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

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

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

© 2019 James et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background 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. Methods 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. Results 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. Conclusion 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

Utilisation of and attitude towards traditional and complementary medicine among ebola survivors in sierra leone

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. 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

Traditional, complementary and alternative medicine use in Sub-Saharan Africa: A systematic review

© Author(s) (or their employer(s)) 2018. background The WHO estimates that a considerable number of people in Sub-Saharan Africa (SSA) rely on traditional, complementary and alternative medicine (TCAM) to meet their primary healthcare needs, yet there remains a dearth of research evidence on the overall picture of TCAM utilisation in the region. Methods We conducted a literature search of original articles examining TCAM use in SSA between 1 January 2006 and 28 February 2017, employing Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Scopus, ProQuest, PubMed, Embase and African Journals Online databases. A critical appraisal of relevant articles reporting a quantitative or mixed-method design was undertaken. results Despite the heterogeneity and general low quality of the identified literature, the review highlights a relatively high use of TCAM alone or in combination with orthodox medicine, in both general population and in specific health conditions in SSA. TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, while there were inconsistencies in age, sex, spatial location and religious affiliation between TCAM users and non-TCAM users. Most TCAM users (55.8%–100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for non-disclosure being fear of receiving improper care, healthcare providers’ negative attitude and a lack of enquiry about TCAM use from healthcare providers. Conclusion TCAM use in SSA is significant, although most studies emerge from a few countries. Factors associated with TCAM use in SSA are similar to those observed in other regions, but further research may be required to further elucidate challenges and opportunities related to TCAM use specific to SSA

The Sphaleron Rate in SU(N) Gauge Theory

The sphaleron rate is defined as the diffusion constant for topological number NCS = int g^2 F Fdual/32 pi^2. It establishes the rate of equilibration of axial light quark number in QCD and is of interest both in electroweak baryogenesis and possibly in heavy ion collisions. We calculate the weak-coupling behavior of the SU(3) sphaleron rate, as well as making the most sensible extrapolation towards intermediate coupling which we can. We also study the behavior of the sphaleron rate at weak coupling at large Nc.Comment: 18 pages with 3 figure

Jet coherence in QCD media: the antenna radiation spectrum

We study the radiation of a highly energetic partonic antenna in a colored state traversing a dense QCD medium. Resumming multiple scatterings of all involved constituents with the medium we derive the general gluon spectrum which encompasses both longitudinal color coherence between scattering centers in the medium, responsible for the well known Landau-Pomeranchuk-Migdal (LPM) effect, and transverse color coherence between partons inside a jet, leading, in vacuum, to angular ordering of the parton shower. We discuss shortly the onset of transverse decoherence which is reached in opaque media. In this regime, the spectrum consists of independent radiation off the antenna constituents.Comment: 15 pages, 2 figures, paper shortened and partly rewritten, references added, results unchange

Bjorken Flow, Plasma Instabilities, and Thermalization

At asymptotically high energies, thermalization in heavy ion collisions can be described via weak-coupling QCD. We present a complete treatment of how thermalization proceeds, at the parametric weak-coupling level. We show that plasma instabilities dominate the dynamics, from immediately after the collision until well after the plasma becomes nearly in equilibrium. Initially they drive the system close to isotropy, but Bjorken expansion and increasing diluteness makes the system again become more anisotropic. At time \tau ~ \alpha^(-12/5) Q^(-1) the dynamics become dominated by a nearly-thermal bath; and at time \tau ~ \alpha^(-5/2) Q^(-1)$ the bath comes to dominate the energy density, completing thermalization. After this time there is a nearly isotropic and thermal Quark-Gluon Plasma.Comment: 22 pages, 5 figure

Health-related quality of life among Ebola survivors in Sierra Leone: the role of socio-demographic, health-related and psycho-social factors.

BACKGROUND: Evidence of how social factors affect the health-related quality of life (HRQoL) of Ebola virus disease (EVD) survivors is limited. Our study explores the association between socio-demographic, health-related and psycho-social (stigma) factors and EVD survivors' health-related quality of life (HRQoL) in Sierra Leone. METHODS: We conducted a nationwide cross-sectional study among 358 EVD survivors between January and August 2018. We used a multistage sampling method to recruit EVD survivors, and the RAND 36-Item Health Survey item was used to assess the HRQoL. Data were analysed using descriptive statistics and multiple linear regression. RESULTS: When comparing by each dimension in relation to their respective summary scores, role limitation physical [0.00 (50.00)] and role limitation emotional [0.00 (33.33)] were the most affected physical health and mental health domains among EVD survivors respectively. EVD survivors who were older (β = - 3.90, 95% CI - 6.47 to - 1.32, p = 0.003), had no formal education (β = - 2.80, 95% CI - 5.16 to - 0.43, p = 0.021), experienced a unit increase in the number of post-Ebola symptoms (β = - 1.08, 95% CI - 1.74 to - 0.43, p < 0.001) and experienced a unit increase in enacted stigma (β = - 2.61, 95% CI - 4.02 to - 1.20, p < 0.001) were more likely to report a decreased level of physical health. EVD survivors who experienced a unit increase in the time spent in the Ebola treatment centre (β = - 0.60, 95% CI - 0.103 to - 0.18, p = 0.006) and those who experienced a unit increase in enacted Stigma were more likely to report decreased levels of mental health (β = - 1.50, 95% CI - 2.67 to - 0.33, p = 0.012). CONCLUSION: Sociodemographic, health-related, and psycho-social factors were significantly associated with decrease levels of HRQoL. Our findings improve our understanding of the factors that might influence the HRQoL and suggest the need for EVD survivors to be provided with a comprehensive healthcare package that caters for their physical and mental health needs

Anomalous Breaking of Anisotropic Scaling Symmetry in the Quantum Lifshitz Model

In this note we investigate the anomalous breaking of anisotropic scaling symmetry in a non-relativistic field theory with dynamical exponent z=2. On general grounds, one can show that there exist two possible "central charges" which characterize the breaking of scale invariance. Using heat kernel methods, we compute these two central charges in the quantum Lifshitz model, a free field theory which is second order in time and fourth order in spatial derivatives. We find that one of the two central charges vanishes. Interestingly, this is also true for strongly coupled non-relativistic field theories with a geometric dual described by a metric and a massive vector field.Comment: 26 pages; major revision (results were unaffected), published versio