Socio-demographic characteristics of respondents

From a total of 23 selected study participants, 10 (43.5%) were females. Most of the study respondents, 19 (82.6%), had an educational level of diploma and above. Only three (13%) of the participants were vaccinated (Table 1).

Table 1 Socio-demographic characteristics of participants in Bahir Dar town, Ethiopia, 2022 (n = 23)

Awareness about and care seeking for long COVID-19 symptoms

The 23 interviews produced over 108 pages of transcripts and notes. Study participants reported symptoms, risk groups, communicability, experience, care advice, and practice of long COVID-19. During the analysis, 83 codes, 12 sub-themes, and three themes were generated. The themes were awareness, experience of symptoms and their effects, and care practices of long COVID-19 (Fig. 1). Themes and selected quotations are organized as follows.

Fig. 1
figure 1

Thematic map indicating three themes

Theme I: Awareness about long COVID 19

Most of the participants did not mention the 19 common symptoms. None of the participants described palpitations, headache, pin or needle feeling, loss of smell, diarrhea, stomach pain, rash, and change in the menstrual cycle. In addition, they associate some of these symptoms with non-long COVID-19 conditions like Asthma, diabetes, and hypertension.

"I do not know the symptom of long COVID. But, I face difficulty when I want to breathe. I was treated for Asthma the last time but it was not Asthma. [64 years old female]

However, a few participants described symptoms like shortness of breath, dizziness, fatigue, joint pain, chest pain, cough, fever, loss of concentration, insomnia, loss of appetite, and depression.

"I have information on the following signs and the symptoms of long COVID-19 like fatigue, cough, chest pain, and fever." [35 years old male]

Most of the participants did not have information about the communicability of the virus during experiencing long COVID-19 symptoms. However, some participants perceived the virus as not transmissible, and other participants perceived the possibility of transmission from individuals with long COVID-19 symptoms.

"I know that the COVID-19 virus cannot be transmitted after recovery because the virus is already cleared from the body. The symptoms come due to damage to the vital organs. And the symptom will continue until the damaged organ gets recovered."[38 years old female]

"I think individuals with long COVID-19 symptoms can transmit the virus. Even if the treatment can weaken its pathogenicity, the virus is still inside and is not cleared. So the possibility of transmitting the virus is still there."[40 years old male]

Regarding the risk groups, most of the study participants were not aware of the risk groups. There is also a perception that COVID-19-vaccinated individuals are at risk for long COVID symptoms. However, a few participants considered females, individuals with comorbidities, and hospitalized individuals as the risk groups for long COVID-19 symptoms.

"My friend has long COVID-19 symptoms but he perceived that these symptoms came due to the COVID-19 vaccine. Therefore, it is associated with the vaccine. No person complains about COVID-19." [73 years old male]

"I think individuals with older age and comorbidity such as diabetes; cancer and AIDS are at risk for long COVID-19 because of declined immunity."[43 years old male]

On the contrary, some participants perceived non-hospitalized patients are a risk group due to getting less medical care when they do not admit to the hospital.

“There is a difference between hospitalized and non-hospitalized individuals. Because none hospitalized individuals do not receive medical care. It is obvious that medication can reduce the risk of many symptoms.” [43 years old male]

The majority of the respondents described that long COVID-19 symptoms will go off by themselves. However, they perceived symptoms will go off quickly through homemade care, lifestyle modification, and physical exercise.

'Though the symptoms will go off by themselves, it is good to strengthen yourself through physical exercise, eating fresh foods, and keeping personal hygiene."[40 years old male]

However, a few study participants perceived that long COVID-19 symptoms need medical care.

“Persons with long COVID-19 symptoms should seek medical care as those symptoms may cause further complications.” [40 years old male]

Theme II: Experience and Effect of Long COVID Symptoms

The survivors experienced general, respiratory, cardiac, digestive, neurological, and other symptoms. These symptoms include rash, fatigue fever, cough, palpitations, shortness of breath, chest pain, abdominal pain, diarrhea, loss of concentration, loss of smell, sleep disorder, depression, and joint and muscle pain. These symptoms brought various physical and psychosocial effects for the participants.

Physical effects include inching, facial discoloration, unable to talk due to cough, forgetfulness, shaking hands, unable to perform daily activities, severe headache, and olfactory dysfunction. The psychosocial effect includes suicidal ideation and social isolation.

"The long COVID-19 symptoms caused facial discoloration to me. I have serious inching thoughts my body likes street children having dermatitis." [59 years old male]

"I have serious muscle pain. I cannot protect myself from different incidents like dog bits and attacks from a mentally ill person. Even I cannot hold an umbrella.'' [73 years old male]

"I had a serious headache for a long time. My head doesn't seem mine. Even it did not respond with anti-pain…. In addition, my neighbors greet me at a far distance [They are not happy to talk with me]. Even others are not voluntary to say hello [they perceive that the virus will be transmitted to them]. They isolate me from social events. I thought to commit suicide" [43 years, male]

“I have severe fatigue. I cannot go to church to pray and cannot receive "kidus kurban.” [57 years old female]

“I totally lost my memory. I cannot find files that I used to easily pick up on my computer before the illness. It highly affected my life and it persists up to now” (40 years, male).

Theme III: Survivor’s care-seeking behavior for long COVID 19

Some survivors seek modern health care for severe symptoms such as muscle and joint pain, stomach pain, and chest pain. They visited to get a diagnostic evaluation, medicine, and different advice.

"I used to visit my doctor. He gave me different medicines. He also advised me to take enough rest, and the foodstuffs I need to take. He also follows my progress with X-rays and different diagnostic evaluations at different times. This made me have an improvement." [50 years old male]

Some survivors used to practice different spiritual care either as the only intervention or in combination with modern health care. The spiritual care practices include praying, holly water, and applying Eminent (


“In addition to modern care, I pray in the church. I used holy water and eminet (
). I massage my body with “Eminet” (
) and baptized with holy water. I go to church on Saturday and Sunday to bring holy water and I drink the holy water. I put "Eminet” on my joint that pains me and massaged as well as with the holy water." [70 years old female]

Some survivors practiced homemade care like applying butter on the head for headaches, avoiding caffeinated drinks, avoiding contact with laptop and mobile, drinking warm water for insomnia, use of garlic, and black cumin, taking hot drinks for chest pain, and eating fruits and salads for loss of appetite. In addition, survivors were doing physical exercise.

“I asked my sister to apply butter to my head when I had a headache and get relief as soon as she applies it. I wash my head after three days to prevent a foul smell.” [50 years old male]

"I avoided beverages and other stimulants, contacts with the different screens [like laptop and mobile], and as much as possible I used to drink warm water, especially during the time of sleep."[40 years old male]

“Since the taste was not good for me, I was not eating. I used to eat fruits and salads. I used to take a lot of hot drinks like pourage, tea with ginger, garlic, and like that because I had chest pain.” [38 years old male]

However, some survivors did not seek any intervention despite they were having severe symptoms.

"I have serious muscle pain. I cannot hold an umbrella; I cannot protect myself from dogs or mentally ill people. Even I cannot hold my grandkid. However, I did not visit a health facility. " [73 years old male]

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