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Youkee D, Deen GF, Sackley C, Lisk DR, Marshall I, Soley-Bori M. Quality of life and quality-adjusted life years after stroke in Sierra Leone. Int J Stroke 2024:17474930241249589. [PMID: 38651761 DOI: 10.1177/17474930241249589] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Stroke is a leading cause of mortality and negatively affects health-related quality of life (HRQoL). HRQoL after stroke is understudied in Africa and there are no reports of quality-adjusted life years after stroke (QALYs) in African countries. We determined the impact of stroke on HRQoL after stroke in Sierra Leone. We calculated QALYs at 1 year post-stroke and determined sociodemographic and clinical variables associated with HRQoL and QALYs in this population. METHODS A prospective stroke register was established at the two-principal adult tertiary government hospitals in Freetown, Sierra Leone. Participants were followed up at 7, 90 days, and 1 year post-stroke to capture all-cause mortality and EQ-5D-3L data. QALYs were calculated at the patient level using EQ-5D-3L utility values and survival data from the register, following the area under the curve method. Utilities were based on the UK and Zimbabwe (as a sensitivity analysis) EQ-5D value sets, as there is no Sierra Leonean or West African value set. Explanatory models were developed based on previous literature to assess variables associated with HRQoL and QALYs at 1 year after stroke. To address missing values, Multiple Imputation by Chained Equations (MICE), with linear and logistic regression models for continuous and binary variables, respectively, were used. RESULTS EQ-5D-3L data were available for 373/460 (81.1%), 360/367 (98.1%), and 299/308 (97.1%) participants at 7, 90 days, and 1 year after stroke. For stroke survivors, median EQ-5D-3L utility increased from 0.20 (95% CI: -0.16 to 0.59) at 7 days post-stroke to 0.76 (0.47 to 1.0) at 90 days and remained stable at 1 year 0.76 (0.49 to 1.0). Mean QALYs at 1 year after stroke were 0.28 (SD: 0.35) and closely associated with stroke severity. Older age, lower educational attainment, patients with subarachnoid hemorrhage and undetermined stroke types all had lower QALYs and lower HRQoL, while being the primary breadwinner was associated with higher HRQoL. Sensitivity analysis with the Zimbabwe value set did not significantly change regression results but did influence the absolute values with Zimbabwe utility values being higher, with fewer utility values less than 0. CONCLUSION We generated QALYs after stroke for the first time in an African country. QALYs were significantly lower than studies from outside Africa, partially explained by the high mortality rate in our cohort. Further research is needed to develop appropriate value sets for West African countries and to examine QALYs lost due to stroke over longer time periods. DATA AVAILABILITY The Stroke in Sierra Leone anonymized dataset is available on request to researchers, see data access section.
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Affiliation(s)
- Daniel Youkee
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
| | | | - Durodami R Lisk
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
| | - Iain Marshall
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Marina Soley-Bori
- School of Life Course & Population Sciences, King's College London, London, UK
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Youkee D, Pessima S, Sackley C, Soley-Bori M, Deen GF, Marshall IJ. The feasibility, repeatability, validity and responsiveness of the EQ-5D-3L in Krio for patients with stroke in Sierra Leone. Health Qual Life Outcomes 2024; 22:29. [PMID: 38549069 PMCID: PMC10976786 DOI: 10.1186/s12955-024-02246-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] [Received: 01/25/2024] [Accepted: 03/22/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES To assess the feasibility, repeatability, validity and responsiveness of the EQ-5D-3L in Krio for patients with stroke in Sierra Leone, the first psychometric assessment of the EQ-5D-3L to be conducted in patients with stroke in Sub Saharan Africa. METHODS A prospective stroke register at two tertiary government hospitals recruited all patients with the WHO definition of stroke and followed patients up at seven days, 90 days and one year post stroke. The newly translated EQ-5D-3L, Barthel Index (BI), modified Rankin Scale (mRS) and National Institute of Health Stroke Scale (NIHSS), a measure of stroke severity, were collected by trained researchers, face to face during admission and via phone at follow up. Feasibility was assessed by completion rate and proportion of floor/ceiling effects. Internal consistency was assessed by inter item correlations (IIC) and Cronbach's alpha. Repeatability of the EQ-5D-3L was examined using test-retest, EQ-5D-3L utility scores at 90 days were compared to EQ-5D-3L utility scores at one year in the same individuals, whose Barthel Index had remained within the minimally clinical important difference. Known group validity was assessed by stroke severity. Convergent validity was assessed against the BI, using Spearman's rho. Responsiveness was assessed in patients whose BI improved or deteriorated from seven to 90 days. Sensitivity analyses were conducted using the UK and Zimbabwe value sets, to evaluate the effect of value set, in a subgroup of patients with no formal education to evaluate the influence of patient educational attainment, and using the mRS instead of the BI to evaluate the influence of utilising an alternative functional scale. RESULTS The EQ-5D-3L was completed in 373/460 (81.1%), 360/367 (98.1%) and 299/308 (97.1%) eligible patients at seven days, 90 days and one year post stroke. Missing item data was low overall, but was highest in the anxiety/depression dimension 1.3% (5/373). Alpha was 0.81, 0.88 and 0.86 at seven days, 90 days and one year post stroke and IIC were within pre-specified ranges. Repeatability of the EQ-5D-3L was moderate to poor, weighted Kappa 0.23-0.49. EQ-5D-3L utility was significantly associated with stroke severity at all timepoints. Convergent validity with BI was strong overall and for shared subscales. EQ-5D-3L was moderately responsive to both improvement Cohen's D 0.55 (95% CI:0.15-0.94) and deterioration 0.92 (95% CI:0.29-1.55). Completion rates were similar in patients with no formal education 148/185 (80.0%) vs those with any formal education 225/275 (81.8%), and known group validity for stroke severity in patients with no formal education was strong. Using the Zimbabwe value set instead of the UK value set, and using the mRS instead of the BI did not change the direction or significance of results. CONCLUSIONS The EQ-5D-3L for stroke in Sierra Leone was feasible, and responsive including in patients with no formal education. However, repeatability was moderate to poor, which may be due to the study design, but should add a degree of caution in the analysis of repeated measures of EQ-5D-3L over time in this population. Known group validity and convergent validity with BI and mRS were strong. Further research should assess the EQ-5D in the general population, examine test-retest reliability over a shorter time period and assess the acceptability and validity of the anxiety/depression dimension against other validated mental health instruments. Development of an EQ-5D value set for West Africa should be a research priority.
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Affiliation(s)
- Daniel Youkee
- King's School of Life Course and Population Sciences, King's College London, London, UK.
| | - Sahr Pessima
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Catherine Sackley
- School of Medicine and Rehabilitation, University of Nottingham, Nottingham, UK
| | - Marina Soley-Bori
- 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
| | - Iain J Marshall
- King's School of Life Course and Population Sciences, King's College London, London, UK
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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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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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Youkee D, Lahai M, Mansaray AR, Samura S, Bunn J, Lakoh S, Sevalie S. Improving the quality of COVID-19 care in Sierra Leone: A modified Delphi process and serial nationwide assessments of quality of COVID-19 care in Sierra Leone. PLOS Glob Public Health 2023; 3:e0002670. [PMID: 38055688 PMCID: PMC10699596 DOI: 10.1371/journal.pgph.0002670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Improving the quality of care that patients receive is paramount to improving patient outcomes and engendering trust during infectious disease outbreaks. Whilst Quality Improvement (QI) is well established to drive improvement in routine care and in health systems, there are fewer reports of its use during infectious disease outbreaks. METHODS A modified Delphi process was undertaken to create a standardized assessment tool for the quality of COVID-19 care in Sierra Leone. Four rounds of assessment were undertaken between July 2020 and July 2021. To assess change across the four assessment periods compared to baseline we used a mixed effects model and report coefficients and p values. RESULTS During the Delphi process, 12/14 participants selected the domains to be assessed within the tool. The final 50 questions included 13 outcome questions, 17 process questions and 20 input questions. A total of 94 assessments were undertaken over four assessment periods at 27 facilities. An increase of 8.75 (p = <0.01) in total score was seen in round 2, 10.67 (p = <0.01) in round 3 and 2.17 (p = 0.43) in round 4 compared to baseline. Mean cumulative scores for COVID-19 Treatment Centres were higher than Hospital Isolation Units (p<0.02) at all four timepoints. Significant improvements were reported in coordination, diagnostics, staffing, infection prevention and control (IPC), nutrition, and vulnerable populations domains, but not in the oxygen, care processes, infrastructure and drugs domains. CONCLUSION We demonstrate the feasibility of creating a quality of care assessment tool and conducting sequential nationwide assessments during an infectious disease outbreak. We report significant improvements in quality-of-care scores in round 2 and round 3 compared to baseline, however, these improvements were not sustained. We recommend the use of QI and the creation of standardised assessment tools to improve quality of care during outbreak responses.
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Affiliation(s)
- Daniel Youkee
- National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
- King’s College London, King’s Global Health Partnerships, School of Life Course and Population Health Sciences, London, United Kingdom
| | - Michael Lahai
- National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdul R. Mansaray
- National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sorie Samura
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - James Bunn
- Foreign Commonwealth and Development Office, British High Commission, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Stephen Sevalie
- National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- 34th Military Hospital, Wilberforce, Freetown, Sierra Leone
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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 PMCID: PMC11070751 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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Youkee D, Deen GF, Baldeh M, Conteh ZF, Fox-Rushby J, Gbessay M, Johnson J, Langhorne P, Leather AJ, Lisk DR, Marshall IJ, O'Hara J, Pessima S, Rudd A, Soley-Bori M, Thompson M, Wafa H, Wang Y, Watkins CL, Williams CE, Wolfe CDA, Sackley CM. Stroke in Sierra Leone: Case fatality rate and functional outcome after stroke in Freetown. Int J Stroke 2023:17474930231164892. [PMID: 36905336 DOI: 10.1177/17474930231164892] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
BACKGROUND There is limited information on long-term outcomes after stroke in sub-Saharan Africa (SSA). Current estimates of case fatality rate (CFR) in SSA are based on small sample sizes with varying study design and report heterogeneous results. AIMS We report CFR and functional outcomes from a large, prospective, longitudinal cohort of stroke patients in Sierra Leone and describe factors associated with mortality and functional outcome. METHODS A prospective longitudinal stroke register was established at both adult tertiary government hospitals in Freetown, Sierra Leone. It recruited all patients ⩾ 18 years with stroke, using the World Health Organization definition, from May 2019 until October 2021. To reduce selection bias onto the register, all investigations were paid by the funder and outreach conducted to raise awareness of the study. Sociodemographic data, National Institute of Health Stroke Scale (NIHSS), and Barthel Index (BI) were collected on all patients on admission, at 7 days, 90 days, 1 year, and 2 years post stroke. Cox proportional hazards models were constructed to identify factors associated with all-cause mortality. A binomial logistic regression model reports odds ratio (OR) for functional independence at 1 year. RESULTS A total of 986 patients with stroke were included, of which 857 (87%) received neuroimaging. Follow-up rate was 82% at 1 year, missing item data were <1% for most variables. Stroke cases were equally split by sex and mean age was 58.9 (SD: 14.0) years. About 625 (63%) were ischemic, 206 (21%) primary intracerebral hemorrhage, 25 (3%) subarachnoid hemorrhage, and 130 (13%) were of undetermined stroke type. Median NIHSS was 16 (9-24). CFR at 30 days, 90 days, 1 year, and 2 years was 37%, 44%, 49%, and 53%, respectively. Factors associated with increased fatality at any timepoint were male sex (hazard ratio (HR): 1.28 (1.05-1.56)), previous stroke (HR: 1.34 (1.04-1.71)), atrial fibrillation (HR: 1.58(1.06-2.34)), subarachnoid hemorrhage (HR: 2.31 (1.40-3.81)), undetermined stroke type (HR: 3.18 (2.44-4.14)), and in-hospital complications (HR: 1.65 (1.36-1.98)). About 93% of patients were completely independent prior to their stroke, declining to 19% at 1 year after stroke. Functional improvement was most likely to occur between 7 and 90 days post stroke with 35% patients improving, and 13% improving between 90 days to 1 year. Increasing age (OR: 0.97 (0.95-0.99)), previous stroke (OR: 0.50 (0.26-0.98)), NIHSS (OR: 0.89 (0.86-0.91)), undetermined stroke type (OR: 0.18 (0.05-0.62)), and ⩾1 in-hospital complication (OR: 0.52 (0.34-0.80)) were associated with lower OR of functional independence at 1 year. Hypertension (OR: 1.98 (1.14-3.44)) and being the primary breadwinner of the household (OR: 1.59 (1.01-2.49)) were associated with functional independence at 1 year. CONCLUSION Stroke affected younger people and resulted in high rates of fatality and functional impairment relative to global averages. Key clinical priorities for reducing fatality include preventing stroke-related complications through evidence-based stroke care, improved detection and management of atrial fibrillation, and increasing coverage of secondary prevention. Further research into care pathways and interventions to encourage care seeking for less severe strokes should be prioritized, including reducing the cost barrier for stroke investigations and care.
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Affiliation(s)
- Daniel Youkee
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
- Connaught Teaching Hospital, University of Sierra Leone Teaching Hospital Complex, Freetown, Freetown, Sierra Leone
| | - Mamadu Baldeh
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
| | - Zainab F Conteh
- Connaught Teaching Hospital, University of Sierra Leone Teaching Hospital Complex, Freetown, Freetown, Sierra Leone
| | - Julia Fox-Rushby
- School of Life Course & Population Sciences, King's College London, London, UK
- Collaboration for Leadership in Applied Health Research and Care South London, National Institute for Health Research, London, UK
| | | | | | - Peter Langhorne
- Academic Section of Geriatric Medicine, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Andrew Jm Leather
- King's Centre for Global Health and Health Partnerships, School of Life Course & Population Sciences, King's College London, London, UK
| | - Durodami R Lisk
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
| | - Iain J Marshall
- School of Life Course & Population Sciences, King's College London, London, UK
- Collaboration for Leadership in Applied Health Research and Care South London, National Institute for Health Research, London, UK
| | - Jessica O'Hara
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Sahr Pessima
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
| | - Anthony Rudd
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Marina Soley-Bori
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Melvina Thompson
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
- Connaught Teaching Hospital, University of Sierra Leone Teaching Hospital Complex, Freetown, Freetown, Sierra Leone
| | - Hatem Wafa
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Yanzhong Wang
- School of Life Course & Population Sciences, King's College London, London, UK
- Collaboration for Leadership in Applied Health Research and Care South London, National Institute for Health Research, London, UK
| | - Caroline L Watkins
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Christine E Williams
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
| | - Charles DA Wolfe
- School of Life Course & Population Sciences, King's College London, London, UK
- Collaboration for Leadership in Applied Health Research and Care South London, National Institute for Health Research, London, UK
| | - Catherine M Sackley
- School of Life Course & Population Sciences, King's College London, London, UK
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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Farrant O, Baldeh M, Kamara JB, Bailey E, Sevalie S, Deen G, Russell JBW, Youkee D, Leather AJ, Davies J, Lakoh S. All-cause mortality of hospitalised patients with suspected COVID-19 in Sierra Leone: a prospective cohort study. BMJ Open 2023; 13:e057369. [PMID: 36858470 PMCID: PMC9979583 DOI: 10.1136/bmjopen-2021-057369] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/05/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVES To study the mortality of patients with COVID-19 in Sierra Leone, to explore the factors associated with mortality during the COVID-19 pandemic and to highlight the complexities of treating patients with a novel epidemic disease in a fragile health system. STUDY DESIGN A prospective single-centre cohort study. Data were extracted from paper medical records and transferred onto an electronic database. Specific indicators were compared between survivors and non-survivors, using descriptive statistics in Stata V.17. STUDY SETTING The infectious diseases unit (IDU) at Connaught Hospital in Freetown, Sierra Leone PARTICIPANTS: Participants were all patients admitted to the IDU between March and July 2020. AIMS OF STUDY The primary outcome of the study was to examine the all-cause mortality of hospitalised patients with suspected COVID-19 in Sierra Leone and the secondary outcome measures were to examine factors associated with mortality in patients positive for COVID-19. RESULTS 261 participants were included in the study. Overall, 41.3% of those admitted to the IDU died, compared with prepandemic in-hospital mortality of 23.8%. Factors contributing to the higher mortality were COVID-19 infection (aOR 5.61, 95% CI 1.19 to 26.30, p=0.02) and hypertension (aOR 9.30, 95% CI 1.18 to 73.27, p=0.03) CONCLUSIONS: This study explores the multiple factors underpinning a doubling in facility mortality rate during the COVID-19 pandemic in Sierra Leone . It provides an insight into the realities of providing front-line healthcare during a pandemic in a fragile health system.
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Affiliation(s)
- Olivia Farrant
- Centre for Global Health Partnerships, King's College London, London, UK
- Kings Global Health Partnerships, Freetown, Sierra Leone
| | - Mamadu Baldeh
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joseph Baio Kamara
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Emma Bailey
- Centre for Global Health Partnerships, King's College London, London, UK
- Kings Global Health Partnerships, Freetown, Sierra Leone
| | | | - Gibrilla Deen
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - James Baligeh Walter Russell
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Daniel Youkee
- Centre for Global Health Partnerships, King's College London, London, UK
| | - Andy Jm Leather
- Centre for Global Health Partnerships, King's College London, London, UK
| | - Justine Davies
- Centre for Global Health Partnerships, King's College London, London, UK
| | - Sulaiman Lakoh
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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9
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Gao Y, Zhao Y, Guyatt G, Fowler R, Kojan R, Ge L, Tian J, Hao Q, Lado M, Youkee D, Ahmad A, Albertson C, Caluwaerts S, Camara M, Crozier I, De Clerck H, Dunachie S, Fischer WA, Jamil B, Kabongo P, Kabuni P, Ngorombi CK, Kakule M, Kolié MC, Lakoh S, Lang HJ, Moses JS, Fiston IM, Mulumba PM, Murthy S, Samura S, Couban R. Effects of therapies for Ebola virus disease: a systematic review and network meta-analysis. Lancet Microbe 2022; 3:e683-e692. [PMID: 35803293 PMCID: PMC9441701 DOI: 10.1016/s2666-5247(22)00123-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/08/2022] [Accepted: 05/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Specific treatments targeting Ebola virus are crucial in managing Ebola virus disease. To support the development of clinical practice guidelines on medications for Ebola virus disease, we aimed to evaluate the efficacy and safety of therapies for patients with Ebola virus disease. METHODS In this systematic review and network meta-analysis, we searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Scopus, Global Health, African Index Medicus, World Health Organization Global Index Medicus, the Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, Epistemonikos, bioRxiv, medRxiv, and SSRN without language restrictions for randomised controlled trials (RCTs) published between database inception and Jan 1, 2022, comparing at least one therapeutic agent for Ebola virus disease against standard care or another therapeutic agent for Ebola virus disease. Two reviewers assessed study eligibility and extracted summary data independently using a standardised form. Our outcomes of interest were mortality, adverse maternal outcomes, risk of onward transmission, duration of admission to a health-care facility, functional status after Ebola virus disease, serious adverse events from medication, adverse perinatal outcomes, time to symptom resolution, and time to viral clearance. We did frequentist network meta-analyses to estimate the effect of all interventions and applied the Grading of Recommendations Assessment, Development and Evaluation approach to rate the certainty of the evidence. We registered the protocol with PROSPERO, CRD42022296539. FINDINGS We identified 7840 records through database searches, of which two RCTs with a total of 753 patients proved eligible. Only data on mortality, the duration of admission, serious adverse events, and time to viral clearance were available for meta-analysis. Compared with standard care, REGN-EB3 (relative risk [RR] 0·40, 95% CI 0·18 to 0·89; moderate certainty) and mAb114 (0·42, 0·19 to 0·93; moderate certainty) probably reduce mortality. Whether ZMapp (0·60, 0·28 to 1·26; very low certainty) and remdesivir (0·64, 0·29 to 1·39; very low certainty) reduce mortality compared with standard care is uncertain. With high certainty, REGN-EB3 reduces mortality compared with ZMapp (0·67, 0·52 to 0·88) and remdesivir (0·63, 0·49 to 0·82). With high certainty, mAb114 also reduces mortality compared with ZMapp (0·71, 0·55 to 0·91) and remdesivir (0·66, 0·52 to 0·84). Compared with standard care, REGN-EB3, mAb114, ZMapp, and remdesivir might have little or no effect on the time to viral clearance (mean difference ranged from -0·25 days to -1·14 days; low certainty). ZMapp might reduce the duration of admission compared with standard care (mean difference -2·02 days, 95% CI -4·05 to 0·01; low certainty). Findings for all comparisons suggested that there might be little or no difference in the prevalence of serious adverse events, but certainty was low or very low in all comparisons but one. INTERPRETATION REGN-EB3 and mAb114 separately reduce mortality compared with ZMapp, remdesivir, or standard care in patients with Ebola virus disease. These findings suggest that health-care workers should prioritise the use of REGN-EB3 and mAb114 for patients with Ebola virus disease during future outbreaks. FUNDING WHO.
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Affiliation(s)
- Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Yunli Zhao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada,National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Robert Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Richard Kojan
- Alliance for International Medical Action, Dakar, Senegal
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | | | - Qiukui Hao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada,Correspondence to: Dr Qiukui Hao, Department of Health Research Methods, Evidence, and Impact and School of Rehabilitation Science, McMaster University, Hamilton, ON L8S 4L8, Canada
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10
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Caviglia M, Putoto G, Conti A, Tognon F, Jambai A, Vandy MJ, Youkee D, Buson R, Pini S, Rosi P, Hubloue I, Della Corte F, Ragazzoni L, Barone-Adesi F. Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study. BMJ Glob Health 2021; 6:e007315. [PMID: 34844999 PMCID: PMC8634006 DOI: 10.1136/bmjgh-2021-007315] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Sierra Leone, one of the countries with the highest maternal and perinatal mortality in the world, launched its first National Emergency Medical Service (NEMS) in 2018. We carried out a countrywide assessment to analyse NEMS operational times for obstetric emergencies in respect the access to timely essential surgery within 2 hours. Moreover, we evaluated the relationship between operational times and maternal and perinatal mortality. METHODS We collected prehospital data of 6387 obstetric emergencies referrals from primary health units to hospital facilities between June 2019 and May 2020 and we estimated the proportion of referrals with a prehospital time (PT) within 2 hours. The association between PT and mortality was investigated using Poisson regression models for binary data. RESULTS At the national level, the proportion of emergency obstetric referrals with a PT within 2 hours was 58.5% (95% CI 56.9% to 60.1%) during the rainy season and 61.4% (95% CI 59.5% to 63.2%) during the dry season. Results were substantially different between districts, with the capital city of Freetown reporting more than 90% of referrals within the benchmark and some rural districts less than 40%. Risk of maternal death at 60, 120 and 180 min of PT was 1.8%, 3.8% and 4.3%, respectively. Corresponding figures for perinatal mortality were 16%, 18% and 25%. CONCLUSION NEMS operational times for obstetric emergencies in Sierra Leone vary greatly and referral transports in rural areas struggle to reach essential surgery within 2 hours. Maternal and perinatal risk of death increased concurrently with operational times, even beyond the 2-hour target, therefore, any reduction of the time to reach the hospital, may translate into improved patient outcomes.
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Affiliation(s)
- Marta Caviglia
- CRIMEDIM - 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, Italy
| | - Giovanni Putoto
- Research Section, Doctors with Africa CUAMM, Padova, Veneto, Italy
| | - Andrea Conti
- CRIMEDIM - 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, Italy
| | - Francesca Tognon
- Research Section, Doctors with Africa CUAMM, Padova, Veneto, Italy
| | - Amara Jambai
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Western Area, Sierra Leone
| | - Matthew Jusu Vandy
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Western Area, Sierra Leone
| | - Daniel Youkee
- School of population health and environmental sciences, King's College London, London, UK
| | - Riccardo Buson
- Research Section, Doctors with Africa CUAMM, Padova, Veneto, Italy
- Cuamm Medical Doctors for Africa, Padova, Veneto, Italy
| | - Sara Pini
- Research Section, Doctors with Africa CUAMM, Padova, Veneto, Italy
- Cuamm Medical Doctors for Africa, Padova, Veneto, Italy
| | - Paolo Rosi
- SUEM 118 - Servizio Urgenza Emergenza Medica, Azienda ULSS 3 Serenissima, Venezia, Veneto, Italy
| | - Ives Hubloue
- Research Group on Emergency and Disaster Medicine, VUB, Brussel, Belgium
| | - Francesco Della Corte
- CRIMEDIM - 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, Italy
| | - Luca Ragazzoni
- CRIMEDIM - 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, Italy
| | - Francesco Barone-Adesi
- CRIMEDIM - 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, Italy
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11
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Sevalie S, Youkee D, van Duinen AJ, Bailey E, Bangura T, Mangipudi S, Mansaray E, Odland ML, Parmar D, Samura S, van Delft D, Wurie H, Davies JI, Bolkan HA, Leather AJM. The impact of the COVID-19 pandemic on hospital utilisation in Sierra Leone. BMJ Glob Health 2021; 6:e005988. [PMID: 34635552 PMCID: PMC8506048 DOI: 10.1136/bmjgh-2021-005988] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/29/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has adversely affected health systems in many countries, but little is known about effects on health systems in sub-Saharan Africa. This study examines the effects of COVID-19 on hospital utilisation in a sub-Saharan country, Sierra Leone. METHODS Mixed-methods study using longitudinal nationwide hospital data (admissions, operations, deliveries and referrals) and qualitative interviews with healthcare workers and patients. Hospital data were compared across quarters (Q) in 2020, with day 1 of Q2 representing the start of the pandemic in Sierra Leone. Admissions are reported in total and disaggregated by sex, service (surgical, medical, maternity and paediatric) and hospital type (government or private non-profit). Referrals in 2020 were compared with 2019 to assess whether any changes were the result of seasonality. Comparisons were performed using Student's t-test. Qualitative data were analysed using thematic analysis. RESULTS From Q1 to Q2, weekly mean hospital admissions decreased by 14.7% (p=0.005). Larger decreases were seen in male 18.8% than female 12.5% admissions. The largest decreases were in surgical admissions, a 49.8% decrease (p<0.001) and medical admissions, a 28.7% decrease (p=0.002). Paediatric and maternity admissions did not significantly change. Total operations decreased by 13.9% (p<0.001), while caesarean sections and facility-based deliveries showed significant increases: 12.7% (p=0.014) and 7.5% (p=0.03), respectively. In Q3, total admissions remained 13.2% lower (p<0.001) than Q1. Mean weekly referrals were lower in Q2 and Q3 of 2020 compared with 2019, suggesting findings were unlikely to be seasonal. Qualitative analysis identified both supply-side factors, prioritisation of essential services, introduction of COVID-19 services and pausing elective care, and demand-side factors, fear of nosocomial infection and financial hardship. CONCLUSION The study demonstrated a decrease in hospital utilisation during COVID-19, the decrease is less than reported in other countries during COVID-19 and less than reported during the Ebola epidemic.
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Affiliation(s)
- Stephen Sevalie
- 34th Military Hospital, Wilberforce, Freetown, Sierra Leone
- Case Management Pillar, National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
| | - Daniel Youkee
- Case Management Pillar, National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - A J van Duinen
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Surgery, St Olavs Hospital University Hospital in Trondheim, Trondheim, Norway
| | - Emma Bailey
- King's Centre for Global Health and Health Partnerships, King's College London School of Population Health and Environmental Sciences, London, UK
| | - Thaimu Bangura
- King's Centre for Global Health and Health Partnerships, King's College London School of Population Health and Environmental Sciences, London, UK
| | - Sowmya Mangipudi
- King's Centre for Global Health and Health Partnerships, King's College London School of Population Health and Environmental Sciences, London, UK
| | - Esther Mansaray
- King's Centre for Global Health and Health Partnerships, King's College London School of Population Health and Environmental Sciences, London, UK
| | - Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Birmingham, Birmingham, UK
| | - Divya Parmar
- King's Centre for Global Health and Health Partnerships, King's College London School of Population Health and Environmental Sciences, London, UK
| | - Sorie Samura
- King's Centre for Global Health and Health Partnerships, King's College London School of Population Health and Environmental Sciences, London, UK
| | | | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Western Area, Sierra Leone
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, Birmingham, UK
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - H A Bolkan
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Surgery, St Olavs Hospital University Hospital in Trondheim, Trondheim, Norway
| | - Andrew J M Leather
- King's Centre for Global Health and Health Partnerships, King's College London School of Population Health and Environmental Sciences, London, UK
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12
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Youkee D, Deen G, Barrett E, Fox-Rushby J, Johnson I, Langhorne P, Leather A, Marshall IJ, O'Hara J, Rudd A, Sama A, Scott C, Thompson M, Wafa H, Wall J, Wang Y, Watkins C, Wolfe C, Lisk DR, Sackley CM. A Prospective Stroke Register in Sierra Leone: Demographics, Stroke Type, Stroke Care and Hospital Outcomes. Front Neurol 2021; 12:712060. [PMID: 34557147 PMCID: PMC8453059 DOI: 10.3389/fneur.2021.712060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Stroke is the second most common cause of adult death in Africa. This study reports the demographics, stroke types, stroke care and hospital outcomes for stroke in Freetown, Sierra Leone. Methods: A prospective observational register recorded all patients 18 years and over with stroke between May 2019 and April 2020. Stroke was defined according to the WHO criteria. Pearson's chi-squared test was used to examine associations between categorical variables and unpaired t-tests for continuous variables. Multivariable logistic regression, to explain in-hospital death, was reported as odds ratios (ORs) and 95% confidence intervals. Results: Three hundred eighty-five strokes were registered, and 315 (81.8%) were first-in-a-lifetime events. Mean age was 59.2 (SD 13.8), and 187 (48.6%) were male. Of the strokes, 327 (84.9%) were confirmed by CT scan. Two hundred thirty-one (60.0%) were ischaemic, 85 (22.1%) intracerebral haemorrhage, 11 (2.9%) subarachnoid haemorrhage and 58 (15.1%) undetermined stroke type. The median National Institutes of Health Stroke Scale on presentation was 17 [interquartile range (IQR) 9-25]. Haemorrhagic strokes compared with ischaemic strokes were more severe, 20 (IQR 12-26) vs. 13 (IQR 7-22) (p < 0.001), and occurred in a younger population, mean age 52.3 (SD 12.0) vs. 61.6 (SD 13.8) (p < 0.001), with a lower level of educational attainment of 28.2 vs. 40.7% (p = 0.04). The median time from stroke onset to arrival at the principal referral hospital was 25 hours (IQR 6-73). Half of the patients (50.4%) sought care at another health provider prior to arrival. One hundred fifty-one patients died in the hospital (39.5%). Forty-three deaths occurred within 48 hours of arriving at the hospital, with median time to death of 4 days (IQR 0-7 days). Of the patients, 49.6% had ≥1 complication, 98 (25.5%) pneumonia and 33 (8.6%) urinary tract infection. Male gender (OR 3.33, 1.65-6.75), pneumonia (OR 3.75, 1.82-7.76), subarachnoid haemorrhage (OR 43.1, 6.70-277.4) and undetermined stroke types (OR 6.35, 2.17-18.60) were associated with higher risk of in-hospital death. Discussion: We observed severe strokes occurring in a young population with high in-hospital mortality. Further work to deliver evidence-based stroke care is essential to reduce stroke mortality in Sierra Leone.
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Affiliation(s)
- Daniel Youkee
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,*Correspondence: Daniel Youkee
| | - Gibrilla Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Edward Barrett
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Julia Fox-Rushby
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,National Institute for Health Research, Biomedical Research Centre, Guy and ST Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Israel Johnson
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Andrew Leather
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Iain J. Marshall
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Jessica O'Hara
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Anthony Rudd
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Albert Sama
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Christella Scott
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Melvina Thompson
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Hatem Wafa
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Jurate Wall
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Yanzhong Wang
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,National Institute for Health Research, Biomedical Research Centre, Guy and ST Thomas' NHS Foundation Trust and King's College London, London, United Kingdom,NIHR Applied Research Collaboration South London, London, United Kingdom
| | - Caroline Watkins
- Faculty of Health and Care, University of Central Lancashire, Preston, United Kingdom
| | - Charles Wolfe
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,National Institute for Health Research, Biomedical Research Centre, Guy and ST Thomas' NHS Foundation Trust and King's College London, London, United Kingdom,NIHR Applied Research Collaboration South London, London, United Kingdom
| | - Durodami Radcliffe Lisk
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Catherine Mary Sackley
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,Division of Stroke Medicine, University of Nottingham, Nottingham, United Kingdom
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13
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Fitzgerald F, Wing K, Naveed A, Gbessay M, Ross J, Checchi F, Youkee D, Jalloh MB, Baion DE, Mustapha A, Jah H, Lako S, Oza S, Boufkhed S, Feury R, Bielicki J, Williamson E, Gibb DM, Klein N, Sahr F, Yeung S. Development of a Pediatric Ebola Predictive Score, Sierra Leone 1. Emerg Infect Dis 2019; 24:311-319. [PMID: 29350145 PMCID: PMC5782873 DOI: 10.3201/eid2402.171018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We compared children who were positive for Ebola virus disease (EVD) with those who were negative to derive a pediatric EVD predictor (PEP) score. We collected data on all children <13 years of age admitted to 11 Ebola holding units in Sierra Leone during August 2014–March 2015 and performed multivariable logistic regression. Among 1,054 children, 309 (29%) were EVD positive and 697 (66%) EVD negative, with 48 (5%) missing. Contact history, conjunctivitis, and age were the strongest positive predictors for EVD. The PEP score had an area under receiver operating characteristics curve of 0.80. A PEP score of 7/10 was 92% specific and 44% sensitive; 3/10 was 30% specific, 94% sensitive. The PEP score could correctly classify 79%–90% of children and could be used to facilitate triage into risk categories, depending on the sensitivity or specificity required.
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14
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Fitzgerald F, Naveed A, Wing K, Gbessay M, Ross JCG, Checchi F, Youkee D, Jalloh MB, Baion D, Mustapha A, Jah H, Lako S, Oza S, Boufkhed S, Feury R, Bielicki JA, Gibb DM, Klein N, Sahr F, Yeung S. Ebola Virus Disease in Children, Sierra Leone, 2014-2015. Emerg Infect Dis 2018; 22:1769-77. [PMID: 27649367 PMCID: PMC5038433 DOI: 10.3201/eid2210.160579] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Children died rapidly, more than half in Ebola holding units before transfer to treatment units. Little is known about potentially modifiable factors in Ebola virus disease in children. We undertook a retrospective cohort study of children <13 years old admitted to 11 Ebola holding units in the Western Area, Sierra Leone, during 2014–2015 to identify factors affecting outcome. Primary outcome was death or discharge after transfer to Ebola treatment centers. All 309 Ebola virus–positive children 2 days–12 years old were included; outcomes were available for 282 (91%). Case-fatality was 57%, and 55% of deaths occurred in Ebola holding units. Blood test results showed hypoglycemia and hepatic/renal dysfunction. Death occurred swiftly (median 3 days after admission) and was associated with younger age and diarrhea. Despite triangulation of information from multiple sources, data availability was limited, and we identified no modifiable factors substantially affecting death. In future Ebola virus disease epidemics, robust, rapid data collection is vital to determine effectiveness of interventions for children.
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15
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Houlihan CF, Youkee D, Brown CS. Novel surveillance methods for the control of Ebola virus disease. Int Health 2017; 9:139-141. [PMID: 28582554 DOI: 10.1093/inthealth/ihx010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/07/2017] [Indexed: 11/14/2022] Open
Abstract
The unprecedented scale of the 2013-2016 West African Ebola virus disease (EVD) outbreak was in a large part due to failings in surveillance: contacts of confirmed cases were not systematically identified, monitored and diagnosed early, and new cases appearing in previously unaffected communities were similarly not rapidly identified, diagnosed and isolated. Over the course of this epidemic, traditional surveillance methods were strengthened and novel methods introduced. The wealth of experience gained, and the systems introduced in West Africa, should be used in future EVD outbreaks, as well as for other communicable diseases in the region and beyond.
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Affiliation(s)
- C F Houlihan
- London School of Hygiene & Tropical Medicine, London, UK.,University College London, London, UK
| | - D Youkee
- King´s Sierra Leone Partnership, King's Centre for Global Health, King's College London, London, UK
| | - C S Brown
- King´s Sierra Leone Partnership, King's Centre for Global Health, King's College London, London, UK.,National Infection Service, Public Health England, London, UK
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16
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Fitzgerald F, Wing K, Naveed A, Gbessay M, Ross JCG, Checchi F, Youkee D, Jalloh MB, Baion D, Mustapha A, Jah H, Lako S, Oza S, Boufkhed S, Feury R, Bielicki J, Williamson E, Gibb DM, Klein N, Sahr F, Yeung S. Risk in the "Red Zone": Outcomes for Children Admitted to Ebola Holding Units in Sierra Leone Without Ebola Virus Disease. Clin Infect Dis 2017; 65:162-165. [PMID: 28369236 PMCID: PMC5693324 DOI: 10.1093/cid/cix223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/10/2017] [Indexed: 11/13/2022] Open
Abstract
We collected data on 1054 children admitted to Ebola Holding Units in Sierra Leone and describe outcomes of 697/1054 children testing negative for Ebola virus disease (EVD) and accompanying caregivers. Case-fatality was 9%; 3/630 (0.5%) children discharged testing negative were readmitted EVD-positive. Nosocomial EVD transmission risk may be lower than feared.
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Affiliation(s)
- F Fitzgerald
- Infection, Immunity, Inflammation and Physiological Medicine, UCL Great Ormond Street Institute of Child Health, United Kingdom
- Save the Children, Sierra Leone and United Kingdom
| | - K Wing
- Save the Children, Sierra Leone and United Kingdom
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, and
| | - A Naveed
- Save the Children, Sierra Leone and United Kingdom
| | - M Gbessay
- Save the Children, Sierra Leone and United Kingdom
| | - JCG Ross
- Save the Children, Sierra Leone and United Kingdom
| | - F Checchi
- Save the Children, Sierra Leone and United Kingdom
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, and
| | - D Youkee
- Kings Sierra Leone Partnership, Kings Centre for Global Health, Kings College London, United Kingdom
| | - MB Jalloh
- 34 Military Hospital, Republic of Sierra Leone Armed Forces, Freetown
| | - D Baion
- Ola During Children’s Hospital, Sierra Leone Ministry of Health, Freetown
| | - A Mustapha
- Ola During Children’s Hospital, Sierra Leone Ministry of Health, Freetown
| | - H Jah
- Cap Anamur (German Emergency Doctors), Ola During Children’s Hospital, Freetown, and
| | - S Lako
- Welbodi Partnership, Ola During Children’s Hospital, Freetown, Sierra Leone
| | - S Oza
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, and
| | - S Boufkhed
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
| | - R Feury
- Western Area Emergency Response Centre, Freetown, Sierra Leone
| | | | - E Williamson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine
- Farr Institute of Health Informatics, London, and
| | | | - N Klein
- Infection, Immunity, Inflammation and Physiological Medicine, UCL Great Ormond Street Institute of Child Health, United Kingdom
| | - F Sahr
- 34 Military Hospital, Republic of Sierra Leone Armed Forces, Freetown
| | - S Yeung
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, United Kingdom
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17
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Bradanini L, Youkee D, Fabris P, Romanò L, Brunetti E, Giordani MT. Acute hepatitis E virus infection in a migrant population in North East Italy: A retrospective analysis. Travel Med Infect Dis 2017; 20:37-42. [PMID: 28411095 DOI: 10.1016/j.tmaid.2017.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To study the epidemiological and clinical features of Hepatitis E Virus (HEV) infection in a migrant population. METHODS We performed a retrospective chart review, identifying a cohort of 21 symptomatic patients of migrant origin with confirmed HEV infection admitted in the period between January 1995-November 2014. RESULTS 20 (95%) patients came from South Asian countries highly endemic for HEV, all positive for HEV genotype 1. Recent travel to a highly endemic country was the most consistent risk factor identified in 90% of cases, duration from return to Italy to hospitalization ranged from 10 to 120 days. Nausea and vomiting (100%), jaundice (95.2%), and anorexia (85.7%) were the most common reported symptoms. Fever was present in 57.1% of cases. Transaminase values were elevated in all patients and serum bilirubin was raised in 86% of patients. We found no statistically significant differences between clinical symptoms, laboratory results or duration of hospitalization in patients with co-morbidities compared to those without. We also report a secondary case of HEV genotype 1 transmitted within Italy. CONCLUSION Our study highlights the epidemiological risk factors and clinical features of HEV infection in a migrant population in Italy and should stimulate further research regarding the prevalence and morbidity of HEV within migrant populations in Europe.
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Affiliation(s)
- Lucia Bradanini
- Infectious and Tropical Diseases Unit, San Bortolo Hospital, Vicenza, Italy
| | - Daniel Youkee
- King's Centre for Global Health, King's College London, London, UK.
| | - Paolo Fabris
- Infectious and Tropical Diseases Unit, San Bortolo Hospital, Vicenza, Italy
| | - Luisa Romanò
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Enrico Brunetti
- Department of Infectious Diseases, San Matteo Hospital Foundation, Pavia, Italy
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18
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Walker NF, Youkee D, Brown CS, Lado M, Johnson O. Management of Ebola Virus Disease: Is Environmental Decontamination Effective? J Infect Dis 2017; 215:485-486. [PMID: 28011909 PMCID: PMC5993093 DOI: 10.1093/infdis/jiw548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/21/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Naomi F Walker
- Department of Clinical Research, London School of Hygiene and Tropical Medicine.,Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
| | - Daniel Youkee
- King's Sierra Leone partnership, King's Centre for Global Health, King's College London and King's Health Partners, London, United Kingdom
| | - Colin S Brown
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom.,King's Sierra Leone partnership, King's Centre for Global Health, King's College London and King's Health Partners, London, United Kingdom
| | - Marta Lado
- King's Sierra Leone partnership, King's Centre for Global Health, King's College London and King's Health Partners, London, United Kingdom
| | - Oliver Johnson
- King's Sierra Leone partnership, King's Centre for Global Health, King's College London and King's Health Partners, London, United Kingdom
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19
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Arkell P, Youkee D, Brown CS, Kamara A, Kamara TB, Johnson O, Lado M, George V, Koroma F, King MB, Parker BE, Baker P. Quantifying the risk of nosocomial infection within Ebola Holding Units: a retrospective cohort study of negative patients discharged from five Ebola Holding Units in Western Area, Sierra Leone. Trop Med Int Health 2016; 22:32-40. [PMID: 27782349 DOI: 10.1111/tmi.12802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A central pillar in the response to the 2014 Ebola virus disease (EVD) epidemic in Sierra Leone was the role of Ebola Holding Units (EHUs). These units isolated patients meeting a suspect case definition, tested them for EVD, initiated appropriate early treatment and discharged negative patients to onward inpatient care or home. Positive patients were referred to Ebola Treatment Centres. We aimed to estimate the risk of nosocomial transmission within these EHUs. METHODS We followed up a cohort of 543 patients discharged with a negative EVD test from five EHUs in the Western Area, Sierra Leone, and examined all line-listed subsequent EVD tests from any facility in the Western Area to see whether the patient was retested within 30 days, matching by name, age and address. We defined possible readmissions as having the same name and age but uncertain address, and confirmed readmissions where name, age and address matched. RESULTS We found a positive readmission rate of 3.3% (18 cases), which included 1.5% confirmed readmissions (8 cases) and 1.8% possible readmissions (10 cases). This is lower than rates previously reported. We cannot ascertain whether EVD was acquired within the EHUs or from re-exposure in the community. No demographic or clinical variables were identified as risk factors for positive readmission, likely due to our small sample size. CONCLUSIONS These findings support the EHU model as a safe method for isolation of suspect EVD patients and their role in limiting the spread of EVD.
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Affiliation(s)
- Paul Arkell
- King's Sierra Leone Partnership, King's College London, London, UK
| | - Daniel Youkee
- King's Sierra Leone Partnership, King's College London, London, UK
| | - Colin S Brown
- King's Sierra Leone Partnership, King's College London, London, UK.,Hospital for Tropical Diseases, University College Hospital London, London, UK
| | - Abdul Kamara
- Republic of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Oliver Johnson
- King's Sierra Leone Partnership, King's College London, London, UK
| | - Marta Lado
- King's Sierra Leone Partnership, King's College London, London, UK
| | | | | | | | | | - Peter Baker
- King's Sierra Leone Partnership, King's College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK
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20
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Fitzgerald F, Naveed A, Wing K, Gbessay M, Ross J, Checchi F, Youkee D, Jalloh MB, Baion D, Mustapha A, Jah H, Lako S, Oza S, Boufkhed S, Feury R, Bielicki JA, Gibb DM, Klein N, Sahr F, Yeung S. Ebola Virus Disease in Children, Sierra Leone, 2014–2015. Emerg Infect Dis 2016. [DOI: 10.3201/eid22210.160579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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21
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Johnson O, Youkee D, Brown CS, Lado M, Wurie A, Bash-Taqi D, Hall A, Hanciles E, Kamara I, Kamara C, Kamboz A, Seedat A, Thomas S, Kamara TB, Leather AJM, Kargbo B. Ebola Holding Units at government hospitals in Sierra Leone: evidence for a flexible and effective model for safe isolation, early treatment initiation, hospital safety and health system functioning. BMJ Glob Health 2016; 1:e000030. [PMID: 28588922 PMCID: PMC5321322 DOI: 10.1136/bmjgh-2016-000030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/31/2016] [Accepted: 04/27/2016] [Indexed: 11/27/2022] Open
Abstract
The 2014-2015 West African outbreak of Ebola Virus Disease (EVD) claimed the lives of more than 11,000 people and infected over 27,000 across seven countries. Traditional approaches to containing EVD proved inadequate and new approaches for controlling the outbreak were required. The Ministry of Health & Sanitation and King’s Sierra Leone Partnership developed a model for Ebola Holding Units (EHUs) at Government Hospitals in the capital city Freetown. The EHUs isolated screened or referred suspect patients, provided initial clinical care, undertook laboratory testing to confirm EVD status, referred onward positive cases to an Ebola Treatment Centre or negative cases to the general wards, and safely stored corpses pending collection by burial teams. Between 29th May 2014 and 19th January 2015, our five units had isolated approximately 37% (1159) of the 3097 confirmed cases within Western Urban and Rural district. Nosocomial transmission of EVD within the units appears lower than previously documented at other facilities and staff infection rates were also low. We found that EHUs are a flexible and effective model of rapid diagnosis, safe isolation and early initial treatment. We also demonstrated that it is possible for international partners and government facilities to collaborate closely during a humanitarian crisis.
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Affiliation(s)
- Oliver Johnson
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | - Daniel Youkee
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | - Colin S Brown
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK.,Hospital for Tropical Diseases, University College London Hospitals, London, UK
| | - Marta Lado
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | - Alie Wurie
- Ministry of Health & Sanitation, Freetown, Sierra Leone
| | | | - Andy Hall
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | | | | | | | - Amardeep Kamboz
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | - Ahmed Seedat
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | - Suzanne Thomas
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | - T B Kamara
- Connaught Hospital, Freetown, Sierra Leone.,Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
| | - Andrew J M Leather
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | - Brima Kargbo
- Ministry of Health & Sanitation, Freetown, Sierra Leone
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22
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Abstract
The West African Ebola virus disease (EVD) outbreak is the largest ever seen, with over 28,000 cases and 11,300 deaths since early 2014. The magnitude of the outbreak has tested fragile governmental health systems and non-governmental organizations (NGOs) to their limit. Here we discuss the outbreak in the Western Area of Sierra Leone, the shape of the local response and the impact the response had on caring for children suspected of having contracted EVD. Challenges encountered in providing clinical care to children whilst working in the "Red Zone" where risk of EVD is considered to be highest, wearing full personal protective equipment are detailed. Suggestions and recommendations both for further research and for operational improvement in the future are made, with particular reference as to how a response could be more child-focused.
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Affiliation(s)
- Felicity Fitzgerald
- Infection, Immunity, Inflammation and Physiological Medicine, UCL Institute of Child Health, UK; Kerry Town Ebola Treatment Centre, Save the Children International, Sierra Leone.
| | - Waheed Awonuga
- Live Case Management Team, Western Area Emergency Response Centre, Freetown, Sierra Leone.
| | - Tejshri Shah
- Department of Paediatric Infectious Diseases, Imperial College NHS Healthcare Trust, UK.
| | - Daniel Youkee
- Kings Sierra Leone Partnership, Connaught Hospital, Freetown, Sierra Leone.
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23
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Brunetti E, Heller T, Richter J, Kaminstein D, Youkee D, Giordani MT, Goblirsch S, Tamarozzi F. Application of Ultrasonography in the Diagnosis of Infectious Diseases in Resource-Limited Settings. Curr Infect Dis Rep 2016; 18:6. [PMID: 26781324 DOI: 10.1007/s11908-015-0512-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Ultrasound (US) has vast potential in the field of infectious diseases, especially so in resource-limited settings. Recent technological advances have increased availability and access to ultrasound in low-resource settings, where the burden of infectious diseases is greatest. This paper collates the evidence for the utilization of ultrasound and evaluates its effectiveness in the diagnosis and management of a range of infectious diseases. This paper explores the role of ultrasound in population-based screening for specific diseases as well as highlights its benefits for individual patient management. We describe the common diagnostic signs seen on US for common and neglected parasitic, bacterial, and viral diseases. We proceed to document the emerging field of chest US which is proving to be a superior imaging modality for the diagnosis of specific pulmonary conditions. We conclude by discussing the efforts needed to formalize and rigorously evaluate the role of ultrasound in infectious diseases.
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Affiliation(s)
- Enrico Brunetti
- Department of Infectious Diseases, San Matteo Hospital Foundation, Pavia, Italy.
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Tom Heller
- Department of Medicine, Klinikum Muenchen-Perlach, Munich, Germany
| | - Joachim Richter
- Tropical Medicine, Clinic of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine University, Düsseldorf, Germany
| | - Daniel Kaminstein
- Department of Emergency Medicine and Hospitalist Services, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | | | | | - Francesca Tamarozzi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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24
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Youkee D, Brown CS, Lilburn P, Shetty N, Brooks T, Simpson A, Bentley N, Lado M, Kamara TB, Walker NF, Johnson O. Assessment of Environmental Contamination and Environmental Decontamination Practices within an Ebola Holding Unit, Freetown, Sierra Leone. PLoS One 2015; 10:e0145167. [PMID: 26692018 PMCID: PMC4687095 DOI: 10.1371/journal.pone.0145167] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/30/2015] [Indexed: 12/21/2022] Open
Abstract
Evidence to inform decontamination practices at Ebola holding units (EHUs) and treatment centres is lacking. We conducted an audit of decontamination procedures inside Connaught Hospital EHU in Freetown, Sierra Leone, by assessing environmental swab specimens for evidence of contamination with Ebola virus by RT-PCR. Swabs were collected following discharge of Ebola Virus Disease (EVD) patients before and after routine decontamination. Prior to decontamination, Ebola virus RNA was detected within a limited area at all bedside sites tested, but not at any sites distant to the bedside. Following decontamination, few areas contained detectable Ebola virus RNA. In areas beneath the bed there was evidence of transfer of Ebola virus material during cleaning. Retraining of cleaning staff reduced evidence of environmental contamination after decontamination. Current decontamination procedures appear to be effective in eradicating persistence of viral RNA. This study supports the use of viral swabs to assess Ebola viral contamination within the clinical setting. We recommend that regular refresher training of cleaning staff and audit of environmental contamination become standard practice at all Ebola care facilities during EVD outbreaks.
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Affiliation(s)
- Daniel Youkee
- King’s Sierra Leone Partnership, King's Centre for Global Health, King's College London, and King’s Health Partners, London, United Kingdom
| | - Colin S. Brown
- King’s Sierra Leone Partnership, King's Centre for Global Health, King's College London, and King’s Health Partners, London, United Kingdom
- The Hospital for Tropical Diseases, University College London Hospitals, London, United Kingdom
| | - Paul Lilburn
- King’s Sierra Leone Partnership, King's Centre for Global Health, King's College London, and King’s Health Partners, London, United Kingdom
| | | | - Tim Brooks
- Public Health England, Salisbury, United Kingdom
| | | | - Neil Bentley
- Public Health England, Salisbury, United Kingdom
| | - Marta Lado
- King’s Sierra Leone Partnership, King's Centre for Global Health, King's College London, and King’s Health Partners, London, United Kingdom
| | | | - Naomi F. Walker
- King’s Sierra Leone Partnership, King's Centre for Global Health, King's College London, and King’s Health Partners, London, United Kingdom
- Department of Infectious Diseases and Immunity, Imperial College London, London, United Kingdom
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Oliver Johnson
- King’s Sierra Leone Partnership, King's Centre for Global Health, King's College London, and King’s Health Partners, London, United Kingdom
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25
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Lado M, Walker NF, Baker P, Haroon S, Brown CS, Youkee D, Studd N, Kessete Q, Maini R, Boyles T, Hanciles E, Wurie A, Kamara TB, Johnson O, Leather AJM. Clinical features of patients isolated for suspected Ebola virus disease at Connaught Hospital, Freetown, Sierra Leone: a retrospective cohort study. Lancet Infect Dis 2015. [PMID: 26213248 DOI: 10.1016/s1473-3099(15)00137-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The size of the west African Ebola virus disease outbreak led to the urgent establishment of Ebola holding unit facilities for isolation and diagnostic testing of patients with suspected Ebola virus disease. Following the onset of the outbreak in Sierra Leone, patients presenting to Connaught Hospital in Freetown were screened for suspected Ebola virus disease on arrival and, if necessary, were admitted to the on-site Ebola holding unit. Since demand for beds in this unit greatly exceeded capacity, we aimed to improve the selection of patients with suspected Ebola virus disease for admission by identifying presenting clinical characteristics that were predictive of a confirmed diagnosis. METHODS In this retrospective cohort study, we recorded the presenting clinical characteristics of suspected Ebola virus disease cases admitted to Connaught Hospital's Ebola holding unit. Patients were subsequently classified as confirmed Ebola virus disease cases or non-cases according to the result of Ebola virus reverse-transcriptase PCR (EBOV RT-PCR) testing. The sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio of every clinical characteristic were calculated, to estimate the diagnostic accuracy and predictive value of each clinical characteristic for confirmed Ebola virus disease. RESULTS Between May 29, 2014, and Dec 8, 2014, 850 patients with suspected Ebola virus disease were admitted to the holding unit, of whom 724 had an EBOV RT-PCR result recorded and were included in the analysis. In 464 (64%) of these patients, a diagnosis of Ebola virus disease was confirmed. Fever or history of fever (n=599, 83%), intense fatigue or weakness (n=495, 68%), vomiting or nausea (n=365, 50%), and diarrhoea (n=294, 41%) were the most common presenting symptoms in suspected cases. Presentation with intense fatigue, confusion, conjunctivitis, hiccups, diarrhea, or vomiting was associated with increased likelihood of confirmed Ebola virus disease. Three or more of these symptoms in combination increased the probability of Ebola virus disease by 3·2-fold (95% CI 2·3-4·4), but the sensitivity of this strategy for Ebola virus disease diagnosis was low. In a subgroup analysis, 15 (9%) of 161 confirmed Ebola virus disease cases reported neither a history of fever nor a risk factor for Ebola virus disease exposure. INTERPRETATION Discrimination of Ebola virus disease cases from patients without the disease is a major challenge in an outbreak and needs rapid diagnostic testing. Suspected Ebola virus disease case definitions that rely on history of fever and risk factors for Ebola virus disease exposure do not have sufficient sensitivity to identify all cases of the disease. FUNDING None.
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Affiliation(s)
- Marta Lado
- King's Sierra Leone Health Partnership, King's Centre for Global Health, King's Health Partners and King's College London, London, UK.
| | - Naomi F Walker
- King's Sierra Leone Health Partnership, King's Centre for Global Health, King's Health Partners and King's College London, London, UK; Department of Infectious Diseases and Immunity, Imperial College London, London, UK; Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Peter Baker
- King's Sierra Leone Health Partnership, King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Shamil Haroon
- Public Health, Epidemiology & Biostatistics, University of Birmingham, Birmingham, UK
| | - Colin S Brown
- King's Sierra Leone Health Partnership, King's Centre for Global Health, King's Health Partners and King's College London, London, UK; The Hospital for Tropical Diseases, University College London Hospitals, London, UK
| | - Daniel Youkee
- King's Sierra Leone Health Partnership, King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Neil Studd
- King's Sierra Leone Health Partnership, King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Quaanan Kessete
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Rishma Maini
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Tom Boyles
- King's Sierra Leone Health Partnership, King's Centre for Global Health, King's Health Partners and King's College London, London, UK; Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa
| | - Eva Hanciles
- Connaught Hospital, Freetown, Sierra Leone; Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Alie Wurie
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Thaim B Kamara
- Connaught Hospital, Freetown, Sierra Leone; Ministry of Health and Sanitation, Freetown, Sierra Leone; Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Oliver Johnson
- King's Sierra Leone Health Partnership, King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Andrew J M Leather
- King's Sierra Leone Health Partnership, King's Centre for Global Health, King's Health Partners and King's College London, London, UK
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26
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Walker NF, Brown CS, Youkee D, Baker P, Williams N, Kalawa A, Russell K, Samba AF, Bentley N, Koroma F, King MB, Parker BE, Thompson M, Boyles T, Healey B, Kargbo B, Bash-Taqi D, Simpson AJ, Kamara A, Kamara TB, Lado M, Johnson O, Brooks T. Evaluation of a point-of-care blood test for identification of Ebola virus disease at Ebola holding units, Western Area, Sierra Leone, January to February 2015. ACTA ACUST UNITED AC 2015; 20. [PMID: 25846490 DOI: 10.2807/1560-7917.es2015.20.12.21073] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Current Ebola virus disease (EVD) diagnosis relies on reverse transcription-PCR (RT-PCR) technology, requiring skilled laboratory personnel and technical infrastructure. Lack of laboratory diagnostic capacity has led to diagnostic delays in the current West African EVD outbreak of 2014 and 2015, compromising outbreak control. We evaluated the diagnostic accuracy of the EVD bedside rapid diagnostic antigen test (RDT) developed by the United Kingdom's Defence Science and Technology Laboratory, compared with Ebola virus RT-PCR, in an operational setting for EVD diagnosis of suspected cases admitted to Ebola holding units in the Western Area of Sierra Leone. From 22 January to 16 February 2015, 138 participants were enrolled. EVD prevalence was 11.5%. All EVD cases were identified by a positive RDT with a test line score of 6 or more, giving a sensitivity of 100% (95% confidence interval (CI): 78.2-100). The corresponding specificity was high (96.6%, 95% CI: 91.3-99.1). The positive and negative predictive values for the population prevalence were 79.0% (95% CI: 54.4-93.8) and 100% (95% CI: 96.7-100), respectively. These results, if confirmed in a larger study, suggest that this RDT could be used as a 'rule-out' screening test for EVD to improve rapid case identification and resource allocation.
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Affiliation(s)
- N F Walker
- King s Sierra Leone Partnership, King's Centre for Global Health, King's College London, and King s Health Partners, London, United Kingdom
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