Utilisation of and Attitude towards Traditional and Complementary Medicine among Ebola Survivors in Sierra Leone

Abstract

Background and objectives: In addition to conventional healthcare, Ebola survivors are known to seek traditional and complementary healthcare (T&CM) options to meet their healthcare needs. However, little is known about the general beliefs of Ebola survivors regarding T&CM and the impact of these beliefs in influencing their decisions around T&CM use. This study examines Ebola survivors’ attitudes towards T&CM use in Sierra Leone. Materials and Methods: We conducted a nationwide quantitative cross-sectional study of 358 Ebola survivors in Sierra Leone between January and August 2018. We used descriptive analysis, chi-square tests and backward stepwise binary logistic regression for data analysis. Results: Close to half of the survivors (n = 163, 45.5%) had used T&CM since their discharge from an Ebola treatment centre. Survivors who viewed T&CM as boosting their immune system/resistance were 3.89 times (95%CI: 1.57–9.63, p = 0.003) more likely to use T&CM than those who did not view T&CM as boosting their immune system/resistance. Additionally, survivors who viewed T&CM as having fewer side effects than conventional medicine were more likely to use T&CM [OR = 5.03 (95%CI: 1.92–13.19, p = 0.001)]. Ebola survivors were more influenced to use T&CM based on their personal experience of the effectiveness of T&CM than by clinical evidence [OR = 13.72 (95%CI: 6.10–30.84, P < 0.001)]. Ebola survivors who perceived T&CM as providing them with more control than conventional medicine over their health/body were more likely to use T&CM [OR = 4.15 (95%CI: 1.74–9.89, p = 0.001)] as opposed to those who did not perceive T&CM in this way. Conclusions: Considering the widespread use of T&CM, an understanding of Ebola survivors’ attitudes/beliefs towards T&CM is useful to healthcare providers and policymakers with regard to public education and practitioner–survivors communication, T&CM regulation and research in Sierra Leone. Ebola survivors appear to turn to T&CM not only for treatment, but also to fill gaps in conventional health care services.

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

“…Most studies on stigma among EVD survivors have focussed on its magnitude and nature both immediately following and over a number of years after discharge from an Ebola treatment centre [11-13, 17-21, 23, 25, 40]. Although recent studies have reported the use of informal healthcare services among EVD survivors [41,42], globally, no study to date has reported whether EVD-related stigma is associated with T&CM utilisation among EVD survivors. In addition, none of the published studies in Sierra Leone on EVD survivors has explored the sociodemographic and health-related factors associated with EVDrelated stigma.…”

Traditional and complementary medicine use among Ebola survivors in Sierra Leone: a qualitative exploratory study of the perspectives of healthcare workers providing care to Ebola survivors

“…Personal and health system factors, including the negative attitudes of healthcare providers towards survivors, were cited as reasons why Ebola survivors decided to seek T&CM. These Sierra Leonean studies also found that disclosure of T&CM use among Ebola survivors was low, which is an indication that communication about T&CM use between healthcare providers and Ebola survivors is not optimal [19][20][21][22]. With these issues and circumstances in mind, we wanted to understand in this study how healthcare providers interact with Ebola survivors regarding T&CM.…”

“…Joint pain and abdominal pain were the most common post-Ebola indications for T&CM use [19]. Ebola survivors were attracted to using T&CM because of personal beliefs, economic, psychological, social and cultural needs as well as health system factors [19][20][21][22]. These factors include the ineffectiveness of conventional medicine, healthcare providers' negative attitudes toward Ebola survivors, high cost of, and unavailability of conventional medicine to manage post-Ebola symptoms and T&CM being in line with Ebola survivors' culture and tradition [19,21,22].…”

“…Also, Ebola survivors' beliefs regarding T&CM have reported influencing their decision to use T&CM. These include the view that T&CM helps boost survivors' immune systems, T&CM being natural and relatively safe than conventional medicine, T&CM provides survivors with more control over their health as well as the relative importance of personal experience of T&CM effectiveness based on prior use when compared to clinical evidence [20].…”

“…Previous Sierra Leonean studies [19][20][21][22] have established that Ebola survivors practice medical pluralism in addressing their healthcare needs, which has the potential to undermine their safety. Personal and health system factors, including the negative attitudes of healthcare providers towards survivors, were cited as reasons why Ebola survivors decided to seek T&CM.…”