Use of traditional and orthodox health services in urban Zimbabwe

Abstract

Background: Health care in Zimbabwe is provided by both orthodox and traditional care providers. With formal medical services under economic strain it is important to understand the extent of consulting with traditional care providers and their effectiveness.

Methods: A cross-sectional community survey recorded consultations and self-treatment for episodes of illness among 1251 individuals in 222 households randomly selected in two high-density suburbs of Harare, Zimbabwe. Three dependent variables (illness experience, consultation behaviour and choice of care provider) were analysed against a range of sociodemographic, episode-related and outcome measures.

Results: More than one-third of the sample had experienced an illness and 83% of these had led to consultation. Medical services were consulted eight times more often than traditional ones. Non-consulting behaviour was associated with lack of money or low perceived significance of problems. Physical problems were usually taken to medical clinics where their outcome was better, but non-specific pain and other problems did no better with medical or traditional care.

Conclusions: While members of the community appear to recognize physical problems and take them to medical care, traditional and orthodox medical consultations appear to be equally effective for non-specific pain or non-specific physical problems. The role of traditional medicine in relation to non-specific physical problems and psychological problems is one which deserves further examination from both clinical and administrative perspectives. Poverty appears to be associated with poorer outcomes; this is a potentially important issue in times of increasing economic hardship.

PIP: A cross-sectional community survey recorded consultations and self-treatment for episodes of illness among 1251 individuals in 222 households randomly selected in 2 high-density suburbs of Harare, Zimbabwe, Dziveresekwa (DV) and Mufakose (MK). The mean age of the sample was 23.6 years. MK residents were better educated; while DV households had significantly lower reported incomes (p = 0.003). Key informants were likely to be women, to be older, and to be less educated. Three dependent variables (illness experience, consultation behavior, and choice of care provider) were analyzed against a range of sociodemographic, episode-related, and outcome measures. More than 1/3 of the sample had experienced an illness and 89% of these illnesses had led to consultation. Of all episodes, 68% involved physical problems (infection, hypertension, or injury); nonspecific pain was the predominant complaint in a further 30% of cases, while 9 episodes involved psychological problems or traditional problems. Medical services were consulted 8 times more often than traditional ones. Of the 450 reported consultations, 89% were with medical agencies and 11% with traditional healers. Non-consulting behavior was associated with lack of money (49%) or the perceived trivial nature of the problems (42%). Physical problems were usually taken to medical clinics where their outcome was better, but non-specific pain and other problems did no better with medical or traditional care. Self-medication was common among nonconsulters. Of all those experiencing illness, children had a better reported outcome (81.75 vs. 58.2% for adults, p 0.00001); and children experienced a recovery rate of 82.3% regardless of whether or not they were taken for consultations. Better outcomes were reported among adults attending medical care vs. traditional care (p = 0.002). Traditional and orthodox medical consultations appear to be equally effective for non-specific pain or non-specific physical problems. Poverty appears to be associated with poorer outcomes; this is a potentially important issue in times of increasing economic hardship.