Traditional medicine practices among community members with chronic kidney disease in northern Tanzania: an ethnomedical survey.

Abstract

BACKGROUND: In sub-Saharan Africa, chronic kidney disease (CKD) is being recognized as a non-communicable disease (NCD) with high morbidity and mortality. In countries like Tanzania, people access many sources, including traditional medicines, to meet their healthcare needs for NCDs, but little is known about traditional medicine practices among people with CKD. Therefore, we sought to characterize these practices among community members with CKD in northern Tanzania. METHODS: Between December 2013 and June 2014, we administered a previously-developed survey to a random sample of adult community-members from the Kilimanjaro Region; the survey was designed to measure traditional medicine practices such as types, frequencies, reasons, and modes. Participants were also tested for CKD, diabetes, hypertension, and HIV as part of the CKD-AFRiKA study. To identify traditional medicines used in the local treatment of kidney disease, we reviewed the qualitative sessions which had previously been conducted with key informants. RESULTS: We enrolled 481 adults of whom 57 (11.9 %) had CKD. The prevalence of traditional medicine use among adults with CKD was 70.3 % (95 % CI 50.0-84.9 %), and among those at risk for CKD (n = 147; 30.6 %), it was 49.0 % (95 % CI 33.1-65.0 %). Among adults with CKD, the prevalence of concurrent use of traditional medicine and biomedicine was 33.2 % (11.4-65.6 %). Symptomatic ailments (66.7 %; 95 % CI 17.3-54.3), malaria/febrile illnesses (64.0 %; 95 % CI 44.1-79.9), and chronic diseases (49.6 %; 95 % CI 28.6-70.6) were the most prevalent uses for traditional medicines. We identified five plant-based traditional medicines used for the treatment of kidney disease: Aloe vera, Commifora africana, Cymbopogon citrullus, Persea americana, and Zanthoxylum chalybeum. CONCLUSIONS: The prevalence of traditional medicine use is high among adults with and at risk for CKD in northern Tanzania where they use them for a variety of conditions including other NCDs. Additionally, many of these same people access biomedicine and traditional medicines concurrently. The traditional medicines used for the local treatment of kidney disease have a variety of activities, and people with CKD may be particularly vulnerable to adverse effects. Recognizing these traditional medicine practices will be important in shaping CKD treatment programs and public health policies aimed at addressing CKD.

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Published Version (Please cite this version)

10.1186/s12882-015-0161-y

Publication Info

Stanifer, John W, Joseph Lunyera, David Boyd, Francis Karia, Venance Maro, Justin Omolo and Uptal D Patel (2015). Traditional medicine practices among community members with chronic kidney disease in northern Tanzania: an ethnomedical survey. BMC Nephrol, 16. p. 170. 10.1186/s12882-015-0161-y Retrieved from https://hdl.handle.net/10161/15878.

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Scholars@Duke

Stanifer

John W. Stanifer

Adjunct Assistant Professor of Medicine

John W. Stanifer, MD, MSc-GH, is a nephrologist and clinical researcher with a focus on using translational and trans-disciplinary methods to uncover mechanisms of global health disparities in kidney disease. John completed his residency training in internal medicine and global health at Duke, completing the Master of Science in Global Health program in 2014. He also completed his sub-specialty training in nephrology at Duke, and during that time, he also completed a fellowship in clinical research at the Duke Clinical Research Institute, where he served as chief fellow in 2016-2017.

He has investigated the epidemiology of chronic kidney disease in Tanzania, where he started and led the CKD-AFRIKA study. This mixed-method study not only was among the first to explore community-based prevalence, risk factors and consequences of chronic kidney disease in sub-Saharan Africa, but it also investigated several cultural and social topics around the use of traditional medicines among individuals living with kidney disease.

More recently, he has also turned his attention to local health disparities. Since 2015, he has been co-leading, with Dr. Cherry Beasley, the KIDNEY NC Study, a mixed-methods study investigating determinants of kidney disease among ethnic and racial minorities in Robeson County, North Carolina, home of the Lumbee Indian tribe. In addition to a Bass Connections team, he and Dr. Beasley have led two Student Research Training programs that included several Duke students working in Robeson County each summer. He is mentored by Drs. L. Ebony Boulware and Myles Wolf.

Lunyera

Joseph Lunyera

Medical Instructor in the Department of Medicine

I am a clinical epidemiologist with a life-long desire to advance our understanding of etiologic mechanisms of kidney disease, and to advocate for policies that promote the highest quality care for individuals with kidney disease. Specifically, I am interested in delineating mechanisms by which exposures in the social environment perpetuate disparate adverse kidney outcomes such as chronic kidney disease and acute kidney injury.

Boyd

David Lorenzo Boyd

Hymowitz Family Professor of the Practice Emeritus in Global Health
Patel

Uptal Dinesh Patel

Adjunct Professor in the Department of Medicine

Uptal Patel, MD is an Adjunct Professor interested in population health with a broad range of clinical and research experience. As an adult and pediatric nephrologist with training in health services and epidemiology, his work seeks to improve population health for patients with  kidney diseases through improvements in prevention, diagnosis and treatment.

Prior efforts focused on four inter-related areas that are essential to improving kidney health: i) reducing the progression of chronic kidney disease by improving its detection and management, particularly by leveraging technology to facilitate engagement and self-management; ii) elucidating the inter-relationships between kidney disease and cardiovascular disease, which together amplify the risk of death; iii) improving the evidence in nephrology through comparative effectiveness research, including clinical trials, observational studies, and meta-analyses; and iv) promoting more optimal clinical health policy for all patients with kidney disease. These inter-disciplinary projects have been funded by a variety of public and private sources including the Robert Wood Johnson Foundation, Veterans Affairs, National Institutes of Health, Agency for Healthcare Research & Quality, Food and Drug Administration, Centers for Medicare & Medicaid Services, Renal Physicians Association, and the American Society of Nephrology. 

Current efforts seek to advance novel therapies for kidney diseases through early clinical development that he leads at AstraZeneca.


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