Traditional medicine practices among community members with chronic kidney disease in northern Tanzania: an ethnomedical survey.
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.
Department of Medicine, Duke University, Durham, NC, USA. John.stanifer@duke.edu.|Duke Global Health Institute, Duke University, Durham, NC, USA. John.stanifer@duke.edu.
John W
JW
Stanifer
Duke Global Health Institute, Duke University, Durham, NC, USA. josephlunyera@gmail.com.
Joseph
J
Lunyera
Duke Global Health Institute, Duke University, Durham, NC, USA. David.boyd@duke.edu.
David
D
Boyd
Kilimanjaro Christian Medical College, Moshi, Tanzania, Africa. Franktz2000@gmail.com.
Francis
F
Karia
Kilimanjaro Christian Medical College, Moshi, Tanzania, Africa. venmaro@ymail.com.
Venance
V
Maro
National Institute for Medical Research, Dar es Salaam, Tanzania, Africa. jusiomolo@yahoo.com.
Justin
J
Omolo
Department of Medicine, Duke University, Durham, NC, USA. uptal.patel@duke.edu.|Duke Global Health Institute, Duke University, Durham, NC, USA. uptal.patel@duke.edu.|Duke Clinical Research Institute, Duke University, Durham, NC, USA. uptal.patel@duke.edu.
Uptal D
UD
Patel
D000293:Adolescent; D000328:Adult; D000504:Aloe; D029744:Commiphora; D031743:Cymbopogon; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D016488:Medicine, African Traditional / Q000706:statistics & numerical data*; D008875:Middle Aged; D027421:Persea; D008517:Phytotherapy / Q000706:statistics & numerical data; D028321:Plant Preparations / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013636:Tanzania; D055815:Young Adult; D032106:Zanthoxylum
D028321:Plant Preparations