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.T...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 the-matically 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 rou-tine 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.展开更多
基金No direct funding was provided for this paper.However,to collect data,the principal investigator jumped on the opportunity to be in the field with a larger research project funded by the Rapid Research Fund for Ebola which was supported by the International Development Research Centre(IDRC),Grant number,108966-002,KAG and SMM.
文摘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 the-matically 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 rou-tine 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.
