Traditional healers' knowledge, experience, and practices related to multiple sclerosis in the Republic of Guinea: A mixed methods study.

BACKGROUND

Traditional healers are central to healthcare delivery across Africa and may play an important role in pathways of care for multiple sclerosis (MS), particularly in countries with severe shortages of neurologists.

OBJECTIVE

To characterize traditional healers' knowledge, experience, and practices related to MS in the lower income, Western Sub-Saharan African country of Guinea.

METHODS

Semi-structured interviews with 30 traditional healers were conducted in person via snowball sampling. Interviews were conducted in local languages, transcribed, translated, and analyzed using a structured approach to summarize key domains, including training, knowledge, explanatory models, treatment practices, and referral patterns related to MS.

RESULTS

Traditional healers (tradithérapeute) (average age 41 years, 43% women, average duration of practice 12.5 years, 73% with primary or no education) rarely had awareness of MS (20%, n = 6); however, most reported currently treating individuals with vision loss (50%, n = 15) and paralysis/motor weakness (70%, n = 21). Explanatory models for MS disease etiology were primarily spiritual-only (birafouré, illness from unseen supernatural or spiritual forces, or yakouifé, illness from witchcraft or intentional harm; 63%), with 7% endorsing physical-only etiology (gninèfé, illness from bodily/physical causes) and 30% endorsing mixed spiritual-physical beliefs. Treatment approaches included herbal (93%), ritualistic (93%), and religious (60%) modalities. Some practices were injurious. One-third of healers referred patients to physicians; 30% received physicians' referrals.

CONCLUSIONS

Traditional healers in Guinea frequently encounter individuals with neurological symptoms suggestive of MS or related disorders despite limited formal awareness of MS, representing a pathway for earlier recognition and referral.