THE USE OF TRADITIONAL MEDICINE BY CAREGIVERS FOR CHILDREN UNDER THE AGE OF FIVE YEARS AS HEALTH SEEKING BEHAVIOUR BY: SHANITHA PILLAY STUDENT NUMBER: 21449552 SUBMITTED TO THE FACULTY OF HEALTH SCIENCES IN FULFILMENT OF THE REQUIREMENTS FOR M TECH: NURSING. INSTITUTION: DURBAN UNIVERSITY OF TECHNOLOGY i ii ABSTRACT Child health has always been a global priority for decades; however, despite efforts to reduce the child mortality statistics, 5.9 million children under the age of five years have deceased in 2015. IMCI guidelines are used to assess, classify and treat sick children under the age of five years, however, despite the prevalent use of traditional medicine for this age group of children, the guidelines excludes the use of traditional medicine, hence the tendency exists to ignore such questions being asked. It is this gap in the history taking pertaining to sick children seeking health care at clinics that the researcher has identified, therefore, this study is intended to highlight the use of traditional medicine in children under the age of five years. The researcher’s methodology is a quantitative descriptive study by means of a self- developed structured questionnaire which was handed out to 183 caregivers attending a Gateway Clinic and 324 caregivers at Paediatric Out – Patient Department. The total sample size was 507 caregivers of children under the age of five years. Data was analysed using SPSS version 17. The data derived from this study indicated that although most caregivers would take their sick children to the clinic for first line treatment, there are a significant number who would rather use home remedies or seek care from traditional healers. The study reveals that 28.5% of caregivers were found to be administering traditional medicine with conventional medicine and 17.4% would do so concurrently. Evidence also revealed that 75.7% of the caregivers would disclose the use of traditional medicine for their children only if nurses enquired about it. Recommendations arising from the study findings are that the IMCI guidelines should incorporate a classification chart for use by health care professionals in order iii to identify children who were treated by traditional medicine preferably as “RED” - requiring urgent attention and possible admission to hospital, in view of the potential threat to life. Since the IMCI guidelines are also a teaching tool in nursing curricula, the assessment of sick children using traditional medicine will be incorporated into the formal teaching of nurses. Key words used were Integrated Management of Childhood Illnesses, effects and use of traditional medicine on children. iv TABLE OF CONTENTS ABSTRACT ............................................................................................................................................III DEDICATION ....................................................................................................................................... XII ACKNOWLEDGEMENTS .................................................................................................................. XIII LIST OF TABLES ............................................................................................................................... XIV LIST OF FIGURES .............................................................................................................................. XV LIST OF ABBREVIATIONS .............................................................................................................. XVI ANNEXURES ..................................................................................................................................... XVII CHAPTER ONE ...................................................................................................................................... 1 1.1 INTRODUCTION........................................................................................................................... 1 1.2 BACKGROUND ............................................................................................................................... 2 1.3 RESEARCH PROBLEM .................................................................................................................. 4 1.4 AIM OF THE STUDY ....................................................................................................................... 5 1.5 OBJECTIVES ................................................................................................................................... 5 1.6 RESEARCH QUESTIONS .............................................................................................................. 5 1.7 CONCEPTUAL FRAMEWORK ...................................................................................................... 6 1.8 ETHICAL CONSIDERATIONS ....................................................................................................... 8 1.9 DEFINITION OF CONCEPTS ......................................................................................................... 9 1.10 SIGNIFICANCE OF THE STUDY ............................................................................................... 11 1.10.1 ON NURSING RESEARCH ..................................................................................................... 11 1.10.2 ON THE ASSESSMENT OF SICK CHILDREN UNDER THE AGE OF FIVE YEARS ....... 12 v 1.10.3 ON CHILD MORTALITY .......................................................................................................... 13 1.11 OUTLINE OF THE STUDY .......................................................................................................... 13 1.12 CONCLUSION.............................................................................................................................. 14 CHAPTER TWO ................................................................................................................................... 15 LITERATURE REVIEW ....................................................................................................................... 15 2.1 INTRODUCTION ............................................................................................................................ 15 2.2 THE GLOBAL USE OF TRADITIONAL MEDICINE ................................................................... 16 2.3 THE USE OF TRADITIONAL MEDICINE IN AFRICA AND SOUTH AFRICA ......................... 18 2.4 PERCEPTIONS OF CAREGIVERS PERTAINING TO THE USE OF TRADITIONAL MEDICINE .................................................................................................................................................... 20 2.5SAFETY, EFFICACY AND QUALITY OF TRADITIONAL MEDICINES .................................... 22 2.5.1 SAFETY ....................................................................................................................................... 22 2.5.2 EFFICACY ................................................................................................................................... 24 2.5.3 QUALITY ..................................................................................................................................... 25 2.6 EFFECTS OF TRADITIONAL MEDICINES ................................................................................. 26 2.7 BENEFITS OF TRADITIONAL MEDICINE .................................................................................. 26 2.8 PRIMARY HEALTH CARE ASSESSMENT STRATEGIES FOR A SICK CHILD ................... 27 2.9 CHILDHOOD ILLNESSES TREATED WITH TRADITIONAL MEDICINES.............................. 29 2.10 THE IMPACT OF TRADITIONAL MEDICINE USE ON CHILD MORBIDITY AND MORTALITY ................................................................................................................................................ 31 2.11 DISCUSSIONS BETWEEN HEALTH CARE PROFESSIONALS AND CAREGIVERS ........ 34 2.12 CONCLUSION.............................................................................................................................. 36 vi CHAPTER 3 .......................................................................................................................................... 38 3.2. RESEARCH METHODOLOGY .................................................................................................... 38 3.2.1 QUANTITATIVE RESEARCH .................................................................................................... 38 3.2.2 RESEARCH DESIGN ................................................................................................................. 39 3.2.3. RESEARCH SETTING .............................................................................................................. 40 3.3. RESEARCH POPULATION ......................................................................................................... 41 3.4.1 SELECTION OF THE RESEARCH SETTING .......................................................................... 42 3.4.2 SELECTION OF THE RESPONDENTS ................................................................................... 43 3.5 SELECTION CRITERIA................................................................................................................. 44 3.5.1 INCLUSION CRITERIA .............................................................................................................. 44 3.5.2 EXCLUSION CRITERIA ............................................................................................................