Tuberculosis management and referral practices among traditional medicine practitioners in Lagos, Nigeria

Victor Abiola Adepoju; Olanrewaju Oladimeji; Maureen Nokuthula Sibiya; Jude Inegbeboh; Ginika Egesemba

doi:10.4081/jphia.2023.1480

Authors

Victor Abiola Adepoju Department of HIV and Infectious Diseases, Jhpiego Nigeria, an affiliate of John Hopkins University, Abuja, Nigeria. https://orcid.org/0000-0001-8379-1001
Olanrewaju Oladimeji
ooladimeji@wsu.ac.za
Department of Public Health, Walter Sisulu University, Eastern Cape; Faculty of Health Sciences, Durban University of Technology, Durban, South Africa.
Maureen Nokuthula Sibiya Faculty of Health Sciences, Durban University of Technology, Durban, South Africa. https://orcid.org/0000-0003-1220-1478
Jude Inegbeboh European Union Maternal, Newborn, and Child Health and Nutrition, UNICEF, Kebbi State, Nigeria.
Ginika Egesemba International Center for AIDS Care and Treatment Program (ICAP) at Columbia University, Sierra Leone Teaching Hospital, Ikeja, Lagos State, Nigeria. https://orcid.org/0000-0003-3366-7840

Introduction: Despite the potential role of Traditional Birth Attendants (TBAs) and Traditional Healers (THs), little is known about their knowledge of tuberculosis (TB) management and refer- ral practices in Nigeria.

Objective: To determine knowledge and self-reported prac- tices of traditional birth attendants and traditional healers in man- aging TB in Lagos, Nigeria.

Methods: A cross-sectional study of 120 THs and TBAs in three high TB burden Local Government Areas (LGAs) in Lagos, Nigeria. Data were collected between April 2018 to September 2018 through interviewer-administered questionnaires. We used Statistical Package for Social Sciences software for data analyses. Independent predictors of being TBA or TH were determined using logistic regression at the statistical significance of P<0.05 and 95% confidence interval.

Results: TB knowledge increased from 52.7% pre-test to 61.7% post-test and did not differ between TBAs and THs. Of the 120 Traditional Medical Practitioners studied, 70% (84) never treated TB; 57.3 % (69) ever referred chronic cough patients to a health facility; 90% (108) were willing to collaborate with National Tuberculosis, Leprosy and Buruli Ulcer Control Programme (NTBLCP), 85% (102) attached monetary and token incentive as a condition for the collaboration. THs had decreased odds of ever referring TB patient to the hospital (AOR: 0.3, 95% CI:0.14-0.64, P=0.002); currently referring TB patients (AOR: 0.06, 95% CI:0.02-0.17, P<0.0001) and consulting <40 patients in a year (AOR: 0.22,95% CI:0.09-0.53, P<0.0001).

Conclusion: Majority of the THs and TBAs were willing to collaborate with NTBLCP in the identification and referral of Presumptive TB patients. We suggest that NTBLCP empowers the TBAs and THs to help with an early referral of TB patients.

Global Tuberculosis Report. Geneva: World Health Organization 2020. Available from: https://www.who.int/publications/i/item/9789240013131

Federal Ministry of Health Nigeria (FMOH), Annual Report 2019. National Tuberculosis & Leprosy Control Programme Nigeria 2020. Available from: https://www.health.gov.ng/doc/Draft-2019-NTBLCP-Annual-report-22032020.pdf

Pharmaccess Group. Nigeria Health Sector Market Study Report 2015. Available from https://www.rvo.nl/sites/default/files/Market_Study_Health_Nigeria.pdf

Oladayo B, Saheed G, Ajibola A, et al. Knowledge, care-seeking behavior, and factors associated with patient delay among newly-diagnosed pulmonary tuberculosis patients, Federal Capital Territory, Nigeria. Pan Afr Med J 2014;18:6. DOI: https://doi.org/10.11604/pamj.supp.2014.18.1.4166

Audet CM, Meridith B, Caitlin R, et al. Symptomatic HIV-positive persons in rural Mozambique who first consult a traditional healer have delays in HIV testing: A cross-sectional study. J Acquir Immune Defic Syndr 2014;66:4. DOI: https://doi.org/10.1097/QAI.0000000000000194

Brouwer JA, Boeree MJ, Kager P, et al. Traditional healers and pulmonary tuberculosis in Malawi. Int J Tuberc Lung Dis 1998;2:231-4.

Banerjee A, Sharma B, Ray A, et al. Acceptability of traditional healers as directly observed treatment providers in tuberculosis control in a tribal area of Andhra Pradesh, India. Int J Tuberc Lung Dis 2004;8:1260-5.

Harper ME, Hill PC, Bah AH, et al. Traditional healers participate in tuberculosis control in The Gambia. Int J Tuberc Lung Dis 2004;8:1266–8.

Colvin M, Gumede L, Grimwade K, et al. Contribution of traditional healers to a rural tuberculosis control programme in Hlabisa, South Africa. Int J Tuberc Lung Dis 2003;7:86-91.

Kale R. Traditional healers in South Africa: a parallel health care system. BMJ 1995;310:1182–5. DOI: https://doi.org/10.1136/bmj.310.6988.1182

Homsy J, Rachel K, Joseph T, et al. Defining minimum standards of practice for incorporating African traditional medicine into HIV/AIDS prevention, care, and support: a regional initiative in eastern and southern Africa. J Altern Complement Med 2004;10:905–10. DOI: https://doi.org/10.1089/1075553042476731

Okome-Nkoumou M, Okome-Miame F, Kendjo E, et al. Delay between first HIV-related symptoms and diagnosis of HIV infection in patients attending the internal medicine department of the Fondation Jeanne Ebori (FJE), Libreville, Gabon. HIV Clin Trials 2005;6:38–42. DOI: https://doi.org/10.1310/ULR3-VN8N-KKB5-05UV

Audet CM, Salato J, Blevins M, et al. Educational Intervention Increased Referrals to Allopathic Care by Traditional Healers in Three High HIV-Prevalence Rural Districts in Mozambique. PLoS One 2013;8:e70326. DOI: https://doi.org/10.1371/journal.pone.0070326

Poudel KC, Jimba M, Joshi AB, et al. Retention and effectiveness of HIV/AIDS training of traditional healers in far western Nepal. Trop Med Int Health 2005;10:640–6. DOI: https://doi.org/10.1111/j.1365-3156.2005.01443.x

Peltzer K, Preez NF, Ramlagan S, et al. Traditional complementary and alternative medicine and antiretroviral treatment adherence among HIV patients in Kwazulu-Natal, South Africa. Afr J Tradit Complement Altern Med 2010;7:125–37. DOI: https://doi.org/10.4314/ajtcam.v7i2.50871

Furin J. The role of traditional healers in community-based HIV care in rural Lesotho. J Community Health 2011;36:849–56. DOI: https://doi.org/10.1007/s10900-011-9385-3

Carlough M, McCall M. Skilled birth attendance: What does it mean and how can it be measured? A clinical skills assessment of maternal and child health workers in Nepal. Int J Gynecol Obstet 2005;89:200-8. DOI: https://doi.org/10.1016/j.ijgo.2004.12.044

Lagos State Government Nigeria Tuberculosis Factsheet. Available from https://photos.state.gov/libraries/nigeria/487468/pdfs/January%20Tuberculosis%20Fact%20Sheet.pdf

Federal Ministry of Health, Nigeria. National tuberculosis and leprosy control program, Workers manual revised (6th ed). BamPrint Ventures. Lagos 2015. Available from: https://www.scirp.org/(S(i43dyn45teexjx455qlt3d2q))/reference/ReferencesPapers.aspx?ReferenceID=1608570

John ME, Udoma EJ, Udoh MO. Knowledge and Practice of Traditional Birth Attendants Concerning Risk Factors in Pregnancy, Labour and Puerperium Africa. J Nursing Midwifery 2002;4.

Viney K, Johnson P, Tagaro M, et al. Traditional healers and the potential for collaboration with the national tuberculosis programme in Vanuatu: results from a mixed methods study. BMC Public Health 2014;14:393. DOI: https://doi.org/10.1186/1471-2458-14-393

Sima BT, Belachew T, Bjune G, et al. Traditional healers’ role in the detection of active tuberculosis cases in a pastoralist community in Ethiopia: a pilot interventional study. BMC Pub Health 2019;19:721. DOI: https://doi.org/10.1186/s12889-019-7074-9

Mchunu GG, Bhengu BR, et al. The knowledge and attitudes of traditional birth attendants towards HIV/AIDS and their beliefs related to perinatal care: a study conducted in KwaZulu Natal. Curationis 2004;27:41-51. DOI: https://doi.org/10.4102/curationis.v27i1.953

Okeke TA, Okafor HU, Uzochukwu BS, et al. Traditional healers in Nigeria: perception of cause, treatment and referral practices for severe malaria. J Biosoc Sci 2006;38:491-500. DOI: https://doi.org/10.1017/S002193200502660X

Davids D, Blouws T, Aboyade O, et al. Traditional health practitioners' perceptions, herbal treatment and management of HIV and related opportunistic infections. J Ethnobiol Ethnomed 2014;10:77. DOI: https://doi.org/10.1186/1746-4269-10-77

Agbor AM, Naidoo S. Knowledge and practice of traditional healers in oral health in the Bui Division, Cameroon. J Ethnobiol Ethnomed 2011;7:4269-76. DOI: https://doi.org/10.1186/1746-4269-7-6

Farley E, Bala HM, Lenglet A, et al. ‘I treat it but I don’t know what this disease is’: a qualitative study on noma (cancrumoris) and traditional healing in northwest Nigeria. Int Health 2020;12:28–35. DOI: https://doi.org/10.1093/inthealth/ihz066

Adepoju, V. A., Oladimeji, O., Sibiya, M. N., Inegbeboh, J., & Egesemba, G. (2023). Tuberculosis management and referral practices among traditional medicine practitioners in Lagos, Nigeria. Journal of Public Health in Africa, 14(2). https://doi.org/10.4081/jphia.2023.1480