Psychosocial and Health Impact on the Healed People of Ebola in the City of Forecariah

Introduction: Ebola virus disease is one of the most serious viral diseases known to man. It belongs to the filovirus family, with a case-fatality rate of 25% to 90%. The aim of this study was to evaluate the psychosocial and health impact of Ebola virus disease on people who have been cured. Method: This was a descriptive study of transversal type extending over a period of 3 months and focused on people cured of the Ebola virus disease of Forecariah prefecture. Results: During the study period, we recorded 114 people cured of the Ebola virus disease in Forecariah prefecture, among whom we interviewed 101 people cured of Ebola virus disease (89%). The socio-demographic characteristics of these healed people were: those of cures whose age ranged between 27-37 years with a frequency of 32.7% and extremes of 5-55 years. There was a female predominance with a sex ratio of 0.80 for women. Malaria was the most dominant antecedent. Social withdrawal 89.1%, moral pain 72.2% and strong sense of guilt 45.5% were the most common psychiatric symptoms in cured people. The dominant somatic symptoms found were headache 36.6%; while defamation 82.1% was the most dominant type of stigma. Conclusion: Despite Significant Progress in Managing People Cured of Ebola Disease, National Study of Ebola Healers Could Better Identify EVD Impact on Healed Individuals.


Introduction
Ebola virus disease is one of the most serious viral diseases known to man. It belongs to the filovirus family, with a case-fatality rate of 25% to 90%. [1] A person cured of Ebola Virus Disease (EVD) is defined as a person: with a confirmed positive result on reverse transcriptase polymerase chain reaction (RT-PCR) tests for the Ebola virus on a body fluid that subsequently reestablished or IgM and / or IgG positive on serological tests for EVD and not vaccinated against Ebola virus. [2] A study conducted by Post Ebola Guinea (POSTEBOGUI) in Conakry and Macenta on 301 cured patients discharged from CTE showed that 14% of people said they had experienced discrimination at least once, most often through gossip or insults. Self-exclusion of social events was described by 15% of people, more frequently in the wake of the CTE exit. Some cured EVD patients have symptoms, or sequelae, after being discharged from the Ebola Treatment Center (ETC). According to the data of the review of the literature the most frequently encountered symptoms are mainly visual disorders with some complications, including uveitis, muscle, joint and abdominal pain, headache, asthenia, memory and hearing. Several psychic symptoms have been reported, ranging from anxiety, sleep disorders, to neuropsychiatric manifestations. Other signs such as erectile dysfunction, amenorrhea, decreased libido have also been reported [3]. Ebola virus disease is a life-threatening infectious disease, a major public health problem. This study aims to assess the psychosocial and health impact of Ebola virus disease on people who have been cured.

Patients and Methods
The prefecture of Forecariah served as a framework for our study. The study focused on people cured of Ebola virus disease identified on behalf of Forecariah prefecture organized in association called association of people cured of Ebola virus disease. This was a descriptive cross-sectional study lasting three (3) months from May 1st to July 31st, 2016, inclusive involving people cured of Ebola.
The study population was represented by people cured of Ebola virus disease identified in Forecariah Prefecture and meeting our selection criteria during the study period. All those cured of Ebola Virus Disease (EVD) from Forecariah prefecture who have agreed to participate in our study and have an exit certificate regardless of age and gender have been included. All the healed people from the EVM of Forecariah prefecture who did not consent to the study and / or did not possess an exit certificate were not included.

Results
Forecariah Prefecture recorded a total of 114 people cured of Ebola and a total of 101 were included in our study.
Socioprofessional characteristics The average age of people cured EVD was 29.02% and extremes of age from 7 years to 55 years. The most represented age group is that of 27-37 years, ie a proportion of 32.7% followed by 17-27 years or 23.7%. The female sex dominates our study population with a frequency of 55% against 45% for men and a sex ration of 0.8 for women The most represented profession was housewives (25.74%) followed by students (21.78%) and farmers (19.80%). In this study we met 59.4% of married couples followed by single with 34.6%. The sub-prefecture of Maferinyah was the locality that registered many people cured of the EVD with 28.7% compared to the urban community of Forecariah 14.9%; Farmorah 12.8% and 10.9%.

Clinical features
Malaria accounted for 15.84% of history of cured EVD, followed by 0.99% of Arterial Hypertension. The average length of stay in the Ebola Treatment Center was 11.68 ± 3.47 with extremes of 5 to 21 days. Most of the cures had done 11-15 days before going out of the disease, 47.53% followed by 6-10 days or 29.70%. Psychiatric symptoms are very common in the cured people of EVD and in our study, we encountered social withdrawal among our respondents in 89.1% of cases followed by moral pain or 72.25; a strong sense of guilt in 45.5% of cases, insomnia 13.8%; the nightmare 11,85; multiple bereavements 10.8% (Table 1).

Psychiatric Symptoms
Effective pourcentage Decreased libido 3 2.9 Abdominal pain 11 10.8 Table 2: Distribution of people cured of Ebola virus disease by somatic symptoms.

J Psychiatry Psychiatric Disord 2018; 2 (1): 23-28
Stigma was a recurring problem among all cured EVD patients, in our study defamation was the most common stigma aspect with 82.1% followed by Reintegration Difficulty in 78.2%. case and rejection by friends 64.3% (Table   3).

Stigma Number Percentage
Refusal to share the same meal 12 11.8

Discussion
This study was carried out in Forecariah prefecture and interested people cured of the Ebola virus disease. It was a descriptive study of the transversal type for a period of 3 months from May 1st to July 31st, 2016. Its objective was to evaluate the psychosocial and health impact of the EVD on people healed from the prefecture. of Forecariah.
During the course of the study we were confronted with the following difficulties: Difficulty of access of certain zones due to the bad state of the roads; Request for the interview premium by some cured people; the unavailability of some cured Ebola virus disease worried about the work field. In the face of the largest outbreak of Ebola virus disease ever seen, and with the improvements seen in the provision of care in the field, there is a high number of survivors of EVD, with a large number of people suffering from sequelae of the disease [4]. women or 55% against 45 men or 45% with a sex ratio of 0.80 for women.

J Psychiatry Psychiatric Disord 2018; 2 (1): 23-28
This high rate of female sex is explained by the fact that it was this layer that played the role of family caregivers, caring for the sick, cleaning the waste in the home and being exposed to all the factors. of risks. Our results are inferior to those found by Mattia JG et al. [5] who found in their study of the systematic clinical evaluation of the sequelae observed in 277 survivors of the 2014-2015 epidemic, in Sierra Leone 163 were women or 59% against 114 men or 41%. Our study revealed a large number of housewives among the cured, ie 25.7% followed by students, that is 21.7% and farmers 19.8%. This result corroborates the predominance of the female layer found in our study and could still be explained by their role as family caregiver because she spends most of their time looking after their family. Thus, during our study, we noted that the majority of people cured of the Ebola virus disease of the prefecture of Forecariah were married or 59.4%, followed by singles 34.6%, widowers 4 % and divorced 2%. This is explained by the predominance of adults in our study, this group of individuals was exposed to risk factors or modalities of contamination in the family environment, namely: family care, funeral toilets and family obligations.
Our study shows that most of our people cured of Ebola virus disease live in the Maferinya sub-prefecture (28. of ocular symptoms is lower than reported by Jay B.V et al. [7] who in their study revealed that 60% of the cured patients reported an ocular symptom. Defamation, difficulty reintegrating into society, and rejection by friends were the types of stigma that healed people experienced, respectively: 82.1%, 78.2%, and 64.3%. This result could be explained by the lack of community ownership of the support provided to people cured of the Ebola virus disease, the community's ignorance of the disease, and the lack of social support by the EVD agencies.

Conclusion
In our study, 101 people cured of the Ebola disease met our selection criteria whose socio-demographic characteristics were relatively young with an average age of 29 years and extremes of 7 and 55 years, there is a female predominance either 56women against 45 men. The symptoms reported by our cured people of Ebola disease are both psychiatric, somatic and ocular. The majority of the healed people were victims of defamation, difficulty of social reintegration and rejection by friends. A national study of people cured of Ebola could help identify their problems.