Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Social Psychiatry and Psychiatric Epidemiology
Published in: Social Psychiatry and Psychiatric Epidemiology 6/2015

01-06-2015 | Review

Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis

Authors: Jonathan K. Burns, Andrew Tomita

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 6/2015

Login to get access

Abstract

Purpose

In resource-limited contexts in low- and middle-income countries (LMICs), a considerable proportion of individuals seeking care for mental disorders consult traditional and religious healers in their pathway to mental health care. Reports from Africa suggest that early involvement of healers may result in delays in the care pathway; a potential barrier to early identification and intervention.

Methods

A systematic review was conducted to evaluate the proportion of patients attending formal health services after making first contact for treatment of mental disorders with traditional or religious healers or other informal and formal care providers within published research in Africa. Electronic databases were searched for the period from January 1990 to February 2014. Quality assessment of included studies was conducted the SAQOR tool.

Results

Fourteen papers were identified with data on category of first care provider. Utilizing random effects modelling with inverse variance method, the pooled proportion of participants making first contact for treatment of mental disorders with two broadly categorised providers (informal and formal) was 48.1 % (95 % CI 36.4–60.0 %) and 49.2 % (95 % CI 38.0–60.4 %), respectively. The pooled proportion of participants making first contact with specific providers was: traditional healers (17.0 %, 95 % CI 10.9–24.1 %); religious healers (26.2 %, 95 % CI 18.1–35.1 %); general health services (24.3 %, 95 % CI 16.9–32.5 %); and mental health services (13.0 %, 95 % CI 5.1–23.5 %). Substantial regional variation in patterns of first provider choice was evident.

Conclusions

Conclusions of this review must be qualified in the light of several limitations. Approximately half of individuals seeking formal health care for mental disorders in Africa, choose traditional and religious healers as their first care provider. Previous reports suggest that this choice is associated with delays in accessing formal mental health services. Strategies to improve pathways to mental health care in Africa must include innovative programmes aimed at fostering collaboration between biomedical mental health services and these key community-based providers.
Appendix
Available only for authorised users
Literature
1.
Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T (2005) Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 62:975–983CrossRefPubMed
2.
Farooq S, Large M, Nielssen O, Waheed W (2009) The relationship between the duration of untreated psychosis and outcome in low-and-middle income countries: a systematic review and meta-analysis. Schizophr Res 109(1–3):15–23CrossRefPubMed
3.
O’Callaghan E, Turner N, Renwick L, Jackson D, Sutton M, Foley SD, McWilliams S, Behan C, Fetherstone A, Kinsella A (2010) First episode psychosis and the trail to secondary care: help-seeking and health-system delays. Soc Psychiatry Psychiatr Epidemiol 45:381–391CrossRefPubMed
4.
Morgan C, Abdul-Al R, Lappin JM, Jones P, Fearon P, Leese M, Croudace T, Morgan K, Dazzan P, Craig T, Leff J, Murray R, AESOP Study Group (2006) Clinical and social determinants of duration of untreated psychosis in the ÆSOP first-episode psychosis study. Br J Psychiatry 189:446–452CrossRefPubMed
5.
Kohn R, Saxena S, Levav I et al (2004) The treatment gap in mental health care. Bull World Health Organ 82(11):858–866PubMedCentralPubMed
6.
Saxena S, Thornicroft G, Knapp M, Whiteford H (2007) Resources for mental health: scarcity, inequity, and inefficiency. Lancet 370(9590):878–889CrossRefPubMed
7.
Saraceno B, Saxena S (2002) Mental health resources in the world: results from Project Atlas of the WHO. World Psychiatry 1(1):40–44PubMedCentralPubMed
8.
Shah AA, Beinecke RH (2009) Global mental health needs, services, barriers and challenges. Int J Ment Health 38(1):14–29CrossRef
9.
10.
11.
12.
Mbatha N, Street RA, Ngcobo M, Gqaleni N (2012) Sick certificates issued by South African traditional health practitioners: current legislation, challenges and the way forward. SAMJ 102:129–131PubMed
13.
World Health Organization (2002) Traditional medicine strategy 2002–2005. WHO, Geneva
14.
15.
Shibre T, Spångéus A, Henriksson L, Negash A, Jacobsson L (2008) Traditional treatment of mental disorders in rural Ethiopia. Ethiopian Med J 46(1):87–91
16.
Abbo C (2011) Profiles and outcome of traditional healing practices for severe mental illnesses in two districts of Eastern Uganda. Glob Health Action 4
17.
Gureje O, Acha RA, Odejide OA (1995) Pathways to psychiatric care in Ibadan. Nigeria. Trop Geogr Med 47(3):125–129
18.
Sorsdahl K, Stein DJ, Flisher AJ (2013) Predicting referral practices of traditional healers of their patients with a mental illness: an application of the Theory of Planned Behaviour. Afr J Psychiatry 16(1):35–40
19.
Ross LE, Grigoriadis S, Mamisashvili L, Koren G, Steiner M, Dennis C-L, Cheung A, Mousmanis P (2011) Quality assessment of observational studies in psychiatry: an example from perinatal psychiatric research. Int J Method Psychiatr Pract 20(4):224–234CrossRef
20.
Bekele YY, Flisher AJ, Alem A, Baheretebeb Y (2009) Pathways to psychiatric care in Ethiopia. Psychol Med 39:475–483CrossRefPubMed
21.
Girma E, Tesfaye M (2011) Patterns of treatment seeking behavior for mental illness in Southwest Ethiopia: a hospital based study. BMC Psychiatry 11:138CrossRefPubMedCentralPubMed
22.
23.
Nonye AP, Oseloka EC (2009) Health-seeking behaviour of mentally ill patients in Enugu. Nigeria. SAJP 15(1):19–22
24.
Aghukwa CN (2012) Care seeking and beliefs about the cause of mental illness among Nigerian psychiatric patients and their families. Psychiatr Serv 63(6):616–618CrossRefPubMed
25.
Lasebikan VO, Owoaje ET, Asuzu MC (2012) Social network as a determinant of pathway to mental health service utilization among psychotic patients in a Nigerian hospital. Ann Afr Med 11:12–20CrossRefPubMed
26.
Adeosun II, Adegbohun AA, Adewumi TA, Jeje OO (2013) The pathways to the first contact with mental health services among patients with schizophrenia in Lagos, Nigeria. Schizophr Res Treatment 2013:769161PubMedCentralPubMed
27.
Bakare MO (2013) Pathway to care: first points of contact and sources of referral among children and adolescent patients seen at Neuropsychiatric Hospital in South-Eastern Nigeria. Niger J Med 22(1):52–56PubMed
28.
Jack-Ide IO, Makoro BP, Azibiri B (2013) Pathways to mental health care services in the Niger Delta region of Nigeria. J Res Nursing Mid 2(2):22–29
29.
Odinka PC, Oche M, Ndukuba AC, Muomah RC, Osika MU, Bakare MO, Agomoh AO, Uwakwe R (2014) The socio-demographic characteristics and patterns of help-seeking among patients with schizophrenia in South-East Nigeria. J Health Care Poor Underserved 25:180–191CrossRefPubMed
30.
Modiba P, Schneider H, Porteus K, Gunnarson V (2001) Profile of community mental health service needs in the Moretele District (North-West Province) in South Africa. J Ment Health Policy Econ 4:189–196PubMed
31.
Mkize LP, Uys LR (2004) Pathways to mental health care in KwaZulu-Natal. Curiatonis 27:62–71
32.
Temmingh HS, Oosthuizen PP (2008) Pathways to care and treatment delays in first and multi episode psychosis. Findings from a developing country. Soc Psychiatry Psychiatr Epidemiol 43(9):727–735CrossRefPubMed
33.
Patel V, Simunyu E, Gwanzura F (1997) The pathways to primary mental health care in high-density suburbs in Harare, Zimbabwe. Soc Psychiatry Psychiatr Epidemiol 32:97–103CrossRefPubMed
34.
Burns JK (2014) The burden of mental disorders in KwaZulu-Natal: mapping the treatment gap. South Afr J Psychiatry 20(1):6–10CrossRef
35.
36.
Schierenbeck I, Johansson P, Andersson L, van Rooyen D (2013) Barriers to accessing and receiving mental health care in Eastern Cape, South Africa. Health Hum Rights 15(2):110–123PubMed
37.
38.
Coomer RA (2013) The experiences of parents of children with mental disability regarding access to mental health care. Afr J Psychiatry 16(4):271–276. doi:10.​4314/​ajpsy.​v16i4.​36
39.
Nsereko JR, Kizza D, Kigozi F, Ssebunnya J, Ndyanabangi S, Flisher AJ, Cooper S, MHaPP Research Programme Consortium (2011) Stakeholders’ perceptions of help-seeking behaviour among people with mental health problems in Uganda. Int J Ment Health Syst 13(5):5. doi:10.​1186/​1752-4458-5-5 CrossRef
40.
41.
Campbell-Hall V, Petersen I, Bhana A, Mjadu S, Hosegood V, Flisher AJ, MHaPP Research Programme Consortium (2010) Collaboration between traditional practitioners and primary health care staff in South Africa: developing a workable partnership for community mental health services. Transcult Psychiatry 47(4):610–628. doi:10.​1177/​1363461510383459​ CrossRefPubMed
42.
Patel V, Musara T, Butau T, Maramba P, Fuyane S (1995) Concepts of mental illness and medical pluralism in Harare. Psychol Med 25(3):485–493CrossRefPubMed
43.
Colvin M, Gumede L, Grimwade K, Maher D, Wilkinson D (2003) Contribution of traditional healers to a rural tuberculosis control programme in Hlabisa, South Africa. Int J Tuberc Lung Dis 7(9 Supp 1):S86–S91PubMed
44.
Harper ME, Hill PC, Bah AH, Manneh K, McAdam KP, Lienhardt C (2004) Traditional healers participate in tuberculosis control in The Gambia. Int J Tuberc Lung Dis 8(10):1266–1268PubMed
45.
Peltzer K, Mngqundaniso N, Petros G (2006) A controlled study of an HIV/AIDS/STI/TB intervention with traditional healers in KwaZulu-Natal, South Africa. AIDS Behav 10(6):683–690CrossRefPubMed
46.
Kayombo EJ, Uiso FC, Mbwambo ZH, Mahunnah RL, Moshi MJ, Mgonda YH (2007) Experience of initiating collaboration of traditional healers in managing HIV and AIDS in Tanzania. J Ethnobiol Ethnomed 3:6CrossRefPubMedCentralPubMed
47.
48.
49.
World Health Organisation (WHO) (1991) Traditional medicine and modern health care (Progress report by the Director General on the Forty-Fourth World Health Assembly). WHO, Geneva
50.
51.
Read UM, Adiibokah E, Nyame S (2009) Local suffering and the global discourse of mental health and human rights: an ethnographic study of responses to mental illness in rural Ghana. Glob Health 14(5):13. doi:10.​1186/​1744-8603-5-13 CrossRef
52.
Adelekan ML, Makanjuola AB, Ndom RJ (2001) Traditional mental health practitioners in Kwara State, Nigeria. East Afr Med J 78(4):190–196CrossRefPubMed
Metadata
Title
Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis
Authors
Jonathan K. Burns
Andrew Tomita
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 6/2015
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-014-0989-7

Other articles of this Issue 6/2015

Social Psychiatry and Psychiatric Epidemiology 6/2015 Go to the issue

Original Paper

Association of moderate and severe food insecurity with suicidal ideation in adults: national survey data from three Canadian provinces

Invited Reviews

The ‘Early Developmental Stages of Psychopathology (EDSP) study’: a 20-year review of methods and findings

Original Paper

How financial hardship is associated with the onset of mental health problems over time

Editorial

Latent variable and network models of comorbidity: toward an empirically derived nosology

Original Paper

Empirically derived subtypes of serious emotional disturbance in a large adolescent sample

Original Paper

Neighborhood ethnic density and suicide risk among different migrant groups in the four big cities in the Netherlands