Mental Health Diagnostic Frameworks, Imputed Causes of Mental Illness, and Alternative Treatments in Northern Tanzania: Exploring Mental Health Providers’ Perspectives
In Tanzania, a nation with a large mental health treatment gap, local stakeholders’ perspectives are critical for informing effective treatment. The practice-based perspectives of mental health providers may be particularly instructive. Existing foundational literature on the professional population in this region is scarce. We conducted semi-structured interviews with 29 mental health providers in northern Tanzania. Interviews focused on three topics: use of international diagnostic frameworks for mental illness, beliefs about causes of mental health concerns, and alternative treatments sought by clients. Interview data were coded and analyzed using consensual qualitative research and the constant comparative method. Usage of diagnostic frameworks varied widely. Providers believed frameworks accurately described many patients but neglected somatic symptoms and contained diagnoses that they had never witnessed. Providers described supernatural and spiritual attributions of mental illness as substantially impacting treatment decisions. Other notable attributions included physical illness, drug/alcohol use, and heredity. Providers reported their clients routinely sought treatment from traditional and spiritual healers prior to seeking care in the formal health system. This study builds a foundation for the ongoing development of the mental health system in northern Tanzania. Findings also support exploration of integrative models of care and task-shifting to incorporate traditional and spiritual beliefs.
KeywordsAttribution East Africa Global mental health Lay beliefs Lay theories of mental illness
Nchini Tanzania, taifa lenye pengo kubwa la matibabu ya afya ya kiakili, matarajio ya wadau wadogo ni muhimu kwa kuarifu matibabu ya ufanisi. Mitazamo ya watoa huduma kwa vitendo /mazoezi inaweza kuwa muhimu sana. Vitabu vya msingi vilivyopo kwa ajili ya wataalamu wa kandaa hii ni vichache. Tulifanya mahojiano ya nusu ya muundo na watoa huduma 29 kaskazini mwa Tanzania. Mahojiano yalizingatia mada matatu: Matumizi ya mifumo ya kimataifa ya utambuzi wa ugonjwa wa akili, imani juu ya sababu husiana na afya ya kiakili, na matibabu mbadala waliyopewa wateja. Takwimu za mahojiano zilihifadhiwa na kuchambuliwa kwa kutumia utafiti wa kuzingatia ubora na utafiti wa mbinu ya kulinganisha. Matumizi ya mifumo ya utambuzi yametofautiana sana. Watoa huduma waliamini kwamba mifumo ilieleza wagonjwa wengi ila ikasahau dalili za kimwili na zikawa na utambuzi ambao hawajawahi kushuhudia. Watoa huduma walieleza pia kwamba matarajio ya kawaida na ya kiroho ya ugonjwa wa akili ndio yanathiri sana maamuzi ya matibabu. Mengine yaliyojuulikana kwa kuchangia ni ugonjwa wa kimwili, matumizi ya madawa ya kulevya/pombe na urithi kama walivyoripoti watoa huduma. Wateja wao walipata matibabu mara kwa mara kutoka kwa waganga wa kienyeji na wa kiroho kabla ya kutafuta huduma kwa njia au mfumo rasmi wa afya. Utafiti huu hujenga msingi kwa ajili ya maendeleo endelevu ya mfumo wa afya ya kiakili kaskazini mwa Tanzania. Matokeo pia yanasaidia utafutaji wa mifano ya unganishi wa hudumana uhamisho wa kazi kwa kuingiza imani za kitamaduni na kiroho.
We would like to acknowledge the contributions of all participants interviewed for the study and the reviewers for their invaluable input. We also wish to thank Lusekelo Nkuwi and Florence Tesha for their contribution to the data analysis, Shanna Strauss for her assistance with the conceptualization of the research, and Elizabeth Knippler for her assistance with editorial review. We would also like to thank Elizabeth Bradley for her guidance and input with the manuscript.
The authors have no funding sources to declare.
Compliance with Ethical Standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
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