OUTLINE OF PRESENTATION

1. TRADITIONAL, COMPLEMENTARY AND ALTERNATIVE MEDICINE IN THE MANAGEMENT OF MALARIA IN THE URBAN-PERIPHERY, GHANAByRAZAK M. GYASI AND CHARLOTTE M. MENSAH DEPARTMENT OF GEOGRAPHY AND RURAL DEVELOPMENT, KNUST, KUMASIGGA Annual Conference, August, 2012, KNUST, Kumasi, Ghana

2. OUTLINE OF PRESENTATION • INTRODUCTION • THE PROBLEM • RESEARCH QUESTIONS • OBJECTIVES OF THE STUDY • HYPOTHESES • METHODS • RESULTS AND DISCUSSION • CONCLUTION AND RECOMMENDATIONS • REFERENCES

3. INTRODUCTION • Malaria affects 350 to 500 million of the world’s population (Souares et al, 2008). • Causes 90% of 1 to 2.5 million deaths annually in Africa (WHO/UNICEF, 2007). • In Ghana, 3.5 million clinical cases of malaria are reported annually. accounts for over 38% of all deaths in children (MoH, 2006).

4. INTRO CONT’D • Malarialeads to loss of productivity (Assenso-Okyere and Asante, 2003) • Malaria causes absenteeism in school children in Ghana (WHO/UNICEF, 2003). • Causes poverty and pressure on the scanty orthodox health facilities.

5. THE PROBLEM • Amongst the top ten diseases, malaria accounted for 41.4% in 2009, 38. 6% in 2010 and 50.5% in 2011 (Kwabre East District Health Directorate, 2011). • Apart from side effects of use of orthodox medicine, malaria control/eradication is under constant threat (Mendis et al, 2009; Orwa, 2007). • ACTs have failed in Cambodia, China, Myanmar and Vietnam (Dondrop et al, 2009; Beisel, 2010). • Efficacy and potency of TCAM is justified and attracting global attention (WHO, 2010; Gyasi et al, 2011)

6. THE PROBLEM CONT’D • 60% of children with malaria was treated with TCAM in Ghana, Mali, Nigeria and Zambia (WHO, 2001). • 70% of Ghanaians depend on TCAM but the frequency of use is ravel in Kwabre East District (MoH/DHA, 2011). • Correlates of TCAM use is mixed and implicit.

7. RESEARCH QUESTIONS • What is the frequency of use of TCAM among malaria patients in the study communities? • What are the factors associated with the use of TCAM among malaria subjects? • What is the knowledge and practice of TCAM healers in managing malaria?

8. STUDY OBJECTIVES • To investigate the frequency of use of TCAM among malaria subjects in Kwabre East District. • To examine the factors that influence TCAM use among malaria patients. • To analyze the knowledge and practices of TCAM practitioners in the management of malaria in the study prefecture.

9. HYPOTHESES • The study was guided by the hypotheses that: • Higher educational level of malaria patients is not associated with TCAM use. • Efficacy of TCAM does not correlate with the use of TCAM. • The use of TCAM is not associated with its side effects. • Cost effectiveness does not show significance to TCAM use

10. DATA AND METHODS • StudyDesign • Cross-sectional survey (Buor, 2004). • Mixed or triangulation approaches (Trochim, 2006; Mack et al, 2005; Cohen and Manion, 2000; Altrichter et al., 2008). • TheVariable • Dependent variable: use of TCAM. • Independent variables: age, sex, income, cost, education, belief, efficacy, availability, side effects, marital status, residential status.

11. DATA AND METHODS CONT’D • Sampling • Study Area: Kwabre East District of Ashanti • Selected Study Prefecture: Mamponteng, Aboaso, Ntonso, Antoa, Kenyasi, Brofoyedu, Abira, Bosore and Abirem.

12. DATA AND METHODS CONT’D • Sources of Data: 2sets of primary data and Secondary information from archives & documents. • Study Sample & Size: 189 Malaria Victims and 5 TCAM Practitioners of malaria. • Sampling Technique: Systematic random sampling & Snowball techniques. • Data Collection Tools:Questionnaire/structured interviews (for Quantitative data) & In-depth interviews (for Qualitative data).

13. DATA AND METHODS CONT’D • Data Analysis: • Quantitative: Stepwise Linear regression technique via PASW v.17.0; Cross-tabulations; Percentages and frequency tables. • Significance: @ ≤ 0.05. • Qualitative: Content analysis via themes & direct quotes.

14. RESULTS AND DISCUSSION • Characteristics of the study sample • Age • Sex • Education • Employment • Monthly Income

15. RESULTS AND DISCUSSION CONT’D • Health care seeking and Frequency of use of TCAM Table 2: Health Seeking and treatment modality for malaria victims.

16. RESULTS AND DISCUSSION CONT’D • Care seeking at TCAM healer and Use of TCAM Table3: Care seeking at TCAM healer

17. RESULTS AND DISCUSSION CONT’D • Factors associated with TCAM use Table 4:

18. RESULTS AND DISCUSSION CONT’D • The perspective of TCAM practitioners related to causes and prevalence of malaria • ‘‘The owners of ‘‘atiridii’’ (malaria) are mosquitoes and they distribute it freely to anybody they meet anywhere through bites. The disease also do not respect anybody as it can affect males and females alike especially women who are pregnant and children’’. • ‘‘Malaria is not just like any other disease. It can invite all sort of fever on you and easily makes you very weak. It makes one have flu-like symptoms, severe headache and vomit, increase body temperature and cannot eat any food. In children, malaria easily brings about convulsion which kills them thereafter. Although, HIV/AIDS is dangerous, malaria can kill better if it is not treated early and with proper approach. Malaria always moves with its casket and carries whoever it meets’’.

19. RESULTS AND DISCUSSION CONT’D • TCAM practitioners’ experiences and practices in the management of malaria • ‘‘I started treating malaria when I was only 18 after the death of my father from whom I got trained. People from far and near come for medicine and they come back to tell me they are cured’’. • Most of malaria medicines are obtained from plants. Icombine herbs, roots of plants, bark of plants, lime, etc. The medicines are put into bottles while others are prepared in the form of concoction and decoction. Plants such as ‘duakankan’, ‘nunum’, ‘iba’, ‘ankodie’, ginger, garlic, etc are used to prepare malaria medicines’’.

20. RESULTS AND DISCUSSION CONT’D • Attitude of TCAM healers and reasons that malaria victims seek TCAM • “Majority of them come to us when they are sick and cannot afford to go to hospital. They prefer coming to us because we are easy to reach”. • “A patient might not be able to offer initial and prompt payment for the medicines we give them. If they don’t have money, we give them medicine so that they come back to pay later, probably after they get well”. • “It is very difficult seeing a doctor at hospital. A patient has to queue for a long time, sometimes till the evening. So it is better they come to us for treatment”. • “Our customers are comfortable with our system of treatment; some people are terrified the sight of the doctor and his tools and technique of medication, viz. injections”. Hence, they come to us.

21. CONCLUSION AND RECOMMENDATION • Knowledge about malaria and its treatment. • There is a need to continue documenting traditional treatments of malaria in Ghana before they are lost. • It is recommended that studies to standardize doses should be carried out. • Make TCAM part of the public health system

22. REFERENCES • Furnham, A and Forey, J (1994) The attitudes, behaviors, and beliefs of patients of conventional vs complementary alternative medicine. J Clin Psychol, 50:458-469. • Gyasi, R. M., Mensah, C. M., Adjei, P. O and Agyemang, S (2011) Public Perceptions of the Role of Traditional Medicine in the Health Care Delivery System in Ghana. Global Journal of Health Science: Vol. 3, No. 2; doi:10.5539/gjhs.v3n2p40. • Osamor, P. E and Owumi, B. E (2010) Contemporary and alternative medicine in the management of hypertension in an urban Nigerian community. BMC Complementary and Alternative Medicine, 10:36 http://www.biomedcentral.com/1472-6882/10/36 • Orwa, J. A., Mwitari, P. G., Matu, E. N., and Rukunga, G. M. (2007) Traditional Healers and the Management of Malaria in KisumuDisrict, Kenya.East African Medical Journal; Vol 84 No: 2 • UNICEF (2007) Malaria and children: Progress in intervention coverage. The United Nations Children’s Fund (UNICEF) • Vincent, C and Furnham, A (1996) Why do patients turn to complementary medicine? An empirical study. Br J Clin Psychol, 35:37-48.

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