in order to characterize the extent of and reasons for the use of traditional medicines among the general population so that we can better inform public health efforts in the region.
Between December 2013 and June 2014 in Kilimanjaro, Tanzania, we conducted 5 focus group discussions and 27 in-depth interviews of key informants. The data from these sessions were analyzed using an inductive framework method with cultural insider-outsider coding. From these results, we developed a structured survey designed to test different aspects of traditional medicine use and administered it to a random sample of 655 adults from the community. The results were triangulated to explore converging and diverging themes.
Most structured survey participants (68%) reported knowing someone who frequently used traditional medicines, and the majority (56%) reported using them themselves in the previous year. The most common uses were for symptomatic ailments (42%), chronic diseases (15%), reproductive problems (11%), and malaria/febrile illnesses (11%). We identified five major determinants for traditional medicine use in Northern Tanzania: biomedical healthcare delivery, credibility of traditional practices, strong cultural identities, individual health status, and disease understanding.
In order to better formulate effective local disease management programs that are sensitive to TM practices, we described the determinants of TM use. Additionally, we found TM use to be high in Northern Tanzania and that its use is not limited to lower-income areas or rural settings. After symptomatic ailments, chronic diseases were reported as the most common reason for TM use which may be particularly important in Northern Tanzania where non-communicable diseases are a rapidly growing burden.
Url:
DOI: 10.1371/journal.pone.0122638
PubMed: 25848762
PubMed Central: 4388565
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<front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Introduction</title>
<p>Traditional medicines are an important part of healthcare in sub-Saharan Africa, and building successful disease treatment programs that are sensitive to traditional medicine practices will require an understanding of their current use and roles, including from a biomedical perspective. Therefore, we conducted a mixed-method study in Northern Tanzania in order to characterize the extent of and reasons for the use of traditional medicines among the general population so that we can better inform public health efforts in the region.</p>
</sec>
<sec id="sec002"><title>Methods</title>
<p>Between December 2013 and June 2014 in Kilimanjaro, Tanzania, we conducted 5 focus group discussions and 27 in-depth interviews of key informants. The data from these sessions were analyzed using an inductive framework method with cultural insider-outsider coding. From these results, we developed a structured survey designed to test different aspects of traditional medicine use and administered it to a random sample of 655 adults from the community. The results were triangulated to explore converging and diverging themes.</p>
</sec>
<sec id="sec003"><title>Results</title>
<p>Most structured survey participants (68%) reported knowing someone who frequently used traditional medicines, and the majority (56%) reported using them themselves in the previous year. The most common uses were for symptomatic ailments (42%), chronic diseases (15%), reproductive problems (11%), and malaria/febrile illnesses (11%). We identified five major determinants for traditional medicine use in Northern Tanzania: biomedical healthcare delivery, credibility of traditional practices, strong cultural identities, individual health status, and disease understanding.</p>
</sec>
<sec id="sec004"><title>Conclusions</title>
<p>In order to better formulate effective local disease management programs that are sensitive to TM practices, we described the determinants of TM use. Additionally, we found TM use to be high in Northern Tanzania and that its use is not limited to lower-income areas or rural settings. After symptomatic ailments, chronic diseases were reported as the most common reason for TM use which may be particularly important in Northern Tanzania where non-communicable diseases are a rapidly growing burden.</p>
</sec>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id>
<journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id>
<journal-id journal-id-type="publisher-id">plos</journal-id>
<journal-id journal-id-type="pmc">plosone</journal-id>
<journal-title-group><journal-title>PLoS ONE</journal-title>
</journal-title-group>
<issn pub-type="epub">1932-6203</issn>
<publisher><publisher-name>Public Library of Science</publisher-name>
<publisher-loc>San Francisco, CA USA</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">25848762</article-id>
<article-id pub-id-type="pmc">4388565</article-id>
<article-id pub-id-type="doi">10.1371/journal.pone.0122638</article-id>
<article-id pub-id-type="publisher-id">PONE-D-14-43531</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>The Determinants of Traditional Medicine Use in Northern Tanzania: A Mixed-Methods Study</article-title>
<alt-title alt-title-type="running-head">Determinants of Traditional Medicine Use</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Stanifer</surname>
<given-names>John W.</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
<xref rid="cor001" ref-type="corresp">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Patel</surname>
<given-names>Uptal D.</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Karia</surname>
<given-names>Francis</given-names>
</name>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Thielman</surname>
<given-names>Nathan</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Maro</surname>
<given-names>Venance</given-names>
</name>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Shimbi</surname>
<given-names>Dionis</given-names>
</name>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kilaweh</surname>
<given-names>Humphrey</given-names>
</name>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lazaro</surname>
<given-names>Matayo</given-names>
</name>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Matemu</surname>
<given-names>Oliver</given-names>
</name>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Omolo</surname>
<given-names>Justin</given-names>
</name>
<xref ref-type="aff" rid="aff005"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Boyd</surname>
<given-names>David</given-names>
</name>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><collab>Comprehensive Kidney Disease Assessment for Risk factors, epIdemiology, Knowledge, and Attitudes (CKD AFRIKA) Study</collab>
</contrib>
</contrib-group>
<aff id="aff001"><label>1</label>
<addr-line>Department of Medicine, Duke University, Durham, North Carolina, United States of America</addr-line>
</aff>
<aff id="aff002"><label>2</label>
<addr-line>Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America</addr-line>
</aff>
<aff id="aff003"><label>3</label>
<addr-line>Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States of America</addr-line>
</aff>
<aff id="aff004"><label>4</label>
<addr-line>Kilimanjaro Christian Medical College, Moshi, Tanzania</addr-line>
</aff>
<aff id="aff005"><label>5</label>
<addr-line>Tanga AIDS Working Group, Tanga, Tanzania</addr-line>
</aff>
<contrib-group><contrib contrib-type="editor"><name><surname>Marsh</surname>
<given-names>Vicki</given-names>
</name>
<role>Academic Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1"><addr-line>Centre for Geographic Medicine Research Coast, KENYA</addr-line>
</aff>
<author-notes><fn fn-type="conflict" id="coi001"><p><bold>Competing Interests: </bold>
Nathan Thielman is indeed a member of the PLOS One Editorial board, but his involvement as a coauthors does not alter the authors' adherence to PLOS ONE Editorial policies and criteria.</p>
</fn>
<fn fn-type="con" id="contrib001"><p>Conceived and designed the experiments: JWS UDP FK NT VM DB. Performed the experiments: JWS FK DS HK ML OM. Analyzed the data: JWS UDP FK VM JO DB. Wrote the paper: JWS UDP FK NT VM DS HK ML OM JO DB.</p>
</fn>
<corresp id="cor001">* E-mail: <email>john.stanifer@duke.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>7</day>
<month>4</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="collection"><year>2015</year>
</pub-date>
<volume>10</volume>
<issue>4</issue>
<elocation-id>e0122638</elocation-id>
<history><date date-type="received"><day>27</day>
<month>9</month>
<year>2014</year>
</date>
<date date-type="accepted"><day>23</day>
<month>2</month>
<year>2015</year>
</date>
</history>
<permissions><copyright-year>2015</copyright-year>
<copyright-holder>Stanifer et al</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>
, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited</license-p>
</license>
</permissions>
<self-uri content-type="pdf" xlink:type="simple" xlink:href="pone.0122638.pdf"></self-uri>
<abstract><sec id="sec001"><title>Introduction</title>
<p>Traditional medicines are an important part of healthcare in sub-Saharan Africa, and building successful disease treatment programs that are sensitive to traditional medicine practices will require an understanding of their current use and roles, including from a biomedical perspective. Therefore, we conducted a mixed-method study in Northern Tanzania in order to characterize the extent of and reasons for the use of traditional medicines among the general population so that we can better inform public health efforts in the region.</p>
</sec>
<sec id="sec002"><title>Methods</title>
<p>Between December 2013 and June 2014 in Kilimanjaro, Tanzania, we conducted 5 focus group discussions and 27 in-depth interviews of key informants. The data from these sessions were analyzed using an inductive framework method with cultural insider-outsider coding. From these results, we developed a structured survey designed to test different aspects of traditional medicine use and administered it to a random sample of 655 adults from the community. The results were triangulated to explore converging and diverging themes.</p>
</sec>
<sec id="sec003"><title>Results</title>
<p>Most structured survey participants (68%) reported knowing someone who frequently used traditional medicines, and the majority (56%) reported using them themselves in the previous year. The most common uses were for symptomatic ailments (42%), chronic diseases (15%), reproductive problems (11%), and malaria/febrile illnesses (11%). We identified five major determinants for traditional medicine use in Northern Tanzania: biomedical healthcare delivery, credibility of traditional practices, strong cultural identities, individual health status, and disease understanding.</p>
</sec>
<sec id="sec004"><title>Conclusions</title>
<p>In order to better formulate effective local disease management programs that are sensitive to TM practices, we described the determinants of TM use. Additionally, we found TM use to be high in Northern Tanzania and that its use is not limited to lower-income areas or rural settings. After symptomatic ailments, chronic diseases were reported as the most common reason for TM use which may be particularly important in Northern Tanzania where non-communicable diseases are a rapidly growing burden.</p>
</sec>
</abstract>
<funding-group><funding-statement>This project was supported by an NIH Research Training Grant (#R25 TW009337) funded by the Fogarty International Center and the National Institute of Mental Health; a Research and Prevention Grant funded by the International Society of Nephrology (ISN) Global Outreach Committee; and a Masters of Science research stipend funded by the Duke Global Health Institute.</funding-statement>
</funding-group>
<counts><fig-count count="2"></fig-count>
<table-count count="3"></table-count>
<page-count count="17"></page-count>
</counts>
<custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name>
<meta-value>Data are from the ongoing Comprehensive Kidney Disease Assessment for Risk factors, epIdemiology, Knowledge, and Attitudes (CKD AFRIKA) Study whose investigators may be contacted at the Duke Global Health Institute (<email>john.stanifer@duke.edu</email>
). Data are available without restrictions for researchers who meet the criteria for access to confidential data.</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
<notes><title>Data Availability</title>
<p>Data are from the ongoing Comprehensive Kidney Disease Assessment for Risk factors, epIdemiology, Knowledge, and Attitudes (CKD AFRIKA) Study whose investigators may be contacted at the Duke Global Health Institute (<email>john.stanifer@duke.edu</email>
). Data are available without restrictions for researchers who meet the criteria for access to confidential data.</p>
</notes>
</front>
</pmc>
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