April, 2017 - SUPPORT Summary of a systematic review | print this article |

Do interventions for educating traditional healers about STDs and HIV improve their knowledge and behaviour?

Traditional healers are important healthcare providers in a number of societies for a variety of healthcare concerns, including sexually transmitted diseases (STDs) and HIV. However, some traditional healing practices are risk factors for HIV infection, such as male circumcision using unsterilized equipment. The provision of training for traditional healers about STDs, HIV and evidence based medicine is seen as a way to improve their knowledge, reduce risk behaviours, and improve acceptance of and collaboration with formal health services. Training could also increase referrals to the formal health services.

Key messages

  • Training traditional healers may increase their general knowledge about HIV/AIDS, as well as their knowledge about HIV/AIDS signs, symptoms and prevention.
  • Training traditional healers may improve their HIV/STD patient management practices.
  • Training traditional healers may lead to little or no difference in the incidence of HIV/AIDS risk behaviours among healers or in their referral practices.
  • Traditional healers who have received training may refer patients to allopathic health more frequently if their traditional treatment fails.

Background

Providing treatment and support for people living with HIV and AIDS places an enormous strain on healthcare systems, particularly in lowincome countries. The shortage of healthcare professionals, and the recognition of the importance of traditional healers as healthcare providers in certain societies, has led to efforts to improve collaboration between traditional healing and allopathic or evidence based medicine. Traditional healers are seen as trustworthy by many people because of their cultural and social familiarity, and because traditional healers are perceived as being more responsive to people’s spiritual concerns. However, some traditional healing practices are risk factors for HIV infection. Training traditional healers about STDs and HIV, or evidence based medicine in general, is seen as a possible way to further knowledge, reduce risk behaviours, and to increase their acceptance of and collaboration with formal health services.



About the systematic review underlying this summary

Review objectives: To evaluate the efficacy of interventions for educating traditional healers in the fundamentals of STDs and HIV medicine.
Type of What the review authors searched for What the review authors found
Study designs & interventions Randomised trials, non randomised trials, and controlled before after studies of interventions aimed at educating traditional healers in STDs and HIV medicine.
  • 1 controlled before after study of a 3.5 day training course for traditional healers focusing on HIV, STDs, TB, nutrition, family planning, motivation for risk behaviour reduction
  • 1 non randomised trial of a seven day training course for traditional healers focusing on malnutrition, acute respiratory infection, diarrhoea, night blindness and HIV
Participants Traditional healers in any setting
Traditional healers
Settings Any setting in which traditional healers are practising
South Africa (1 study in 2 urban and 2 rural communities in KwaZulu Natal Province) and Nepal (I study in 10 village development committee areas in a remote, rural region).
Outcomes
  • Increase in knowledge about STDs and HIV medicine (HIV transmission, prevention, antiretroviral therapy)
  • Changes in behaviour (HIV risk practices, referral for testing, condom distribution, safe sex advice and counselling, referral to allopathic medical services)
  • Increase in knowledge about STDs and HIV (signs and symptoms, prevention) (2 studies)
  • Change in behaviour (patient management practices, HIV/AIDS risk behaviours, referral practices) (2 studies)
Date of most recent search: November 2008
Limitations: This is a well conducted systematic review with only minor limitations.
Sorsdahl K, Ipser JC, Stein DJ. Interventions for educating traditional healers about STD and HIV medicine. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD007190. DOI: 10.1002/14651858.CD007190.pub2

Summary of findings

Two studies were identified which assessed the impact of short training courses on HIV, STDs and other health issues for traditional healers. One study was performed in South Africa and one in Nepal. Both reported the impact of the training on STD and HIV knowledge, and on behaviour.

 

  • Training traditional healers may increase their general knowledge about HIV/AIDS, as well as their knowledge about HIV/AIDS signs, symptoms and prevention. The certainty of this evidence is low.
  • Training traditional healers may improve their HIV/STD patient management practices. The certainty of this evidence is low.
  • Training traditional healers may lead to little or no difference in the incidence of HIV/AIDS risk behaviours among healers or in their referral practices. The certainty of this evidence is low.
  • Traditional healers who have received training may refer patients to allopathic health more frequently if their traditional treatment fails. The certainty of this evidence is low.

Short training course in allopathic, evidence based medicine versus no training

People: Traditional healers.
Settings
:  South Africa, Nepal.
Intervention
: Training course.
Comparison
: No training course.
Outcomes Impact Certainty of the evidence
(GRADE)
Increase in knowledge about STDs and HIV
Training traditional healers may increase their general knowledge about HIV/AIDS, knowledge about HIV/AIDS prevention and knowledge about HIV/AIDS signs and symptoms.
Low
Change in behaviour

One study showed that training traditional healers may improve their HIV/STD patient management practices but may lead to little or no difference in the incidence of HIV/AIDS risk behaviours among healers or in their self reported referral practices.

A second study showed that traditional healers who have received training may refer patients to allopathic health more frequently if their traditional treatment fails.

Low
GRADE: GRADE Working Group grades of evidence (see above and last page)

 


 


Relevance of the review for low-income countries

Findings Interpretation*
APPLICABILITY

Both of the included studies were conducted in low and middle income countries.

 

  • Two groups of traditional healers were included across the two included studies.

Traditional healers are an integral part of certain societies but uncommon in others. In addition, the extent to which healers are integrated into allopathic healthcare systems differs widely between societies. Knowledge of where traditional healers are commonly used should guide efforts to engage with these groups and to offer them training in evidence based medicine.

 

  • In some settings, a range of different traditional healers may be practising. It is unclear to what extent the findings of this review can be applied to all types of traditional healers.
EQUITY

The studies provided little information regarding the differential effects of the interventions for the most disadvantaged populations.

 

  • Both of the studies included traditional healers working in rural areas, and in one study these areas were described as remote.

Where traditional healers work in poor or more remote communities, with poorer access to allopathic healthcare, training these healers about STDs and HIV might benefit these otherwise marginalised populations.

 

  • For disadvantaged populations, the relative benefits and disbenefits of putting in place training programmes for traditional healers compared to implementing programmes to strengthen allopathic health services need to be considered.
ECONOMIC CONSIDERATIONS
The review did not include information on the absolute costs or cost effectiveness of the interventions.

The resources needed to implement training for traditional healers will vary across settings, depending on the range and number of traditional healers in practice and where they are based.

 

  • Training traditional healers may increase their referrals of people to health facilities that offer allopathic medicine which, in turn, may increase the resources needed by these facilities. These increased resources may be offset by lower levels of morbidity among those referred.
MONITORING & EVALUATION
The certainty of the evidence on the effects of educating traditional healers about STDs and HIV is low.

The effectiveness of educating traditional healers about STDs and HIV should be further evaluated using rigorous designs.

 

  • The effectiveness of different types of education for traditional healers with regard to their knowledge and behaviours should be evaluated.
  • Where training programmes are implemented, their impacts on the advice given by traditional healers, on referrals to allopathic health services and on resources used should be monitored.

*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low income countries. For additional details about how these judgements were made see:www.supportsummaries.org/methods

 

Additional information

Related literature

Flint A, Payne J. Reconciling the irreconcilable? HIV/AIDS and the potential for middle ground between the traditional and biomedical healthcare sectors in South Africa. Forum for Development Studies. 2013; 40 (1): 47-68.

Lakshmi JK, Nambiar D, Narayan V, Sathyanarayana TN, Porter J, Sheikh K. Cultural consonance, constructions of science and co existence: a review of the integration of traditional, complementary and alternative medicine in lowand middle income countries. Health policy and planning. 2015;30(8):1067-77.

Mills E, Singh S, Wilson K, Peters E, Onia R, Kanfer, I. The challenges of involving traditional healers in HIV/AIDS care. International Journal of STD & AIDS. 2006;17: 360-363.

Wreford, J. Missing each other: Problems and potentials for collaborative efforts between biomedicine and traditional healers in South Africa in the time of AIDS. Social Dynamics. 2005; 31;2(55): 89.

 

This summary was prepared by

Peter Steinmann, Swiss Tropical and Public Health Institute, Switzerland.

 

Conflict of interest

None declared. For details, see: www.supportsummaries.org/coi

 

Acknowledgements

This summary has been peer reviewed by: Katherine Sorsdahl, Harriet Nabudere, Robert Basaza, Simon Goudie, and Hanna Bergman.

 

This review should be cited as

Sorsdahl K, Ipser JC, Stein DJ. Interventions for educating traditional healers about STD and HIV medicine. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD007190.

 

The summary should be cited as

Steinmann P. Do interventions for educating traditional healers about STDs and HIV improve their knowledge and behaviour? A SUPPORT Summary of a systematic review. April 2017. www.supportsummaries.org

 

Keywords

evidence-informed health policy, evidence based, systematic review, health systems research, health care, low and middle income countries, developing countries, primary health care, education, HIV, medicine, traditional healer, traditional medicine, training.

 

 



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