Traditional healers are a widely-used source of primary care in most African countries. What is their role in the treatment of common mental disorders (CMD)? Researchers from the UK Institute of Psychiatry investigated the levels of CMDs among people attending primary health clinics and traditional healer centres in Dar-Es-Salaam, Tanzania.

The researchers interviewed 178 adult patients from two primary health clinics (PHCs) and 176 from traditional health centres (THCs). They found that about half of the people attending THCs have CMD compared with only one in four of PHC users. Symptoms are similar in both settings: most commonly fatigue, obsessions, worries about physical health and depression. People attending THCs are more likely to have chronic complaints and to have seen several doctors before. They are twice as likely as PHC patients to be unable to say what is wrong with them. They are also more commonly:

• older
• Christian
• better educated
• employed
• divorced, separated or widowed
• parents.

However, gender, age, education and socio-economic status are not linked to CMDs.

These results suggest that THCs are a last resort for patients with long-term problems who may be unhappy with the outcome of biomedical treatment. PHC consultations are free, but very short, with little time to discuss symptoms or their causes. In rural Tanzania, there is one doctor per 20 000 population; for traditional healers the figure is one per 25. There are no formal community mental health services and only ten psychiatrists countrywide.

The Ministry of Health is planning a Traditional Health Care Practitioners Act to register, control and regulate the use of traditional healers, their practices and medicines. In the meantime, healers have set up an organisation, CHAWATIATA, to register practitioners. In order to optimise treatment of CMDs in a setting with limited resources, the researchers recommend that policy-makers should:

• involve traditional healers and their associations in plans to develop responsive and comprehensive community-based mental health services
• set up joint training programmes in medical schools and primary healthcare facilities
• encourage true collaboration, where each group of practitioners can learn about the benefits of the other’s practices.

Source(s):
‘Common mental disorders among attendees at primary health clinics and traditional healer centres in Dar-Es-Salaam, Tanzania’, British Journal of Psychiatry 183: 349-355, by M. Ngoma, M. Prince and A. Mann, 2003

Funded by: The Commonwealth Universities

id21 Research Highlight: 4 November 2003

Further Information:
Mdimu Ngoma
187 Parswood Road
Didsbury
Manchester
M20 4RR
UK

Institute of Psychiatry, King's College London, UK

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