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

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.