Health seeking behavior after the 2013-16 Ebola epidemic: Lassa fever as a metric of persistent changes in Kenema District, Sierra Leone.

Autor: Koch MR; Program in Human Biology, Stanford University, Stanford, California, United States of America., Kanneh L; Pediatrics-Neonatal and Developmental Medicine, Stanford University, Stanford, California, United States of America., Wise PH; Pediatrics-Neonatal and Developmental Medicine, Stanford University, Stanford, California, United States of America., Kurina LM; Program in Human Biology, Stanford University, Stanford, California, United States of America., Alhasan F; Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone., Garry RF; Tulane University, School of Medicine, Department of Microbiology and Immunology, New Orleans, Louisiana, United States of America.; Zalgen Labs, LCC, Germantown, MD, United States of America., Schieffelin JS; Sections of Infectious Disease, Department of Pediatrics, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America., Shaffer JG; Department of Biostatistics and Bioinformatics, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America., Grant DS; Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.; Ministry of Health and Sanitation, Freetown, Sierra Leone.
Jazyk: angličtina
Zdroj: PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2021 Jul 14; Vol. 15 (7), pp. e0009576. Date of Electronic Publication: 2021 Jul 14 (Print Publication: 2021).
DOI: 10.1371/journal.pntd.0009576
Abstrakt: Background: The West African Ebola epidemic of 2013-2016 killed nearly 4,000 Sierra Leoneans and devastated health infrastructure across West Africa. Changes in health seeking behavior (HSB) during the outbreak resulted in dramatic underreporting and substantial declines in hospital presentations to public health facilities, resulting in an estimated tens of thousands of additional maternal, infant, and adult deaths per year. Sierra Leone's Kenema District, a major Ebola hotspot, is also endemic for Lassa fever (LF), another often-fatal hemorrhagic disease. Here we assess the impact of the West African Ebola epidemic on health seeking behaviors with respect to presentations to the Kenema Government Hospital (KGH) Lassa Ward, which serves as the primary health care referral center for suspected Lassa fever cases in the Eastern Province of Sierra Leone.
Methodology/principal Findings: Presentation frequencies for suspected Lassa fever presenting to KGH or one of its referral centers from 2011-2019 were analyzed to consider the potential impact of the West African Ebola epidemic on presentation patterns. There was a significant decline in suspected LF cases presenting to KGH following the epidemic, and a lower percentage of subjects were admitted to the KGH Lassa Ward following the epidemic. To assess general HSB, a questionnaire was developed and administered to 200 residents from 8 villages in Kenema District. Among 194 completed interviews, 151 (78%) of respondents stated they felt hospitals were safer post-epidemic with no significant differences noted among subjects according to religious background, age, gender, or education. However, 37 (19%) subjects reported decreased attendance at hospitals since the epidemic, which suggests that trust in the healthcare system has not fully rebounded. Cost was identified as a major deterrent to seeking healthcare.
Conclusions/significance: Analysis of patient demographic data suggests that fewer individuals sought care for Lassa fever and other febrile illnesses in Kenema District after the West African Ebola epidemic. Re-establishing trust in health care services will require efforts beyond rebuilding infrastructure and require concerted efforts to rebuild the trust of local residents who may be wary of seeking healthcare post epidemic.
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: L.K., F.A., J.S.S., R.F.G., J.G.S., and D.S.G are members of the Viral Hemorrhagic Fever Consortium (www.vhfc.org). The VHFC is a partnership of academic and industry scientists who are developing diagnostic tests, therapeutic agents, and vaccines for Lassa fever, Ebola, and other severe diseases. Tulane University and its various academic and industry partners have filed U.S. and foreign patent applications on behalf of the consortium for several of these technologies. Technical information may also be kept as trade secrets. If commercial products are developed, consortium members may receive royalties or profits. This does not alter our adherence to all policies of the NIH and PLOS Neglected Tropical Diseases on sharing data and materials. Financial and non-financial competing interests that the editors consider relevant to the content of the manuscript have been disclosed. R.F.G. is a co-founder of Zalgen Labs, LLC. All other authors declare no competing interests.
Databáze: MEDLINE
Externí odkaz: