Educational intervention increased referrals to allopathic care by traditional healers in three high HIV-prevalence rural districts in Mozambique.
BACKGROUND
Delayed uptake of clinical services impedes favorable clinical outcomes in Mozambique. Care is delayed among patients who initiate care with traditional healers; patients with conditions like human immunodeficiency virus (HIV) or tuberculosis are rarely referred to the health system in a timely fashion.


METHODS
We conducted a pre-post educational intervention with traditional healers, assessing healer referral rates and HIV knowledge in three rural districts in Zambézia Province.


RESULTS
The median monthly referral rate prior to the intervention was 0.25 patients (interquartile range [IQR]: 0-0.54) compared with a post-intervention rate of 0.34 patients (IQR: 0-0.71), a 35% increase (p=0.046). A median HIV knowledge score of 67% (IQR: 59-78) was noted 4-months pre-intervention and a median score of 81% (IQR: 74-89) was recorded 2½ months post-intervention (p<0.001). One hundred and eleven healers referred 127 adults, 36 pregnant women, and 188 children to health facilities. Referred patients were most likely to be diagnosed with bronchopneumonia (20% adults; 13% children) and/or malaria (15% adults; 37% children). Of 315 non-pregnant persons referred, 3.5% were tested for HIV and 2.5% were tested for tuberculosis.


CONCLUSIONS
We engaged traditional healers with some success; referral rates were low, but increased post-intervention. Once seen in the clinics, patients were rarely tested for HIV or tuberculosis, though symptoms suggested screening was indicated. We found increased referral rates through an inexpensive intervention with traditional healers, a viable, cost-effective method of directing patients to health facilities. However, quality improvement within the clinics is necessary before a substantial impact can be expected.
Institute for Global Health Vanderbilt University School of Medicine, Nashville, Tennessee, USA. carolyn.m.audet@vanderbilt.edu
Carolyn M
CM
Audet
José
J
Salato
Meridith
M
Blevins
David
D
Amsalem
Sten H
SH
Vermund
Felisbela
F
Gaspar
D000328:Adult; D002648:Child; D004282:Documentation; D005246:Feedback; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy*; D006266:Health Education; D006268:Health Facilities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016488:Medicine, African Traditional; D008875:Middle Aged; D009073:Mozambique / Q000453:epidemiology; D009938:Organizations; D011247:Pregnancy; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D014495:Universities