A framework to explore traditional, complementary and alternative medicine use for children at health care facilities in eThekwini District

Abstract

Background Decades of prioritisation and immense efforts directed towards interventions for improving child health care globally have yielded a considerable decline in child mortality rates. Nevertheless, in 2019 5.2 million children died before reaching their fifth birthday, which equates to approximately 14 000 deaths every day, this being an intolerably high number of largely preventable child deaths. Health care in South Africa encompasses different systems which include medical care, self-medication, and the use of traditional, complementary, and alternative medicine (TCAM), which is the fundamental type of health care in many communities within the country. Aim: In view of the high prevalence of TCAM use as part of health care seeking behaviour of caregivers for children under the age of five years, the researcher conducted a study to gain more insight on TCAM use with the ultimate aim of developing interventions to strengthen current child health care assessments in eThekwini district. Methods: A qualitative exploratory descriptive research design was used for this study. Data were collected over three months using face-to-face interviews with 22 caregivers in Phase 1 and five focus group discussions in Phase 2, with professional nurses trained either in child nursing, primary health care or integrated management of childhood illnesses (IMCI) in two selected regional hospitals and two selected primary healthcare clinics in eThekwini district. Data were analysed using Tesch’s 8 step coding procedure. Findings: Caregivers indicated that the use of TCAM for their children either on its own or concurrently with conventional medicine. The disclosure of TCAM use presented a challenge for many caregivers, stemming from fears of being blamed, to a lack of understanding among professional nurses. The researcher analysed Phase 1 of the data collection first to ensure data saturation was reached before proceeding to Phase 2 which was also analysed to ensure data saturation as well. Caregivers expressed the use of TCAM for their children either on its own or concurrently with conventional medicine. The disclosure of TCAM use posed a challenge to most caregivers, ranging from fear of being blamed to professional nurses not understanding. Professional nurses reported a high prevalence of TCAM use for children, however stated that enquiry regarding its use was only conducted if they suspected it’s use in critically ill children. This revealed the need for routine guided enquiry, hence a framework to explore the use of TCAM in children attending health care facilities, with guidelines for implementation, was developed. Successful implementation of the proposed framework regarding TCAM use in children at health care facilities in eThekwini, in conjunction with IMCI guidelines, would contribute to the provision of holistic, family centred, culturally sensitive care which could positively influence child survival in eThekwini district, and even South Africa as a whole. Early identification of TCAM use would prevent caregivers administering it concurrently with conventional medicine through routine guided education by professional nurses. It would also allow for prompt identification of potential complications associated with TCAM use, thus improving the prognosis and survival of children in eThekwini district. Audits at healthcare facilities should monitor the communication process between professional nurses and caregivers, as well as monitor for efficient assessment, classification, management, and referral of children found to have used TCAM inappropriately. Should the proposed framework be implemented, it should be incorporated into nurse training programmes that include IMCI. Further studies are recommended regarding TCAM use for children in all nine provinces in South Africa, as well as the use of TCAM during the perinatal period.