BIOMEDICAL HEALTH AND AFRICAN INDIGENOUS HEALTH PRACTITIONERS

Get Complete Project Material File(s) Now! »

INTRODUCTION AND BACKGROUND

Tuberculosis (TB) remains a major global health problem, ranking as the second leading cause of death from an infectious disease worldwide. Globally, there were an estimated 9.27 million cases of TB in 2007. Worldwide, reported data in 2008 accounts for 99.6% of the world’s estimated number of TB cases and 99.7% of the world’s population (Klinikleri 2011:1).Comparing the above statistics of TB worldwide there has been major progress in tackling TB in the 21 years since the 1993 WHO declaration of it as a global public health emergency. Globally, the TB mortality rate (deaths per 100,000 population per year) has fallen by 45% since 1990 and TB incidence rates (new cases per 100,000 population per year) are decreasing in most parts of the world. Between 2000 and 2013, an estimated 37 million lives were saved through effective diagnosis and treatment, however, the Stop TB Strategy developed by WHO (2014:1) for the period of 2006-2015 has not yet reached its goals. The latest estimates are that there were 9.0 million new TB cases in 2013 and 1.5 million deaths.
According to WHO (2014:1), in 2013 there were an estimated 3.3 million cases and 510,000 deaths among women, as well as an estimated 550,000 cases and 80,000 deaths among children. Six countries that stand out as having the largest number of incidents in 2013 were India (2.0 million-2.3 million), China (0.9 million – 1.1 million), Nigeria (340,000 – 880,000), Pakistan (370,000 – 650,000), Indonesia (410,000 – 520,000) and South Africa (410,000 – 520,000), these and the other five countries that make up the top ten in terms of numbers of cases (WHO 2014:8).
In sub-Saharan Africa the incidence of tuberculosis (per 100,000 people) was last measured at 282 in 2013, (WHO, 2014:1), from 255 in 2012. South Africa is one of the countries with the highest burden of TB, with WHO statistics giving an estimated incidence of 450,000 cases of active TB in 2013. Out of the 450,000 incident cases in South Africa it was estimated by WHO (2014: 24) that about 270,000 (60%) had both HIV and TB infection. The latest figure from South Africa Department of Health is that 73% of TB patients are HIV positive. Statistics South Africa (Stats SA) indicated a little decrease in tuberculosis to 8, 8% in 2013 according to the Department’s 2013/2014 Annual Performance Plan, Statistics South Africa (Stats, SA 2014:27). Despite of the programmes developed to alleviate TB infection around the world, South Africa still reporting high rate of infection.
One of the provinces in South Africa hardest hit by TB, Mpumalanga, has been identified as having a high infection rate, with an estimated 7,831 in 2004, rising to 15,035 in 2006 (Department of Health, DoH 2009:1, Department of Health Mid-term Review Report 2014-2015, 2016:6-9). This poses serious health risks to families, communities and nations, and places financial pressure on the government. TB remains the leading cause of death in Mpumalanga Province. In addition people rely on indigenous health because of their accessibility. Public Protector Thuli Madonsela visited Mpumalanga in the month of July 2013 in the Kabokweni and Kanyamazane townships in Mbombela to investigate the state of healthcare and remarked about the increase of TB infection and the way in which it was treated (Nelspruit News 2013:2).

PERCEPTIONS OF TUBERCULOSIS

Tuberculosis is perceived differently by a South African population that is diverse. For instance, differing beliefs and worldviews have an impact on understanding and meaning of concepts such as disease, illness and wellness. The condition is perceived differently in various communities, with some believing that it is caused by witchcraft and others that it is the result of cleansing rituals not having been carried out. The work of biomedical health practitioners on TB and treatment has evolved over centuries, with USAID programmes for investigation, treatment and Direct Observed Treatment (DOT) being implemented, but to this day infection remains high (Pretorius & Small 2007:1). The biomedical health practitioners must devise strategies for engaging community belief systems to ensure effective intervention is informed by the context of the patients.
The juxtaposition of two medical practitioners, one formal (the biomedical), the other less formal (the indigenous), has brought into focus the differences between histories and traditions, and the understanding of health and disease (Napolitano 2007:18)

TABLE OF CONTENTS

• Declaration
• Acknowledgements
• Abstracts
• Table of Contents
• List of tables
• List of figures
• List of references
• List of annexures
• List of abbreviations
• CHAPTER 1: OVERVIEW OF THE STUDY
  • 1.1 Introduction and Background
  • 1.2 Perceptions of Tuberculosis
  • 1.3 Rationale of the study
  • 1.4 Problem statement
  • 1.5 Research Questions
  • 1.6 Purpose of the study
  • 1.7 Definition of terms
  • 1.7.1 African indigenous health practitioners
  • 1.7.2 Biomedical health practitioners
  • 1.7.3 Convergence
  • 1.7.4 Culture
  • 1.7.5 Engagement
  • 1.7.6 Tuberculosis
  • 1.8 Significance of the study
  • 1.9 Research outline
  • 1.10 Summary
• CHAPTER 2: RESEARCH DESIGN AND METHOD
  • 2.1 Introduction
  • 2.2 Research design and methodological assumptions
  • 2.3 Research methods
  • 2.3.1 Population
  •  Research population
  • 2.3.1.1 Group1: Biomedical health practitioners
  • 2.3.1.2 Group 2: African indigenous health practitioners
  • 2.3.1.3 Group 3: DOT supporters who are supervising patients with TB to take their treatment
  • 2.3.2 Sampling
  • 2.3.3 Inclusion criteria
  • Data collection and analysis
  • 2.4 Data collection
  • 2.5 Data analysis
  • 2.6 Literature control
  • 2.7 Measures to ensure trustworthiness
  •  Credibility
  •  Transferability
  •  Dependability
  •  Confirmability
  • 2.8 Ethical considerations
  • 2.9 Summary
• CHAPTER 3: DATA ANALYSIS, INTERPRETATION AND LITERATURE CONTROL
  • 3.1 Introduction
  • 3.2 Research findings
  • 3.3 Individual interview: Biomedical health practitioners
  • 3.4 The demographics of the biomedical health practitioners
  • 3.4.1 Theme 1: Acknowledgement of integration with the African indigenous health practitioners
  • 3.4.1.1 Category one: Referral method
  • Acknowledgement of expertise
  •  Inability to identify signs and symptoms
  •  Strong and unmeasured African medicine and the dirty environment
  •  Delays in referral
  •  Default on treatment
  •  Lack of food during the period of treatment
  • 3.4.1.2 Category two: Group integration  Meeting
  •  Awareness campaign, health education and workshops
  • 3.4.2 Theme 2: Acknowledgement of establishment of Traditional healers Act 2007,Act no. 22 of
  • 3.4.2.1 Category one: Acceptance of the Act
  •  Collaboration
  • Health education
  • 3.4.2.2 Category two: Against the Act
  •  Unhygienic conditions
  • 3.4.3 Theme 3: Empowerment of African indigenous health practitioners
  • 3.4.3.1 Category one: Mutual respect
  •  Changing mind-set
  •  Building relationship
  • 3.4.3.2 Category two: Understanding each other’s sector
  •  Communication
  •  Research regarding traditional medicine
  • 3.5 Focus group interview: African indigenous health practitioners
  • 3.5.1 Theme 1:Perceptions regarding patient’s consultation
  • 3.5.1.1 Category one: Consult for treatment
  •  Trust
  •  Affordability and availability
  • 3.5.1.2 Category two: strong believe system
  •  Socialisation
  •  Client satisfaction in being cured
  •  Source of illness
  • 3.5.2 Theme 2: Attitude of biomedical health practitioners
  • 3.5.2.1 Category one: Disrespect
  •  Superiority complex and lack of acknowledgement of African indigenous and
  • their treatment
  • 3.5.2.2 Category two: Scepticism about their treatment
  •  One-sided referral
  •  Lack of collaboration
  •  Act forces biomedical to work with African indigenous health practitioners
  • 3.5.3 Theme 3: Views to enhance integration
  • 3.5.3.1 Category one: Capacity building
  •  Education, awareness and workshop
  •  Engagement of other stakeholders: ward councillors, traditional healers and the nurses
  •  Sharing of ideas
  •  Formal training of African indigenous health practitioners
  • 3.6 Group 3: DOT supporters supervising patients with TB
  • 3.6.1 Theme 1: Challenges during supervision of patients with TB
  • 3.6.1.1 Category one: Experiences during supervision
  •  Lack of food during the period of treatment
  •  Patient’s misconceptions about treatment
  •  Defaulting on treatment and referral to hospital
  •  Resistance on discontinuing traditional medicine when on TB treatment
  • 3.7 Summary
• CHAPTER 4: CONCEPT ANALYSIS
  • 4.1 Introduction
  • 4.2 Concept analysis process
  • 4.2.1 Identification of the concepts
  • 4.2.2 Determination of the purpose or aims of the analysis
  • 4.2.3 Definition of the concepts
  • 4.2.3.1 Defining the concept: convergence
  • 4.2.4 Identification of the uses of the concept
  • 4.2.5 Determination of the defining attributes
  • 4.2.6 Construction of the model case ‘convergence’
  • 4.2.7 Identification of antecedents and consequences
  •  Antecedents
  •  Consequences
  • 4.3 Engagement
  • 4.3.1 Uses of the concepts
  • 4.3.2 Construction of the model case ‘engagement’
  • 4.3.3 Identification of antecedents and consequences
  •  Antecedents
  •  Appointment
  •  Gathering
  •  Consequences
  •  Knowledge
  • 4.4 Summary
• CHAPTER 5: DEVELOPMENT AND DESCRIPTION OF A MODEL FOR CONVERGENCE AND ENGAGEMENT BETWEEN BIOMEDICAL HEALTH AND AFRICAN INDIGENOUS HEALTH PRACTITIONERS REGARDING TREATMENT OF TB CONDITION
  • 5.1 Introduction
  • 5.2 Model development
  •  Phase one
  •  Phase two
  •  Phase three
  • o The agent
  • o The recipient
  • o The context
  • o The process / procedure
  • o The dynamic
• CHAPTER 6: OVERVIEW OF RESEARCH FINDINGS, RECOMMENDATIONS, IMPLICATIONS, LIMITATIONS AND CONCLUSIONS
  • 6.1 Introduction
  • 6.2 Overview of research findings
  • 6.2.1 Phase one: Empirical perspectives
  • 6.2.2 Phase two: Concept analysis
  • 6.2.3 Phase three: Model development
  • 6.3 Recommendations
  • 6.4 Recommendations for further research
  • 6.5 Implications
  • 6.5.1 For the South African Nursing Council
  • 6.5.2 For the Department of Health
  • 6.6 Contribution to the body of knowledge
  • 6.7 Limitations
  • 6.8 Conclusion

GET THE COMPLETE PROJECT