International Journal of TROPICAL DISEASE & Health

Background: Since the emergence of coronavirus disease 2019 (COVID-19), many people with symptoms suggestive of the disease have followed therapeutic routes outside the formal healthcare system. Auto-medication, the use of any remedy without the advice of a health professional, is widespread in sub-Saharan Africa. Understanding why people avoided formal care during COVID-19 remains essential for preparedness against future epidemics. This study aimed to analyse the determinants of auto-medication among people with symptoms related to COVID-19 in Yaoundé, Cameroon.

Methods: A phenomenological qualitative study was conducted between July and September 2020. Data were collected through the triangulation of three techniques: direct observation in four households in different neighbourhoods of Yaoundé, semi-structured individual interviews with 12 purposively selected residents (until saturation), and one 90-minute focus group discussion with 10 participants (4 women, 6 men). Data were analysed thematically and interpreted through the Health Belief Model (HBM) and commitment theory.

Results: Participants were informed about the symptoms and barrier measures of COVID-19, so auto-medication did not stem from a lack of knowledge. Seven of the 12 interviewees usually treated flu-like symptoms with herbal remedies, four used roadside drug sellers and one used a health facility. Determinants were behavioural, psychological, socio-economic, socio-cultural and health-system-related. Through the HBM lens, two opposite pathways led to the same behaviour: participants who denied or minimised the disease saw no need for formal care, while those who feared it saw the hospital itself as a threat. In both cases, the perceived barriers to formal care (isolation and lost income, stigma, fear of contamination in hospitals and the non-return of bodies for religious burial) outweighed its perceived benefits, whereas home remedies were seen as familiar, affordable and within personal control. Cues to action came mainly from neighbours, relatives, social media and religious figures rather than from health authorities.

Conclusion: Auto-medication was a reasoned response to the perceived costs of formal care rather than simple ignorance. Future epidemic responses should lower these costs through income support during isolation, community-based and home-based testing, safe and dignified burials designed with religious leaders, visibly safe health facilities, and partnerships with trusted community messengers and informal drug providers.