Attitudes of HIV positive patients in South Africa to African traditional healers and their practices

This study explores the use of African traditional healers by people using Antiretroviral (ARV) treatment in South Africa. It focuses on the insights and? opinions of two different populations: HIV positive patients attending ARV services and lay healthcare workers (patient advocates and ARV counsellors) providing counselling services parallel to ARV treatment. A semi-structured questionnaire was used to explore the attitudes of patients to African traditional healers and their practices. This was complemented by in depth interviews with patients who reported use of traditional healing systems in the past year. The responses show that the majority of respondents had never accessed a traditional healing service. Only two patients were found to be actively crossing between ARV treatment facilities and traditional healing services at the time of their interview. The study also included two focus group discussions with lay health workers (i.e. ARV counsellors and patient advocates) at two ARV sites. On the whole it showed that lay health workers support an ARV roll out process that effectively underplays the role of traditional healers and therefore actively discourages their patients from using traditional healing services while taking ARV treatment

The impact of African traditional healers on Antiretroviral (ARV) treatment in South Africa

Includes bibliographical references (leaves 90-93).There are few studies on the impact of African traditional healing on HIV/AIDS care and treatment in South Africa. There is a need for concrete data on the subject as many people across the African continent are thought to be accessing these kinds of healing services. This study which consists of three inter-related sub studies, investigated the impact of African traditional healers on Antiretroviral (ARV) treatment in South Africa. Each of the sub studies focused on the insights and opinions of three different populations, i.e. health care workers, traditional healers (who were affiliated with HIV/AIDS care services) and HIV positive patients. The first of the sub studies used in- depth interviews to explore the attitudes and approaches often health care professionals (nurses, doctors, ARV counsellors and a pharmacy assistant) working in ARV roll out sites in South Africa to their patients taking traditional medicine and accessing traditional healing paradigms. The sub study also probed their opinions of collaborating with traditional healers to strengthen ARV care. Furthermore, this sub study included two focus group discussions with lay health workers at two ARV sites (i.e. ARV counsellors and patient advocates). On the whole the study showed that health care professionals are concerned about the possibility of traditional healers undermining an ARV roll out programme. These perceptions are based on concerns that traditional healers may provide untested substances to HIV positive patients that could interact adversely with ARV drugs. They also believed that traditional healers could discourage patients from adhering to their ARV regimen. However, despite these concerns, most of the health care professionals were willing to collaborate with traditional healers but the partnership would have to be formed on the basis of the principles of the biomedical paradigm of healing. Health care professionals preferred to be solely in charge of the ARV drug regimen with (biomedically) trained traditional healers supporting them. They preferred traditional healers to concentrate solely on symbolic rituals. The focus groups with the ARV counsellors and patient advocates show that these lay health workers support an ARV roll out process that effectively underplays the role of traditional healers and therefore actively discourage their patients from using traditional healing services while taking ARV treatment. The second sub study complements the first and used in-depth interviews to explore the attitudes and approaches of five female traditional healers (working in HIV/AIDS organizations in the Western Cape) towards the use of ARV treatment by their clients. This study also explored their attitudes towards a partnership with the formal public health sector with regard to HIV/ AIDS care. The sub study showed that traditional healers are concerned about the wellbeing of HIV positive people. All of the traditional healers who were recruited into this study were in favour of a partnership with health care workers as long as such a partnership is based on mutual collaboration and respect. The third sub study was a study of HIV positive patients attending health facilities that provide ARV care. A semi structured questionnaire was adapted from instruments used in previous studies and was complemented by in depth interviews with patients who reported use of traditional healing systems in the past year. This sub study explored the attitudes of the respondents towards African traditional healers and their practices. The responses of the patients show that the majority of respondents have never accessed a traditional healing service. Some of the patients recruited in the study said they had accessed a traditional healing service before they had begun ARV treatment or before they were recruited into this study. They expressed the reasons for their choice. Only two patients were found to be actively crossing between ARV treatment facilities and traditional healing services at the time of their interview. A public health and human rights analysis suggests means of incorporating a traditional healer in ARV care, whereby an ARV treatment policy can respect cultural rights of patients and traditional healers while simultaneously improving ARV treatment infrastructure. Limitations encountered in the study such as location of the research sites, nature of the respondents and the ways in which the questions were worded to the respondents were addressed through efforts by the researcher. The study concludes that a partnership between traditional healers and the formal public health sector is feasible but must incorporate respect for cultural rights

Demand and access to mental health services: a qualitative formative study in Nepal

BACKGROUND: Nepal is experiencing a significant 'treatment gap' in mental health care. People with mental disorders do not always receive appropriate treatment due to a range of structural and individual issues, including stigma and poverty. The PRIME (Programme for Improving Mental Health Care) programme has developed a mental health care plan to address this issue in Nepal and four other low and middle income countries. This study aims to inform the development of this comprehensive care plan by investigating the perceptions of stakeholders at different levels of the care system in the district of Chitwan in southern Nepal: health professionals, lay workers and community members. It focuses specifically on issues of demand and access to care, and aims to identify barriers and potential solutions for reaching people with priority mental disorders. METHODS: This qualitative study consisted of key informant interviews (33) and focus group discussions (83 participants in 9 groups) at community and health facility levels. Data were analysed using a framework analysis approach. RESULTS: As well as pragmatic barriers at the health facility level, mental health stigma and certain cultural norms were found to reduce access and demand for services. Respondents perceived the lack of awareness about mental health problems to be a major problem underlying this, even among those with high levels of education or status. They proposed strategies to improve awareness, such as channelling education through trusted and respected community figures, and responding to the need for openness or privacy in educational programmes, depending on the issue at hand. Adapting to local perceptions of stigmatised treatments emerged as another key strategy to improve demand. CONCLUSIONS: This study identifies barriers to accessing care in Nepal that reach beyond the health facility and into the social fabric of the community. Stakeholders in PRIME's integrated care plan advocate strategic awareness raising initiatives to improve the reach of integrated services in this low-income setting

Prevalence and correlates of mental and neurodevelopmental symptoms and disorders among deaf children and adolescents : a systematic review protocol

CITATION: Swanepoel, Brandon et al. 2020. Prevalence and correlates of mental and neurodevelopmental symptoms and disorders among deaf children and adolescents : a systematic review protocol. BMJ Open, 10(10):e038431, doi:10.1136/bmjopen-2020-038431.The original publication is available at: https://pubmed.ncbi.nlm.nih.govIntroduction: Little is known of the prevalence and correlates of mental and neurodevelopmental symptoms and disorders among deaf children and adolescents. Research suggests that this is a vulnerable population group at high risk of these disorders. However, little is known of correlates of prevalence estimates of these mental disorders and it seems that heterogeneous tools have been used to derive these estimates. Given the heterogeneity of studies measuring the prevalence and correlates of mental and neurodevelopmental symptoms and disorders among deaf children and adolescents, we seek to systematically examine and synthesise observational epidemiological evidence in this area to articulate a more detailed account of these symptoms and disorders and their correlates among this population group. Methods and analysis: We will conduct a systematic search of the following electronic databases to identify published observational epidemiological studies examining the prevalence and correlates of mental and neurodevelopmental symptoms and disorders among deaf children and adolescents: EBSCOhost, ERIC, PsycARTICLES, PsycINFO, PubMED, ScienceDirect, SCOPUS and Web of Science. As research in this area is limited, eight databases have been included to widen our search to include as many articles as possible. The search terms will be related to mental and neurodevelopmental symptoms and disorders as well as deaf children and adolescents. Two reviewers will review and extract data from each article independently and, where relevant, discuss differences to reach consensus. Additionally, the reviewers will assess overall study quality and risk of bias using a quality appraisal scale. Findings from studies will be synthesised to produce a quantitative review that summarises existing evidence on mental and neurodevelopmental symptoms and disorders among deaf children and adolescents and their correlates. The publication date of studies will not be restricted so that as much data as possible that fit our inclusion criteria can be sourced. We will conduct our searches between August 2020 and March 2021.Publisher's versio

The HIV epidemic and sexual and reproductive health policy integration: views of South African policymakers

Background: Integration of sexual and reproductive health (SRH) and HIV policies and services delivered by the same provider is prioritised worldwide, especially in sub-Saharan Africa where HIV prevalence is highest. South Africa has the largest antiretroviral treatment (ART) programme in the world, with an estimated 2.7 million people on ART, elevating South Africa’s prominence as a global leader in HIV treatment. In 2011, the Southern African HIV Clinicians Society published safer conception guidelines for people living with HIV (PLWH) and in 2013, the South African government published contraceptive guidelines highlighting the importance of SRH and fertility planning services for people living with HIV. Addressing unintended pregnancies, safer conception and maternal health issues is crucial for improving PLWH’s SRH and combatting the global HIV epidemic. This paper explores South African policymakers’ perspectives on public sector SRH-HIV policy integration, with a special focus on the need for national and regional policies on safer conception for PLWH and contraceptive guidelines implementation. Methods: It draws on 42 in-depth interviews with national, provincial and civil society policymakers conducted between 2008–2009 and 2011–2012, as the number of people on ART escalated. Interviews focused on three key domains: opinions on PLWH’s childbearing; the status of SRH-HIV integration policies and services; and thoughts and suggestions on SRH-HIV integration within the restructuring of South African primary care services. Data were coded and analysed according to themes. Results: Participants supported SRH-HIV integrated policy and services. However, integration challenges identified included a lack of policy and guidelines, inadequately trained providers, vertical programming, provider work overload, and a weak health system. Participants acknowledged that SRH-HIV integration policies, particularly for safer conception, contraception and cervical cancer, had been neglected. Policymakers supported public sector adoption of safer conception policy and services. Participants interviewed after expanded ART were more positive about safer conception policies for PLWH than participants interviewed earlier. Conclusion: The past decade’s HIV policy changes have increased opportunities for SRH–HIV integration. The findings provide important insights for international, regional and national SRH-HIV policy and service integration initiatives

Prevalence and clinical correlates of substance use disorders in South African Xhosa patients with schizophrenia

Purpose: To determine the prevalence of substance use disorders (SUDs) in patients with schizophrenia in a sample from South Africa and compare the clinical and demographic correlates in those with and without co-occurring SUDs. Methods: Patients with schizophrenia were interviewed using the Xhosa version SCID-I for DSM-IV. We used logistic regression to determine the predictors of SUDs. Results: In the total sample of 1420 participants, SUDs occurred in 47.8%, with the most prevalent SUD being cannabis use disorders (39.6%), followed by alcohol (20.5%), methaqualone (6.2%), methamphetamine (4.8%) and other SUDs (cocaine, ecstasy, opioids, 0.6%). Polydrug use occurred in 40%, abuse occurred in 13.5%, and 39.6% had at least one substance dependence diagnosis. Signifcant predictors of any SUD were younger age (41–55 vs. 21–30: OR=0.7, 95% CI=0.5–0.9), male sex (OR=8.6, 95% CI=5.1–14.6), inpatient status (OR=1.7, 95% CI=1.3–2.1), post-traumatic stress symptoms (OR=4.6, 95% CI=1.6–13.3), legal (OR=3.4, 95% CI=2.0–5.5) and economic problems (OR=1.4, 95% CI=1.0–2.0). Methamphetamine use disorders occurred signifcantly less often in the Eastern compared to the Western Cape provinces. Inpatient status and higher levels of prior admissions were signifcantly associated with cannabis and methamphetamine use disorders. Post-traumatic stress symptoms were signifcantly associated with alcohol use disorders. Anxiety disorders were associated with other SUDs. Conclusion: SUDs occurred in almost half of the sample. It is important for clinicians to identify the presence of SUDs as their presence is associated with characteristics, such as male sex, younger age, inpatient status, more prior hospitalisations, legal and economic problems, PTSD symptoms and anxiety

The relationship between childhood adversity, recent stressors, and depression in college students attending a South African university

Background College students are at risk of depression. This risk may be increased by the experience of childhood adversity and/or recent stressors. This study examined the association between reported experiences of childhood adversity, recent stressors and depression during the last 12 months in a cohort of South African university students. Methods Six hundred and eighty-six first year students at Stellenbosch University in South Africa completed a health-focused e-survey that included items on childhood adversity, recent stressors and mood. Individual and population attributable risk proportions (PARP) between experiences of childhood adversity and 12-month stressful experiences and 12-month depression were estimated using multivariate binomial logistic regression analysis. Results About one in six students reported depression during the last 12 months. Being a victim of bullying and emotional abuse or emotional neglect during childhood were the strongest predictors of depression in the past year at both individual and population level. With regard to recent stressors, a romantic partner being unfaithful, serious ongoing arguments or break-ups with some other close friend or family member and a sexual or gender identity crisis were the strongest predictors of depression. The predictor effect of recent stressors was significantly reduced in the final model that adjusted for the type and number of childhood traumatic experiences. At a population level, academic stress, serious ongoing arguments or break-ups with a close friend or family member, and serious betrayal by someone close were the variables that yielded the highest PARP. Conclusions Our findings suggest a significant relationship between early adversity, recent stressors, and depression here and throughout, consistent with the broader literature on predictors of depression. This study contributes to the limited data on college students’ mental health in low and middle income countries including on the African continent. The findings provide information on the population level effect sizes of trauma as a risk factor for depression, as well as on the relationship between specific recent stressors and depression in college students

Systematic review of feasibility and acceptability of psychosocial interventions for schizophrenia in low and middle income countries

Abstract Background In low and middle income countries there is evidence to suggest effectiveness of community-based psychosocial interventions for schizophrenia. Many psychosocial interventions have however been conceptualized in high income countries and assessing their feasibility and acceptability in low and middle income countries is pertinent and the objective of this review. Methods Six databases were searched using search terms (i) “Schizophrenia”; (ii) “Low and middle income or developing countries” and (iii) “Psychosocial interventions”. Abstracts identified were extracted to an EndNote Database. Two authors independently reviewed abstracts according to defined inclusion and exclusion criteria. Full papers were accessed of studies meeting these criteria, or for which more information was needed to include or exclude them. Data were extracted from included studies using a predesigned data extraction form. Qualitative synthesis of qualitative and quantitative data was conducted. Results 14 037 abstracts were identified through searches. 196 full articles were reviewed with 17 articles meeting the inclusion criteria. Little data emerged on feasibility. Barriers to feasibility were noted including low education levels of participants, unavailability of caregivers, and logistical issues such as difficulty in follow up of participants. Evidence of acceptability was noted in high participation rates and levels of satisfaction with interventions. Conclusions While there is preliminary evidence to suggest acceptability of community-based psychosocial interventions for schizophrenia in low and middle income countries, evidence for overall feasibility is currently lacking. Well-designed intervention studies incorporating specific measures of acceptability and feasibility are needed

The relationship between childhood trauma and schizophrenia in the Genomics of Schizophrenia in the Xhosa people (SAX) study in South Africa

Background. Evidence from high-income countries suggests that childhood trauma is associated with schizophrenia. Studies of childhood trauma and schizophrenia in low and middle income (LMIC) countries are limited. This study examined the prevalence of childhood traumatic experiences among cases and controls and the relationship between specific and cumulative childhood traumatic experiences and schizophrenia in a sample in South Africa. Methods. Data were from the Genomics of Schizophrenia in the South African Xhosa people study. Cases with schizophrenia and matched controls were recruited from provincial hospitals and clinics in the Western and Eastern Cape regions in South Africa. Childhood traumatic experiences were measured using the Childhood Trauma Questionnaire (CTQ). Adjusted logistic regression models estimated associations between individual and cumulative childhood traumatic experiences and schizophrenia. Results. Traumatic experiences were more prevalent among cases than controls. The odds of schizophrenia were 2.44 times higher among those who experienced any trauma than those who reported no traumatic experiences (95% CI 1.77–3.37). The odds of schizophrenia were elevated among those who experienced physical/emotional abuse (OR 1.59, CI 1.28–1.97), neglect (OR 1.39, CI 1.16–1.68), and sexual abuse (OR 1.22, CI 1.03–1.45) compared to those who did not. Cumulative physical/emotional abuse and neglect experiences increased the odds of schizophrenia as a dose–response relationship. Conclusion. Childhood trauma is common in this population. Among many other benefits, interventions to prevent childhood trauma may contribute to a decreasing occurrence of schizophrenia