{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T05:36:10Z","timestamp":1785562570403,"version":"3.56.0"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","award":["217135\/Z\/19\/Z"],"award-info":[{"award-number":["217135\/Z\/19\/Z"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","award":["NIHR302394"],"award-info":[{"award-number":["NIHR302394"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>A growing ageing population in Africa underscores the need to reorient health systems to provide care for non-communicable conditions impacting older populations such as hip fractures. In The Gambia, the number of hip fractures are expected to quadruple for both men and women in the next 30 years. This is comparable to hip fracture incidence rates in other South and West African countries. Moreover, mortality rates post-hip fracture are 2\u20133 fold higher in populations from the African Region than for those in other high-income countries. Globally, in many countries including in The Gambia, musculoskeletal conditions are treated in a pluralistic medical system by both biomedical healthcare professionals and traditional bone setters (TBS). Further research is required to understand the interactions between these different therapeutic modalities in the treatment of fractures, including hip fractures \u2013 a life changing injury. Such evidence is important for developing collaborative initiatives between traditional and biomedical practitioners. This study sought to describe the practices and procedures used by TBS to treat hip fractures and their interactions between with biomedical care in The Gambia. In-depth interviews were conducted with 16 TBS and 38 healthcare professionals involved in hip fracture care provision in both rural and urban regions of the country. Data were analysed using an inductive thematic analysis. TBS used different modalities to identify a hip fracture. Most TBS misidentified and treated hip fractures as dislocations. On account of this, treatment consisted of pulling, massaging, and kneading the limb back into the hip socket. During this process, TBS applied concoctions of herbs and butters followed by splinting and tying the limb. Few TBS provided pain relief medication during treatment and most advised an extensive period of immobilisation of the limb. Follow up visits reviewed recovery. The narratives of both TBS and healthcare professionals further highlighted the informal referral of hip fracture patients from TBS to biomedical care to receive radiographs, analgesia, and for other ailments. While some biomedical healthcare professionals maintained that TBS should have no role in hip fracture care, others noted the importance of regulation of TBS practices and training initiatives. Considering these findings, we propose short-, medium- and long-term recommendations for the integration of traditional and biomedical sectors in the treatment of hip fractures in The Gambia. This includes the need to establish regulatory mechanisms for TBS practices and patient referral pathways between biomedical and TBS care.<\/jats:p>","DOI":"10.1371\/journal.pgph.0006582","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T17:46:46Z","timestamp":1784051206000},"page":"e0006582","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Traditional bone setter practices and the interaction with biomedical care in the treatment of hip fractures in The Gambia: A qualitative study"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2360-6955","authenticated-orcid":true,"given":"Awa","family":"Touray","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6016-3416","authenticated-orcid":true,"given":"Kimberly","family":"Lakin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3353-2882","authenticated-orcid":true,"given":"Rachael","family":"Gooberman-Hill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Cessay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8627-3418","authenticated-orcid":true,"given":"Lucy","family":"Gates","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jainaba","family":"Badjie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tida","family":"Saidy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaddy","family":"Darboe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew 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Omololu","year":"2008","journal-title":"Clin Orthop Relat Res"},{"key":"pgph.0006582.ref025","article-title":"Understanding factors that impact patient access and engagement with biomedical and traditional care for hip fractures in The Gambia: an ethnographic study using a social ecological model","author":"RG-H Touray","year":"2025","journal-title":"PLOS Global Public Health"},{"key":"pgph.0006582.ref026","volume-title":"Rural population (% of total population) - Gambia","author":"Bank W","year":"2024"},{"key":"pgph.0006582.ref027","volume-title":"Ministry of Health National Health Policy: Building Partnerships for Quality Health Care For All","author":"Ministry of Health TG","year":"2021"},{"key":"pgph.0006582.ref028","doi-asserted-by":"crossref","first-page":"261","DOI":"10.12688\/wellcomeopenres.19391.1","article-title":"Fractures in sub-Saharan Africa: epidemiology, economic impact and ethnography (Fractures-E3): study protocol","volume":"8","author":"A Burton","year":"2023","journal-title":"Wellcome Open Res"},{"issue":"13","key":"pgph.0006582.ref029","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1177\/1049732315617444","article-title":"Sample Size in Qualitative Interview Studies: Guided by Information Power","volume":"26","author":"K Malterud","year":"2016","journal-title":"Qual Health Res"},{"issue":"2","key":"pgph.0006582.ref030","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"V Braun","year":"2006","journal-title":"Qualitative Research in Psychology"},{"issue":"10","key":"pgph.0006582.ref031","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1177\/1077800410383121","article-title":"Qualitative Quality: Eight \u201cBig-Tent\u201d Criteria for Excellent Qualitative Research","volume":"16","author":"SJ Tracy","year":"2010","journal-title":"Qualitative Inquiry"},{"key":"pgph.0006582.ref032","first-page":"157","article-title":"Health care, hierarchy and the intracultural politics of recognition: Medical pluralism and its narratives as ethnographic objects","volume":"1","author":"H Lambert","year":"2017","journal-title":"L\u2019Uomo"},{"issue":"4","key":"pgph.0006582.ref033","first-page":"170","article-title":"Role of traditional bone setters in Africa: experience in Calabar, Nigeria","volume":"5","author":"AM Udosen","year":"2006","journal-title":"Annals of African Medicine"},{"issue":"1","key":"pgph.0006582.ref034","doi-asserted-by":"crossref","first-page":"61","DOI":"10.5334\/aogh.2878","article-title":"Practices and Perspectives of Traditional Bone Setters in Northern Tanzania","volume":"86","author":"EB Card","year":"2020","journal-title":"Ann Glob Health"},{"issue":"1","key":"pgph.0006582.ref035","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/00494755221122543","article-title":"Systematic review of complications 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The Care of Patients with Fragility Fracture. 2007."},{"issue":"6","key":"pgph.0006582.ref038","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0325353","article-title":"Challenges and opportunities for integrating traditional healing approaches with biomedical care for mental illness: A scoping review from healers\u2019 perspectives","volume":"20","author":"AM Wollie","year":"2025","journal-title":"PLoS One"},{"issue":"4","key":"pgph.0006582.ref039","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1080\/17542863.2018.1556715","article-title":"Closing the Mental Health Treatment Gap through the Collaboration of Traditional and Western Medicine in Liberia","volume":"11","author":"AR Herman","year":"2018","journal-title":"Int J Cult Ment Health"},{"key":"pgph.0006582.ref040","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s13002-015-0075-6","article-title":"Forming a joint dialogue among faith healers, traditional healers and formal health workers in mental health in a Kenyan setting: towards common grounds","volume":"12","author":"CW Musyimi","year":"2016","journal-title":"J Ethnobiol Ethnomed"},{"issue":"6","key":"pgph.0006582.ref041","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1080\/13674676.2013.871628","article-title":"The role of Pentecostal clergy in mental health-care delivery in Ghana","volume":"17","author":"MK Asamoah","year":"2014","journal-title":"Mental Health, Religion & Culture"},{"issue":"24","key":"pgph.0006582.ref042","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.2106\/JBJS.22.01304","article-title":"Training Traditional Bonesetters in Basic Principles of Fracture Treatment: A Proof of Concept in Ghana","volume":"105","author":"D Konadu-Yeboah","year":"2023","journal-title":"J Bone Joint Surg Am"},{"issue":"5","key":"pgph.0006582.ref043","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1177\/1049732319889354","article-title":"\u201cEverything Is Perfect, and We Have No Problems\u201d: Detecting and Limiting Social Desirability Bias in Qualitative Research","volume":"30","author":"N Bergen","year":"2020","journal-title":"Qual Health Res"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006582","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T17:46:56Z","timestamp":1784051216000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006582"}},"subtitle":[],"editor":[{"given":"Barnabas Tobi","family":"Alayande","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":43,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0006582","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]}}}