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Practices and Perspectives of Traditional Bone Setters in Northern Tanzania.

ABSTRACT: Background:Traditional health practitioners remain a critical source of care in Tanzania, more than 50% of Tanzanians frequently using their services. With a severe shortage of orthopaedic surgeons (1:3.3 million Tanzanians) traditional bone setters (TBSs) could potentially expand access to musculoskeletal care and improve outcomes for morbidity as a result of trauma. Objective:We sought to identify the advantages and disadvantages of traditional bone setting in Tanzania and to assess potential for collaboration between TBSs and allopathic orthopaedic surgeons. Methods:Between June and July 2017 we interviewed six TBSs identified as key informants in the regions of Kilimanjaro, Arusha, and Manyara. We conducted semi-structured interviews about practices and perspectives on allopathic healthcare, and analyzed the data using a deductive framework method. Findings:The TBSs reported that their patients were primarily recruited from their local communities via word-of-mouth communication networks. Payment methods for services included bundling costs, livestock barter, and sliding scale pricing. Potentially unsafe practices included lack of radiographic imaging to confirm reduction; cutting and puncturing of skin with unsterile tools; and rebreaking healed fractures. The TBSs described past experience collaborating with allopathic healthcare providers, referring patients to hospitals, and utilizing allopathic techniques in their practice. All expressed enthusiasm in future collaboration with allopathic hospitals. Conclusions:TBSs confer the advantages of word-of-mouth communication networks and greater financial and geographic accessibility. However, some of their practices raise concerns relating to infection, fracture malunion or nonunion, and iatrogenic trauma from manipulating previously healed fractures. A formal collaboration between TBSs and orthopaedic surgeons, based on respect and regular communication, could alleviate concerns through the development of care protocols and increase access to optimal orthopaedic care through a standardized triage and follow-up system.

SUBMITTER: Card EB

PROVIDER: S-EPMC7304448 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Practices and Perspectives of Traditional Bone Setters in Northern Tanzania.

Card Elizabeth B EB Obayemi Joy E JE Shirima Octavian O Lazaro Matayo M Massawe Honest H Stanifer John W JW Premkumar Ajay A Sheth Neil P NP

Annals of global health 20200616 1

<h4>Background</h4>Traditional health practitioners remain a critical source of care in Tanzania, more than 50% of Tanzanians frequently using their services. With a severe shortage of orthopaedic surgeons (1:3.3 million Tanzanians) traditional bone setters (TBSs) could potentially expand access to musculoskeletal care and improve outcomes for morbidity as a result of trauma.<h4>Objective</h4>We sought to identify the advantages and disadvantages of traditional bone setting in Tanzania and to as ...[more]

PMID: 32587811

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Project description:IntroductionTraditional medicines are an important part of healthcare in sub-Saharan Africa, and building successful disease treatment programs that are sensitive to traditional medicine practices will require an understanding of their current use and roles, including from a biomedical perspective. Therefore, we conducted a mixed-method study in Northern Tanzania in order to characterize the extent of and reasons for the use of traditional medicines among the general population so that we can better inform public health efforts in the region.MethodsBetween December 2013 and June 2014 in Kilimanjaro, Tanzania, we conducted 5 focus group discussions and 27 in-depth interviews of key informants. The data from these sessions were analyzed using an inductive framework method with cultural insider-outsider coding. From these results, we developed a structured survey designed to test different aspects of traditional medicine use and administered it to a random sample of 655 adults from the community. The results were triangulated to explore converging and diverging themes.ResultsMost structured survey participants (68%) reported knowing someone who frequently used traditional medicines, and the majority (56%) reported using them themselves in the previous year. The most common uses were for symptomatic ailments (42%), chronic diseases (15%), reproductive problems (11%), and malaria/febrile illnesses (11%). We identified five major determinants for traditional medicine use in Northern Tanzania: biomedical healthcare delivery, credibility of traditional practices, strong cultural identities, individual health status, and disease understanding.ConclusionsIn order to better formulate effective local disease management programs that are sensitive to TM practices, we described the determinants of TM use. Additionally, we found TM use to be high in Northern Tanzania and that its use is not limited to lower-income areas or rural settings. After symptomatic ailments, chronic diseases were reported as the most common reason for TM use which may be particularly important in Northern Tanzania where non-communicable diseases are a rapidly growing burden.

Project description:BackgroundKnowledge, attitudes, and practices (KAP) surveys regarding zoonotic diseases are crucial to understanding the extent of knowledge among citizens and for guiding health-related education programs.MethodEmploying a structured questionnaire, we interviewed residents (n?=?388) in three districts of northern Tanzania (Karatu n?=?128, Monduli n?=?114, Babati n?=?146) to assess knowledge, attitudes and reported practices regarding three zoonotic diseases that occur in the region (anthrax, brucellosis, and rabies). We used generalized linear mixed effects models and multi-model inference to identify demographic correlates of knowledge.ResultsProportional average district- and disease- specific knowledge scores ranged from 0.14-0.61. We found positive correlations between age and knowledge of symptoms, causes and treatments of anthrax (three districts), brucellosis (three districts), and rabies (one district). Gender, ethnic identity, formal education and ownership of livestock or dogs had variable effects on knowledge among the interviewed population. Risk perceptions regarding different diseases varied across districts and were positively correlated with knowledge of the specific diseases. Direct interactions with livestock and domestic dogs were reported to occur across all demographic groups, suggesting that most people living in rural settings of our study area are potentially exposed to zoonotic diseases. Behaviors which may favor transmission of specific pathogens (such as consumption of raw milk or meat) were occasionally reported and varied by district. Wildlife was generally regarded as negative or neutral with regard to overall veterinary and human health.ConclusionThe combination of variable knowledge about zoonotic diseases in the three districts, reported occurrence of practices that are conducive to pathogen transmission, and previously documented circulation of pathogens causing anthrax, brucellosis and rabies in our study system, call for health education programs embedded in a holistic One Health approach.

Project description:BackgroundNon-communicable diseases (NCDs) are a leading cause of death among adults in sub-Saharan Africa, and chronic kidney disease (CKD) is a growing public health threat. Understanding knowledge, attitudes, and practices associated with NCDs is vital to informing optimal policy and public health responses in the region, but few community-based assessments have been performed for CKD. To address this gap, we conducted a cross-sectional survey of adults in northern Tanzania using a validated instrument.MethodsBetween January and June 2014, we administered a structured survey to a random sample of adults from urban and rural communities. The validated instrument consisted of 25 items designed to measure knowledge, attitudes, and practices associated with kidney disease. Participants were also screened for CKD, diabetes, hypertension, and human immunodeficiency virus.ResultsWe enrolled 606 participants from 431 urban and rural households. Knowledge of the etiologies, symptoms, and treatments for kidney disease was low (mean score 3.28 out of 10; 95% CI 2.94, 3.63). There were no significant differences by CKD status. Living in an urban setting and level of education had the strongest independent associations with knowledge score. Attitudes were characterized by frequent concern about the health (27.3%; 20.2, 36.0%), economic (73.1%; 68.2, 77.5%), and social impact (25.4%; 18.6, 33.6%) of kidney disease. Practices included the use of traditional healers (15.2%; 9.1, 24.5%) and traditional medicines (33.8%; 25.0, 43.9%) for treatment of kidney disease as well as a willingness to engage with mobile-phone technology in CKD care (94.3%; 90.1, 96.8%).ConclusionsCommunity-based adults in northern Tanzania have limited knowledge of kidney disease. However, there is a modest knowledge base upon which to build public health programs to expand awareness and understanding of CKD, but these programs must also consider the variety of means by which adults in this population meet their healthcare needs. Finally, our assessment of local attitudes suggested that such public health efforts would be well-received.

Project description:BackgroundHypertension, a leading risk for cardiovascular mortality, is an important co-morbidity among people living with HIV (PLHIV). In Tanzania, hypertension prevalence among PLHIV approaches 20 to 30%. However, most patients are unaware of their diagnosis and are not receiving treatment. Understanding the barriers to hypertension care is a critical first step in developing interventions to improve cardiovascular outcomes among PLHIV in Tanzania and similar settings.MethodsBetween September 1st and November 26th, 2018 thirteen semi structured in-depth interviews were conducted with hypertensive patients engaged in HIV care in two HIV clinics located in government health facilities in northern Tanzania. Interviews were audio-recorded, translated into English, transcribed and thematically coded using NVivo. Data analysis was conducted using applied thematic analysis.ResultsParticipants had a median age of 54 (IQR 41-65) years. Of the 13 participants, eight stated they had used antihypertensive medication previously, but only one participant described current use of antihypertensive therapy. All participants were currently using antiretroviral therapy. The data revealed a range of themes including limited hypertension knowledge. Universally, all participants believed that "thinking too much", i.e. stress, was the major contributor to hypertension and that by "reducing thoughts", one may control hypertension. Additional emerging themes included a perceived overlap between hypertension and HIV, delays in hypertension diagnosis and linkage to care, challenges with provider communication and counseling, reluctance towards antihypertensive medication, lack of integration of hypertension and HIV care, and additional structural barriers to hypertension care.ConclusionsParticipants described multiple, intersecting challenges related to hypertension management. Barriers specific to PLHIV included siloed care, HIV-related stigma, and burden from multiple medical conditions. Multifaceted strategies that seek to address structural barriers, hypertension education, psychosocial stressors and stigma, and that are integrated within HIV care are urgently needed to improve cardiovascular outcomes among PLHIV in sub-Saharan Africa.

Project description:Rapid rates of land use and land cover change (LULCC) in eastern Africa and limited instances of genuinely equal partnerships involving scientists, communities and decision makers challenge the development of robust pathways toward future environmental and socioeconomic sustainability. We use a participatory modelling tool, Kesho, to assess the biophysical, socioeconomic, cultural and governance factors that influenced past (1959-1999) and present (2000-2018) LULCC in northern Tanzania and to simulate four scenarios of land cover change to the year 2030. Simulations of the scenarios used spatial modelling to integrate stakeholders' perceptions of future environmental change with social and environmental data on recent trends in LULCC. From stakeholders' perspectives, between 1959 and 2018, LULCC was influenced by climate variability, availability of natural resources, agriculture expansion, urbanization, tourism growth and legislation governing land access and natural resource management. Among other socio-environmental-political LULCC drivers, the stakeholders envisioned that from 2018 to 2030 LULCC will largely be influenced by land health, natural and economic capital, and political will in implementing land use plans and policies. The projected scenarios suggest that by 2030 agricultural land will have expanded by 8-20% under different scenarios and herbaceous vegetation and forest land cover will be reduced by 2.5-5% and 10-19% respectively. Stakeholder discussions further identified desirable futures in 2030 as those with improved infrastructure, restored degraded landscapes, effective wildlife conservation, and better farming techniques. The undesirable futures in 2030 were those characterized by land degradation, poverty, and cultural loss. Insights from our work identify the implications of future LULCC scenarios on wildlife and cultural conservation and in meeting the Sustainable Development Goals (SDGs) and targets by 2030. The Kesho approach capitalizes on knowledge exchanges among diverse stakeholders, and in the process promotes social learning, provides a sense of ownership of outputs generated, democratizes scientific understanding, and improves the quality and relevance of the outputs.

Project description:IntroductionChildhood undernutrition is a major public health problem especially in low and middle-income countries (LMIC). The prevalence of early introduction of complementary feeding, low meal frequency, and low dietary diversity are frequent in LMICs. The effect of inappropriate complementary feeding practices on the nutritional status of children is not well documented in East African countries including Tanzania. Therefore, this study aimed at determining the effect of inappropriate complementary feeding practices on the nutritional status of children aged 6-24 months in urban Moshi, Tanzania.MethodologyA retrospective cohort study was done using the Pasua and Majengo cohorts of mother-child pairs in urban Moshi who were enrolled from 2002 to 2017. About 3355 mother-child pairs were included in the analysis. Appropriate complementary feeding practices were assessed using WHO IYFP indicators such as age at introduction of solid, semi-solid, or soft foods, minimum dietary diversity, and minimum meal frequency. Nutritional status (stunting, wasting, and underweight) was determined. Multilevel modeling was applied to obtain the effect of inappropriate complementary feeding practices on the nutritional status of children and to account for the clustering effect of mothers and children and the correlation of repeated measures within each child.ResultsMajority of the children (91.2%) were given soft/semi-solid/solid foods before six months of age, 40.3percent had low meal frequency, and 74percent had low dietary diversity. Early introduction of complementary food at age 0-1 month was statistically significantly associated with higher risks of wasting and underweight (ARR 2.9, 95%CI 1.3-6.3; and ARR 2.6, 95% CI 1.3-5.1 respectively). Children with low minimum meal frequency had higher risks of stunting, wasting, and underweight (ARR 2.9, 95%CI 2.3-3.6; ARR 1.9, 95%CI 1.5-2.5 and ARR 1.9, 95%CI 1.5-2.4 respectively). Children with low minimum dietary diversity were more likely to be stunted than is the case with their peers who received the minimum dietary diversity (ARR 1.3, 95% CI 1.01-1.6).ConclusionThere were a high proportion of children, which were fed inappropriately; Inappropriate complementary feeding practices predisposed children to undernutrition. Our study supports the introduction of complementary feeding, providing minimum dietary diversity, and minimum feeding frequency at six months of age as important in improving the nutritional status of the children.

Dataset Information

Practices and Perspectives of Traditional Bone Setters in Northern Tanzania.

Publications

Practices and Perspectives of Traditional Bone Setters in Northern Tanzania.

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