Mixed-methods assessment of health and mental health characteristics and barriers to healthcare for Ebola survivors in Beni, Butembo and Katwa health zones of the Democratic Republic of Congo

Abstract

ObjectivesHealth and mental health characteristics of all respondents, barriers to accessing health and mental health services and the characteristics and those most at risk for mental health disorders.SettingBeni, Butembo and Katwa health zones in the Democratic Republic of Congo.ParticipantsThe sample contained 223 Ebola survivors, 102 sexual partners and 74 comparison respondents living in the same areas of the survivors. Survivors were eligible if aged >18 years with confirmed Ebola-free status. The comparison group was neither a survivor nor a partner of a survivor and did not have any household members who contracted Ebola virus disease (EVD).Primary and secondary outcome measuresHealth and mental health characteristics, barriers to care and the association of association of mental health disorders with study population characteristics.ResultsFunding was a barrier to accessing needed health services among all groups. Nearly one-third (28.4%, 95% CI 18.0% to 38.7%) of comparison households avoided getting injections for their children. Although most pregnant women were attending antenatal care, less than 40% of respondents stated EVD precautions were discussed at those visits. Trouble sleeping and anger were the strongest predictors of post-traumatic stress disorder, major depressive disorder (MDD), anxiety and suicide attempts with 3-fold to 16-fold increases in the odds of these disorders. There was a 71% decrease in the odds of MDD if current substance abuse (aOR 0.29; 95% CI 0.13 to 0.67; p<0.01) was reported.ConclusionsSpecialised mental health services were limited. Fear of contracting EVD influenced vaccine compliance. Anger and sleep disorders significantly increased the odds of mental health disorders across all groups. Respondents may be using substance abuse as self-medication for MDD. Ebola outbreak areas would benefit from improved screening of mental health disorders and associated conditions like anger and sleep difficulties and improved mental health services that include substance abuse prevention and treatment.

Cross-sectional study of mental health and sexual behaviours for Ebola Survivors in Beni, Butembo and Katwa health zones of the Democratic Republic of Congo

“…This study is the first to assess mental health symptoms and understand sexual behaviour among Ebola-affected communities (not just survivors). 8 These data add to the understanding of the sexual behaviours of communities in EVD outbreak areas and help to make recommendations for prevention of future EVD outbreaks in eastern DRC.…”

“…[4][5][6][7] Post-EVD, psychosocial distress, post-traumatic stress, depression, anxiety, stigma and discrimination among EVD survivors in the West Africa and DRC outbreaks are prevalent and widespread. [8][9][10][11] After the West African Ebola epidemic, post-Ebola sequela and viral persistence in bodily fluids were documented with EVD re-emergence attributable to sexual transmission by EVD survivors. 12 13 Thus, survivors from the Eastern DRC 10th outbreak are followed monthly (until 2022), to include semen or breast milk screening for viral persistence/clearance.…”

“…15 16 Stigma, however, was not associated with mental health among survivors or partners in eastern DRC (10th outbreak). 8 Given low rates of condom use at baseline (3%) in DRC and the prolonged risk of re-emergence of EVD from sexual transmission, we performed a cross-sectional study of survivors, their sexual partners and a comparison population in health zones (HZs) of North Kivu province with the highest numbers of survivors relative to other HZs. 17 18 A previous publication reviewed the predictors of mental health disorders in this population.…”

“…17 18 A previous publication reviewed the predictors of mental health disorders in this population. 8 The intersection of mental health symptoms, stigma and discrimination may impact condom use in EVD-affected populations. This is a concern given that EVD is a sexually transmitted disease, and condom use may limit further infection and recurrent infections.…”

“…The EVD epidemic was complicated by the fact that these areas are chronically insecure and largely rural and was also marked by the deaths of healthcare providers, largely due to misinformation, rumours and misunderstandings of EVD 4–7. Post-EVD, psychosocial distress, post-traumatic stress, depression, anxiety, stigma and discrimination among EVD survivors in the West Africa and DRC outbreaks are prevalent and widespread 8–11…”