Determinants of Delayed Healthcare-Seeking Along the Care Pathway and their Association with Lassa Fever Severity in West Africa: A Systematic Review

Abstract

Objective: Lassa fever, an acute viral disease, is most commonly transmitted through contact with infected rodents or contaminated objects; West Africa in particular is mostly affected by Lassa fever. It initially presents generic symptoms, which when not diagnosed and treated quickly and effectively, may have a severe outcome and cause death. This study has comprehensively examined factors affecting delay in seeking medical attention along the treatment pathway and how they are correlated with the severity of the Lassa fever in West Africa.

Method: A comprehensive literature search was conducted with the PRISMA methodology, by using Google Scholar and with the help of some manual search. This gave a total of 56 studies with 12 meeting the inclusion criteria after rigorous screening. The different studies included different designs such as cohort, cross-sectional, qualitative, mixed-method, modelling, and review studies. There was methodological variability which prompted the use of a narrative synthesis technique.

Result: Findings indicated that delayed healthcare-seeking is driven by a multifactorial relationship of intersections of sociodemographic, sociocultural, economic, psychological, and health system-related influences. Little knowledge about Lassa fever, stigma, reliance on alternative medicines, financial constraints, distance, and reliance of referral networks and the lack of confidence in medical services played critical roles. Some of the steps of the care pathway that featured delays included patient delays (between onset of symptoms and first contact), decision delays (between recognition and decision to seek care), access delays (between accessing healthcare facilities), and system level delays (between referral and starting treatment). Studies have consistently demonstrated that there is a close relation between the delay in seeking medical care and deterioration of disease. Delays of more than 11 days were significantly related to severe disease and increased death with the smallest delay related to worsening outcomes approximating about 6 days post-onset of symptoms. Reported case fatality as high as 13.6% in late presenters was a significant clinical risk.

Conclusion: In general, the study demonstrates that time lag at any stage of the care pathway accumulates to issue a poor prognosis, which underlines the importance of targeted efforts aimed at mitigation of institutional and individual barriers to timely care in West Africa.