Abstract
BackgroundTraditional healers are acceptable and highly accessible health practitioners throughout sub-Saharan Africa. Patients in South Africa often seek concurrent traditional and allopathic treatment leading to medical pluralism.Methods & findingsWe studied the cause of five traditional illnesses known locally as “Mavabyi ya nhloko” (sickness of the head), by conducting 27 in-depth interviews and 133 surveys with a randomly selected sample of traditional healers living and working in rural, northeastern South Africa. These interviews were carried out to identify treatment practices of mental, neurological, and substance abuse (MNS) disorders. Participating healers were primarily female (77%), older in age (median: 58.0 years; interquartile range [IQR]: 50–67), had very little formal education (median: 3.7 years; IQR: 3.2–4.2), and had practiced traditional medicine for many years (median: 17 years; IQR: 9.5–30). Healers reported having the ability to successfully treat: seizure disorders (47%), patients who have lost touch with reality (47%), paralysis on one side of the body (59%), and substance abuse (21%). Female healers reported a lower odds of treating seizure disorders (Odds Ratio (OR):0.47), patients who had lost touch with reality (OR:0.26; p-value<0.05), paralysis of one side of the body (OR:0.36), and substance abuse (OR:0.36) versus males. Each additional year of education received was found to be associated with lower odds, ranging from 0.13–0.27, of treating these symptoms. Each additional patient seen by healers in the past week was associated with roughly 1.10 higher odds of treating seizure disorders, patients who have lost touch with reality, paralysis of one side of the body, and substance abuse. Healers charged a median of 500 South African Rand (~US$35) to treat substance abuse, 1000 Rand (~US$70) for seizure disorders or paralysis of one side of the body, and 1500 Rand (~US$105) for patients who have lost touch with reality.ConclusionsWhile not all healers elect to treat MNS disorders, many continue to do so, delaying allopathic health services to acutely ill patients.
Highlights
Mental health, neurological, and substance abuse disorders (MNS) are the leading cause of disability worldwide, accounting for 28.5% of all years lived with disability[1] Despite this global burden, fewer than 25% of affected individuals ever access mental health or neurological treatment [2]; in low and middle income countries (LMICs), utilization is much lower [3]
We studied the cause of five traditional illnesses known locally as “Mavabyi ya nhloko”, by conducting 27 in-depth interviews and 133 surveys with a randomly selected sample of traditional healers living and working in rural, northeastern South Africa
Neurological, and substance abuse disorders (MNS) are the leading cause of disability worldwide, accounting for 28.5% of all years lived with disability[1] Despite this global burden, fewer than 25% of affected individuals ever access mental health or neurological treatment [2]; in low and middle income countries (LMICs), utilization is much lower [3]
Summary
Neurological, and substance abuse disorders (MNS) are the leading cause of disability worldwide, accounting for 28.5% of all years lived with disability[1] Despite this global burden, fewer than 25% of affected individuals ever access mental health or neurological treatment [2]; in low and middle income countries (LMICs), utilization is much lower [3]. The recognition of the paucity of allopathic mental health care providers in South Africa’s public sector—there are only 0.4 psychiatrists and 0.3 psychologists per 100,000 people [8]–has led to innovative solutions, including task sharing models being proposed and recently adopted in the government’s Mental Health Policy Framework and Action Plan (2013–2020)[9]. Even with these innovative policies, challenges in implementing the integration remain [10]. Patients in South Africa often seek concurrent traditional and allopathic treatment leading to medical pluralism
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