Barriers and facilitators to healthcare facility utilization by non-Ebola patients during the 2018-2020 Ebola outbreak in the Democratic Republic of Congo.

Autor: Kyomba GK; Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, Democratic Republic of Congo. gabykyomba@gmail.com., Law MR; Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada., Grépin KA; School of Public Health, University of Hong Kong, Pokfulam, Hong Kong SAR., Mayaka SM; Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, Democratic Republic of Congo., Mambu TN; Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, Democratic Republic of Congo., Mbunga BK; Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, Democratic Republic of Congo., Hategeka C; Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada., Mapatano MA; Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, Democratic Republic of Congo., Konde JN; Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, Democratic Republic of Congo., Ngo-Bebe D; Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, Democratic Republic of Congo., Babakazo PD; Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, Democratic Republic of Congo., Mafuta EM; Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, Democratic Republic of Congo., Kiyombo GM; Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, Democratic Republic of Congo.
Jazyk: angličtina
Zdroj: Global health research and policy [Glob Health Res Policy] 2024 Nov 19; Vol. 9 (1), pp. 47. Date of Electronic Publication: 2024 Nov 19.
DOI: 10.1186/s41256-024-00387-6
Abstrakt: Background: An Ebola Virus Disease (EVD) outbreak occurred in North Kivu between 2018 and 2020. This eastern province of the Democratic Republic of Congo was also grappling with insecurity caused by several armed groups. This study aimed to explore the barriers and facilitators to utilizing Healthcare Facilities (HCFs) by non-Ebola patients during the crisis.
Methods: A qualitative case study was conducted in Beni and Butembo with 24 relatives of 15 deceased non-EVD patients, 47 key informants from healthcare workers (HCWs), as well as community leaders. Semi-structured interviews were conducted to explore three key areas: (i) the participants' illness history, care pathway, care, and social support; (ii) their perceptions of how EVD affected the care outcome; and (iii) their opinions on the preparedness, supply, use, and quality of healthcare before and during the outbreak. All interviews were recorded, transcribed verbatim, and thematically analysed using Atlas-ti 8.0.
Results: Nine of the 15 deaths were female and their ages ranged from 7 to 79 years. The causes of death were non-communicable (13) or infectious (2) diseases. Conspiracy theories, failure to establish security, and the concept of the ''Ebola business'' were associated with misinformation and lower levels of trust in government and HCFs. The negative perceptions, fear of being identified as an Ebola case, apprehension about the triage unit, and inadequacy of personal protective equipment resulted in a preference for private or informal HCFs. For half of the deceased's relatives, the Ebola outbreak hastened their death. Conversely, community involvement, employing familiar, neutral, and credible HCWs, and implementing a free care policy increased the number of visits. These results were observable despite a lack of funds, overstretched HCWs, and long waiting time.
Conclusions: Our findings can inform policies before and during future outbreaks to enhance the resilience of routine HCFs by maintaining dialogue between HCWs and patients, and rebuilding confidence in HCFs. Quantitative studies including context analysis are essential to identify the determinants of care-seeking during such a crisis.
Competing Interests: Declarations Competing interests The authors have declared that no competing interests exist.
(© 2024. The Author(s).)
Databáze: MEDLINE
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