Systematic review of lay consultation in symptoms and illness experiences in informal urban settlements of low-income and middle-income countries

Objectives: Lay consultation is the process of discussing a symptom or an illness with lay social network members. This can have positive or negative consequences on health-seeking behaviours. Understanding how consultation with lay social networks works in informal urban settlements of low-income and middle-income countries (LMICs) is important to enable health and policy-makers to maximise its potential to aid healthcare delivery and minimise its negative impacts. This study explored the composition, content and consequences of lay consultation in informal urban settlements of LMICs. Design: Mixed-method systematic review. Data sources: Six key public health and social science databases, Google Scholar and reference lists of included studies were searched for potential articles. Eligibility criteria: Papers that described discussions with lay informal social network members during symptoms or illness experiences. Data analysis and synthesis: Quality assessment was done using the Mixed Methods Appraisal Tool. Data were analysed and synthesised using a stepwise thematic synthesis approach involving two steps: identifying themes within individual studies and synthesising themes across studies. Results: 13 studies were included in the synthesis. Across the studies, three main categories of networks consulted during illness: kin, non-kin associates and significant community groups. Of these, kin networks were the most commonly consulted. The content of lay consultations were: asking for suggestions, negotiating care-seeking decisions, seeking resources and non-disclosure due to personal or social reasons. Lay consultations positively and negatively impacted access to formal healthcare and adherence to medical advice. Conclusion: Lay consultation is mainly sought from social networks in immediate environments in informal urban settlements of LMICs. Policy-makers and practitioners need to utilise these networks as mediators of healthcare-seeking behaviours. PROSPERO registration number: CRD42020205196

Understanding the knowledge and attitudes to dementia in Sub‐Saharan Africa : a systematic review

Background A direct result of an ageing population is an increase in the prevalence of chronic non-communicable diseases such as dementia. Creating dementia awareness and promoting positive attitude is key in early symptom recognition, diagnosis, help seeking and clarifying misconceptions about dementia. This review sought to explore the knowledge and attitudes about dementia in SSA, where there has been a rapid increase in the number of people with dementia within the last decade, and a region where spirituality and superstitions affect health behaviours. Method Six electronic databases were searched from inception to present using a predetermined search strategy and a defined eligibility criteria. Our search initially produced 1853 articles. Three independent reviewers screened the results in two phases and 14 articles were finally selected for this review. All included papers were assessed for quality with the Mixed Methods Appraisal Tool. Relevant information about the studies were extracted by three independent investigators and recorded on a standardised form. Data synthesis followed a thematic analysis and overall themes were discussed narratively. Result Three themes were apparent; Dementia Conceptualization, Care Arrangements and Social Responses and Dementia Gaps. A consistent finding across majority of the studies was the poor to fair knowledge of dementia among the study populations. Majority of people believed dementia was part of normal ageing and a biomedical definition of dementia was vastly lacking. Treatment seeking was pluralistic with people often combining modern medicine, traditional medicine and their religious faith. Caregiving in dementia was considered a filial responsibility with positive and negative attributes described. Negative attitudes surrounding dementia originated from the superstitions and beliefs related to dementia causation such as the belief in witchcraft. The psychological sequalae from caregiving coupled with societal representations of dementia contribute to stigmatization and abuse of persons with dementia in SSA. Dementia training for health professionals, social support for caregivers and public education were identified as urgent needs. Conclusion Dementia literacy is relatively poor in SSA. There is evidence of numerous challenges faced by persons with dementia, their caregivers and health professionals involved in dementia care. Culturally appropriate education campaigns are essential in advancing a dementia friendly SSA