Changing use of traditional healthcare amongst those dying of HIV related disease and TB in rural South Africa from 2003 – 2011: a retrospective cohort study

BMC Complementary and Alternative Medicine

Stephen M Tollman²  Peter Byass⁴  Mark Collinson²  Sangeetha Madhavan³  Kathleen Kahn²  Chodziwadziwa Kabudula²  Francesc Xavier Gómez-Olivé²  Ryan G Wagner²  Paul Mee¹ 

[1] Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK;International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana;Department of African-American Studies, University of Maryland-College Park, College Park, MD, USA;WHO Collaborating Centre for Verbal Autopsy, Umeå, Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

关键词: Risk factor;    Sub-Saharan Africa;    South Africa;    Demographic surveillance system;    Tuberculosis;    Mortality;    AIDS;    HIV;    Antiretroviral therapy;    Traditional medicine;    Traditional medical practitioner;   

Others  :  1117840
DOI  :  10.1186/1472-6882-14-504

 received in 2014-07-04, accepted in 2014-11-20,  发布年份 2014

【 摘 要 】

Background

In 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. The effective integration of traditional medical practitioners and biomedical providers in HIV prevention and care has been demonstrated. However concerns remain that the use of traditional treatments for HIV-related disease may lead to pharmacokinetic interactions between herbal remedies and ART drugs and delay ART initiation. Here we analyse the changing prevalence and determinants of traditional healthcare use amongst those dying of HIV-related disease, pulmonary tuberculosis and other causes in a rural South African community between 2003 and 2011. ART was made available in this area in the latter part of this period.

Methods

Data was collected during household visits and verbal autopsy interviews. InterVA-4 was used to assign causes of death. Spatial analyses of the distribution of traditional healthcare use were performed. Logistic regression models were developed to test associations of determinants with traditional healthcare use.

Results

There were 5929 deaths in the study population of which 47.7% were caused by HIV-related disease or pulmonary tuberculosis (HIV/AIDS and TB). Traditional healthcare use declined for all deaths, with higher levels throughout for those dying of HIV/AIDS and TB than for those dying of other causes. In 2003-2005, sole use of biomedical treatment was reported for 18.2% of HIV/AIDS and TB deaths and 27.2% of other deaths, by 2008–2011 the figures were 49.9% and 45.3% respectively. In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003–2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality. In the multivariate model only country of origin, time period and illness duration remained associated.

Conclusions

There were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB. No associations between socio-economic position, age or gender and the likelihood of traditional healthcare use were seen. Further qualitative and quantitative studies are needed to assess whether these figures reflect trends in healthcare use amongst the entire population and the reasons for the temporal changes identified.

【 授权许可】

   
2014 Mee et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Peltzer K, Mngqundaniso N: Patients consulting traditional health practioners in the context of HIV/AIDS in urban areas in KwaZulu-Natal, South Africa. Afr J Tradit Complement Altern Med 2008, 5(4):370-379.
• [2]WHO: Fact sheet No.134, Traditional Medicine. 2003. http://www.who.int/mediacentre/factsheets/2003/fs134/en/ webcite Access date 04-Dec-2014
• [3]Peltzer K: Traditional health practitioners in South Africa. Lancet 2009, 374(9694):956-957.
• [4]Homsy J, King R, Balaba D, Kabatesi D: Traditional health practitioners are key to scaling up comprehensive care for HIV/AIDS in sub-Saharan Africa. AIDS 2004, 18(12):1723-1725.
• [5]King RBD, Kaboru B, Kabatesi D, Pharris A, Homsy J: The role of traditional Healers in comprehensive HIV/AIDS Prevention and care in africa: untapped opportunities. In From the Ground Up: Building Comprehensive HIV/AIDS Care Programme in Resource-Limited Settings, Developing Pathways and Partnerships, Volume 3. Washington DC: Elisabeth Glaser Pediatric AIDS Foundation; 2009. http://b.3cdn.net/glaser/515eaa8068b5e71d44_mlbrof7xw.pdf webcite
• [6]Harding R, Higginson IJ: Palliative care in sub-Saharan Africa. Lancet 2005, 365(9475):1971-1977.
• [7]Harding R, Stewart K, Marconi K, O'Neill JF, Higginson IJ: Current HIV/AIDS end-of-life care in sub-Saharan Africa: a survey of models, services, challenges and priorities. BMC Public Health 2003, 3(1):33. BioMed Central Full Text
• [8]Schatz E, Gilbert L, McDonald C: ‘If the doctors see that they don't know how to cure the disease, they say it's AIDS’: How older women in rural South Africa make sense of the HIV/AIDS epidemic. Afr J AIDS Res 2013, 12(2):95-104.
• [9]Peltzer K: Utilization and practice of traditional/complementary/alternative medicine (TM/CAM) in South Africa. Afr J Tradit Complement Altern Med 2009, 6(2):175.
• [10]Lewando-Hundt G, Stuttaford M, Ngoma B: The social diagnostics of stroke - like symptoms: healers, doctors and prophets in Agincourt, Limpopo province, south Africa. J Biosoc Sci 2004, 36:433-443.
• [11]Ibanez-Gonzalez DL: Perspectives on Healthcare, Chronic non-Communicable Disease and Healthworlds in an Urban and Rural Setting: University of the Witwatersrand. Accessible from The University of the Witwatersrand Electronic Thesis and Dissertation Repository; 2013. http://wiredspace.wits.ac.za/handle/10539/15245 webcite Access date 04-Dec-2014
• [12]UNAIDS: AIDS Info. 2013. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo/ webcite Access date 04-Dec-2014
• [13]UN Office for the Coordination of Humanitarian Affairs: South Africa: Small Clinic at Centre of Debate Over Traditional Medicine. 2007. http://www.irinnews.org/report/58887/south-africa-small-clinic-at-centre-of-debate-over-traditional-medicine webcite Access date 04-Dec-2014
• [14]Mills E, Cooper C, Seely D, Kanfer I: African herbal medicines in the treatment of HIV: Hypoxis and Sutherlandia. An overview of evidence and pharmacology. Nutr J 2005, 4:19. BioMed Central Full Text
• [15]Ojikutu B, Makadzange AT, Gaolathe T: Scaling up ART treatment capacity: lessons learned from South Africa, Zimbabwe, and Botswana. Curr HIV/AIDS Reports 2008, 5(2):94-98.
• [16]Global Update on HIV Treatment 2013: Results, Impact and Opportunities WHO, UNICEF and UNAIDS WHO Geneva; 2013. http://www.who.int/hiv/pub/progressreports/update2013/en/ webcite Access date 04-Dec-2014
• [17]Floyd S, Molesworth A, Dube A, Banda E, Jahn A, Mwafulirwa C, Ngwira B, Branson K, Crampin AC, Zaba B: Population-level reduction in adult mortality after extension of free anti-retroviral therapy provision into rural areas in northern Malawi. PLoS One 2010, 5(10):e13499.
• [18]Herbst AJ, Cooke GS, Bärnighausen T, KanyKany A, Tanser F, Newell M-L: Adult mortality and antiretroviral treatment roll-out in rural KwaZulu-Natal, South Africa. Bull World Health Organ 2009, 87(10):754-762.
• [19]Müller AC, Kanfer I: Potential pharmacokinetic interactions between antiretrovirals and medicinal plants used as complementary and African traditional medicines. Biopharm Drug Dispos 2011, 32(8):458-470.
• [20]Mills E, Montori V, Perri D, Phillips E, Koren G: Natural health product–HIV drug interactions: a systematic review. Int J STD AIDS 2005, 16(3):181-186.
• [21]Peltzer K, Friend Du Preez N, Ramlagan S, Fomundam H, Anderson J, Chanetsa L: Antiretrovirals and the use of traditional, complementary and alternative medicine by HIV patients in Kwazulu-Natal, South Africa: a longitudinal study. Afr J Tradit Complement Altern Med 2011, 8:4.
• [22]Banda Y, Chapman V, Goldenberg RL, Stringer JS, Culhane JF, Sinkala M, Vermund SH, Chi BH: Use of traditional medicine among pregnant women in Lusaka, Zambia. J Altern Complement Med 2007, 13(1):123-128.
• [23]Moshabela M, Pronyk P, Williams N, Schneider H, Lurie M: Patterns and implications of medical pluralism among HIV/AIDS patients in rural South Africa. Aids Behav 2011, 15(4):842-852.
• [24]Barker R, Millard F, Malatsi J, Mkoana L, Ngoatwana T, Agarawal S, De Valliere S: Traditional healers, treatment delay, performance status and death from TB in rural South Africa. Int J Tuberc Lung Dis 2006, 10(6):670-675.
• [25]Baylies C: The impact of AIDS on rural households in Africa: a shock like any other? Dev Chang 2002, 33(4):611-632.
• [26]Babb DA, Pemba L, Seatlanyane P, Charalambous S, Churchyard GJ, Grant AD: Use of traditional medicine by HIV-infected individuals in South Africa in the era of antiretroviral therapy. Psychol Health Med 2007, 12(3):314-320.
• [27]Case A, Menendez A, Ardington C: Health Seeking Behavior in Northern KwaZulu-Natal. University of Chicago: Irving B. Harris Graduate School of Public Policy Studies; 2005. https://www.princeton.edu/rpds/papers/pdfs/case_etal_hsb.pdf webcite Access date 04-Dec-2014
• [28]Golooba Mutebi FS, Tollman SM: Confronting HIV/AIDS in a South African village: The impact of health seeking behaviour. Scand J Public Health 2007, 35(supplement 69):175-180.
• [29]Stadler J: Rumor, gossip and blame: implications for HIV/AIDS prevention in the South African lowveld. AIDS Educ Prev 2003, 15(4: Special issue):357-368.
• [30]Fottrell E, Tollman S, Byass P, Golooba-Mutebi F, Kahn K: The epidemiology of ‘bewitchment’ as a lay-reported cause of death in rural South Africa. J Epidemiol Community Health 2012, 66(8):704-709.
• [31]Okome-Nkoumou M, Okome-Miame F, Kendjo E, Obiang GP, Kouna P, Essola-Biba O, Bruno Boguikouma J, Mboussou M, Clevenbergh P: Delay between first HIV-related symptoms and diagnosis of HIV infection in patients attending the internal medicine department of the Fondation Jeanne Ebori (FJE), Libreville. Gabon HIV Clin Trials 2005, 6(1):38-42.
• [32]Wanyenze RK, Kamya MR, Fatch R, Mayanja-Kizza H, Baveewo S, Sawires S, Bangsberg DR, Coates T, Hahn JA: Missed opportunities for HIV testing and late-stage diagnosis among HIV-infected patients in Uganda. PLoS One 2011, 6(7):e21794.
• [33]Horwitz RH, Tsai AC, Maling S, Bajunirwe F, Haberer JE, Emenyonu N, Muzoora C, Hunt PW, Martin JN, Bangsberg DR: No association found between traditional healer use and delayed antiretroviral initiation in rural Uganda. Aids Behav 2013, 17(1):260-265.
• [34]Peltzer K, Preez NF, Ramlagan S, Fomundam H: Use of traditional complementary and alternative medicine for HIV patients in KwaZulu-Natal, South Africa. BMC Public Health 2008, 8(1):255. BioMed Central Full Text
• [35]Hughes GD, Puoane TR, Clark BL, Wondwossen TL, Johnson Q, Folk W: Prevalence and predictors of traditional medicine utilization among persons living with AIDS (PLWA) on antiretroviral (ARV) and prophylaxis treatment in both rural and urban areas in south Africa. Afr J Tradit Complement Altern Med 2012, 9(4):470-484.
• [36]Lubinga S, Kintu A, Atuhaire J, Asiimwe S: Concomitant herbal medicine and Antiretroviral Therapy (ART) use among HIV patients in Western Uganda: A cross-sectional analysis of magnitude and patterns of use, associated factors and impact on ART adherence. AIDS Care 2012, 24(11):1375-1383.
• [37]Namuddu B, Kalyango JN, Karamagi C, Mudiope P, Sumba S, Kalende H, Wobudeya E, Kigozi BK, Waako P: Prevalence and factors associated with traditional herbal medicine use among patients on highly active antiretroviral therapy in Uganda. BMC Public Health 2011, 11(1):855. BioMed Central Full Text
• [38]Sato A: Does socio-economic status explain use of modern and traditional health care services? Soc Sci Med 2012, 75(8):1450-1459.
• [39]Kahn K, Collinson M, Gómez-Olivé F, Mokoena O, Twine R, Mee P, Afolabi SA, Clark BD, Kabudula CW, Khosa A, Khoza S, Shabangu MG, Silaule B, Tibane JB, Wagner RG, Garenne ML, Clark SJ, Tollman SM: Profile: Agincourt health and socio-demographic surveillance system. Int J Epidemiol 2012, 41:988-1001.
• [40]Polzer Ngwato T: Together apart: migration, integration and spatialised identities in South African border villages. Geoforum 2012, 43(3):561-572.
• [41]Pronyk PM, Kim JC, Makhubele MB, Hargreaves JR, Mohlala R, Hausler HP: Introduction of voluntary counselling and rapid testing for HIV in rural South Africa: from theory to practice. AIDS Care 2002, 14(6):859-865.
• [42]Gómez Olivé FX: ‘Measuring, Monitoring, Investigating and Responding to HIV Epidemic in Agincourt: Development of an HIV Research Agenda’. Opening Address at the Wits AIDS Research Symposium, University of the Witwatersrand, Johannesburg 2009.
• [43]Houle B, Clark SJ, Gómez-Olivé FX, Kahn K, Tollman SM: The unfolding counter-transition in rural south Africa: mortality and cause of death, 1994–2009. PLoS One 2014, 9(6):e100420.
• [44]Gómez Olivé FX, Angotti N, Houle B, Klipstein Grobusch K, Kabudula C, Menken J, Williams J, Tollman S, Clark SJ: Prevalence of HIV among those 15 and older in rural South Africa. AIDS Care 2013.
• [45]Kahn K, Tollman SM, Garenne M, Gear JS: Validation and application of verbal autopsies in a rural area of South Africa. Tropical Med Int Health 2000, 5(11):824-831.
• [46]Byass P, Chandramohan D, Clark SJ, D'Ambruoso L, Fottrell E, Graham WJ, Herbst AJ, Hodgson A, Hounton S, Kahn K, Krishnan A, Leitao J, Odhiambo F, Sankoh OA, Tollman SM: Strengthening standardised interpretation of verbal autopsy data: the new InterVA-4 tool. Global Health Action 2012, 5:19281.
• [47]Byass P, Fottrell E, Dao Lan H, Berhane Y, Corrah T, Kahn K, Muhe L, Do Duc V: Refining a probabilistic model for interpreting verbal autopsy data. Scand J Public Health 2006, 34(1):26-31.
• [48]Leitao J, Chandramohan D, Byass P, Jakob R, Bundhamcharoen K, Choprapawon C, De Savigny D, Fottrell E, França E, Frøen F: Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring. Global Health Action 2013, 6:21518.
• [49]Byass P, Kahn K, Fottrell E, Mee P, Collinson MA, Tollman SM: Using verbal autopsy to track epidemic dynamics: the case of HIV-related mortality in South Africa. Popul Health Metrics 2011, 9:46. BioMed Central Full Text
• [50]Karim SSA, Churchyard GJ, Karim QA, Lawn SD: HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response. Lancet 2009, 374(9693):921-933.
• [51]Byass P, Calvert C, Miiro-Nakiyingi J, Lutalo T, Michael D, Crampin A, Gregson S, Takaruza A, Robertson L, Herbst K: InterVA-4 as a public health tool for measuring HIV/AIDS mortality: a validation study from five African countries. Global Health Action 2013, 6:22448.
• [52]Environmental Systems Research Institute Redlands California: ArcGIS Desktop Release 10. 2011.
• [53]Collinson MA: Striving against adversity: the dynamics of migration, health and poverty in rural South Africa. Global Health Action 2010, 3:5080.
• [54]Collinson M, Gerritsen A, Clark S, Kahn K, Tollman S: Migration and socio-economic change in rural South Africa, 2000–2007. The Dynamics of Migration, Health and Livelihoods: INDEPTH Network Perspectives Aldershot: Ashgate 2009, 81-208.
• [55]Stata Corporation College Station Texas USA: Stata Version 10 IC. 2009.
• [56]Audet CM, Blevins M, Moon TD, Sidat M, Shepherd BE, Pires P, Vergara A, Vermund SH: HIV/AIDS-related attitudes and practices among traditional healers in Zambézia Province, Mozambique. J Altern Complement Med 2012, 18(12):1133-1141.