Barriers and Facilitators to Healthcare Facility Utilization by Non-Ebola Patients During the 2018-2020 Ebola Outbreak in the Democratic Republic of Congo

Overview

Journal Glob Health Res Policy

Publisher Biomed Central

Specialty Public Health

Date 2024 Nov 19

PMID 39558388

Authors

Gabriel Kalombe Kyomba

Michael Robert Law

Karen Ann Grepin

Serge Manitu Mayaka

Therese Nyangi-Mondo Mambu

Branly Kilola Mbunga

Celestin Hategeka

Mala Ali Mapatano

Joel Nkiama-Numbi Konde

Dosithee Ngo-Bebe

Pelagie Diambalula Babakazo

Eric Musalu Mafuta

Guillaume Mbela Kiyombo

Affiliations

Soon will be listed here.

Abstract

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.

References

Bolkan H, Van Duinen A, Samai M, Bash-Taqi D, Gassama I, Waalewijn B . Admissions and surgery as indicators of hospital functions in Sierra Leone during the west-African Ebola outbreak. BMC Health Serv Res. 2018; 18(1):846. PMC: 6230245. DOI: 10.1186/s12913-018-3666-9. View

Domapielle M, Sumankuuro J, Bebelleh F . Revisiting the debate on health financing in Low and Middle-income countries: An integrative review of selected models. Int J Health Plann Manage. 2022; 37(6):3061-3074. DOI: 10.1002/hpm.3566. View

Collins T, Akselrod S, Atun R, Bennett S, Ogbuoji O, Hanson M . Converging global health agendas and universal health coverage: financing whole-of-government action through UHC. Lancet Glob Health. 2023; 11(12):e1978-e1985. PMC: 10664822. DOI: 10.1016/S2214-109X(23)00489-8. View

McLean K, Abramowitz S, Ball J, Monger J, Tehoungue K, McKune S . Community-based reports of morbidity, mortality, and health-seeking behaviours in four Monrovia communities during the West African Ebola epidemic. Glob Public Health. 2016; 13(5):528-544. DOI: 10.1080/17441692.2016.1208262. View

Ridde V, Meessen B, Kouanda S . [Selective free health care in sub-Saharan Africa: an opportunity for strengthening health systems?]. Sante Publique. 2011; 23(1):61-7. View

Nunez A, Sreeganga S, Ramaprasad A . Access to Healthcare during COVID-19. Int J Environ Res Public Health. 2021; 18(6). PMC: 7999346. DOI: 10.3390/ijerph18062980. View

Bowles J, Hjort J, Melvin T, Werker E . Ebola, jobs and economic activity in Liberia. J Epidemiol Community Health. 2015; 70(3):271-7. PMC: 4789821. DOI: 10.1136/jech-2015-205959. View

Rosmulder R, Krabbendam J, Kerkhoff A, Schinkel E, Beenen L, Luitse J . ['Advanced triage' improves patient flow in the emergency department without affecting the quality of care]. Ned Tijdschr Geneeskd. 2010; 154:A1109. View

Takahashi S, Metcalf C, Ferrari M, Moss W, Truelove S, Tatem A . Reduced vaccination and the risk of measles and other childhood infections post-Ebola. Science. 2015; 347(6227):1240-2. PMC: 4691345. DOI: 10.1126/science.aaa3438. View

10.

Wagenaar B, Augusto O, Beste J, Toomay S, Wickett E, Dunbar N . The 2014-2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010-2016. PLoS Med. 2018; 15(2):e1002508. PMC: 5819774. DOI: 10.1371/journal.pmed.1002508. View

11.

Reddy S, Valderrama A, Kuhar D . Improving the Use of Personal Protective Equipment: Applying Lessons Learned. Clin Infect Dis. 2019; 69(Suppl 3):S165-S170. DOI: 10.1093/cid/ciz619. View

12.

Debie A, Khatri R, Assefa Y . Successes and challenges of health systems governance towards universal health coverage and global health security: a narrative review and synthesis of the literature. Health Res Policy Syst. 2022; 20(1):50. PMC: 9059443. DOI: 10.1186/s12961-022-00858-7. View

13.

Kyomba G, Kiyombo G, Grepin K, Mayaka S, Mambu T, Hategeka C . Assessing routine health information system performance during the tenth outbreak of Ebola virus disease (2018-2020) in the Democratic Republic of the Congo: A qualitative study in North Kivu. PLOS Glob Public Health. 2023; 2(7):e0000429. PMC: 10021379. DOI: 10.1371/journal.pgph.0000429. View

14.

Brown L, Munro J, Rogers S . Use of personal protective equipment in nursing practice. Nurs Stand. 2019; 34(5):59-66. DOI: 10.7748/ns.2019.e11260. View

15.

Chu D, Chen R, Ku C, Chou P . The impact of SARS on hospital performance. BMC Health Serv Res. 2008; 8:228. PMC: 2613902. DOI: 10.1186/1472-6963-8-228. View

16.

Theuring S, Koroma A, Harms G . "In the hospital, there will be nobody to pamper me": a qualitative assessment on barriers to facility-based delivery in post-Ebola Sierra Leone. Reprod Health. 2018; 15(1):155. PMC: 6139160. DOI: 10.1186/s12978-018-0601-9. View

17.

Parpia A, Ndeffo-Mbah M, Wenzel N, Galvani A . Effects of Response to 2014-2015 Ebola Outbreak on Deaths from Malaria, HIV/AIDS, and Tuberculosis, West Africa. Emerg Infect Dis. 2016; 22(3):433-41. PMC: 4766886. DOI: 10.3201/eid2203.150977. View

18.

Desclerc-Dulac D . [Information and care package, keywords for improving the reception of patients in emergency departments]. Soins. 2018; 63(825):56-58. DOI: 10.1016/j.soin.2018.03.011. View

19.

Morse B, Grepin K, Blair R, Tsai L . Patterns of demand for non-Ebola health services during and after the Ebola outbreak: panel survey evidence from Monrovia, Liberia. BMJ Glob Health. 2017; 1(1):e000007. PMC: 5321298. DOI: 10.1136/bmjgh-2015-000007. View

20.

Marston B, Dokubo E, van Steelandt A, Martel L, Williams D, Hersey S . Ebola Response Impact on Public Health Programs, West Africa, 2014-2017. Emerg Infect Dis. 2017; 23(13). PMC: 5711323. DOI: 10.3201/eid2313.170727. View