Orthodox Health Research Articles

Assessing the Use and Diversity of the Common Ethnomedicinal Flora of Pangi- A Cold Desert Region of North-West Himalayas

Pangi -a dry temperate region of north-west Himalayas, is known ordnance of aromatic & medicinal plants and conventional knowledge coupled with these plants. Rich traditions and philosophy are deeply imbued in the cultural ethos of the natives while the modernity still eludes them, signalling a good scope for ethnobotanical studies. The inhabitants of the Pangi valley use various plant parts for curing different diseases like cough & cold, fever, burns, joint pains and stomach troubles besides using them for making household articles and in religious rites. The present study deals with twenty major medicinal plants used by the natives of the Pangi valley to cure a variety of ailments as the orthodox health care system practised by the local healers (Vaidyas). On extensive review of relevant research literature it was revealed that the use of these plants was never recorded before and hence the present investigation qualifies as a pioneering endeavour. The traditional herbal medicine is still the most prevalent system in the area while the modern health care systems are slowly creeping in.

Prevalence of obstetric complications in pregnant women in Osisioma-NgwaLocal Government Area, (LGA). Abia State, Nigeria

Background: Complications during pregnancy and childbirth are leading causes of death and disability among women of reproductive age in developing countries even though majority of these deaths are due to preventable causes; consequently, improving maternal health is one of the Millennium Development Goals with a target of 75% reduction in maternal deaths by 2015. Objective: To determine the prevalence of obstetric complications in both orthodox and un-orthodox health care in Osisioma-Ngwa LGA., Abia state, Nigeria. Methods and Materials: A descriptive cross-sectional study carried out in Osisioma-Ngwa LGA,Abia State, among 431 women of child bearing age selected using systemic sampling method. Data were collected using a self- administered questionnaire; data analysis was done using Statistical Package for Social Sciences (SPSS) version 26. Result: Out of the 431 participants in the study, there was 384 (90%) response rate, 178 (46.40%) had Ante-natal Care (ANC) in non-orthodox centers, whereas 206 (53.60%) had ANC in orthodox centers. One hundred and twenty-one (31.50%) delivered their babies outside a hospital setting and 263 (68.50%) had their babies in orthodox setting. Out of 92 (24.40%) of those who had problem during pregnancy, 51 (55.43%) of them had ANC outside a hospital setting while 41 (44.57%) used the hospital ANC. These problems were hypertension 22 (23.91%) and bleeding 70 (76.09%). Also, out of 231 (60.20%) of those who had problem during delivery or immediately after, 119 (51.52%) delivered outside a hospital setting. Prevalence of complication is 13.28% from non-orthodox centres against 10.68% from orthodox centres. The major problems included; bleeding per vaginum 120 (31.25%), failure to progress in labor 53 (13.80%), fever 51 (13.28%). Conclusion: The findings in this study suggest the importance of strengthening maternal and child health policies in the state. The prevalence of obstetric complications is higher with the patronage of non-orthodox obstetric care facilities.

Where, why and who delivers our babies? Examining the perspectives of women on utilization of antenatal and delivery services in a developing country

BackgroundThe differences in maternal mortality between developed and developing countries is due to differences in use of antenatal and delivery services. The study was designed to determine the views of women on utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria.MethodsCommunity based descriptive exploratory study design was employed. Qualitative data was collected through use of pre-tested focus group discussion (FGD) guide. Eight FGDs were conducted among women who were pregnant and others who have delivered babies one year prior to the study. Four FGDs each were conducted in urban and rural communities. QDA Miner Lite v2.0.6 was used in the analysis of the data.ResultsMost of the participants in urban and rural areas prefer the man and woman deciding on where to receive antenatal and deliver care. All the participants in urban and rural communities wish for the support of their husbands when pregnant. Perceived quality of care is the major reason the women choose a facility for antenatal and delivery services. Others reasons included cost of services and proximity to a facility. Participants in rural communities were of the opinion that traditional birth attendants deliver unique services including helping women to achieve conception. For participants in urban, traditional birth attendants are very friendly and perhaps on divine assignment. These reasons explain why women still patronize their services. The major criticism of services of traditional birth attendants is their inability to manage complications associated with pregnancy and delivery. The major reasons why women delivery at home included poverty and cultural beliefs.ConclusionsAll efforts should be made to reduce the huge maternal death burden in Nigeria. This may necessitate the involvement of men and by extension communities in antenatal and delivery matters. There is need to train health workers in orthodox health facilities on delivery of quality healthcare. Public enlightenment on importance of health facility delivery will be of essence. Encouraging women to deliver in health facilities should be prioritized. This may entail the provision of free or subsidized delivery services. The deficiencies of primary health centers especially in rural communities should be addressed.

We love orthodox medicine but still use our 'Elewe omo': Utilization of traditional healers among women in an urban community in Nigeria.

Background:Traditional Medicine refers to knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures. Women have been reported to utilize orthodox health care facilities more hence this study in an urban center.Objective:To determine the utilization of traditional healers, preference of healthcare and co-utilization of traditional and orthodox medicine among women in an urban community in Lagos, Nigeria.Method:A cross sectional design using a multistage sampling to select 270 women in Mosan Okunola, Lagos, Nigeria in 2019. A pretested semi-structured intervieweradministered questionnaire and an in-depth interview were used to obtain data from participants. Utilization of traditional healers was referenced within the last 12 months.Result:Sixty three percent (63.2%) of the study population utilized traditional healers and 80.6% of respondents that accessed healthcare utilized traditional healers. The Traditional Medicine ingredient dealer was the most patronized (74.6% of respondents). Eighty three percent (83.3%) of study participants indicated preference for orthodox medicine and 53.1% of the study respondents co-utilized both traditional healers and orthodox medicine. Concurrent use of both traditional and orthodox medicine was not a common practice among the women. Level of education, monthly income and means of payment for treatment had a statistical significant association (P < 0.05) with utilization of traditional healers but means of payment for treatment was the singular predictive factor of utilization of traditional healers.Conclusion:Utilization of traditional healers among women in this community was high with majority indicating a preference for orthodox medicine. It is recommended that an in-depth history of remedies used by patients should be delved into by orthodox health practitioners.

African Rigorous Innovative Stroke Epidemiological Surveillance: Protocol for a Community-Based Mobile-Health Study

Despite projections of stroke being a leading cause of mortality in Africa, reliable estimates of stroke burden on the continent using rigorous methods are not available. We aimed to implement a mobile-Health community-based interactive Stroke Information and Surveillance System to sustainably measure stroke burden and improve stroke health literacy and outcomes in urban and rural sites in Nigeria. African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) is an observational cohort study, which will be conducted in urban (Ibadan North LGA Ward 3) and rural (Ibarapa Central LGA) sites with a combined base population of over 80,000 people. The study will use a consultative approach to establish an mHealth-based Stroke Information and Surveillance System comprising a Stroke Alert System and a Stroke Finding System. These systems will enable the community to report stroke events and the research team/health workers find stroke cases using phone calls, short message service, and Voice Over Internet Protocols (VoIP). We will update community household data and geo-locate all households. Over the 5 years of the study, the system will collect information on stroke events and educate the community about this disease. Reported stroke cases will be clinically adjudicated at home and in prespecified health facilities. Baseline and endline community surveys will be conducted to assess stroke occurrence and other important study variables. The proportion of strokes alerted and found will be determined over the study period. Focus group discussions and key informant interviews will be conducted to understand community stroke literacy and perspectives. The study will also assess any impact of these efforts on time from stroke onset to referral, community uptake of orthodox health services for stroke patients. ARISES is anticipated to establish proof of concept about using mHealth for stroke surveillance in Africa. The potential impact of the SISS on improving patient outcomes will also be determined.

Perceptions and Experiences of Orthodox Health Practitioners and Hospital Administrators towards Integrating Traditional Medicine into the Ghanaian Health System.

The government of Ghana has been piloting traditional medicine (TM) integration in 17 health facilities across the country. However, the nature of current practice of integrated healthcare has not been thoroughly explored. This paper sought to explore the experiences and recommendations of orthodox health practitioners and hospital administrators in the Ashanti region regarding the practice of integrated healthcare in Ghana. The study adopted a qualitative, phenomenological approach involving 22 interviews. Purposive sampling technique was used in selecting study participants. Framework analysis was used to draw on the experiences of participants relating to TM integration. Participants were knowledgeable about the existence of integrated health facilities and stated that TM integration has created options in health services. However, participants deemed the integrated system ineffective and attributed the inefficiency to poor processing and certification of TM products, opposition of medical doctors to TM usage, absence of a protocol to guide the integration process, and inadequate publicity. Professional training of TM practitioners and inclusion of TM in medical school curriculum could improve collaboration between the health practitioners. Future research should focus on assessing the opinions and involvements of TM practitioners regarding the integration of traditional therapies into national health systems.

Facilitators and Barriers to Health Seeking among People Who Use Drugs in the Sunyani Municipality of Ghana: An Exploratory Study.

Drug use is one of the global public health issues, and its accompanying disorders have consequences on people's mental, physical, and environmental health. Nevertheless, the majority of people who use drugs have never been treated for drug dependence and other health conditions whilst others discontinue their treatment for drug use disorder. Using the health belief model, the study aimed at exploring facilitators and barriers to health-seeking among people who use drugs in the Sunyani Municipality of Ghana. A descriptive study design was used, employing a qualitative approach. In-depth interviews were conducted with a total of 22 participants, including two key informants (male and female). The first group of participants was recruited from the ghetto (an area in the municipality where people who use drugs are usually located). The other group of participants was recruited using hospital-based records. The interview data were transcribed, coded, and analysed for the generation of themes with the aid of Nvivo version 12 pro. The results showed that people who use drugs face health challenges such as drug dependence, malaria, lungs and breathing complications, cardiovascular complications, and skin complications. People who use drugs experienced poor perceived quality of life and low health status. Health-seeking behaviours of interviewees were influenced by the perceived benefit, perceived severity, cues to action, among others. Multiple sources of healthcare were used by the people who use drugs. Whereas ease of communication, perceived severity, benefit, among others were facilitators to their health-seeking behaviours, cost, dwindling social support, lack of knowledge of the condition, and fear of arrest by law enforcement agencies also served as barriers to seeking healthcare at the orthodox health facilities. This paper suggests a holistic approach to help improve the health and health-seeking behaviours of people who use drugs. The researchers wish to indicate that an earlier version of this manuscript has been presented at the University of Ghana as a thesis.

Medical Cultures, Therapeutic Properties, and Laws in Global History

Medical Cultures, Therapeutic Properties, and Laws in Global History

Interface between orthodox and traditional medicine and alternative paradigm for integrating orthodox and traditional health care in Nigeria

Traditional medicine refers to the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, used in the maintenance of health and in the prevention, diagnosis, improvement of physical and mental illness. Herbal treatments are the most form of traditional medicine and 70 – 80% of the African region has used a form as primary health care. There is little doubt that the use of herbal medicines is growing and one of the most problems found in medicinal plants is the absence of clinical, toxicological and pharmacological studies. Many African countries depend on herbal medicines because of their efficacy, affordability and availability. The future of African traditional medicine is bright if view in the context of service provision, increase of health care coverage, economic potential and poverty reduction. Formal recognition and integration of traditional medicine into conventional medicine would be of good advantage.

Improving dog bite victim survey and estimation of annual human deaths due to suspected rabies cases in three selected Liberian cities and environs, 2008-2017.

Rabies remains a public health challenge of unknown magnitude in Liberia in spite of the goal of ensuring that no human in the country dies of rabies by 2030. The annual prevalence of Dog Bite Victims (DBVs) and true load of Annual Human Deaths (AHDs) due to rabies were not known. We investigated three selected cities of Liberia for annual prevalence of DBVs and true load of AHD due to suspected rabies, using 10–year retrospective record, 2008–2017 obtained from Buchanan, Gbarnga, and Voinjama, three socio-economically important cities in post-conflict Liberia. Data were sourced at County Reference Hospitals and at the Liberia National Institute of Health for these cities and their local environs. In addition, household questionnaire survey was used to identify and audit data quality for unreported DBVs, and treatment received from traditional caregivers. The proportion was used to audit the 10-year data on unreported DBVs in the cities. Descriptive statistics was used to summarize annual DBVs over the 10-year period in the three cities, respectively. A standardized clinical decision tree model was used to estimate AHDs due to suspected rabies. Based on questionnaire survey, 140/365, 148/375 and 146/350 DBVs did not visit any orthodox health facility in Buchanan, Gbarnga and Voinjama cities, respectively in 2014. An estimated total of 559 DBVs died of suspected rabies in the three cities and their environs during the 10-year period. Mean yearly prevalence of DBVs was 179±106.82, 393±257.85 and 76.9±38.11 per 100,000 population, while mean AHDs due to suspected rabies was 14.3±8.47, 35.5±23.25, and 6.1±3.21 per 100,000 population in Buchanan, Gbarnga, and Voinjama cities, respectively. The present findings provide annual prevalence of suspected rabies cases, corrected for under-reporting in three selected cities of Liberia. The findings would be useful in planning for stepwise actions towards rabies elimination, ensuring that no human dies of rabies in Liberia by 2030.

Socio-clinical correlates of the perinatal outcome of severe perinatal asphyxia among referred newborn babies in Sagamu

Background: Most deliveries in the developing world take place outside the hospital with poor assistance for the newborn. This puts the babies at risk of severe intrapartum events such as perinatal asphyxia. Most newborn babies admitted in tertiary centres with severe asphyxia are referred.Objectives: To determine the socio-demographic and clinical correlates of the perinatal outcome of neonates referred to a Nigerian tertiary facility on account of severe perinatal asphyxia.Methods: A prospective crosssectional study was conducted at the Children’s Emergency Room and Neonatal Ward among newborn babies referred with severe asphyxia. Socio-demographic and clinical parameters were recorded and statistically analysed.Results: A total of 72 mother infant pairs were studied. Half of the babies were admitted after 24 hours of birth and 75.0% of the families belonged to the lower socio-economic classes. Only 62.5% of mothers received antenatal care at orthodox health facilities. Most of the deliveries tookplace at private hospitals (29; 40.3%) and Traditional Birth Homes (18; 25.0%). Hypoxic- Ischaemic encephalopathy (HIE) was diagnosed among 57 (79.2%) babies with 46 (80.7%) and 11 (19.3%) classified as Stages II and III HIE respectively. There were 15 (20.8%) early neonatal deaths giving a perinatal mortality rate of 208.3/1000 admissions. The poor perinatal outcome was associated with age at admission within 24 hours, poor intrapartum careseeking behaviour and the commencement of feeding before admission .Conclusion: The quality of antenatal care, intrapartum care, and delivery services appear to influence perinatal outcomes among referred babies with severe asphyxia.&#x0D; Keywords: Asphyxia, Hypoxic-Ischaemic Encephalopathy, Intrapartum care, Perinatal mortality, Out-born

Health-seeking behaviour among migrant female head porters in the City of Accra, Ghana

Migration is an important feature of human development and a significant driver of societal change and well-being across populations. One key aspect of contemporary migration is the rise in female migration, contributing to the debate on urbanization with implications for the health of migrants. This study examined the health behaviour of migrant female head porters in Accra. The study design was cross-sectional with an interview-administered survey. A multistage sampling technique was employed to select communities and 213 respondents. Data were analysed using the SPSS software. From the results, 41.1% were within ages 15-19 years, 41.7% were Mamprusis, and 59.1% were not married. About 65.5% knew the existence of a health facility around their residence, with 75.5% seeking healthcare outside orthodox health facilities. A significant association was established between marital status and education and where healthcare was sought. Respondents who saved money, had Health Insurance cards, and receive support from others were more likely to visit health facilities. The study concludes that the predictors of health-seeking behaviour among the respondents are the possession of health insurance; level of saving, social support they receive from others including marital status and education. Respondents should be encouraged to possess health insurance and save money. Keywords: Health-Seeking, Behaviour, Migrants, Female, Head-Porters, Behaviour

Cultural beliefs and practices of women influencing home births in rural Northern Ghana.

Background: One of the maternal health care strategies identified by the World Health Organization as being crucial for saving lives of pregnant women, which also serves as an indicator for progress in reducing maternal mortality, is the provision and utilization of skilled birth care. Despite the importance of skilled birth care in preventing maternal morbidity and mortality, many women continue to give birth at home without the assistance of skilled birth attendants in rural communities of Ghana.Purpose: The purpose of this study was to explore the cultural beliefs that potentially influenced the choice of home births among rural women in Ghana.Methods: A qualitative approach was utilized to conduct this study. Twenty participants who delivered at home were purposefully selected and interviewed individually. Semistructured interviews were used to explore the cultural belief patterns that potentially influenced the choice of home births among women in rural Ghana. Thematic analysis approach was used to analyze the data.Results: Four major themes emerging from the data analysis which influenced rural women’s decision to give birth at home are namely: opportunity to access psychological support through family members, opportunity to access culturally acceptable food, opportunity to adopt a birthing position of choice, and opportunity for safe and culturally accepted disposal of placenta.Conclusion: This study concluded that the cultural beliefs held by these women greatly affected their decision to deliver at home. Hence, there is a need for health care managers to facilitate collaborative practices between the skilled birth attendants and traditional birth attendants. This is because this approach could enhance the integration of the cultural beliefs and practices of women in the orthodox health care delivery system to facilitate the utilization of skilled birth care.

Maternal mortality: Lessons of the millenium development goals, a way forward

Maternal mortality: Lessons of the millenium development goals, a way forward

Factors influencing the utilization of TBA services by women in the Tolon district of the northern region of Ghana

Maternal mortality issues have become a major cause for concern especially in developing counties as they struggle to attain the Sustainable Development Goals 3.1 and 3.2. Tradi tional Birth Attendants (TBAs) have played a significant role in providing maternal health services, especially in rural Africa. Health service providers have done a lot to provide ma- ternal health services to pregnant women in Ghana yet most women, especially in rural areas, still, patronize the services of (TBAs). The aim of this paper is to determine the fac- tors that influence women in the Tolon district of Ghana to patronize the services of TBAs. The paper employed a mixed research approach and adopted the cross-sectional survey design to collect and analyse data. The study involved 360 women who have sought the services of TBAs within the last five years. Data were collected with the use of question- naires containing both open-ended and closed-ended questions. The factors that influenced the patronage of TBAs included the fact that TBA services are cheaper, more culturally ac- cepted, nearer to the homes of pregnant women than the hospital, TBAs being more caring than orthodox health workers and being the only maternity care that women know. It is recommended that since the factors that influence the patronage of TBA services cannot easily be abolished the health authorities should integrate TBA services in mainstream maternal health care delivery.

Prevalence and pattern of cardiovascular-related causes of out-of-hospital deaths in Lagos, Nigeria

In developed countries 50% - 75% of deaths from cardiovascular-diseases occurs out-of-hospital. In Nigeria where patronage of orthodox health facilities is low, the impact of cardiovascular-related diseases on out-of-hospital mortality has been sparsely studied. To determine the prevalence and pattern of cardiovascular-related causes of out-of-hospital deaths in Lagos, Nigeria. A 5-year retrospective review of all autopsied medical decedents brought-in-dead (BID) to a Nigerian tertiary health facility to identify cardiovascular-related causes of death. A total of 90 cardiovascular-related deaths out of 176 medical BID cases were identified, giving a prevalence of 51.1%. Mean age was 65.2 ± 15.6 years. Male: Female ratio was 1.4: 1, the females were older (68.29 ± 14.89) vs (61.63 ± 15.55) years. Age group > 60 years accounted for 63.3% of deaths. Commonest primary diseases were hypertensive heart disease (48.9%) and cerebrovascular accident (24.4%). Myocardial infarction occurred in 8.9%. Heart failure, cerebral dysfunction and unspecified circulatory collapse were the causes of death in 54.4%, 23.3% and 14.4% respectively. Cardiovascular-related diseases are major contributors to out-of-hospital medical deaths occurring chiefly in those >60 years. Hypertensive heart disease and heart failure are the greatest contributors to this cardiovascular-related disease mortality.

Justifications for using complementary and alternative medicine reported by persons with musculoskeletal conditions: A narrative literature synthesis.

BackgroundComplementary and alternative medicine (CAM) is very popular with patients frequently combining it with orthodox health care. The high prevalence of CAM use and satisfaction with CAM reported by patients directly challenges an orthodox system that can only approve such use if it results from the application of biomedical concepts and science. Studies highlighting this as a cultural, sociological and historical phenomenon emphasise the value of choice for consumers of health care. Musculoskeletal conditions typify common problems for which the effectiveness of orthodox care is often unclear. We postulated that the reasons people give for using or not using CAM for musculoskeletal conditions, would therefore indicate the full range of expectations that people have of health care. Furthermore, these reasons would indicate how much people feel orthodox health care is or is not meeting their expectations. Therefore, this study aims to investigate people’s reasons for choosing or avoiding CAM for non-traumatic musculoskeletal conditions.MethodsA systematic search and narrative synthesis was conducted of published qualitative and quantitative studies related to CAM and non-traumatic musculoskeletal conditions.ResultsWe identified 169 relevant papers detailing 152 separate studies, from which 1486 justifications were extracted concerning CAM use. Content analysis resulted in 11 distinct categories across four themes: practical aspects of care, clinical effectiveness, non-clinical outcomes of care, and a person’s philosophy of illness and care. People provided similar rationales for both using and avoiding CAM, emphasising that, whilst CAM is perceived by many patients with musculoskeletal conditions to fill gaps in care (such as practitioner time or quality of the therapeutic relationship), orthodox care also seeks to deliver these aspects of care. However, people who used CAM also highlighted its alignment with their general philosophy and ideas about illness and health care, and often emphasised CAM’s capacity to give them control over their condition and its treatment.ConclusionCurrently, CAM appears to have a significant role for patients with common painful long-term conditions in providing choices to enable individual needs to be met.

Socio-Economic Determinants of Healthcare Service Utilization among Rural Dwellers in Akpabuyo Lga, of Cross River State, Nigeria

Abstract Socio-economic determinants of healthcare services utilization were investigated in Akpabuyo Local Government Area using structured questionnaires, administered to adults in the study area. The general objective of this study was to determine the reason behind underutilization of orthodox health services in the area with particular attention to the socio-economic factors; specific objectives were to ascertain the influence of income level and the relationship between proximity of health facilities and utilization. The research design adopted for this study was the cross-sectional survey design; a sample size of 400 was drawn from adults, selected from each household and the Multi-stage sampling technique was utilized for the process of data collection, which consisted of the systematic random and the purposive sampling techniques. One way analysis of variance (ANOVA) and the Pearson product moment correlation (PPMC) were used in the analysis of data generated, for the purpose of arriving at a conclusion and policy recommendation. The findings from this research revealed that income level at all three categories; low, middle and high had significant influence on the utilization of healthcare services, and the proximity of healthcare facilities concerning their distance and location also had a significant relationship on their utilization. Conclusively, it was recommended that there should be equitable distribution of functional health facilities within the wards to reduce distance and travel time, as well as an improvement on household income of rural dwellers in Akpabuyo through numerous private and government interventions as well as improved commercial activities.

Assessment of Perinatal Care Satisfaction Amongst Mothers Attending Postnatal Care in Ibadan, Nigeria.

Introduction:Patient satisfaction has been identified as a major index in the assessment of quality of healthcare globally. Mothers judge the quality of perinatal care received based on their satisfaction with the services provided, thus influencing their utilization of the available health facilities. There is currently a dearth of literature on users’ satisfaction of services rendered at the primary level of care, which is the first port of call to the health system aimed at serving majority of the populace.Objectives:The study was set out to investigate maternal satisfaction with perinatal care received in selected primary health centres in Ibadan.Methods:The study was a cross-sectional survey involving 66 women receiving postpartum care from five randomly selected primary health centres in Ibadan north-west local government using a 72-itemed questionnaire with p ≤ 0.05.Findings:The majority of the respondents (98.5%) perceived the perinatal care they received as high quality, and 94% and 98% were satisfied with services and facilities used for their care, respectively. Identified causes of dissatisfaction included dirty hospital environment, inadequate water supply and hospital facilities, distance of hospital location, cost of materials, time wasting, inadequate staffing and poor attitude, and verbal and physical abuse. An association exists between maternal satisfaction with quality of care and future intention for subsequent utilization (χ2 = 13.306; p = 0.0001).Conclusion:The overall maternal satisfaction on the perinatal care provided was perceived as very good. However, few domains of dissatisfaction were identified that would need to be addressed by healthcare professionals and policymakers to sustain and improve utilization of orthodox health care services amongst mothers, thereby contributing to achieving the third Sustainable Development Goal.

COllaborative Shared care to IMprove Psychosis Outcome (COSIMPO): study protocol for a randomized controlled trial

BackgroundPsychotic disorders are a group of severe mental disorders that cause considerable disability to sufferers and a high level of burden to families. In many low- and middle-income countries (LMIC), traditional and faith healers are the main providers of care to affected persons. Even though frequently canvassed as desirable for improved care delivery, collaboration between these complementary alternative health providers (CAPs) and conventional health providers has yet to be rigorously tested for feasibility and effectiveness on patient outcomes.Methods/designCOSIMPO is a single-blind, cluster randomized controlled trial (RCT) being conducted in Nigeria and Ghana to compare the effectiveness of a collaborative shared care (CSC) intervention program implemented by CAPs and primary health care providers (PHCPs) with care as usual (CAU) at improving the outcome of patients with psychosis. The study is designed to test the hypotheses that patients receiving CSC will have a better clinical outcome and experience fewer harmful treatment practices from the CAPs than patients receiving CAU at 6 months after study entry. An estimated sample of 296 participants will be recruited from across 51 clusters, with a cluster consisting of a primary care clinic and its neighboring CAP facilities. CSC is a manualized intervention package consisting of regular and scheduled visits of PHCPs to CAP facilities to assist with the management of trial participants. Assistance includes the administration of antipsychotic medications, management of comorbid physical condition, assisting the CAP to avoid harmful treatment practices, and engaging with CAPs, caregivers and participants in planning discharge and rehabilitation. The primary outcome, assessed at 6 months following trial entry, is improvement on the Positive and Negative Symptom Scale (PANSS). Secondary outcomes, assessed at 3 and 6 months, consist of levels of disability, experience of harmful treatment practices and of victimization, and levels of perceived stigma and of caregivers’ burden.DiscussionInformation about whether collaboration between orthodox and complementary health providers is feasible and can lead to improved outcome for patients is important to formulating policies designed to formally engage the services of traditional and faith healers within the public health system.Trial registrationNational Institutes of Health Clinical Trial registry, ID: NCT02895269. Registered on 30 July 2016