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Erschienen in: Social Psychiatry and Psychiatric Epidemiology 6/2015

01.06.2015 | Review

Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis

verfasst von: Jonathan K. Burns, Andrew Tomita

Erschienen in: Social Psychiatry and Psychiatric Epidemiology | Ausgabe 6/2015

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Abstract

Purpose

In resource-limited contexts in low- and middle-income countries (LMICs), a considerable proportion of individuals seeking care for mental disorders consult traditional and religious healers in their pathway to mental health care. Reports from Africa suggest that early involvement of healers may result in delays in the care pathway; a potential barrier to early identification and intervention.

Methods

A systematic review was conducted to evaluate the proportion of patients attending formal health services after making first contact for treatment of mental disorders with traditional or religious healers or other informal and formal care providers within published research in Africa. Electronic databases were searched for the period from January 1990 to February 2014. Quality assessment of included studies was conducted the SAQOR tool.

Results

Fourteen papers were identified with data on category of first care provider. Utilizing random effects modelling with inverse variance method, the pooled proportion of participants making first contact for treatment of mental disorders with two broadly categorised providers (informal and formal) was 48.1 % (95 % CI 36.4–60.0 %) and 49.2 % (95 % CI 38.0–60.4 %), respectively. The pooled proportion of participants making first contact with specific providers was: traditional healers (17.0 %, 95 % CI 10.9–24.1 %); religious healers (26.2 %, 95 % CI 18.1–35.1 %); general health services (24.3 %, 95 % CI 16.9–32.5 %); and mental health services (13.0 %, 95 % CI 5.1–23.5 %). Substantial regional variation in patterns of first provider choice was evident.

Conclusions

Conclusions of this review must be qualified in the light of several limitations. Approximately half of individuals seeking formal health care for mental disorders in Africa, choose traditional and religious healers as their first care provider. Previous reports suggest that this choice is associated with delays in accessing formal mental health services. Strategies to improve pathways to mental health care in Africa must include innovative programmes aimed at fostering collaboration between biomedical mental health services and these key community-based providers.
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Literatur
1.
Zurück zum Zitat Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T (2005) Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 62:975–983CrossRefPubMed Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T (2005) Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 62:975–983CrossRefPubMed
2.
Zurück zum Zitat Farooq S, Large M, Nielssen O, Waheed W (2009) The relationship between the duration of untreated psychosis and outcome in low-and-middle income countries: a systematic review and meta-analysis. Schizophr Res 109(1–3):15–23CrossRefPubMed Farooq S, Large M, Nielssen O, Waheed W (2009) The relationship between the duration of untreated psychosis and outcome in low-and-middle income countries: a systematic review and meta-analysis. Schizophr Res 109(1–3):15–23CrossRefPubMed
3.
Zurück zum Zitat O’Callaghan E, Turner N, Renwick L, Jackson D, Sutton M, Foley SD, McWilliams S, Behan C, Fetherstone A, Kinsella A (2010) First episode psychosis and the trail to secondary care: help-seeking and health-system delays. Soc Psychiatry Psychiatr Epidemiol 45:381–391CrossRefPubMed O’Callaghan E, Turner N, Renwick L, Jackson D, Sutton M, Foley SD, McWilliams S, Behan C, Fetherstone A, Kinsella A (2010) First episode psychosis and the trail to secondary care: help-seeking and health-system delays. Soc Psychiatry Psychiatr Epidemiol 45:381–391CrossRefPubMed
4.
Zurück zum Zitat Morgan C, Abdul-Al R, Lappin JM, Jones P, Fearon P, Leese M, Croudace T, Morgan K, Dazzan P, Craig T, Leff J, Murray R, AESOP Study Group (2006) Clinical and social determinants of duration of untreated psychosis in the ÆSOP first-episode psychosis study. Br J Psychiatry 189:446–452CrossRefPubMed Morgan C, Abdul-Al R, Lappin JM, Jones P, Fearon P, Leese M, Croudace T, Morgan K, Dazzan P, Craig T, Leff J, Murray R, AESOP Study Group (2006) Clinical and social determinants of duration of untreated psychosis in the ÆSOP first-episode psychosis study. Br J Psychiatry 189:446–452CrossRefPubMed
5.
Zurück zum Zitat Kohn R, Saxena S, Levav I et al (2004) The treatment gap in mental health care. Bull World Health Organ 82(11):858–866PubMedCentralPubMed Kohn R, Saxena S, Levav I et al (2004) The treatment gap in mental health care. Bull World Health Organ 82(11):858–866PubMedCentralPubMed
6.
Zurück zum Zitat Saxena S, Thornicroft G, Knapp M, Whiteford H (2007) Resources for mental health: scarcity, inequity, and inefficiency. Lancet 370(9590):878–889CrossRefPubMed Saxena S, Thornicroft G, Knapp M, Whiteford H (2007) Resources for mental health: scarcity, inequity, and inefficiency. Lancet 370(9590):878–889CrossRefPubMed
7.
Zurück zum Zitat Saraceno B, Saxena S (2002) Mental health resources in the world: results from Project Atlas of the WHO. World Psychiatry 1(1):40–44PubMedCentralPubMed Saraceno B, Saxena S (2002) Mental health resources in the world: results from Project Atlas of the WHO. World Psychiatry 1(1):40–44PubMedCentralPubMed
8.
Zurück zum Zitat Shah AA, Beinecke RH (2009) Global mental health needs, services, barriers and challenges. Int J Ment Health 38(1):14–29CrossRef Shah AA, Beinecke RH (2009) Global mental health needs, services, barriers and challenges. Int J Ment Health 38(1):14–29CrossRef
11.
12.
Zurück zum Zitat Mbatha N, Street RA, Ngcobo M, Gqaleni N (2012) Sick certificates issued by South African traditional health practitioners: current legislation, challenges and the way forward. SAMJ 102:129–131PubMed Mbatha N, Street RA, Ngcobo M, Gqaleni N (2012) Sick certificates issued by South African traditional health practitioners: current legislation, challenges and the way forward. SAMJ 102:129–131PubMed
13.
Zurück zum Zitat World Health Organization (2002) Traditional medicine strategy 2002–2005. WHO, Geneva World Health Organization (2002) Traditional medicine strategy 2002–2005. WHO, Geneva
15.
Zurück zum Zitat Shibre T, Spångéus A, Henriksson L, Negash A, Jacobsson L (2008) Traditional treatment of mental disorders in rural Ethiopia. Ethiopian Med J 46(1):87–91 Shibre T, Spångéus A, Henriksson L, Negash A, Jacobsson L (2008) Traditional treatment of mental disorders in rural Ethiopia. Ethiopian Med J 46(1):87–91
16.
Zurück zum Zitat Abbo C (2011) Profiles and outcome of traditional healing practices for severe mental illnesses in two districts of Eastern Uganda. Glob Health Action 4 Abbo C (2011) Profiles and outcome of traditional healing practices for severe mental illnesses in two districts of Eastern Uganda. Glob Health Action 4
17.
Zurück zum Zitat Gureje O, Acha RA, Odejide OA (1995) Pathways to psychiatric care in Ibadan. Nigeria. Trop Geogr Med 47(3):125–129 Gureje O, Acha RA, Odejide OA (1995) Pathways to psychiatric care in Ibadan. Nigeria. Trop Geogr Med 47(3):125–129
18.
Zurück zum Zitat Sorsdahl K, Stein DJ, Flisher AJ (2013) Predicting referral practices of traditional healers of their patients with a mental illness: an application of the Theory of Planned Behaviour. Afr J Psychiatry 16(1):35–40 Sorsdahl K, Stein DJ, Flisher AJ (2013) Predicting referral practices of traditional healers of their patients with a mental illness: an application of the Theory of Planned Behaviour. Afr J Psychiatry 16(1):35–40
19.
Zurück zum Zitat Ross LE, Grigoriadis S, Mamisashvili L, Koren G, Steiner M, Dennis C-L, Cheung A, Mousmanis P (2011) Quality assessment of observational studies in psychiatry: an example from perinatal psychiatric research. Int J Method Psychiatr Pract 20(4):224–234CrossRef Ross LE, Grigoriadis S, Mamisashvili L, Koren G, Steiner M, Dennis C-L, Cheung A, Mousmanis P (2011) Quality assessment of observational studies in psychiatry: an example from perinatal psychiatric research. Int J Method Psychiatr Pract 20(4):224–234CrossRef
20.
Zurück zum Zitat Bekele YY, Flisher AJ, Alem A, Baheretebeb Y (2009) Pathways to psychiatric care in Ethiopia. Psychol Med 39:475–483CrossRefPubMed Bekele YY, Flisher AJ, Alem A, Baheretebeb Y (2009) Pathways to psychiatric care in Ethiopia. Psychol Med 39:475–483CrossRefPubMed
21.
Zurück zum Zitat Girma E, Tesfaye M (2011) Patterns of treatment seeking behavior for mental illness in Southwest Ethiopia: a hospital based study. BMC Psychiatry 11:138CrossRefPubMedCentralPubMed Girma E, Tesfaye M (2011) Patterns of treatment seeking behavior for mental illness in Southwest Ethiopia: a hospital based study. BMC Psychiatry 11:138CrossRefPubMedCentralPubMed
22.
Zurück zum Zitat Abiodun OA (1995) Pathways to mental health care in Nigeria. Psychiatric Services 46(8):823–826CrossRefPubMed Abiodun OA (1995) Pathways to mental health care in Nigeria. Psychiatric Services 46(8):823–826CrossRefPubMed
23.
Zurück zum Zitat Nonye AP, Oseloka EC (2009) Health-seeking behaviour of mentally ill patients in Enugu. Nigeria. SAJP 15(1):19–22 Nonye AP, Oseloka EC (2009) Health-seeking behaviour of mentally ill patients in Enugu. Nigeria. SAJP 15(1):19–22
24.
Zurück zum Zitat Aghukwa CN (2012) Care seeking and beliefs about the cause of mental illness among Nigerian psychiatric patients and their families. Psychiatr Serv 63(6):616–618CrossRefPubMed Aghukwa CN (2012) Care seeking and beliefs about the cause of mental illness among Nigerian psychiatric patients and their families. Psychiatr Serv 63(6):616–618CrossRefPubMed
25.
Zurück zum Zitat Lasebikan VO, Owoaje ET, Asuzu MC (2012) Social network as a determinant of pathway to mental health service utilization among psychotic patients in a Nigerian hospital. Ann Afr Med 11:12–20CrossRefPubMed Lasebikan VO, Owoaje ET, Asuzu MC (2012) Social network as a determinant of pathway to mental health service utilization among psychotic patients in a Nigerian hospital. Ann Afr Med 11:12–20CrossRefPubMed
26.
Zurück zum Zitat Adeosun II, Adegbohun AA, Adewumi TA, Jeje OO (2013) The pathways to the first contact with mental health services among patients with schizophrenia in Lagos, Nigeria. Schizophr Res Treatment 2013:769161PubMedCentralPubMed Adeosun II, Adegbohun AA, Adewumi TA, Jeje OO (2013) The pathways to the first contact with mental health services among patients with schizophrenia in Lagos, Nigeria. Schizophr Res Treatment 2013:769161PubMedCentralPubMed
27.
Zurück zum Zitat Bakare MO (2013) Pathway to care: first points of contact and sources of referral among children and adolescent patients seen at Neuropsychiatric Hospital in South-Eastern Nigeria. Niger J Med 22(1):52–56PubMed Bakare MO (2013) Pathway to care: first points of contact and sources of referral among children and adolescent patients seen at Neuropsychiatric Hospital in South-Eastern Nigeria. Niger J Med 22(1):52–56PubMed
28.
Zurück zum Zitat Jack-Ide IO, Makoro BP, Azibiri B (2013) Pathways to mental health care services in the Niger Delta region of Nigeria. J Res Nursing Mid 2(2):22–29 Jack-Ide IO, Makoro BP, Azibiri B (2013) Pathways to mental health care services in the Niger Delta region of Nigeria. J Res Nursing Mid 2(2):22–29
29.
Zurück zum Zitat Odinka PC, Oche M, Ndukuba AC, Muomah RC, Osika MU, Bakare MO, Agomoh AO, Uwakwe R (2014) The socio-demographic characteristics and patterns of help-seeking among patients with schizophrenia in South-East Nigeria. J Health Care Poor Underserved 25:180–191CrossRefPubMed Odinka PC, Oche M, Ndukuba AC, Muomah RC, Osika MU, Bakare MO, Agomoh AO, Uwakwe R (2014) The socio-demographic characteristics and patterns of help-seeking among patients with schizophrenia in South-East Nigeria. J Health Care Poor Underserved 25:180–191CrossRefPubMed
30.
Zurück zum Zitat Modiba P, Schneider H, Porteus K, Gunnarson V (2001) Profile of community mental health service needs in the Moretele District (North-West Province) in South Africa. J Ment Health Policy Econ 4:189–196PubMed Modiba P, Schneider H, Porteus K, Gunnarson V (2001) Profile of community mental health service needs in the Moretele District (North-West Province) in South Africa. J Ment Health Policy Econ 4:189–196PubMed
31.
Zurück zum Zitat Mkize LP, Uys LR (2004) Pathways to mental health care in KwaZulu-Natal. Curiatonis 27:62–71 Mkize LP, Uys LR (2004) Pathways to mental health care in KwaZulu-Natal. Curiatonis 27:62–71
32.
Zurück zum Zitat Temmingh HS, Oosthuizen PP (2008) Pathways to care and treatment delays in first and multi episode psychosis. Findings from a developing country. Soc Psychiatry Psychiatr Epidemiol 43(9):727–735CrossRefPubMed Temmingh HS, Oosthuizen PP (2008) Pathways to care and treatment delays in first and multi episode psychosis. Findings from a developing country. Soc Psychiatry Psychiatr Epidemiol 43(9):727–735CrossRefPubMed
33.
Zurück zum Zitat Patel V, Simunyu E, Gwanzura F (1997) The pathways to primary mental health care in high-density suburbs in Harare, Zimbabwe. Soc Psychiatry Psychiatr Epidemiol 32:97–103CrossRefPubMed Patel V, Simunyu E, Gwanzura F (1997) The pathways to primary mental health care in high-density suburbs in Harare, Zimbabwe. Soc Psychiatry Psychiatr Epidemiol 32:97–103CrossRefPubMed
34.
Zurück zum Zitat Burns JK (2014) The burden of mental disorders in KwaZulu-Natal: mapping the treatment gap. South Afr J Psychiatry 20(1):6–10CrossRef Burns JK (2014) The burden of mental disorders in KwaZulu-Natal: mapping the treatment gap. South Afr J Psychiatry 20(1):6–10CrossRef
36.
Zurück zum Zitat Schierenbeck I, Johansson P, Andersson L, van Rooyen D (2013) Barriers to accessing and receiving mental health care in Eastern Cape, South Africa. Health Hum Rights 15(2):110–123PubMed Schierenbeck I, Johansson P, Andersson L, van Rooyen D (2013) Barriers to accessing and receiving mental health care in Eastern Cape, South Africa. Health Hum Rights 15(2):110–123PubMed
38.
Zurück zum Zitat Coomer RA (2013) The experiences of parents of children with mental disability regarding access to mental health care. Afr J Psychiatry 16(4):271–276. doi:10.4314/ajpsy.v16i4.36 Coomer RA (2013) The experiences of parents of children with mental disability regarding access to mental health care. Afr J Psychiatry 16(4):271–276. doi:10.​4314/​ajpsy.​v16i4.​36
39.
Zurück zum Zitat Nsereko JR, Kizza D, Kigozi F, Ssebunnya J, Ndyanabangi S, Flisher AJ, Cooper S, MHaPP Research Programme Consortium (2011) Stakeholders’ perceptions of help-seeking behaviour among people with mental health problems in Uganda. Int J Ment Health Syst 13(5):5. doi:10.1186/1752-4458-5-5 CrossRef Nsereko JR, Kizza D, Kigozi F, Ssebunnya J, Ndyanabangi S, Flisher AJ, Cooper S, MHaPP Research Programme Consortium (2011) Stakeholders’ perceptions of help-seeking behaviour among people with mental health problems in Uganda. Int J Ment Health Syst 13(5):5. doi:10.​1186/​1752-4458-5-5 CrossRef
41.
Zurück zum Zitat Campbell-Hall V, Petersen I, Bhana A, Mjadu S, Hosegood V, Flisher AJ, MHaPP Research Programme Consortium (2010) Collaboration between traditional practitioners and primary health care staff in South Africa: developing a workable partnership for community mental health services. Transcult Psychiatry 47(4):610–628. doi:10.1177/1363461510383459 CrossRefPubMed Campbell-Hall V, Petersen I, Bhana A, Mjadu S, Hosegood V, Flisher AJ, MHaPP Research Programme Consortium (2010) Collaboration between traditional practitioners and primary health care staff in South Africa: developing a workable partnership for community mental health services. Transcult Psychiatry 47(4):610–628. doi:10.​1177/​1363461510383459​ CrossRefPubMed
42.
Zurück zum Zitat Patel V, Musara T, Butau T, Maramba P, Fuyane S (1995) Concepts of mental illness and medical pluralism in Harare. Psychol Med 25(3):485–493CrossRefPubMed Patel V, Musara T, Butau T, Maramba P, Fuyane S (1995) Concepts of mental illness and medical pluralism in Harare. Psychol Med 25(3):485–493CrossRefPubMed
43.
Zurück zum Zitat Colvin M, Gumede L, Grimwade K, Maher D, Wilkinson D (2003) Contribution of traditional healers to a rural tuberculosis control programme in Hlabisa, South Africa. Int J Tuberc Lung Dis 7(9 Supp 1):S86–S91PubMed Colvin M, Gumede L, Grimwade K, Maher D, Wilkinson D (2003) Contribution of traditional healers to a rural tuberculosis control programme in Hlabisa, South Africa. Int J Tuberc Lung Dis 7(9 Supp 1):S86–S91PubMed
44.
Zurück zum Zitat Harper ME, Hill PC, Bah AH, Manneh K, McAdam KP, Lienhardt C (2004) Traditional healers participate in tuberculosis control in The Gambia. Int J Tuberc Lung Dis 8(10):1266–1268PubMed Harper ME, Hill PC, Bah AH, Manneh K, McAdam KP, Lienhardt C (2004) Traditional healers participate in tuberculosis control in The Gambia. Int J Tuberc Lung Dis 8(10):1266–1268PubMed
45.
Zurück zum Zitat Peltzer K, Mngqundaniso N, Petros G (2006) A controlled study of an HIV/AIDS/STI/TB intervention with traditional healers in KwaZulu-Natal, South Africa. AIDS Behav 10(6):683–690CrossRefPubMed Peltzer K, Mngqundaniso N, Petros G (2006) A controlled study of an HIV/AIDS/STI/TB intervention with traditional healers in KwaZulu-Natal, South Africa. AIDS Behav 10(6):683–690CrossRefPubMed
46.
Zurück zum Zitat Kayombo EJ, Uiso FC, Mbwambo ZH, Mahunnah RL, Moshi MJ, Mgonda YH (2007) Experience of initiating collaboration of traditional healers in managing HIV and AIDS in Tanzania. J Ethnobiol Ethnomed 3:6CrossRefPubMedCentralPubMed Kayombo EJ, Uiso FC, Mbwambo ZH, Mahunnah RL, Moshi MJ, Mgonda YH (2007) Experience of initiating collaboration of traditional healers in managing HIV and AIDS in Tanzania. J Ethnobiol Ethnomed 3:6CrossRefPubMedCentralPubMed
49.
Zurück zum Zitat World Health Organisation (WHO) (1991) Traditional medicine and modern health care (Progress report by the Director General on the Forty-Fourth World Health Assembly). WHO, Geneva World Health Organisation (WHO) (1991) Traditional medicine and modern health care (Progress report by the Director General on the Forty-Fourth World Health Assembly). WHO, Geneva
50.
51.
Zurück zum Zitat Read UM, Adiibokah E, Nyame S (2009) Local suffering and the global discourse of mental health and human rights: an ethnographic study of responses to mental illness in rural Ghana. Glob Health 14(5):13. doi:10.1186/1744-8603-5-13 CrossRef Read UM, Adiibokah E, Nyame S (2009) Local suffering and the global discourse of mental health and human rights: an ethnographic study of responses to mental illness in rural Ghana. Glob Health 14(5):13. doi:10.​1186/​1744-8603-5-13 CrossRef
52.
Zurück zum Zitat Adelekan ML, Makanjuola AB, Ndom RJ (2001) Traditional mental health practitioners in Kwara State, Nigeria. East Afr Med J 78(4):190–196CrossRefPubMed Adelekan ML, Makanjuola AB, Ndom RJ (2001) Traditional mental health practitioners in Kwara State, Nigeria. East Afr Med J 78(4):190–196CrossRefPubMed
Metadaten
Titel
Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis
verfasst von
Jonathan K. Burns
Andrew Tomita
Publikationsdatum
01.06.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Social Psychiatry and Psychiatric Epidemiology / Ausgabe 6/2015
Print ISSN: 0933-7954
Elektronische ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-014-0989-7

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