Scoping review framework
The authors will conduct a scoping review of peer-reviewed literature on the following specific points: concurrent use of traditional medicines and prescribed antimicrobials, the collaboration between THPs and BHPs, and treatment of bacterial and viral diseases. The scoping review method's selection was to make easy the mapping of the topic under study and build evidence around the related to the subject . This review will use the framework developed by Arksey and O'Malley . This framework stipulated the following steps (a) identification of research questions, (b) identification of relevant studies, (c) charting the data, and (d) collation, summary, and report of findings.
Identifying the research questions
The general research question of this study is, "What is the evidence of collaboration between THPs and BHPs in the reduction of antimicrobial resistance among people living with infectious diseases in sub-Sahara African countries?"
The specific research questions to answer the general question are as follows:
- What is the evidence of TM's concurrent use, prescribed ATB, and ARVs medicine for viral and bacterial infections?
- What is the evidence of the perceptions of TPHs and BHPs about the interaction between TM and prescribed ATB and ARV medicine for viral and bacterial infections?
- Is there a bidirectional referral of patients between THPs and BHPs to manage bacterial and viral diseases?
Eligibility of research questions
The study will use an amended Population, Intervention, Comparison, Outcomes, and Study setting (PICOS) framework to evaluate research questions' eligibility (Table 1).
Table 1. PICOS framework for determination of eligibility of review question
THPs and BHPs
Collaboration between traditional and biomedically healthcare workers
Absence of collaboration between THPs and BHPs
Primary outcome: Prevention and reduction of antimicrobial resistance
Secondary outcome: Effective collaboration
Identification of relevant studies
Studies that utilize mixed methods, qualitative and quantitative, published in peer-reviewed journals and university research spaces, thesis and dissertations, conference papers, and government desks will be assessed as part of the grey literature. Collected data will be from January 2005 to January 2020, addressing the above research questions. Different types of study designs will be used during the process of screening data. Authors will conduct an electronic search from the following databases: Science Direct, Scopus, Web of Science and Embase, Google Scholar, PubMed, and MEDLINE via EBSCOhost. Authors will explore internet sites such as the World Health Organization (WHO) and government internet sites for reports and policies on the collaboration of healthcare workers, measures on antimicrobial resistance, safe use of traditional medicine, and concurrent use of traditional medicine prescribed medicines. Through "Cited by," other articles will also be searched in the reference lists of selected papers. The search keywords will include Collaboration, Traditional Health Practitioners, Drug-resistance, traditional medicine, Absence, Conventional antimicrobial, Prevention, Effective, and sub-Saharan Africa.
To be sure that the included studies have the specific information according to the eligibility criteria, they should respond to the evidence of collaboration between THPs and BHPs in reducing antimicrobial resistance and treatment failure in bacterial and viral diseases.
For the inclusion of publications in this study, they should match with the undermentioned criteria:
- There will be no language restriction in the inclusion of studies. The authors will request English or French versions of Italian, German, Chinese, and Portuguese exciting materials.
- Focus on strategies of collaboration between THPs and BHPs.
- Publications from January 2005 to January 2020.
- Report on cases of treatment failure, drug-interactions, drug-resistance, and antimicrobial stewardship.
- Publications on the use of traditional medicine in conjunction with prescribed antimicrobials by community members of 18 years and above.
- Reports on death cause worldwide, with particular emphasis on sub-Saharan Africa.
Studies will be excluded if they meet the following characteristics:
- Articles published before 2005 and after January 2020.
- Articles that they do not report on TM's use for the management of bacterial and viral diseases.
- Articles that report on other diseases than infectious diseases.
A pilot study will be carried out to check the chosen studies' appropriateness, keywords, and databases. Selected articles will be shared between two reviewers using research manager software such as Endnote library. According to the eligibility criteria, both the first and second reviewers will conduct a comprehensive title screening. Eligible publications will be exported using Endnote management software. Articles duplication will be checked using the EndNote program.
Table (2) below presents how publications will be recorded. Full articles and abstracts of studies will be screened according to the eligible criteria. The authors will consider a third reviewer of the research in case of non-accordance between the two previous reviewers. In case of difficulty to find some articles. The authors will need the assistance of the UKZN library.
Table 2. Electronic search record
Keyword search: Search engine used Number of articles or publications selected
The mainstream healthcare system, orthodox therapy, modern therapy, western medicine
Traditional herbal mixtures, herbal medicines, herbal concoctions, herbal teas, herbal formulations, traditional medicines
Microbial adaptation, antimicrobial resistance,
Mutual referral, bi-directional
Concurrent use, concomitant use, simultaneous use, use in association
Bacterial, viral, microbial, pathogen
Infectious diseases, viral infectious diseases, contagious bacterial diseases
Collaboration, cooperation, coaction
However, for authors whose publications will be cited and challenging to retrieve, they will be asked for assistance through a correspondence letter. If they do not respond to the correspondence, then their articles will be excluded.
The present protocol will use the developed guideline for reporting known as the Preferred Reporting Items for Systematic Reviews and Protocol Meta-Analyses 2015 (PRISMA-P 2015). The PRISMA-P consists of a checklist of 17 elements designed to promote the planning and reporting of a robust systematic review protocol.
Charting the data
Table (3) presents the flow or the charting of included studies. A data charting form will be conceived and piloted. Variables to have to summarize the included articles are shown in Table 3.
Table 3. Form for Data charting
Author and date
Article or study title
Journal full reference
Aims or main research question
Characteristics of participants
Recruitment context (e.g. where participants were recruited).
Study method or design
Data collection (what data collection methods were used?)
Data analysis (how was the data analyzed?)
Most relevant findings
Collating, summarizing, and reporting the findings
This study aims to map the evidence of collaboration THPs and BHPs in reducing antimicrobial resistance and treatment failure in bacterial and viral diseases in sub-Saharan Africa and summarizing the results as found from the included studies. Following data extraction, thematic content analysis will be carried out to code the data according to the following themes: types of interactions registered in publications; causes of treatment failure, approach system and medicinal plants used by THPs to treat infectious diseases; barriers and facilitators towards collaboration between THPs and BHPs in the management of infectious diseases which may lead to antimicrobial resistance and; types of infectious disease not cured by western medicine. The emerging theme will also be coded. NVIVO software version 11 will be employed to assist with the coding of the themes.
- Coding data from the included articles
- Categorizing the codes into major themes
- Displaying the data
- Identification of critical patterns in the data and identification of subthemes
The mixed-method appraisal tool (MMAT)-Version 2011 will evaluate the quality of the included studies . This tool will assess the appropriateness of the study's aim, adequacy and methodology, study design, participant recruitment, data collection, data analysis, presentation of findings, and authors' discussions and conclusions. Selected studies will be scored based on a criterion that will use a score to describe them (50% and above). The strength of the body of evidence in the systematic review will be assessed using GRADE.
The resulting themes will be analyzed and critically examined in relationship with the research questions. Reviewers will explore the meanings of the results in reference to the aim of the research and the implications of these results for the forthcoming research, practice, and policy.