Establishing views of traditional healers and biomedical practitioners on collaboration in mental health care in Zanzibar: a qualitative pilot study

Abstract

Background: This qualitative pilot study aimed to establish views of traditional and biomedical practitioners towards collaboration between the two sectors on the treatment of people with mental illness in Zanzibar, Tanzania. Methods: Six traditional healers (known as "waganga" in Swahili) and six nurses working in government secondary mental health services were invited to participate in a series of focus group discussions (FGDs). Two sets of FGDs took place approximately seven weeks apart. In each set, FGDs were conducted with traditional healers only, nurses only, and finally nurses and traditional healers together. FGDs were conducted in Swahili, audio-recorded and then translated to English by an independent translator and coded thematically using NVivo software. Results: All participants expressed that they were in favour of collaboration between traditional and biomedical practitioners on mental healthcare. Opinions varied regarding what form this collaboration should take. For many nurses and healers, there was acknowledgement of the role of the other group in providing treatment for people with mental illness, with support for the idea of bi-directional referrals between the two sectors. For some nurses, the value of collaboration would be purely in the education of traditional healers in the recognition of mental illness, with subsequent referral to biomedical services. For some traditional healers, the idea of collaboration seemed to appeal in part because of a perceived opportunity to learn additional skills from biomedical practitioners. Both categories of participant expressed a belief that patients possessed by a jinn (a spirit) or those that had been bewitched needed treatment by traditional healers. On the other hand, those with what participants considered to be "mental illness" needed treatment at the hospital clinic. However, some nurses felt that that traditional healers might be able to provide helpful treatment for mental illness, as well as those suspected to be affected by jinn or witchcraft. There was agreement on the need to establish clear referral pathways between the two service providers. The creation of an office for traditional healers at the hospital was an area where there was disagreement among participants. Conclusions: We conclude that there is a positive view of collaboration among traditional healers and nurses who participated, and a willingness to work towards actual collaboration. The results suggest that views vary as to what form this collaboration should take, with opinions differing between nurses, as well as between traditional healers. Additional work is needed in order to further explore the nature of potential collaboration and extend the research to the wider population of traditional and biomedical practitioners in Zanzibar, to include primary health care workers.

Depression and associated factors among HIV-positive youths attending antiretroviral therapy clinics in Jimma town, southwest Ethiopia

“…Conversely, this finding is much higher than the study conducted among HIV-positive adults in Ethiopia such as, 20% in Dessie [ 40 ], 14.6% in Aksum [ 41 ], and 11.7% in Debre Markos [ 42 ]. Exposure to psychosocial stress, developmental, and hormonal factors will increase depression in youths but not in adults [ 43 ].…”

The Effect of Poor Social Support on Depression among HIV/AIDS Patients in Ethiopia: A Systematic Review and Meta-Analysis

“…The study sample sizes ranged from 340 reported from a study in Southern Nations Nationalities, and People (SNNP) [ 25 ] to 507 from a study in Addis Ababa [ 26 ] participants. Of the eight studies included in the final analysis, three were conducted in Addis Ababa [ 21 , 26 , 27 ], two studies were from the SNNPR region [ 25 , 28 ], two studies were conducted in Amhara regions [ 20 , 22 ], and the remaining one study was from Oromia region [ 29 ].…”

“…The response rates of the studies ranged from 93.5% [ 22 ] to 100% [ 21 , 27 ]. The mean age of the patients included in this systematic review and meta-analysis ranged from 18.6 ± 3.024 years [ 26 ] to 38 ± 10.228 [ 28 ].…”

“…The mean age of the patients included in this systematic review and meta-analysis ranged from 18.6 ± 3.024 years [ 26 ] to 38 ± 10.228 [ 28 ]. Regarding assessment tools of depressive symptoms, five studies used the Patient Health Questionnaire-9 (PHQ-9) [ 22 , 25 , 27 – 29 ], two studies used Hospital Anxiety and Depression Scale (HADS) [ 20 , 21 ], and the other one study used Beck Depression Inventory-II (BDI-II) [ 26 ] ( Table 1 ).…”

“…While the relationship between poor social support and depression is fairly well-established in high-income settings, fewer studies have investigated the association in low-resource setting like Ethiopia. Studies that have examined the association between poor social support and depression among PLWHA in Ethiopia in particular have presented inconsistent results, with some finding strong positive associations [ 20 , 21 ] and others finding negative associations [ 22 ].…”