The role of traditional healers along the cancer care continuum in Sub-Saharan Africa: a scoping review

Abstract

Background

Traditional healers play a significant role in Sub-Saharan Africa's healthcare system, but little is known about their role across the cancer care continuum in this context. Given the prevalence of patients consulting healers, we aimed to elucidate their role and impact on cancer care delivery in Sub-Saharan Africa.

Methods

Following the PRISMA reporting standards, all research focused on the role of traditional healers in the cancer care continuum in sub-Saharan Africa was included in this scoping review. Data sources assessed include PubMed, Cochrane Library, Embase, and CINAHL Plus with Full Text, Scopus, Sociological Abstracts, African Journals Online, African Index Medicus, and Google Scholar. Studies that lacked perspectives on the healers’ role, focused solely on the actual herbal medicines, were written in non-English language, were not primary research, or the full-text was unavailable were excluded. Two reviewers performed screening and data extraction for each article, confirmed by a third reviewer.

Results

One thousand four hundred seventy-one studies were identified, with 1437 screened and 191 full-texts reviewed. Of those, 158 were excluded, and 33 (comprising of 1564 healers) were included for final data extraction and analysis. Five studies (64 healers) showed their role in prevention, eleven (454 healers) in diagnosis, twenty-seven (1524 healers) in treatment, and two (25 healers) in palliative care in Sub-Saharan Africa. While some desired increased collaboration with the biomedical system and referred patients, others lacked trust and remained hesitant to provide referrals.

Conclusion

Results showed that traditional healers play an important role in cancer treatment. This provides an opportunity to leverage the skills of traditional healers to improve cancer outcomes, in a way that recognizes and respects local culture. Future research focused on improving the collaboration between traditional healers and the biomedical healthcare system may lead to strengthening the referral system and early detection and treatment of cancer.

Registration

 This study was registered on PROSPERO, CRD42022293055.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-025-01521-7.

Text box 1. Contributions to the literature
• Traditional Healers are involved across the cancer continuum, including prevention, diagnosis, treatment, and palliative care with the most emphasis on treatment.
• Increasing their roles in prevention and diagnosis may be leveraged to improve early cancer detection.
• Traditional healers’ attitudes toward biomedical collaboration are varied

Background

Traditional healers are integral to the informal health sector in Sub-Saharan Africa, with about 80% of the population using traditional medicine for their primary healthcare needs [1]. Traditional healers, including herbal vendors or herbalists, spiritual and faith healers, and traditional birth attendants, are practitioners of traditional medicine, using plant, animal, and mineral-based medicines, spiritual therapies, and manual techniques to diagnose and treat disease [2]. They treat infectious, non-communicable diseases (wounds, hemorrhoids, fractures, liver disease, cancer, blood pressure, diabetes, arthritis, prostate diseases, kidney failure, fibroids, infertility, and impotence), and pain [3, 4]. Payment for services generally consists of a registration fee and cost of medicines, and in certain cases, services may be provided for free or with payment deferment [5, 6]. Sometimes, traditional healers refer cases beyond their competency or for conditions best treated at the hospital to biomedical facilities, yet express concern over medical doctors not reciprocating these efforts [4, 6]. Some Sub-Saharan African countries have introduced traditional medicine services into mainstream healthcare to formally recognize the traditional medicine system; however, traditional services are still generally practiced in parallel rather than being truly integrated [3, 7].

Individuals often seek traditional healing due to cultural beliefs, high costs and long wait times at hospitals, perceived safety and effectiveness of traditional medicine [3, 6, 8]. For example, in breast cancer studies in Ethiopia, Ghana, Kenya, and South Africa, patients were more likely to visit healers if they were unable to afford modern medicine, were from rural areas and without formal education, experienced stigma with diagnosis, or believed that witchcraft caused symptoms [9–13]. Similarly, patients with cervical cancer and Burkitt’s lymphoma in Cameroon, Uganda, South Africa and Zambia relied on traditional healers’ services due to its affordability, the stigma and fear of a cancer diagnosis, the ability to alleviate symptoms and manage pain, perceiving the condition as fatal, encouragement from a support network, and witchcraft theories [5, 7, 14, 15].

Despite this aforementioned evidence of patients’ use of traditional healers in Sub-Saharan Africa for cancer diagnosis and treatment, data focusing specifically on traditional healers’ role in cancer care delivery is unclear. Studies in our review have shown consulting a traditional healer to be associated with delayed presentation, diagnosis, and treatment of cancer [8–10, 16–18]. Thus, the aim of this scoping review is to assess primary literature involving traditional healers themselves to understand their role along the cancer care continuum, involving screening, early detection, diagnosis, treatment, survivorship, and palliative care. In other words, our research question is what is the role of traditional healers along the cancer care continuum?

Methods

Study design

This is a scoping review aimed at generating knowledge on roles played in cancer continuum among traditional healers in Sub-Saharan Africa (SSA). This is achieved through a six-stage scoping review framework that includes: 1) identification of research question; 2) searching for relevant studies; 3) selecting studies based on predetermined criteria; 4) charting the studies; 5) collating and summarizing findings and consultations with relevant stakeholders to validate study findings [19].

Search strategy, eligibility criteria, and data analysis

Search strategy

The study team discussed the proposed review, formulated the review question, defined the issues of concern and identified key search terms. The search terms were developed based on the research question guiding the review. An experienced medical librarian (RB) conversant with and scoping reviews and literature searches in health and social sciences guided the formulation of the search terms. The librarian conducted literature searches for this scoping review. All research focused on the role of traditional healers in the cancer care continuum in sub-Saharan Africa was included for this scoping review. Relevant publications were located through systematic searches on February 16, 2022, for the initial searches and again on May 2, 2023, to capture new publications. The search terms, databases, date of last search, and number of articles retrieved from each database are detailed in (Appendix 1) in the following databases: PubMed, Cochrane Library, Embase, and CINAHL Plus with Full Text, Scopus, Sociological Abstracts, African Journals Online, African Index Medicus, and Google Scholar. Both database-specific subject headings and keywords were used in combination to create the search strategies. The concepts covered included 1) Traditional healers (“Medicine, African Traditional” [subject term] OR “traditional healer*” [keywords] OR “traditional medical practitioner*” [keywords] OR “African witch doctor*” [keywords] OR “TMPs” [keywords] OR “TCAM” [keywords]) AND 2) Cancer (“Neoplasms” [subject term] OR “Neoplasm Staging” [subject term] OR “Early Detection of Cancer” [subject term] OR “Cancer Pain” [subject term] OR "Cancer Care Facilities" [subject term] OR “neoplasm*” [keywords] OR “cancer*” [keywords] OR “oncology*” [keywords]) AND 3) sub-Saharan African countries (“Africa South of the Sahara” [subject term] OR sub-Sahara* [keywords]). No date limits were applied.

In addition to the articles retrieved based on search terms, the authors reviewed the bibliographies of included articles. However, the search was limited to these databases, so study authors were not contacted, and non-English articles were not translated. No data was sought from unpublished studies identified or trial registries, and the level of data extracted included entire article. This was to ensure that relevant articles identified from references of included articles were included for evaluation.

A licensed medical librarian experienced in systematic reviews performed the searches, and a total of 1570 articles were identified in the initial literature review. There were 383 duplicate citations removed in EndNote and then again in Covidence, leaving 1187 references for title and abstract screening. On May 2, 2023, an additional 250 citations were captured a year later to include new publications to be screened. Two reviewers screened a total of 1437 deduplicated titles and abstracts (including new records) from the literature review for relevance, of which 1246 were deemed irrelevant and removed. This produced a set of 191 reports that were sought for retrieval. An additional nine articles from this set were discarded when it was seen that the full text of the articles would not be accessible, leaving a total of 181 records that were evaluated for eligibility at the full text stage. Two reviewers again applied the existing inclusion and exclusion criteria to these full-text articles, which eliminated another 148 references, resulting in a set of 33 articles judged to be highly relevant and included for synthesis (Fig. 1). Conflicts over inclusion were resolved by a third independent reviewer. Three reviewers then applied the inclusion and exclusion criteria and evaluated study design quality.

Fig. 1.

Scoping review on role of traditional healers in cancer care in Sub-Saharan Africa as of May 2023. Source : Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372:n71. 10.1136/bmj.n71

Inclusion criteria

Inclusion criteria for relevant articles consisted of the following: 1) focused on the role of traditional healers; 2) study took place in a sub-Saharan African country; 3) traditional healer saw a patient at some point during the cancer care continuum including but not limited to prevention, detection, diagnosis and treatment, and palliative care or survivorship for any type of cancer;4) all study designs were eligible and 5) published in English language.

Exclusion criteria

Eliminated studies based on the following:

1) not about cancer care; 2) did not include perspectives or views on the role of traditional healers from either the traditional healer, another healthcare provider, or patient/patient's family; 3) abstracts only; 4) non-primary research reports; 5) outcomes did not include role of the traditional healer; 6) not focused on traditional healers as primary subjects/participants of study; 7) review(systematic, literature, scoping, e.c.t.); 8)focused on ethnobotany or herbal medicines themselves; 9) not a sub-Saharan African country and 10) non-English articles. These exclusion criteria helped to include final articles selected on traditional healers in sub-Saharan Africa. Inclusion and exclusion criteria eliminated another 148 references, resulting in a set of 33 articles judged to be highly relevant and included for synthesis. See Fig. 1: PRISMA.

Quality assessment

The quality of eligible studies was evaluated using the Critical Appraisal Skills Programme (CASP) tool [20]. This tool contains ten questions relating to the quality of the study design, recruitment strategies, data collection and analysis, findings, ethical considerations, and whether the research is valuable to research practice. Each question had the option of yes/no/can’t tell. Two reviewers evaluated each study using the criteria and choosing one of the three options (yes/no/can’t tell). A third independent reviewer resolved any conflicts. No overall score was calculated. The quality assessment table visually represents the reviewers’ evaluation of each question leaving the interpretation of the overall quality of the study to the reader. The quality assessment and criteria are available in the appendix (Appendix 2).

Data analysis and synthesis

We did not conduct statistical analyses on the data, mainly because of the heterogeneity of the study designs. Instead, an in-depth approach using thematic synthesis was done. For each study, data was extracted to include country, aim of study and design, type of cancer treated, start and end dates of working with a traditional healer, type and gender of traditional healer, religion, highest level of education, source of training, location of traditional healer, inclusion and exclusion criteria, participant recruitment method, traditional healer’s role in cancer care, specifically where along the cancer continuum, and the healer’s interaction with the biomedical system. The study is registered in PROSPERO: CRD42022293055. Link: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022293055

Results

Altogether, 33 qualitative studies comprising of 1564 healers were included in this review (Fig. 1, Table 1). The majority of the articles were from Nigeria (33%, n = 11) and South Africa (21%, n = 7) (Table 1). Table 2 demonstrates that studies varied in the reporting of the age of the traditional healers 20 studies reported an age range of traditional healers. 5 studies provided an average age, 8 studies did not specify the age). Most studies did not specify the religion of the traditional healers. Among reported religions 187 (12.3%) participants were Muslim, 145 (9.6%) Christian, 136 (9.0%) traditional (Traditional African, Yoruba, Hausa, and Fulani ethnic groups). Seventeen studies did not provide the education level of the traditional healers. Within the studies that did not specify the education level, five studies reported that the healers had some form of education. The highest education level reported among the traditional healers was post- secondary school (n = 27 (1.7%)). Fifteen studies did not specify the traditional healer’s source of knowledge/training. Most participants who indicated their source of knowledge reported it was passed down within the family. The majority of traditional healers were involved in the treatment of cancer (n = 1524 (97.4%)), with fewer involved along other aspects of the cancer continuum such as prevention (n = 63, 4%) diagnosis (n = 454, 29%), and palliative care (n = 25, 1.6%). Some studies reported traditional healers being involved in multiple cancer continuum stages.

Table 1.

Characteristics of included studies in scoping review on the role of traditional healers in cancer care in Sub-Saharan Africa as of May 2023

Author, Year	Country of Study	Location of participants	Total Number of participants/genders	Type of Cancer Treated	Method of recruitment of participants	Method of Data Collection	Aim of study
Mekonnen, 2022 [21]	Ethiopia	North Shewa zone, Amhara regional state, Ethiopia	4 males; 0 females	Breast cancer	Purposeful sampling and the sample size was determined based on information saturation	Semi-structured interviews	To explore lived experiences of patients with breast cancer with their treatment and the traditional healer's understanding of the causes and clinical manifestations of breast cancer in Ethiopia
Lutoti, 2023 [22]	Uganda	Kampala, Wakiso, Mukono	81 males; 38 females	Breast cancer	Other: contact information obtained from leaders of Buganda's traditional healer associations	Semi-structured interviews; Survey	to document the existing knowledge and practices related to breast cancer recognition and treatment using medicinal plants by traditional health practitioners in central Uganda
Tuasha, 2018 [23]	Ethiopia	Megera, Dalle District (Sidama Zone, South Ethiopia)	14 males; 6 females	Not specified	Other: Local admin, elders, rural dev. agents, and center for training farmers were contacted and used their recommendations to locate/approach local traditional healers	Semi-structured interviews; Survey	Identify/record medicinal plants and traditional uses in treating various ailments with emphasis on malignancies and frequently reported diseases
Tesfaye, 2020 [24]	Ethiopia	Oromia, Amhara, Afar, Southern Nations (states of Ethiopia)	66 males, 8 females	Skin, breast, lung, cervical, throat, and intestinal Cancer	Other: Snowball technique	Semi-structured interviews	Document medicinal plants commonly used to traditionally treat cancer-like symptoms in 11 districts in Ethiopia
Steyn, 2000 [25]	South Africa	Atteridgeville (suburb of Petoria)	8 males, 22 females	Not specified	Other: List of traditional healers with help of 2 health promotion advisors. of 117 names, random sampling used.	Semi-structured interviews	To explore possibility of incorporating traditional healers in Atteridgeville into westernized medical efforts to combat cancer
Segun, 2018 [26]	Nigeria	Ogun State (SW Nigeria)	28 males, 11 females	breast, stomach, skin, and "other"	Voluntary	Semi-structured interviews	To identify and document plant species used for treatment of various cancer types amongst Ijebu ethnic group
Oystacher, 2018 [27]	South Africa	Peri-urban townships within South Africa: Khayelitsha, Soweto, and East London	Unknown	type not specified	Voluntary	Focus Groups	Examine ways in which people are identified as having cancer through perspectives of traditional healing or biomedical model and understand stigma associated with cancer
Opoku, 2012 [28]	Ghana	Ghanaian cities, Accra and Sunyani	2 (gender not specified)	breast	Voluntary	Semi-structured interviews; Survey	To explore breast cancer related knowledge and practices to develop an appropriate socioeconomic and culture specific model to improve breast cancer in Ghana
Ochwang'I, 2014 [29]	Kenya	Kakamega County (west Kenya)	22 males, 10 females	Skin, stomach, breast, Cervical Uterine, Prostate and throat cancer	Voluntary	Semi-structured interviews; Survey	To identify and document medicinal plants used for treating and managing cancer by communities living adjacent to Kakamega tropical rainforest
O'Brien, 2012 [30]	Ghana	Kumasi	28 males, 14 females	Breast, Prostate, head and neck, skin, and cervix.	Phone	Semi-structured interviews	To examine the role that traditional herbalists play in cancer management in Kumasi.
Raimi, 2021 [31]	South Africa	Hammanskraal and Winterveld, South Africa	22 males, 68 females	skin, lung, breast, prostate, cervical	Voluntary	Semi-structured interviews	Record medicinal plants traditionally used for treating cancer in Hammanskraal and Winterveld, South Africa and document different methods of preparation and administration of these plants
Nwoga, 1994 [32]	Nigeria	Anambra state of Nigeria	16 males, 4 females	Caner- no specific type mentioned	Voluntary	Semi-structured interviews	To understand why some Nigerian patients rely on traditional system for cure of cancer by exploring perceptions of Igbo traditional healers regarding causes and treatment of cancer
Nkosi, 2018 [33]	South Africa	KZN province in South Africa	19 males, 9 females	All types of cancer	Other: Snowball and purposive sampling method	Semi-structured interviews	To explore the perceptions of traditional health practitioners and radiation oncologists regarding referral of cancer patients
Ngoua-Meye-Misso, 2019 [34]	Gabon	Woleu-Ntem province in Gabon - Mebane Endama village, Douala village, neighborhoods Fek-sole and Miang-si	75 males, 28 females	colorectal cancer, breast cancer, cervical cancer, liver cancer, stomach cancer, skin cancer, nose and pulmonary cancer	Voluntary	Semi-structured interveiws; Survey	To popularize medicinal plants used by Gabonese herbal therapists in cancer treatment
Nelson, 2010 [35]	South Africa	Johannesburg	1 male, 11 females	cervical	Other: Sangomas working in black township in Johannesburg, focus group was in parallel with larger study of 85 women	Focus Groups	Assess Sangomas' knowledge and attitudes about HPV and cervical cancer prevention, determine role as health care providers, and assess interest in working with western doctors
Mwaka, 2021 [36]	Uganda	Northern Uganda (involving participants from all 8 Acoli districts)	16 males, 5 females	no specific cancer mentioned	Other: List of THPs registered with Ker Kwaro Acoli obtained and inquired from traditional chiefs/local council leaders about people regarded as THPs in study districts	Semi-structured interviews; Other: direct observation of practices	To explore perception of traditional healers regarding cancer, its causes, and preferred treatment to identify aspects that can inform interventions to improve cancer outcomes in Uganda
Moshi, 2012 [37]	Tanzania	Kikuku village	1 male, 0 females	type not specified	Other: Arrangements with Regional Cultural Office made to identify prominent traditional healers in different parts of region.	Semi-structured interviews; Survey	To report on the medicinal plants used in Kikuku village, Muleba district
Mokgadi, 2008 [38]	South Africa	Ga Mothapo (rural village in Limpopo province)	4 males, 4 females	Cervical	Other: Snowball sampling	Other: Unstructured in-depth interviews	To explore and describe the perceptions of traditional healers of cervical cancer care
Mohammed, 2014 [39]	Nigeria	Maiduguri, Nguru, Jimeta	Unknown	Breast	Voluntary	Semi-structured interviews	To document important medicinal plants with possible anti breast cancer potential
Matowa, 2020 [40]	Zimbabwe	10 provinces in Zimbabwe	15 males, 5 females	breast, prostate, colon, skin, blood	Other: Convenience sampling; identified from the Traditional Medicine Practitioners Council which falls under the Ministry of Health and Child Care - visited in homes and invited for interviews.	Semi-structured interviews	To identify the plants used by traditional medicine practitioners(TMPs) in Zimbabwe to treat cancer.
Mandizadza, 2016 [41]	Zimbabwe	Urban (Harare) and rural (Chiweshe) Zimbabwe	Unknown	no focus on specific type; cervical was most common among study participants	Other: Various sources of recruitment: hospice, Cancer Association of Zimbabwe, contacts of registered traditional health practitioner, Parirenyatwa Hospital radiotherapy center, snowballed from initial contacts	Focus Groups; Semi-structured interviews	The aim of this study is to discover the point at which people diagnosed with cancer seek the services of traditional health practitioners and to shed light on the interactions between traditional health practitioners and individuals diagnosed with cancer
Malami, 2020 [42]	Nigeria	Sokoto state, Northwest Nigeria	48 males, 2 females	#NAME? Skin, Breast, Head and neck, Colon, Lung, Cervical and Scrotum Cancer	Other: Participants in selected LGAs were randomly visited	Semi-structured interviews; Survey	To explore and record various medicinal plants integrated into traditional medicine for cancer treatment
Kuteyi, 2020 [43]	Nigeria	Nigeria	Unknown	Breast cancer is mentioned but treatment of other types of cancer are implied.	Voluntary	Semi-structured interviews	To assess cancer patients and traditional healers‚ Äô conception of cancer, its cause(s), treatment effectiveness, as well as their opinion about collaboration between western medical practitioner and traditional healers as part of overall health care system.
Gumisiriza, 2021 [44]	Uganda	Bwambara sub-county in Rukunguri district (400 km west of Kampala)	82 males, 114 females	Cervical cancer	Voluntary	Semi-structured interviews; Survey	To document medicinal plant species associated with the management of “African” diseases by the local communities of Bwambara sub-county in Rukungiri district, Western Uganda.
Famojuro, 2020 [45]	Nigeria	Three local government areas (LGA of Ekiti State, Southwestern Nigeria: Gbonyin (Ekiti South), Moba (Ekiti North), and Efon (Ekiti Central).	26 males, 12 females	no specific type	Other: Village heads, elders, and herbalist head was consulted to obtain names of healers, who were then contacted for the interview.	Semi-structured interviews; Other: Open interview	To document medicinal plants used by both traditional healers and the people of Gbonyin, Moba and Efon local government areas of Ekiti State, Nigeria for managing cancer and cancer related diseases
Balogun, 2018 [46]	Nigeria	Five communities which made up the ward 3 of Ibadan North Local Government Area. These communities are:O¡je, Yemetu, O¡kèAremo, Beere and Alaàa-dorin	4 males, 0 females	Cervical cancer	Other: Study participants were identified with the assistance of the Ward Development Committee chairman	Focus Groups; Semi-structured interviews	To assess contextual interpretations of stakeholders regarding cervical cancer and HPV vaccines for adolescent in 5 communities in Ibadan
Balde, 2021 [47]	Guinea	Low and Middle Guinea	88 males, 143 females	Breast	Voluntary	Semi-structured interviews; Survey	To list the breast diseases managed and plants used by Guinean traditional healers and to evaluate traditional Guinean consideration and management of breast diseases.
Asuzu, 2019 [48]	Nigeria	Ibadan Oyo Stateand Ipetu-Remo in Ogun State both in Southwest Nigeria	11 males, 0 females	Cervical, breast and throat cancer	Other: The cancer patients said they patronized alternative healers before or after treatment at the University college hospital in Ibadan and some gave the addresses of the alternative healers. Two healers were approached and asked to invite their colleagues to participate in this study.	Focus Groups; Semi-structured interviews	To assess cancer patients and their alternative (traditional and faith based) healers‚ Äô conception of cancer, its cause(s), treatment effective-ness, as well as their stance on collaboration between alternative healers and orthodox medicine physicians.
Ashidi, 2010 [49]	Nigeria	Ogun, Oyo, Lagos and Ekiti in the South-western region of Nigeria.	Unknown	Breast	Other: Meetings with all traditional healers in various districts were held and those who had handled cases that were diagnosed first in a hospital with some degree of success were enrolled to participate in the survey.	Survey; Other: cytoxicity testing of plants	The aim of this study was to document plants commonly used to treat cancer in South-western Nigeria and to test scientific basis of claims using in vitro cytotoxicity tests.
Agyare, 2018 [50]	Ghana	Ashanti region (surrounds regional capital Kumasi, central Ghana), non-Ashanti healers- east and central areas	43 males, 43 females	commonly treated cancers by healers include breast and skin cancer followed by lung, throat, prostate, and stomach cancer	Other: Selection of healers was based on list provided by Ashanti regional branch of GHAFTRAM (Ghana Federation of Traditional Medicine Healers Association)	Semi-structured interviews; Survey	This study was designed to find out how traditional healers recognize cancer and how they classify and treat the disease with medicinal plants. Collection and identification of specific plants, which parts were used, how they are obtained, prepared, and applied for treatment of cancer were investigated.
Afolayan, 2020 [51]	Nigeria	Iwo and Ibadan, South-Western, Nigeria	31 males, 29 females	Liver, breast, cervical, skin, lung, prostate, stomach, bladder cancer	Other: Snowball method	Survey	To reveal and document the medicinal plants used to treat cancer.
Abubakar, 2007 [52]	Nigeria	Zaria, Kaduna, and Kano in Northern Nigeria	78 males, 22 females	no focus on specific cancer type	Other: Survey conducted among Hausa and Fulani tribes found in study site	Semi-structured interviews	To identify plants and methods used traditionally in the treatment of cancers and inflammatory diseases.
Wright, 1997 [53]	South Africa	Cape Town	Unknown	Breast cancer	Other: Hospital contact, word of mouth referrals	Focus Groups; Semi-structured interviews; Other: participant observation	To ascertain attitudes, beliefs, and practices of black African breast cancer patients about choice of healer

Table 2.

Characteristics of traditional healers of the studies included in scoping review of the role of traditional healers in cancer care in Sub-Saharan Africa as of May 2023

	N (%)
Total Participants	1564
Male	831 (53.1%)
Female	608 (38.9%)
Unspecified gender	125 (8%)
Age range	21–85 years
Religion
Christian	145 (9.3%)
Local tribe (Yoruba, Hausa, Fulani, Traditional)	136 (8.7%)
Muslim	187 (12%)
Study did not specify	1096 (70%)
Highest Level Education Achieved
No schooling	133 (8.5%)
Primary School	330 (21.1%)
Secondary School	241 (15.4%)
Post-secondary school	27 (1.7%)
Study did not specify	833 (53.3%)
Source of Knowledge/Training in Traditional Medicine
Apprenticeship with Traditional healer	16 (1%)
Passed down in family	407 (26%)
Divine knowledge	35 (2.2%)
Study did not specify	1106 (70.7%)
Role played in Cancer Care Continuum
Prevention	63 (4%)
Screening	0 (0%)
Diagnosis	454 (29%)
Treatment	1524 (97.4%)
Palliative Care	25 (1.6%)
Type of Cancer treated
Breast	20(60.6%)
Cervical	9(27.2%)
Skin	7(21.2%)
Prostate	6(18.1%)
Stomach	5(15.1%)
Lung	4(12.1%)
Throat	4(12.1%)
Liver	1(3.03%)
Colon	1(3.03%)
Blood	1(3.03%)
Colorectal	1(3.03%)
Uterine	1(3.03%)
Countries Studies have been conducted
Ethiopia	3(9%)
Uganda	3(9%)
South Africa	7(21%)
Nigeria	11(33%)
Ghana	3(9%)
Kenya	1(3%)
Gabon	1(3%)
Guinea	1(3%)
Tanzania	1(3%)
Zimbabwe	2(6%)

Traditional healer role along the cancer care continuum

Cancer Prevention

Five studies, including 63 (4%) healers, identified cancer prevention as a traditional healers’ role. This included medicinal approaches like providing oral concoctions to prevent cancer development [25, 36].Three articles showed that traditional healers play an important role in equipping their communities with cancer prevention knowledge [30, 35, 38]. Traditional healers who claimed to have cancer prevention knowledge indicated lifestyle improvements (avoiding alcohol and smoking, increasing exercise, improving diet, avoiding antibiotics, safe sexual practices, and early diagnosis and treatment), and some reported educating on these practices [30]. In a focus group study on traditional healers’ understanding of cervical cancer and Human Papillomavirus (HPV), traditional healers already understood that pap smears were a tool for cervical cancer prevention [35]. After learning about the HPV vaccine, healers reported plans to create vaccine awareness campaigns via parental education as well as patient referral to the hospital when traditional healers are unable to cure them [35]. These traditional healers had an interest in collaborating with biomedical doctors and commented that providing the vaccine to girls of 9 years will offer parents a way to discuss sexual health [35]. Studies included in this review did not explicitly describe the role of traditional healers in cancer screening.

Cancer diagnosis

Eleven articles, including 454 (29%) traditional healers, identified cancer diagnosis as a role of traditional healers [22, 24–26, 30, 34, 38, 40, 42, 47, 50]. History taking, symptom observation, and physical examinations were important in the diagnostic process [22, 24–26, 34, 38, 42, 47]. When evaluating patients, traditional healers noted symptoms including scaly rashes and nipple color change, pus, ulcerative wounds or bleeding, tickling, fever, swelling, pain, and weight loss [22, 24, 26, 34, 47]. Healers also completed “physical examinations to classify tumors” internally or externally [42]. Three studies revealed that some traditional healers used divine powers to diagnose breast cancer [25, 26, 38]. One spiritual practice traditional healers performed was “throwing of bones”, which was used as a diagnostic method prior to obtaining medical history or performing a physical exam [25, 38].

Cancer treatment

Twenty-seven studies, including 1524 (97.4%) traditional healers, identified cancer treatment as a traditional healer’s role. Herbal remedies and spiritual treatment were the two dominant treatment modalities.

Herbal medicines

Twenty-six articles described traditional healers using herbal remedies to treat cancer [21–26, 29–32, 34, 37–40, 42–45, 47–53]. Traditional healers use leaves, roots, stems, fruits, flowers, and bark to prepare remedies [22, 29, 31, 32, 37, 39, 43–45, 47, 51, 52]. Some obtain herbs from the forest, which they bring home to make medicinal preparations. One study reported that herbs were mixed with cancer drugs [50]. Traditional healers normally use water, milk, or honey as solvents when preparing leaves, roots, and bark [23, 24, 26, 34]. Decoctions (plant boiled with liquid) and infusions (hot water poured over plant creating oral extract) are the most common methods of preparation; others include blending into paste, grinding into powder, drying, creating essence, squeezing, and burning [23–26, 29, 31, 34, 37, 39, 42–45, 47–50, 52]. Treatment is commonly administered orally or topically [21–25, 31, 34, 38, 39, 42, 43, 45, 47, 48, 51–53]. To a lesser extent, other routes include sublingual, steam, and inhalation [24, 31, 38]. In addition to herbs, some traditional healers apply non-plant substances on the wounds such as cow dung, honey, local gun, snails, and minerals [22, 26, 40, 43–45, 48, 49, 51, 52]. Traditional healers sometimes prohibit patients from eating certain types of foods like meat, fat, alcohol, and wet foods [53]. One study mentioned treatment duration as one to two weeks [29].

Spiritual treatment

In addition to herbal preparations, healers perform spiritual therapies to treat cancer, including spoken word, prayer, divination and incantation, holy water, anointing oil, bone throwing, healing ceremonies, and fasting on the patient’s behalf [25, 26, 30, 32, 38, 43, 45, 48]. Some traditional healers claimed that “cancer can only be treated by spiritual powers and not by doctors”, and they also believed in their abilities, claiming “to treat every condition including breast cancer” [28].

Palliative Care

Two studies, including 25 (1.6%) traditional healers, identified palliative care as a role of traditional healers [23, 41]. Traditional healers noted that they generally see patients who have already undergone hospital treatment without improvement [41]. Patients who have exhausted all available hospital treatment options or with advanced disease often seek out traditional healing to alleviate pain and improve quality of life [41].

Interaction with biomedical health system

Traditional Healers described various interactions with the biomedical health system. Some believe that they do not have the ability to diagnose cancer, so they send patients to health facilities for diagnosis [27, 33, 40, 51]. For treatment, while some traditional healers readily referred their patients to healthcare facilities, [36, 38, 40, 42] others only referred once traditional treatments failed [22, 30, 33, 35]. Traditional healers who referred patients cited their medicines failing to produce the desired result and patients with severe conditions as reasons for referral [36, 40]. A few traditional healers embraced cultural values alongside modern treatments by combining modern medicines and herbs to treat cancer [50, 52]. Traditional healers also provided traditional medicines to patients currently undergoing hospital treatment [22, 41].

Most traditional healers desired increased collaboration with doctors to treat patients more effectively and share knowledge about cancer treatment [35, 36, 43, 48, 50, 52]. It was noted that “both groups could learn from each other” [35] and there was “value in collaboration, [as] traditional healers provide culturally appropriate and spiritual healing” [43]. For example, in South Africa, collaboration is already under way as traditional healers had reportedly attended primary healthcare courses led by the medical team and talks on cancer by an oncologist [25]. Some participants noted that knowledge from this kind of training would increase their confidence in diagnosing cancer [25].

However, other traditional healers do not trust biomedical facilities or believe in collaboration. Some traditional healers do not believe in the treatments performed at modern facilities [44, 53]. One study showed the majority of traditional healers treated cancer based on symptoms instead of referring patients to confirm the diagnosis, and only a quarter of traditional healers referred patients to health facilities when the traditional treatment failed [22]. Similarly, other traditional healers were concerned that using Western medicine in the African population could be fatal [44]. Traditional healers in another study reported that modern treatments prevented the full efficacy of traditional herbs, believing that surgery would lead to cancer spreading throughout the body and radiotherapy created a scar covering the disease [53]. Traditional healers felt un recognized by Western physicians who inaccurately diagnose disease, perform unethical experiments on black people, and are not knowledgeable [27]. Traditional healers are hesitant to allow patients to seek care at health facilities due to a strong belief that herbal medicines will cure cancer and their skills are superior to the biomedical health system [22, 28]. Traditional healers also reasoned that referring patients to modern providers would cause patients to lose confidence in the traditional healer and question their faith in God [48].

Discussion

Understanding traditional healers’ role in the context of cancer care in Sub-Saharan Africa is crucial for developing comprehensive, culturally sensitive cancer control strategies. It facilitates better collaboration between traditional healers and biomedical systems. Our review demonstrated that along the cancer continuum, traditional healers function primarily in treating cancer, which aligns with literature that demonstrates seeking treatment from traditional healers prior to biomedical systems contributes to late-stage cancer diagnosis [8–10, 16–18]. Countries in which reviewed studies were conducted include Ethiopia, Uganda, South Africa, Nigeria, Ghana, Kenya, Gabon, Tanzania, Zimbabwe, and Guinea. It is well-established that traditional healers often serve as primary care providers in their communities [54]. Thus, this role can be leveraged in promoting preventive measures and early cancer diagnosis as well as hospital treatment compliance and co-management of cancer-related side effects like pain and medication toxicities. As evidenced by a qualitative study highlighting traditional healers’ role in cancer health education and exploring the possibility of integrating traditional healers into westernized medical efforts, traditional healers are uniquely positioned in their communities to help promote cancer prevention [25]. Only two studies in this scoping review showed traditional healers’ palliative care involvement, serving patients who already underwent hospital treatment without any improvement and managing cancer-related pain [23, 41]. Training traditional healers to aid in cancer prevention and palliative care aspects can promote healthy practices and increase quality of life.

Research in disciplines beyond cancer found effective strategies to collaborate with, educate, train, and empower traditional healers. For example, a Cameroon pilot project that trained healers on diabetes management practices resulted in traditional healers educating patients, peers, and community members about diabetes [55]. Another program in Uganda, educated traditional healers on HIV prevention and family planning, and similarly found that traditional healers implemented this education into their practice as evidenced by increased discussions with clients [56]. Beyond education and health promotion, several HIV studies demonstrated the impact of traditional healers in testing, early detection, and diagnosis. A cluster-randomized trial in rural Uganda examined traditional healers providing counseling and point-of-care HIV testing to eligible adults compared to standard-of-care patient referrals to clinics for HIV testing [57]. Testing provided directly by traditional healers significantly increased HIV testing rates (with 100% uptake) and HIV care linkage for newly diagnosed patients [57]. Another study trained eight traditional healers on HIV and tuberculosis care, including the distribution of HIV self-test kits, and findings showed that over six months, 82% of clients accepted the HIV self-testing kit from the traditional healer, and 14% of traditional healers reported a reactive result [58]. In Mozambique, a three-day HIV educational intervention for traditional healers resulted in a 35% overall increase in referral rates for diagnosis and a 14% increase in the traditional healers’ HIV knowledge [59]. Similarly, after training on signs and symptoms of tuberculosis, pediatric malaria, and Human African Trypanosomiasis (HAT), traditional healers significantly increased their referrals for suspected cases with high diagnostic accuracy [60–62]. These studies all highlight the benefit of training traditional healers to act as primary referral sources and catalysts for patients to seek out allopathic medicine. These strategies can also be applied to the cancer landscape. Considering the trusting relationships between healers and their communities, training traditional healers on cancer community awareness, screening interventions, and early detection pathways has much potential to improve cancer knowledge and increase screening and early detection rates, in turn, potentially down staging cancer in Sub-Saharan Africa. Additionally, a systematic review evaluating the traditional healers’ impact in treating mental health disorders demonstrated that although they are unlikely to effectively treat severe illness, they can provide psychosocial interventions that relieve distress depression and, anxiety symptoms [63]. Given this information, this is another avenue traditional healers can be directed to offer emotional support to those in their community who are at various points of the cancer continuum, whether diagnosis, treatment, or survivorship journey.

This review revealed mixed reporting on attitudes and interactions with the modern healthcare system, highlighting both the desire for collaboration and understanding of traditional healing limitations as well the complete rejection of modern healthcare by traditional healers. Other research in Sub-Saharan Africa found successful approaches to forging meaningful collaborations between biomedical health systems and traditional healers, all leading to improvement in patient outcomes. For example, in Ghana, there is a fruitful collaboration between a district hospital and a type of traditional healer called a bone-setter [64]. After taking X-rays, the hospital often refers patients to the healer for treatment while the healer refers patients with open wounds to the hospital; the healer also visits patients whom he has referred to the hospital and discusses complex cases with physicians [64]. Also, initiatives in Ghana include the Association of Church-Based Development Projects, which provides phones to traditional healers to increase communication and referrals, as well as the local Ghana Federation of Traditional Medicine Practitioners Association which did a radio commercial motivating healers to join its organization, later connecting traditional healers to the local hospital’s public health manager so they could collaborate with the biomedical system [64]. Lessons from these collaborative efforts, can be applied to better integrate these two parallel health systems in SSA to optimize the delivery of cancer care. Furthermore, traditional healers can also share a responsibility in providing care. One cluster-randomized control trial in Ghana and Nigeria assessed the effectiveness of a shared care model where patients with psychosis would be admitted to a traditional healer’s facility with a primary healthcare worker visiting to deliver clinical care and manage acute issues [65]. Compared to the control group, patients in shared care showed significant improvement in general psychopathology symptoms and were more likely to have episodic rather than continuous illness [65]. This serves as an ideal example of how a traditional healer and healthcare worker can work together to positively influence patients’ health, which is only possible through respecting each other’s differences. Such a shared care model could be beneficial for cancer patients if traditional healers served as a touch point by providing care in the community, following up, and ensuring the patient’s needs were met when they were not at the hospital receiving treatment.

The authors of a UNICEF-funded ethnographic study in rural Ghana examining the status and integration of healthcare by traditional healers and the biomedical system describe recommendations to improve integration, which should be noted when initiating collaboration [64]. They recommend selecting credible traditional healers, promoting promising existing initiatives as models, building strong relationships between traditional healers and biomedical staff, appreciating traditional healers and providing supplies, and developing a communication strategy that motivates both groups [64]. Incorporating such strategies may alleviate the negative outcomes often associated with traditional healers in cancer care.

This is the first known scoping review focusing on traditional healers’ as the study population and their role in delivering cancer care. However, it has several limitations. This review included mainly qualitative studies of small sample sizes, potentially limiting the generalizability of findings. Additionally, only English-language studies were included, which may exclude pertinent literature from non-English-speaking Sub-Saharan African countries. Furthermore, only 10 different countries were included from this large geographic region. We recognize that Sub-Saharan Africa is an incredibly rich and diverse region with various cultures, languages, religions and that the findings from this review may not be generalizable to other countries or even to all regions within the countries included here.

Conclusion

The results based on this review demonstrate that along the cancer care continuum, traditional healers are primarily involved in cancer treatment, followed by diagnosis, prevention, and palliative care. While some healers are willing to collaborate with modern healthcare providers, others lack trust in the biomedical system and remain skeptical toward modern interventions. Given how traditional healers play a pivotal role in their communities, empowering them with skills in cancer prevention and early detection can potentially lead to downstaging of cancer in the Sub-Saharan Africa region and may be a worthwhile avenue to explore. Training traditional healers in cancer prevention such as knowledge dissemination of the HPV vaccine and effective screening mechanisms like clinical breast exams has the potential to equip them with knowledge and tools necessary to educate their patients and raise cancer awareness, as they are recognized pillars of their communities and trusted figures. This scoping review suggests an opportunity to prioritize interventions and research focused on building collaborations between traditional healers and modern healthcare providers. Cultivating dialogue between the two systems potentially offers an avenue to reduce treatment delays and ultimately improve cancer outcomes for patients in Sub-Saharan Africa.

Authors’ contributions

LG and EM conceived of this study idea. LG, EM, and RB contributed to the formulation of the study design. RB undertook the literature searches, organized retrieval of articles, and selection of studies. EM, LG, SD, RS, and RM screened retrieved articles against eligibility criteria and cross-checked the data and the quality assessment. RS consulted for data analysis and interpretation of data. LG, EM, SD, RM, RB, and RS wrote the first draft of the manuscript. LG, BM, and AB contributed to the critical revision of the manuscript. All authors had full access to all data, reviewed, and approved the final manuscript.

Funding

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Data availability

No datasets were generated or analysed during the current study.

Declarations

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Competing interests

The authors declare no competing interests.