Pattern of health care utilization and traditional and complementary medicine use among Ebola survivors in Sierra Leone

Autoři: Peter Bai James aff001;  Jon Wardle aff001;  Amie Steel aff001;  Jon Adams aff001
Působiště autorů: Australian Research Centre inw Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Sydney, Australia aff001;  Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone aff002
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223068



It is well established that Ebola Survivors experience a myriad of physical and psychological sequelae. However, little is known about how they seek care to address their health needs. Our study determines the current healthcare seeking behaviour among Ebola survivors and determines the prevalence, pattern of use and correlates of traditional and complementary medicine (T&CM) use among Ebola survivors in Sierra Leone.


We conducted a nationwide questionnaire survey among a cross-sectional sample of Ebola Survivors in Sierra Leone between January and August 2018. We employed descriptive statistics, chi-square test, Fisher exact two-tailed test and backward stepwise binary regression analysis for data analysis. A p-value less than 0.05 was considered statistically significant.


Ebola Survivors who participated in our study (n = 358), visited a healthcare provider (n = 308, 86.0%), self-medicated with conventional medicines (n = 255, 71.2%) and visited a private pharmacy outlet (n = 141, 39.4%). Survivors also self-medicated with T&CM products (n = 107, 29.9%), concurrently self-medicated with conventional and T&CM products (n = 62, 17.3%), and visited a T&CM practitioner (n = 41, 11.5%). Almost half of (n = 163, 45.5%) Ebola survivors reported using T&CM treatments for post ebola related symptoms and non-Ebola related symptoms since their discharge from an Ebola treatment centre. Ebola survivors who considered their health to be fair or poor (AOR = 4.08; 95%CI: 2.22–7.50; p<0.01), presented with arthralgia (AOR = 2.52; 95%CI: 1.11–5.69, p = 0.026) and were discharged three years or less (AOR = 3.14; 95%CI: 1.13–8.73, p = 0.028) were more likely to use T&CM. Family (n = 101,62.0%) and friends (n = 38,23.3%) were the common sources of T&CM information. Abdominal pain (n = 49, 30.1%) followed by joint pain (n = 46, 28.2%) and back pain (n = 43, 26.4%) were the most cited post–Ebola indications for T&CM use. More than three-quarters of T&CM users (n = 135, 82.8%) failed to disclose their use of T&CM to their healthcare providers.


Ebola survivors in Sierra Leone employ a myriad of healthcare options including T&CM in addressing their healthcare needs. Researchers, health policy makers and healthcare providers should be aware of the substantial role of T&CM in the health seeking of survivors, and this topic that should be factored into future research, policy formulation and implementation as well as routine practice regarding Ebola survivors.

Klíčová slova:

Complementary and alternative medicine – Health care providers – Malaria – Traditional medicine – Sierra Leone – Abdominal pain – Ebola hemorrhagic fever – Arthralgia


1. WHO. WHO traditional medicine strategy: 2014–2023. Geneva: World Health Organization. 2013.

2. James PB, Wardle J, Steel A, Adams J. Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review. BMJ global health. 2018;3(5):e000895. doi: 10.1136/bmjgh-2018-000895 30483405

3. James PB, Bah AJ, Tommy MS, Wardle J, Steel A. Herbal medicines use during pregnancy in Sierra Leone: An exploratory cross-sectional study. Women and Birth. 2017;31(5):e302–e9. 29254852 PubMed Central PMCID: PMC29254852

4. James PB, Kaikai AI, Bah AJ, Steel A, Wardle J. Herbal medicine use during breastfeeding: a cross-sectional study among mothers visiting public health facilities in the Western area of Sierra Leone. BMC Complementary and Alternative Medicine. 2019;19(1):66. doi: 10.1186/s12906-019-2479-7 30876454

5. James PB, Kamara H, Bah AJ, Steel A, Wardle J. Herbal medicine use among hypertensive patients attending public and private health facilities in Freetown Sierra Leone. Complementary Therapies in Clinical Practice. 2018;31:7–15. 29705483

6. James PB, Taidy-Leigh L, Bah AJ, Kanu JS, Kangbai JB, Sevalie S. Prevalence and Correlates of Herbal Medicine Use among Women Seeking Care for Infertility in Freetown, Sierra Leone. Evidence-Based Complementary and Alternative Medicine. 2018;2018.

7. Bakshi SS, McMahon S, George A, Yumkella F, Bangura P, Kabano A, et al. The role of traditional treatment on health care seeking by caregivers for sick children in Sierra Leone: results of a baseline survey. Acta tropica. 2013;127(1):46–52. doi: 10.1016/j.actatropica.2013.03.010 23545128

8. Diaz T, George AS, Rao SR, Bangura PS, Baimba JB, McMahon SA, et al. Healthcare seeking for diarrhoea, malaria and pneumonia among children in four poor rural districts in Sierra Leone in the context of free health care: results of a cross-sectional survey. BMC public health. 2013;13(1):157.

9. Ranasinghe S, Ansumana R, Lamin JM, Bockarie AS, Bangura U, Buanie JA, et al. Herbs and herbal combinations used to treat suspected malaria in Bo, Sierra Leone. J Ethnopharmacol. 2015;166:200–4. Epub 2015/03/22. doi: 10.1016/j.jep.2015.03.028 25794802.

10. Morens DM, Fauci AS. Emerging infectious diseases: threats to human health and global stability. PLoS Pathog. 2013;9(7):e1003467–e. doi: 10.1371/journal.ppat.1003467 23853589.

11. Organization WH. The world health report 2007-a safer future: global public health security in the 21st century: World Health Organization; 2007.

12. Mills A. Health care systems in low-and middle-income countries. New England Journal of Medicine. 2014;370(6):552–7. doi: 10.1056/NEJMra1110897 24499213

13. WHO. The top 10 causes of death.Leading causes of death by economy income group Geneva, Switzerland: World health Organisation; 2017 [cited 2017 31 October ]. Available from:

14. Lorenc A, Robinson N. A review of the use of complementary and alternative medicine and HIV: issues for patient care. AIDS patient care and STDs. 2013;27(9):503–10. doi: 10.1089/apc.2013.0175 23991688.

15. WHO. SARS: Clinical trials on treatment using a combination of Traditional Chinese medicine and Western medicine. Report of the WHO International Expert Meeting to review and analyse clinical reports on combination treatment for SARS 8–10 October 2003 Beijing, People's Republic of China Geneva, Switzerland World Health Organization 2004 [cited 2019 5 August]. Available from:

16. Hsu C-H, Hwang K-C, Chao C-L, Chang SGN, Ho M-S, Lin J-G, et al. An Evaluation of the Additive Effect of Natural Herbal Medicine on SARS or SARS-like Infectious Diseases in 2003: A Randomized, Double-blind, and Controlled Pilot Study. Evidence-based complementary and alternative medicine: eCAM. 2008;5(3):355–62. Epub 2007/05/29. doi: 10.1093/ecam/nem035 18830453.

17. Deng Y, Zeng L, Bao W, Xu P, Zhong G. [Experience of integrated traditional Chinese and Western medicine in first case of imported Zika virus disease in China]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2016;28(2):106–9. doi: 10.3760/cma.j.issn.2095-4352.2016.02.005 26911940.

18. WHO. Ebola Situation Report—30 March 2016 Accessed 16 October 2017. 2017.

19. WHO. Ebola Situation Report—12 May 2016 2019 Accessed 12 January 2019.

20. Vetter P, Kaiser L, Schibler M, Ciglenecki I, Bausch DG. Sequelae of Ebola virus disease: the emergency within the emergency. The Lancet Infectious diseases. 2016;16(6):e82–e91. Epub 2016/03/30. doi: 10.1016/S1473-3099(16)00077-3 27020309.

21. Lotsch F, Schnyder J, Goorhuis A, Grobusch MP. Neuropsychological long-term sequelae of Ebola virus disease survivors—A systematic review. Travel medicine and infectious disease. 2017. Epub 2017/05/10. doi: 10.1016/j.tmaid.2017.05.001 28478336.

22. James PB, Wardle J, Steel A, Adams J. Post-Ebola psychosocial experiences and coping mechanisms among Ebola survivors: a systematic review. Trop Med Int Health. 2019;24(6):671–91. Epub 2019/03/08. doi: 10.1111/tmi.13226 30843627.

23. Manguvo A, Mafuvadze B. The impact of traditional and religious practices on the spread of Ebola in West Africa: time for a strategic shift. The Pan African Medical Journal. 2015;22(Suppl 1):9. doi: 10.11694/pamj.supp.2015.22.1.6190 26779300 PubMed PMID: PMC4709130.

24. De Roo A, Ado B, Rose B, Guimard Y, Fonck K, Colebunders R. Survey among survivors of the 1995 Ebola epidemic in Kikwit, Democratic Republic of Congo: their feelings and experiences. Tropical Medicine & International Health. 1998;3(11).

25. WHO. Sierra Leone: A traditional healer and a funeral. World Health Organization Retrieved from: http://wwwwhoint/csr/disease/ebola/ebola-6-months/sierra-leone/en/ Accessed on 12 October 2017. 2017.

26. Yoon-Cho. Experiences of Ebola survivors on healthcare access in Bombali District, Sierra Leone; University of Sheffield. Accessed 12 December 20182016.

27. WHO. Interim Guidance. Clinical care for survivors of Ebola virus disease. 2016 Accessed 12 December 2018.

28. Statistics Sierra Leone. Sierra Leone 2015 Population and Housing Census National Analytical Report. Freetown Statistics Sierra Leone, Leone SS; 2017.

29. Ministry of Health and Sanitation. National Health Sector Strategic Plan 2017–2021. Freetown Ministry of Health and Sanitation, 2017.

30. Government of Sierra Leone Ministry of Health and Sanitation. Annual Health Sector Performance Report 2016 Freetown Sierra Leone: Ministry of Health and Sanitation, 2016.

31. WHO. Ebola maps. Maps from 30 March 2016. Geographical distribution of new and total confirmed cases in Guinea, Liberia, and Sierra Leone Genevaswitzerland: World Health Organisation; 2016 [cited 2018 8 November ]. Available from:

32. Etard JF, Sow MS, Leroy S, Toure A, Taverne B, Keita AK, et al. Multidisciplinary assessment of post-Ebola sequelae in Guinea (Postebogui): an observational cohort study. The Lancet Infectious diseases. 2017;17(5):545–52. Epub 2017/01/18. doi: 10.1016/S1473-3099(16)30516-3 28094208.

33. Wilson HW, Amo-Addae M, Kenu E, Ilesanmi OS, Ameme DK, Sackey SO. Post-Ebola syndrome among Ebola virus disease survivors in Montserrado County, Liberia 2016. BioMed research international. 2018;2018.

34. Draucker CB, Martsolf DS, Poole C. Developing distress protocols for research on sensitive topics. Archives of psychiatric nursing. 2009;23(5):343–50. doi: 10.1016/j.apnu.2008.10.008 19766925

35. Naidoo P. Other health-seeking behaviour of HIV and AIDS patients visiting private sector doctors in the eThekwini Metropolitan Municipality of KwaZulu-Natal. South African Family Practice. 2014;56(4):223–8.

36. Ukwaja KN, Alobu I, Nweke CO, Onyenwe EC. Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study. BMC health services research. 2013;13(1):25. doi: 10.1186/1472-6963-13-25 23327613

37. James PB, Bah AJ, Kondorvoh IM. Exploring self-use, attitude and interest to study complementary and alternative medicine (CAM) among final year undergraduate medical, pharmacy and nursing students in Sierra Leone: a comparative study. BMC complementary and alternative medicine. 2016;16(1):121.

38. Stawicki SP, Sharpe RP, Galwankar SC, Sweeney J, Martins N, Papadimos TJ, et al. Reflections on the Ebola Public Health Emergency of International Concern, Part 1: Post-Ebola Syndrome: The Silent Outbreak. Journal of global infectious diseases. 2017;9(2):41–4. Epub 2017/06/07. doi: 10.4103/jgid.jgid_20_17 28584453; PubMed Central PMCID: PMC5452549.

39. Donnelly J. How did Sierra Leone provide free health care? The Lancet. 2011;377(9775):1393–6.

40. Government of Sierra Leone. Government of Sierra Leone Press Release updated 4 April, 2016; Accessed 2017 24 July 2016;2017(24 July). PubMed Central PMCID: PMC24 July.

41. Corp N, Jordan JL, Croft PR. Justifications for using complementary and alternative medicine reported by persons with musculoskeletal conditions: A narrative literature synthesis. PLoS One. 2018;13(7):e0200879. doi: 10.1371/journal.pone.0200879 30024952

42. Mbizo J, Okafor A, Sutton MA, Leyva B, Stone LM, Olaku O. Complementary and alternative medicine use among persons with multiple chronic conditions: results from the 2012 National Health Interview Survey. BMC complementary and alternative medicine. 2018;18(1):281-. doi: 10.1186/s12906-018-2342-2 30340577.

43. Lee LS, Andrade ASA, Flexner C. Interactions between Natural Health Products and Antiretroviral Drugs: Pharmacokinetic and Pharmacodynamic Effects. Clin Infect Dis. 2006;43(8):1052–9. doi: 10.1086/507894 16983620

44. Auerbach BJ, Reynolds SJ, Lamorde M, Merry C, Kukunda-Byobona C, Ocama P, et al. Traditional herbal medicine use associated with liver fibrosis in rural Rakai, Uganda. PLoS One. 2012;7(11):e41737. doi: 10.1371/journal.pone.0041737 23209545

45. Peltzer K, Friend-du Preez N, Ramlagan S, Fomundam H, Anderson J. Traditional complementary and alternative medicine and antiretroviral treatment adherence among HIV patients in Kwazulu-Natal, South Africa. African Journal of Traditional, Complementary and Alternative Medicines. 2010;7(2).

46. Wardle JJL, Adams J. Indirect and non-health risks associated with complementary and alternative medicine use: An integrative review. European Journal of Integrative Medicine. 2014;6(4):409–22.

47. Foley H, Steel A, Cramer H, Wardle J, Adams J. Disclosure of complementary medicine use to medical providers: a systematic review and meta-analysis. Scientific reports. 2019;9(1):1573. doi: 10.1038/s41598-018-38279-8 30733573

48. Nlooto M. Comorbidities of HIV infection and health care seeking behavior among HIV infected patients attending public sector healthcare facilities in KwaZulu-Natal: A cross sectional study. PLoS One. 2017;12(2):e0170983–e. doi: 10.1371/journal.pone.0170983 28151951.

49. Peltzer K, Pengpid S. Prevalence and determinants of traditional, complementary and alternative medicine provider use among adults from 32 countries. Chinese Journal of Integrative Medicine. 2016:1–7. doi: 10.1007/s11655-016-2748-y 28028721

50. Warren N, Canaway R, Unantenne N, Manderson L. Taking control: Complementary and alternative medicine in diabetes and cardiovascular disease management. Health (London, England: 1997). 2013;17(4):323–39. Epub 2012/09/28. doi: 10.1177/1363459312460699 23014892.

51. Falci L, Shi Z, Greenlee H. Multiple Chronic Conditions and Use of Complementary and Alternative Medicine Among US Adults: Results From the 2012 National Health Interview Survey. Preventing chronic disease. 2016;13:E61–E. doi: 10.5888/pcd13.150501 27149072.

52. de St. Maurice A, Ervin E, Orone R, Choi M, Dokubo EK, Rollin PE, et al. Care of Ebola Survivors and Factors Associated With Clinical Sequelae—Monrovia, Liberia. Open Forum Infectious Diseases. 2018;5(10):ofy239. doi: 10.1093/ofid/ofy239 30386807 PubMed PMID: PMC6202424.

53. Tiffany A, Vetter P, Mattia J, Dayer JA, Bartsch M, Kasztura M, et al. Ebola Virus Disease Complications as Experienced by Survivors in Sierra Leone. Clin Infect Dis. 2016;62(11):1360–6. Epub 2016/03/24. doi: 10.1093/cid/ciw158 27001797; PubMed Central PMCID: PMC4872294.

54. Scott JT, Sesay FR, Massaquoi TA, Idriss BR, Sahr F, Semple MG. Post-Ebola Syndrome, Sierra Leone. Emerging infectious diseases. 2016;22(4):641–6. Epub 2016/03/18. doi: 10.3201/eid2204.151302 26983037; PubMed Central PMCID: PMC4806950.

55. Artus M, Croft P, Lewis M. The use of CAM and conventional treatments among primary care consulters with chronic musculoskeletal pain. BMC family practice. 2007;8(1):26.

56. National Malaria Control Programme (NMCP) [Sierra Leone] SSL, University of Sierra Leone, Catholic Relief Services, and ICF. Sierra Leone Malaria Indicator Survey 2016. Freetown, Sierra Leone: NMCP, SSL, CRS, and ICF. Accessed 17 January 2019. 2016.

Článek vyšel v časopise


2019 Číslo 9