Healthcare utilisation and medical pluralism among Ebola survivors in Sierra Leone: an insight for safe and informed care for survivors experiencing post-Ebola sequelae
- Publication Type:
- Thesis
- Issue Date:
- 2020
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๐๐ฎ๐ฐ๐ธ๐ด๐ฟ๐ผ๐๐ป๐ฑ: Evidence suggests that Ebola virus disease (EVD) survivors are suffering from immediate and long term physical and mental health complications, some of which are severe. While current research has focused on understanding the sequelae of EVD survivors in the post-Ebola era, healthcare-seeking behaviour of EVD survivors is largely unknown. This PhD study aimed to investigate EVD survivorโs healthcare-seeking behaviour with particular emphasis on their use of traditional and complementary medicine (T&CM) products and services in Sierra Leone.
๐ ๐ฒ๐๐ต๐ผ๐ฑ๐: This thesis employed an exploratory partially mixed, concurrent dominant status triangulation research design. Male and female adult EVD survivors with post-Ebola sequelae were recruited for both the quantitative and qualitative arms of the study. The quantitative survey explored EVD survivorsโ (n=358) pattern of healthcare utilisation, attitude towards T&CM and Ebola-related stigma. The qualitative arm employed a descriptive exploratory, inductive approach using focus group discussion sessions (n=4) to collect data on EVD survivorsโ (n=41) healthcare-seeking experiences and preferences. Descriptive statistics and backward stepwise binary regression analysis were used to analyse quantitative data while the framework approach was used to guide qualitative data analysis.
๐ฅ๐ฒ๐๐๐น๐๐: The quantitative survey indicated EVD survivors visited a healthcare provider (n = 308, 86.0%), self-medicated with conventional medicines (n =255, 71.2%) and visited a private pharmacy outlet (n = 141, 39.4%). EVD survivors also self-medicated with T&CM products (n = 107, 29.9%), concurrently self-medicated with conventional and T&CM products (n = 62, 17.3%), and visited a T&CM practitioner (n = 41, 11.5%). Almost half of EVD survivors (n = 163, 45.5%) reported using T&CM treatments for post-Ebola related symptoms and non-Ebola related symptoms since their discharge from an Ebola treatment centre. EVD survivors who perceived that T&CM boosted their immune system, that T&CM had fewer side effects than conventional medicine, or that T&CM provided them with more control than conventional medicine over their health were more likely to use T&CM compared to who do not hold those views. Also, EVD survivors were more influenced to use T&CM based on their personal experience of the effectiveness of T&CM than by clinical evidence. EVD survivors reported higher levels of internalised stigma (0.92 ยฑ 0.77) compared to enacted stigma (0.71 ยฑ 0.61). EVD survivors who experienced enacted stigma were [AOR=4.58, 95%CI: 1.51-13.83, p=0.007] more likely to use T&CM. Verbal abuse [AOR = 1.95, 95%CI: 1.09โ3.49, p = 0.025] and healthcare neglect [AOR = 2.35, 95%CI: 1.37โ4.02, p = 0.002] were independent predictors of T&CM use among EVD survivors.
The qualitative component revealed that conventional healthcare was the first choice of treatment option for most EVD survivors immediately following their discharge from the Ebola treatment centre (ETC). However, EVD survivors described the current Free Healthcare Initiative (FHCI) as inadequate in addressing their healthcare needs. Personal and health system factors influenced EVD survivorsโ decision to seek non-formal healthcare approaches, especially T&CM.
๐๐ผ๐ป๐ฐ๐น๐๐๐ถ๐ผ๐ป: The findings from this thesis provide the first ever insights into how EVD survivors navigate the healthcare landscape to address their health needs. The findings of this thesis are useful for policymakers, healthcare providers and EVD survivors, and it highlights the need for further research to explore this topic more closely.
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