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

How do patients interpret terms for medically unexplained symptoms?

OBJECTIVE: To investigate how primary care patients interpret the existing terminology used to describe medically unexplained symptoms; to contribute to the current academic discussion on unequivocal terminology.DESIGN: Descriptive cohort study.METHODS: We approached patients in the waiting rooms of two general medical practices in the city of Groningen and in the province of Drenthe. Based on a fictitious case, the patients were asked to assign connotations to a number of possible diagnoses for medically unexplained tiredness. The patients could choose from seven predetermined connotations. Among the diagnoses for medically unexplained tiredness were 'functional fatigue', 'chronic fatigue syndrome', 'psychosomatic tiredness', and 'medically unexplained tiredness'. From the seven connotations, we labeled three connotations as being negative. When patients gave at least one negative connotation to a possible diagnosis, the diagnosis was labeled as 'offensive'.RESULTS: A total of 184 patients participated in the study. From the alternative diagnoses for medically unexplained tiredness, 'psychosomatic tiredness' had the most negative connotations: at least one negative connotation for 65 (35%) patients. 'Chronic fatigue syndrome' and 'functional fatigue' had the fewest negative connotations: at least one negative connotation for respectively 17 (9%) and 24 (13%) patients.CONCLUSION: The terms 'chronic fatigue syndrome' and 'functional fatigue' were less offensive. Our results could imply that terms for medically unexplained tiredness that refer less to a psychological basis are most acceptable for the patient.</p

How do patients interpret terms for medically unexplained symptoms?

OBJECTIVE: To investigate how primary care patients interpret the existing terminology used to describe medically unexplained symptoms; to contribute to the current academic discussion on unequivocal terminology.DESIGN: Descriptive cohort study.METHODS: We approached patients in the waiting rooms of two general medical practices in the city of Groningen and in the province of Drenthe. Based on a fictitious case, the patients were asked to assign connotations to a number of possible diagnoses for medically unexplained tiredness. The patients could choose from seven predetermined connotations. Among the diagnoses for medically unexplained tiredness were 'functional fatigue', 'chronic fatigue syndrome', 'psychosomatic tiredness', and 'medically unexplained tiredness'. From the seven connotations, we labeled three connotations as being negative. When patients gave at least one negative connotation to a possible diagnosis, the diagnosis was labeled as 'offensive'.RESULTS: A total of 184 patients participated in the study. From the alternative diagnoses for medically unexplained tiredness, 'psychosomatic tiredness' had the most negative connotations: at least one negative connotation for 65 (35%) patients. 'Chronic fatigue syndrome' and 'functional fatigue' had the fewest negative connotations: at least one negative connotation for respectively 17 (9%) and 24 (13%) patients.CONCLUSION: The terms 'chronic fatigue syndrome' and 'functional fatigue' were less offensive. Our results could imply that terms for medically unexplained tiredness that refer less to a psychological basis are most acceptable for the patient.</p

Hoe interpreteert de patiënt de huidige terminologie voor lichamelijk onverklaarde klachten?

OBJECTIVE: To investigate how primary care patients interpret the existing terminology used to describe medically unexplained symptoms; to contribute to the current academic discussion on unequivocal terminology. DESIGN: Descriptive cohort study. METHODS: We approached patients in the waiting rooms of two general medical practices in the city of Groningen and in the province of Drenthe. Based on a fictitious case, the patients were asked to assign connotations to a number of possible diagnoses for medically unexplained tiredness. The patients could choose from seven predetermined connotations. Among the diagnoses for medically unexplained tiredness were 'functional fatigue', 'chronic fatigue syndrome', 'psychosomatic tiredness', and 'medically unexplained tiredness'. From the seven connotations, we labeled three connotations as being negative. When patients gave at least one negative connotation to a possible diagnosis, the diagnosis was labeled as 'offensive'. RESULTS: A total of 184 patients participated in the study. From the alternative diagnoses for medically unexplained tiredness, 'psychosomatic tiredness' had the most negative connotations: at least one negative connotation for 65 (35%) patients. 'Chronic fatigue syndrome' and 'functional fatigue' had the fewest negative connotations: at least one negative connotation for respectively 17 (9%) and 24 (13%) patients. CONCLUSION: The terms 'chronic fatigue syndrome' and 'functional fatigue' were less offensive. Our results could imply that terms for medically unexplained tiredness that refer less to a psychological basis are most acceptable for the patient

The prospective association between childhood cognitive ability and somatic symptoms and syndromes in adulthood: the 1958 British birth cohort

BACKGROUND: Cognitive ability is negatively associated with functional somatic symptoms (FSS) in childhood. Lower childhood cognitive ability might also predict FSS and functional somatic syndromes in adulthood. However, it is unknown whether this association would be modified by subjective and objective measures of parental academic expectations. METHODS: 14 068 participants from the 1958 British birth cohort, whose cognitive ability was assessed at 11 years. Outcomes were somatic symptoms at 23, 33 and 42 years. Self-reported irritable bowel syndrome (IBS), chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and operationally defined CFS-like illness were measured at 42 years. RESULTS: Lower cognitive ability at age 11 years was associated with somatic symptoms at ages 23, 33 and 42 years. Adjusting for sex, childhood internalising problems, previous somatic symptoms and concurrent psychological symptoms, childhood cognitive ability remained negatively associated with somatic symptoms at age 23 years (β=-0.060, 95% CI -0.081 to -0.039, p<0.01), 33 years (β = -0.031, 95% CI -0.050 to -0.011, p<0.01), but not with somatic symptoms at 42 years. Overall, we found no clear association between lower childhood cognitive ability and CFS/ME, CFS-like illness and IBS. Associations between cognitive ability and somatic symptoms at 23 years were moderated by low parental social class, but not by subjective indicators of parental academic expectations. CONCLUSIONS: Lower childhood cognitive ability predicted somatic symptoms, but not CFS/ME, CFS-like illness and IBS in adulthood. While earlier research indicated an important role for high parental academic expectations in the development of early-life FSS, these expectations do not seem relevant for somatic symptoms or functional somatic syndromes in later adulthood

Predictors for Persistence of Functional Somatic Symptoms in Adolescents

Objective To identify risk factors for persistence of functional somatic symptoms (FSS; ie, somatic symptoms that cannot be sufficiently explained by underlying organic pathology). Study design The first (N = 2230, mean age = 11.1 years [SD 0.6], 50.8% girls), second (N = 2149, mean age = 13.7 years [ SD 0.5], 51.0% girls), and third (N = 1816, mean age = 16.3 years [ SD 0.7], 52.3% girls) assessment waves of the general population study TRacking Adolescents' Individual Lives Survey were used. FSS were assessed with the Youth Self-Report and the Child Behavior Checklist. Growth mixture models were used to identify different subgroups of adolescents on the basis of the developmental trajectory of their symptoms. Adolescents with persistent symptoms were compared with adolescents with decreasing symptoms with a multivariable logistic regression analysis. Results In our general population cohort, 4.1% of adolescents suffered from persistent FSS. Risk factors for persistent FSS were being a girl (OR 4.69, 95% CI 2.17-10.12), suffering from depressive symptoms (OR 5.35, 95% CI 1.46-16.62), poor self-rated health (OR 1.56, 95% CI 1.02-2.39), and high parent-reported FSS (OR 4.03, 95% CI 1.20-13.54). Anxiety, parental overprotection, school absenteeism, and diversity of symptoms did not predict persistence of FSS. Conclusions This study identified risk factors for persistence of FSS in adolescents. Future studies might study effects of coping strategies and iatrogenic factors on symptom persistence

Age- and sex-specific associations between adverse life events and functional bodily symptoms in the general population

Objective: To test age- and sex-specific associations between adverse life events and functional bodily symptoms (FBS) in the general population. Methods: In a population-based cohort, 964 participants (mean age 55 years SD 11,48% male) completed two measurements waves of the present study. Lifetime exposure to 12 adverse life events was assessed through a modified version of the List of Threatening Experiences. Stress-sensitive personality was assessed with the 12-item neuroticism scale of the Eysenck Personality Questionnaire-Revised. Socio-economic status was retrieved from questionnaires. Participants completed the somatization section of the Composite International Diagnostic Interview to survey the presence of 42 FBS in the previous year. Results: Regression analyses, adjusted for age, revealed that lifetime scores of adverse life events were significantly associated with FBS in the previous year, an association that was nearly identical for females (beta = 0.18, t = 4.07, p <0.01) and males (beta = 0.19, t = 424, p <0.01). This association remained statistically significant when stress-sensitive personality and socio-economic status were added to the model. Associations between adverse life events during childhood and FBS were statistically significant in females (beta = 0.13, t = 2.90, p = 0.04) but not in males (beta = 0.06, t = 1.24, p = 0.22), whereas there was a stronger association with adverse life events during adulthood in males (beta = 0.20, t = 437, p <0.01) compared to females (beta = 0.15, t = 3.38, p = 0.01). Life events in the previous year were not associated with FBS in the previous year. Conclusion: Adverse life events during lifetime were associated with FBS in the previous year. This association was dependent on age and sex but largely independent of having a stress-sensitive personality or low socioeconomic status. Future studies could adopt a life course perspective to study the role of adverse life events in FBS. (C) 2015 Elsevier Inc. All rights reserved