# Traditional medicine use among rabies exposed individuals in Ethiopia: A systematic review and meta-analysis

## TL;DR

In Ethiopia, over half of people exposed to rabies use traditional medicine, highlighting the need to include traditional healers in rabies control efforts.

## Contribution

This study is the first to systematically quantify the role of traditional healers in rabies exposure management in Ethiopia.

## Key findings

- 57% of rabies-exposed individuals in Ethiopia use traditional medicine.
- Traditional healers are a significant but unregulated part of rabies response in Ethiopia.
- Inclusion of traditional healers in the One Health strategy could improve rabies prevention.

## Abstract

Worldwide, traditional medicine (TM) is an important and often underestimated part of health services. TM, of proven quality, safety, and efficacy, contributes to the goal of universal health coverage. However, no TM is approved worldwide for rabies treatment. Rabies is almost 100% fatal once symptomatic, leading to acute encephalitis. The challenges of rabies prevention and control in Ethiopia are multifaceted. Successful prevention and control of rabies requires the collaboration of important stakeholders with the One Health approach. But in Ethiopia, the one health model has missed a very important player in rabies control intervention, the traditional healers. This review aims to assess the proportion of individuals visiting traditional healers to provide evidence-based recommendation.

We prepared a review protocol per Joanna Briggs Institute (JBI) manual for evidence synthesis and conducted a comprehensive search of PubMed, Cochrane, Google Scholar and African Index Medicus databases and grey literature from 17 December 2023–30 January 2024. The pooled proportion of traditional medicine use among rabies-exposed individuals was computed using R v 4.3.1 software. Subgroup analysis was done on sample size, geographical location and year of publication. Publication bias was assessed using a funnel plot.

The pooled proportion of traditional medicine use following rabies exposure was 0.57 at 95% CI (0.45-0.69) for the random effects model with I2 = 98% and p < 0.01. To investigate the source of heterogeneity, sub-group analysis has been done on sample size, study area, and year of publication. All the above-listed variables were significant sources of statistical heterogeneity. Of which year of publication from 2019-2023 (I2 = 99%, p < 0.01), Studies from Oromia regional state (I2 = 99%, p < 0.01) and study sample size >500 (I2 = 99%, p < 0.01) were the highest source of heterogeneity.

More than half of rabies-exposed individuals visit traditional healers. This implies that significant healthcare demand related to rabies is addressed by traditional healers, even though the quality is not yet audited. The EMOH in collaboration with partners should work on the integration of traditional healers for rabies prevention and control interventions as One Health stakeholder.

Traditional medicine plays important role in healthcare across many countries, including Ethiopia, though it is often ignored by the formal health system. In Ethiopia, traditional remedies are commonly used for a range of illnesses, including rabies exposure, despite no scientific evidence supporting traditional treatments for rabies, a disease that is almost always fatal once symptoms begin. Ethiopia uses the “One Health” strategy to prevent and control rabies through collaboration across sectors. However, traditional healers have not been included in this approach as they have greater contribution for delaying the access of post exposure prophylaxis. This review aimed to determine how many people exposed to rabies seek help from traditional healers to facilitate evidence informed decision making. Authors conducted review of both published and unpublished studies in Ethiopia their analysis showed that 57% of individuals exposed to rabies visited traditional healers, either before or instead of seeking modern medical care. This implies that traditional healers play a major role in how communities respond to rabies. Therefore, we recommend that the Ministry of Health involve traditional healers in rabies prevention and control as part of the One Health strategy to improve awareness and access to timely post exposure prophylaxis service.