Seizures: The Perceptions and Frustrations of Healthcare Providers and Traditional Health Practitioners in Namibia

Du Toit, Anina (2018-12)

Thesis (PhD)--Stellenbosch University, 2018.

Thesis

ENGLISH ABSTRACT: There are currently no official statistics on the incidence or prevalence of psychogenic nonepileptic seizures (PNES) or epileptic seizures (ES) in Namibia. Furthermore, very little is available with respect to diagnostic and treatment guidelines for these disorders. In a developing, resource-poor country such as Namibia, providing services to people with seizures may be fraught with difficulties. In addition, providing healthcare in a multicultural setting may present its own unique challenges and opportunities. This mixed-method research study aimed to explore the perceptions and frustrations of biomedical and traditional health practitioners in managing medically explained (MES) and unexplained seizures (MUS) in Namibia. The objectives were to describe and interpret their conceptualization of seizures, the diagnostic and treatment practices used in the management of seizures and the challenges encountered in managing seizure patients. A concurrent quantitative and quantitative design was used to investigate both the context and the experiences of healthcare providers (HCPs) and traditional health practitioners (THPs) during the diagnosis and treatment of seizures. Quantitative data were collected using two surveys that focused on gathering information on the diagnostic techniques and practices used by HCPs in the management of MES and MUS. Fifty HCPs completed these surveys and data were analysed using descriptive statistics. As part of the qualitative phases of the study, thirty healthcare providers participated in semi-structured interviews regarding PNES and ES. Eleven THPs were interviewed as part of the qualitative phase of the study. Thematic analysis was used to analyse the semi-structured interviews to identify themes and subthemes within the data. The four systems of the ecological systems theory (Bronfenbrenner, 1977; 1979) were used to conceptualize the discussion and integration of the findings. The perceptions and frustrations of HCPs and THPs centred on the areas of diagnosis, treatment, patients and awareness. Findings pointed to a lack of knowledge and awareness regarding seizures, financial constraints that hamper access to specialized services and equipment, lack of collaboration across disciplines and between HPCs and state healthcare facilities, the recognition that the untapped potential of THPs may play a valuable role in bridging the treatment gap for seizures and a need for increased awareness and training opportunities that focus on seizures among both the public and healthcare workers. The unique challenges that a developing country such as Namibia faces were evident in some of the subthemes that highlighted the cultural differences in how seizures are conceptualized and treated. Biomedical practitioners indicated their willingness to engage with THPs in providing culturally inclusive health services for seizure patients. This may be a first step in advocating for the formal recognition of THPs in Namibia. This study is but a first for Namibia and opens the way for future studies to build on the findings reported here. The current study can contribute to the goals of the International League against Epilepsy and the International League against Epilepsy Psychogenic Nonepileptic Seizure Task Force by providing information on the diagnostic techniques and treatment modalities used in Namibia for the management of seizures. Secondly, the findings from the multi-layered investigation could guide policy and future research on seizures in Namibia.

AFRIKAANSE OPSOMMING: Daar is tans geen amptelike statistieke met betrekking tot die omvang of voorkomssyfer van psigogeniese nie-epileptiese toevalle (PNET) of epileptiese toevalle (ET) in Namibië nie. Verder is baie min beskikbaar in verband met diagnostiese en behandelingsriglyne vir hierdie toestande. In ’n ontwikkelende land soos Namibië wat ʼn tekort aan hulpbronne het, is diensverskaffing aan mense wat toevalle kry besaai met hindernisse. Verder kan die verskaffing van gesondheidsorg in ’n multikulturele omgewing ook unieke uitdagings en geleenthede inhou. Hierdie gemengde-metode navorsingstudie het ten doel gehad om die persepsies en frustrasies van biomediese (BGW) en tradisionele gesondheidsorgwerkers (TGW) oor die bestuur van medies verklaarde (MVT) en mediese onverklaarde toevalle (MOT) in Namibië te toets. Die doel daarvan was om hulle konseptualisering, diagnostiese- en behandelingspraktyke, en uitdagings met betrekking tot toevalle te beskryf en te interpreteer. ’n Gelyklopende kwantitatiewe en kwalitatiewe ontwerp is gebruik om beide die konteks en die ervaring van BGW en TGW gedurende die diagnose en behandeling van toevalle te ondersoek. Kwantitatiewe data is ingesamel met behulp van twee vraelyste wat gemik was op inligting rakende die diagnostiese tegnieke en praktyke wat gebruik word deur BGW in die bestuur van MVT en MOT. Vyftig BGW het hierdie vraelyste ingevul en die data is ontleed aan die hand van beskrywende statistiek. As deel van die kwalitatiewe fase van die studie, het dertig BGW deelgeneem aan semigestruktureerde onderhoude oor PNET en ET. Elf verdere onderhoude is met TGW gedoen as deel van die kwalitatiewe fase van die studie. Tematiese analise is gebruik om die semigestruktureerde onderhoude te ontleed ten einde temas en subtemas uit die data te onttrek. Die vier stelsels van die ekologiese stelselteorie (Bronfenbrenner, 1977; 1979) is gebruik om die bespreking te konseptualiseer en om die bevindinge te integreer. Die persepsies en frustrasies van BGW en TGW het gesentreer rondom diagnose, behandeling, pasiënte en bewustheid. Bevindinge het gedui op ’n gebrek aan kennis en bewustheid van toevalle, finansiële beperkinge wat toegang tot gespesialiseerde dienste en toerusting belemmer, ’n tekort aan samewerking oor die grense van dissiplines heen en tussen BGW en die gesondheidsorgfasiliteite van die staat, die erkenning van die feit dat die ongebruikte potensiaal van TGW ’n waardevolle rol kan speel in die oorbrugging van die behandelingsgaping met betrekking tot toevalle, en die nood aan bewustheid en opleidingsgeleenthede wat fokus op toevalle onder beide die publiek en BGW. Die unieke uitdagings wat ’n ontwikkelende land soos Namibië in die gesig staar het duidelik geblyk uit sommige van die subtemas wat die kulturele verskille in hoe toevalle gekonseptualiseer en behandel word uitgewys het. Biomediese gesondheidsorgwerkers het hulle bereidheid om met TGW saam te werk om kultureel inklusiewe gesondheidsorg te bied aangedui. Dit kan dalk ’n eerste stap wees in die rigting van die formele erkenning van tradisionele gesondheidsorgwerkers in Namibië. Hierdie studie is maar ’n eerste tree vir Namibië en dit maak die pad oop vir toekomstige studies wat op die bevindinge van hierdie studie kan bou. Die studie dra eerstens by tot die doelwitte van die International League against Epilepsy en die International League against Epilepsy Psychogenic Nonepileptic Seizure Task Force deur inligting te verskaf rakende die diagnostiese tegnieke en behandelingsmodaliteite wat in Namibië gebruik word vir die bestuur van toevalle. Tweedens kan die bevindinge van hierdie komplekse ondersoek toekomstige beleid en navorsing oor toevalle in Namibië lei.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/104829
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