Exploring Health-Seeking Behaviour Among Adolescent Mothers During the Ebola Epidemic in Rural District of Freetown, Sierra Leone

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Abstract Background: In May 2014, the largest Ebola outbreak in history threatened Sierra Leone and its neighbouring countries, Guinea and Liberia. The devastating outcome of the outbreak left a negative impact on maternal health while causing an increase in adolescent pregnancy. The aim of this study is to understand health seeking behaviour and the use of health services among adolescent mothers who were pregnant during the Ebola epidemic in Freetown, 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 lock downs, roadblocks, loss of income and extreme poverty was 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.

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