Practices and Perspectives of Traditional Bone Setters in Northern Tanzania

Card, Elizabeth B.; Obayemi, Joy E.; Shirima, Octavian; Lazaro, Matayo; Massawe, Honest; Stanifer, John W.; Premkumar, Ajay; Sheth, Neil P.

doi:10.5334/aogh.2878

Cited by 10 publications

(11 citation statements)

References 18 publications

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“…Centralising care for patients with musculoskeletal infection may facilitate MDT working and has been recommended in some high resource settings ( 59 ) but comes at a significant cost to patients, who in low resource settings already face catastrophic out-of-pocket costs. Low resource settings may have specific considerations around community involvement and the role of traditional medicine and ‘bone setters’ ( 60 ).…”

Section: Resultsmentioning

confidence: 99%

Management of fracture-related infection in low resource settings: how applicable are the current consensus guidelines?

Tissingh

Marais

Loro³

et al. 2022

EFORT Open Reviews

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The global burden of fracture-related infection (FRI) is likely to be found in countries with limited healthcare resources and strategies are needed to ensure the best available practice is context appropriate. This study has two main aims: (i) to assess the applicability of recently published expert guidance from the FRI consensus groups on the diagnosis and management of FRI to low- and middle-income countries (LMICs); (ii) to summarise the available evidence on FRI, with consideration for strategies applicable to low resource settings. Data related to the International Consensus Meeting Orthopaedic Trauma Work Group and the International Fracture Related Infection Consensus Group FRI guidelines were collected including panel membership, country of origin, language of publication, open access status and impact factor of the journal of publication. The recommendations and guidelines were then summarised with specific consideration for relevance and applicability to LMICs. Barriers to implementation were explored within a group of LMIC residents and experienced workers. The authorship, evidence base and reach of the FRI consensus guidelines lack representation from low resource settings. The majority of authors (78.5–100%) are based in high-income countries and there are no low-income country collaborators listed in any of the papers. All papers are in English. The FRI consensus guidelines give a clear set of principles for the optimum management of FRI. Many of these – including the approach to diagnosis, multidisciplinary team working and some elements of surgical management – are achievable in low resource settings. Current evidence suggests that it is important that a core set of principles is prioritised but robust evidence for this is lacking. There are major organisational and infrastructure obstacles in LMICs that will make any standardisation of FRI diagnosis or management challenging. The detail of how FRI consensus principles should be applied in low resource settings requires further work. The important work presented in the current FRI consensus guidelines is relevant to low resource settings. However, leadership, collaboration, creativity and innovation will be needed to implement these strategies for communities who need it the most.

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Section: Resultsmentioning

confidence: 99%

Management of fracture-related infection in low resource settings: how applicable are the current consensus guidelines?

Tissingh

Marais

Loro³

et al. 2022

EFORT Open Reviews

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“…However, it is lower than the studies done in Kano, Nigeria, which was 60.5% [ 14 ] and Northern region of Ghana, 65.7% [ 15 ]. On the other hand, it is higher than the studies done in Tanzania 6.3% [ 16 ], rural areas of Nigeria, 25.6% [ 17 ] and in Ilorin, north central Nigeria, 28.7% [ 9 ]. This difference could be due to the differences in the study setting, and socio-demographic characteristics of study participants in which Ethiopia is less developed than those listed settings.…”

Section: Discussionmentioning

confidence: 82%

Traditional bone setting service users and associated factors among people with trauma in Mecha district, Ethiopia

Endeshaw

Belay

Gete

et al. 2023

BMC Complement Med Ther

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World Health Organization stated that traditional medicine is an important part of health care and countries need to consider integrating it into their primary health care system. Traditional bone setting has a long history in Ethiopia and it enjoys enormous acceptance in the community. However, these methods are raw, there is no standardized training and at the same time, complications are common. Therefore, this research aimed to assess the prevalence of traditional bone setting service utilization and associated factors among people with trauma in Mecha district.Methods A Community- based cross-sectional study design was employed from January 15 to February 15, 2021. A total of 836 participants were selected using a simple random sampling technique. Binary and multiple logistic regressions were employed to assess the association between the independent variables with traditional bone setting service utilization.Results The prevalence of traditional bone setting service utilization was 46.05%. Factors significantly associated with TBS utilization were: Age ≥ 60 years (AOR = 0.13, 95% CI: 0.03- 0.43), rural residence (AOR = 3.63, 95% CI: 1.76 -7.50), occupation (merchant (AOR = 0.21, 95% CI: 0.07 -0.61), and housewife (AOR = 4.12, 95% CI: 1.33 -12.70), type of trauma: dislocation (AOR = 6.40, 95% CI: 3.69–11.10), and strain (AOR = 2.09, 95% CI: 1.05- 4.14)), site of trauma: extremity (AOR = 0.20, 95% CI: 0.11, 0.37), trunk (AOR = 0.08, 95% CI: 0.03–0.22), and shoulder (AOR = 0.20, 95% CI: 0.11–0.37), cause of trauma: fall down and natural deformity (AOR = 9.87, 95% CI: 5.93–16.42) and household annual income greater than > 36,500 (AOR = 2.33, 95% CI: 1.29–4.22).Conclusion The prevalence of traditional bone setting practice is high in the study area, despite recent advancements in the practice of orthopedics and trauma in Ethiopia. Since TBS services are more accepted in society, the integration of TBS into the health care delivery system is recommended.

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“…A study in Kenya also indicated that the cheaper fees requested by TBS increase the belief and reliance on treatment by TBS practitioners [14]. In addition, the possibility of a payment in the form of a kind such as cloth and animals could be another driving force [15][16][17][18]. Bamboo splinting, massaging, splinting by homemade materials, and application of herbal medicines were the commonly used practices for the treatment of fracture by TBS.…”

Section: Discussionmentioning

confidence: 99%

“…Bamboo splinting, massaging, splinting by homemade materials, and application of herbal medicines were the commonly used practices for the treatment of fracture by TBS. ese practices are also implemented by other African countries such as Sudan [6], Nigeria [15], Tanzania [17], and Ghana [19]. Twenty-eight percent of the patients were delayed to get treatment from the hospital due to difficulty to reach care, that is, lack of transportation.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Predictors of Patients with Fracture in Debre Markos Comprehensive Specialized Hospital, North West Ethiopia: A Prospective Cohort Study

Yimenu

Mengist

2022

Advances in Orthopedics

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Background. Fracture continues to be a major public health concern in many parts of the developing world that results in several consequences and complications including lifelong morbidity and mortality. This study aimed to assess clinical outcomes of patients following fracture in Debre Markos Comprehensive Specialized Hospital, North West Ethiopia. Methods. An institution-based prospective cohort study was conducted from November 2020 to July 2021 among 207 fracture patients (69 visited traditional bone setter and 138 did not visit traditional bone setter). Data were collected through face-to-face interviews, physical examinations, and radiological investigations. Data were entered using Epi-Data version 3.1 and analysis was done using STATA 14 statistical software. Descriptive statistics were summarized using mean, median, standard deviation, and percentage and presented in tables and figures. The generalized linear model was fitted to identify the risks of the outcome variable. Risk Ratio with its 95% confidence interval was used and factors with a P-value less than 0.05 were considered as a statistically significant association. Result. The mean age of the participants was 37.5 ± 13.6 years and two-thirds of the participants were males. Nearly half of the patients 92 (44%), 50 (54%) from the exposed and 42 (46%) from the nonexposed group, were delayed getting treatment from the hospital. The majority of the patients had been treated with Plaster of Paris immobilization (55%) followed by fixation (15%) and a combination of both (12%). Nearly half of the participants (48%), 74% from the exposed and 35% from the nonexposed group, developed complications during the follow-up period. The commonest complication was joint stiffness (45%) followed by osteoarthritis (21%). The risk of fracture-related complications among patients who did not visit traditional bone setter was decreased by 54% as compared to visitors (RR 0.46; 95% CI: (0.35, 0.60)) Conclusion. The magnitude of complications following the fracture is found to be high and the risk of complications among patients who visited traditional bone setters increased significantly. Therefore, prevention measures should be strengthened and integration between hospitals and traditional bone setters should be made so that basic training on fractures management will be given.

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Practices and Perspectives of Traditional Bone Setters in Northern Tanzania

Cited by 10 publications

References 18 publications

Management of fracture-related infection in low resource settings: how applicable are the current consensus guidelines?

Management of fracture-related infection in low resource settings: how applicable are the current consensus guidelines?

Traditional bone setting service users and associated factors among people with trauma in Mecha district, Ethiopia

Clinical Outcomes and Predictors of Patients with Fracture in Debre Markos Comprehensive Specialized Hospital, North West Ethiopia: A Prospective Cohort Study

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