Abstract
ObjectiveTo determine the naturalistic outcome of treatment of psychosis by traditional healers in Jinja and Iganga districts of Eastern Uganda.MethodA cohort of patients with psychosis receiving treatment from traditional healers’ shrines were recruited between January and March 2008 and followed up at three and six months. The Mini International Neuropsychiatry Interview (MINI Plus) was used for making specific diagnosis at the point of contact. For specific symptoms, Positive and Negative Symptom Scale (PANSS), Young Mania Rating Scale (YMRS) and Montgomery Asberg Depression Rating Scale (MADRS) were used to measure severity of schizophrenia, mania and psychotic depression, respectively. The Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) were used for objective assessments. The Compass Mental Health Index measured well being. Mean scores of the scales were computed using one way ANOVA for independent samples. Associations between outcome and categorical variables were examined at bivariate and multivariate levels.ResultsAll the symptom scales had a percentage reduction of more than 20% at three and six months follow up. The differences between the mean scores of the scales at baseline and 3 months, baseline and 6 months, and 3 and 6 months were all significant (P < 0.0001). The post test for pair wise comparisons, the Tukey HSD (Honestly Significant Difference) test was also all significant at P < 0.01 except for MADRS where there was no significant difference between 3 and 6 months for depression severity. Over 80% of the participants used biomedical services for the same symptoms in the study period. At 3 months follow up, patients who combined treatment were less likely to be cases (P = 0.002; OR 0.26 [0.15-0.58]), but more likely to be cases at 6 months follow up (P = 0.020; OR 2.05 [1.10-3.189]). Being in debt was associated with caseness both at 3 and 6 months.ConclusionThis study suggests that there may be some positive effects for patients with psychosis who combine both biomedical services and traditional healing. Further research in the area of naturalistic outcome of traditional healing is necessary.
Highlights
This study suggests that there may be some positive effects for patients with psychosis who combine both biomedical services and traditional healing
Faced with the challenge of evidence-based medicine, those who argue for the collaboration with traditional healers are often challenged with the question: “Does it work?” The lack of evidence is partly due to the difficulty of conducting evaluations of the complex social interventions typically deployed within traditional healing practices [14]
Conventional Western Medicine (CWM) practitioners will be able to serve as more useful sources of information to their patients and advise them appropriately and give the much needed information to policy makers on the role of traditional healing practices in planning community mental health care [14]
Summary
The sample of 115 participants consisting of 51 Females (44.35%) and 64 males (55.65%), were drawn from 387 attendees at the traditional healers’ shrines or clinics over a six months period Their specific diagnoses were: Schizophrenia (28, 24.30%); Mania (41, 35.70%); Psychotic depression (46, 40%). In the six months follow up, the figures dropped by about half for mania and psychotic depression (18/36, 50.00%, 95%CI 34.40-65.60) and (13/28, 46.43%, 95%CI 29.4564.31), respectively. While for schizophrenia, it more or less remained the same (12/26, 46.13%, 95% CI 28.6764.67).
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