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Eskew EA, Bird BH, Ghersi BM, Bangura J, Basinski AJ, Amara E, Bah MA, Kanu MC, Kanu OT, Lavalie EG, Lungay V, Robert W, Vandi MA, Fichet-Calvet E, Nuismer SL. Reservoir displacement by an invasive rodent reduces Lassa virus zoonotic spillover risk. Nat Commun 2024; 15:3589. [PMID: 38678025 DOI: 10.1038/s41467-024-47991-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 04/17/2024] [Indexed: 04/29/2024] Open
Abstract
The black rat (Rattus rattus) is a globally invasive species that has been widely introduced across Africa. Within its invasive range in West Africa, R. rattus may compete with the native rodent Mastomys natalensis, the primary reservoir host of Lassa virus, a zoonotic pathogen that kills thousands annually. Here, we use rodent trapping data from Sierra Leone and Guinea to show that R. rattus presence reduces M. natalensis density within the human dwellings where Lassa virus exposure is most likely to occur. Further, we integrate infection data from M. natalensis to demonstrate that Lassa virus zoonotic spillover risk is lower at sites with R. rattus. While non-native species can have numerous negative effects on ecosystems, our results suggest that R. rattus invasion has the indirect benefit of decreasing zoonotic spillover of an endemic pathogen, with important implications for invasive species control across West Africa.
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Affiliation(s)
- Evan A Eskew
- Institute for Interdisciplinary Data Sciences, University of Idaho, Moscow, ID, USA.
| | - Brian H Bird
- One Health Institute, School of Veterinary Medicine, University of California - Davis, Davis, CA, USA
| | - Bruno M Ghersi
- One Health Institute, School of Veterinary Medicine, University of California - Davis, Davis, CA, USA
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
| | | | - Andrew J Basinski
- Institute for Interdisciplinary Data Sciences, University of Idaho, Moscow, ID, USA
| | | | - Mohamed A Bah
- Ministry of Agriculture and Forestry, Freetown, Sierra Leone
| | | | | | | | | | | | | | | | - Scott L Nuismer
- Department of Biological Sciences, University of Idaho, Moscow, ID, USA.
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Amman BR, Koroma AH, Schuh AJ, Conteh I, Sealy TK, Foday I, Johnny J, Bakarr IA, Whitmer SLM, Wright EA, Gbakima AA, Graziano J, Bangura C, Kamanda E, Osborne A, Saidu E, Musa JA, Bangura DF, Williams SMT, Fefegula GM, Sumaila C, Jabaty J, James FH, Jambai A, Garnett K, Kamara TF, Towner JS, Lebbie A. Sosuga Virus Detected in Egyptian Rousette Bats ( Rousettus aegyptiacus) in Sierra Leone. Viruses 2024; 16:648. [PMID: 38675988 DOI: 10.3390/v16040648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Sosuga virus (SOSV), a rare human pathogenic paramyxovirus, was first discovered in 2012 when a person became ill after working in South Sudan and Uganda. During an ecological investigation, several species of bats were sampled and tested for SOSV RNA and only one species, the Egyptian rousette bat (ERBs; Rousettus aegyptiacus), tested positive. Since that time, multiple other species have been sampled and ERBs in Uganda have continued to be the only species of bat positive for SOSV infection. Subsequent studies of ERBs with SOSV demonstrated that ERBs are a competent host for SOSV and shed this infectious virus while exhibiting only minor infection-associated pathology. Following the 2014 Ebola outbreak in West Africa, surveillance efforts focused on discovering reservoirs for zoonotic pathogens resulted in the capture and testing of many bat species. Here, SOSV RNA was detected by qRT-PCR only in ERBs captured in the Moyamba District of Sierra Leone in the central region of the country. These findings represent a substantial range extension from East Africa to West Africa for SOSV, suggesting that this paramyxovirus may occur in ERB populations throughout its sub-Saharan African range.
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Affiliation(s)
- Brian R Amman
- Centers for Disease Control and Prevention, Viral Special Pathogens Branch, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA
| | - Alusine H Koroma
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
| | - Amy J Schuh
- Centers for Disease Control and Prevention, Viral Special Pathogens Branch, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA
| | - Immah Conteh
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
| | - Tara K Sealy
- Centers for Disease Control and Prevention, Viral Special Pathogens Branch, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA
| | - Ibrahim Foday
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
| | - Jonathan Johnny
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
| | - Ibrahim A Bakarr
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
| | - Shannon L M Whitmer
- Centers for Disease Control and Prevention, Viral Special Pathogens Branch, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA
| | - Emily A Wright
- Oak Ridge Institute Science and Education, Oak Ridge, TN 37830, USA
| | - Aiah A Gbakima
- National Public Health Agency, Wilberforce, 42A Main Mottor Road, Freetown, Sierra Leone
| | - James Graziano
- Centers for Disease Control and Prevention, Viral Special Pathogens Branch, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA
| | - Camilla Bangura
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
| | - Emmanuel Kamanda
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
| | - Augustus Osborne
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
| | - Emmanuel Saidu
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
| | - Jonathan A Musa
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
| | - Doris F Bangura
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
| | | | - George M Fefegula
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
| | - Christian Sumaila
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
| | - Juliet Jabaty
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
| | - Fatmata H James
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
| | - Amara Jambai
- Ministry of Health and Sanitation, Brookfields, Youyi Building, Freetown, Sierra Leone
| | - Kate Garnett
- Ministry of Agriculture and Forestry, Brookfields, Youyi Building, Freetown, Sierra Leone
| | - Thomas F Kamara
- National Protected Area Authority, 4-6 FA John Avenue, Main Congo Town Road, Freetown, Sierra Leone
| | - Jonathan S Towner
- Centers for Disease Control and Prevention, Viral Special Pathogens Branch, 1600 Clifton Rd. NE, Atlanta, GA 30329, USA
| | - Aiah Lebbie
- Department of Biological Sciences, Njala University, Njala, Sierra Leone
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3
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Ameyaw EK, Woytowich D, Gbagbo FY, Amoah PA. Assessing geographical variation in ovulatory cycle knowledge among women of reproductive age in Sierra Leone: Analysis of the 2019 Demographic and Health Survey. PLoS One 2024; 19:e0300239. [PMID: 38625990 PMCID: PMC11020968 DOI: 10.1371/journal.pone.0300239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 02/23/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Sierra Leone has poor indicators of reproductive health and a high prevalence of unintended pregnancies. To date, no study has explored determinants of ovulatory cycle knowledge in Sierra Leone. We investigated geographic region to determine where the needs for improved ovulatory cycle knowledge are greatest in Sierra Leone. METHODS This is a cross-sectional study of women of reproductive age (n = 15,574) based on the 2019 Sierra Leone Demographic and Health Survey. Geographic region and sociodemographic covariates were included in a multivariate logistic regression model predicting the odds that participants possessed accurate knowledge of when in the ovulatory cycle pregnancy initiation is most likely. RESULTS In Sierra Leone, 39.8% (CI = 37.4-40.9) of 15-49-year-old women had accurate knowledge of the ovulatory cycle. Women in the Northern and Southern regions possessed the highest prevalence of correct knowledge (46.7%, CI = 43.1-50.3 and 45.1%, CI = 41.9-48.2, respectively). Women from the Northwestern (AOR = 0.29, CI = 0.22-0.38), Eastern (AOR = 0.55, CI = 0.41-0.72), and Western regions (AOR = 0.63, CI = 0.50-0.80) had significantly lower odds of accurate ovulatory cycle knowledge compared to others. Women aged 15-19, those with a primary school education, and participants with a parity of none all had the lowest odds of correct ovulatory cycle knowledge as well. CONCLUSION Less than four in ten women in Sierra Leone had accurate knowledge of when in the ovulatory cycle pregnancy is most likely to occur. This suggests that family planning outreach programs should include education on the ovulatory cycle and the importance of understanding the implications of its timing. This can reduce the risk of unintended pregnancies throughout Sierra Leone, and can have an especially positive impact in the Northwestern, Eastern, and Western regions, where ovulatory cycle knowledge was significantly lower.
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Affiliation(s)
- Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
| | - Daniel Woytowich
- California State University Los Angeles, Los Angeles, California, United States of America
| | | | - Padmore Adusei Amoah
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
- Department of Psychology, School of Graduate Studies, Institute of Policy Studies, Lingnan University, Tuen Mun, Hong Kong SAR
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Osborne A, James PB, Olorunsaiye CZ, Bangura C, Lebbie A. Cannabis use and its psychosocial correlates among school-going adolescents in Sierra Leone. BMC Public Health 2024; 24:986. [PMID: 38589826 PMCID: PMC11003035 DOI: 10.1186/s12889-024-18491-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/31/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND In Sierra Leone, adolescents are increasingly engaging in risky activities, including cannabis use, which can lead to substance abuse, poor academic performance, and psychotic symptoms. This study aims to investigate the prevalence and associated factors of cannabis use among school-going adolescents in the country. METHOD Data for the study was sourced from the 2017 Sierra Leone Global School-based Student Health Survey (GSHS), a nationally representative survey conducted among adolescents aged 10-19 years using a multistage sampling methodology. A weighted sample of 1,467 adolescents in Sierra Leone was included in the study. The study utilised bivariate and multivariable logistic regression analysis to identify factors linked to cannabis use, presenting results using adjusted odds ratios and 95% confidence intervals. RESULTS The prevalence of cannabis use was 5.1% [3.0,8.6] among school-going adolescents in Sierra Leone. School-going adolescents who attempted suicide [aOR = 6.34, 95% CI = 1.71-23.45], used amphetamine [aOR = 15.84, 95% CI = 7.94-31.62] and were involved in sexual risk behaviour [aOR = 5.56, 95% CI = 2.18-14.20] were more likely to be associated with cannabis use. CONCLUSION In Sierra Leone, a small but non-trivial minority of students use cannabis. Ever-used amphetamines or methamphetamines, suicidal attempts, and sexual risk behaviour were the factors associated with cannabis use in Sierra Leone. The development of school-based health intervention programmes is crucial to address the risk factors associated with cannabis use among school-going adolescents.
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Affiliation(s)
- Augustus Osborne
- Department of Biological Sciences, School of Basic Sciences, Njala University, PMB, Freetown, Sierra Leone.
| | - Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, Australia
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Comfort Z Olorunsaiye
- Department of Public Health, Arcadia University, 450 S Easton Road, Glenside, PA, 19038, USA
| | - Camilla Bangura
- Department of Biological Sciences, School of Basic Sciences, Njala University, PMB, Freetown, Sierra Leone
| | - Aiah Lebbie
- Department of Biological Sciences, School of Basic Sciences, Njala University, PMB, Freetown, Sierra Leone
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Suluku R, Jabaty J, Fischer K, Diederich S, Groschup MH, Eiden M. Hepatitis E Seroprevalence and Detection of Genotype 3 Strains in Domestic Pigs from Sierra Leone Collected in 2016 and 2017. Viruses 2024; 16:558. [PMID: 38675900 DOI: 10.3390/v16040558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Hepatitis E virus (HEV) is the main cause of acute hepatitis in humans worldwide and is responsible for a large number of outbreaks especially in Africa. Human infections are mainly caused by genotypes 1 and 2 of the genus Paslahepevirus, which are exclusively associated with humans. In contrast, viruses of genotypes 3 and 4 are zoonotic and have their main reservoir in domestic and wild pigs, from which they can be transmitted to humans primarily through the consumption of meat products. Both genotypes 3 and 4 are widespread in Europe, Asia, and North America and lead to sporadic cases of hepatitis E. However, there is little information available on the prevalence of these genotypes and possible transmission routes from animal reservoirs to humans in African countries. We therefore analysed 1086 pig sera collected in 2016/2017 in four districts in Sierra Leone for antibodies against HEV using a newly designed in-house ELISA. In addition, the samples were also analysed for HEV RNA by quantitative real-time RT-PCR. The overall seroprevalence in Sierra Leone was low with only 44 positive sera and a prevalence of 4.0%. Two serum pools were RT-PCR-positive and recovered partial sequences clustered into the genotype 3 (HEV-3) of the order Paslahepevirus, species Paslahepevirus balayani. The results are the first evidence of HEV-3 infection in pigs from Sierra Leone and demonstrate a low circulation of the virus in these animals to date. Further studies should include an examination of humans, especially those with close contact with pigs and porcine products, as well as environmental sampling to evaluate public health effects within the framework of a One Health approach.
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Affiliation(s)
- Roland Suluku
- Animal Science, Serology and Molecular Laboratory, Njala University, Bo, Sierra Leone
| | - Juliet Jabaty
- Sierra Leone Agricultural Research Institute, Teko Livestock Research Centre, Teko, Sierra Leone
| | - Kerstin Fischer
- Institute of Novel and Emerging Infectious Diseases (INNT), Friedrich-Loeffler-Institut, 17493 Greifswald-Insel Riems, Germany
| | - Sandra Diederich
- Institute of Novel and Emerging Infectious Diseases (INNT), Friedrich-Loeffler-Institut, 17493 Greifswald-Insel Riems, Germany
| | - Martin H Groschup
- Institute of Novel and Emerging Infectious Diseases (INNT), Friedrich-Loeffler-Institut, 17493 Greifswald-Insel Riems, Germany
- Partner Site Hamburg-Lübeck-Borstel-Riems, German Centre for Infection Research (DZIF), 17493 Greifswald-Insel Riems, Germany
| | - Martin Eiden
- Institute of Novel and Emerging Infectious Diseases (INNT), Friedrich-Loeffler-Institut, 17493 Greifswald-Insel Riems, Germany
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Osborne A, Aboagye RG, Olorunsaiye CZ, James PB, Bangura C, Seidu AA, Kangbai JB, Ahinkorah BO. Alcohol use among in-school adolescents in Sierra Leone. BMJ Open 2024; 14:e080222. [PMID: 38569692 PMCID: PMC10989102 DOI: 10.1136/bmjopen-2023-080222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To examine the prevalence of alcohol use and its associated factors among in-school adolescents in Sierra Leone. DESIGN Data for the study was sourced from the 2017 Sierra Leone Global School-Based Student Health Survey, a nationally representative survey conducted among in-school adolescents aged 10-19 years using a multistage sampling methodology. Percentages were used to present the prevalence of alcohol use among in-school adolescents. Multivariable binary logistic regression analysis was performed to examine the factors associated with alcohol use among in-school adolescents. The results were presented using adjusted odds ratios (aOR) with their respective 95% confidence interval (CI). SETTING Sierra Leone. PARTICIPANTS A weighted sample of 1730 in-school adolescents in Sierra Leone. OUTCOME MEASURE Current alcohol use. RESULTS The prevalence of alcohol use among in-school adolescents was 10.7% (7.3, 15.3). In-school adolescents in senior secondary schools were more likely to use alcohol compared with those in junior secondary school (aOR=2.13; 95% CI 1.37, 3.30). The odds of alcohol use was higher among in-school adolescents who were truant at school relative to those who were not (aOR=2.24; 95% CI 1.54, 3.26). Also, in-school adolescents who were bullied (aOR=1.85; 95% CI 1.24, 2.76), ever engaged in sexual intercourse (aOR=2.06; 95% CI 1.39, 3.06), and used marijuana (aOR=3.36; 95% CI 1.72, 6.53) were more likely to use alcohol compared with those who were not. However, in-school adolescents who reported that their parents understood their problems (aOR=0.52; 95% CI 0.33, 0.82) had a lower likelihood of consuming alcohol. CONCLUSION Our study has shown that alcohol use is prevalent among in-school adolescents in Sierra Leone. Grade level, experiences of being bullied, history of sexual intercourse, truancy at school, and previous use of marijuana were the factors influencing alcohol use among in-school adolescents. The findings emphasise the necessity of creating school-based health interventions in Sierra Leone that can effectively identify in-school adolescents potentially vulnerable to alcohol-related issues. Also, existing policies and programmes aimed at reducing alcohol use among in-school adolescents need to be strengthened.
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Affiliation(s)
| | - Richard Gyan Aboagye
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | - Peter Bai James
- Faculty of Pharmaceutical Sciences, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
- Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
| | | | - Abdul-Aziz Seidu
- Public Health & Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | | | - Bright Opoku Ahinkorah
- School of Clinical Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
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Grayo S, Camara A, Doukouré B, Ellis I, Troupin C, Fischer K, Vanhomwegen J, White M, Groschup MH, Diederich S, Tordo N. Geographic Disparities in Domestic Pig Population Exposure to Ebola Viruses, Guinea, 2017-2019. Emerg Infect Dis 2024; 30:681-690. [PMID: 38526081 PMCID: PMC10977825 DOI: 10.3201/eid3004.231034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Although pigs are naturally susceptible to Reston virus and experimentally to Ebola virus (EBOV), their role in Orthoebolavirus ecology remains unknown. We tested 888 serum samples collected from pigs in Guinea during 2017-2019 (between the 2013-16 epidemic and its resurgence in 2021) by indirect ELISA against the EBOV nucleoprotein. We identified 2 hotspots of possible pig exposure by IgG titer levels: the northern coast had 48.7% of positive serum samples (37/76), and Forest Guinea, bordering Sierra Leone and Liberia, where the virus emerged and reemerged, had 50% of positive serum samples (98/196). The multitarget Luminex approach confirms ELISA results against Ebola nucleoprotein and highlights cross-reactivities to glycoprotein of EBOV, Reston virus, and Bundibugyo virus. Those results are consistent with previous observations of the circulation of Orthoebolavirus species in pig farming regions in Sierra Leone and Ghana, suggesting potential risk for Ebola virus disease in humans, especially in Forest Guinea.
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Lakoh S, Bangura MM, Adekanmbi O, Barrie U, Jiba DF, Kamara MN, Sesay D, Jalloh AT, Deen GF, Russell JBW, Egesimba G, Yendewa GA, Firima E. Impact of COVID-19 on the Utilization of HIV Testing and Linkage Services in Sierra Leone: Experience from Three Public Health Facilities in Freetown. AIDS Behav 2024; 28:1235-1243. [PMID: 37642824 PMCID: PMC10940454 DOI: 10.1007/s10461-023-04149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/31/2023]
Abstract
The COVID-19 pandemic adversely affected the delivery of essential health services globally. In this study, we aimed to assess the impact of the pandemic on HIV testing and linkage services at three public health facilities in Freetown, Sierra Leone. We conducted a retrospective study to assess the impact of COVID-19 on HIV testing and linkage to treatment services (HTS) at Connaught Hospital (CH-tertiary), Lumley Government Hospital (LGH-secondary) and George Brooke Community Health Center (GBC-primary) in Freetown. Statistical analyses were conducted in Stata (16.1, StataCorp LLC, College Station, TX). Intra-pandemic HTS (2020) and HTS during recovery (2021) were compared with pre-pandemic HTS (2019). Of the 8538 people tested for HIV in the three facilities, 4929 (57.5%) visited CH. Only 2249 people were tested for HIV in 2020 compared to 3825 in 2019 (difference: - 41.2%, P < 0.001). Fewer people were also tested in 2021 (difference: - 35.6% P < 0.001). The largest reductions in testing in 2020 occurred in women (- 47.7%), children under 15 (- 95.2%), married people (- 42.6%), and CH (- 46.2%). Overall, 1369 (16.0%) people were positive for HIV; CH (878, 17.9%), LGH (469, 15.6%) and GBC (22, 3.5%). The likelihood of a positive HIV test was 26% lower in 2020 than 2019 (PR 0.74; 95% CI 0.64-0.85; P < 0.001), but 16% higher in 2021 than 2019 (PR 1.16; 95% CI 1.03-1.30; P < 0.05). Of the 1369 HIV diagnosis, 526 (38.4%) were linked to care. We found significant disruptions in HIV testing and linkage services at different levels of service delivery during the COVID-19 pandemic, underscoring the need to strengthen essential health services during public health emergencies.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
| | - Moses M Bangura
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Darlinda F Jiba
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Daniel Sesay
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Abdulai Tejan Jalloh
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Ginika Egesimba
- ICAP at Columbia University Mailman School of Public Health, Freetown, Sierra Leone
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emmanuel Firima
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland.
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria.
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9
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Kamara IF, Tengbe SM, Bah AJ, Nuwagira I, Ali DB, Koroma FF, Kamara RZ, Lakoh S, Sesay S, Russell JBW, Theobald S, Lyons M. Prevalence of hypertension, diabetes mellitus, and their risk factors in an informal settlement in Freetown, Sierra Leone: a cross-sectional study. BMC Public Health 2024; 24:783. [PMID: 38481202 PMCID: PMC10935859 DOI: 10.1186/s12889-024-18158-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs), especially hypertension and diabetes mellitus are on the increase in sub-Saharan Africa (SSA). Informal settlement dwellers exhibit a high prevalence of behavioural risk factors and are highly vulnerable to hypertension and diabetes. However, no study has assessed the prevalence of hypertension, diabetes, and NCDrisk factors among informal settlement dwellers in Sierra Leone. We conducted a study in June 2019 to determine the prevalence of hypertension, diabetes, and NCD risk factors among adults living in the largest Sierra Leonean informal settlement (KrooBay). METHODS AND MATERIALS We conducted a community-based cross-sectional survey among adults aged ≥ 35 years in the KrooBay community. Trained healthcare workers collected data on socio-demographic characteristics and self-reported health behaviours using the World Health Organization STEPwise surveillance questionnaire for chronic disease risk factors. Anthropometric, blood glucose, and blood pressure measurements were performed following standard procedures. Logistics regression was used for analysis and adjusted odd ratios with 95% confidence intervals were calculated to identify risk factors associated with hypertension. RESULTS Of the 418 participants, 242 (57%) were females and those below the age of 45 years accounted for over half (55.3%) of the participants. The prevalence of smoking was 18.2%, alcohol consumption was 18.8%, overweight was 28.2%, obesity was 17.9%, physical inactivity was 81.5%, and inadequate consumption of fruits and vegetables was 99%. The overall prevalence of hypertension was 45.7% (95% CI 41.0-50.5%), systolic hypertension was 34.2% (95% CI 29.6-38.8%), diastolic blood pressure was 39.9% (95% CI 35.2-44.6), and participants with diabetes were 2.2% (95% CI 0.7-3.6%). Being aged ≥ 55 years (AOR = 7.35, 95% CI 1.49-36.39) and > 60 years (AOR 8.05; 95% CI 2.22-29.12), separated (AOR = 1.34; 95% 1.02-7.00), cohabitating (AOR = 6.68; 95% CL1.03-14.35), vocational (AOR = 3.65; 95% CI 1.81-7.39 ) and having a university education (AOR = 4.62; 95% CI 3.09-6.91) were found to be independently associated with hypertension. CONCLUSION The prevalence of hypertension,and NCD risk factors was high among the residents of the Kroobay informal settlement. We also noted a low prevalence of diabetes. There is an urgent need for the implementation of health education, promotion, and screening initiatives to reduce health risks so that these conditions will not overwhelm health services.
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Affiliation(s)
- Ibrahim Franklyn Kamara
- World Health Organization Sierra Leone, 21A-B Riverside Drive, Off Kingharman Road, Freetown, Sierra Leone
| | | | - Abdulai Jawo Bah
- College of Medicine and Allied Health Sciences, University of Sierra Leone, A.J.Momoh Street, Freetown, Sierra Leone
| | - Innocent Nuwagira
- World Health Organization Sierra Leone, 21A-B Riverside Drive, Off Kingharman Road, Freetown, Sierra Leone
| | - Desta Betula Ali
- Ministry of Health, 4th Floor, Youyi Building, Freetown, Sierra Leone
| | - Fanny F Koroma
- Ministry of Health, 4th Floor, Youyi Building, Freetown, Sierra Leone
| | - Rugiatu Z Kamara
- United States CDC Country Office, EOC, Wilkinson Road, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Ministry of Health, 4th Floor, Youyi Building, Freetown, Sierra Leone
| | - Santigie Sesay
- Ministry of Health, 4th Floor, Youyi Building, Freetown, Sierra Leone
| | - James B W Russell
- Ministry of Health, 4th Floor, Youyi Building, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, A.J.Momoh Street, Freetown, Sierra Leone
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Mary Lyons
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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Kargbo-Labour I, Bah MS, Melchers NVSV, Conteh A, Redwood-Sawyerr V, Stolk WA, Paye J, Sonnie M, Veinoglou A, Koroma JB, Hodges MH, Weaver AM, Zhang Y. Impact assessment of onchocerciasis through lymphatic filariasis transmission assessment surveys using Ov-16 rapid diagnostic tests in Sierra Leone. Parasit Vectors 2024; 17:121. [PMID: 38468307 PMCID: PMC10926616 DOI: 10.1186/s13071-024-06198-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/15/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Onchocerciasis is endemic in 14 of Sierra Leone's 16 districts with high prevalence (47-88.5%) according to skin snips at baseline. After 11 rounds of mass treatment with ivermectin with good coverage, an impact assessment was conducted in 2017 to assess the progress towards eliminating onchocerciasis in the country. METHODS A cluster survey was conducted, either integrated with lymphatic filariasis (LF) transmission assessment survey (TAS) or standalone with the LF TAS sampling strategy in 12 (now 14) endemic districts. Finger prick blood samples of randomly selected children in Grades 1-4 were tested in the field using SD Bioline Onchocerciasis IgG4 rapid tests. RESULTS In total, 17,402 children aged 4-19 years in 177 schools were tested, and data from 17,364 children aged 4-14 years (14,230 children aged 5-9 years) were analyzed. Three hundred forty-six children were confirmed positive for Ov-16 IgG4 antibodies, a prevalence of 2.0% (95% CI 1.8-2.2%) in children aged 4-14 years with prevalence increasing with age. Prevalence in boys (2.4%; 95% CI 2.1-2.7%) was higher than in girls (1.6%; 95% CI 1.4-1.9%). There was a trend of continued reduction from baseline to 2010. Using data from children aged 5-9 years, overall prevalence was 1.7% (95% CI 1.5-1.9%). The site prevalence ranged from 0 to 33.3% (median prevalence = 0.0%): < 2% in 127 schools, 2 to < 5% in 34 schools and ≥ 5% in 16 schools. There was a significant difference in average prevalence between districts. Using spatial analysis, the Ov-16 IgG4 antibody prevalence was predicted to be < 2% in coastal areas and in large parts of Koinadugu, Bombali and Tonkolili Districts, while high prevalence (> 5%) was predicted in some focal areas, centered in Karene, Kailahun and Moyamba/Tonkolili. CONCLUSIONS Low Ov-16 IgG4 antibody prevalence was shown in most areas across Sierra Leone. In particular, low seroprevalence in children aged 5-9 years suggests that the infection was reduced to a low level after 11 rounds of treatment intervention. Sierra Leone has made major progress towards elimination of onchocerciasis. However, attention must be paid to those high prevalence focal areas.
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Affiliation(s)
- Ibrahim Kargbo-Labour
- National Neglected Tropical Disease Control Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Natalie V S Vinkeles Melchers
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Social Sciences, Health and Society, Wageningen University and Research Centre, Wageningen, The Netherlands
| | - Abdulai Conteh
- National Neglected Tropical Disease Control Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Wilma A Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jusufu Paye
- Helen Keller International, Freetown, Sierra Leone
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11
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Blankson HNA, Kamara RF, Barilar I, Andres S, Conteh OS, Dallenga T, Foray L, Maurer F, Kranzer K, Utpatel C, Niemann S. Molecular determinants of multidrug-resistant tuberculosis in Sierra Leone. Microbiol Spectr 2024; 12:e0240523. [PMID: 38289066 PMCID: PMC10923214 DOI: 10.1128/spectrum.02405-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/28/2023] [Indexed: 03/06/2024] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) management has become a serious global health challenge. Understanding its epidemic determinants on the regional level is crucial for developing effective control measures. We used whole genome sequencing data of 238 of Mycobacterium tuberculosis complex (MTBC) strains to determine drug resistance profiles, phylogeny, and transmission dynamics of MDR/rifampicin-resistant (RR) MTBC strains from Sierra Leone. Forty-two strains were classified as RR, 196 as MDR, 5 were resistant to bedaquiline (BDQ) and clofazimine (CFZ), but none was found to be resistant to fluoroquinolones. Sixty-one (26%) strains were resistant to all first-line drugs, three of which had additional resistance to BDQ/CFZ. The strains were classified into six major MTBC lineages (L), with strains of L4 being the most prevalent, 62% (n = 147), followed by L6 (Mycobacterium africanum) strains, (21%, n = 50). The overall clustering rate (using ≤d12 single-nucleotide polymorphism threshold) was 44%, stratified into 31 clusters ranging from 2 to 16 strains. The largest cluster (n = 16) was formed by sublineage 2.2.1 Beijing Ancestral 3 strains, which developed MDR several times. Meanwhile, 10 of the L6 strains had a primary MDR transmission. We observed a high diversity of drug resistance mutations, including borderline resistance mutations to isoniazid and rifampicin, and mutations were not detected by commercial assays. In conclusion, one in five strains investigated was resistant to all first-line drugs, three of which had evidence of BDQ/CFZ resistance. Implementation of interventions such as rapid diagnostics that prevent further resistance development and stop MDR-TB transmission chains in the country is urgently needed. IMPORTANCE A substantial proportion of MDR-TB strains in Sierra Leone were resistant against all first line drugs; however this makes the all-oral-six-month BPaLM regimen or other 6-9 months all oral regimens still viable, mainly because there was no FQ resistance.Resistance to BDQ was detected, as well as RR, due to mutations outside of the hotspot region. While the prevalence of those resistances was low, it is still cause for concern and needs to be closely monitored.
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Affiliation(s)
- Harriet N. A. Blankson
- Molecular and Experimental Mycobacteriology, Research Center Borstel Leibniz Lung Center, Borstel, Germany
- German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Reims, Borstel, Germany
- School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
| | - Rashidatu Fouad Kamara
- National Leprosy and Tuberculosis Control Programme Sierra Leone, Freetown, Sierra Leone
| | - Ivan Barilar
- Molecular and Experimental Mycobacteriology, Research Center Borstel Leibniz Lung Center, Borstel, Germany
- German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Reims, Borstel, Germany
| | - Sönke Andres
- National and WHO Supranational Reference Center for Mycobacteria, Research Center Borstel Leibniz Lung Center, Borstel, Germany
| | - Ousman S. Conteh
- National Leprosy and Tuberculosis Control Programme Sierra Leone, Freetown, Sierra Leone
| | - Tobias Dallenga
- German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Reims, Borstel, Germany
- Cellular Microbiology, Research Center Borstel Leibniz Lung Center, Borstel, Germany
| | - Lynda Foray
- National Leprosy and Tuberculosis Control Programme Sierra Leone, Freetown, Sierra Leone
| | - Florian Maurer
- German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Reims, Borstel, Germany
- National and WHO Supranational Reference Center for Mycobacteria, Research Center Borstel Leibniz Lung Center, Borstel, Germany
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Kranzer
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christian Utpatel
- Molecular and Experimental Mycobacteriology, Research Center Borstel Leibniz Lung Center, Borstel, Germany
- German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Reims, Borstel, Germany
| | - Stefan Niemann
- Molecular and Experimental Mycobacteriology, Research Center Borstel Leibniz Lung Center, Borstel, Germany
- German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Reims, Borstel, Germany
- National and WHO Supranational Reference Center for Mycobacteria, Research Center Borstel Leibniz Lung Center, Borstel, Germany
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12
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Buttenheim A, Thirumurthy H. Mobile delivery of COVID-19 vaccines improved uptake in rural Sierra Leone. Nature 2024; 627:497-499. [PMID: 38480939 DOI: 10.1038/d41586-023-03186-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
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13
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Mokaya EN, Atem NA, Awzenio G, Mukombo L, Sesay T, Kangbai DM, Nyandemoh H, Musanhu P. Lessons From the COVID-19 Pandemic Response Implementation: A Case Study of South Sudan and Sierra Leone. Glob Health Sci Pract 2024; 12:e2300180. [PMID: 38050064 PMCID: PMC10948125 DOI: 10.9745/ghsp-d-23-00180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/12/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION The COVID-19 pandemic caused havoc to health systems worldwide and in countries that already had weak health systems. There are lessons to be learned that could contribute to improved response preparedness to future public health emergencies, but there is little documentation on best practices in fragile countries. We describe lessons from South Sudan and Sierra Leone during the COVID-19 response implementation. METHODS We conducted a retrospective descriptive analysis of COVID-19 vaccination implementation at national and subnational levels between 2020 and 2022 in South Sudan and Sierra Leone to identify those practices that had a positive impact on public health. RESULTS Several interventions were identified that not only improved the COVID-19 situation but also had a positive effect on routine immunizations. The development of a near-real-time vaccination dashboard gave stakeholders a quick look at vaccine implementation, allowing them to make decisions based on current data. The experience acquired from deploying the COVID-19 dashboard has since been applied to the development of a routine immunization dashboard in South Sudan. Surge vaccination was an effective approach to improving COVID-19 vaccination uptake. A measles reactive campaign was conducted during the initial stages of the pandemic when movement was restricted; experience gained from that effort was subsequently applied to COVID-19 mass vaccination initiatives and outbreak reactive campaigns. Additional vaccinators recruited for COVID-19 response also received comprehensive Immunization in Practice training, allowing them to provide routine childhood vaccinations alongside COVID-19 vaccination, contributing to the maintenance of routine vaccination services in both countries. CONCLUSION Lessons were learned during the COVID-19 response implementation that have had a positive impact on routine health services. However, it is essential that these effects are maintained and further refined to strengthen the country's preparedness for future public health emergencies and better support the broader immunization service delivery.
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Affiliation(s)
| | | | | | - Lawrence Mukombo
- South Sudan World Health Organization Country Office, Juba, South Sudan
| | - Tom Sesay
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Haurace Nyandemoh
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
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14
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Stone H, Bailey E, Wurie H, Leather AJM, Davies JI, Bolkan HA, Sevalie S, Youkee D, Parmar D. A qualitative study examining the health system's response to COVID-19 in Sierra Leone. PLoS One 2024; 19:e0294391. [PMID: 38306321 PMCID: PMC10836672 DOI: 10.1371/journal.pone.0294391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/31/2023] [Indexed: 02/04/2024] Open
Abstract
The paper examines the health system's response to COVID-19 in Sierra Leone. It aims to explore how the pandemic affected service delivery, health workers, patient access to services, leadership, and governance. It also examines to what extent the legacy of the 2013-16 Ebola outbreak influenced the COVID-19 response and public perception. Using the WHO Health System Building Blocks Framework, we conducted a qualitative study in Sierra Leone where semi-structured interviews were conducted with health workers, policymakers, and patients between Oct-Dec 2020. We applied thematic analysis using both deductive and inductive approaches. Twelve themes emerged from the analysis: nine on the WHO building blocks, two on patients' experiences, and one on Ebola. We found that routine services were impacted by enhanced infection prevention control measures. Health workers faced additional responsibilities and training needs. Communication and decision-making within facilities were reported to be coordinated and effective, although updates cascading from the national level to facilities were lacking. In contrast with previous health emergencies which were heavily influenced by international organisations, we found that the COVID-19 response was led by the national leadership. Experiences of Ebola resulted in less fear of COVID-19 and a greater understanding of public health measures. However, these measures also negatively affected patients' livelihoods and their willingness to visit facilities. We conclude, it is important to address existing challenges in the health system such as resources that affect the capacity of health systems to respond to emergencies. Prioritising the well-being of health workers and the continued provision of essential routine health services is important. The socio-economic impact of public health measures on the population needs to be considered before measures are implemented.
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Affiliation(s)
- Hana Stone
- King’s Centre for Global Health and Health Partnerships, Department of Population Health Sciences, School of Life Course and Population Sciences, King’s College London, London, United Kingdom
| | - Emma Bailey
- King’s Centre for Global Health and Health Partnerships, Department of Population Health Sciences, School of Life Course and Population Sciences, King’s College London, London, United Kingdom
- King’s Sierra Leone Partnership, Connaught Hospital, Freetown, Sierra Leone
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Andrew J. M. Leather
- King’s Centre for Global Health and Health Partnerships, Department of Population Health Sciences, School of Life Course and Population Sciences, King’s College London, London, United Kingdom
| | - Justine I. Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Håkon A. Bolkan
- CapaCare, Freetown, Sierra Leone
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Case Management Pillar, National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
- 34 Military Hospital, Wilberforce, Freetown, Sierra Leone
| | - Daniel Youkee
- King’s Sierra Leone Partnership, Connaught Hospital, Freetown, Sierra Leone
- Case Management Pillar, National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
| | - Divya Parmar
- King’s Centre for Global Health and Health Partnerships, Department of Population Health Sciences, School of Life Course and Population Sciences, King’s College London, London, United Kingdom
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15
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Sibanda L, Ghotane SG, Bernabe E, Challacombe SJ, Pitts NB, Gallagher JE. Caries clusters at lesion-severity thresholds: A Sierra Leone case study. Community Dent Oral Epidemiol 2024; 52:76-83. [PMID: 37622680 DOI: 10.1111/cdoe.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/30/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES Despite being almost entirely preventable, globally, dental caries is extremely prevalent. Moreover, dental caries will continue to present an even larger challenge for lower income countries, particularly those in the African context, as they transition to a more Western diet. Hence, epidemiological data providing insight into disease patterns and trends is critical to inform public health action. The purpose of this study was to examine dental caries clusters by caries detection threshold among 15-year-old adolescents in Sierra Leone, using data from the latest national survey, and to explore associated sociodemographic factors. METHODS This paper presents a secondary analysis of oral health data on 490 15-year-olds from the Sierra Leone national oral health survey of schoolchildren. Hierarchical cluster analysis of dental caries experience was conducted across all surfaces at four decay detection thresholds using the International Caries Detection and Assessment System (ICDAS) (clinical: ICDAS 2-6, cavitated: ICDAS 3-6, obvious: ICDAS 4-6 and extensive obvious: ICDAS 5-6 decay) across the four regions of Sierra Leone. Ordered logistic regression was used to estimate the association of sociodemographic factors with generated clusters relating to clinical and obvious decay experience. These are of both clinical and epidemiological relevance. RESULTS A 3-cluster decay pattern representing a 'low' to 'high' decay experience distribution was observed under each decay detection threshold across surfaces. For clinical decay (including visual enamel caries), 28.8% had low, 55.1% medium and 15.9% high caries status. In the adjusted model, the only significant risk factor across obvious and clinical decay thresholds was region, with adolescents outside the Western region more likely to experience decay. CONCLUSION This study suggests that adolescents in Sierra Leone fall into three distinct caries clusters: low, medium to high decay experience distribution, regardless of decay threshold. It reinforces the importance of recognizing dental caries detection thresholds and the use of contemporary epidemiological methodology. This suggests that adolescents outside the Western region are likely to have higher caries experience. The data also provides insight to the nature of adolescents in each cluster and should help to inform policy and planning of the integration of oral health into primary care and school systems.
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Affiliation(s)
- L Sibanda
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, London, UK
- NHS England London Region, Wellington House, London, UK
| | - S G Ghotane
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - E Bernabe
- Centre of Dental Public Health and Primary Care, Institute of Dentistry, Queen Mary University of London, London, UK
| | - S J Challacombe
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, Tower Wing, Guys Hospital, London, UK
| | - N B Pitts
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Oral, Clinical and Translational Sciences, King's College London, Tower Wing, Guys Hospital, London, UK
| | - J E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, London, UK
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16
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Collier KM, Klein EK, Sevalie S, Molleh B, Kabba Y, Kargbo A, Bangura J, Gbettu H, Simms S, O'Leary C, Drury S, Schieffelin JS, Betancourt TS, Crea TM. Ebola Virus Disease Sensitization: Community-Driven Efforts in Sierra Leone. J Community Health 2024; 49:108-116. [PMID: 37531047 DOI: 10.1007/s10900-023-01265-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/03/2023]
Abstract
The 2014-2016 West Africa Ebola outbreak was the largest in history, resulting in approximately 11,000 deaths. Despite the outbreak's eventual end, national and international health sensitization and containment efforts were subject to criticism. This study investigates disease-related knowledge and beliefs, as well as trusted sources of health information among EVD-survivors and their family members, highlighting the importance of community-informed public health responses. Participants (n = 134) were adults who were either EVD-infected, affected families/caregivers, or community leaders. In-depth interviews and focus groups explored EVD-related experiences, including health effects, stigma, and community relationships. Using a grounded theory and thematic content analysis approach, transcripts were coded for evidence of health sensitization, as well as compliance with mitigation measures and trusted sources of information. Participants displayed a high level of knowledge around EVD and reported compliance with mandated and personal prevention measures. Levels of health sensitization and subsequent reintegration of survivors were reported to be largely the products of community-based efforts, rather than the top-down, national public health response. Primary sources of trusted information included EVD survivors acting as peer educators; local leaders; and EVD sensitization by community health workers. This study highlights the importance of a community-based response for increasing the effectiveness of public health campaigns. Participants expressed that relying on the experiences of trusted cultural insiders led to a deeper understanding of Ebola compared to top-down public health campaigns, and helped infected and affected community members reintegrate. Future public health efforts should incorporate community-based participatory approaches to address infectious disease outbreaks.
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Affiliation(s)
- K Megan Collier
- School of Social Work, Boston College, Chestnut Hill, MA, USA.
| | | | | | | | - Yusuf Kabba
- Sierra Leone Association of Ebola Survivors, Freetown, Sierra Leone
| | - Abdulai Kargbo
- Sierra Leone Association of Ebola Survivors, Freetown, Sierra Leone
| | | | | | - Stewart Simms
- School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Clara O'Leary
- School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Stacy Drury
- School of Medicine, Tulane University, New Orleans, LA, USA
| | | | | | - Thomas M Crea
- School of Social Work, Boston College, Chestnut Hill, MA, USA
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Das U, Fielding D. Higher local Ebola incidence causes lower child vaccination rates. Sci Rep 2024; 14:1382. [PMID: 38228678 PMCID: PMC10791637 DOI: 10.1038/s41598-024-51633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/08/2024] [Indexed: 01/18/2024] Open
Abstract
Ebola is a highly infectious and often fatal zoonotic disease endemic to West and Central Africa. Local outbreaks of the disease are common, but the largest recorded Ebola epidemic originated in Guinea in December 2013, spreading to Liberia, and Sierra Leone in the following year and lasting until April 2016. The epidemic presented a serious challenge to local healthcare systems and foreign aid agencies: it degraded services, caused the loss of healthcare professionals, disrupted the economy, and reduced trust in modern healthcare. This study aims to estimate the extent to which variation in one long-term measure of the quality of local healthcare (the child vaccination rate) is a consequence of local variation in the intensity of the epidemic. Applying a "difference-in-differences" model to household survey data from before and after the epidemic, we show that in 2018-2019, overall rates of vaccination for BCG, DPT, measles, and polio are lower in Guinean and Sierra Leonean districts that had a relatively high incidence of Ebola; statistical analysis indicates that this is a causal effect. The effects of the epidemic on access to healthcare have been local effects, at least in part.
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Affiliation(s)
- Upasak Das
- Global Development Institute, University of Manchester, Manchester, M13 9PL, UK
| | - David Fielding
- Global Development Institute, University of Manchester, Manchester, M13 9PL, UK.
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18
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Shafiq Y, Caviglia M, Juheh Bah Z, Tognon F, Orsi M, K Kamara A, Claudia C, Moses F, Manenti F, Barone-Adesi F, Sessay T. Causes of maternal deaths in Sierra Leone from 2016 to 2019: analysis of districts' maternal death surveillance and response data. BMJ Open 2024; 14:e076256. [PMID: 38216175 PMCID: PMC10806740 DOI: 10.1136/bmjopen-2023-076256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION Sierra Leone is among the top countries with the highest maternal mortality rates. Although progress has been made in reducing maternal mortality, challenges remain, including limited access to skilled care and regional disparities in accessing quality care. This paper presents the first comprehensive analysis of the burden of different causes of maternal deaths reported in the Maternal Death Surveillance and Response (MDSR) system at the district level from 2016 to 2019. METHODS The MDSR data are accessed from the Ministry of Health and Sanitation, and the secondary data analysis was done to determine the causes of maternal death in Sierra Leone. The proportions of each leading cause of maternal deaths were estimated by districts. A subgroup analysis of the selected causes of death was also performed. RESULTS Overall, obstetric haemorrhage was the leading cause of maternal death (39.4%), followed by hypertensive disorders (15.8%) and pregnancy-related infections (10.1%). Within obstetric haemorrhage, postpartum haemorrhage was the leading cause in each district. The burden of death due to obstetric haemorrhage slightly increased over the study period, while hypertensive disorders showed a slightly decreasing trend. Disparities were found among districts for all causes of maternal death, but no clear geographical pattern emerged. Non-obstetric complications were reported in 11.5% of cases. CONCLUSION The MDSR database provides an opportunity for shared learning and can be used to improve the quality of maternal health services. To improve the accuracy and availability of data, under-reporting must be addressed, and frontline community staff must be trained to accurately capture and report death events.
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Affiliation(s)
- Yasir Shafiq
- Department of Translational Medicine and Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Piemonte, Italy
- Center of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Pakistan
| | - Marta Caviglia
- Università degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Italy
| | - Zainab Juheh Bah
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area, Sierra Leone
| | | | - Michele Orsi
- Doctors with Africa CUAMM, Padova, Veneto, Italy
| | - Abibatu K Kamara
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area, Sierra Leone
| | | | - Francis Moses
- Reproductive Health and Family Planning Programme, Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area, Sierra Leone
| | | | - Francesco Barone-Adesi
- CRIMEDIM - Research Center in Emergency and Disaster Medicine, Università degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Piemonte, Italy
| | - Tom Sessay
- Bombali District Ebola Response - Surveillance Team, Sierra Leone Ministry of Health and Sanitation, Bombali District, Makeni, Bombali, Sierra Leone
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Wassenaar M, Fombah AE, Chen H, Owusu-Kyei K, Williams J, Sunders JHC, Llach M, Quinto L, Sesay T, Samai M, Menéndez C, González R. Immunisation coverage and factors associated with incomplete immunisation in children under two during the COVID-19 pandemic in Sierra Leone. BMC Public Health 2024; 24:143. [PMID: 38200476 PMCID: PMC10777622 DOI: 10.1186/s12889-023-17534-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Routine childhood immunisation is one of the most important life-saving public health interventions. However, many children still have inadequate access to these vaccines and millions remain (partially) unvaccinated globally. As the COVID-19 pandemic disrupted health systems worldwide, its effects on immunisation have become apparent. This study aimed to estimate routine immunisation coverage among children under two in Sierra Leone and to identify factors associated with incomplete immunisation during the COVID-19 pandemic. METHODS A cross-sectional household survey was conducted in three districts in Sierra Leone: Bombali, Tonkolili and Port Loko. A three-stage cluster sampling method was followed to enrol children aged 10-23 months. Information regarding immunisation status was based on vaccination cards or caretaker's recall. Using WHO's definition, a fully immunised child received one BCG dose, three oral polio vaccine doses, three pentavalent vaccine doses and one measles-containing vaccine dose. Following the national schedule, full immunisation status can be achieved at 9 months of age. Data were weighted to reflect the survey's sampling design. Associations between incomplete immunisation and sociodemographic characteristics were assessed through multivariable logistic regression. RESULTS A total of 720 children were enrolled between November and December 2021. Full vaccination coverage was estimated at 65.8% (95% CI 60.3%-71.0%). Coverage estimates were highest for vaccines administered at birth and decreased with doses administered subsequently. Adjusting for age, the lowest estimated coverage was 40.7% (95% CI 34.5%-47.2%) for the second dose of the measles-containing vaccine. Factors found to be associated with incomplete immunisation status were: living in Port Loko district (aOR = 3.47, 95% CI = 2.00-6.06; p-value < 0.001), the interviewed caretaker being Muslim (aOR = 1.94, 95% CI = 1.25-3.02; p-value = 0.015) and the interviewed caretaker being male (aOR = 1.93, 95% CI = 1.03-3.59, p-value = 0.039). CONCLUSION Though full immunisation coverage at district level improved compared with pre-pandemic district estimates from 2019, around one in three surveyed children had missed at least one basic routine vaccination and over half of eligible children had not received the recommended two doses of a measles-containing vaccine. These findings highlight the need to strengthen health systems to improve vaccination uptake in Sierra Leone, and to further explore barriers that may jeopardise equitable access to these life-saving interventions.
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Affiliation(s)
- Myrte Wassenaar
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- University Medical Center Utrecht - Utrecht University, Utrecht, the Netherlands
| | - Augustin E Fombah
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
- Ministry of Health, Freetown, Sierra Leone.
| | - Haily Chen
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Julian Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joe-Henry C Sunders
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mireia Llach
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Llorenç Quinto
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
| | - Tom Sesay
- Directorate of Reproductive Child Health, Ministry of Health, Freetown, Sierra Leone
| | - Mohamed Samai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Directorate of Research and Training, Ministry of Health, Freetown, Sierra Leone
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
| | - Raquel González
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
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20
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Salifu MG, Da-Costa Vroom FB, Guure C. Anaemia among women of reproductive age in selected sub-Saharan African countries: multivariate decomposition analyses of the demographic and health surveys data 2008-2018. Front Public Health 2024; 11:1128214. [PMID: 38249368 PMCID: PMC10799556 DOI: 10.3389/fpubh.2023.1128214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/08/2023] [Indexed: 01/23/2024] Open
Abstract
Objectives The burden and highest regional prevalence of anaemia is reported in sub-Saharan Africa (SSA). The study evaluated changes in anaemia prevalence across the Demographic Health Surveys (DHS) periods in SSA and reported factors influencing observed changes in the trend. Method The study was implemented by a two-stage cross-sectional stratified sampling approach. The study involved women of reproductive age (15-49 years) in sub-Saharan Africa countries (Ghana, Sierra Leone, Mali, and Benin) using two different periods of their demographic health surveys (DHS) data. The study adopted both descriptive and inferential statistical methods. The chi-square test was used to determine the existence of a statistically significant relationship between the outcome and predictor variables and test the observed changes in anaemia. Multivariable logistic regression analyses were conducted on each survey year and the pooled dataset for eligible study countries. Multivariate decomposition analysis was performed to explain how compositional changes and behavioural effects of women characteristics affected the changes in anaemia prevalence. The study reported frequencies, percentages and odds ratios along with their 95% confidence intervals (CI). Results Ghana and Sierra Leone experienced 17.07% [95% CI: 14.76-19.37, p < 0.001] and 1% [95% CI: 1.0-2.9, p > 0.05] of anaemia decrease from period 1 to period 2, respectively, while Mali and Benin experienced 11% [95% CI: 9.14-12.90, p < 0.001] and 16.7% [95% CI: 14.99-18.5, p < 0.001] of increase in anaemia prevalence from period 1 to period 2, respectively. Behavioural effects explained the decrease in Ghana and the increase in Benin and Mali while endowments or compositional changes explained the decrease in Sierra Leone. Conclusion Anaemia continues to pose a significant challenge in sub-Saharan Africa. Therefore, there is an imperative need to scale up the implementation of nutrition-related programmes and advocacies to ensure optimum changes in women nutrition-related behaviours.
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Affiliation(s)
- Mohammed Gazali Salifu
- Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, United States
| | - Frances Baaba Da-Costa Vroom
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana – Legon, Accra, Ghana
| | - Chris Guure
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana – Legon, Accra, Ghana
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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21
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Mchenga M. Female Genital Mutilation and Sexual Risk Behaviors of Adolescent Girls and Young Women Aged 15-24 Years: Evidence From Sierra Leone. J Adolesc Health 2024; 74:186-193. [PMID: 37804304 DOI: 10.1016/j.jadohealth.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/15/2023] [Accepted: 08/14/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Considering the high levels of female genital mutilation (FGM) in Sierra Leone with over 83% of girls and young women aged 15-24 years having undergone the practice, the study explores the potential influence of FGM on sexual behaviors of adolescent girls and young women (AGYW) in Sierra Leone. METHODS Cross-sectional data from the 2019 Demographic Health Survey were utilized to examine the association between FGM and three sexual behaviors; sexual debut before 18 years, child marriage and adolescent motherhood. To model this association, a generalized estimation equation technique was employed, while controlling for socio-demographic characteristics. Additionally, the study corrected for multiple-hypothesis testing using the Benjamini-Hochberg procedure with a specified false discovery rate of 0.05. Finally, percentage predicted probabilities of occurrence of the sexual risk behaviors in the presence of FGM were also calculated. RESULTS Of the 5524 AGYW, 76% had undergone FGM. FGM was associated with all three sexual risk behaviors. Sexual debut before 18 years had the highest predicted probability increase (+18.00 ppt, 95% CI: 14.41 to -21.59), followed by adolescent motherhood (+13.38 ppt, 95% CI: 10.16-16.60) and child marriage (+12.61 ppt; 95% CI: 10.22-15.01). Education was found to be protective against all three sexual risk behaviors. DISCUSSION The findings of this study demonstrate that FGM remains a prevalent practice in Sierra Leone, even among the younger generation. This practice is strongly associated with sexual behaviors that pose a significant risk to the health outcomes of AGYW. Investments in education by removing barriers to access for AGYW could lead to multiple gains.
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Affiliation(s)
- Martina Mchenga
- Centre for Social Science Research, University of Cape Town, Rondebosch, South Africa.
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22
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Schindell BG, Kangbai JB, Shaw SY, Kindrachuk J. Stigmatization of Ebola virus disease survivors in 2022: A cross-sectional study of survivors in Sierra Leone. J Infect Public Health 2024; 17:35-43. [PMID: 37992432 DOI: 10.1016/j.jiph.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Evidence has demonstrated a high proportion of Ebola virus disease (EVD) survivors experienced stigma due to the disease. This study sought to understand the longer-term effects of stigma encountered by survivors of the 2014-2016 EVD epidemic living in Sierra Leone. METHODS This was a cross-sectional study of 595 EVD survivors and 403 close contacts (n = 998) from Sierra Leone. Assessments were conducted using a three-part survey between November 2021 to March 2022. We explored the socio-demographic factors associated with stigma experienced by EVD survivors. FINDINGS 50·6 % (n = 301) of EVD survivors reported that they continued to experience at least one aspect of stigma. Females were disproportionately affected by stigma, with 45·2 % of females reporting isolation from friends and family compared to 33·9 % of men (p = 0·005). Multivariable logistic regression models revealed those aged 40-44, living rurally, and reporting an acute infection longer than seven days was associated with EVD-related stigma at the time of survey. INTERPRETATION This study demonstrates stigma is still prevalent among people who survived EVD in 2022. It also identified socio-demographic factors associated with stigma that can be used for targeting interventions. Importantly, this highlights the continued need for EVD survivors to access mental healthcare and social support systems well after disease recovery. FUNDING This study was funded by the Canadian Institutes for Health Research (Grant no. PJT-175098. JK is funded by a Tier 2 Canada Research Chair in the Molecular Pathogenesis of Emerging and Re-Emerging Viruses. SS is funded by a Tier 2 Canada Research Chair in Program Science and Global Public Health.
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Affiliation(s)
- Brayden G Schindell
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
| | - Jia B Kangbai
- Department of Public Health, Eastern Technical University of Sierra Leone, Kenema, Sierra Leone.
| | - Souradet Y Shaw
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
| | - Jason Kindrachuk
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
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23
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Obeng-Kusi M, Martin J, Abraham I. The economic burden of Ebola virus disease: a review and recommendations for analysis. J Med Econ 2024; 27:309-323. [PMID: 38299454 DOI: 10.1080/13696998.2024.2313358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/30/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Ebola virus disease (EVD) continues to be a major public health threat globally, particularly in the low-and-middle-income countries (LMICs) of Africa. The social and economic burdens of EVD are substantial and have triggered extensive research into prevention and control. We aim to highlight the impact and economic implications, identify research gaps, and offer recommendations for future economic studies pertaining to EVD. METHOD We conducted a comprehensive librarian-led search in PubMed/Medline, Embase, Google Scholar, EconLit and Scopus for economic evaluations of EVD. After study selection and data extraction, findings on the impact and economics of EVD were synthesized using a narrative approach, while identifying gaps, and recommending critical areas for future EVD economic studies. RESULTS The economic evaluations focused on the burden of illness, vaccine cost-effectiveness, willingness-to-pay for a vaccine, EVD funding, and preparedness costs. The estimated economic impact of the 2014 EVD outbreak in Guinea, Liberia, and Sierra Leone across studies ranged from $30 billion to $50 billion. Facility construction and modification emerged as significant cost drivers for preparedness. The EVD vaccine demonstrated cost-effectiveness in a dynamic transmission model; resulting in an incremental cost-effectiveness ratio of about $96 per additional disability adjusted life year averted. Individuals exhibited greater willingness to be vaccinated if it incurred no personal cost, with a minority willing to pay about $1 for the vaccine. CONCLUSIONS The severe impact of EVD puts pressure on governments and the international community for better resource utilization and re-allocation. Several technical and methodological issues related to economic evaluation of EVD remain to be addressed, especially for LMICs. We recommend conducting cost-of-sequelae and cost-of-distribution analyses in addition to adapting existing economic analytical methods to EVD. Characteristics of the affected regions should be considered to provide evidence-based economic plans and economic-evaluation of mitigations that enhance resource allocation for prevention and treatment.
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Affiliation(s)
- Mavis Obeng-Kusi
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
| | - Jennifer Martin
- Arizona Health Sciences Library, University of Arizona, Tucson, AZ, USA
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
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24
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Mansaray A, Bangura M, Watson-Jones D, Greenwood B, Burns R, Susan Lees S, Faye F, Leigh B, Enria L. Engaging the public in decisions about emergency vaccine deployment strategies: Lessons from scenario-based discussions in Sierra Leone. Glob Public Health 2024; 19:2334887. [PMID: 38625999 DOI: 10.1080/17441692.2024.2334887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/20/2024] [Indexed: 04/18/2024]
Abstract
ABSTRACTThe COVID-19 pandemic has amplified discussions on emergency vaccine deployment strategies, with current perspectives often neglecting extensive community involvement in ethical, logistical and political aspects. Existing social science literature predominantly delves into factors influencing trust, overlooking the untapped potential for community engagement.Our study examines community preparedness in Sierra Leone's Kambia District, exploring diverse viewpoints on vaccine deployment strategies, emphasising Ebola and COVID-19 vaccinations. Utilising extensive ethnographic research from the Ebola vaccine trials (EBOVAC Salone) conducted in Kambia District from 2015 to 2021, including participant observation and tailored focus group discussions, we investigated various deployment scenarios with community leaders and citizens.Our findings underscore the multifaceted contributions of social science research with communities in shaping emergency vaccination strategies. These contributions span logistical insights, aligning campaigns with local livelihoods and social structures, and grounded ethical concerns assessing social justice outcomes across epidemic scenarios. This study emphasises the imperative of integrating discussions on vaccine confidence and deployment. It highlights communities' proficiency in epidemiological reasoning and their ability to bring this in conversation with salient socio-cultural, economic and religious dimensions. We therefore promote the cultivation of public dialogue, collaborative creation of impactful vaccination initiatives alongside relevant communities in recognition of their invaluable perspectives .
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Affiliation(s)
| | - Mahmood Bangura
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | | | - Rose Burns
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Farba Faye
- London School of Hygiene and Tropical Medicine, London, UK
| | - Bailah Leigh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Luisa Enria
- London School of Hygiene and Tropical Medicine, London, UK
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25
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Kamara IF, Kanu J, Maruta A, Fofanah BD, Kamara KN, Sheriff B, Katawera V, D'Almeida SA, Musoke R, Nuwagira I, Lakoh S, Kamara RZ, Tengbe SM, Mansaray AR, Koroma Z, Thomas F, Abiri OT, Koroma AT, Russell JBW, Squire J, Vandi MA. Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology. BMJ Open 2023; 13:e078367. [PMID: 38159961 PMCID: PMC10759135 DOI: 10.1136/bmjopen-2023-078367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Inappropriate use of antibiotics is a major driver of antibiotic resistance. A few studies conducted in Africa have documented that about half of hospitalised patients who receive antibiotics should not have received them. A few hospital-based studies that have been conducted in Sierra Leone have documented a high usage of antibiotics in hospitals. Therefore, we conducted a nationwide point prevalence survey on antibiotic use among hospitalised patients in Sierra Leone. DESIGN We conducted a hospital-based, cross-sectional survey on the use of antibiotics using the WHO point prevalence survey methodology. SETTING The study was conducted in 26 public and private hospitals that are providing inpatient healthcare services. PARTICIPANTS All patients admitted to paediatric and adult inpatient wards before or at 08:00 on the survey date were enrolled. OUTCOME MEASURES Prevalence of antibiotic use, antibiotics Access, Watch and Reserve (AWaRe) categorisation, indication for antibiotic use prevalence and proportion of bacteria culture done. RESULTS Of the 1198 patient records reviewed, 883 (73.7%, 95% CI 71.1% to 76.2%) were on antibiotics. Antibiotic use was highest in the paediatric wards (306, 85.7%), followed by medical wards (158, 71.2%), surgical wards (146, 69.5%), mixed wards (97, 68.8%) and lowest in the obstetrics and gynaecology wards (176, 65.7%). The most widely prescribed antibiotics were metronidazole (404, 22.2%), ceftriaxone (373, 20.5%), ampicillin (337, 18.5%), gentamicin (221, 12.1%) and amoxicillin (90, 5.0%). Blood culture was only done for one patient and antibiotic treatments were given empirically. The most common indication for antibiotic use was community-acquired infection (484, 51.9%) followed by surgical prophylaxis (222, 23.8%). CONCLUSION There was high usage of antibiotics in hospitals in Sierra Leone as the majority of patients admitted received an antibiotic. This has the potential to increase the burden of antibiotic resistance in the country. We, therefore, recommend the establishment of hospital antimicrobial stewardship programmes according to the WHO core components.
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Affiliation(s)
- Ibrahim Franklyn Kamara
- Reproductive Maternal Newborn Child and Adolescent Health Unit, Universal Health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Joseph Kanu
- National Disease Surveillance Programme, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
- Community Health, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Anna Maruta
- World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | | | - Kadijatu Nabie Kamara
- National Surveillance Program, Directorate of Health Security and Emergencies, Ministry of Health, Freetown, Sierra Leone
| | - Bockarie Sheriff
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Victoria Katawera
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Selassi A D'Almeida
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Robert Musoke
- Emergency Preparedness and Response, World Health Organization Country Office, Sierra Leone, Freetown, Sierra Leone
| | - Innocent Nuwagira
- World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Rugiatu Z Kamara
- US Center for Disease Control and Prevention Country Office, Sierra Leone, Freetown, Sierra Leone
| | | | - Abdul Razak Mansaray
- Laboratory, Diagnostic and Blood Services, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Microbiology, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Zikan Koroma
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Fawzi Thomas
- Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
| | - Onome T Abiri
- Pharmacovigilance and Clinical Trials Department, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
- Pharmacology, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Aminata Tigiedankay Koroma
- National Surveillance Program, Directorate of Health Security and Emergency, Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - James Squire
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Mohamed Alex Vandi
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
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26
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Youkee D, Marshall IJ, Fox-Rushby J, Lisk DR, O’Hara J, Wang Y, Rudd A, Wolfe CDA, Deen GF, Sackley C. Cohort Profile: The Stroke in Sierra Leone (SISLE) Register. Int J Epidemiol 2023; 52:e308-e314. [PMID: 37555838 PMCID: PMC10749756 DOI: 10.1093/ije/dyad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/30/2023] [Indexed: 08/10/2023] Open
Affiliation(s)
- Daniel Youkee
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
| | - Iain J Marshall
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
| | - Julia Fox-Rushby
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
| | - Durodami R Lisk
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Jessica O’Hara
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
| | - Yanzhong Wang
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
| | - Anthony Rudd
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
| | - Charles D A Wolfe
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Catherine Sackley
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
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27
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Bilgin GM, Lokuge K, Jabbie E, Munira SL, Glass K. COVID-19 vaccination strategies in settings with limited rollout capacity: a mathematical modelling case study in Sierra Leone. BMC Public Health 2023; 23:2466. [PMID: 38082260 PMCID: PMC10712073 DOI: 10.1186/s12889-023-17374-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND COVID-19 vaccine coverage in low- and middle-income countries continues to be challenging. As supplies increase, coverage is increasingly becoming determined by rollout capacity. METHODS We developed a deterministic compartmental model of COVID-19 transmission to explore how age-, risk-, and dose-specific vaccine prioritisation strategies can minimise severe outcomes of COVID-19 in Sierra Leone. RESULTS Prioritising booster doses to older adults and adults with comorbidities could reduce the incidence of severe disease by 23% and deaths by 34% compared to the use of these doses as primary doses for all adults. Providing a booster dose to pregnant women who present to antenatal care could prevent 38% of neonatal deaths associated with COVID-19 infection during pregnancy. The vaccination of children is not justified unless there is sufficient supply to not affect doses delivered to adults. CONCLUSIONS Our paper supports current WHO SAGE vaccine prioritisation guidelines (released January 2022). Individuals who are at the highest risk of developing severe outcomes should be prioritised, and opportunistic vaccination strategies considered in settings with limited rollout capacity.
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Affiliation(s)
- Gizem Mayis Bilgin
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia.
| | - Kamalini Lokuge
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Ernest Jabbie
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Syarifah Liza Munira
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Kathryn Glass
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
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28
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Lisk DR, Kanu A, Russell JBW. The Stigma of Epilepsy among Patients Attending the Epilepsy Clinic at Connaught Hospital, Sierra Leone. West Afr J Med 2023; 40:1209-1215. [PMID: 38096502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Epilepsy is one of the world's most common neurological disorders with about eighty percent of cases living in low and middle-income countries. Due to superstitious cultural and traditional beliefs in Sub-Saharan Africa, the stigma associated with epilepsy is particularly disabling. Stigma negatively affects the psychosocial wellbeing of people with epilepsy (PWE) and their acceptance of medical treatment. Very limited studies have been done on the types and extent of stigma in PWE in Sierra Leone. OBJECTIVE This study will assess the extent and correlates of perceived and enacted stigma among patients attending the epilepsy clinic at Connaught hospital in Freetown, Sierra Leone. METHODS Using a semi-structured questionnaire to identify both perceived and enacted stigma, a cross-sectional descriptive study was conducted among patients attending the epilepsy clinic at Connaught hospital aged ten years and above with no major psychiatric co-morbidity. Frequency of stigma and socio-demographic and clinical correlates of stigma were determined. RESULTS Of the 128 patients, (9 below 18 years) 57.8% were males. Participants had a mean age of 32.9 years. 53.9% and 79.9% of participants reported experiencing perceived and enacted stigma, respectively. Longer duration of illness and being single correlated with perceived stigma, while lower educational achievement and early age of onset of seizure correlated with enacted stigma. A seizure frequency of more than two attacks a month was significantly related to both forms of stigma. CONCLUSION The level of epilepsy-related social stigma is high in Sierra Leone. This is likely due to poor community education, leading to misconceptions and biases. An appropriate educational intervention coupled with effective clinical management of cases is needed to mitigate epilepsy-related stigma. CONTEXTE L'épilepsie est l'un des troubles neurologiques les plus courants dans le monde, avec environ quatre-vingts pour cent des cas vivant dans des pays à revenu faible et intermédiaire. En raison des croyances culturelles et traditionnelles superstitieuses en Afrique subsaharienne, la stigmatisation associée à l'épilepsie est particulièrement handicapante. La stigmatisation affecte négativement le bien-être psychosocial des personnes épileptiques (PWE) et leur acceptation du traitement médical. Très peu d'études ont été menées sur les types et l'étendue de la stigmatisation chez les PWE en Sierra Leone. OBJECTIF Cette étude évaluera l'étendue et les corrélats de la stigmatisation perçue et manifeste chez les patients fréquentant la clinique de l'épilepsie à l'hôpital Connaught à Freetown, Sierra Leone. MÉTHODES À l'aide d'un questionnaire semi-structuré pour identifier la stigmatisation perçue et manifeste, une étude descriptive transversale a été menée chez des patients fréquentant la clinique de l'épilepsie à l'hôpital Connaught, âgés de dix ans et plus, sans co-morbidité psychiatrique majeure. La fréquence de la stigmatisation et les corrélats socio-démographiques et cliniques de la stigmatisation ont été déterminés. RÉSULTATS Sur les 128 patients (9 de moins de 18 ans), 57,8% étaient des hommes. Les participants avaient un âge moyen de 32,9 ans. 53,9% et 79,9% des participants ont signalé avoir éprouvé une stigmatisation perçue et manifeste, respectivement. Une durée plus longue de la maladie et le fait d'être célibataire étaient corrélés à la stigmatisation perçue, tandis qu'un niveau d'éducation inférieur et un jeune âge de début des crises étaient corrélés à la stigmatisation manifeste. Une fréquence de crises de plus de deux attaques par mois était significativement liée aux deux formes de stigmatisation. CONCLUSION Le niveau de stigmatisation sociale liée à l'épilepsie est élevé en Sierra Leone. Cela est probablement dû à une éducation communautaire insuffisante, conduisant à des idées fausses et des préjugés.Une intervention éducative appropriée couplée à une gestion clinique efficace des cas est nécessaire pour atténuer la stigmatisation liée à l'épilepsie. Mots-clés Épilepsie, Manifeste, Perçue, Stigmatisation, Sierra Leone.
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Affiliation(s)
- Durodami R Lisk
- Department of Internal Medicine, Connaught Teaching Hospital, Ministry of Health and Sanitation, Sierra Leone. , , Tel: +23276412442
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone
| | - Alieu Kanu
- Department of Internal Medicine, Connaught Teaching Hospital, Ministry of Health and Sanitation, Sierra Leone. , , Tel: +23276412442
| | - James B W Russell
- Department of Internal Medicine, Connaught Teaching Hospital, Ministry of Health and Sanitation, Sierra Leone. , , Tel: +23276412442
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone
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Boland ST, Balabanova D, Mayhew S. Examining the militarised hierarchy of Sierra Leone's Ebola response and implications for decision making during public health emergencies. Global Health 2023; 19:89. [PMID: 37993942 PMCID: PMC10664671 DOI: 10.1186/s12992-023-00995-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND In September, 2014, Médecins Sans Frontières (MSF) called for militarised assistance in response to the rapidly escalating West Africa Ebola Epidemic. Soon after, the United Kingdom deployed its military to Sierra Leone, which (among other contributions) helped to support the establishment of novel and military-led Ebola Virus Disease (Ebola) response centres throughout the country. To examine these civil-military structures and their effects, 110 semi-structured interviews with civilian and military Ebola Response Workers (ERWs) were conducted and analysed using neo-Durkheimian theory. RESULTS The hierarchical Ebola response centres were found to be spaces of 'conflict attenuation' for their use of 'rule-bound niches', 'neutral zones', 'co-dependence', and 'hybridity', thereby not only easing civil-military relationships (CMRel), but also increasing the efficiency of their application to Ebola response interventions. Furthermore, the hierarchical response centres were also found to be inclusive spaces that further increased efficiency through the decentralisation and localisation of these interventions and daily decision making, albeit for mostly privileged groups and in limited ways. CONCLUSIONS This demonstrates how hierarchy and localisation can (and perhaps should) go hand-in-hand during future public health emergency responses as a strategy for more robustly including typically marginalised local actors, while also improving necessary efficiency-in other words, an 'inclusive hierarchical coordination' that is both operationally viable and an ethical imperative.
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Affiliation(s)
- Samuel T Boland
- Centre for Universal Health, Chatham House, 10 St James's Square, London, SW1Y 4LE, UK.
| | - Dina Balabanova
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Square, London, WC1H 9SH, UK
| | - Susannah Mayhew
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Square, London, WC1H 9SH, UK
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Röbl K, Fischer HT, Delamou A, Mbawah AK, Geurts B, Feddern L, Baldé H, Kaba I, Pozo-Martin F, Weishaar H, Menelik-Obbarius S, Burger G, Diaconu V, Dörre A, El Bcheraoui C. Caregiver acceptance of malaria vaccination for children under 5 years of age and associated factors: cross-sectional household survey, Guinea and Sierra Leone, 2022. Malar J 2023; 22:355. [PMID: 37986067 PMCID: PMC10662512 DOI: 10.1186/s12936-023-04783-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Malaria is a leading cause of death and reduced life span in Guinea and Sierra Leone, where plans for rolling out the malaria vaccine for children are being made. There is little evidence about caregiver acceptance rates to guide roll-out policies. To inform future vaccine implementation planning, this analysis aimed to assess potential malaria vaccine acceptance by caregivers and identify factors associated with acceptance in Guinea and Sierra Leone. METHODS A cross-sectional household survey using lot quality assurance sampling was conducted in three regions per country between May 2022 and August 2022. The first survey respondent in each household provided sociodemographic information. A household member responsible for childcare shared their likelihood of accepting a malaria vaccine for their children under 5 years and details about children's health. The prevalence of caregiver vaccine acceptance was calculated and associated factors were explored using multivariable logistic regression modelling calculating adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS Caregivers in 76% of 702 sampled households in Guinea and 81% of 575 households in Sierra Leone were accepting of a potential vaccine for their children. In both countries, acceptance was lower in remote areas than in urban areas (Guinea: aOR 0.22 [95%CI 0.09-0.50], Sierra Leone: 0.17 [0.06-0.47]). In Guinea, acceptance was lower among caregivers living in the richest households compared to the poorest households (0.10 [0.04-0.24]), among those whose children were tested for malaria when febrile (0.54 [0.34-0.85]) and in households adopting more preventative measures against malaria (0.39 [0.25-0.62]). Better knowledge of the cause of malaria infection was associated with increased acceptance (3.46 [1.01-11.87]). In Sierra Leone, vaccine acceptance was higher among caregivers living in households where the first respondent had higher levels of education as compared to lower levels (2.32 [1.05-5.11]). CONCLUSION In both countries, malaria vaccine acceptance seems promising for future vaccine roll-out programmes. Policy makers might consider regional differences, sociodemographic factors, and levels of knowledge about malaria for optimization of implementation strategies. Raising awareness about the benefits of comprehensive malaria control efforts, including vaccination and other preventive measures, requires attention in upcoming campaigns.
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Affiliation(s)
- Klara Röbl
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Seestraße 10, 13353, Berlin, Germany
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch-Institute, Seestraße 10, 13353, Berlin, Germany
- ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), Gustav III:S Boulevard 40, 16973, Solna, Sweden
| | - Hanna-Tina Fischer
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Alexandre Delamou
- Centre d'Excellence Africain pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Université Gamal Abdel Nasser de Conakry (UGANC), Dixinn, PoBox 1017, Conakry, Guinea
- Faculté des sciences techniques de la santé (FSTS), Université Gamal Abdel Nasser de Conakry (UGANC), Conakry, Guinea
| | - Abdul Karim Mbawah
- College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone, Connaught Hospital, Freetown, Sierra Leone
| | - Brogan Geurts
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Lukas Feddern
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Habibata Baldé
- Centre d'Excellence Africain pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Université Gamal Abdel Nasser de Conakry (UGANC), Dixinn, PoBox 1017, Conakry, Guinea
- Faculté des sciences techniques de la santé (FSTS), Université Gamal Abdel Nasser de Conakry (UGANC), Conakry, Guinea
| | - Ibrahima Kaba
- Centre d'Excellence Africain pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Université Gamal Abdel Nasser de Conakry (UGANC), Dixinn, PoBox 1017, Conakry, Guinea
- Faculté des sciences techniques de la santé (FSTS), Université Gamal Abdel Nasser de Conakry (UGANC), Conakry, Guinea
| | - Francisco Pozo-Martin
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Heide Weishaar
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Sara Menelik-Obbarius
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Gerrit Burger
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Viorela Diaconu
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Achim Dörre
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Seestraße 10, 13353, Berlin, Germany
| | - Charbel El Bcheraoui
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany.
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Lakoh S, Vamboi PL, Ouédraogo AR, Adekanmbi O, Deen GF, Russell JBW, Sankoh-Hughes A, Kamara JB, Kanu JE, Yendewa GA, Firima E, Amaral AFS. High prevalence of TB multimorbidity among adults of a tertiary hospital in Sierra Leone: a cross-sectional study. BMC Res Notes 2023; 16:337. [PMID: 37974272 PMCID: PMC10655410 DOI: 10.1186/s13104-023-06476-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/25/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Tuberculosis (TB) is a leading cause of death globally, with approximately 1.5 million deaths in 2020. TB often coexists with chronic communicable and non-communicable diseases, but data to determine the extent of comorbid diseases are limited. In this study, we aimed to assess the prevalence of TB multimorbidity and its risk factors in a tertiary hospital in Sierra Leone. This is a cross-sectional study of 240 adults with microbiologically-confirmed TB at Connaught Hospital in Freetown, between March and May 2022. Logistic regression analysis was used to identify factors associated with TB multimorbidity. RESULTS The mean age of the patients was 37 years. More than two-thirds were males and about the same number had two or more chronic diseases. The most common were hypertension (47.9%) and diabetes (24.2%). Patients under 35 years of age were less likely to have TB multimorbidity (< 25 years: adjusted OR 0.07, 95%CI 0.01-0.6; 25-34 years: adjusted OR 0.2, 95%CI 0.01-0.9). We report a high prevalence of comorbid diseases among TB patients in the largest treatment center in Sierra Leone, with hypertension and diabetes being the most common. These findings support the current call for addressing comorbid non-communicable diseases in TB patients through integrated care.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
| | - Patricia Lombeh Vamboi
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdoul Risgou Ouédraogo
- Division of Pulmonology, Training and Research Unit in Health Sciences, University Joseph KI-ZEBRO, Ouagadougou, Burkina Faso
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Ahmed Sankoh-Hughes
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joseph B Kamara
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Joseph Edwin Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
| | - André F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
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Kallon LH, Raven J, Wurie HR, Mansour W. From policy to practice: a qualitive study exploring the role of community health workers during the COVID-19 response in Sierra Leone. BMC Health Serv Res 2023; 23:1228. [PMID: 37946253 PMCID: PMC10634028 DOI: 10.1186/s12913-023-10272-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, community health workers (CHWs) were required to help their communities respond to the outbreak in Sierra Leone. The Government of Sierra Leone released a policy that provided an interim guidance on the specific role of CHWs during the pandemic including support required to maintain continuity of routine and essential services during the COVID-19 response. This study explores how CHWs adapted their roles during the COVID-19 pandemic in Sierra Leone and the support they received from families, communities, and the health system. METHODS A qualitative exploratory study was conducted in two districts in Sierra Leone. We conducted eight key informant interviews with district and community level managers and leaders and four focus group discussions with CHWs. Thematic data analysis and synthesis were guided by the interim guidance released by the Government of Sierra Leone at the onset of the COVID-19 pandemic and supported by NVivo 11. RESULTS CHWs quickly took on COVID-19 frontline roles which included surveillance, contact tracing, social mobilization, and provision of psychosocial support. CHWs were trusted with these responsibilities as they were recognized as being knowledgeable about the community, were able to communicate effectively with community members and had experience of dealing with other outbreaks. Despite the release of the interim guidance aimed to optimize CHW contribution, motivate CHWs, ensure continuity of core and essential community-based services alongside COVID-19 services, CHWs faced many challenges in their work during the pandemic including heavy workload, low financial remuneration, lack of mental health support, and shortages of protective equipment, communication and transportation allowances. However, they were generally satisfied with the quality of the training and supervision they received. Support from families and communities was mixed, with some CHWs experiencing stigma and discrimination. CONCLUSION During the COVID-19 pandemic, CHWs played a critical role in Sierra Leone. Although, a policy was released by the government to guide their role during the crisis, it was not fully implemented. This resulted in CHWs being overworked and under supported. It is important that CHWs are provided with the necessary training, tools and support to take on their vital roles in managing health crises at the community level. Strengthening the capacity of CHWs will not only enhance pandemic response, but also lay the foundation for improved primary health care delivery and community resilience in the face of future health emergencies.
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Affiliation(s)
- Lansana Hassim Kallon
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joanna Raven
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Haja Ramatulai Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Wesam Mansour
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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Jiba DF, Lakoh S, Wang S, Sun W, Barrie U, Kamara MN, Jalloh AT, Tamba FK, Yendewa GA, Song JW, Yang G. Sero-prevalence of syphilis infection among people living with HIV in Sierra Leone: a cross-sectional nationwide hospital-based study. BMC Infect Dis 2023; 23:762. [PMID: 37932713 PMCID: PMC10626761 DOI: 10.1186/s12879-023-08740-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Globally, there were an estimated 7.1 million new syphilis infections in 2020, with more than 30% of these new infections reported in African countries such as Sierra Leone. Despite this, there is no HIV-specific syphilis screening program in Sierra Leone. Thus, data are needed to inform public health practice. In this study, we aimed to determine the prevalence of syphilis seropositivity and factors associated with syphilis seropositivity among people living with HIV (PLHIV). METHODS A cross-sectional study was conducted at 10 health facilities in Sierra Leone, among adults with HIV, aged 18 years or older, from September 2022 to January 2023. Parameters of interest were collected including age, sex, marriage, antiretroviral therapy (ART) regimen, HIV viral load, duration of ART treatment, and hospital level of care. The syphilis antibody was detected by a rapid test based on immunochromatography assay. Data were analyzed using R-software version 4.2.3 (R Core Team, Vienna, Austria). Pearson's χ2 test, Fisher's exact test and Kruskal-Wallis H test were applied to assess the differences in syphilis seropositivity between groups as appropriate. Univariate logistic regression and multivariate logistic regression analysis was used to assess factors associated with syphilis seropositivity. The level of statistical significance was set at P < 0.05. RESULTS Of the 3082 PLHIV individuals in our study, 2294 (74.4%) were female and 2867 (93.0%) were receiving ART. With a median age of 36 years, 211 (6.8%, 95% CI 6.0-7.7) were positive for syphilis. The prevalence of syphilis was highest in people aged 60 years and over (21.1%, 95%CI 14.7-29.2), followed by people aged 50-60 years (15.5%, 95%CI 11.9-19.9) and in the widowed population (11.9%, 95%CI 8.9-15.8). There were no differences in syphilis seropositivity between gender, ART status, ART regimen, duration of ART, HIV viral load and hospital level of care. Older age (50-60 years: adjusted OR 3.49, 95%CI 2.09-5.85 P < 0.001; 60-100 years: adjusted OR 4.28, 95%CI 2.21-8.17, P < 0.001) was an independent predictor of seropositive syphilis. CONCLUSIONS We observed a high prevalence of syphilis among PLHIV. Older people and widowed population have higher syphilis seropositivity. Older age was an independent predictor of syphilis positivity. Therefore, we call for the integration of syphilis screening, treatment and prevention in HIV services.
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Affiliation(s)
- Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
| | - Shuchao Wang
- Changchun Veterinary Institute, Chinese Academy of Agricultural Sciences, Changchun, China
| | - Wei Sun
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdulai Tejan Jalloh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Francis K Tamba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jin-Wen Song
- Senior Department of Infectious Diseases, the Fifth Medical Centre of PLA General Hospital, Beijing, China.
| | - Guang Yang
- Department of Clinical Laboratory, the Fifth Medical Center of PLA General Hospital, Beijing, China.
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Yendewa GA, James PB, Mohareb A, Barrie U, Massaquoi SPE, Yendewa SA, Ghazzawi M, Bockarie T, Cummings PE, Diallo IS, Johnson A, Vohnm B, Babawo LS, Deen GF, Kabba M, Sahr F, Lakoh S, Salata RA. Determinants of incomplete childhood hepatitis B vaccination in Sierra Leone, Liberia, and Guinea: Analysis of national surveys (2018-2020). Epidemiol Infect 2023; 151:e193. [PMID: 37920110 PMCID: PMC10728985 DOI: 10.1017/s0950268823001735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/10/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
Vaccination against hepatitis B virus (HBV) is effective at preventing vertical transmission. Sierra Leone, Liberia, and Guinea are hyperendemic West African countries; yet, childhood vaccination coverage is suboptimal, and the determinants of incomplete vaccination are poorly understood. We analyzed national survey data (2018-2020) of children aged 4-35 months to assess complete HBV vaccination (receiving 3 doses of the pentavalent vaccine) and incomplete vaccination (receiving <3 doses). Statistical analysis was conducted using the complex sample command in SPSS (version 28). Multivariate logistic regression was used to identify determinants of incomplete immunization. Overall, 11,181 mothers were analyzed (4,846 from Sierra Leone, 2,788 from Liberia, and 3,547 from Guinea). Sierra Leone had the highest HBV childhood vaccination coverage (70.3%), followed by Liberia (64.6%) and Guinea (39.3%). Within countries, HBV vaccination coverage varied by socioeconomic characteristics and healthcare access. In multivariate regression analysis, factors that were significantly associated with incomplete vaccination in at least one country included sex of the child, Muslim mothers, lower household wealth index, <4 antenatal visits, home delivery, and distance to health facility vaccination (all p < 0.05). Understanding and addressing modifiable determinants of incomplete vaccination will be essential to help achieve the 2030 viral hepatitis elimination goals.
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Affiliation(s)
- George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, Australia
| | - Amir Mohareb
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Umaru Barrie
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Tahir Bockarie
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Ambulai Johnson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Lawrence S. Babawo
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
| | - Gibrilla F. Deen
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mustapha Kabba
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Foday Sahr
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Abstract
OBJECTIVE To evaluate the common industry claim that higher tobacco taxation leads to higher levels of smuggling, particularly in a limited state capacity setting. DESIGN This paper evaluates the effects of a tobacco tax increase in Sierra Leone on smuggling by using gap analyses. Its models are based on multiple rounds of the Demographic and Health Survey and customs data as well as newly collected data on cigarette prices. RESULTS The paper shows that despite a substantial increase in cigarette taxation, and despite the absence of other formal tobacco control policies, smuggling has not increased in Sierra Leone. Its primary model shows a decrease in cigarette smuggling by 16.74% following the tax increase, alongside a decrease in cigarette consumption more widely and an increase in tax revenue. CONCLUSIONS By presenting a low income and lower enforcement capacity case study, this paper provides novel and critical evidence to the debate on the tax-smuggling link. Furthermore, it points to new questions on how states in these contexts can limit cigarette smuggling.
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Affiliation(s)
- Max Gallien
- Governance Cluster, Institute of Development Studies, Brighton, UK
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Lakoh S, Yi L, Russell JBW, Zhang J, Sevalie S, Zhao Y, Kanu JS, Liu P, Conteh SK, Williams CEE, Barrie U, Adekanmbi O, Jiba DF, Kamara MN, Sesay D, Deen GF, Okeibunor JC, Yendewa GA, Guo X, Firima E. High incidence of catheter-associated urinary tract infections and related antibiotic resistance in two hospitals of different geographic regions of Sierra Leone: a prospective cohort study. BMC Res Notes 2023; 16:301. [PMID: 37907960 PMCID: PMC10619308 DOI: 10.1186/s13104-023-06591-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE Catheter-associated urinary tract infections (CAUTI) are common worldwide, but due to limited resources, its actual burden in low-income countries is unknown. Currently, there are gaps in knowledge about CAUTI due to lack of surveillance activities in Sierra Leone. In this prospective cohort study, we aimed to determine the incidence of CAUTI and associated antibiotic resistance in two tertiary hospitals in different regions of Sierra Leone. RESULTS The mean age of the 459 recruited patients was 48.8 years. The majority were females (236, 51.3%). Amongst the 196 (42.6%) catheterized patients, 29 (14.8%) developed CAUTI. Bacterial growth was reported in 32 (84%) patients. Escherichia coli (14, 23.7%), Klebsiella pneumoniae (10, 17.0%), and Klebsiella oxytoca (8, 13.6%) were the most common isolates. Most isolates were ESBL-producing Enterobacteriaceae (33, 56%) and WHO Priority 1 (Critical) pathogens (38, 71%). Resistance of K. pneumoniae, K. oxytoca, E. coli, and Proteus mirabilis was higher with the third-generation cephalosporins and penicillins but lower with carbapenems, piperacillin-tazobactam and amikacin. To reduce the high incidence of CAUTI and multi-drug resistance organisms, urgent action is needed to strengthen the microbiology diagnostic services and develop and implement catheter bundles that provide clear guidance for catheter insertion, care and removal.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
- Infectious Disease Research Network, Freetown, Sierra Leone.
| | - Le Yi
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Juling Zhang
- Department of Clinical Laboratory, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
- 34 Military Hospital, Freetown, Sierra Leone
| | - Yongkun Zhao
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Peng Liu
- Department of Emergency Medicine, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Sarah K Conteh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Christine Ellen Elleanor Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Daniel Sesay
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | | | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xuejun Guo
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone.
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- , SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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Lakoh S, Williams CEE, Sevalie S, Russell JBW, Conteh SK, Kanu JS, Barrie U, Deen GF, Maruta A, Sesay D, Adekanmbi O, Jiba DF, Okeibunor JC, Yendewa GA, Firima E. Antibiotic use and consumption among medical patients of two hospitals in Sierra Leone: a descriptive report. BMC Infect Dis 2023; 23:737. [PMID: 37891476 PMCID: PMC10612171 DOI: 10.1186/s12879-023-08517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Although one of the main drivers of antimicrobial resistance is inappropriate antibiotic prescribing, there are limited resources to support the surveillance of antibiotic consumption in low-income countries. In this study, we aimed to assess antibiotic use and consumption among medical patients of two hospitals in different geographic regions of Sierra Leone. METHODS This is a cross-sectional study of adult (18 years or older) patients receiving medical care at two hospitals (34 Military Hospital-MH and Makeni Government Hospital-MGH) between March 2021 and October 2021. After admission to the medical or intensive care unit, patients were sequentially recruited by a nurse from each hospital. Demographic and clinical characteristics and information on the dose of antibiotics, their routes, and frequency of administration and duration were collected using a questionnaire adapted from previous studies and encrypted in EpiCollect software (Epic, Verona WI). A physician reviews and verifies each completed questionnaire. Data analysis was done using STATA version 16. RESULTS The mean age of the 468 patients evaluated in this study was 48.6 years. The majority were women (241, 51.7%) and treated at MGH (245, 52.0%). Clinical diagnosis of bacterial infection was made in only 180 (38.5%) patients. Regardless of the diagnosis, most (442, 94.9%) patients received at least one antibiotic. Of a total 813 doses of antibiotics prescribed by the two hospitals, 424 (52.2%) were administered in MH. Overall, antibiotic consumption was 66.9 defined daily doses (DDDs) per 100 bed-days, with ceftriaxone being the most commonly used antibiotic (277, 34.1%). The ACCESS and WATCH antibiotics accounted for 18.9 DDDs per 100 bed-days (28.2%) and 48.0 DDDs per 100 bed-days (71.7%), respectively. None of the patients were prescribed a RESERVE antibiotics. The antibiotic consumption was lower in MH (61.3 DDDs per 100 bed-days) than MGH (76.5 DDDs per 100 bed-days). CONCLUSION Antibiotic consumption was highest with ceftriaxone, followed by levofloxacin and metronidazole. Given the high rate of consumption of antibiotics in the WATCH category of the AWaRe classification, there is a need to initiate surveillance of antibiotic consumption and establish hospital-based antibiotic stewardship in these settings.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone.
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
- Infectious Disease Research Network, Freetown, Sierra Leone.
| | - Christine Ellen Elleanor Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
- 34 Military Hospital, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Sarah K Conteh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Anna Maruta
- World Health Organization Country Office, Freetown, Sierra Leone
| | - Daniel Sesay
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | | | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, OH, Cleveland, USA
- Johns Hopkins Bloomberg School of Public Health, MD, Baltimore, USA
| | - Emmanuel Firima
- Department of Medicine, Clinical Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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Shaikh MA. Prevalence, correlates, and trends of intimate partner violence against women in Sierra Leone: findings from 2013 and 2019 demographic and health surveys. Front Public Health 2023; 11:1227165. [PMID: 37920586 PMCID: PMC10619914 DOI: 10.3389/fpubh.2023.1227165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023] Open
Abstract
Background Intimate partner violence (IPV) is a globally pervasive public health and medical problem in addition to being a serious violation of women's rights. The two-fold objectives of this study were to compute the lifetime prevalence and correlates of IPV perpetrated by current/former husbands/partners of ever-married women aged 15-49 years using the nationally representative Sierra Leone Demographic and Health Survey (DHS) conducted in 2019; ethnicity-based levels and trends of IPV were also computed using the data from the DHS conducted in 2013 along with the 2019 DHS. Methods Twelve IPV correlates pertaining to socio-demographic, attitudinal, and experiential attributes were analyzed using logistic regression models for bivariate and multivariable analysis. IPV was computed as a composite variable comprising of physical, emotional, and/or sexual IPV. Results Lifetime prevalence of experiencing any kind of IPV was a staggering 60.81%, whereas emotional, physical, and sexual IPV prevalence were reported by 45.90%, 49.81%, and 8.14% of the respondents, respectively. No ethnicity reported a statistically significant decrease in any type of IPV during the intervening period between the two surveys. Five out of nine ethnicities reported a statistically significant increase in emotional IPV, while few ethnicities reported a statistically significant increase in one or more types of IPV. Conclusion The high lifetime prevalence of IPV is alarming and points to the need for targeted health promotion campaigns to reverse the tide of IPV in Sierra Leone, including focusing on changes in cultural and ethnicity-based norms and mores to ensure women's human rights are respected and upheld.
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Samuels RJ, Sumah I, Alhasan F, McHenry R, Short L, Chappell JD, Haddadin Z, Halasa NB, Valério ID, Amorim G, Grant DS, Schieffelin JS, Moon TD. Respiratory virus surveillance in hospitalized children less than two-years of age in Kenema, Sierra Leone during the COVID-19 pandemic (October 2020- October 2021). PLoS One 2023; 18:e0292652. [PMID: 37816008 PMCID: PMC10564235 DOI: 10.1371/journal.pone.0292652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
Globally, viral pathogens are the leading cause of acute respiratory infection in children under-five years. We aim to describe the epidemiology of viral respiratory pathogens in hospitalized children under-two years of age in Eastern Province of Sierra Leone, during the second year of the SARS-CoV-2 pandemic. We conducted a prospective study of children hospitalized with respiratory symptoms between October 2020 and October 2021. We collected demographic and clinical characteristics and calculated each participant´s respiratory symptom severity. Nose and throat swabs were collected at enrollment. Total nucleic acid was purified and tested for multiple respiratory viruses. Statistical analysis was performed using R version 4.2.0 software. 502 children less than two-years of age were enrolled. 376 (74.9%) had at least one respiratory virus detected. The most common viruses isolated were HRV/EV (28.2%), RSV (19.5%) and PIV (13.1%). Influenza and SARS-CoV-2 were identified in only 9.2% and 3.9% of children, respectively. Viral co-detection was common. Human metapneumovirus and RSV had more than two-fold higher odds of requiring O2 therapy while hospitalized. Viral pathogen prevalence was high (74.9%) in our study population. Despite this, 100% of children received antibiotics, underscoring a need to expand laboratory diagnostic capacity and to revisit clinical guidelines implementation in these children. Continuous surveillance and serologic studies among more diverse age groups, with greater geographic breadth, are needed in Sierra Leone to better characterize the long-term impact of COVID-19 on respiratory virus prevalence and to better characterize the seasonality of respiratory viruses in Sierra Leone.
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Affiliation(s)
- Robert J. Samuels
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Ibrahim Sumah
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Foday Alhasan
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Rendie McHenry
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Laura Short
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - James D. Chappell
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Zaid Haddadin
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Natasha B. Halasa
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Inaê D. Valério
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Gustavo Amorim
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Donald S. Grant
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - John S. Schieffelin
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Tulane University, New Orleans, Louisiana, United States of America
| | - Troy D. Moon
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Tulane University, New Orleans, Louisiana, United States of America
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
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Baldeh M, Kizito S. Call to action: HIV among adolescents in Sierra Leone. Lancet 2023; 402:1240. [PMID: 37805214 DOI: 10.1016/s0140-6736(23)01788-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/21/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Mamadu Baldeh
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul 273, The Gambia; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Samuel Kizito
- International Center for Child Health and Development, Brown School, Washington University, St. Louis, MO, USA
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Ekman AT, Sengeh PA, Webber N, Jalloh MB, Hollander AC, Newby H, Cappa C, Orsini N, Alfvén T, Frielingsdorf H. Prevalence of children under five with disabilities in Sierra Leone in 2017: Insights from a population-based multiple indicator cluster survey. Disabil Health J 2023; 16:101481. [PMID: 37316393 DOI: 10.1016/j.dhjo.2023.101481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/16/2023] [Accepted: 04/27/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Children with disabilities have been low on the agenda of child health, including in Sierra Leone, and there are still many gaps in our knowledge and understanding of the issue. OBJECTIVE To estimate the prevalence of children with disabilities in Sierra Leone using functional difficulty as a proxy and to understand the factors associated with disabilities among children two to four years living in Sierra Leone. METHODS We used cross-sectional data from the Sierra Leone 2017 Multiple Indicator Cluster Survey. Disability was defined using a functional difficulty definition with additional thresholds used to define children with severe functional difficulty and multiple disabilities. Logistic regression models estimated odds ratios (ORs) of childhood disability and how they were associated with socioeconomic factors and living conditions. RESULTS Prevalence of children with disabilities was 6.6% (95% confidence interval (CI) 5.8-7.6%) and there was a high risk of comorbidity between different functional difficulties. Children with disabilities were less likely to be girls (adjusted odds ratio (AOR) 0.8 (CI 0.7-1.0) and older (AOR 0.3 (CI 0.2-0.4)), but more prone to be stunted (AOR 1.4 (CI 1.1-1.7)) and have younger caregivers (AOR 1.3 (CI 0.7-2.3)). CONCLUSION The prevalence of disabilities in young Sierra Leonean children was comparable to other countries in West and Central Africa when using the same measure of disability. Preventive as well as early detection and intervention efforts are recommended to be integrated with other programs, e.g vaccinations, nutrition, and poverty reducing programs.
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Affiliation(s)
- Anna-Theresia Ekman
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Paul A Sengeh
- FOCUS 1000, 7E Conteh Drive, Off Old Railway Line, Tengbeh Town, Freetown, Sierra Leone.
| | - Nance Webber
- FOCUS 1000, 7E Conteh Drive, Off Old Railway Line, Tengbeh Town, Freetown, Sierra Leone.
| | - Mohammad Bailor Jalloh
- FOCUS 1000, 7E Conteh Drive, Off Old Railway Line, Tengbeh Town, Freetown, Sierra Leone.
| | - Anna-Clara Hollander
- Epidemiology of Psychiatric Conditions, Substance Use and Social Environment (EPiCSS), Department of Global Public Health Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | | | - Claudia Cappa
- Data & Analytics Section, UNICEF, New York City, USA.
| | - Nicola Orsini
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
| | - Helena Frielingsdorf
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.
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Dwomoh D, Wurie I, Harding Y, Sedzro KM, Kandeh J, Tagoe H, Addo C, Arhinful DK, Sessay ARC, Kamara JL, Mansaray K, Ampofo WK. Estimating prevalence and modelling correlates of HIV test positivity among female sex workers, men who have sex with men, people who inject drugs, transgender people and prison inmates in Sierra Leone, 2021. AIDS Res Ther 2023; 20:70. [PMID: 37759241 PMCID: PMC10537076 DOI: 10.1186/s12981-023-00566-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Key populations (KPs) are particularly vulnerable to HIV infection and efforts to prevent HIV infections among KPs have been less successful, largely due to existing laws and legislation that classify the groups as illegal. Understanding the HIV infection pathway and the burden of HIV infection among Female Sex Workers (FSWs), Transgender people (TG), Men who have sex with Men (MSM), People who Inject Drugs (PWID), and Prison Inmates (PIs) is critical to combatting the HIV epidemic globally. This study aims to estimate HIV prevalence and model the risk factors of HIV positivity rate among the aforementioned KPs in Sierra Leone. This study used Time Location Sampling, Respondent Driven Sampling (RDS), and Conventional cluster Sampling designs to generate a representative sample of FSWs, MSM, TG, PI, and PWID. HIV prevalence and the corresponding 95% confidence intervals among each KP were estimated by adjusting for sampling weight using the logit-transformed confidence intervals. To determine correlates of HIV test positivity among KPs, a multivariable modified Poisson regression model that adjusts for RDS survey weights was used and sensitivity analysis was conducted using a multivariable logistic regression model with cluster robust standard errors. The prevalence of HIV among FSWs in the six regional headquarter towns was estimated to be 11.8% (95% CI: 7.9-17.1); MSM was 3.4% [95% CI: 1.9-5.8]; TGs was 4.2% (95% CI: 2.9-6.1); PWIDs was 4.2% (95% CI: 2.7-6.4) and PI was 3.7% (95% CI: 1.4-9.6). The correlates of HIV test positivity among KPs and PIs include HIV-related knowledge, marital status, district, income, age and sex of KP, level of education, alcohol intake, injecting drugs, and use of lubricants. HIV prevalence is relatively high among FSWs, MSMs, PWID, and TGs as compared to the previous estimate of the general population. There is a need to scale up and strengthen evidence-based HIV prevention interventions such Pre-Exposure Prophylaxis and needle and syringe exchange programmes targeting KPs, including prison inmates. Government must scale up both non-clinical and clinical routine HIV and STI testing and counseling services at the correctional center and drop-in centers for KPs screening/testing, and ensure that services are responsive to the needs of KP.
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Affiliation(s)
- Duah Dwomoh
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana.
| | - Issata Wurie
- Health and Education Quality Systems Strengthening, Freetown, Sierra Leone
| | - Yvonne Harding
- Health and Education Quality Systems Strengthening, Freetown, Sierra Leone
| | - Kojo Mensah Sedzro
- Department of Epidemiology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joseph Kandeh
- Health and Education Quality Systems Strengthening, Freetown, Sierra Leone
| | - Henry Tagoe
- John Snow Resarch & Training Institute Inc, Accra, Ghana
| | - Christabel Addo
- Department of Epidemiology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Daniel Kojo Arhinful
- Department of Epidemiology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Abdul Rahman Cherinoh Sessay
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | | | - William Kwabena Ampofo
- Department of Virology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Witter S, Zou G, Cheedella K, Walley J, Wurie H. Learning from implementation of a COVID case management desk guide and training: a pilot study in Sierra Leone. BMC Health Serv Res 2023; 23:1026. [PMID: 37743494 PMCID: PMC10518973 DOI: 10.1186/s12913-023-10024-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND When the COVID pandemic hit the world, there was need for applied guides and training materials to support frontline health care staff to manage patients effectively and safely and to educate themselves and communities. This article reports on the development and piloting of such a set of materials in Sierra Leone, which were based on international evidence but adapted to the local context. Reflecting on this experience, including community and health system barriers and enablers, is important to prepare for future regional shocks. METHODS This study, in Bombali district in 2020, piloted user-friendly COVID guides for frontline health workers (the intervention), which was evaluated using facility checklists (pre and post training), routine data analysis and 32 key informant interviews. RESULTS Key informants at district, hospital and community health centre levels identified gains from the training and desk guides, including improved diagnosis, triaging, infection prevention and management of patients. They also reported greater confidence to share messages on protection with colleagues and community members, which was needed to encourage continued use of essential services during the pandemic. However, important barriers were also revealed, including the lack of testing facilities, which reduced the sense of urgency, as few cases were identified. Actions based on the Ebola experience, such as setting up testing and isolation centres, which the community avoided, were not appropriate to COVID. Stigma and fear were important factors, although these were reduced with outreach activities. Supplies of essential medicines and personal protective equipment were also lacking. CONCLUSION This pilot study demonstrated the relevance and importance of guides adapted to the context, which were able to improve the confidence of health staff to manage their own and the community's fears in the face of a new pandemic and improve their skills. Previous epidemics, particularly Ebola, complicated this by both creating structures that could be revitalised but also assumptions and behaviours that were not adapted to the new disease. Our study documents positive adaptations and resilience by health staff but also chronic system weaknesses (particularly for medicines, supplies and equipment) which must be urgently addressed before the next shock arrives.
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Affiliation(s)
- Sophie Witter
- NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Guanyang Zou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Kiran Cheedella
- NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - John Walley
- Nuffield Centre for International Health and Development, Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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Semagn BE, Gebreegziabher ZA, Abebaw WA. Iron-rich food consumption and associated factors among children aged 6-23 months in Sierra Leone: multi-level logistic regression analysis. BMC Public Health 2023; 23:1793. [PMID: 37715168 PMCID: PMC10503148 DOI: 10.1186/s12889-023-16737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Iron deficiency is the most common micronutrient deficiency worldwide. Also, iron deficiency is a significant public health problem in low- and middle-income countries. Thus, this study aimed to assess iron-rich food consumption and associated factors among children aged 6-23 months in Sierra Leone. METHOD This study is a cross-sectional study based on data from the Sierra Leone Demographic and Health Survey dataset with a total weighted sample of 2622 children aged 6-23 months. Data cleaning, coding, and labeling were done using STATA version 14 software. A multilevel logistic regression model was employed to identify associated factors. RESULT Almost half (53.38%) of children aged between 6-23 months consumed iron-rich foods. The odds of iron rich food consumption were high among children in the age group of 12-17 months (AOR = 4.81, 95% CI: 3.67, 6.31) and 18-23 months (AOR = 9.3, 95% CI: 6.55, 13.2), and who fed minimum acceptable diet (AOR = 22.5, 95% CI: 11.65, 43.46). Moreover, a child from a mother who had work (AOR = 1.49, 95% CI: 1.08, 2.06), and with a mother who had more than four ANC visits during her pregnancy of the most recent live birth (AOR = 1.87; 95%CI: 1.36-2.55) had higher odds of iron-rich food consumption compared to their counterparts. On the other hand, children who were breastfeeding (AOR = 0.72, 95% CI: 0.53, 0.97), and mothers aged 15-19 (AOR = 0.48, 95% CI: 0.27, 0.85) decreased the odds of iron rich food consumption. CONCLUSION Consumption of iron-rich food is low among children aged 6-23 months in Sierra Leone. Iron-rich food consumption among children was significantly associated with maternal occupation, child's age, child's breastfeeding status, taking drugs for intestinal parasites, minimum acceptable diet, frequency, and timing of ANC, and region. Thus, special emphasis should be given to those children aged between 6-11 months, currently breastfeeding, children who did not get the minimum acceptable diet, and children from women who did not have work.
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Affiliation(s)
- Birhan Ewunu Semagn
- Department of Public Health, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.
| | - Zenebe Abebe Gebreegziabher
- Department of Epidemiology and Biostatistics, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Wondwosen Abey Abebaw
- Department of Public Health, School of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
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Baldeh M, Youkee D, Lakoh S, Rudd A, Langhorne P, Deen GF, Conteh ZF, Lisk DR, O'Hara J, Thompson M, Brima MT, Wang Y, Wolfe CDA, Sackley CM. Stroke in Sierra Leone. the stroke risk factors for people with HIV: A prospective case-control study. J Stroke Cerebrovasc Dis 2023; 32:107279. [PMID: 37523881 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND HIV infection rates are relatively low in Sierra Leone and in West Africa but the contribution of HIV to the risk factors for stroke and outcomes is unknown. In this study, we examined stroke types, presentation, risk factors and outcome in HIV stroke patients compared with controls. METHODS We used data from the Stroke in Sierra Leone Study at 2 tertiary hospitals in Freetown, Sierra Leone. A case control design was used to compare stroke type, presentation, risk factors and outcome in sero-positive HIV patients with HIV negative stroke controls. Controls were matched for age and gender and a 1:4 ratio cases to controls was used to optimize power. Analysis was performed using the Pearson x2 for categorical variable, Paired-T test and Mann-Whitney U test for continuous variables. A p-value of less than 0.05 was taken as the level of statistical significance. RESULTS Of 511 (51.8%) stroke patients tested for HIV, 36 (7.1%) were positive. Univariate unmatched analysis showed a stroke mean age of 49 years in HIV-positive versus 58 years in HIV-negative population (p = <0.001). In the case-control group, ischaemic stroke is the major type reported in both populations, HIV-negative population: 77 (53.5%) versus HIV-positive: 25 (69.4%) (p = 0.084). Hypertension is the most prevalent risk factor in both groups, HIV-positive: 23 (63.9%) versus HIV-negative: 409 (86.1%) (p = 0.001). Lower CD4+ count is associated in-hospital mortality (p = <0.001). CONCLUSION These findings support the current call for timely management of stroke and HIV through integrated care.
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Affiliation(s)
- Mamadu Baldeh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Medical Research Council Gambia at London School of Hygiene and Tropical Medicine, UK.
| | - Daniel Youkee
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Connaught Teaching Hospital, University of Sierra Leone teaching Hospital Complex, Freetown, Sierra Leone
| | - Anthony Rudd
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Peter Langhorne
- Academic Section of Geriatric Medicine, School of Cardiovascular and Metabolic Health, University of Glasgow
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Connaught Teaching Hospital, University of Sierra Leone teaching Hospital Complex, Freetown, Sierra Leone
| | - Zainab F Conteh
- Connaught Teaching Hospital, University of Sierra Leone teaching Hospital Complex, Freetown, Sierra Leone
| | - Durodami R Lisk
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Jessica O'Hara
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Melvina Thompson
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Connaught Teaching Hospital, University of Sierra Leone teaching Hospital Complex, Freetown, Sierra Leone
| | - Michael Tanu Brima
- Connaught Teaching Hospital, University of Sierra Leone teaching Hospital Complex, Freetown, Sierra Leone
| | - Yanzhong Wang
- School of Life Course and Population Sciences, King's College London, London, UK; National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London, London, UK
| | - Charles DA Wolfe
- School of Life Course and Population Sciences, King's College London, London, UK; National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London, London, UK
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Tengbe SM, Kamara IF, Ali DB, Koroma FF, Sevalie S, Dean L, Theobald S. Psychosocial impact of COVID-19 pandemic on front-line healthcare workers in Sierra Leone: an explorative qualitative study. BMJ Open 2023; 13:e068551. [PMID: 37607792 PMCID: PMC10445370 DOI: 10.1136/bmjopen-2022-068551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 07/21/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has wide-reaching health and non-health consequences, especially on mental health and psychosocial well-being. Healthcare workers involved in COVID-19 patient care are particularly vulnerable to psychosocial distress due to increased pressure on healthcare systems. We explored the psychosocial experiences of front-line healthcare workers during the COVID-19 pandemic in Sierra Leone. METHODS This qualitative study used purposive sampling to recruit 13 healthcare workers from different cadres across 5 designated COVID-19 treatment centres in Freetown, Sierra Leone. In-depth interviews were conducted remotely in July and August 2020, transcribed verbatim and analysed using the framework approach. RESULTS This study identified three overarching themes: vulnerability, resilience and support structures. Participants expressed vulnerability relating to the challenging work environment and lack of medications as key stressors resulting in anxiety, stress, anger, isolation and stigmatisation. Signs of resilience with experiences drawn from the 2014 Ebola outbreak, teamwork and a sense of duty were also seen. Peer support was the main support structure with no professional psychosocial support services available to healthcare workers. CONCLUSIONS This is the first study to provide evidence of the psychosocial impacts of COVID-19 among front-line healthcare workers in Sierra Leone. Despite signs of resilience and coping mechanisms displayed, they also experienced adverse psychosocial outcomes. There is a need to focus on enhancing strategies such as psychosocial support for healthcare workers and those that overall strengthen the health system to protect healthcare workers, promote resilience and guide recommendations for interventions during future outbreaks.
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Affiliation(s)
| | - Ibrahim Franklyn Kamara
- Emergency Preparedness and Response Cluster, World Health Organisation Country Office for Sierra Leone, Freetown, Sierra Leone
| | - Desta B Ali
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Fanny F Koroma
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Stephen Sevalie
- 34 Military Hospital, Wilberforce, Freetown, Sierra Leone
- Case Management Pillar, National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
| | - Laura Dean
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sally Theobald
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Mortara M, Turay MS, Boyle S, Caracciolo C, Bah S, Kargbo H, Hanciles E, John-Cole V, Scapini E, Benoni R, Dissanayake V, Beane A, Haniffa R, Adetunji AO, Taylor W, Pisani L. Impact and burden of sickle cell disease in critically ill obstetric patients in a high dependency unit in Sierra Leone-a registry based evaluation. BMC Pregnancy Childbirth 2023; 23:580. [PMID: 37573345 PMCID: PMC10422830 DOI: 10.1186/s12884-023-05888-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/31/2023] [Indexed: 08/14/2023] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) in pregnancy is associated with worse maternal and neonatal outcomes. There is limited available data describing the burden and outcomes of critically ill obstetric patients affected by SCD in low-income settings. OBJECTIVES We aimed to define SCD burden and impact on mortality in critically-ill obstetric patients admitted to an urban referral hospital in Sierra Leone. We hypothesized that SCD burden is high and independently associated with increased mortality. METHODS We performed a registry-based cross-sectional study from March 2020 to December 2021 in the high-dependency unit (HDU) of Princess Christian Maternity Hospital PCMH, Freetown. Primary endpoints were the proportion of patients identified in the SCD group and HDU mortality. Secondary endpoints included frequency of maternal direct obstetric complications (MDOCs) and the maternal early obstetric warning score (MEOWS). RESULTS Out of a total of 497 patients, 25 (5.5%) qualified to be included in the SCD group. MEOWS on admission was not different between patients with and without SCD and SCD patients had also less frequently reported MDOCs. Yet, crude HDU mortality in the SCD group was 36%, compared to 9.5% in the non SCD group (P < 0.01), with an independent association between SCD group exposure and mortality when accounting for severity on admission (hazard ratio 3.40; 95%CI 1.57-7.39; P = 0.002). Patients with SCD had a tendency to longer HDU length of stay. CONCLUSIONS One out of twenty patients accessing a HDU in Sierra Leone fulfilled criteria for SCD. Despite comparable severity on admission, mortality in SCD patients was four times higher than patients without SCD. Optimization of intermediate and intensive care for this group of patients should be prioritized in low-resource settings with high maternal mortality.
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Affiliation(s)
- Milena Mortara
- Department of Anesthesia and Intensive Care, University of Piemonte Orientale, Novara, Italy
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Momoh Sitta Turay
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Sonia Boyle
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Claudia Caracciolo
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
- Section of Operational Research, Doctors with Africa-Cuamm, Padova, Italy
| | - Sarjoh Bah
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Henry Kargbo
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Eva Hanciles
- Department of Anesthesia and Intensive Care, Connaught Hospital, University of Sierra Leone, Freetown, Sierra Leone
| | - Valerie John-Cole
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Ester Scapini
- Anesthesia and Intensive Care Medicine, University of Bari, Bari, Italy
| | - Roberto Benoni
- Section of Operational Research, Doctors with Africa-Cuamm, Padova, Italy
| | - Vishmi Dissanayake
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Abi Beane
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Rashan Haniffa
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Adeniji O Adetunji
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Williamson Taylor
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Luigi Pisani
- Section of Operational Research, Doctors with Africa-Cuamm, Padova, Italy.
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.
- Intensive Care Unit, Miulli Regional Hospital, Acquaviva Delle Fonti, Italy.
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Mdluli FP, Batidzirai JM. Discrete-time survival analysis with survey weights: a case study of age at child death in Sierra Leone. BMC Public Health 2023; 23:1522. [PMID: 37563601 PMCID: PMC10413765 DOI: 10.1186/s12889-023-16412-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Child death rates are often regarded as reliable indicators for overall welfare of a country since they give insight of health accessibility and development. For planning and controlling purposes, it is important to understand which ages are at higher risks of experiencing child death as well as determinants thereof. METHODS We used the Sierra Leone DHS 2019 data which was collected using two stage sampling methods. Data collection involved interviewing women aged from 15-49 to obtain information about children they had in the past up to 2019. Age at death of child was modelled using discrete-time survival analysis with a logit link at the same time applying survey weights. The analysis also sought to estimate the determinants of child death (under-five mortality). The baseline hazard was modelled with a polynomial function. RESULTS Results showed that children from rural areas had significantly lower odds of dying compared with those from urban areas (odds ratio (OR) = 0.861, p-value = 0.0003). Children of mothers who were currently using contraceptives, and those whose mothers had been using since their last birth were at higher odds of child death compared to children whose mothers had never used contraceptives before (currently using: OR = 1.118, p-value = < .0001; used since last birth: OR = 1.372, p-value = < .0001). Children with no health insurance had significantly higher odds of death than those with health insurance (OR = 1.036, p-value = < .0001). Children of women who were married, and of women who were formerly married were at significantly higher odds of experiencing child death than children of women who had never been in union (married: OR = 1.207, p-value = 0.0003; formerly married: OR = 1.308, p-value = 0.0009 compared to those that have never been married). Increase in the age group of mothers increases the odds of their children experiencing child death compared to mothers in their teenage years (20-29: OR = 1.943, p-value = < .0001, 30-39: OR = 2.397, p-value = < .0001 and > = 40: OR = 2.895, p-value = < .0001 compared to mothers in their 15-19 years). CONCLUSION The study provides evidence that residing in urban areas, marital union of the mother, children having no health insurance, use of contraceptives by mother, older ages of the mother and no health insurance significantly increase the odds of child death. This points out to a possible need for improved health infrastructure to be made available to citizens in all places of delivery and more awareness on pregnancy related complications.
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Affiliation(s)
- Fundiswa Pearl Mdluli
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
| | - Jesca Mercy Batidzirai
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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Kasonia K, Tindanbil D, Kitonsa J, Baisley K, Zalwango F, Enria L, Mansaray A, James M, Nije Y, Tata DT, Lawal BJ, Drammeh A, Lowe B, Mukadi-Bamuleka D, Mounier-Jack S, Nakiyimba F, Obady P, Muhavi J, Bangura JS, Greenwood B, Samai M, Leigh B, Watson-Jones D, Kavunga-Membo H, Ruzagira E, Gallagher KE. The impact of the COVID-19 pandemic on the provision & utilisation of primary health care services in Goma, Democratic Republic of the Congo, Kambia district, Sierra Leone & Masaka district, Uganda. PLoS One 2023; 18:e0286295. [PMID: 37267240 PMCID: PMC10237403 DOI: 10.1371/journal.pone.0286295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 05/12/2023] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION This study aimed to determine whether the COVID-19 pandemic had an impact on essential primary healthcare services at public primary healthcare facilities. METHODS The number of weekly consultations for antenatal care (ANC), outpatient (OPD), immunisations (EPI), family planning (FP) and HIV services, between January 2018 and December 2020, were collected from 25 facilities in Masaka district, Uganda, 21 in Goma, and 29 in Kambia district, Sierra Leone. Negative binomial regression models accounting for clustering and season were used to analyse changes in activity levels between 2018, 2019 and 2020. RESULTS In Goma, we found no change in OPD, EPI or ANC consultations, FP was 17% lower in March-July 2020 compared to 2019, but this recovered by December 2020. New diagnoses of HIV were 34% lower throughout 2020 compared to 2019. In Sierra Leone, compared to the same periods in 2019, facilities had 18-29% fewer OPD consultations throughout 2020, and 27% fewer DTP3 doses in March-July 2020. There was no evidence of differences in other services. In Uganda there were 20-35% fewer under-5 OPD consultations, 21-66% fewer MCV1 doses, and 48-51% fewer new diagnoses of HIV throughout 2020, compared to 2019. There was no difference in the number of HPV doses delivered. CONCLUSIONS The level of disruption varied across the different settings and qualitatively appeared to correlate with the strength of lockdown measures and reported attitudes towards the risk posed by COVID-19. Mitigation strategies such as health communications campaigns and outreach services may be important to limit the impact of lockdowns on primary healthcare services.
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Affiliation(s)
- K. Kasonia
- LSHTM-INRB Research Partnership, Goma, Democratic Republic of the Congo
| | - D. Tindanbil
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - J. Kitonsa
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - K. Baisley
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - F. Zalwango
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - L. Enria
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - A. Mansaray
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - M. James
- LSHTM-INRB Research Partnership, Goma, Democratic Republic of the Congo
| | - Y. Nije
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - D. Tetsa Tata
- LSHTM-INRB Research Partnership, Goma, Democratic Republic of the Congo
| | - B. J. Lawal
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - A. Drammeh
- LSHTM-COMAHS Research Partnership, Kambia, Sierra Leone
| | - B. Lowe
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - D. Mukadi-Bamuleka
- Laboratoire Rodolphe-Merieux, Institut National de Recherche Biomédicale (INRB-Goma), Goma, Democratic Republic of the Congo
| | - S. Mounier-Jack
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - F. Nakiyimba
- Ministry of Health, Masaka, Masaka District, Uganda
| | - P. Obady
- Ministry of Health, Goma, Democratic Republic of Congo
| | - J. Muhavi
- Ministry of Health, Goma, Democratic Republic of Congo
| | - J. S. Bangura
- University of Sierra Leone College of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone
- Ministry of Health, Kambia, Kambia District, Sierra Leone
| | - B. Greenwood
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - M. Samai
- University of Sierra Leone College of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone
| | - B. Leigh
- University of Sierra Leone College of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone
| | - D. Watson-Jones
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - H. Kavunga-Membo
- Laboratoire Rodolphe-Merieux, Institut National de Recherche Biomédicale (INRB-Goma), Goma, Democratic Republic of the Congo
| | - E. Ruzagira
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - K. E. Gallagher
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
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50
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Lawal BJ, Gallagher KE, Kitonsa J, Tindanbil D, Kasonia K, Drammeh A, Lowe B, Mukadi-Bamuleka D, Patterson C, Greenwood B, Samai M, Leigh B, Tetteh KKA, Ruzagira E, Watson-Jones D, Kavunga-Membo H. Prevalence of immunoglobulin G and M to SARS-CoV-2 and other human coronaviruses in The Democratic Republic of Congo, Sierra Leone, and Uganda: A longitudinal study. Int J Infect Dis 2023; 131:183-192. [PMID: 37001799 PMCID: PMC10060023 DOI: 10.1016/j.ijid.2023.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES We assessed the prevalence of immunoglobulin G (IgG) and IgM against four endemic human coronaviruses and two SARS-CoV-2 antigens among vaccinated and unvaccinated staff at health care centers in Uganda, Sierra Leone, and the Democratic Republic of Congo. METHODS The government health facility staff who had patient contact in Goma (Democratic Republic of Congo), Kambia District (Sierra Leone), and Masaka District (Uganda) were enrolled. Questionnaires and blood samples were collected at three time points over 4 months. Blood samples were analyzed with the Luminex MAGPIXⓇ. RESULTS Among unvaccinated participants, the prevalence of IgG/IgM antibodies against SARS-CoV-2 receptor-binding domain or nucleocapsid protein at enrollment was 70% in Goma (138 of 196), 89% in Kambia (112 of 126), and 89% in Masaka (190 of 213). The IgG responses against endemic human coronaviruses at baseline were not associated with SARS-CoV-2 sero-acquisition during follow-up. Among the vaccinated participants, those who had evidence of SARS-CoV-2 IgG/IgM at baseline tended to have higher IgG responses to vaccination than those who were SARS-CoV-2 seronegative at baseline, controlling for the time of sample collection since vaccination. CONCLUSION The high levels of natural immunity and hybrid immunity should be incorporated into both vaccination policies and prediction models of the impact of subsequent waves of infection in these settings.
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Affiliation(s)
| | - Katherine E Gallagher
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
| | | | - Daniel Tindanbil
- LSHTM-COMAHS Research Partnership, Kambia District, Sierra Leone
| | - Kambale Kasonia
- LSHTM-INRB Research Partnership, Goma, Democratic Republic of the Congo
| | - Abdoulie Drammeh
- LSHTM-COMAHS Research Partnership, Kambia District, Sierra Leone
| | - Brett Lowe
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Daniel Mukadi-Bamuleka
- Laboratoire Rodolphe Merieux-Institute National Research biomedical (INRB), Goma, Democratic Republic of the Congo
| | - Catriona Patterson
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Brian Greenwood
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Mohamed Samai
- University of Sierra Leone College of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone
| | - Bailah Leigh
- University of Sierra Leone College of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone
| | - Kevin K A Tetteh
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | | | - Deborah Watson-Jones
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Hugo Kavunga-Membo
- Laboratoire Rodolphe Merieux-Institute National Research biomedical (INRB), Goma, Democratic Republic of the Congo
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