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Changing use of traditional healthcare amongst those dying of HIV related disease and TB in rural South Africa from 2003 - 2011: a retrospective cohort study.

Mee P, Wagner RG, Gómez-Olivé FX, Kabudula C, Kahn K, Madhavan S, Collinson M, Byass P, Tollman SM - BMC Complement Altern Med (2014)

Bottom Line: In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003-2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality.In the multivariate model only country of origin, time period and illness duration remained associated.There were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB.

View Article: PubMed Central - PubMed

Affiliation: Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. paul.mee@wits.ac.za.

ABSTRACT

Background: In 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. The effective integration of traditional medical practitioners and biomedical providers in HIV prevention and care has been demonstrated. However concerns remain that the use of traditional treatments for HIV-related disease may lead to pharmacokinetic interactions between herbal remedies and ART drugs and delay ART initiation. Here we analyse the changing prevalence and determinants of traditional healthcare use amongst those dying of HIV-related disease, pulmonary tuberculosis and other causes in a rural South African community between 2003 and 2011. ART was made available in this area in the latter part of this period.

Methods: Data was collected during household visits and verbal autopsy interviews. InterVA-4 was used to assign causes of death. Spatial analyses of the distribution of traditional healthcare use were performed. Logistic regression models were developed to test associations of determinants with traditional healthcare use.

Results: There were 5929 deaths in the study population of which 47.7% were caused by HIV-related disease or pulmonary tuberculosis (HIV/AIDS and TB). Traditional healthcare use declined for all deaths, with higher levels throughout for those dying of HIV/AIDS and TB than for those dying of other causes. In 2003-2005, sole use of biomedical treatment was reported for 18.2% of HIV/AIDS and TB deaths and 27.2% of other deaths, by 2008-2011 the figures were 49.9% and 45.3% respectively. In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003-2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality. In the multivariate model only country of origin, time period and illness duration remained associated.

Conclusions: There were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB. No associations between socio-economic position, age or gender and the likelihood of traditional healthcare use were seen. Further qualitative and quantitative studies are needed to assess whether these figures reflect trends in healthcare use amongst the entire population and the reasons for the temporal changes identified.

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Related in: MedlinePlus

Short title - Residential locations and traditional healthcare use for those dying between 2003 and 2011. Detailed legend - This map shows the geographical distribution of the home location for those using traditional or herbal medicines during their final illness. To preserve anonymity the geographical coordinates are randomly shifted in the range +/- 0.5 km in the X and Y directions.
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Fig1: Short title - Residential locations and traditional healthcare use for those dying between 2003 and 2011. Detailed legend - This map shows the geographical distribution of the home location for those using traditional or herbal medicines during their final illness. To preserve anonymity the geographical coordinates are randomly shifted in the range +/- 0.5 km in the X and Y directions.

Mentions: There were 6392 deaths recorded for those aged 18 years and over between 2003 and 2011. Health care utilisation (HCU) data was available for 5929 individuals (92.8%), who constituted the study population (Additional file 2: Table S1). The geographical distribution of the households and TH use status of those who died is shown in Figure 1. There was no indication from this of variations in likelihood of TH use amongst the deceased across the site. The characteristics of the study population are shown in Table 1. There were 2833 deaths attributable to HIV/AIDS and TB, 47.8% of the total.Figure 1


Changing use of traditional healthcare amongst those dying of HIV related disease and TB in rural South Africa from 2003 - 2011: a retrospective cohort study.

Mee P, Wagner RG, Gómez-Olivé FX, Kabudula C, Kahn K, Madhavan S, Collinson M, Byass P, Tollman SM - BMC Complement Altern Med (2014)

Short title - Residential locations and traditional healthcare use for those dying between 2003 and 2011. Detailed legend - This map shows the geographical distribution of the home location for those using traditional or herbal medicines during their final illness. To preserve anonymity the geographical coordinates are randomly shifted in the range +/- 0.5 km in the X and Y directions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4325963&req=5

Fig1: Short title - Residential locations and traditional healthcare use for those dying between 2003 and 2011. Detailed legend - This map shows the geographical distribution of the home location for those using traditional or herbal medicines during their final illness. To preserve anonymity the geographical coordinates are randomly shifted in the range +/- 0.5 km in the X and Y directions.
Mentions: There were 6392 deaths recorded for those aged 18 years and over between 2003 and 2011. Health care utilisation (HCU) data was available for 5929 individuals (92.8%), who constituted the study population (Additional file 2: Table S1). The geographical distribution of the households and TH use status of those who died is shown in Figure 1. There was no indication from this of variations in likelihood of TH use amongst the deceased across the site. The characteristics of the study population are shown in Table 1. There were 2833 deaths attributable to HIV/AIDS and TB, 47.8% of the total.Figure 1

Bottom Line: In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003-2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality.In the multivariate model only country of origin, time period and illness duration remained associated.There were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB.

View Article: PubMed Central - PubMed

Affiliation: Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. paul.mee@wits.ac.za.

ABSTRACT

Background: In 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. The effective integration of traditional medical practitioners and biomedical providers in HIV prevention and care has been demonstrated. However concerns remain that the use of traditional treatments for HIV-related disease may lead to pharmacokinetic interactions between herbal remedies and ART drugs and delay ART initiation. Here we analyse the changing prevalence and determinants of traditional healthcare use amongst those dying of HIV-related disease, pulmonary tuberculosis and other causes in a rural South African community between 2003 and 2011. ART was made available in this area in the latter part of this period.

Methods: Data was collected during household visits and verbal autopsy interviews. InterVA-4 was used to assign causes of death. Spatial analyses of the distribution of traditional healthcare use were performed. Logistic regression models were developed to test associations of determinants with traditional healthcare use.

Results: There were 5929 deaths in the study population of which 47.7% were caused by HIV-related disease or pulmonary tuberculosis (HIV/AIDS and TB). Traditional healthcare use declined for all deaths, with higher levels throughout for those dying of HIV/AIDS and TB than for those dying of other causes. In 2003-2005, sole use of biomedical treatment was reported for 18.2% of HIV/AIDS and TB deaths and 27.2% of other deaths, by 2008-2011 the figures were 49.9% and 45.3% respectively. In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003-2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality. In the multivariate model only country of origin, time period and illness duration remained associated.

Conclusions: There were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB. No associations between socio-economic position, age or gender and the likelihood of traditional healthcare use were seen. Further qualitative and quantitative studies are needed to assess whether these figures reflect trends in healthcare use amongst the entire population and the reasons for the temporal changes identified.

Show MeSH
Related in: MedlinePlus