The Determinants of Traditional Medicine Use in Northern Tanzania: A Mixed-Methods Study

Introduction

Traditional medicines are an important part of healthcare in sub-Saharan Africa, and building successful disease treatment programs that are sensitive to traditional medicine practices will require an understanding of their current use and roles, including from a biomedical perspective. Therefore, we conducted a mixed-method study in Northern Tanzania in order to characterize the extent of and reasons for the use of traditional medicines among the general population so that we can better inform public health efforts in the region.

Methods

Between December 2013 and June 2014 in Kilimanjaro, Tanzania, we conducted 5 focus group discussions and 27 in-depth interviews of key informants. The data from these sessions were analyzed using an inductive framework method with cultural insider-outsider coding. From these results, we developed a structured survey designed to test different aspects of traditional medicine use and administered it to a random sample of 655 adults from the community. The results were triangulated to explore converging and diverging themes.

Results

Most structured survey participants (68%) reported knowing someone who frequently used traditional medicines, and the majority (56%) reported using them themselves in the previous year. The most common uses were for symptomatic ailments (42%), chronic diseases (15%), reproductive problems (11%), and malaria/febrile illnesses (11%). We identified five major determinants for traditional medicine use in Northern Tanzania: biomedical healthcare delivery, credibility of traditional practices, strong cultural identities, individual health status, and disease understanding.

Conclusions

In order to better formulate effective local disease management programs that are sensitive to TM practices, we described the determinants of TM use. Additionally, we found TM use to be high in Northern Tanzania and that its use is not limited to lower-income areas or rural settings. After symptomatic ailments, chronic diseases were reported as the most common reason for TM use which may be particularly important in Northern Tanzania where non-communicable diseases are a rapidly growing burden.     

Do we need theory to study disease? Lessons from cancer research and their implications for mental illness

This article applies general ideas from contemporary philosophy of science--chief among them that much good science proceeds without theories and laws--to the science of medicine. I claim that traditional philosophical debates over the nature of disease make demands on medicine that are mistaken. I demonstrate this philosophical error by applying the perspective of the philosophy of science to understanding the nature of disease in two concrete cases, cancer and depression. I first argue that cancer research produces various kinds of piecemeal causal explanation and does so without any well-developed theory of normal and malignant functioning, despite the rhetoric of some leading cancer researchers. I then defuse doubts about the scientific status of psychiatry, by demonstrating that it is not necessary to have a theory of normal functioning in order to understand and treat depression.     

Was there a Bacteriological Revolution in late nineteenth-century medicine?

That there was a 'Bacteriological Revolution' in medicine in the late nineteenth-century, associated with the development of germ theories of disease, is widely assumed by historians; however, the notion has not been defined, discussed or defended. In this article a characterisation is offered in terms of four linked rapid and radical changes: (i) a series of discoveries of the specific causal agents of infectious diseases and the introduction of Koch's Postulates; (ii) a reductionist and contagionist turn in medical knowledge and practice; (iii) greater authority for experimental laboratory methods in medicine; (iv) the introduction and success of immunological products. These features are then tested against developments in four important but previously neglected diseases: syphilis, leprosy, gonorrhoea and rabies. From these case-studies I conclude that the case for a Bacteriological Revolution in late nineteenth-century medicine in Britain remains unproven. I suggest that historians have read into the 1880s changes that occurred over a much longer period, and that while there were significant shifts in ideas and practices over the decade, the balance of continuities and changes was quite uneven across medicine. My argument is only for Britain; in other countries the rate and extent of change may have been different.     

Challenges for effective marker-assisted selection in plants

The basic principle of Marker-Assisted Selection (MAS) is to exploit Linkage Disequilibrium (LD) between markers and QTLs. With strong enough LD, MAS should in theory be easier, faster, cheaper, or more efficient than classical (phenotypic) selection. I briefly review the major MAS methods, describing some ‘success stories’ where MAS was applied successfully in the context of plant breeding, and detailing other cases where efficiency was not as high as expected. I discuss the possible causes explaining the difference between theoretical expectations and practical observations. Finally, I review the principal challenges and issues that must be tackled to make marker-assisted selection in plants more effective in the future, namely: managing and controlling QTL stability to apply MAS to complex traits, and integrating MAS in traditional breeding practices to make it more economically attractive and applicable in developing countries.     

To what extent can traditional medicine contribute a complementary or alternative solution to malaria control programmes?

Recent studies on traditional medicine (TM) have begun to change perspectives on TM effects and its role in the health of various populations. The safety and effectiveness of some TMs have been studied, paving the way to better collaboration between modern and traditional systems. Traditional medicines still remain a largely untapped health resource: they are not only sources of new leads for drug discoveries, but can also provide lessons and novel approaches that may have direct public-health and economic impact. To optimize such impact, several interventions have been suggested, including recognition of TM's economic and medical worth at academic and health policy levels; establishing working relationships with those prescribing TM; providing evidence for safety and effectiveness of local TM through appropriate studies with malaria patients; spreading results for clinical recommendations and health policy development; implementing and evaluating results of new health policies that officially integrate TM.     

Ethical and regulatory issues surrounding African traditional medicine in the context of HIV/AIDS

It has been estimated that more than 80% of people in Africa use traditional medicine (TM). With the HIV/AIDS epidemic claiming many lives in Africa, the majority of people affected rely on TM mainly because it is relatively affordable and available to the poor populations who cannot afford orthodox medicine. Whereas orthodox medicine is practiced under stringent regulations and ethical guidelines emanating from The Nuremburg Code, African TM seems to be exempt from such scrutiny. Although recently there have been calls for TM to be incorporated into the health care system, less emphasis has been placed on ethical and regulatory issues. In this paper, an overview of the use of African TM in general, and for HIV/AIDS in particular, is given, followed by a look at: (i) the relative laxity in the application of ethical standards and regulatory requirements with regards to TM; (ii) the importance of research on TM in order to improve and demystify its therapeutic qualities; (iii) the need to tailor-make intellectual property laws to protect traditional knowledge and biodiversity. A framework of partnerships involving traditional healers' associations, scientists, policy makers, patients, community leaders, members of the communities, and funding organizations is suggested as a possible method to tackle these issues. It is hoped that this paper will stimulate objective and constructive debate that could enhance the protection of patients' welfare.     

Herbal medicine use in the districts of Nakapiripirit, Pallisa, Kanungu, and Mukono in Uganda

ABSTRACT: BACKGROUND: Traditional medicine (TM) occupies a special place in the management of diseases in Uganda. Not with standing the many people relying on TM, indigenous knowledge (IK) related to TM is getting steadily eroded. To slow down this loss it is necessary to document and conserve as much of the knowledge as possible. This study was conducted to document the IK relevant to traditional medicine in the districts of Mukono, Nakapiripirit, Kanungu and Pallisa, in Uganda. METHODS: An ethnobotanical survey was conducted between October 2008 and February 2009 using techniques of key informant interviews and household interviews. RESULTS: The common diseases and conditions in the four districts include malaria, cough, headache, diarrhea, abdominal pain, flu, backache and eye diseases. Respondents stated that when they fall sick they self medicate using plant medicines or consult western-trained medicine practitioners. Self medication using herbal medicines was reported mostly by respondents of Nakapiripirit and Mukono. Respondents have knowledge to treat 78 ailments using herbal medicines. 44 species, mentioned by three or more respondents have been prioritized. The most frequently used part in herbal medicines is the leaf, followed by the stem and root. People sometime use animal parts, soil, salt and water from a grass roof, in traditional medicines. Herbal medicines are stored for short periods of time in bottles. The knowledge to treat ailments is acquired from parents and grandparents. Respondents' age and tribe appears to have a significant influence on knowledge of herbal medicine, while gender does not. CONCLUSION: This survey has indicated that IK associated with TM stills exists and that TM is still important in Uganda because many people use it as a first line of health care when they fall sick. Age and tribe influence the level of IK associated with herbal medicine, but gender does not.     

Sunday Lunch in Fiji: Continuity and Transformation in Ideas of the Household

In this article, I compare drawings of "Sunday lunch" produced by Fijian village children in 1990 and 2005 and their responses to prepared drawings in 1982, which show remarkable continuity over time. I suggest this continuity is largely attributable to the ritualization of eating practices. At the same time, the children's data indicate that a substantive, if subtle, change is occurring in ideas of the inclusiveness of the household; I suggest that this change may be a function of an intensification of commodity exchange in day-to-day village life. As the children's data demonstrate, continuity as well as transformation in ideas over time may be understood as a function of the self-same ontogenetic process through which we make sense of our relations with others in the lived world. I argue that such ethnographic studies of ontogeny enable us both to appreciate the material validity of our informants' ideas and to render them analytical.     

Cysteine-scanning mutagenesis and thiol modification of the Rickettsia prowazekii ATP/ADP translocase: evidence that transmembrane regions I and II, but not III, are structural components of the aqueous translocation channel

The contribution of transmembrane regions I, II, and III of the Rickettsia prowazekii ATP/ADP translocase to the structure of the putative water-filled ATP translocation channel was evaluated from the accessibility of hydrophilic, thiol-reactive, methanethiosulfonate reagents to a library of 68 independent cysteine-substitution mutants heterologously expressed in Escherichia coli. The MTS reagents used were MTSES (negatively charged) and MTSET and MTSEA (both positively charged). Mutants F036C, Y042C, and R046C (TM I), K066C and P072C (TM II), and F101C, F105C, F108C, Y113C, and P114C (TM III) had no assayable transport activity, indicating that cysteine substitution at these positions may not be tolerated. All three MTS reagents inhibit the transport of ATP in mutants of TM I (L039C, S043C, S047C, I048C) and TM II (S061C, S063C, T067C, I069C, V070C, A074C). Further, these residues appear to cluster along a single face of the transmembrane domain. Preexposure of MTS-reactive mutants S047C (TM I) and T067C (TM II) to high levels of ATP resulted in protection from MTS-mediated inhibition. This indicated that both TM I and TM II make major contributions to the structure of an aqueous ATP translocation pathway. Finally, on the basis of the lack of accessibility of charged MTS reagents to the thiol groups in mutants of TM III, it appears that TM III is not exposed to the ATP translocation channel. Cysteine substitution of residues constituting a highly conserved "phenylalanine face" in TM III resulted in ablation of ATP transport activity. Further, substituting these phenylalanine residues for either isoleucine or tyrosine also resulted in much lower transport activity, indicating that some property of phenylalanine at these positions that is not shared by cysteine, isoleucine, or tyrosine is critical to translocase activity.     

The replicability crisis in science and protected area research: Poor practices and potential solutions

The reliability of some published research from well-funded disciplines of medicine and psychology has been brought into question. This is because some researchers failed to achieve consistent results after replicating published studies using the same methodology. Researchers have referred to this as the ‘replicability in science crisis’ and have identified several practices contributing to unreliable science. Protected area and other conservation researchers are unlikely to be immune from these poor practices given they use the same scientific approaches as other disciplines. Fortunately, there are solutions to the poor practices contributing to unreliable science. In this paper I identify those poor practices and describe solutions as identified by researchers from a range of disciplines. These solutions are transferable to protected area science and related conservation disciplines. Most solutions are not costly or demanding to implement. Adopting these solutions can improve the reliability of both published and unpublished research.     

Is there a right to access innovative surgery?

Demands for access to experimental therapies are frequently framed in the language of rights. This article examines the justifiability of such demands in the specific context of surgical innovations, these being promising but non‐validated and potentially risky departures from standard surgical practices. I argue that there is a right to access innovative surgery, drawing analogies with other generally accepted rights in medicine, such as the right not to be forcibly treated, to buy contraceptives, and to choose to have an abortion, including a post‐viability abortion where the mother's life or health is threatened by the pregnancy. I argue that we accept these rights because we believe that people are entitled to try to preserve their lives and health and to make choices of an important and intensely personal kind, and I suggest that a person's choice of medical treatment should be seen in the same light. However, since few rights are absolute, I also consider the circumstances in which it may be justifiable to limit the right to access innovative surgery. In discussing this question, I apply the human rights standard of proportionality, comparing the importance of the reasons for limiting the right with the severity of the invasion on liberty.     

“THAT’S NOT HIS ONLY PROBLEM...” CLINICAL TEAMWORK IN A PSYCHIATRIC EMERGENCY ROOM

This article is a qualitative study of the social organization of clinical work in a psychiatric emergency room. The research involved observation of emergency room practices and interviews with the clinical staff members. Due to responsibility of ensuring confidentiality, audio taping was not possible. Observations and interviews were recorded by hand, and thus, except in brief instances, I describe talk rather than reproduce it verbatim. Psychiatry, I argue, should not be explored as a singular profession but as the team practice of a team of occupational groups. These groups are often seen as subordinate to psychiatric physicians, but as this paper will demonstrate these groups are often able to call upon their specific claims to expert knowledge to assume clinical authority over a patient’s diagnosis and treatment. The successful pursuit of such a claim puts these clinical occupational groups in a position to challenge psychiatrists over crucial hospital resources such as beds. These groups’ claim to authority emerges from two sources. The first is their specific histories and their clinical knowledge systems that initially developed independently of cosmopolitan medicine. The second is the political economic environment of urban hospital psychiatric departments which largely treat patients with opaque symptoms of unclear origin that defy easy psychiatric classification.     

Treating Emotion-Related Disorders in Japanese Traditional Medicine: Language, Patients and Doctors

This paper analyses how the conceptual and therapeutic formation of Japanese traditional medicine (Kampo) has been socially constructed through interactions with popular interpretations of illness. Taking the example of emotion-related disorders, this paper focuses on the changing meaning of constraint (utsu) in Kampo medicine. Utsu was once a name for one of the most frequently cited emotion-related disorders and pathological concerns during the Edo period. With the spread of Western medicine in the Meiji period, neurasthenia replaced utsu as the dominant emotion-related disorder in Japanese society. As a result, post-Meiji doctors developed other conceptual tools and strategies to respond to these new disease categories, innovations that continue to influence contemporary practitioners. I begin this history by focusing on Wada Tōkaku, a Japanese doctor of the Edo period who developed a unique theory and treatment strategy for utsu. Secondly, I examine. Yomuto Kyūshin and Mori Dōhaku, Kampo doctors of the early twentieth century, who privileged neurasthenia over utsu in their medical practice. The paper concludes with a discussion of the flexibility and complexity of Kampo medicine, how its theory and practices have been influenced by cross-cultural changes in medicine and society, while incorporating the popular experience of illness as well.     

Going to ‘Pentecost’: how to study Pentecostalism – in Melanesia,for example

In this article, I question regional context as primary context in anthropological analyses. I argue that the idea of historical continuity in a geographical locality/region might prevent us from understanding not only radical change, but also more gradually emerging social patterns that connect the ethnography to very different kinds of histories and places. Concretely, I focus on the global Charismatic and Pentecostal movements, and as an experiment, I ask whether it is possible to go to ‘Pentecost’, instead of going to Melanesia. With ‘going to Pentecost’ as a heuristic device, I suggest it is possible to overcome methodological challenges in the study of global religious movements. In this article, I thus trace the practices and articulations of my interlocutors as part of a wider Pentecostal universe. I show how notions of seeing, borders, separations, and protection are crucial in ‘Pentecost’, and I connect this to key Christian ideas and values.     

Anthropology at the heart of medicine

Anthropology and medicine share many concerns, but have had trouble collaborating in the past. The anthropologist has had to plead both with his colleagues and physicians to move beyond a < culturalist > vision that would confine him to the study of traditional or alternative medicines and representations of populations and the sick. The anthropologist's approach perceived as intrusive has also raised fears in the medical world. These reciprocal misunderstandings and stereotypes need to be overcome by an anthropology that studies the practices and knowledge of modern medicine as they are elaborated daily. Anthropology will dialogue with medicine without judging it. In its turn, medicine will open its sites of healing and teaching to the anthropologist. Anthropology at the heart of medicine is organized around the idea that the paths and expectations of health professionals reflect the specicifities of the local system of health. The individual dimensions of practices cannot be divorced from the functioning of structures of health and decision. Finally, like any other kind of anthropology, medical anthropology must scrutinize its own methods and ethics in a critical way.     

Invertebrate pests and diseases of sweetpotato (Ipomoea batatas): a review and identification of research priorities for smallholder production

Sweetpotato has been the subject of little research worldwide compared with other major crop staples, and this is especially so for less developed countries where sweetpotato is critical for food security. This review synthesises information on plant protection issues that affect smallholder sweetpotato farmers in less developed countries to identify major issues and suggest research priorities. Though the pests and diseases of sweetpotato in less developed countries are largely common to industrialised systems, their relative importance differs and losses tend to be more severe as a result of differing agronomic practices and relative unavailability of management options and technical support that are important in developed countries. Smallholders are heavily reliant on cultural practices such as traditional forms of biological control using ants and livestock, fallowing and composting (sometimes with plant materials having biocidal properties). Crop protection methods that have been developed for use in sweetpotato production in developed countries, such as pathogen‐tested planting material, early maturing varieties, pheromone trapping and pesticides are less accessible to, and relevant for, smallholders. Smallholders also typically harvest a given crop progressively which extends the period over which storage roots are potentially vulnerable to attack but reduces the risk of post‐harvest losses. Human population growth in developing countries is leading to an increase in cropping intensity with shorter fallow periods and more years of continuous crops. This has the dual effect of depleting soil nutrients and increasing the potential for pest and pathogen build‐up. Associated with this, the adoption of strategies to manage crop nutrition, such as not burning crop residues, promote carryover of pests and pathogen inocula. As a consequence of these factors, sweetpotato yield losses from diseases, especially viruses, and pests, particularly weevils, can be high. Climate change is likely to result in more frequent drought and this will increase losses caused by sweetpotato weevils that are favoured by dry conditions. This review of sweetpotato pests and their management options concludes with suggestions for some future research priorities including the combination of traditional practices that have pest management outcomes with relevant practices from industrial production that are able to be transferred or modified for use in smallholder production. Increased technical support for decision making and diagnostics, including molecular approaches that have scope for field use, will be important in reducing the burden imposed by biotic threats to this important global crop.     

On the use of the word 'epigenetic'

Over the past few years we have seen an odd change, or extension, in the use of the word 'epigenetic' when describing matters of gene regulation in eukaryotes. Although it may generally be that it is not worth arguing over definitions, this is true only insofar as the participants in the discussion know what each other means. I believe the altered use of the term carries baggage from the standard definition that can have misleading implications. Here I wish to probe our use of language in this way, and to show how such a discussion leads to some more general considerations concerning gene regulation.     

Hunter-gatherer energetics and fertility: A reassessment of the !Kung San

This paper examines the question of why the total fertility rate of the !Kung San hunter-gatherers of the Northern Kalahari desert is as low as 4.69 births. When the intermediate variables involved are examined through the employment of a reproductive equation, it becomes clear that low fecundity is a major issue. Arguments offered previously to explain the low fertility of !Kung women, depending on factors such as nutrition, health status, and lactational practices are insufficient. Drawing upon recent data from sports medicine and endocrinology, I suggest that the pattern of San female energetics in their gathering and subsistence routine has a direct effect upon their fecundity. Such a correlation between activity patterns, endocrine function, and reproductive capacity may also be important for understanding the fertility of other mobile hunter-gatherer groups.     

Sequence requirements for membrane assembly of polytopic membrane proteins: molecular dissection of the membrane insertion process and topogenesis of the human MDR3 P-glycoprotein.

The biogenesis of membrane proteins with a single transmembrane (TM) segment is well understood. However, understanding the biogenesis and membrane assembly of membrane proteins with multiple TM segments is still incomplete because of the complexity and diversity of polytopic membrane proteins. In an attempt to investigate further the biogenesis of polytopic membrane proteins, I used the human MDR3 P-glycoprotein (Pgp) as a model polytopic membrane protein and expressed it in a coupled cell-free translation/translocation system. I showed that the topogenesis of the C-terminal half MDR3 Pgp molecule is different from that of the N-terminal half. This observation is similar to that of the human MDR1 Pgp. The membrane insertion properties of the TM1 and TM2 in the N-terminal half molecule are different. The proper membrane anchorage of both TM1 and TM2 of the MDR3 Pgp is affected by their C-terminal amino acid sequences, whereas only the membrane insertion of the TM1 is dependent on the N-terminal amino acid sequences. The efficient membrane insertion of TM3 and TM5 of MDR3 Pgp, on the other hand, requires the presence of the putative TM4 and TM6, respectively. The TM8 in the C-terminal half does not contain an efficient stop-transfer activity. These observations suggest that the membrane insertion of putative TM segments in the human MDR3 Pgp does not simply follow the prevailing sequential event of the membrane insertion by signal-anchor and stop-transfer sequences. These results, together with my previous findings, suggest that different isoforms of Pgp can be used in comparison as a model system to understand the molecular mechanism of topogenesis of polytopic membrane proteins.