An assessment of Ebola-related stigma and its association with informal healthcare utilisation among Ebola survivors in Sierra Leone: a cross-sectional study
An assessment of Ebola-related stigma and its association with informal healthcare utilisation among Ebola survivors in Sierra Leone: a cross-sectional study
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DOI：
10.1186/s12889-020-8279-7
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发表时间：
2020-02-05
影响因子：
4.5
通讯作者：
Adams, Jon
中科院分区：
文献类型：
--
作者：
James, Peter Bai;Wardle, Jonathan;Adams, Jon
背景我们调查了塞拉利昂埃博拉病毒病幸存者自返回社区以来与埃博拉病毒病相关的污名的程度和相关性。此外，我们还确定了与埃博拉相关的污名是否是埃博拉幸存者使用非正式医疗服务的预测指标。方法我们对塞拉利昂所有四个地理区域(西部地区、北部省、东部省和南部省)5个地区的358名埃博拉病毒幸存者进行了横断面研究。埃博拉相关污名是通过调整艾滋病毒/艾滋病患者有效的艾滋病毒相关污名工具来衡量的。我们还衡量了传统和补充医学(T&CM)的使用(作为非正式医疗保健使用的衡量标准)。数据分析采用描述性统计和回归分析。结果EVD幸存者报告的内在性污名(0.92+/-0.77)高于总的内在性污名(0.71+/-0.61)。社会隔离(0.96+/-0.88)是已报道的最高污名分量表。埃博拉幸存者认为自己的健康状况一般/差的基督徒[aOR=2.51，95%CI：1.15-5.49，p=0.021]。居住在塞拉利昂北部地区[aOR=2.8，95%CI：1.29-6.07，p=0.009]的人更有可能经历内在化的耻辱。言语虐待[AOR=1.95，95%CI：1.09-3.49，p=0.025]和医疗保健忽视[AOR=2.35，95%CI：1.37-4.02，P=0.002]是EVD幸存者使用T&CM的独立预测因素。结论我们的研究结果表明，自埃博拉幸存者返回社区后，与埃博拉相关的污名(内在化和实施化)在他们中很普遍。宗教信仰、感觉到的健康状况和地区被确定为内在化污名的独立预测因素。言语辱骂和忽视医疗保健预示着非正式的医疗保健使用。需要以埃博拉病毒幸存者为中心并由社区驱动的反污名方案，以促进埃博拉病毒幸存者的康复和社区重新融合。
Background We examined the magnitude and correlates of Ebola virus disease (EVD)-related stigma among EVD survivors in Sierra Leone since their return to their communities. In addition, we determined whether EVD-related stigma is a predictor of informal health care use among EVD survivors. Methods We conducted a cross-sectional study among 358 EVD survivors in five districts across all four geographic regions (Western Area, Northern Province, Eastern Province and Southern Province) of Sierra Leone. Ebola-related stigma was measured by adapting the validated HIV related stigma for people living with HIV/AIDS instrument. We also measured traditional and complementary medicine (T&CM) use (as a measure of informal healthcare use). Data were analysed using descriptive statistics and regression analysis. Results EVD survivors report higher levels of internalised stigma (0.92 +/- 0.77) compared to total enacted stigma (0.71 +/- 0.61). Social isolation (0.96 +/- 0.88) was the highest reported enacted stigma subscale. Ebola survivors who identified as Christians [AOR = 2.51, 95%CI: 1.15-5.49, p = 0.021], who perceived their health to be fair/poor [AOR = 2.58, 95%CI: 1.39-4.77. p = 0.003] and who reside in the northern region of Sierra Leone [AOR = 2.80, 95%CI: 1.29-6.07, p = 0.009] were more likely to experience internalised stigma. Verbal abuse [AOR = 1.95, 95%CI: 1.09-3.49, p = 0.025] and healthcare neglect [AOR = 2.35, 95%CI: 1.37-4.02, p = 0.002] were independent predictors of T&CM use among EVD survivors. Conclusion Our findings suggest EVD-related stigma (internalised and enacted) is prevalent among EVD survivors since their return to their communities. Religiosity, perceived health status and region were identified as independent predictors of internalised stigma. Verbal abuse and healthcare neglect predict informal healthcare use. EVD survivor-centred and community-driven anti-stigma programs are needed to promote EVD survivors' recovery and community re-integration.