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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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Short title – Patterns of healthcare use amongst those dying of HIV/AIDS and TB in the study population between 2003 and 2011 stratified by cause of death. Legend – This plot shows the percentage of the study population dying in each 3 year period for which a particular category of traditional and/or biomedical healthcare use was reported in the verbal autopsy interview. The study population comprises adults (aged over 18) who died in the Agincourt sub-district between 2003 and 2011 for whom healthcare utilisation data was available. Vertical lines indicate the 95% confidence intervals. Diagonal shading indicates that the p-value for the difference in percentages in the type of healthcare usage between the two cause of death categories in a particular time period was less than 0.05. Full results tables are shown in the additional materials (Additional file 2: Tables S2-S5).
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Fig2: Short title – Patterns of healthcare use amongst those dying of HIV/AIDS and TB in the study population between 2003 and 2011 stratified by cause of death. Legend – This plot shows the percentage of the study population dying in each 3 year period for which a particular category of traditional and/or biomedical healthcare use was reported in the verbal autopsy interview. The study population comprises adults (aged over 18) who died in the Agincourt sub-district between 2003 and 2011 for whom healthcare utilisation data was available. Vertical lines indicate the 95% confidence intervals. Diagonal shading indicates that the p-value for the difference in percentages in the type of healthcare usage between the two cause of death categories in a particular time period was less than 0.05. Full results tables are shown in the additional materials (Additional file 2: Tables S2-S5).

Mentions: An assessment was made of the effect of excluding individuals from the study population due to missing HCU data (Additional file 2: Table S1). The entire population of deceased had a higher percentage of deaths of unknown cause than the study population (p < 0.001) and the distribution of illness duration categories differed between the two groups (p < 0.001) although there was no evidence for a difference in the mean values of illness duration. For those dying of HIV/AIDS and TB, reported TH use decreased from 77.5% to 38.5% between 2003–2005 and 2009–2011, whilst for those dying of other causes the decrease was from 53.6% to 23.6% (Figure 2 & Additional file 2: Table S2). The level of TH use for those dying of HIV/AIDS and TB was significantly higher than that for those dying of other causes in all three time periods (p < 0.001 in each case). A decrease in the percentage of deaths for which TH use was the first treatment option was seen for HIV/AIDS and TB and other causes of death between 2006–2008 and 2009–2011. First use of TH was significantly higher for those dying of HIV/AIDS and TB than for those dying of other causes in 2006–2008 but not in 2009-2011(Figure 2 & Additional file 2: Table S3).The level of reported dual use of biomedical treatment and TH was significantly higher for those dying of HIV/AIDS and TB than for those dying of other causes in each time period. In both CoD categories there were large decreases in the percentage using both biomedical treatments and traditional and herbal medicines between each successive time period (Figure 2 & Additional file 2: Table S4). The percentage of deaths for which only biomedical treatment was reported was higher for those dying of other causes than those dying of HIV/AIDS and TB in 2003 to 2005 (27.2% vs. 18.2% ) and 2006 to 2008 (44.4% vs. 36.6%) (Figure 2 and Additional file 2: Table S5). However in 2009 to 2011 sole use of biomedical treatment was reported for 49.9% of HIV/AIDS and TB deaths and 45.3% of deaths due to other causes, the difference between the two was significant (p = 0.035).Figure 2


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 – Patterns of healthcare use amongst those dying of HIV/AIDS and TB in the study population between 2003 and 2011 stratified by cause of death. Legend – This plot shows the percentage of the study population dying in each 3 year period for which a particular category of traditional and/or biomedical healthcare use was reported in the verbal autopsy interview. The study population comprises adults (aged over 18) who died in the Agincourt sub-district between 2003 and 2011 for whom healthcare utilisation data was available. Vertical lines indicate the 95% confidence intervals. Diagonal shading indicates that the p-value for the difference in percentages in the type of healthcare usage between the two cause of death categories in a particular time period was less than 0.05. Full results tables are shown in the additional materials (Additional file 2: Tables S2-S5).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Short title – Patterns of healthcare use amongst those dying of HIV/AIDS and TB in the study population between 2003 and 2011 stratified by cause of death. Legend – This plot shows the percentage of the study population dying in each 3 year period for which a particular category of traditional and/or biomedical healthcare use was reported in the verbal autopsy interview. The study population comprises adults (aged over 18) who died in the Agincourt sub-district between 2003 and 2011 for whom healthcare utilisation data was available. Vertical lines indicate the 95% confidence intervals. Diagonal shading indicates that the p-value for the difference in percentages in the type of healthcare usage between the two cause of death categories in a particular time period was less than 0.05. Full results tables are shown in the additional materials (Additional file 2: Tables S2-S5).
Mentions: An assessment was made of the effect of excluding individuals from the study population due to missing HCU data (Additional file 2: Table S1). The entire population of deceased had a higher percentage of deaths of unknown cause than the study population (p < 0.001) and the distribution of illness duration categories differed between the two groups (p < 0.001) although there was no evidence for a difference in the mean values of illness duration. For those dying of HIV/AIDS and TB, reported TH use decreased from 77.5% to 38.5% between 2003–2005 and 2009–2011, whilst for those dying of other causes the decrease was from 53.6% to 23.6% (Figure 2 & Additional file 2: Table S2). The level of TH use for those dying of HIV/AIDS and TB was significantly higher than that for those dying of other causes in all three time periods (p < 0.001 in each case). A decrease in the percentage of deaths for which TH use was the first treatment option was seen for HIV/AIDS and TB and other causes of death between 2006–2008 and 2009–2011. First use of TH was significantly higher for those dying of HIV/AIDS and TB than for those dying of other causes in 2006–2008 but not in 2009-2011(Figure 2 & Additional file 2: Table S3).The level of reported dual use of biomedical treatment and TH was significantly higher for those dying of HIV/AIDS and TB than for those dying of other causes in each time period. In both CoD categories there were large decreases in the percentage using both biomedical treatments and traditional and herbal medicines between each successive time period (Figure 2 & Additional file 2: Table S4). The percentage of deaths for which only biomedical treatment was reported was higher for those dying of other causes than those dying of HIV/AIDS and TB in 2003 to 2005 (27.2% vs. 18.2% ) and 2006 to 2008 (44.4% vs. 36.6%) (Figure 2 and Additional file 2: Table S5). However in 2009 to 2011 sole use of biomedical treatment was reported for 49.9% of HIV/AIDS and TB deaths and 45.3% of deaths due to other causes, the difference between the two was significant (p = 0.035).Figure 2

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