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Integration of Traditional and Complementary Medicine Into Medical School Curricula: a Survey Among Medical Students in Makerere University, Uganda

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Integration of Traditional and Complementary Medicine Into Medical School Curricula: a Survey Among Medical Students in Makerere University, Uganda Open access Research BMJ Open: first published as 10.1136/bmjopen-2019-030316 on 4 September 2019. Downloaded from Integration of traditional and complementary medicine into medical school curricula: a survey among medical students in Makerere University, Uganda Amos Deogratius Mwaka,1 Gersave Tusabe,2 Christopher Orach Garimoi,3 Sunita Vohra,4 Charles Ibingira5 To cite: Mwaka AD, Tusabe G, ABSTRACT Strengths and limitations of this study Garimoi CO, et al. Integration of Objective To describe the disposition and traditional and complementary sociodemographic characteristics of medical students ► To our knowledge, this is the first study to system- medicine into medical school associated with inclusion of traditional and complementary curricula: a survey among atically evaluate the disposition of medical students medicine in medical school curricula in Uganda. medical students in Makerere and their sociodemographic factors associated with Design A cross-sectional study conducted during May University, Uganda. BMJ Open intention to include principles of traditional and 2017. A pretested questionnaire was used to collect 2019;9:e030316. doi:10.1136/ complementary medicine into medical school cur- data. Disposition to include principles of traditional and bmjopen-2019-030316 ricula in Uganda. complementary medicine into medical school curricula ► More than 70.8% (395/558) of registered medical ► Prepublication history and was determined as proportion and associated factors additional material for this students enthusiastically participated in the study; determined through multivariate logistic regression. paper are available online. To no eligible participants available at the time of study Participants and setting Medical students in their view these files, please visit declined participation. second to fifth years at the College of Health Sciences, the journal online (http:// dx. doi. ► The study involved students from only one public Makerere University, Uganda. Makerere University is the org/ 10. 1136/ bmjopen- 2019- medical school; so findings may be systematically oldest public university in the East African region. 030316). different from studies conducted in the newer med- Results 393 of 395 participants responded. About 60% ical schools. Received 08 March 2019 (192/325) of participants recommended inclusion of ► The cross-sectional nature of the study limits attrib- http://bmjopen.bmj.com/ Revised 08 August 2019 traditional and complementary medicine principles into uting the difference in dispositions to include tradi- Accepted 14 August 2019 medical school curricula in Uganda. The disposition to tional and complementary medicine by year of study include traditional and complementary medicine into to the effect of time in training and interactions in medical school curricula was not associated with sex, the medical school. age group or region of origin of the students. However, compared with the second year students, the third (OR 0.34; 95% CI 0.17 to 0.66) and fifth (OR 0.39; 95% CI For example, a systematic review of 26 studies 0.16 to 0.93) year students were significantly less likely done in 13 countries showed that 7%–64% of to recommend inclusion of traditional and complementary patients with cancer (average use 31%) use on October 2, 2021 by guest. Protected copyright. medicine into the medical school curricula. Participants 1 who hold positive attributes and believe in effectiveness of T&CM at some point during their illness. traditional and complementary medicine were statistically In sub-Saharan Africa, a recent systematic significantly more likely to recommend inclusion into the review showed a high use of T&CM alone or medical school curricula in Uganda. in combination with conventional medicine. Conclusions Inclusion of principles of traditional and Most of the users were likely to be of low complementary medicine into medical school curricula socioeconomic status and low educational © Author(s) (or their to increase knowledge, inform practice and research, attainment. The review also showed that most employer(s)) 2019. Re-use and moderate attitudes of physicians towards traditional of the users (55.8%–100%) do not disclose permitted under CC BY-NC. No medicine practice is acceptable by medical students at use to healthcare professionals (HCPs).2 In commercial re-use. See rights Makerere University. These findings can inform review of and permissions. Published by Uganda, T&CM practice is common across a medical schools’ curricula in Uganda. BMJ. range of illnesses including diabetes, hyper- For numbered affiliations see tension and cancers. People use T&CM for end of article. BACKGROUND various reasons including beliefs in intrinsic Correspondence to Worldwide, a significant proportion of patients efficacy, long history of use, and perceived 3–6 Dr Amos Deogratius Mwaka; use traditional and complementary medicines barriers to biomedical care. It is likely that mwakaad@ yahoo. com (T&CM) in the treatment of various illnesses. T&CM use and traditional healing practices Mwaka AD, et al. BMJ Open 2019;9:e030316. doi:10.1136/bmjopen-2019-030316 1 Open access BMJ Open: first published as 10.1136/bmjopen-2019-030316 on 4 September 2019. Downloaded from will continue side by side with biomedicine for the fore- evidence, and makes use of all appropriate therapeutic seeable future.7 In addition, the WHO supports the incor- approaches, healthcare professionals and disciplines to poration of T&CM into national health systems and has achieve optimal health and healing’.12 There is a clear developed a traditional medicine strategy (2014–2023) common philosophical strand that spans through the that stipulates the importance of and how to integrate above definitions of integrative medicine and traditional traditional medicine into the national biomedical health medicine; the need to respect the right of the patients system. The WHO strategies acknowledge that T&CM of and to provide safe, effective and accessible healthcare to proven quality, safety and efficacy essentially contributes the human population. to improving access to care by all people in need.8 Regardless of whether patients choose to use T&CM The WHO8 9 has described traditional medicine as ‘the in parallel, interchangeably or in combination with sum total of the knowledge, skill and practices based biomedicine, physicians ought to uphold the ethical on the theories, beliefs and experiences traditional to principles of beneficence and safeguard public welfare different cultures, whether explicable or not, used in the among others by providing appropriate management maintenance of health as well as in the prevention, diag- based on best available evidence.13 The duty to prevent nosis, improvement or treatment of physical and mental harm and protect patients’ welfare demands that HCPs illness’. On the other hand, WHO8 9 describes comple- have access to information regarding evidence on effica- mentary medicine as: ‘a broad set of healthcare prac- cious and effective T&CM. Physicians are also obliged to tices that are not part of that country’s own tradition or know the harmful effects of T&CM in order to be able conventional medicine and are not fully integrated into to provide appropriate guidance to their patients and the dominant healthcare system.’ In this study, T&CM was the public regarding their healthcare choices.14 Failure described as any practices that is not part of conventional of HCPs to advise patients against potentially harmful medicine (biomedicine), whose philosophical underpin- T&CM is deemed unethical because such patients could nings are beliefs, customs and experiences traditional to get harmed by using the T&CMs.15 Including aspects of the people concern, and whose aims are maintenance T&CM into medical school curricula increases awareness of health, prevention of ill health, determination of and knowledge of the future clinicians on T&CM, enables causes of ill health and the treatment of diseases and ill the students to understand better the paradigm from health including physical, social and mental disorders. which traditional health practitioners (THP) treat their The foregoing descriptions of T&CM do not include patients and potentially fosters cooperation and collab- issues of evidence for effectiveness or harm of the prac- oration between T&CM practitioners and conventional tices. Evidence-based use of T&CM in combinations with medicine.16 17 In addition, there is evidence that general conventional medicine fall in the realm of integrative knowledge regarding the theories and fundamentals in medicine. In the high-income countries, particularly T&CM practices could help physicians in guiding patients Canada and USA, a tight working relationship has devel- about their health choices.18 To that extent, physicians oped between conventional medicine and traditional ought to know about T&CM so they can guide their http://bmjopen.bmj.com/ medicine practices. This has led to the emergence of a patients appropriately and ensure safety of use of T&CM hybrid system of healthcare dispensation, the integrative alone or in combinations with conventional medicine. medicine, which brings together the two practices under This requires that medical schools include principles of one roof. Integrative medicine has variously been defined T&CM into their curricula, so the medical students could as ‘a sound combination of safe and effective ancient tradi- learn about T&CM principles including why T&CM tional medicine or complementary medicine,
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