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

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.