Ebola virus disease-related stigma among survivors declined in Liberia over an 18-month, post-outbreak period: An observational cohort study

Abstract

BackgroundWhile qualitative assessments of Ebola virus disease (EVD)-related stigma have been undertaken among survivors and the general public, quantitative tools and assessment targeting survivors have been lacking.Methods and findingsBeginning in June 2015, EVD survivors from seven Liberian counties, where most of the country’s EVD cases occurred, were eligible to enroll in a longitudinal cohort. Seven stigma questions were adapted from the People Living with HIV Stigma Index and asked to EVD survivors over the age of 12 at initial visit (median 358 days post-EVD) and 18 months later. Primary outcome was a 7-item EVD-related stigma index. Explanatory variables included age, gender, educational level, pregnancy status, post-EVD hospitalization, referred to medical care and EVD source. Proportional odds logistic regression models and generalized linear mixed-effects models were used to assess stigma at initial visit and over time. The stigma questions were administered to 859 EVD survivors at initial visit and 741 (86%) survivors at follow-up. While 63% of survivors reported any stigma at initial visit, only 5% reported any stigma at follow-up. Over the 18-month period, there was a significant decrease in stigma among EVD survivors (Adjusted Odds Ratio [AOR], 0.02; 95% Confidence Interval [CI], 0.01–0.04). At initial visit, having primary, junior high or vocational education, and being referred to medical care was associated with higher odds of stigma (educational level: AOR, 1.82; 95%CI, 1.27–2.62; referred: AOR, 1.50; 95%CI, 1.16–1.94). Compared to ages of 20–29, those who had ages of 12–19 or 50+ experienced lower odds of stigma (12–19: AOR, 0.32; 95%CI, 0.21–0.48; 50+: AOR, 0.58 95%CI, 0.37–0.91).ConclusionsOur data suggest that EVD-related stigma was much lower more than a year after active Ebola transmission ended in Liberia. Among survivors who screened negative for stigma, additional probing may be considered based on age, education, and referral to care.

An assessment of Ebola-related stigma and its association with informal healthcare utilisation among Ebola survivors in Sierra Leone: a cross-sectional study

“…This is the first nationally representative study to determine the prevalence of stigma, its sociodemographic correlates and association with informal and nonintegrated forms of health care such as T&CM use among EVD survivors in Sierra Leone. One key finding from our study is that EVD survivors report high levels of internalised and enacted stigma since discharge from an Ebola treatment centre which is in line with findings from a longitudinal Liberian study that reported high levels of stigma at baseline but lower levels at subsequent follow-up visits [21,23]. Our finding also resonates with similar short term and smaller sample size cross-sectional studies in Sierra Leone [24,25,48], Liberia [20], Guinea [49], and DR Congo [19,40],which reported that EVD survivors experience several forms of internalised and enacted stigma.…”

“…EVD-related stigma has been reported by EVD survivors and their communities in DR Congo (35%), Guinea (26%) and Liberia (3%) [18][19][20], and may be more common among female rather than male EVD survivors [12]. Other factors, which have been reported as predictors of EVD-related stigma, are age, level of education, and having accessed medical care [21]. Liberian research also suggests EVD survivors are reported to be more likely to experience stigma compared to their close contacts who were not infected with EVD virus [22] however the degree of EVD-related stigma may decline among survivors over time [21,23].…”

“…Other factors, which have been reported as predictors of EVD-related stigma, are age, level of education, and having accessed medical care [21]. Liberian research also suggests EVD survivors are reported to be more likely to experience stigma compared to their close contacts who were not infected with EVD virus [22] however the degree of EVD-related stigma may decline among survivors over time [21,23]. In Sierra Leone, stigmatisation is reported in approximately one third of EVD survivors [24,25].…”

A Review of Hearing Loss Associated with Zika, Ebola, and Lassa Fever

“…Of the 3,385 individuals studied, 223 (6.6%) were found to have some degree of HL using audiometric evaluation and survey instruments. 19,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] Only one of 21 articles used audiometry to objectively measure HL. This study, by Rowe et al, 19 recruited convalescent Ebola survivors and household contacts following the conclusion of the 1995 Ebola outbreak in Kikwit, DRC.…”

Scaling-up Community Self-reporting Rate for COVID-19: Implication for Assessing the Perceived Stigmatization of COVID-19 Survivors Among Residents of Agege Local Government, Lagos, Nigeria

“…Based on the previous study on Ebola virus disease-related stigma in Liberia, a prevalence of 63.0% [11] was used and the margin of error was set at 5%. Factoring non-response rate of 10%, a minimum sample size of 394 was arrived at.…”