title: The determinants of traditional medicine use in Northern Tanzania: a mixed-methods study.
abstract: BACKGROUND
  Traditional medicines are an important part of healthcare in sub-Saharan Africa, and building successful disease treatment programs that are sensitive to traditional medicine practices will require an understanding of their current use and roles, including from a biomedical perspective. Therefore, we conducted a mixed-method study in Northern Tanzania in order to characterize the extent of and reasons for the use of traditional medicines among the general population so that we can better inform public health efforts in the region.
  
  
  METHODS
  Between December 2013 and June 2014 in Kilimanjaro, Tanzania, we conducted 5 focus group discussions and 27 in-depth interviews of key informants. The data from these sessions were analyzed using an inductive framework method with cultural insider-outsider coding. From these results, we developed a structured survey designed to test different aspects of traditional medicine use and administered it to a random sample of 655 adults from the community. The results were triangulated to explore converging and diverging themes.
  
  
  RESULTS
  Most structured survey participants (68%) reported knowing someone who frequently used traditional medicines, and the majority (56%) reported using them themselves in the previous year. The most common uses were for symptomatic ailments (42%), chronic diseases (15%), reproductive problems (11%), and malaria/febrile illnesses (11%). We identified five major determinants for traditional medicine use in Northern Tanzania: biomedical healthcare delivery, credibility of traditional practices, strong cultural identities, individual health status, and disease understanding.
  
  
  CONCLUSIONS
  In order to better formulate effective local disease management programs that are sensitive to TM practices, we described the determinants of TM use. Additionally, we found TM use to be high in Northern Tanzania and that its use is not limited to lower-income areas or rural settings. After symptomatic ailments, chronic diseases were reported as the most common reason for TM use which may be particularly important in Northern Tanzania where non-communicable diseases are a rapidly growing burden.
authors.affiliation: Department of Medicine, Duke University, Durham, North Carolina, United States of America; Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: John W
authors.initials: JW
authors.lastname: Stanifer
authors.affiliation: Department of Medicine, Duke University, Durham, North Carolina, United States of America; Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Uptal D
authors.initials: UD
authors.lastname: Patel
authors.affiliation: Kilimanjaro Christian Medical College, Moshi, Tanzania.
authors.forename: Francis
authors.initials: F
authors.lastname: Karia
authors.affiliation: Department of Medicine, Duke University, Durham, North Carolina, United States of America; Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Nathan
authors.initials: N
authors.lastname: Thielman
authors.affiliation: Kilimanjaro Christian Medical College, Moshi, Tanzania.
authors.forename: Venance
authors.initials: V
authors.lastname: Maro
authors.affiliation: Kilimanjaro Christian Medical College, Moshi, Tanzania.
authors.forename: Dionis
authors.initials: D
authors.lastname: Shimbi
authors.affiliation: Kilimanjaro Christian Medical College, Moshi, Tanzania.
authors.forename: Humphrey
authors.initials: H
authors.lastname: Kilaweh
authors.affiliation: Kilimanjaro Christian Medical College, Moshi, Tanzania.
authors.forename: Matayo
authors.initials: M
authors.lastname: Lazaro
authors.affiliation: Kilimanjaro Christian Medical College, Moshi, Tanzania.
authors.forename: Oliver
authors.initials: O
authors.lastname: Matemu
authors.affiliation: Tanga AIDS Working Group, Tanga, Tanzania.
authors.forename: Justin
authors.initials: J
authors.lastname: Omolo
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Boyd
mesh_terms: D000328:Adult; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D008297:Male; D016488:Medicine, African Traditional; D012959:Socioeconomic Factors; D013636:Tanzania
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