Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review

Abstract

BackgroundThe WHO estimates that a considerable number of people in Sub-Saharan Africa (SSA) rely on traditional, complementary and alternative medicine (TCAM) to meet their primary healthcare needs, yet there remains a dearth of research evidence on the overall picture of TCAM utilisation in the region.MethodsWe conducted a literature search of original articles examining TCAM use in SSA between 1 January 2006 and 28 February 2017, employing Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Scopus, ProQuest, PubMed, Embase and African Journals Online databases. A critical appraisal of relevant articles reporting a quantitative or mixed-method design was undertaken.ResultsDespite the heterogeneity and general low quality of the identified literature, the review highlights a relatively high use of TCAM alone or in combination with orthodox medicine, in both general population and in specific health conditions in SSA. TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, while there were inconsistencies in age, sex, spatial location and religious affiliation between TCAM users and non-TCAM users. Most TCAM users (55.8%–100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for non-disclosure being fear of receiving improper care, healthcare providers’ negative attitude and a lack of enquiry about TCAM use from healthcare providers.ConclusionTCAM use in SSA is significant, although most studies emerge from a few countries. Factors associated with TCAM use in SSA are similar to those observed in other regions, but further research may be required to further elucidate challenges and opportunities related to TCAM use specific to SSA.

Use of traditional and complementary medicines by cancer patients at a national cancer referral facility in a low‐income country

“…Data from a population‐based sample of 1,065 breast cancer women in urban Shanghai showed that, overall, 86.7% of patients had used traditional Chinese medicine (Cui et al, ). A recent systematic review on the use of traditional, complementary and alternative medicine in sub‐Saharan Africa showed that T&CM use by patients with cancer ranged from 34.5% to 79% (James, Wardle, Steel, & Adams, ). Use was highest in Ethiopia (Erku, ; James et al, ).…”

“…A recent systematic review on the use of traditional, complementary and alternative medicine in sub‐Saharan Africa showed that T&CM use by patients with cancer ranged from 34.5% to 79% (James, Wardle, Steel, & Adams, ). Use was highest in Ethiopia (Erku, ; James et al, ). It is, therefore, important that healthcare professionals be aware of the high prevalence and the likelihood of persistence of use of T&CM by patients with cancer.…”

An assessment of Ebola-related stigma and its association with informal healthcare utilisation among Ebola survivors in Sierra Leone: a cross-sectional study

“…EVD survivors were asked about their health care utilisation, including whether they have used T&CM treatment (products and practitioners) since their discharge from the ETC. The common T&CM modalities considered in our study were informed by studies undertaken previously in Sierra Leone [31-33, 35, 45-47] and across Africa [30]. We considered T&CM in our study to include biological based therapy (herbal medicine and animal extract), spiritual therapy (prayer/faith healing), alternative medicine systems (Chinese herbal medicine, and acupuncture), and physical therapy/body manipulations (massage therapy, traditional bone setting).…”

“…T&CM refers to a number of health systems, products and practices considered to be predominantly outside conventional medical practice and the medical curriculum [28,29]. In sub-Saharan Africa, an average of 58% of the general population is estimated to use T&CM products and 29% consult T&CM practitioners [30]. The key reasons for T&CM use in Africa have been attributed to its low cost, easy accessibility, the alignment between T&CM philosophy and local cultural and religious values, perceived safety and efficacy, and dissatisfaction with conventional medicine [30].…”

“…In sub-Saharan Africa, an average of 58% of the general population is estimated to use T&CM products and 29% consult T&CM practitioners [30]. The key reasons for T&CM use in Africa have been attributed to its low cost, easy accessibility, the alignment between T&CM philosophy and local cultural and religious values, perceived safety and efficacy, and dissatisfaction with conventional medicine [30]. In Sierra Leone, T&CM utilisation is common especially among hypertensive, pregnant women, infertile women, and lactating mothers and in the management of malaria and diarrhoea [31][32][33][34][35][36].…”