Survey on Knowledge, Attitudes and perceptions about Traditional Healers and healing conducted on Health Professionals working at Mtubatuba Clinics and Hlabisa Hospital, KwaZulu-Natal, South Africa.

FN Mbatha1; T. Ngwenya2; D Ngcobo3; SE Mthembu4; JF Aguilera5,6

1Partnership for the Delivery of Primary Health Care including HIV and AIDS Programme (PDPHCP), KwaZulu-Natal Provincial Management Unit, Department of Health (DOH), South Africa2AMREF SA, KwaZulu Natal, Umkhanyakude District, South Africa3PDPHCP, KwaZulu Natal, District Programme Management Unit, DOH, South Africa4PDPHCP, KwaZulu Natal, Provincial Programme Management Unit, DOH, South Africa5National Programme Management Unit, DOH, Pretoria, South Africa6AEDES, Brussels, Belgium

PDPHCP is funded by the European Commission. The views and opinions expressed are not necessarily those of the European Commission

Abstract

Introduction

Objectives

Conclusions

Results

Methods

Objectives. In 2004, it was estimated that 70% of South Africans consulted traditional healers when they were ill. We aim to assess the knowledge, attitudes and perceptions (KAP) of the health professionals working in Mtubatuba clinics and Hlabisa hospital with regards to traditional healers and their practice, and look at opportunities for collaboration between DOH and THs.Methods. The AMREF Traditional Healers Project (THP) in Umkhanyakude District in Northern KwaZulu-Natal was funded by DOH to provide quality PHC services to their clients. Based on a literature review, the KAP study used in-depth interviews and a survey questionnaire including demographic details and a short 22-item KAP measure scored on a Lickert scale. Informed consents were obtained from participants. Data were analysed using Excel. A total of 16 interviewees participated with one focus group held at Hlabisa hospital. Results. A total of 98 questionnaires were completed to staff at Hlabisa hospital (49%) and at 8 clinics visited (51%). Positive attitudes towards THs included (1) 63% would be happy to work hand in hand with TH in dealing with HIV and AIDS, (2) 42% would personally visit a TH if they were ill, (3) 75% felt that TH could be trained to provide DOT for TB. Negative attitudes included (1) 78% stated that “some TH practices could increase the risks of HIV infection”, (2) 65% stated that TH do not have adequate knowledge on HIV and AIDS. Conclusions. KAP study highlighted that collaboration between THs and DOH was not optimal and could be improved. Strategies to address resistance of both parties’ on collaboration and concerns relating to TH healthcare provision were recommended. Since this is a pilot project, in an area where a majority of patients seek support from THs, the findings suggested that this programme deserves to be further monitored and evaluated. .

The EU in partnership with the KwaZulu-Natal Department of Health funded AMREF to develop the capacity of traditional healers in the Mtubatuba area at Umkhanyakude District in Northern KZN

A total of 80 Traditional healers were trained on topics related to HIV and AIDS such as TB, VCT

A needs assessment and KAP survey were conducted to support the implementation of the traditional healers project.

The AMREF Traditional Healers project was developed taking into account that:

1. Traditional healers play a unique role in the lives of many of those who are infected or at risk of HIV and AIDS (AMREF,2005)

2.An estimated that about 80% of rural communities in South Africa still seek help from traditional healers as they live within their communities and are easily accessible. WHO(2003)

3.There is an assumption that traditional healers are well placed to refer complex cases to medical health, especially since people often consult them before they seek western medicine. (AMREF, 2005)

Table 1: General responses towards THP and their services

Table 2: Responses towards THP treatments/healing practices

Table 3: Responses towards support for and potential collaborative models

The results indicate a strong support for collaboration between health professionals and THs.However, challenges have also been identified which could make this collaboration difficult.Moreover, results suggest that more work has to be done with respect to shifting the knowledge, attitudes and perceptions of staff at the clinic and hospitals.

Way Forward:More training of THs on health related topicsDevelopment of a THs data collection tool and referral letter adapted to their literacy levels with pictures and graphics (see Figure 1)Opening of a VCT center in a community where traditional healers can refer their clients to a professional nurse for VCT.Strengthen the communication link between department of health and traditional healers.

Item n Agree%

Disagree%

I do not feel that THP have anything to offer those who have an STI

85 27% 60%

Traditional healers are fakes who pretend to cure AIDS

80 41% 41%

THP are ideally placed in their communities to provide effective support for people living with HIV/Aids

79 47% 37%

Item n Agree%

Disagree%

Some traditional healing practices could increase risk of HIV infection

92 78% 15%

THP have all the knowledge needed to treat people living with HIV/AIDS

83 19% 65%

Traditional medicines can have a role in the treatment of PLWHA

78 48% 31%

THP cannot be trusted to treat people with HIV/AIDS

76 31% 47%

Traditional healers can cure AIDS 73 12% 62%

Item n Agree%

Disagree%

I would be happy to work in a team with a traditional healer to provide treatment for TB

97 60% 39%

I would be happy to work hand in hand with traditional healers in dealing with HIV/AIDS in a hospital situation

91 63% 30%

I would prefer that a doctor or nurse provides counseling during VCT than a THP

90 75% 18%

Traditional healers can be trained to effectively treat people living with HIV/AIDS

89 77% 18%

I would be happy to work with traditional healers in the treatment and prevention of STIs

88 59% 31%

Traditional medicine and western medicine cannot work together in helping people living with HIV/AIDS

76 34% 44%

The primary aim of the study was assess the knowledge, attitudes and perceptions (KAP) of the health professionals working in the Mtubatuba clinics and Hlabisa hospital regarding the traditional healers practitioners (THP) and their practices.

Within this aim, key research questions include KAP on:

What THP do and can offer to health and well-being of the target community?

Role that THP do and may play in treating HIV/AIDS?

Collaboration with THP through a system of patient referral in responding to HIV/AIDS, STIs and TB treatment and prevention?

Work and collaboration with THP (if at all) in general health and well-being of the target community?

Strengths and challenges related to strengthening their collaboration and work with THP in the area?

1. Quantitative Approach: Survey Questionnaire

Target population: A random sample of all health professionals working in the Mtubatuba clinics and Hlabisa hospital

A copy of the questionnaire in preferred language (English or Zulu) was provided to participants

Collection of demographic details and a short 22-item KAP measure (Lickert scale)

Data was captured in Excel and analyzed using SPSS

2. Qualitative Approach: In-depth Interviews

Convenient sample of survey questionnaire participants were selected

Individual interviews and focus groups at Hlabisa Hospital and in one of the clinics visited

Semi-structured interviews were used Qualitative thematic analysis was conducted on the

transcripts of the interviews and focus groups.

3. All social science ethical conventions were maintained

One Hospital and a total of 8 out of the 9 clinics in the Hlabisa sub district were visited.

A total of 98 questionnaires were completed. 48 at the Hlabisa hospital 50 at the 8 clinics visited

Staff interviewed were mainly nurses (44%) and HIV counselors (11%)

A total of 4 persons participated in in-depth-interviews

Two focus groups of 6 participants each were conducted in Hlabisa hospital and at eMonzi clinic.

Figure 1. Traditional Healers Referral Letter