# Community perceptions of yellow fever and its treatment practices in regions with reported outbreaks in Uganda: A qualitative study

## TL;DR

This study explores how people in Uganda perceive yellow fever and its treatment, highlighting gaps in knowledge and access to healthcare that hinder effective outbreak responses.

## Contribution

The study provides novel insights into community perceptions of yellow fever among vulnerable groups in Uganda, emphasizing the need for tailored public health education and improved diagnostic access.

## Key findings

- Participants recognized jaundice but often confused yellow fever with other diseases like malaria or hepatitis.
- Survivors in remote areas relied on traditional medicine due to limited access to healthcare and diagnostics.
- Awareness campaigns focused on symptoms and prevention, leaving gaps in understanding the cause and transmission of yellow fever.

## Abstract

Yellow fever (YF), a mosquito-borne viral hemorrhagic fever, is endemic to Uganda and has caused numerous outbreaks in recent years. This study explored local perceptions of YF outbreaks among vulnerable groups in Uganda to inform future public health campaigns.

A qualitative study examined community perceptions of YF and its treatment practices. Data were collected in six districts where YF outbreaks were reported in 2010 and 2016. A total of 76 individuals participated, comprising 43 semi-structured interviews, 10 expert interviews, and 4 focus group discussions, including vulnerable groups of older adults ≥ 65 years and pregnant women. Data were analyzed using grounded theory.

Participants often recognized jaundice but did not distinguish YF from other causes of jaundice, such as newborn jaundice, severe malaria or hepatitis. Nevertheless, participants still considered YF a deadly disease. It was perceived to be transmitted through multiple pathways, including mosquito bites, airborne transmission, close contact with sick individuals, sexual intercourse, vertical transmission during pregnancy, poor hygiene, and certain foods. Treatments ranged from herbal remedies to visiting health centers. Several YF survivors shared first-hand experience, often relying on traditional medicine due to limited access to health facilities, diagnostic options, and no specific treatment for YF. In remote areas, participants often did not know the cause of the outbreak, as awareness campaigns focused on symptoms, prevention, and mass vaccination.

If YF is not seen as a distinct disease entity, implementing diagnostic and preventive measures may be impeded. Moreover, failure to diagnose YF in clinical settings can hamper timely outbreak response. We recommend strengthening health literacy through health education and public participation in vulnerable communities with programs tailored to local needs, given that other infectious diseases are prevalent in the region. Furthermore, we propose that access to diagnostic testing for YF may be enhanced.

Yellow fever is a life-threatening disease transmitted by mosquitoes, with frequent outbreaks in Uganda despite a highly effective vaccine. This study addresses disease perceptions and treatment practices in communities affected by yellow fever outbreaks. Through qualitative analysis of interviews and group discussions with vulnerable groups (pregnant women and older adults) and medical experts we explored these perceptions aiming to improve future public health campaigns. Our findings showed that for most participants, yellow fever was a novel and deadly disease. Participants understood who is most susceptible to yellow fever, but their knowledge on the underlying cause, transmission, and prevention often overlapped with other diseases. Survivors often relied on herbal medicine due to limited access to healthcare and diagnostics. Furthermore, we found that there was an unequal access to health information, particularly in remote areas where people were often unaware of the cause of the outbreak, as awareness campaigns focused mainly on the symptoms and prevention. This study contributes to broader efforts in global health by emphasizing the importance of engaging communities in disease control programs, through health education and public participation, in addition to enhancing yellow fever diagnosis in the clinical setting.