A triangulation study of the use of traditional medicine and prescribed antischistosomal medicine in communities with high prevalence schistsomiasis infections: perspectives from traditional healers, patients and healthcare workers.
Mushebenge, Aganze Gloire-Aime'.
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Schistosomes are parasitic worms found in tropical and sub-tropical fresh waters. An estimated 4.5 million South Africans, mainly in settings of rural poverty, are in need of treatment for urogenital schistosomiasis. Women with schistosomiasis are exposed to HIV infection prevalent in African countries. Praziquantel is the treatment used in the mainstream healthcare system to manage schistosomiasis. Although conventional treatment is available, traditional medicine (TM) has been reported to be used for schistosomiasis. This study evaluated the prevalence of the use of traditional medicine and prescribed antischistosomal medicines in communities having high prevalence schistosomiasis infection in ILembe District, KwaZulu-Natal and established whether the unavailability of prescribed antischistosomal medicines led to the use of traditional medicine. Methods Methods This study was a cross-sectional descriptive study using a questionnaire. An exploratory mixed-method approach through interviews was conducted from December 2017 to April 2018 in the ILembe District, KwaZulu-Natal. In addition, a review of medical chart records of patients with schistosomiasis was further carried out to triangulate the information from interviews. Qualitative data were coded and analyzed using thematic analysis while descriptive statistics including frequency and percentage were used for quantitative data, categorical data were presented as tables. Chi-squared tests were performed for the association between continuous variables. A p-value ≤ 0.05 was estimated as statistically significant. Results A protocol mapping evidence of the concurrent use of TM and antischistosomal treatment was drafted. It anticipated findings on identified gaps in the current literature on this topic and provided direction for future research. After mapping for evidence, face-to-face interviews were conducted in phase 1 of this study among 22 traditional health practitioners (THPs) who diagnosed and managed schistosomiasis symptoms based on their knowledge and experiences using plants either alone or in combination with other plants. Senecio serratuloides (Asteraceae) and Hypoxis hemerocallidea (Hypoxidaceae) were prominently used in the study area by THPs for the management schistosomiasis. THPs provided services to individuals who did not want to be treated in the mainstream health care system for schistosomiasis. Following the interviews with THPs, 124 healthcare workers (HCWs) were interviewed with the majority of them (114/124; 91.9%) reporting that Praziquantel was readily available in healthcare facilities. However, most of HCWs (76/124; 61.3%) did not know whether patients seen by them used concurrently TM and Praziquantel for schistosomiasis. No significant relationship between the availability of Praziquantel and the concurrent use of TM by patients for schistosomiasis (X2 = 3.042, p = 0.551) was found. Patients seen by THPs (20) were also interviewed in the same phase 1. They reported that they used TM only for schistosomiasis. Patients attending outpatient departments were also interviewed in this phase. More than half of them (8/15, 53.3%) crossed from TM to the mainstream healthcare system, but they did not disclose their use of TM to HCWs. After the interviews in phase 1, a medical chart review was conducted in phase 2 of the study to analyse the concurrent use of traditional medicine with conventional medicine for schistosomiasis. None of the medical chart records analyzed; documented the concurrent use of TM and Praziquantel. Conclusion TM played a key role in the management of schistosomiasis in the study area. HCWs indicated that although Praziquantel was readily available and free in public sector healthcare facilities, patients used TM for schistosomiasis. HCWs reported not to be aware of whether patients used concurrently TM and Praziquantel for the treatment of schistosomiasis. Further investigations are needed to establish the reasons for use, potential benefits or risks of the concurrent use of modern and traditional medicine for schistosomiasis. Biological studies on TM used for schistosomiasis in the study area are warranted to confirm the pharmacological properties and active compounds of medicinal plants used by THPs for schistosomiasis.