Exploring health-seeking behavior among adolescent mothers during the Ebola epidemic in Western rural district of Freetown, Sierra Leone

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Abstract

Background

From 2014 to 2016, the largest Ebola outbreak in history threatened Sierra Leone and its neighbouring countries, Guinea and Liberia. The Ebola outbreak impacted pregnant adolescent girl’s access to prenatal care during the pandemic. The aim of this study is to understand health-seeking behaviour among adolescent mothers who were pregnant during the Ebola epidemic in Waterloo, Sierra Leone.

Methods

The present qualitative study uses the “Three Delay” model, as a theoretical framework to understand and explore adolescent mother’s health-seeking behaviour through four focus group discussions with five participants in each discussion group. The data were analysed using thematic analysis.

Results

A multitude of challenges were identified following the Ebola epidemic. The fear of contracting Ebola was a common reason for not seeking care or utilising services. This notion was perpetuated by perceptions in the community and participants personal experiences. Quarantines, national lockdowns, roadblocks, loss of income and extreme poverty were also identified as barriers to accessing health facilities during Ebola. The different encounters with health workers and the challenges that arose at the health facilities were subsequently additional discouraging factors influencing participant’s decision not to seek health care.

Conclusion

Many of the pre-existing maternal health, societal and social-economic challenges were exacerbated during the Ebola. The epidemic also contributed new challenges such as public fear, mistrust towards health professionals and the health system. Greater emphasis needs to be placed on improving maternal care in general, but also improving preparedness for maternal care in case of future outbreaks, especially for the most vulnerable groups such as adolescent mothers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-020-03521-7.

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Most cited references 22

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Using thematic analysis in psychology

Virginia Braun, Victoria Clarke (2014)

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Too far to walk: maternal mortality in context.

S Thaddeus, D Maine (1994)

The Prevention of Maternal Mortality Program is a collaborative effort of Columbia University's Center for Population and Family Health and multidisciplinary teams of researchers from Ghana, Nigeria and Sierra Leone. Program goals include dissemination of information to those concerned with preventing maternal deaths. This review, which presents findings from a broad body of research, is part of that activity. While there are numerous factors that contribute to maternal mortality, we focus on those that affect the interval between the onset of obstetric complication and its outcome. If prompt, adequate treatment is provided, the outcome will usually be satisfactory; therefore, the outcome is most adversely affected by delayed treatment. We examine research on the factors that: (1) delay the decision to seek care; (2) delay arrival at a health facility; and (3) delay the provision of adequate care. The literature clearly indicates that while distance and cost are major obstacles in the decision to seek care, the relationships are not simple. There is evidence that people often consider the quality of care more important than cost. These three factors--distance, cost and quality--alone do not give a full understanding of decision-making process. Their salience as obstacles is ultimately defined by illness-related factors, such as severity. Differential use of health services is also shaped by such variables as gender and socioeconomic status. Patients who make a timely decision to seek care can still experience delay, because the accessibility of health services is an acute problem in the developing world. In rural areas, a woman with an obstetric emergency may find the closest facility equipped only for basic treatments and education, and she may have no way to reach a regional center where resources exist. Finally, arriving at the facility may not lead to the immediate commencement of treatment. Shortages of qualified staff, essential drugs and supplies, coupled with administrative delays and clinical mismanagement, become documentable contributors to maternal deaths. Findings from the literature review are discussed in light of their implications for programs. Options for health programs are offered and examples of efforts to reduce maternal deaths are presented, with an emphasis on strategies to mobilize and adapt existing resources.

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Effect of Ebola virus disease on maternal and child health services in Guinea: a retrospective observational cohort study

Alexandre Delamou, Alison El Ayadi, Sidikiba Sidibé … (2017)

Summary Background The 2014 west African epidemic of Ebola virus disease posed a major threat to the health systems of the countries affected. We sought to quantify the consequences of Ebola virus disease on maternal and child health services in the highly-affected Forest region of Guinea. Methods We did a retrospective, observational cohort study of women and children attending public health facilities for antenatal care, institutional delivery, and immunisation services in six of seven health districts in the Forest region (Beyla, Guéckédou, Kissidougou, Lola, Macenta, and N’Zérékoré). We examined monthly service use data for eight maternal and child health services indicators: antenatal care (≥1 antenatal care visit and ≥3 antenatal care visits), institutional delivery, and receipt of five infant vaccines: polio, pentavalent (diphtheria, tetanus, pertussis, hepatitis B virus, and Haemophilus influenzae type b), yellow fever, measles, and tuberculosis. We used interrupted time series models to estimate trends in each indicator across three time periods: pre-Ebola virus disease epidemic (January, 2013, to February, 2014), during-epidemic (March, 2014, to February, 2015) and post-epidemic (March, 2015, to Feb, 2016). We used segmented ordinary least-squares (OLS) regression using Newey-West standard errors to accommodate for serial autocorrelation, and adjusted for any potential effect of birth seasonality on our outcomes. Findings In the months before the Ebola virus disease outbreak, all three maternal indicators showed a significantly positive change in trend, ranging from a monthly average increase of 61 (95% CI 38–84) institutional deliveries to 119 (95% CI 79–158) women achieving at least three antenatal care visits. These increasing trends were reversed during the epidemic: fewer institutional deliveries occurred (–240, 95% CI −293 to −187), and fewer women achieved at least one antenatal care visit (–418, 95% CI −535 to −300) or at least three antenatal care visits (–363, 95% CI −485 to −242) per month (p<0·0001 for all). Compared with the negative trend during the outbreak, the change in trend during the post-outbreak period showed that 173 more women per month (95% CI 51–294; p=0·0074) had at least one antenatal care visit, 257 more (95% CI 117–398; p=0·0010) had at least three antenatal care visits and 149 more (95% CI 91–206; p<0·0001) had institutional deliveries. However, although the numbers for these indicators increased in the post-epidemic period, the trends for all stagnated. Similarly, the increasing trend in child vaccination completion during the pre-epidemic period was followed by significant immediate and trend reductions across most vaccine types. Before the outbreak, the number of children younger than 12 months who had completed each vaccination ranged from 5752 (95% CI 2821–8682) for tuberculosis to 8043 (95% CI 7621–8464) for yellow fever. Immediately after the outbreak, significant reductions occurred in the level of all vaccinations except for yellow fever for which the reduction was marginal. The greatest reductions were noted for polio and tuberculosis at −3594 (95% CI −4811 to −2377; p<0·0001) and −3048 (95% CI −5879 to −216; p=0·0362) fewer vaccines administered, respectively. Compared with pre-Ebola virus disease outbreak trends, significant decreases occurred for all vaccines except polio, with the trend of monthly decreases in the number of children vaccinated ranging from −419 (95% CI −683 to −155; p=0·0034) fewer for BCG to −313 (95% CI–446 to −179; p<0·0001) fewer for pentavalent during the outbreak. In the post-Ebola virus disease outbreak period, vaccination coverage for polio, measles, and yellow fever continued to decrease, whereas the trend in coverage for tuberculosis and pentavalent did not significantly differ from zero. Interpretation Most maternal and child health indicators significantly declined during the Ebola virus disease outbreak in 2014. Despite a reduction in this negative trend in the post-outbreak period, the use of essential maternal and child health services have not recovered to their pre-outbreak levels, nor are they all on a course that suggests that they will recover without targeted interventions.

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Author and article information

Contributors

Hamida Massaquoi: Hamidamassaquoi@gmail.com

Catherine Atuhaire:

ORCID: http://orcid.org/0000-0002-6028-7491

catuhaire@must.ac.ug

Gorgeous Sarah Chinkonono: gschinkonono@gmail.com

Betty Nyawira Christensen: gusbetch@student.gu.se

Hannah Bradby: hannah.bradby@soc.uu.se

Samuel Nambile Cumber: samuelcumber@yahoo.com

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 7 January 2021

Publication date PMC-release: 7 January 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 37

Affiliations

[1 ]GRID grid.8993.b, ISNI 0000 0004 1936 9457, Department of Women’s and Children Health, International Maternal and Child Heath, , Uppsala University, ; Uppsala, Sweden

[2 ]GRID grid.33440.30, ISNI 0000 0001 0232 6272, Faculty of Medicine, Department of Nursing, , Mbarara University of Science and Technology, ; Mbarara, Uganda

[3 ]GRID grid.8761.8, ISNI 0000 0000 9919 9582, Section for Epidemiology and Social Medicine, Department of Public Health, Institute of Medicine (EPSO), , The Sahlgrenska Academy at University of Gothenburg, ; Gothenburg, Sweden

[4 ]GRID grid.8993.b, ISNI 0000 0004 1936 9457, Department of Sociology, , Uppsala University, ; Uppsala, Sweden

[5 ]GRID grid.412219.d, ISNI 0000 0001 2284 638X, Office of the Dean, Faculty of Health Sciences, , University of the Free State, ; Bloemfontein, South Africa

[6 ]GRID grid.49697.35, ISNI 0000 0001 2107 2298, School of Health Systems and Public Health, Faculty of Health Sciences, , University of Pretoria, ; Pretoria, South Africa

[7 ]GRID grid.8761.8, ISNI 0000 0000 9919 9582, Institute of Health and Care Sciences, , The Sahlgrenska Academy at University of Gothenburg, ; Gothenburg, Sweden

Author information

Catherine Atuhaire http://orcid.org/0000-0002-6028-7491

Article

Publisher ID: 3521

DOI: 10.1186/s12884-020-03521-7

PMC ID: 7791629

PubMed ID: 33413227

SO-VID: 832a062b-7e7c-4bd9-861d-2b83aa5ea8b2

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 24 April 2020

Date accepted : 22 December 2020

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: maternal health,health-seeking behaviour,adolescent pregnancy,ebola,sierra leone

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: maternal health, health-seeking behaviour, adolescent pregnancy, ebola, sierra leone

Exploring health-seeking behavior among adolescent mothers during the Ebola epidemic in Western rural district of Freetown, Sierra Leone

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Abstract

Background

Methods

Results

Conclusion

Supplementary Information

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Advocacy for Maternal and Women’s Health

Most cited references 22

Using thematic analysis in psychology

Too far to walk: maternal mortality in context.

Effect of Ebola virus disease on maternal and child health services in Guinea: a retrospective observational cohort study

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Contributors

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