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Editorial and opinion


Guest editorial


The impact of traditional treatments on wound care in sub-Saharan Africa


Francis Ojok, Bua Emmanuel and Regina Akise discuss the findings of their study into the problems clinicians face when dealing with traditional remedies


T


he continent of Africa is one of the most diverse areas on the planet, with over 50 countries,


more than 3000 languages and a myriad of cultural practices, traditional beliefs and strongly held values. The different practices found in


the region, mean that there is also a wide range of wound aetiologies, treatment-seeking behaviors and, significantly, a varied compliance with standard wound care practice. The effectiveness of therapeutic


relationships between wound care clinicians and patients is also highly dependent on an understanding of the cultural issues surrounding patients and their wounds. It is evident, therefore, that when


attempting to address wound care issues, whether these be preventive measures or ongoing clinical treatment, clinicians will not be effective unless they recognise the importance of cultural issues and try to address them. In this sense, culture is a vital aspect of wound care planning in this part of Africa.


The study We sampled 10 sub-Saharan countries, including Uganda, Kenya, Tanzania,


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Rwanda, Burundi, Zimbabwe, Malawi, South Africa and Botswana. Through our contacts with wound care clinicians in these countries we sent out questionnaires to assess patients' wound aetiology, treatment-seeking behaviour, wound complications, compliance to standard clinical care and overall prognosis (in relation to culture) in each country's hospitals. A total of 300 patients from 10


countries took part in this study and each patient had either a chronic or an acute wound. The clinicians who administered the questionnaires and collected the data included doctors, specialists, nurses and physiotherapists. Questionnaires were emailed to the wound care clinicians and emailed back to the researchers upon completion. The raw data obtained was then analysed.


In Africa, wound aetiology is often rooted in cultural practices, such as female genital mutilation, traditional circumcision, tattooing and scarification.


Major findings Cultural practices were found to affect all aspects of wound care, both with regards to aetiology and clinical care. Up to 70% of the wounds had been treated with some traditional remedy prior to being seen in the hospital and some patients continued with traditional remedies despite receiving wound care from clinicians. Up to 36% of the wounds were either directly or indirectly caused, or made worse, by a particular cultural


Wounds International Vol 3 | Issue 1 | ©Wounds International 2012


practice and patients' treatment- seeking behaviour was affected by a cultural practice in 30% of the patients assessed. Similarly, compliance with standard treatment was reduced in 60% of patients due to traditional beliefs surrounding the wound and 40% of wound symptoms had been complicated as a result of a particular cultural practice. Many patients were on their second


or third visit to clinicians before they mentioned their wounds and 75% of them had not discussed any cultural issues during their initial assessment or in the development of the care plan. A number of cultural practices and


beliefs came up in the data, most of which significantly affected the patients' wound care. These included traditional remedies such as animal fur, saliva, soil and local herbs. There were also varying beliefs about the aetiology of wounds and practices, such as female genital mutilation, traditional circumcision and scarification, were often a direct cause of the wounds.


Discussion In Africa, wound aetiology is often rooted in cultural practices, such as tooth extraction, female genital mutilation, traditional circumcision, tattooing and scarification, especially in rural areas. These procedures are often performed by untrained practitioners with non-sterile instruments. In many cases (up to 70% of this study) the first step in any wound care regimen is a traditional remedy. This was observed in all the 10 countries sampled here. These remedies are a common source of contamination and hence worsen the wounds. Septicaemia, gangrene and cellulits are some of the complications seen following these traditional remedies.


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