Integrating Traditional Healers into the Health Care System:Challenges and Opportunities in Rural Northern Ghana

Traditional medicine is widespread in Ghana, with 80% of Ghanaians relying on its methods for primary health care. This paper argues that integrating traditional and biomedical health systems expands the reach and improves outcomes of community health care. Moving beyond literature, it stresses the importance of trust-relationships between healers and biomedical staff. Insights are based on qualitative research conducted in Ghana’s Northern Region (2013–2014). Five challenges to integration emerged out of the data: a lack of understanding of traditional medicine, discrimination, high turnover of biomedical staff, declining interest in healing as a profession, and equipment scarcity. Besides challenges, opportunities for integration exist, including the extensive infrastructure of traditional medicine, openness to collaboration, and grassroots initiatives. Contemplating challenges and opportunities this paper provides recommendations for integration, including: identify/select healers, promote best practices, institute appropriate forms of appreciation/recognition of healers, provide aid and equipment, use communication campaigns to promote integration and steer attitudinal change towards healers among biomedical staff. Most crucial, we argue successful implementation of these recommendations depends on a concerted investment in relationships between healers and biomedical staff

Potential impacts of climate and environmental change on the stored water of Lake Victoria Basin and economic implications

The changing climatic patterns and increasing human population within the Lake Victoria Basin (LVB), together with overexploitation of water for economic activities call for assessment of water management for the entire basin. This study focused on the analysis of a combination of available in situ climate data, Gravity Recovery and Climate Experiment (GRACE), Tropical Rainfall Measuring Mission (TRMM) observations, and high resolution Regional Climate simulations during recent decade(s) to assess the water storage changes within LVB that may be linked to recent climatic variability/changes and anomalies. We employed trend analysis, principal component analysis (PCA), and temporal/spatial correlations to explore the associations and covariability among LVB stored water, rainfall variability, and large-scale forcings associated with El-Niño/Southern Oscillation (ENSO) and Indian Ocean Dipole (IOD). Potential economic impacts of human and climate-induced changes in LVB stored water are also explored.Overall, observed in situ rainfall from lake-shore stations showed a modest increasing trend during the recent decades. The dominant patterns of rainfall data from the TRMM satellite estimates suggest that the spatial and temporal distribution of precipitation have not changed much during the period of 1998–2012 over the basin consistent with in situ observations. However, GRACE-derived water storage changes over LVB indicate an average decline of 38.2 mm/yr for 2003–2006, likely due to the extension of the Owen Fall/Nalubale dam, and an increase of 4.5 mm/yr over 2007–2013, likely due to two massive rainfalls in 2006–2007 and 2010–2011. The temporal correlations between rainfall and ENSO/IOD indices during the study period, based on TRMM and model simulations, suggest significant influence of large-scale forcing on LVB rainfall, and thus stored water. The contributions of ENSO and IOD on the amplitude of TRMM-rainfall and GRACE-derived water storage changes, for the period of 2003–2013, are estimated to be ~2.5 cm and ~1.5 cm, respectively

Model and experiences of initiating collaboration with traditional healers in validation of ethnomedicines for HIV/AIDS in Namibia

Many people with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) in Namibia have access to antiretroviral drugs but some still use traditional medicines to treat opportunistic infections and offset side-effects from antiretroviral medication. Namibia has a rich biodiversity of indigenous plants that could contain novel anti-HIV agents. However, such medicinal plants have not been identified and properly documented. Various ethnomedicines used to treat HIV/AIDS opportunistic infections have not been scientifically validated for safety and efficacy. These limitations are mostly attributable to the lack of collaboration between biomedical scientists and traditional healers. This paper presents a five-step contextual model for initiating collaboration with Namibian traditional healers in order that candidate plants that may contain novel anti-HIV agents are identified, and traditional medicines used to treat HIV/AIDS opportunistic infections are subjected to scientific validation. The model includes key structures and processes used to initiate collaboration with traditional healers in Namibia; namely, the National Biosciences Forum, a steering committee with the University of Namibia (UNAM) as the focal point, a study tour to Zambia and South Africa where other collaborative frameworks were examined, commemorations of the African Traditional Medicine Day (ATMD), and consultations with stakeholders in north-eastern Namibia. Experiences from these structures and processes are discussed. All traditional healers in north-eastern Namibia were willing to collaborate with UNAM in order that their traditional medicines could be subjected to scientific validation. The current study provides a framework for future collaboration with traditional healers and the selection of candidate anti-HIV medicinal plants and ethnomedicines for scientific testing in Namibia

Correlates of Out-of-Pocket and Catastrophic Health Expenditures in Tanzania: Results from a National Household Survey.

Inequality in health services access and utilization are influenced by out-of-pocket health expenditures in many low and middle-income countries (LMICs). Various antecedents such as social factors, poor health and economic factors are proposed to direct the choice of health care service use and incurring out-of-pocket payments. We investigated the association of these factors with out-of-pocket health expenditures among the adult and older population in the United Republic of Tanzania. We also investigated the prevalence and associated determinants contributing to household catastrophic health expenditures. We accessed the data of a multistage stratified random sample of 7279 adult participants, aged between 18 and 59 years, as well as 1018 participants aged above 60 years, from the first round of the Tanzania National Panel survey. We employed multiple generalized linear and logistic regression models to evaluate the correlates of out-of-pocket as well as catastrophic health expenditures, accounting for the complex sample design effects. Increasing age, female gender, obesity and functional disability increased the adults' out-of-pocket health expenditures significantly, while functional disability and visits to traditional healers increased the out-of-pocket health expenditures in older participants. Adult participants, who lacked formal education or worked as manual laborers earned significantly less (p < 0.001) and spent less on health (p < 0.001), despite having higher levels of disability. Large household size, household head's occupation as a manual laborer, household member with chronic illness, domestic violence against women and traditional healer's visits were significantly associated with high catastrophic health expenditures. We observed that the prevalence of inequalities in socioeconomic factors played a significant role in determining the nature of both out-of-pocket and catastrophic health expenditures. We propose that investment in social welfare programs and strengthening the social security mechanisms could reduce the financial burden in United Republic of Tanzania

Experience of initiating collaboration of traditional healers in managing HIV and AIDS in Tanzania

RefereedCollaboration between traditional healers and biomedical practitioners is now being accepted by many African countries south of the Sahara because of the increasing problem of HIV/AIDS. The key problem, however, is how to initiate collaboration between two health systems which differ in theory of disease causation and management. This paper presents findings on experience learned by initiation of collaboration between traditional healers and the Institute of Traditional Medicine in Arusha and Dar-es-Salaam Municipalities, Tanzania where 132 and 60 traditional healers respectively were interviewed. Of these 110 traditional healers claimed to be treating HIV/AIDS. The objective of the study was to initiate sustainable collaboration with traditional healers in managing HIV/AIDS. Consultative meetings with leaders of traditional healers' associations and government officials were held, followed by surveys at respective traditional healers' "vilinge" (traditional clinics). The findings were analysed using both qualitative and quantitative methods. The findings showed that influential people and leaders of traditional healers' association appeared to be gatekeepers to access potential good healers in the two study areas. After consultative meetings these leaders showed to be willing to collaborate; and opened doors to other traditional healers, who too were willing to collaborate with the Institute of Traditional Medicine in managing HIV/AIDS patients. Seventy five percent of traditional healers who claimed to be treating HIV/AIDS knew some HIV/AIDS symptoms; and some traditional healers attempted to manage these symptoms. Even though, they were willing to collaborate with the Institute of Traditional Medicine there were nevertheless some reservations based on questions surrounding sharing from collaboration. The reality of past experiences of mistreatment of traditional healers in the colonial period informed these reservations. General findings suggest that initiating collaboration is not as easy as it appears to be from the literature, if it is to be meaningful; and thus we are calling for appropriate strategies to access potential healers targeted for any study designed with sustainability in mind.Tanzania HIV/AIDS Commissio

Characteristics of drug abusers in an urban community of Tanzania

ABSTRACT Objective: Problem of drug abuse in Tanzania is serious and growing one. The thrust of this study was to identify core characteristics of drug abusers in Dar es Salaam, the biggest commercial city of the United Republic of Tanzania. Statistical Analysis and Results: Descriptive statistical analysis was used. In this study, the highest percentage of drug abusers was found within age group of 21-30 years for males while in the females the highest user age group was less than 20 years. Employment status was 33.6%. Labourers with primary education were among the highest users (63.9%). Amazingly among literates the abuse was very low (7.4%). Regarding the marital status of respondents 57% were not married. Smoking was the commonest route of administered drugs accounting for 90.5% of respondents Conclusion: The study was a problem identifier of the magnitude of the problem in one of the biggest cities of Tanzania, which can be prevented if tackled prudently

Nonlinear characterization of resonant piezocomposites 1-3 for NDT ultrasonic transducers

A comparative nonlinear characterization is carried out between the nonlinear behavior of a composite and the piezoceramic used to obtain it. This study is necessary for using the composite in power transducer applications, as in the Non Destructive Testing (NDT) by ultrasonic waves at high frequencies (300 kHz−800 kHz). Measurements of the losses and the resonator stiffness variations have also been done. Both these effects, as well as the possibility of the frequency hysteresis, show different behavior in the composites, since the increases in the ceramics are different from those in the composites. In this study two measure methods are used; principally the motional impedance increase with the motional current measurements. The results obtained are normalized in order to make them independent of the resonator size, and thus make the comparison between the composite and the ceramic easier. The figure of the mechanical loss tangent tg $\delta_{\rm m}$ versus the mean strain $\langle S \rangle$ shows that the losses can be greater in the ceramic than in the composite for soft ceramics. The dependence behavior of the losses versus the mean strain shows that hard composite transducers have lower losses and higher strains than the soft ones. However, these losses in hard composites are higher than those in the bulk ceramic transducers

Reducing therapeutic injection overuse through patients-prescribers Interaction Group Discussions in Kinondoni District, Dar es Salaam, Tanzania

Inappropriately prescription of injections has been reported in developing and developed countries. Previous studies in Tanzania showed that over 70% of patients attending out- patient clinics at private dispensaries received at least one injection per consultation, a value higher than WHO recommended target of 10%. This is of concern considering the likelihood of adverse effects of possible use of unsafe syringes to transmit HIV, hepatitis B and C, poliomyelitis and added economic impact on the patient and the healthcare system. This study aimed to investigate the impact of Interaction Group Discussion on behavioural change on injection prescribing practices in ten selected public dispensaries in Kinondoni District, Dar es Salaam, Tanzania. Patient records of injection prescriptions were obtained covering the period three months prior to the study from 5 randomly selected control and 5 randomly selected intervention facilities. At each health facility IGDs were conducted for one month on mothers and prescribers followed by a survey 3 months after IGD to determine the impact of IGDs. Chi-square statistical calculations were made to compare data on the percent of prescriptions with an injection prescribed and in those conforming to national standard treatment guidelines (STG) between baseline and 3 months follow up. Results showed no significant difference between the percentage of prescriptions with an injection prescribed at baseline and 3 months follow-up in public dispensaries (P>0.05, Χ2 test). Prescribed injections that complied with STG was low at baseline and did not significantly improve 3 months after (P>0.05, Χ2 test). Comprehensive studies and sensitization of compliance to STG by prescribers are recommended