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Lakoh S, Bangura MM, Adekanmbi O, Barrie U, Jiba DF, Kamara MN, Sesay D, Jalloh AT, Deen GF, Russell JBW, Egesimba G, Yendewa GA, Firima E. Impact of COVID-19 on the Utilization of HIV Testing and Linkage Services in Sierra Leone: Experience from Three Public Health Facilities in Freetown. AIDS Behav 2024; 28:1235-1243. [PMID: 37642824 PMCID: PMC10940454 DOI: 10.1007/s10461-023-04149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/31/2023]
Abstract
The COVID-19 pandemic adversely affected the delivery of essential health services globally. In this study, we aimed to assess the impact of the pandemic on HIV testing and linkage services at three public health facilities in Freetown, Sierra Leone. We conducted a retrospective study to assess the impact of COVID-19 on HIV testing and linkage to treatment services (HTS) at Connaught Hospital (CH-tertiary), Lumley Government Hospital (LGH-secondary) and George Brooke Community Health Center (GBC-primary) in Freetown. Statistical analyses were conducted in Stata (16.1, StataCorp LLC, College Station, TX). Intra-pandemic HTS (2020) and HTS during recovery (2021) were compared with pre-pandemic HTS (2019). Of the 8538 people tested for HIV in the three facilities, 4929 (57.5%) visited CH. Only 2249 people were tested for HIV in 2020 compared to 3825 in 2019 (difference: - 41.2%, P < 0.001). Fewer people were also tested in 2021 (difference: - 35.6% P < 0.001). The largest reductions in testing in 2020 occurred in women (- 47.7%), children under 15 (- 95.2%), married people (- 42.6%), and CH (- 46.2%). Overall, 1369 (16.0%) people were positive for HIV; CH (878, 17.9%), LGH (469, 15.6%) and GBC (22, 3.5%). The likelihood of a positive HIV test was 26% lower in 2020 than 2019 (PR 0.74; 95% CI 0.64-0.85; P < 0.001), but 16% higher in 2021 than 2019 (PR 1.16; 95% CI 1.03-1.30; P < 0.05). Of the 1369 HIV diagnosis, 526 (38.4%) were linked to care. We found significant disruptions in HIV testing and linkage services at different levels of service delivery during the COVID-19 pandemic, underscoring the need to strengthen essential health services during public health emergencies.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
| | - Moses M Bangura
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Darlinda F Jiba
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Daniel Sesay
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Abdulai Tejan Jalloh
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Ginika Egesimba
- ICAP at Columbia University Mailman School of Public Health, Freetown, Sierra Leone
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emmanuel Firima
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland.
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria.
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Abiri OT, Ninka A, Coker J, Thomas F, Smalle IO, Lakoh S, Turay FU, Komeh J, Sesay M, Kanu JS, Mustapha AM, Bell NVT, Conteh TA, Conteh SK, Jalloh AA, Russell JBW, Sesay N, Bawoh M, Samai M, Lahai M. An Assessment of Medication Errors Among Pediatric Patients in Three Hospitals in Freetown Sierra Leone: Findings and Implications for a Low-Income Country. Pediatric Health Med Ther 2024; 15:145-158. [PMID: 38567243 PMCID: PMC10986401 DOI: 10.2147/phmt.s451453] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
Background Pediatric patients are prone to medicine-related problems like medication errors (MEs), which can potentially cause harm. Yet, this has not been studied in this population in Sierra Leone. Therefore, this study investigated the prevalence and nature of MEs, including potential drug-drug interactions (pDDIs), in pediatric patients. Methods The study was conducted in three hospitals among pediatric patients in Freetown and consisted of two phases. Phase one was a cross-sectional retrospective review of prescriptions for completeness and accuracy based on the global accuracy score against standard prescription writing guidelines. Phase two was a point prevalence inpatient chart review of MEs categorized into prescription, administration, and dispensing errors and pDDIs. Data was analyzed using frequency, percentages, median, and interquartile range. Kruskal-Wallis H and Mann-Whitney U-tests were used to compare the prescription accuracy between the hospitals, with p<0.05 considered statistically significant. Results Three hundred and sixty-six (366) pediatric prescriptions and 132 inpatient charts were reviewed in phases one and two of the study, respectively. In phase one, while no prescription attained the global accuracy score (GAS) gold standard of 100%, 106 (29.0%) achieved the 80-100% mark. The patient 63 (17.2%), treatment 228 (62.3%), and prescriber 33 (9.0%) identifiers achieved an overall GAS range of 80-100%. Although the total GAS was not statistically significant (p=0.065), the date (p=0.041), patient (p=<0.001), treatment (p=0.022), and prescriber (p=<0.001) identifiers were statistically significant across the different hospitals. For phase two, the prevalence of MEs was 74 (56.1%), while that of pDDIs was 54 (40.9%). There was a statistically positive correlation between the occurrence of pDDI and number of medicines prescribed (r=0.211, P=0.015). Conclusion A Low GAS indicates poor compliance with prescription writing guidelines and high prescription errors. Medication errors were observed at each phase of the medication use cycle, while clinically significant pDDIs were also reported. Thus, there is a need for training on prescription writing guidelines and medication errors.
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Affiliation(s)
- Onome T Abiri
- Department of Pharmacology and Therapeutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Department of Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
| | - Alex Ninka
- Department of Clinical Pharmacy and Therapeutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joshua Coker
- Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Fawzi Thomas
- Department of Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
- Department of Pharmaceutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Isaac O Smalle
- Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Foday Umaro Turay
- Department of Pharmaceutical Chemistry, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - James Komeh
- Department of Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
- Department of Clinical Pharmacy and Therapeutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mohamed Sesay
- Department of Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
- Department of Pharmaceutical Chemistry, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- Department of Community Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Ayeshatu M Mustapha
- Department of Pediatrics, Ola During Children Hospital, Freetown, Sierra Leone
| | - Nellie V T Bell
- Department of Pediatrics, Ola During Children Hospital, Freetown, Sierra Leone
| | - Thomas Ansumus Conteh
- Department of Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
- Department of Pharmaceutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sarah Kadijatu Conteh
- Department of Pediatrics, King Harman Road Maternity and Children Hospital, Freetown, Sierra Leone
| | - Alhaji Alusine Jalloh
- Department of Pediatrics, King Harman Road Maternity and Children Hospital, Freetown, Sierra Leone
| | - James B W Russell
- Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Noah Sesay
- Department of Clinical Pharmacy and Therapeutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mohamed Bawoh
- Department of Pharmacology and Therapeutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mohamed Samai
- Department of Pharmacology and Therapeutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Michael Lahai
- Department of Pharmaceutical Chemistry, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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Kamara IF, Tengbe SM, Bah AJ, Nuwagira I, Ali DB, Koroma FF, Kamara RZ, Lakoh S, Sesay S, Russell JBW, Theobald S, Lyons M. Prevalence of hypertension, diabetes mellitus, and their risk factors in an informal settlement in Freetown, Sierra Leone: a cross-sectional study. BMC Public Health 2024; 24:783. [PMID: 38481202 PMCID: PMC10935859 DOI: 10.1186/s12889-024-18158-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs), especially hypertension and diabetes mellitus are on the increase in sub-Saharan Africa (SSA). Informal settlement dwellers exhibit a high prevalence of behavioural risk factors and are highly vulnerable to hypertension and diabetes. However, no study has assessed the prevalence of hypertension, diabetes, and NCDrisk factors among informal settlement dwellers in Sierra Leone. We conducted a study in June 2019 to determine the prevalence of hypertension, diabetes, and NCD risk factors among adults living in the largest Sierra Leonean informal settlement (KrooBay). METHODS AND MATERIALS We conducted a community-based cross-sectional survey among adults aged ≥ 35 years in the KrooBay community. Trained healthcare workers collected data on socio-demographic characteristics and self-reported health behaviours using the World Health Organization STEPwise surveillance questionnaire for chronic disease risk factors. Anthropometric, blood glucose, and blood pressure measurements were performed following standard procedures. Logistics regression was used for analysis and adjusted odd ratios with 95% confidence intervals were calculated to identify risk factors associated with hypertension. RESULTS Of the 418 participants, 242 (57%) were females and those below the age of 45 years accounted for over half (55.3%) of the participants. The prevalence of smoking was 18.2%, alcohol consumption was 18.8%, overweight was 28.2%, obesity was 17.9%, physical inactivity was 81.5%, and inadequate consumption of fruits and vegetables was 99%. The overall prevalence of hypertension was 45.7% (95% CI 41.0-50.5%), systolic hypertension was 34.2% (95% CI 29.6-38.8%), diastolic blood pressure was 39.9% (95% CI 35.2-44.6), and participants with diabetes were 2.2% (95% CI 0.7-3.6%). Being aged ≥ 55 years (AOR = 7.35, 95% CI 1.49-36.39) and > 60 years (AOR 8.05; 95% CI 2.22-29.12), separated (AOR = 1.34; 95% 1.02-7.00), cohabitating (AOR = 6.68; 95% CL1.03-14.35), vocational (AOR = 3.65; 95% CI 1.81-7.39 ) and having a university education (AOR = 4.62; 95% CI 3.09-6.91) were found to be independently associated with hypertension. CONCLUSION The prevalence of hypertension,and NCD risk factors was high among the residents of the Kroobay informal settlement. We also noted a low prevalence of diabetes. There is an urgent need for the implementation of health education, promotion, and screening initiatives to reduce health risks so that these conditions will not overwhelm health services.
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Affiliation(s)
- Ibrahim Franklyn Kamara
- World Health Organization Sierra Leone, 21A-B Riverside Drive, Off Kingharman Road, Freetown, Sierra Leone
| | | | - Abdulai Jawo Bah
- College of Medicine and Allied Health Sciences, University of Sierra Leone, A.J.Momoh Street, Freetown, Sierra Leone
| | - Innocent Nuwagira
- World Health Organization Sierra Leone, 21A-B Riverside Drive, Off Kingharman Road, Freetown, Sierra Leone
| | - Desta Betula Ali
- Ministry of Health, 4th Floor, Youyi Building, Freetown, Sierra Leone
| | - Fanny F Koroma
- Ministry of Health, 4th Floor, Youyi Building, Freetown, Sierra Leone
| | - Rugiatu Z Kamara
- United States CDC Country Office, EOC, Wilkinson Road, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Ministry of Health, 4th Floor, Youyi Building, Freetown, Sierra Leone
| | - Santigie Sesay
- Ministry of Health, 4th Floor, Youyi Building, Freetown, Sierra Leone
| | - James B W Russell
- Ministry of Health, 4th Floor, Youyi Building, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, A.J.Momoh Street, Freetown, Sierra Leone
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Mary Lyons
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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Russell JBW, Koroma TR, Sesay S, Samura SK, Lakoh S, Bockarie A, Abiri OA, Conteh V, Conteh S, Smith M, Mahdi OZ, Lisk DR. Prevalence and correlates of metabolic syndrome among adults in freetown, Sierra Leone: A comparative analysis of NCEP ATP III, IDF and harmonized ATP III criteria. Int J Cardiol Cardiovasc Risk Prev 2024; 20:200236. [PMID: 38299125 PMCID: PMC10827589 DOI: 10.1016/j.ijcrp.2024.200236] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/25/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024]
Abstract
Background Metabolic syndrome (MetS) is a global health concern, especially for low and middle-income countries with limited resources and information. The study's objective was to assess the prevalence of MetS in Freetown, Sierra Leone, using the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III), International Diabetes Federation (IDF) and Harmonize ATP III. Additionally, we aimed to establish the concordance between these three different criteria used. Methods This community-based health screening survey was conducted from October 2019 to October 2022. A multistage stratified random design was used to select adults aged 20 years and above. Mean, interquartile range (IQR), and logistic regression were used for statistical analysis. The kappa coefficient statistics resolved the agreement between these defined criteria. Results The prevalence for NCEP ATP III, Harmonize ATP III and IDF criteria was 11.8 % (95 % CI: 9.0-15.15), 14.3 % (95 % CI: 11.3-18.0), and 8.5 % (95 % CI: 6.2-11.2), respectively for the 2394 selected adults. The kappa coefficient (κ) agreement between the MetS is: Harmonized ATP III and IDF criteria = [(208 (60.8 %); (κ = 0.62)]; Harmonized ATP III and NCEP ATP III = [(201 (58.7 %); (κ = 0.71)]; while IDF and NCEP ATP III was [(132 (38.6 %); (κ = 0.52)]. In the multivariable regression analysis, waist circumference correlated with all three MetS criteria: ATP III [AOR = 0.85; C.I 95 %: (0.40-1.78), p = 0.032], Harmonized ATP III [AOR = 1.14; C.I 95 %: (0.62-2.11), p = 0.024], IDF [AOR = 1.06; C.I 95 % (0.52-2.16), p = 0.018]. Conclusion We reported a high prevalence of MetS in Freetown, Sierra Leone and identified waist circumference as a major risk factor for MetS. This underscores the crucial role of health education and effective management of MetS in Sierra Leone.
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Affiliation(s)
- James Baligeh Walter Russell
- Department of Internal Medicine, Faculty of Clinical Sciences & Dentistry, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, University of Sierra Leone Teaching Hospital Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Theresa Ruba Koroma
- Department of Internal Medicine, Faculty of Clinical Sciences & Dentistry, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, University of Sierra Leone Teaching Hospital Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Santigie Sesay
- Directorate of Non-Communicable Disease & Mental Health, Ministry of Health & Sanitation, Freetown, Sierra Leone
| | - Sallieu K. Samura
- Department of Mathematics and Statistics, Fourah Bah College, University of Sierra Leone, Sierra Leone
| | - Sulaiman Lakoh
- Department of Internal Medicine, Faculty of Clinical Sciences & Dentistry, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, University of Sierra Leone Teaching Hospital Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Ansumana Bockarie
- Department of Internal Medicine, School of Medical Sciences, University of Cape Coast, Ghana
| | - Onomeh Abiri Abiri
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Victor Conteh
- Department of Internal Medicine, Faculty of Clinical Sciences & Dentistry, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, University of Sierra Leone Teaching Hospital Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Sorie Conteh
- Department of Internal Medicine, Faculty of Clinical Sciences & Dentistry, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, University of Sierra Leone Teaching Hospital Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Mohamed Smith
- Department of Internal Medicine, Faculty of Clinical Sciences & Dentistry, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, University of Sierra Leone Teaching Hospital Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Othman Z. Mahdi
- Department of Medicine, Choithrams Memorial Hospital, Freetown, Sierra Leone
| | - Durodami R. Lisk
- Department of Internal Medicine, Faculty of Clinical Sciences & Dentistry, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, University of Sierra Leone Teaching Hospital Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
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Kamara IF, Kanu J, Maruta A, Fofanah BD, Kamara KN, Sheriff B, Katawera V, D'Almeida SA, Musoke R, Nuwagira I, Lakoh S, Kamara RZ, Tengbe SM, Mansaray AR, Koroma Z, Thomas F, Abiri OT, Koroma AT, Russell JBW, Squire J, Vandi MA. Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology. BMJ Open 2023; 13:e078367. [PMID: 38159961 PMCID: PMC10759135 DOI: 10.1136/bmjopen-2023-078367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Inappropriate use of antibiotics is a major driver of antibiotic resistance. A few studies conducted in Africa have documented that about half of hospitalised patients who receive antibiotics should not have received them. A few hospital-based studies that have been conducted in Sierra Leone have documented a high usage of antibiotics in hospitals. Therefore, we conducted a nationwide point prevalence survey on antibiotic use among hospitalised patients in Sierra Leone. DESIGN We conducted a hospital-based, cross-sectional survey on the use of antibiotics using the WHO point prevalence survey methodology. SETTING The study was conducted in 26 public and private hospitals that are providing inpatient healthcare services. PARTICIPANTS All patients admitted to paediatric and adult inpatient wards before or at 08:00 on the survey date were enrolled. OUTCOME MEASURES Prevalence of antibiotic use, antibiotics Access, Watch and Reserve (AWaRe) categorisation, indication for antibiotic use prevalence and proportion of bacteria culture done. RESULTS Of the 1198 patient records reviewed, 883 (73.7%, 95% CI 71.1% to 76.2%) were on antibiotics. Antibiotic use was highest in the paediatric wards (306, 85.7%), followed by medical wards (158, 71.2%), surgical wards (146, 69.5%), mixed wards (97, 68.8%) and lowest in the obstetrics and gynaecology wards (176, 65.7%). The most widely prescribed antibiotics were metronidazole (404, 22.2%), ceftriaxone (373, 20.5%), ampicillin (337, 18.5%), gentamicin (221, 12.1%) and amoxicillin (90, 5.0%). Blood culture was only done for one patient and antibiotic treatments were given empirically. The most common indication for antibiotic use was community-acquired infection (484, 51.9%) followed by surgical prophylaxis (222, 23.8%). CONCLUSION There was high usage of antibiotics in hospitals in Sierra Leone as the majority of patients admitted received an antibiotic. This has the potential to increase the burden of antibiotic resistance in the country. We, therefore, recommend the establishment of hospital antimicrobial stewardship programmes according to the WHO core components.
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Affiliation(s)
- Ibrahim Franklyn Kamara
- Reproductive Maternal Newborn Child and Adolescent Health Unit, Universal Health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Joseph Kanu
- National Disease Surveillance Programme, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
- Community Health, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Anna Maruta
- World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | | | - Kadijatu Nabie Kamara
- National Surveillance Program, Directorate of Health Security and Emergencies, Ministry of Health, Freetown, Sierra Leone
| | - Bockarie Sheriff
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Victoria Katawera
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Selassi A D'Almeida
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Robert Musoke
- Emergency Preparedness and Response, World Health Organization Country Office, Sierra Leone, Freetown, Sierra Leone
| | - Innocent Nuwagira
- World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Rugiatu Z Kamara
- US Center for Disease Control and Prevention Country Office, Sierra Leone, Freetown, Sierra Leone
| | | | - Abdul Razak Mansaray
- Laboratory, Diagnostic and Blood Services, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Microbiology, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Zikan Koroma
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Fawzi Thomas
- Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
| | - Onome T Abiri
- Pharmacovigilance and Clinical Trials Department, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
- Pharmacology, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Aminata Tigiedankay Koroma
- National Surveillance Program, Directorate of Health Security and Emergency, Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - James Squire
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Mohamed Alex Vandi
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
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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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Ghazzawi M, Babawo LS, Mohareb AM, James PB, Yendewa SA, Massaquoi SP, Cummings PE, Lakoh S, Salata RA, Yendewa GA. Impact of COVID-19 on hepatitis B screening in Sierra Leone: insights from a community pharmacy model of care. IJID Reg 2023; 9:7-13. [PMID: 37711649 PMCID: PMC10498170 DOI: 10.1016/j.ijregi.2023.08.006] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/16/2023]
Abstract
Objectives To assess the impact of COVID-19-related interruptions and seasonal patterns on hepatitis B virus (HBV) screening in a hyperendemic setting in Sierra Leone. Methods We conducted a retrospective study of HBV testing in a community pharmacy in Freetown, Sierra Leone, from October 01, 2019, through September 30, 2022. We compared participant characteristics using Pearson's chi-square test. We evaluated trends in HBV screening and diagnosis using one-way analysis of variance with Tukey's or Dunnett's post-test. Results Of 920 individuals screened, 161 had detectable HBV surface antigen (seroprevalence 17.5% [95% CI 14.9-20.4]). There was a 100% decrease in HBV screening during January-June of 2020; however, screening increased by 27% and 23% in the first and second years after COVID-19, respectively. Mean quarterly tests showed a significant upward trend: 55 ± 6 tests during January-March (baseline), 74 ± 16 tests during April-June, 101 ± 3 tests during July-September, and 107 ± 17 tests during October-December (one-way analysis of variance test for trend, F = 7.7, P = 0.0254) but not the mean quarterly number of people diagnosed with HBV (F = 0.34, P = 0.7992). Conclusion Community-based HBV screening dramatically improved following temporary disruptions related to COVID-19. Seasonal variation in HBV screening, but not HBV diagnosis, may have implications for HBV elimination efforts in Sierra Leone and other West African countries.
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Affiliation(s)
| | - Lawrence S. Babawo
- Department of Nursing, School of Community Health Sciences, Njala University, Bo, Sierra Leone
| | - Amir M. Mohareb
- Center for Global Health, Massachusetts General Hospital, Boston, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA
- Department of Medicine, Harvard Medical School, Boston, USA
| | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, Australia
| | | | | | | | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Song JW, Yang G, Kamara MN, Sun W, Guan Q, Barrie U, Jiba DF, Jalloh AT, Liu M, Tamba FK, Yendewa GA, Wang L, Zhao R, Lakoh S. HIV viral suppression at different thresholds and duration of treatment in the dolutegravir treatment era in Sierra Leone: a nationwide survey. Virol J 2023; 20:279. [PMID: 38031075 PMCID: PMC10687966 DOI: 10.1186/s12985-023-02245-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/18/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Viral load assessment for people living with HIV is key for monitoring treatment and achieving the 95-95-95. In this study, we aimed to assess the degree of viral suppression at different thresholds and treatment duration after the introduction of dolutegravir-based therapy in ten public hospitals in Sierra Leone. METHODS We used a cross-sectional study design to recruits patients aged 18 years or older between August 2022 and January 2023. Statistical analyses were performed using R-software. Logistic regression was used to assess factors independently associated with viral suppression. The level of significance was set at P < 0.05. RESULTS Of the 2,253 patients recruited, 1,720 (76%) were women and 1,705 (76%) were receiving a fixed dose combination of tenofovir, lamivudine and dolutegravir. The median age and duration of anti-retroviral therapy (ART) was 36.0 (IQR, 28.0-45.0) years and 40.9 (IQR, 14.4-79.6) months, respectively. Using a threshold of HIV RNA < 1000 copies/mL, 1,715 (88.4%) patients on ART for more than 6 months were virally suppressed. Viral suppression rates were higher with dolutegravir-based (1,277, 89.5%) than efavirenz-based (418, 86.2%) ART. HIV RNA was < 200 copies/mL in 1,643 (84.6%) patients or < 50 copies/mL in 1,487 (76.6%) patients or between 50 and 999 copies/mL in 228 (11.7%) patients. Viral suppression rates at different ART durations (months) were as follows: 84.2% (≤ 3), 88.8% (4-6), 90.9% (6-12), and 88.1% (> 12). Viral suppression rates were higher for patients aged 40 or older (40-50 years: aOR 2.05, 95%CI 1.41-3.04, P < 0.01; 50-60 years: aOR 2.51, 95%CI 1.53-4.35, P < 0.01; >60 years: aOR 2.69, 95%CI 1.28-6.63, P = 0.02). Men had 49% lower odds of viral suppression than women (aOR 0.50, 95% CI 0.38-0.67, P < 0.01). CONCLUSION We report a viral suppression rate of 88.4% among patients on treatment for at least 6 months, with higher rate of suppression with dolutegravir than efavirenz. Factors associated with virological suppression were age and gender, emphasizing the need for innovative differentiated ART delivery models to optimize viral suppression and achieve the 95% target.
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Affiliation(s)
- Jin-Wen Song
- Senior Department of Infectious Diseases, the Fifth Medical Center of PLA General Hospital, Beijing, China
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - Guang Yang
- Department of Clinical Laboratory, the Fifth Medical Center of PLA General Hospital, Beijing, China
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Wei Sun
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Qun Guan
- The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Abdulai Tejan Jalloh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Ming Liu
- Department of Clinical Laboratory, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Francis K Tamba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ligui Wang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Rongtao Zhao
- Chinese PLA Center for Disease Control and Prevention, Beijing, China.
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
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Scheier TC, Youssouf N, Mosepele M, Kanyama C, Adekanmbi O, Lakoh S, Muzoora CK, Meintjes G, Mertz D, Eikelboom JW, Wasserman S. Standard of care in advanced HIV disease: review of HIV treatment guidelines in six sub-Saharan African countries. AIDS Res Ther 2023; 20:83. [PMID: 37996881 PMCID: PMC10668471 DOI: 10.1186/s12981-023-00581-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends an evidence-based package of care to reduce mortality and morbidity among people with advanced HIV disease (AHD). Adoption of these recommendations by national guidelines in sub-Saharan Africa is poorly documented. We aimed to review national guidelines for AHD management across six selected countries in sub-Saharan Africa for benchmarking against the 2021 WHO recommendations. METHODS We reviewed national guidelines from six countries participating in an ongoing randomized controlled trial recruiting people with AHD. We extracted information addressing 18 items of AHD diagnosis and management across the following domains: [1] Definition of AHD, [2] Screening, [3] Prophylaxis, [4] Supportive care, and [5] HIV treatment. Data from national guideline documents were compared to the 2021 WHO consolidated guidelines on HIV and an agreement score was produced to evaluate extent of guideline adoption. RESULTS The distribution of categories of agreement varied for the national documents. Four of the six countries addressed all 18 items (Malawi, Nigeria, Sierra Leone, Uganda). Overall agreement with the WHO 2021 guidelines ranged from 9 to 15.5 out of 18 possible points: Malawi 15.5 points, Nigeria, and Sierra Leone 14.5 points, South Africa 13.5 points, Uganda 13.0 points and Botswana with 9.0 points. Most inconsistencies were reported for the delay of antiretroviral therapy (ART) in presence of opportunistic diseases. None of the six national guidelines aligned with WHO recommendations around ART timing in patients with tuberculosis. Agreement correlated with the year of publication of the national guideline. CONCLUSION National guidelines addressing the care of advanced HIV disease in sub-Saharan Africa are available. Besides optimal timing for start of ART in presence of tuberculosis, most national recommendations are in line with the 2021 WHO standards.
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Affiliation(s)
- Thomas C Scheier
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Nabila Youssouf
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Cecilia Kanyama
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Conrad K Muzoora
- Department of Internal Medicine Faculty of Medicine Mbarara, University of Science and Technology Mbarara, Mbarara, Uganda
| | - Graeme Meintjes
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Dominik Mertz
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methodology, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - John W Eikelboom
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sean Wasserman
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
- Institute for Infection and Immunity, St George's, University of London, London, UK.
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10
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Lakoh S, Vamboi PL, Ouédraogo AR, Adekanmbi O, Deen GF, Russell JBW, Sankoh-Hughes A, Kamara JB, Kanu JE, Yendewa GA, Firima E, Amaral AFS. High prevalence of TB multimorbidity among adults of a tertiary hospital in Sierra Leone: a cross-sectional study. BMC Res Notes 2023; 16:337. [PMID: 37974272 PMCID: PMC10655410 DOI: 10.1186/s13104-023-06476-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/25/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Tuberculosis (TB) is a leading cause of death globally, with approximately 1.5 million deaths in 2020. TB often coexists with chronic communicable and non-communicable diseases, but data to determine the extent of comorbid diseases are limited. In this study, we aimed to assess the prevalence of TB multimorbidity and its risk factors in a tertiary hospital in Sierra Leone. This is a cross-sectional study of 240 adults with microbiologically-confirmed TB at Connaught Hospital in Freetown, between March and May 2022. Logistic regression analysis was used to identify factors associated with TB multimorbidity. RESULTS The mean age of the patients was 37 years. More than two-thirds were males and about the same number had two or more chronic diseases. The most common were hypertension (47.9%) and diabetes (24.2%). Patients under 35 years of age were less likely to have TB multimorbidity (< 25 years: adjusted OR 0.07, 95%CI 0.01-0.6; 25-34 years: adjusted OR 0.2, 95%CI 0.01-0.9). We report a high prevalence of comorbid diseases among TB patients in the largest treatment center in Sierra Leone, with hypertension and diabetes being the most common. These findings support the current call for addressing comorbid non-communicable diseases in TB patients through integrated care.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
| | - Patricia Lombeh Vamboi
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdoul Risgou Ouédraogo
- Division of Pulmonology, Training and Research Unit in Health Sciences, University Joseph KI-ZEBRO, Ouagadougou, Burkina Faso
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Ahmed Sankoh-Hughes
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joseph B Kamara
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Joseph Edwin Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
| | - André F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
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11
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Baldeh M, Kizito S, Lakoh S, Sesay D, Dennis F, Barrie U, Williams SA, Robinson DR, Lamontagne F, Amahowe F, Turay P, Sensory-Bahar O, Geng E, Ssewamala FM. Prevalence and factors associated with advanced HIV disease among young people aged 15 - 24 years in a national referral hospital in Sierra Leone: A cross-sectional study. medRxiv 2023:2023.11.07.23296880. [PMID: 37986831 PMCID: PMC10659455 DOI: 10.1101/2023.11.07.23296880] [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] [Indexed: 11/22/2023]
Abstract
Background Advanced HIV in young people living with HIV is an increasingly pressing public health issue in sub-Saharan Africa. Despite global progress in early HIV testing and reducing HIV-related deaths, many young people with HIV continue to experience HIV disease progression in sub-Saharan Africa. This study provides an overview of the prevalence, clinical manifestations, and factors associated with advanced HIV in young people seeking medical services in a major hospital in Sierra Leone. Methods We used a cross-sectional design to collect data from HIV patients aged 15 to 24 years at a major hospital in Sierra Leone between September 2022 and March 2023. Advanced HIV was defined as (i) CD4+ below 200 cells/mm3 or (ii) WHO clinical stage 3 or 4. Logistic regression models determined the association between observable independent characteristics and advanced HIV. The statistical significance level was set at 0.05 for all statistical tests. Results About 40% (231/574) of patients were recruited; 70.6% (163/231) were inpatients, and 29.4% (68/231) were outpatients. The mean age was approximately 21.6 years (SD ±2.43). The overall prevalence of advanced HIV was 42.9% (99/231), 51.5% (35/68) of outpatients, and 39.3% (64/163) of inpatients. Age of inpatients (OR, 1.23; 95% CI, 1.00-1.52; p= 0.047) was associated with a higher risk. Female sex (OR, 0.51; 95% CI, 0.28-0.94; p= 0.030), higher education (OR, 0.27; 95% CI, 0.10 - 0.78; p= 0.015), and Body Mass (OR, 0.10; 95% CI, 0.01-0.77; p= 0.028) were at lower risk of advance HIV. Common conditions diagnosed in this population are tuberculosis (13.58%), hepatitis B (6.13%), Kaposi sarcoma (3.07%), and esophageal candidiasis (2.45%). Conclusion We reported a high prevalence of advanced HIV among young patients in a referral Hospital in Sierra Leone. This emphasises the need to strengthen public health measures and policies that address challenges of access to HIV services.
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Affiliation(s)
- Mamadu Baldeh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | - Daniel Sesay
- University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | - Frida Dennis
- University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | - Umu Barrie
- University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | - Samuel Adeyemi Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | | | - Franck Amahowe
- Solthis - Solidarité Thérapeutique et Initiatives pour la Santé
| | | | | | - Elvin Geng
- Washington University in St. Louis, Missouri, USA
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12
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Jiba DF, Lakoh S, Wang S, Sun W, Barrie U, Kamara MN, Jalloh AT, Tamba FK, Yendewa GA, Song JW, Yang G. Sero-prevalence of syphilis infection among people living with HIV in Sierra Leone: a cross-sectional nationwide hospital-based study. BMC Infect Dis 2023; 23:762. [PMID: 37932713 PMCID: PMC10626761 DOI: 10.1186/s12879-023-08740-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Globally, there were an estimated 7.1 million new syphilis infections in 2020, with more than 30% of these new infections reported in African countries such as Sierra Leone. Despite this, there is no HIV-specific syphilis screening program in Sierra Leone. Thus, data are needed to inform public health practice. In this study, we aimed to determine the prevalence of syphilis seropositivity and factors associated with syphilis seropositivity among people living with HIV (PLHIV). METHODS A cross-sectional study was conducted at 10 health facilities in Sierra Leone, among adults with HIV, aged 18 years or older, from September 2022 to January 2023. Parameters of interest were collected including age, sex, marriage, antiretroviral therapy (ART) regimen, HIV viral load, duration of ART treatment, and hospital level of care. The syphilis antibody was detected by a rapid test based on immunochromatography assay. Data were analyzed using R-software version 4.2.3 (R Core Team, Vienna, Austria). Pearson's χ2 test, Fisher's exact test and Kruskal-Wallis H test were applied to assess the differences in syphilis seropositivity between groups as appropriate. Univariate logistic regression and multivariate logistic regression analysis was used to assess factors associated with syphilis seropositivity. The level of statistical significance was set at P < 0.05. RESULTS Of the 3082 PLHIV individuals in our study, 2294 (74.4%) were female and 2867 (93.0%) were receiving ART. With a median age of 36 years, 211 (6.8%, 95% CI 6.0-7.7) were positive for syphilis. The prevalence of syphilis was highest in people aged 60 years and over (21.1%, 95%CI 14.7-29.2), followed by people aged 50-60 years (15.5%, 95%CI 11.9-19.9) and in the widowed population (11.9%, 95%CI 8.9-15.8). There were no differences in syphilis seropositivity between gender, ART status, ART regimen, duration of ART, HIV viral load and hospital level of care. Older age (50-60 years: adjusted OR 3.49, 95%CI 2.09-5.85 P < 0.001; 60-100 years: adjusted OR 4.28, 95%CI 2.21-8.17, P < 0.001) was an independent predictor of seropositive syphilis. CONCLUSIONS We observed a high prevalence of syphilis among PLHIV. Older people and widowed population have higher syphilis seropositivity. Older age was an independent predictor of syphilis positivity. Therefore, we call for the integration of syphilis screening, treatment and prevention in HIV services.
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Affiliation(s)
- Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
| | - Shuchao Wang
- Changchun Veterinary Institute, Chinese Academy of Agricultural Sciences, Changchun, China
| | - Wei Sun
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdulai Tejan Jalloh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Francis K Tamba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jin-Wen Song
- Senior Department of Infectious Diseases, the Fifth Medical Centre of PLA General Hospital, Beijing, China.
| | - Guang Yang
- Department of Clinical Laboratory, the Fifth Medical Center of PLA General Hospital, Beijing, China.
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13
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Yendewa GA, James PB, Mohareb A, Barrie U, Massaquoi SPE, Yendewa SA, Ghazzawi M, Bockarie T, Cummings PE, Diallo IS, Johnson A, Vohnm B, Babawo LS, Deen GF, Kabba M, Sahr F, Lakoh S, Salata RA. Determinants of incomplete childhood hepatitis B vaccination in Sierra Leone, Liberia, and Guinea: Analysis of national surveys (2018-2020). Epidemiol Infect 2023; 151:e193. [PMID: 37920110 PMCID: PMC10728985 DOI: 10.1017/s0950268823001735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/10/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
Vaccination against hepatitis B virus (HBV) is effective at preventing vertical transmission. Sierra Leone, Liberia, and Guinea are hyperendemic West African countries; yet, childhood vaccination coverage is suboptimal, and the determinants of incomplete vaccination are poorly understood. We analyzed national survey data (2018-2020) of children aged 4-35 months to assess complete HBV vaccination (receiving 3 doses of the pentavalent vaccine) and incomplete vaccination (receiving <3 doses). Statistical analysis was conducted using the complex sample command in SPSS (version 28). Multivariate logistic regression was used to identify determinants of incomplete immunization. Overall, 11,181 mothers were analyzed (4,846 from Sierra Leone, 2,788 from Liberia, and 3,547 from Guinea). Sierra Leone had the highest HBV childhood vaccination coverage (70.3%), followed by Liberia (64.6%) and Guinea (39.3%). Within countries, HBV vaccination coverage varied by socioeconomic characteristics and healthcare access. In multivariate regression analysis, factors that were significantly associated with incomplete vaccination in at least one country included sex of the child, Muslim mothers, lower household wealth index, <4 antenatal visits, home delivery, and distance to health facility vaccination (all p < 0.05). Understanding and addressing modifiable determinants of incomplete vaccination will be essential to help achieve the 2030 viral hepatitis elimination goals.
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Affiliation(s)
- George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, Australia
| | - Amir Mohareb
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Umaru Barrie
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Tahir Bockarie
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Ambulai Johnson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Lawrence S. Babawo
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
| | - Gibrilla F. Deen
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mustapha Kabba
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Foday Sahr
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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14
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Cummings PE, Lakoh S, Yendewa SA, Massaquoi SPE, James PB, Sahr F, Deen GF, Salata RA, Gevao P, Yendewa GA. Understanding COVID-19 Vaccine Uptake and Hesitancy among People with HIV in Freetown, Sierra Leone: A Cross-Sectional Study. Vaccines (Basel) 2023; 11:1685. [PMID: 38006017 PMCID: PMC10674940 DOI: 10.3390/vaccines11111685] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
People with HIV (PWH) incur a higher risk of COVID-19-related morbidity and mortality rates, yet less is known about COVID-19 vaccine uptake and hesitancy in this group. We conducted a cross-sectional study in Freetown, Sierra Leone, from April to June 2022, using the VAX scale, a validated instrument, to assess attitudes towards COVID-19 vaccination and calculate the hesitancy (VAX) scores. We used generalized linear models to identify the factors associated with vaccine hesitancy. Overall, 490 PWH were enrolled (71.4% female, median age: 38 years, median CD4 count: 412 cells/mm3). About 17.3% received ≥1 dose of a COVID-19 vaccine. The mean VAX score was 43.14 ± 7.05, corresponding to 59.9% participants being vaccine-hesitant. A preference for natural immunity (65.8%) and concerns about profiteering (64.4%) were the commonest reasons for hesitancy, followed by a mistrust of vaccine benefits (61.4%) and worries about future effects (48.0%). In the adjusted regression analysis, being a Muslim (β = 2.563, p < 0.001) and having an urban residence (β = 1.709, p = 0.010) were associated with greater vaccine hesitancy, while testing for COVID-19 was associated with reduced vaccine hesitancy (β = -3.417, p = 0.027). These findings underscore the importance of addressing vaccine hesitancy as a critical element boosting COVID-19 vaccine uptake among PWH.
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Affiliation(s)
- Peterlyn E. Cummings
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.A.Y.); (S.P.E.M.)
| | - Sahr A. Yendewa
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.A.Y.); (S.P.E.M.)
| | | | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia;
| | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
| | - Gibrilla F. Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.A.Y.); (S.P.E.M.)
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Pelema Gevao
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Republic of Sierra Leone Armed Forces, Department of Defense, Freetown 00232, Sierra Leone
| | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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15
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Lakoh S, Yi L, Russell JBW, Zhang J, Sevalie S, Zhao Y, Kanu JS, Liu P, Conteh SK, Williams CEE, Barrie U, Adekanmbi O, Jiba DF, Kamara MN, Sesay D, Deen GF, Okeibunor JC, Yendewa GA, Guo X, Firima E. High incidence of catheter-associated urinary tract infections and related antibiotic resistance in two hospitals of different geographic regions of Sierra Leone: a prospective cohort study. BMC Res Notes 2023; 16:301. [PMID: 37907960 PMCID: PMC10619308 DOI: 10.1186/s13104-023-06591-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE Catheter-associated urinary tract infections (CAUTI) are common worldwide, but due to limited resources, its actual burden in low-income countries is unknown. Currently, there are gaps in knowledge about CAUTI due to lack of surveillance activities in Sierra Leone. In this prospective cohort study, we aimed to determine the incidence of CAUTI and associated antibiotic resistance in two tertiary hospitals in different regions of Sierra Leone. RESULTS The mean age of the 459 recruited patients was 48.8 years. The majority were females (236, 51.3%). Amongst the 196 (42.6%) catheterized patients, 29 (14.8%) developed CAUTI. Bacterial growth was reported in 32 (84%) patients. Escherichia coli (14, 23.7%), Klebsiella pneumoniae (10, 17.0%), and Klebsiella oxytoca (8, 13.6%) were the most common isolates. Most isolates were ESBL-producing Enterobacteriaceae (33, 56%) and WHO Priority 1 (Critical) pathogens (38, 71%). Resistance of K. pneumoniae, K. oxytoca, E. coli, and Proteus mirabilis was higher with the third-generation cephalosporins and penicillins but lower with carbapenems, piperacillin-tazobactam and amikacin. To reduce the high incidence of CAUTI and multi-drug resistance organisms, urgent action is needed to strengthen the microbiology diagnostic services and develop and implement catheter bundles that provide clear guidance for catheter insertion, care and removal.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
- Infectious Disease Research Network, Freetown, Sierra Leone.
| | - Le Yi
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Juling Zhang
- Department of Clinical Laboratory, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
- 34 Military Hospital, Freetown, Sierra Leone
| | - Yongkun Zhao
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Peng Liu
- Department of Emergency Medicine, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Sarah K Conteh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Christine Ellen Elleanor Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Daniel Sesay
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | | | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xuejun Guo
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone.
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- , SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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16
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Lakoh S, Williams CEE, Sevalie S, Russell JBW, Conteh SK, Kanu JS, Barrie U, Deen GF, Maruta A, Sesay D, Adekanmbi O, Jiba DF, Okeibunor JC, Yendewa GA, Firima E. Antibiotic use and consumption among medical patients of two hospitals in Sierra Leone: a descriptive report. BMC Infect Dis 2023; 23:737. [PMID: 37891476 PMCID: PMC10612171 DOI: 10.1186/s12879-023-08517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Although one of the main drivers of antimicrobial resistance is inappropriate antibiotic prescribing, there are limited resources to support the surveillance of antibiotic consumption in low-income countries. In this study, we aimed to assess antibiotic use and consumption among medical patients of two hospitals in different geographic regions of Sierra Leone. METHODS This is a cross-sectional study of adult (18 years or older) patients receiving medical care at two hospitals (34 Military Hospital-MH and Makeni Government Hospital-MGH) between March 2021 and October 2021. After admission to the medical or intensive care unit, patients were sequentially recruited by a nurse from each hospital. Demographic and clinical characteristics and information on the dose of antibiotics, their routes, and frequency of administration and duration were collected using a questionnaire adapted from previous studies and encrypted in EpiCollect software (Epic, Verona WI). A physician reviews and verifies each completed questionnaire. Data analysis was done using STATA version 16. RESULTS The mean age of the 468 patients evaluated in this study was 48.6 years. The majority were women (241, 51.7%) and treated at MGH (245, 52.0%). Clinical diagnosis of bacterial infection was made in only 180 (38.5%) patients. Regardless of the diagnosis, most (442, 94.9%) patients received at least one antibiotic. Of a total 813 doses of antibiotics prescribed by the two hospitals, 424 (52.2%) were administered in MH. Overall, antibiotic consumption was 66.9 defined daily doses (DDDs) per 100 bed-days, with ceftriaxone being the most commonly used antibiotic (277, 34.1%). The ACCESS and WATCH antibiotics accounted for 18.9 DDDs per 100 bed-days (28.2%) and 48.0 DDDs per 100 bed-days (71.7%), respectively. None of the patients were prescribed a RESERVE antibiotics. The antibiotic consumption was lower in MH (61.3 DDDs per 100 bed-days) than MGH (76.5 DDDs per 100 bed-days). CONCLUSION Antibiotic consumption was highest with ceftriaxone, followed by levofloxacin and metronidazole. Given the high rate of consumption of antibiotics in the WATCH category of the AWaRe classification, there is a need to initiate surveillance of antibiotic consumption and establish hospital-based antibiotic stewardship in these settings.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone.
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
- Infectious Disease Research Network, Freetown, Sierra Leone.
| | - Christine Ellen Elleanor Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
- 34 Military Hospital, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Sarah K Conteh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Anna Maruta
- World Health Organization Country Office, Freetown, Sierra Leone
| | - Daniel Sesay
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | | | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, OH, Cleveland, USA
- Johns Hopkins Bloomberg School of Public Health, MD, Baltimore, USA
| | - Emmanuel Firima
- Department of Medicine, Clinical Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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17
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Kamara MN, Lakoh S, Kallon C, Kanu JS, Kamara RZ, Kamara IF, Moiwo MM, Kpagoi SSTK, Adekanmbi O, Manzi M, Fofanah BD, Shewade HD. Hand Hygiene Practices and Promotion in Public Hospitals in Western Sierra Leone: Changes Following Operational Research in 2021. Trop Med Infect Dis 2023; 8:486. [PMID: 37999605 PMCID: PMC10674222 DOI: 10.3390/tropicalmed8110486] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/09/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
Hand hygiene is the most important intervention for preventing healthcare-associated infections and can reduce preventable morbidity and mortality. We described the changes in hand hygiene practices and promotion in 13 public hospitals (six secondary and seven tertiary) in the Western Area of Sierra Leone following the implementation of recommendations from an operational research study. This was a "before and after" observational study involving two routine cross-sectional assessments using the WHO hand hygiene self-assessment framework (HHSAF) tool. The overall mean HHSAF score changed from 273 in May 2021 to 278 in April 2023; it decreased from 278 to 250 for secondary hospitals but increased from 263 to 303 for tertiary hospitals. The overall mean HHSAF score and that of the tertiary hospitals remained at the "intermediate" level, while secondary hospitals declined from "intermediate" to "basic" level. The mean score increased for the "system change" and "institutional safety climate" domains, decreased for "training and education" and "reminders in the workplace" domains, and remained the same for the "evaluation and feedback" domain. Limited resources for hand hygiene promotion, lack of budgetary support, and formalized patient engagement programs are the persistent gaps that should be addressed to improve hand hygiene practices and promotion.
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Affiliation(s)
- Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Christiana Kallon
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Rugiatu Z Kamara
- US Center for Disease Control and Prevention, Freetown 00232, Sierra Leone
| | | | - Matilda Mattu Moiwo
- Republic of Sierra Leone Armed Forces, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Satta S T K Kpagoi
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, University of Ibadan, Ibadan 200005, Nigeria
- Department of Medicine, University College Hospital, Ibadan 200005, Nigeria
| | | | | | - Hemant Deepak Shewade
- Division of Health Systems Research, ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai 600077, India
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18
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Sartelli M, Barie PS, Coccolini F, Abbas M, Abbo LM, Abdukhalilova GK, Abraham Y, Abubakar S, Abu-Zidan FM, Adebisi YA, Adamou H, Afandiyeva G, Agastra E, Alfouzan WA, Al-Hasan MN, Ali S, Ali SM, Allaw F, Allwell-Brown G, Amir A, Amponsah OKO, Al Omari A, Ansaloni L, Ansari S, Arauz AB, Augustin G, Awazi B, Azfar M, Bah MSB, Bala M, Banagala ASK, Baral S, Bassetti M, Bavestrello L, Beilman G, Bekele K, Benboubker M, Beović B, Bergamasco MD, Bertagnolio S, Biffl WL, Blot S, Boermeester MA, Bonomo RA, Brink A, Brusaferro S, Butemba J, Caínzos MA, Camacho-Ortiz A, Canton R, Cascio A, Cassini A, Cástro-Sanchez E, Catarci M, Catena R, Chamani-Tabriz L, Chandy SJ, Charani E, Cheadle WG, Chebet D, Chikowe I, Chiara F, Cheng VCC, Chioti A, Cocuz ME, Coimbra R, Cortese F, Cui Y, Czepiel J, Dasic M, de Francisco Serpa N, de Jonge SW, Delibegovic S, Dellinger EP, Demetrashvili Z, De Palma A, De Silva D, De Simone B, De Waele J, Dhingra S, Diaz JJ, Dima C, Dirani N, Dodoo CC, Dorj G, Duane TM, Eckmann C, Egyir B, Elmangory MM, Enani MA, Ergonul O, Escalera-Antezana JP, Escandon K, Ettu AWOO, Fadare JO, Fantoni M, Farahbakhsh M, Faro MP, Ferreres A, Flocco G, Foianini E, Fry DE, Garcia AF, Gerardi C, Ghannam W, Giamarellou H, Glushkova N, Gkiokas G, Goff DA, Gomi H, Gottfredsson M, Griffiths EA, Guerra Gronerth RI, Guirao X, Gupta YK, Halle-Ekane G, Hansen S, Haque M, Hardcastle TC, Hayman DTS, Hecker A, Hell M, Ho VP, Hodonou AM, Isik A, Islam S, Itani KMF, Jaidane N, Jammer I, Jenkins DR, Kamara IF, Kanj SS, Jumbam D, Keikha M, Khanna AK, Khanna S, Kapoor G, Kapoor G, Kariuki S, Khamis F, Khokha V, Kiggundu R, Kiguba R, Kim HB, Kim PK, Kirkpatrick AW, Kluger Y, Ko WC, Kok KYY, Kotecha V, Kouma I, Kovacevic B, Krasniqi J, Krutova M, Kryvoruchko I, Kullar R, Labi KA, Labricciosa FM, Lakoh S, Lakatos B, Lansang MAD, Laxminarayan R, Lee YR, Leone M, Leppaniemi A, Hara GL, Litvin A, Lohsiriwat V, Machain GM, Mahomoodally F, Maier RV, Majumder MAA, Malama S, Manasa J, Manchanda V, Manzano-Nunez R, Martínez-Martínez L, Martin-Loeches I, Marwah S, Maseda E, Mathewos M, Maves RC, McNamara D, Memish Z, Mertz D, Mishra SK, Montravers P, Moro ML, Mossialos E, Motta F, Mudenda S, Mugabi P, Mugisha MJM, Mylonakis E, Napolitano LM, Nathwani D, Nkamba L, Nsutebu EF, O’Connor DB, Ogunsola S, Jensen PØ, Ordoñez JM, Ordoñez CA, Ottolino P, Ouedraogo AS, Paiva JA, Palmieri M, Pan A, Pant N, Panyko A, Paolillo C, Patel J, Pea F, Petrone P, Petrosillo N, Pintar T, Plaudis H, Podda M, Ponce-de-Leon A, Powell SL, Puello-Guerrero A, Pulcini C, Rasa K, Regimbeau JM, Rello J, Retamozo-Palacios MR, Reynolds-Campbell G, Ribeiro J, Rickard J, Rocha-Pereira N, Rosenthal VD, Rossolini GM, Rwegerera GM, Rwigamba M, Sabbatucci M, Saladžinskas Ž, Salama RE, Sali T, Salile SS, Sall I, Kafil HS, Sakakushev BE, Sawyer RG, Scatizzi M, Seni J, Septimus EJ, Sganga G, Shabanzadeh DM, Shelat VG, Shibabaw A, Somville F, Souf S, Stefani S, Tacconelli E, Tan BK, Tattevin P, Rodriguez-Taveras C, Telles JP, Téllez-Almenares O, Tessier J, Thang NT, Timmermann C, Timsit JF, Tochie JN, Tolonen M, Trueba G, Tsioutis C, Tumietto F, Tuon FF, Ulrych J, Uranues S, van Dongen M, van Goor H, Velmahos GC, Vereczkei A, Viaggi B, Viale P, Vila J, Voss A, Vraneš J, Watkins RR, Wanjiru-Korir N, Waworuntu O, Wechsler-Fördös A, Yadgarova K, Yahaya M, Yahya AI, Xiao Y, Zakaria AD, Zakrison TL, Zamora Mesia V, Siquini W, Darzi A, Pagani L, Catena F. Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action. World J Emerg Surg 2023; 18:50. [PMID: 37845673 PMCID: PMC10580644 DOI: 10.1186/s13017-023-00518-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023] Open
Abstract
Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules," for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.
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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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Kpagoi SSTK, Kamara KN, Carshon-Marsh R, Delamou A, Manzi M, Kamara RZ, Moiwo MM, Kamara M, Koroma Z, Lakoh S, Fofanah BD, Kamara IF, Kanu ABJ, Kenneh S, Kanu JS, Margao S, Kamau EM. Assessing Changes in Surgical Site Infections and Antibiotic Use among Caesarean Section and Herniorrhaphy Patients at a Regional Hospital in Sierra Leone Following Operational Research in 2021. Trop Med Infect Dis 2023; 8:385. [PMID: 37624323 PMCID: PMC10458420 DOI: 10.3390/tropicalmed8080385] [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] [Received: 06/25/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Surgical site infections (SSIs) are a major public health threat to the success of surgery. This study assessed changes in SSIs and use of antibiotics among caesarean section (CS) and herniorrhaphy patients at a regional hospital in Sierra Leone following operational research. This was a comparative before and after study using routine hospital data. The study included all the CS and herniorrhaphy patients who underwent surgery between two time periods. Of the seven recommendations made in the first study, only one concerning improving the hospital's records and information system was fully implemented. Three were partially implemented and three were not implemented. The study population in both studies showed similar socio-demographic characteristics. The use of postoperative antibiotics for herniorrhaphy in both studies remained the same, although a significant increase was found for both pre- and postoperative antibiotic use in the CS patients, 589/596 (98.8%) in 2023 and 417/599 (69.6%) in 2021 (p < 0.001). However, a significant decrease was observed in the overall incidence of SSIs, 22/777 (2.8%) in 2023 and 46/681 (6.7%) in 2021 (p < 0.001), and the incidence of SSIs among the CS patients, 15/596 (2.5%) in 2023 and 45/599 (7.5%) in 2021 (p < 0.001). The second study highlights the potential value of timely assessment of the implementation of recommendations following operational research.
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Affiliation(s)
- Satta Sylvia Theresa Kumba Kpagoi
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
- Department of Nursing, School of Community Health Sciences, Bo Campus, Njala University, Bo 00232, Sierra Leone
| | - Kadijatu Nabie Kamara
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
| | - Ronald Carshon-Marsh
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Alexandre Delamou
- Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry 00224, Guinea;
| | | | - Rugiatu Z. Kamara
- United States Centers for Disease Control and Prevention, Public Health Emergency Operations Center, Freetown 00232, Sierra Leone;
| | - Matilda Mattu Moiwo
- Ministry of Defense, Republic of Sierra Leone Armed Forces, Freetown 00232, Sierra Leone;
| | - Matilda Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Zikan Koroma
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Bobson Derrick Fofanah
- World Health Organization Country Office, 21A-B Riverside Drive, Freetown 00232, Sierra Leone; (B.D.F.); (I.F.K.)
| | - Ibrahim Franklyn Kamara
- World Health Organization Country Office, 21A-B Riverside Drive, Freetown 00232, Sierra Leone; (B.D.F.); (I.F.K.)
| | - Alex Bumble John Kanu
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
| | - Sartie Kenneh
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
| | - Joseph Sam Kanu
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Senesie Margao
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
| | - Edward Mberu Kamau
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) at the World Health Organization (WHO), 1211 Geneva, Switzerland;
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21
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Margao S, Fofanah BD, Thekkur P, Kallon C, Ngauja RE, Kamara IF, Kamara RZ, Tengbe SM, Moiwo M, Musoke R, Fullah M, Kanu JS, Lakoh S, Kpagoi SSTK, Kamara KN, Thomas F, Mannah MT, Katawera V, Zachariah R. Improvement in Infection Prevention and Control Performance Following Operational Research in Sierra Leone: A Before (2021) and After (2023) Study. Trop Med Infect Dis 2023; 8:376. [PMID: 37505672 PMCID: PMC10383112 DOI: 10.3390/tropicalmed8070376] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Infection prevention and control (IPC) is crucial to limit health care-associated infections and antimicrobial resistance. An operational research study conducted in Sierra Leone in 2021 reported sub-optimal IPC performance and provided actionable recommendations for improvement. METHODS This was a before-and-after study involving the national IPC unit and all twelve district-level secondary public hospitals. IPC performance in 2021 (before) and in 2023 (after) was assessed using standardized World Health Organization checklists. IPC performance was graded as: inadequate (0-25%), basic (25.1-50%), intermediate (50.1-75%), and advanced (75.1-100%). RESULTS The overall IPC performance in the national IPC unit moved from intermediate (58%) to advanced (78%), with improvements in all six core components. Four out of six components achieved advanced levels when compared to the 2021 levels. The median score for hospitals moved from basic (50%) to intermediate (59%), with improvements in six of eight components. Three of four gaps identified in 2021 at the national IPC unit and four of seven at hospitals had been addressed by 2023. CONCLUSIONS The study highlights the role of operational research in informing actions that improved IPC performance. There is a need to embed operational research as part of the routine monitoring of IPC programs.
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Affiliation(s)
- Senesie Margao
- National Infection Prevention and Control Coordinating Unit, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (C.K.); (R.E.N.)
| | - Bobson Derrick Fofanah
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 75001 Paris, France;
| | - Christiana Kallon
- National Infection Prevention and Control Coordinating Unit, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (C.K.); (R.E.N.)
| | - Ramatu Elizabeth Ngauja
- National Infection Prevention and Control Coordinating Unit, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (C.K.); (R.E.N.)
| | - Ibrahim Franklyn Kamara
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Rugiatu Zainab Kamara
- US Centre for Disease Control and Prevention Country Office, Freetown 00232, Sierra Leone;
| | - Sia Morenike Tengbe
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Matilda Moiwo
- Republic of Sierra Leone Armed Forces, HIV/AIDS/TB Control Program Coordinator, 34th Military Hospital, Wilberforce, Western Area Urban 00232, Sierra Leone;
| | - Robert Musoke
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Mary Fullah
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Joseph Sam Kanu
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Satta Sylvia T. K. Kpagoi
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Kadijatu Nabie Kamara
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Fawzi Thomas
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
- National Pharmacovigilance Center, Pharmacy Board of Sierra Leone, Freetown 047235, Sierra Leone
| | - Margaret Titty Mannah
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Victoria Katawera
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Rony Zachariah
- UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Diseases (TDR), 1211 Geneva, Switzerland;
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22
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Yendewa GA, Kpaka RA, Sellu E, Yendewa SA, Massaquoi SPE, Cummings PE, Ghazzawi M, Barrie U, Dubé K, Lakoh S, James PB, Salata RA, Babawo LS. Perceived and Enacted HIV-Related Stigma in Eastern and Southern Sierra Leone: A Psychometric Study of an HIV Stigma Scale. medRxiv 2023:2023.07.07.23292152. [PMID: 37503110 PMCID: PMC10370221 DOI: 10.1101/2023.07.07.23292152] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background HIV stigma continues to hinder the care of people with HIV (PWH), especially in low-resource settings. We aimed to adapt and validate a concise HIV stigma scale for perceived HIV stigma in Sierra Leone. Methods We enrolled participants in two HIV clinics in Eastern and Southern Sierra Leone in 2022. We assessed perceived stigma using a 12-item adaptation of Berger's HIV Stigma Scale and enacted stigma using select USAID indicators. We used ordinal logistic regression to identify predictors of perceived stigma and Pearson's correlation to examine associations between perceived and enacted stigma. Results 624 PWH were enrolled. The final adapted 6-item HIV stigma scale demonstrated acceptable internal consistency (Cronbach's α = 0.72) and a four-factor solution accounting for 84.8% of variance: concern about public attitude (2 items), personalized stigma (2 items), negative self-image (1 item), and disclosure concerns (1 item). The prevalence of perceived HIV stigma was 68.6%, with disclosure concerns as the most prominent contributor. Enacted HIV stigma was reported by only 6.7% of participants, with partner/spousal abandonment and workplace stigma being the most common discriminatory experiences. Employment (β = 0.525, p <0.001), residence in Eastern Sierra Leone (β = 3.215, p < 0.001), and experiencing enacted stigma (β = 0.804, p < 0.001) were significantly associated with perceived stigma. Having a family member or friend with HIV (β = -0.499, p < 0.001), and HIV disclosure (β = -0.710, p < 0.001) were protective against perceived stigma. Enacted stigma strongly correlated with partner abandonment and family isolation (r = 0.223, p < 0.001). Conclusion We found high levels of perceived HIV stigma, underscoring the need for targeted interventions to combat stigma and promote inclusivity for PWH in Sierra Leone.
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Affiliation(s)
- George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Edmond Sellu
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
| | - Sahr A Yendewa
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | | | - Umaru Barrie
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, California, USA
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Peter B James
- Faculty of Health, Southern Cross University, Lismore, Australia
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lawrence S Babawo
- Eastern Technical University, Kenema, Sierra Leone
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
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23
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Lakoh S, Kamara JB, Orefuwa E, Sesay D, Jiba DF, Adekanmbi O, Deen GF, Russell JBW, Bah AB, Kargbo MJ, Firima E, Yendewa GA, Denning DW. Prevalence and predictors of Aspergillus seropositivity and chronic pulmonary aspergillosis in an urban tertiary hospital in Sierra Leone: A cross-sectional study. PLoS Negl Trop Dis 2023; 17:e0011284. [PMID: 37459359 PMCID: PMC10374077 DOI: 10.1371/journal.pntd.0011284] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/27/2023] [Accepted: 05/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND In the World Health Organization Global Tuberculosis (TB) Report 2022, 37% of pulmonary TB patients were clinically diagnosed and thus many people were treated for TB without evidence of the disease. Probably the most common TB misdiagnosis is chronic pulmonary aspergillosis (CPA). In this study, we aimed to assess the prevalence and predictors of Aspergillus seropositivity and CPA in patients with chronic respiratory symptoms in an urban tertiary hospital in Sierra Leone. METHODOLOGY/PRINCIPAL FINDINGS We used a cross-sectional study design to recruit adults (≥18 years) from the Chest Clinic of Connaught Hospital, Freetown between November 2021 and July 2022. Aspergillus antibody was detected using LDBio Aspergillus IgM/IgG. Logistic regression was performed to assess the independent predictors of Aspergillus seropositivity and CPA. Of the 197 patients with chronic respiratory symptoms, 147 (74.6%) were male. Mean age was 47.1 ± 16.4 years. More than half (104, 52.8%) had been diagnosed with TB in the past, while 53 (26.9%) were on TB treatment at the time of recruitment. Fifty-two (26.4%) patients were HIV positive, 41 (20.8%) were seropositive for Aspergillus and 23 (11.6%) had CPA, 2 (3.8%) with current TB and 18 (17.3%) with past TB. Common radiologic abnormalities reported were localized fibrotic changes 62 (31.5%), consolidation 54 (27.4%), infiltrates 46 (23.4%), hilar adenopathy 40 (20.3%) and pleural effusion 35 (17.85) and thickening 23 (11.7%). Common symptoms were weight loss 144 (73.1%), cough 135 (68.5%), fever 117 (59.4%) and dyspnea 90 (45.7%). Current or past TB infection {aOR 3.52, 95% CI (1.46, 8.97); p = 0.005} was an independent predictor of Aspergillus seropositivity and CPA. CONCLUSIONS/SIGNIFICANCE We report a high prevalence of Aspergillus antibody seropositivity and CPA, underscoring the need to integrate the prevention and management of pulmonary fungal infections with TB services and asthma care in order to reduce unnecessary morbidity and mortality.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
| | - Joseph B Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Emma Orefuwa
- Global Action For Fungal Infections, Geneva, Switzerland
| | - Daniel Sesay
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Abubakarr Bailor Bah
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Maxwell Joseph Kargbo
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Emmanuel Firima
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - David W Denning
- Global Action For Fungal Infections, Geneva, Switzerland
- Manchester Fungal Infection Group, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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24
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Spencer SA, Adipa FE, Baker T, Crawford AM, Dark P, Dula D, Gordon SB, Hamilton DO, Huluka DK, Khalid K, Lakoh S, Limbani F, Rylance J, Sawe HR, Simiyu I, Waweru-Siika W, Worrall E, Morton B. A health systems approach to critical care delivery in low-resource settings: a narrative review. Intensive Care Med 2023; 49:772-784. [PMID: 37428213 PMCID: PMC10354139 DOI: 10.1007/s00134-023-07136-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/02/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
There is a high burden of critical illness in low-income countries (LICs), adding pressure to already strained health systems. Over the next decade, the need for critical care is expected to grow due to ageing populations with increasing medical complexity; limited access to primary care; climate change; natural disasters; and conflict. In 2019, the 72nd World Health Assembly emphasised that an essential part of universal health coverage is improved access to effective emergency and critical care and to "ensure the timely and effective delivery of life-saving health care services to those in need". In this narrative review, we examine critical care capacity building in LICs from a health systems perspective. We conducted a systematic literature search, using the World Heath Organisation (WHO) health systems framework to structure findings within six core components or "building blocks": (1) service delivery; (2) health workforce; (3) health information systems; (4) access to essential medicines and equipment; (5) financing; and (6) leadership and governance. We provide recommendations using this framework, derived from the literature identified in our review. These recommendations are useful for policy makers, health service researchers and healthcare workers to inform critical care capacity building in low-resource settings.
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Affiliation(s)
- Stephen A Spencer
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Tim Baker
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Queen Marys University of London, London, UK
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Paul Dark
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK
| | - Dingase Dula
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Stephen B Gordon
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - David Oliver Hamilton
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Karima Khalid
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Felix Limbani
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Jamie Rylance
- Health Care Readiness Unit, World Health Organisation, Geneva, Switzerland
| | - Hendry R Sawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ibrahim Simiyu
- Liverpool School of Tropical Medicine, Liverpool, UK
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Eve Worrall
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ben Morton
- Liverpool School of Tropical Medicine, Liverpool, UK.
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
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25
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Lakoh S, John-Cole V, Luke RD, Bell N, Russell JB, Mustapha A, Barrie U, Abiri OT, Coker JM, Kamara MN, Coker FJ, Adekanmbi O, Kamara IF, Fofanah BD, Jiba DF, Adeniji AO, Kenneh S, Deen GF, Moon TD, Yendewa GA, Firima E. Antibiotic use and consumption in Freetown, Sierra Leone: A baseline report of prescription stewardship in outpatient clinics of three tertiary hospitals. IJID Reg 2023; 7:43-51. [PMID: 37038468 PMCID: PMC10082370 DOI: 10.1016/j.ijregi.2023.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
Objective As there are no country-representative data on bacterial sensitivities to guide antimicrobial stewardship (AMS) interventions, an AMS programme was established in the outpatient clinics of three tertiary hospitals in Freetown, Sierra Leone. Methods The study employed a cross-sectional design to collect antibiotic prescribing data from 370 pregnant women and lactating mothers, 314 children and 229 regular patients in the outpatient clinics of the Princess Christian Maternity Hospital (PCMH), Ola During Children's Hospital and Connaught Hospital (CH), respectively, in April 2022. All data were analysed using Stata Version 16. Results Of 913 patients, most were female (n=635, 69.5%), treated at PCMH (n=370, 40.5%) and had a bacterial infection (n=661, 72.4%). The indication for prescribing antibiotics was inappropriate in 252 (27.6%) patients. Of the 1236 prescriptions, 393 (31.8%) were made at CH. The duration of antibiotic use was not stated in 230 (18.6%) prescriptions. Overall antibiotic consumption was 55.3 defined daily doses per 1000 outpatient-days. Conclusion Gaps in antibiotic prescriptions were identified in the outpatient clinics of three national referral hospitals in Sierra Leone. In order to combat antimicrobial resistance, AMS interventions are needed to reduce the prescription of antibiotics for inappropriate indications or without specified duration.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Valerie John-Cole
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Ronita D.C. Luke
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Nellie Bell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - James B.W. Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Ayeshatu Mustapha
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Onome T. Abiri
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Joshua M. Coker
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Matilda N. Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Freddie J. Coker
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | - Darlinda F. Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Adetunji O. Adeniji
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
- Department of Obstetrics & Gynaecology, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Sartie Kenneh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla F. Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Troy D. Moon
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emmanuel Firima
- Division Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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26
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Yendewa GA, Wang GM, James PB, Massaquoi SPE, Yendewa SA, Ghazawi M, Babawo LS, Ocama P, Russell JBW, Deen GF, Sahr F, Kabba M, Tatsuoka C, Lakoh S, Salata RA. Prevalence of Chronic Hepatitis B Virus Infection in Sierra Leone, 1997-2022: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2023:tpmd220711. [PMID: 37217165 DOI: 10.4269/ajtmh.22-0711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/18/2023] [Indexed: 05/24/2023] Open
Abstract
Hepatitis B virus (HBV) infection is a major public health problem in Sierra Leone, yet reliable estimates of cases are lacking. This study aimed to provide an estimate of the national prevalence of chronic HBV infection in the general population and select groups in Sierra Leone. We used the electronic databases PubMed/MEDLINE, Embase, Scopus, ScienceDirect, Web of Science, Google Scholar, and African Journals Online to systematically review articles reporting hepatitis B infection surface antigen seroprevalence estimates in Sierra Leone during 1997-2022. We estimated pooled HBV seroprevalence rates and assessed potential sources of heterogeneity. Of 546 publications screened, 22 studies with a total sample size of 107,186 people were included in the systematic review and meta-analysis. The pooled prevalence of chronic HBV infection was 13.0% (95% CI, 10.0-16.0) (I2 = 99%; Pheterogeneity < 0.01). During the study period, the HBV prevalence rates were as follows: 17.9% (95% CI, 6.7-39.8) before 2015, 13.3% (95% CI, 10.4-16.9) during 2015-2019, and 10.7% (95% CI, 7.5-14.9) during 2020-2022. The use of the 2020-2022 HBV prevalence estimates corresponded to 870,000 cases of chronic HBV infection (uncertainty interval, 610,000-1,213,000), or approximately one in nine people. The highest HBV seroprevalence estimates were among adolescents aged 10-17 years (17.0%; 95% CI, 8.8-30.5), Ebola survivors (36.8%; 95% CI, 26.2-48.8), people living with HIV (15.9%; 95% CI, 10.6-23.0), and those in the Northern Province (19.0%; 95% CI, 6.4-44.7) and Southern Province (19.7%; 95% CI, 10.9-32.8) regions. These findings may help inform national HBV program implementation in Sierra Leone.
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Affiliation(s)
- George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gi-Ming Wang
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Peter B James
- Faculty of Health, Southern Cross University, Lismore, Australia
| | | | - Sahr A Yendewa
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Lawrence S Babawo
- Department of Nursing, School of Community Health Sciences, Njala University, Bo, Sierra Leone
| | - Ponsiano Ocama
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - James B W Russell
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Gibrilla F Deen
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Foday Sahr
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mustapha Kabba
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Curtis Tatsuoka
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Centers for AIDS Research, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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27
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Russell JBW, Koroma TR, Sesay S, Samura SK, Lakoh S, Bockarie A, Abir OT, Kanu JS, Coker J, Jalloh A, Conteh V, Conteh S, Smith M, Mahdi OZ, Lisk DR. Burden of cardiometabolic risk factors and preclinical target organ damage among adults in Freetown, Sierra Leone: a community-based health-screening survey. BMJ Open 2023; 13:e067643. [PMID: 37192807 DOI: 10.1136/bmjopen-2022-067643] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVE To investigate the prevalence of cardiometabolic risk factors (CMRFs), target organ damage (TOD) and its associated factors among adults in Freetown, Sierra Leone. DESIGN This community-based cross-sectional study used a stratified multistage random sampling method to recruit adult participants. SETTING The health screening study was conducted between October 2019 and October 2021 in Western Area Urban, Sierra Leone. PARTICIPANTS A total of 2394 adult Sierra Leoneans aged 20 years or older were enrolled. OUTCOME MEASURE Anthropometric data, fasting lipid profiles, fasting plasma glucose, TOD, clinical profiles and demographic characteristics of participants were described. The cardiometabolic risks were further related to TOD. RESULTS The prevalence of known CMRFs was 35.3% for hypertension, 8.3% for diabetes mellitus, 21.1% for dyslipidaemia, 10.0% for obesity, 13.4% for smoking and 37.9% for alcohol. Additionally, 16.1% had left ventricular hypertrophy (LVH) by ECG, 14.2% had LVH by two-dimensional echo and 11.4% had chronic kidney disease (CKD). The odds of developing ECG-LVH were higher with diabetes (OR=1.255, 95% CI (0.822 to 1.916) and dyslipidaemia (OR=1.449, 95% CI (0.834 to 2.518). Associated factors for higher odds of Left Ventricular Mass Index by echo were dyslipidaemia (OR=1.844, 95% CI (1.006 to 3.380)) and diabetes mellitus (OR=1.176, 95% CI (0.759 to 1.823)). The odds of having CKD were associated with diabetes mellitus (OR=1.212, 95% CI (0.741 to 1.983)) and hypertension (OR=1.163, 95% CI (0.887 to 1.525)). A low optimal cut-off point for ECG-LVH (male 24.5 mm vs female 27.5 mm) was required to maximise sensitivity and specificity by a receiver operating characteristics curve since the odds for LVH by ECG were low. CONCLUSIONS This study provides novel data-driven information on the burden of CMRF and its association with preclinical TOD in a resource-limited setting. It illustrates the need for interventions in improving cardiometabolic health screening and management in Sierra Leonean.
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Affiliation(s)
- James Baligeh Walter Russell
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Theresa Ruba Koroma
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Santigie Sesay
- Directorate of Non-Communicable Diseases and Mental Health, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Sallieu Kabay Samura
- Department of Mathematics and Statistics, Fourah Bay College, University of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Ansumana Bockarie
- School of Medical Sciences, Department of Internal Medicine, University of Cape Coast, Cape Coast, Ghana
| | - Onome Thomas Abir
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- Department of Community Health, Faculty of Clinical Sciences, College of Medicine & Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joshua Coker
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdul Jalloh
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Victor Conteh
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sorie Conteh
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mohamed Smith
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Othman Z Mahdi
- Department of Internal Medicine, Choithrams Memorial Hospital, Freetown, Sierra Leone
| | - Durodami R Lisk
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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28
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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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29
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Yendewa GA, Sellu EJ, Kpaka RA, James PB, Yendewa SA, Cummings PE, Babawo LM, Massaquoi SP, Ghazawi M, Ocama P, Lakoh S, Babawo LS, Salata RA. Measuring Stigma Associated with Hepatitis B Virus Infection in Sierra Leone: Validation of an Abridged Berger HIV Stigma Scale. medRxiv 2023:2023.02.17.23286086. [PMID: 36824916 PMCID: PMC9949200 DOI: 10.1101/2023.02.17.23286086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Stigma associated with hepatitis B virus (HBV) is common in endemic countries; however; instruments are lacking to accurately measure HBV-related stigma. We therefore aimed to develop and validate a concise instrument for measuring perceived HBV-related stigma in Sierra Leone. We enrolled 220 people living with HBV (PWHB) aged ≥ 18 years from August to November 2022. The initial Likert-scale instrument entailed 12 items adapted from Berger's HIV Stigma Scale. We included 4 additional items adapted from the USAID indicators for enacted stigma. The proposed scale's psychometric properties were assessed. After item reduction, the final HBV Stigma Scale consisted of 10 items and had good internal consistency (overall Cronbach's α = 0.74), discriminant and construct validity. Exploratory factor analysis produced a 3-dimensional structure accounting for 59.3% of variance: personalized stigma driven by public attitudes (6 items), negative self-image (2 items), and disclosure concerns (2 items). Overall, 72.8% of respondents reported perceived HBV stigma (mean score 29.11 ± 4.14) and a similar a proportion (73.6%) reported at least one instance of enacted stigma. In assessing criterion-related validity, perceived HBV-related stigma correlated strongly with enacted stigma (r = 0.556) and inversely with having family/friends with HBV (r = -0.059). The 10-item HBV Stigma Scale demonstrated good internal consistency and validity and is suitable for screening for HBV-related stigma in Sierra Leone. The psychometric properties of the scale can be optimized with item additions/modifications and confirmatory factor analysis. The scale may help in combating stigma as a barrier to achieving HBV global elimination goals.
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30
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Park SH, Hong SH, Kim K, Lee SW, Yon DK, Jung SJ, Abdeen Z, Ghayda RA, Ahmed MLCB, Serouri AA, Al‐Herz W, Al‐Shamsi HO, Ali S, Ali K, Baatarkhuu O, Nielsen HB, Bernini‐Carri E, Bondarenko A, Cassell A, Cham A, Chua MLK, Dadabhai S, Darre T, Davtyan H, Dragioti E, East B, Edwards RJ, Ferioli M, Georgiev T, Ghandour LA, Harapan H, Hsueh P, Mallah SI, Ikram A, Inoue S, Jacob L, Janković SM, Jayarajah U, Jesenak M, Kakodkar P, Kapata N, Kebede Y, Khader Y, Kifle M, Koh D, Maleš VK, Kotfis K, Koyanagi A, Kretchy J, Lakoh S, Lee J, Lee JY, Mendonça MDLL, Ling L, Llibre‐Guerra J, Machida M, Makurumidze R, Memish ZA, Mendoza I, Moiseev S, Nadasdy T, Nahshon C, Ñamendys‐Silva SA, Yongsi BN, Nicolasora AD, Nugmanova Z, Oh H, Oksanen A, Owopetu O, Ozguler ZO, Parperis K, Perez GE, Pongpirul K, Rademaker M, Radojevic N, Roca A, Rodriguez‐Morales AJ, Roshi E, Saeed KMI, Sah R, Sakakushev B, Sallam DE, Sathian B, Schober P, Ali PSS, Simonović Z, Singhal T, Skhvitaridze N, Solmi M, Subbaram K, Tizaoui K, Tlhakanelo JT, Torales J, Torres‐Roman JS, Tsartsalis D, Tsolmon J, Vieira DN, Rosa SGV, Wanghi G, Wollina U, Xu R, Yang L, Zia K, Zildzic M, Il Shin J, Smith L. Nonpharmaceutical interventions reduce the incidence and mortality of COVID‐19: A study based on the survey from the International COVID‐19 Research Network (ICRN). J Med Virol 2023; 95. [DOI: https:/doi.org/10.1002/jmv.28354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/02/2022] [Indexed: 09/03/2023]
Abstract
AbstractThe recently emerged novel coronavirus, “severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2),” caused a highly contagious disease called coronavirus disease 2019 (COVID‐19). It has severely damaged the world's most developed countries and has turned into a major threat for low‐ and middle‐income countries. Since its emergence in late 2019, medical interventions have been substantial, and most countries relied on public health measures collectively known as nonpharmaceutical interventions (NPIs). We aimed to centralize the accumulative knowledge of NPIs against COVID‐19 for each country under one worldwide consortium. International COVID‐19 Research Network collaborators developed a cross‐sectional online survey to assess the implications of NPIs and sanitary supply on the incidence and mortality of COVID‐19. The survey was conducted between January 1 and February 1, 2021, and participants from 92 countries/territories completed it. The association between NPIs, sanitation supplies, and incidence and mortality were examined by multivariate regression, with the log‐transformed value of population as an offset value. The majority of countries/territories applied several preventive strategies, including social distancing (100.0%), quarantine (100.0%), isolation (98.9%), and school closure (97.8%). Individual‐level preventive measures such as personal hygiene (100.0%) and wearing facial masks (94.6% at hospitals; 93.5% at mass transportation; 91.3% in mass gathering facilities) were also frequently applied. Quarantine at a designated place was negatively associated with incidence and mortality compared to home quarantine. Isolation at a designated place was also associated with reduced mortality compared to home isolation. Recommendations to use sanitizer for personal hygiene reduced incidence compared to the recommendation to use soap. Deprivation of masks was associated with increased incidence. Higher incidence and mortality were found in countries/territories with higher economic levels. Mask deprivation was pervasive regardless of economic level. NPIs against COVID‐19 such as using sanitizer, quarantine, and isolation can decrease the incidence and mortality of COVID‐19.
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Affiliation(s)
- Seung Hyun Park
- Yonsei University College of Medicine Seoul Republic of Korea
| | - Sung Hwi Hong
- Yonsei University College of Medicine Seoul Republic of Korea
| | - Kwanghyun Kim
- Department of Preventive Medicine Yonsei University College of Medicine Seoul Republic of Korea
- Department of Public Health Yonsei University Seoul Republic of Korea
| | - Seung Won Lee
- Department of Precision Medicine Sungkyunkwan University School of Medicine Suwon Republic of Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine Seoul Republic of Korea
| | - Sun Jae Jung
- Department of Preventive Medicine Yonsei University College of Medicine Seoul Republic of Korea
- Department of Public Health Yonsei University Seoul Republic of Korea
| | - Ziad Abdeen
- Department of Community Health, Faculty of Medicine Al‐Quds University East Jerusalem Palestine
| | - Ramy Abou Ghayda
- Urology Institute, University Hospitals Case Western Reserve University, Cleveland Ohio United States of America
| | | | | | | | - Humaid O. Al‐Shamsi
- Burjeel Cancer Institute, Burjeel Medical City Abu Dhabi United Arab Emirates
| | - Sheeza Ali
- School of Medicine, The Maldives National University Male Maldives
| | - Kosar Ali
- University of Sulaimani College of Medicine Sulaymaniyah Iraq
| | - Oidov Baatarkhuu
- Department of Infectious Diseases Mongolian National University of Medical Sciences Ulaanbaatar Mongolia
| | - Henning Bay Nielsen
- Department of Anesthesia and Intensive Care Zealand University Hospital Roskilde Roskilde Denmark
- Department of Nutrition Exercise and Sports, University of Copenhagen Copenhagen Denmark
| | - Enrico Bernini‐Carri
- European Centre for Disaster Medicine, Council of Europe (CEMEC) Strasbourg France
| | - Anastasiia Bondarenko
- Department of Pediatrics, Immunology, Infectious and Rare Diseases International European University Kyiv Ukraine
| | - Ayun Cassell
- John F. Kennedy Medical Center, Edison New Jersey United States of America
| | - Akway Cham
- School of Medicine, University of Juba Juba South Sudan
| | - Melvin L. K. Chua
- Department of Head and Neck and Thoracic Cancers, Division of Radiation Oncology National Cancer Centre Singapore Singapore Singapore
- Oncology Academic Programme, Duke‐NUS Medical School Singapore Singapore
- Division of Medical Sciences National Cancer Centre Singapore Singapore Singapore
| | - Sufia Dadabhai
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland United States of America
| | - Tchin Darre
- Department of Pathology University of Lomé Lome Togo
| | - Hayk Davtyan
- Tuberculosis Research and Prevention Center Yerevan Armenia
| | - Elena Dragioti
- Department of Health, Medicine and Caring Sciences Pain and Rehabilitation Centre, Linköping University Linköping Sweden
| | - Barbora East
- 3rd Department of Surgery 1st Medical Faculty of Charles University, Motol University Hospital Prague Czech Republic
| | | | - Martina Ferioli
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna Bologna Italy
| | - Tsvetoslav Georgiev
- First Department of Internal Medicine Medical University—Varna Varna Bulgaria
| | | | - Harapan Harapan
- Department of Microbiology Universitas Syiah Kuala Banda Aceh Indonesia
| | - Po‐Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine China Medical University Hospital China Medical University Taichung Taiwan
| | - Saad I. Mallah
- Royal College of Surgeons in Ireland ‐ Bahrain Al Sayh Bahrain
| | - Aamer Ikram
- National Institute of Health, Islamabad Pakistan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health Tokyo Medical University Tokyo Japan
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas Barcelona Spain
- Faculty of Medicine University of Versailles Saint‐Quentin‐en‐Yvelines, Montigny‐le‐Bretonneux France
| | | | - Umesh Jayarajah
- Postgraduate Institute of Medicine, University of Colombo Colombo Sri Lanka
| | - Milos Jesenak
- Department of Pediatrics, Jessenius Faculty of Medicine in Martin University Teaching Hospital in Martin, Comenius University in Bratislava Bratislava Slovakia
| | | | - Nathan Kapata
- Zambia National Public Health Institute Lusaka Zambia
| | - Yohannes Kebede
- Department of Health, Behavior and Society Jimma University Jimma Ethiopia
| | - Yousef Khader
- Department of Public Health Jordan University of Science and Technology Irbid Jordan
| | - Meron Kifle
- Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, Nuffield University of Oxford Oxford United Kingdom
| | - David Koh
- Saw Swee Hock School of Public Health National University of Singapore, Singapore Singapore
| | - Višnja Kokić Maleš
- Clinical Hospital Centre Split, University Department of Health Studies University of Split Croatia
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications Pomeranian Medical University in Szczecin Szczecin Poland
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Deu, ICREA, CIBERSAM, ISCIII Barcelona Spain
| | - James‐Paul Kretchy
- Public Health Unit, School of Medicine and Health Sciences Central University Accra Ghana
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences University of Sierra Leone Freetown Sierra Leone
| | - Jinhee Lee
- Department of Psychiatry Yonsei University Wonju College of Medicine, Wonju‐si Gangwon‐do Republic of Korea
| | - Jun Young Lee
- Department of Nephrology Yonsei University Wonju College of Medicine, Wonju‐si Gangwon‐do Republic of Korea
| | | | - Lowell Ling
- The Chinese University of Hong Kong, Hong Kong SAR China
| | | | - Masaki Machida
- Department of Preventive Medicine and Public Health Tokyo Medical University Tokyo Japan
| | - Richard Makurumidze
- Family Medicine, Global and Public Health Unit University of Zimbabwe Faculty of Medicine and Health Sciences Harare Zimbabwe
| | - Ziad A. Memish
- Director Research and Innovation Center, King Saud Medical City, Ministry of Health & College of Medicine Alfaisal University Riyadh Saudi Arabia
| | - Ivan Mendoza
- Tropical Cardiology Central University of Venezuela, Caracas Venezuela
| | - Sergey Moiseev
- Sechenov First Moscow State Medical University Moscow Russia
| | | | - Chen Nahshon
- Department of Gynecologic Surgery & Oncology Carmel Medical Center Haifa Israel
| | - Silvio A. Ñamendys‐Silva
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Instituto Nacional de Cancerologia Mexico City Mexico
| | | | | | | | - Hans Oh
- University of Southern California, Los Angeles California United States of America
| | - Atte Oksanen
- Faculty of Social Sciences Tampere University Tampere Finland
| | - Oluwatomi Owopetu
- Department of Community Medicine University College Hospital Ibadan Nigeria
| | - Zeynep Ozge Ozguler
- General Directorate of Public Health Ministry of Health of Turkey Adnan Saygun St, Çankaya Ankara Turkey
| | | | | | - Krit Pongpirul
- School of Global Health and Department of Preventive and Social Medicine, Faculty of Medicine Chulalongkorn University Bangkok Thailand
| | - Marius Rademaker
- Clinical Trials New Zealand, Waikato Hospital Campus Hamilton New Zealand
| | | | - Anna Roca
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara Gambia
| | - Alfonso J. Rodriguez‐Morales
- Grupo de Investigación Biomedicina Faculty of Medicine, Fundación Universitaria Autónoma de las Americas ‐ Institución Universitaria Visión de las Américas Pereira Colombia
- Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur Lima Peru
- Gilbert and Rose‐Marie Chagoury School of Medicine, Lebanese American University Beirut Lebanon
| | - Enver Roshi
- Department of Public Health, Faculty of Medicine University of Medicine of Tirana Albania
| | | | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Institute of Medicine Kathmandu Nepal
| | - Boris Sakakushev
- RIMU/Research Institute of Medical University Plovdiv Bulgaria
- Chair of Propedeutics of Surgical Diseases
- University Hospital St. George, Plovdiv, Bulgaria
| | - Dina E. Sallam
- Pediatrics and Pediatric Nephrology Department Faculty of Medicine Ain Shams University Cairo Egypt
| | - Brijesh Sathian
- Geriatrics and Long Term Care Department Rumailah Hospital Doha Qatar
| | - Patrick Schober
- Department of Anesthesiology Amsterdam UMC location Vrije Universiteit Amsterdam Amsterdam Netherlands
| | | | | | - Tanu Singhal
- Kokilaben Dhirubhai Ambani Hospital and Research Institute Mumbai India
| | | | - Marco Solmi
- Department of Psychiatry University of Ottawa Ontario Canada
- Department of Mental Health Ontario Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa Ontario Canada
- Department of Child and Adolescent Psychiatry Charité Universitätsmedizin Berlin Germany
| | - Kannan Subbaram
- School of Medicine, The Maldives National University Male Maldives
| | - Kalthoum Tizaoui
- Laboratory of Microorganisms and Actives Biomolecules, Faculty of Sciences of Tunis University Tunis El Manar Tunis Tunisia
| | - John Thato Tlhakanelo
- Department of Family Medicine and Public Health University of Botswana, Faculty of Medicine Gaborone Botswana
| | - Julio Torales
- National University of Asunción, School of Medical Sciences San Lorenzo Paraguay
| | | | | | - Jadamba Tsolmon
- Mongolian National University of Medical Sciences (MNUMS) Ulaanbaatar Mongolia
| | | | | | - Guy Wanghi
- Department of Basic Sciences, University of Kinshasa Faculty of Medicine, Laboratory of Physiology Kinshasa, Democratic Republic of the Congo
| | - Uwe Wollina
- Department of Dermatology and Allergology Städtisches Klinikum Dresden – Academic Teaching Hospital Dresden Germany
| | - Ren‐He Xu
- Faculty of Health Sciences University of Macau Macau China
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services School of Medicine, University of Calgary Calgary Canada
| | - Kashif Zia
- School of Health and Wellbeing, University of Glasgow Glasgow United Kingdom
| | - Muharem Zildzic
- Academy of Medical Science of Bosnia and Herzegovina Sarajevo Bosnia and Herzegovina
| | - Jae Il Shin
- Department of Pediatrics Yonsei University College of Medicine Seoul Republic of Korea
| | - Lee Smith
- Centre for Health Performance and Wellbeing Anglia Ruskin University Cambridge United Kingdom
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Ghazzawi M, Yendewa SA, James PB, Massaquoi SP, Babawo LS, Sahr F, Deen GF, Kabba M, Ocama P, Lakoh S, Salata RA, Yendewa GA. Assessment of Knowledge, Stigmatizing Attitudes and Health-Seeking Behaviors Regarding Hepatitis B Virus Infection in a Pharmacy and Community Setting in Sierra Leone: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11020177. [PMID: 36673546 PMCID: PMC9859485 DOI: 10.3390/healthcare11020177] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/15/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
Hepatitis B virus (HBV) is a major global health challenge. Emerging evidence suggests that poor knowledge and stigma are impacting HBV control efforts in sub-Saharan Africa (SSA), but their role is not well understood. We conducted a cross-sectional study of adults aged ≥18 years in a community and pharmacy setting in Freetown, Sierra Leone. A structured questionnaire was used to assess knowledge, stigmatizing attitudes and health-seeking behaviors regarding HBV. Logistic regression was used to identify predictors of HBV knowledge and related stigma. A total of 306 adult participants were enrolled (50.7% male, 7.5% HBV positive and 11.7% vaccinated). Overall, 52.2% had good HBV knowledge and 49.3% expressed a stigmatizing attitude towards people with HBV. Notwithstanding, 72.2% stated they would receive the HBV vaccine if offered, 80.4% would take anti-HBV medication and 78.8% would be willing to attend clinic regularly. Good HBV knowledge was associated with HBV positive status (aOR 4.41; p = 0.029) and being vaccinated against HBV (aOR 3.30; p = 0.034). HBV-related stigma was associated with secondary or higher level of education (aOR 2.36; p < 0.001), good HBV knowledge (aOR 2.05; p = 0.006) and pharmacy setting (aOR 1.74, p = 0.037). These findings suggest that education and stigma reduction may benefit HBV elimination efforts in SSA.
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Affiliation(s)
| | | | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia
| | | | - Lawrence S. Babawo
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Freetown, Sierra Leone
| | - Foday Sahr
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Gibrilla F. Deen
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mustapha Kabba
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Ponsiano Ocama
- Department of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Correspondence: ; Tel.: +1-2168441988
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32
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Lakoh S, Kamudumuli PS, Penney ROS, Haumba SM, Jarvis JN, Hassan AJ, Moudoute NLE, Ocansey BK, Izco S, Kipkerich S, Sacarlal J, Awopeju AT, Govender NP, Munyanji CIM, Guyguy K, Orefuwa E, Denning DW. Diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa: a continent-wide survey. Lancet Infect Dis 2022; 23:598-608. [PMID: 36565714 DOI: 10.1016/s1473-3099(22)00656-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Fungal infections are common causes of death and morbidity in those with advanced HIV infection. Data on access to diagnostic tests in Africa are scarce. We aimed to evaluate the diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa. METHODS We did a continent-wide survey by collecting data from 48 of 49 target countries across Africa with a population of more than 1 million; for Lesotho, only information on the provision of cryptococcal antigen testing was obtained. This survey covered 99·65% of the African population. We did the survey in six stages: first, questionnaire development, adaptation, and improvement; second, questionnaire completion by in-country respondents; third, questionnaire review and data analysis followed by video conference calls with respondents; fourth, external validation from public or private sources; fifth, country validation by video conference with senior figures in the Ministry of Health; and sixth, through five regional webinars led by the Africa Centres for Disease Control and Prevention with individual country profiles exchanged by email. Data was compiled and visualised using the Quantum Geographic Information System software and Natural Earth vectors to design maps showing access. FINDINGS Data were collected between Oct 1, 2020, and Oct 31, 2022 in the 48 target countries. We found that cryptococcal antigen testing is frequently accessible to 358·39 million (25·5%) people in 14 African countries. Over 1031·49 million (73·3%) of 1·4 billion African people have access to a lumbar puncture. India ink microscopy is frequently accessible to 471·03 million (33·5%) people in 23 African countries. About 1041·62 million (74·0%) and 1105·11 million (78·5%) people in Africa do not have access to histoplasmosis and Pneumocystis pneumonia diagnostics in either private or public facilities, respectively. Fungal culture is available in 41 countries covering a population of 1·289 billion (94%) people in Africa. MRI is routinely accessible to 453·59 million (32·2%) people in Africa and occasionally to 390·58 million (27·8%) people. There was a moderate correlation between antiretroviral therapy usage and external expenditure on HIV care (R2=0·42) but almost none between external expenditure and AIDS death rate (R2=0·18), when analysed for 40 African countries. INTERPRETATION This survey highlights the enormous challenges in the diagnosis of HIV-associated Pneumocystis pneumonia, cryptococcal disease, histoplasmosis, and other fungal infections in Africa. Urgent political and global health leadership could improve the diagnosis of fungal infections in Africa, reducing avoidable deaths. FUNDING Global Action For Fungal Infections.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | | | - Samson M Haumba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Joseph N Jarvis
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | | | - Bright K Ocansey
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana; Manchester Fungal Infection Group, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Santiago Izco
- Office of HIV/AIDS, Tuberculosis and Hepatitis, Ministry of Health and Social Welfare, Malabo, Equatorial Guinea
| | - Stephen Kipkerich
- National Public Health Reference Laboratories, Ministry of Health, Nairobi, Kenya
| | - Jahit Sacarlal
- Department of Microbiology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Abimbola T Awopeju
- Department of Medical Microbiology and Parasitology, University of Port Harcourt, Port Harcourt, Nigeria
| | - Nelesh P Govender
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa; Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa; Institute of Infection and Immunity, St George's University of London, London, UK; MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | | | - Kamwiziku Guyguy
- Department of Microbiology, Kinshasa University Hospital, University of Kinshasa, Kinshasa, DR Congo
| | - Emma Orefuwa
- Global Action For Fungal Infections, Geneva, Switzerland
| | - David W Denning
- Global Action For Fungal Infections, Geneva, Switzerland; Manchester Fungal Infection Group, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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33
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Lakoh S, Yi L, Russell JB, Zhang J, Sevalie S, Zhao Y, Kanu JS, Liu P, Conteh SK, Williams CEE, Barrie U, Sheku MG, Jalloh MB, Adekanmbi O, Jiba DF, Kamara MN, Deen GF, Okeibunor JC, Yendewa GA, Guo X, Firima E. The burden of surgical site infections and related antibiotic resistance in two geographic regions of Sierra Leone: a prospective study. Ther Adv Infect Dis 2022; 9:20499361221135128. [PMID: 36518726 PMCID: PMC9742716 DOI: 10.1177/20499361221135128] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/09/2022] [Indexed: 12/13/2022] Open
Abstract
Despite the prolongation of hospitalization, increase in morbidity, mortality and cost of care associated with both surgical site infections (SSIs) and antibiotic resistance, there are limited data on SSIs and antibiotic resistance to guide prevention strategies in Sierra Leone. This study assessed the burden of SSIs and related antibiotic resistance in the 34 Military Hospital (MH) and Makeni Government Hospital (MGH) located in two geographic regions of Sierra Leone using a prospective study design to collect data from adults aged 18 years or older. Of the 417 patients, 233 (55.9%) were enrolled in MGH. Most were women 294 (70.5%). The incidence rate of SSI was 5.5 per 1000 patient-days, and the cumulative incidence of SSI was 8.2%. Common bacteria isolated in MH were Escherichia coli (6,33.3%) and Pseudomonas aeruginosa (3,16.7%) and in MGH were P. aeruginosa (3,42.9%) and Proteus mirabilis (2,28.9%). Of the gram-negative bacteria, 40% were Extended-spectrum beta-lactamase-producing Enterobacteriaceae, 33% were Carbapenem-resistant P. aeruginosa and 10% were carbapenem-resistant Enterobacteriaceae. Although the incidence of SSIs in our study is lower than previously reported, the rate of antibiotic resistance reported in this study is high. Urgent action is needed to invest in the microbiology infrastructure to support SSI surveillance and prevention strategies.
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Affiliation(s)
| | | | - James B.W. Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Juling Zhang
- Department of Clinical Laboratory, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,Sustainable Health Systems Sierra Leone,34 Military Hospital, Freetown, Sierra Leone
| | - Yongkun Zhao
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Peng Liu
- Department of Emergency Medicine, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Sarah K. Conteh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Christine Ellen Elleanor Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Mohamed Gbessay Sheku
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Mohamed Boie Jalloh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,34 Military Hospital, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria,Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Darlinda F. Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Matilda N. Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla F. Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | | | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xuejun Guo
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland,University of Basel, Basel, Switzerland,SolidarMed, Old Europa, Lesotho,Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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34
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Coker J, Niang A, Turay I, Lakoh S, Conteh V, Russell JBW. An Evaluation of Renal Care received by Human Immunodeficiency Virus (HIV) Patients admitted in a Tertiary Hospital in Sierra Leone. West Afr J Med 2022; 39:1188-1192. [PMID: 36455207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The burden of HIV is on the rise and patients with HIV are also vulnerable to renal impairment from both acute and chronic causes. This study sets out to evaluate renal care received by such patients. METHODS The study was conducted at Connaught Hospital, the main tertiary hospital (for medical and surgical cases) in the country. A retrospective review of all admitted patients with HIV between January and December 2019. Data was collected using a well- structured study proforma. RESULTS A total of 230 patients were admitted with HIV during the study period. The mean age of patients was 36.9 ± (11.5) years with a female preponderance of 61.3%. A vast majority of the patients (54.8%) could afford to do some renal investigations and only 13.9% were seen by renal physicians; 69.1% of patients with azotaemia died while on admission. CONCLUSION The extent of renal care observed from the study was poor because the majority of the patients were not seen by renal physicians and could not afford renal investigations. Also, the occurrence of renal impairment in patients with HIV suggests a poor prognosis.
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Affiliation(s)
- J Coker
- Connaught Hospital, University of Sierra Leone Teaching Hospitals' Complex, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
| | - A Niang
- Cheikh Anta Diop University, Dakar, Senegal
| | - I Turay
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
| | - S Lakoh
- Connaught Hospital, University of Sierra Leone Teaching Hospitals' Complex, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
| | - V Conteh
- Connaught Hospital, University of Sierra Leone Teaching Hospitals' Complex, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
| | - J B W Russell
- Connaught Hospital, University of Sierra Leone Teaching Hospitals' Complex, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
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35
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Park SH, Hong SH, Kim K, Lee SW, Yon DK, Jung SJ, Abdeen Z, Brahim Ahmed MLC, Serouri AA, Al‐Herz W, Subbaram K, Shaik Syed P, Ali S, ALI KOSAR, Al‐Shamsi HO, Baatarkhuu O, Nielsen HB, BERNINI‐CARRI E, Bondarenko A, Cassell A, Cham A, Chua MLK, Dadabhai S, Darre T, Davtyan H, Dragioti E, East B, Jeffrey Edwards R, Ferioli M, Georgiev T, Ghandour L, Harapan H, Hsueh P, Ikram A, Inoue S, Jacob L, Janković S, Jayarajah U, Jesenak M, Kakodkar P, Kapata N, Kebede Y, Khader Y, Kifle M, Koh D, Maleš VK, Kotfis K, Koyanagi A, Kretchy J, Lakoh S, Lee J, Lee JY, Mendonça MDLL, Ling L, Llibre‐Guerra J, Machida M, Makurumidze R, Mallah S, Memish ZA, MENDOZA IVAN, Moiseev S, Nadasdy T, Nahshon C, ÑAMENDYS‐SILVA SILVIOA, Yongsi BN, Nicolasora AD, Nugmanova Z, Oh H, Oksanen A, OWOPETU OLUWATOMI, Ozguler ZO, Perez GE, Pongpirul K, Rademaker M, Radojevic N, Roca A, Rodriguez‐Morales AJ, Viveiros Rosa SG, Roshi E, SAEED KMI, Sah R, Sakakushev B, Sallam DE, SATHIAN BRIJESH, Schober P, Simonović Z, Singhal T, Skhvitaridze N, Solmi M, Tizaoui K, TLHAKANELO JOHNTHATO, Torales J, Torres‐Roman S, Tsartsalis D, Tsolmon J, Vieira DN, Wanghi G, Wollina U, Xu R, Yang L, Zia K, Zildzic M, Il Shin J, Smith L. Nonpharmaceutical interventions reduce the incidence and mortality of COVID-19: A study based on the survey from the International COVID-19 Research Network (ICRN). J Med Virol 2022; 95:e28354. [PMID: 36447130 PMCID: PMC9878143 DOI: 10.1002/jmv.28354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/14/2022] [Revised: 08/17/2022] [Accepted: 09/02/2022] [Indexed: 12/02/2022]
Abstract
The recently emerged novel coronavirus, "severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)," caused a highly contagious disease called coronavirus disease 2019 (COVID-19). It has severely damaged the world's most developed countries and has turned into a major threat for low- and middle-income countries. Since its emergence in late 2019, medical interventions have been substantial, and most countries relied on public health measures collectively known as nonpharmaceutical interventions (NPIs). We aimed to centralize the accumulative knowledge of NPIs against COVID-19 for each country under one worldwide consortium. International COVID-19 Research Network collaborators developed a cross-sectional online survey to assess the implications of NPIs and sanitary supply on the incidence and mortality of COVID-19. The survey was conducted between January 1 and February 1, 2021, and participants from 92 countries/territories completed it. The association between NPIs, sanitation supplies, and incidence and mortality were examined by multivariate regression, with the log-transformed value of population as an offset value. The majority of countries/territories applied several preventive strategies, including social distancing (100.0%), quarantine (100.0%), isolation (98.9%), and school closure (97.8%). Individual-level preventive measures such as personal hygiene (100.0%) and wearing facial masks (94.6% at hospitals; 93.5% at mass transportation; 91.3% in mass gathering facilities) were also frequently applied. Quarantine at a designated place was negatively associated with incidence and mortality compared to home quarantine. Isolation at a designated place was also associated with reduced mortality compared to home isolation. Recommendations to use sanitizer for personal hygiene reduced incidence compared to the recommendation to use soap. Deprivation of masks was associated with increased incidence. Higher incidence and mortality were found in countries/territories with higher economic levels. Mask deprivation was pervasive regardless of economic level. NPIs against COVID-19 such as using sanitizer, quarantine, and isolation can decrease the incidence and mortality of COVID-19.
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Affiliation(s)
| | - Sung Hwi Hong
- Yonsei University College of MedicineSeoulRepublic of Korea
| | - Kwanghyun Kim
- Department of Preventive Medicine, Yonsei University College of MedicineSeoulKorea,Department of Public HealthYonsei UniversitySeoulKorea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software ConvergenceSeoulSouth Korea,Department of Precision Medicine, Sungkyunkwan University School of MedicineSuwonRepublic of Korea
| | - Dong Keon Yon
- Medical Science Research Institute, Kyung Hee University College of MedicineSeoulSouth Korea
| | - Sun Jae Jung
- Department of Public HealthYonsei UniversitySeoulKorea
| | - Ziad Abdeen
- Department of Emergency Medicine, Augusta Victoria Hospital, Address: Al Tour, East Jerusalem
| | | | | | | | - Kannan Subbaram
- School of Medicine, The Maldives National University School of MedicineMaldives
| | - P. Shaik Syed
- School of Medicine, The Maldives National University School of MedicineMaldives
| | - Sheeza Ali
- School of Medicine, The Maldives National University School of MedicineMaldives
| | - KOSAR ALI
- University of Sulaimani college of medicine
| | - Humaid O. Al‐Shamsi
- Burjeel Cancer Institute, Burjeel Medical City, Abu DhabiUnited Arab Emirates
| | - Oidov Baatarkhuu
- Department of Infectious Diseases, Mongolian National University of Medical Sciences
| | - Henning Bay Nielsen
- Department of Anesthesia and Intensive Care, Zealand University Hospital RoskildeRoskildeDenmark,Department of Nutrition, Exercise and Sports, Faculty of Science, University of CopenhagenDenmark
| | | | | | | | | | - Melvin LK Chua
- National Cancer Centre Singapore,Duke‐NUS medical school
| | - Sufia Dadabhai
- Johns Hopkins Bloomberg School of Public Health; BlantyreMalawi
| | - Tchin Darre
- Department of Pathology, University of LoméTogo
| | | | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping UniversityLinköpingSweden
| | - Barbora East
- 3rd, Department of Surgery, 1st Medical Faculty of Charles University, Motol University HospitalPrague, Czech Republic
| | | | - Martina Ferioli
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care UnitBolognaItaly,Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum UniversityBolognaItaly
| | | | | | - Harapan Harapan
- Medical Research UnitUniversitas Syiah KualaBanda AcehIndonesia
| | - Po‐Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, China Medical University HospitalChina Medical UniversityTaichungTaiwan
| | | | - Shigeru Inoue
- Tokyo Medical University, Department of Preventive Medicine and Public Health
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de LlobregatBarcelona08830Spain,Faculty of Medicine, University of Versailles Saint‐Quentin‐en‐Yvelines78180Montigny‐le‐BretonneuxFrance
| | | | - Umesh Jayarajah
- Postgraduate Institute of Medicine, University of ColomboSri Lanka
| | - Milos Jesenak
- Department of Pediatrics, Jessenius Faculty of Medicine in MartinComenius University in Bratislava, University Teaching Hospital in Martin
| | | | | | - Yohannes Kebede
- Department of Health, Behavior and Society, Jimma UniversityEthiopia
| | | | - Meron Kifle
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of OxfordOxfordUK
| | - David Koh
- Saw Swee Hock School of Public Health, National University of Singapore
| | | | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in SzczecinPoland
| | - Ai Koyanagi
- Parc Sanitari San Joan de Deu, ICREA, CIBERSAM, ISCIII
| | - James‐Paul Kretchy
- Public Health Unit, School of Medicine and Health Sciences, Central University, P. O. Box2305AccraGhana
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone
| | - Jinhee Lee
- Yonsei University Wonju College of Medicine
| | | | | | | | | | - Masaki Machida
- Tokyo Medical University, Department of Preventive Medicine and Public Health
| | - Richard Makurumidze
- University of Zimbabwe Faculty of Medicine and Health Sciences; Family Medicine, Global and Public Health Unit
| | - Saad Mallah
- Royal College of Surgeons in Ireland ‐Bahrain
| | - Ziad A Memish
- Director Research and Innovation Center, King Saud Medical City, Ministry of health
| | - IVAN MENDOZA
- Tropical Cardiology. Central University of Venezuela
| | | | | | - Chen Nahshon
- Department of Gynecologic Surgery & Oncology, Carmel Medical Center, HaifaIsrael
| | - SILVIO A. ÑAMENDYS‐SILVA
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran; Instituto Nacional de CancerologiaMexico CityMexico
| | | | - Amalea Dulcene Nicolasora
- Molecular Biology Laboratory, Research Institute for Tropical Medicine, Alabang, Muntinlupa CityPhilippines1781
| | | | - Hans Oh
- University of Southern California
| | - Atte Oksanen
- Faculty of social sciencesTampere UniversityFinland
| | - OLUWATOMI OWOPETU
- Department of Community Medicine, University College HospitalIbadanNigeria
| | | | | | | | - Marius Rademaker
- Marius Rademaker Waikato Clinical Campus, University of Auckland Medical SchoolHamiltonNew Zealand
| | | | - Anna Roca
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia
| | - Alfonso J. Rodriguez‐Morales
- Grupo de Investigación BiomedicinaFaculty of Medicine, Fundación Universitaria Autónoma de las AmericasPereiraColombia,Universidad Cientifica del SurLimaPeru
| | | | | | | | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Institute of Medicine
| | - Boris Sakakushev
- RIMU/Research Institute of Medical University Plovdiv,Chair of Propedeutics of Surgical Diseases,University Hospital St George Plovdiv
| | - Dina Ebrahem Sallam
- Pediatrics & Pediatric Nephrology Department, Faculty of MedicineAin Shams UniversityCairoEgypt
| | - BRIJESH SATHIAN
- Geriatrics and long term care department, Rumailah HospitalDohaQatar
| | - Patrick Schober
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of AnesthesiologyAmsterdamThe Netherlands
| | | | - Tanu Singhal
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute
| | | | - Marco Solmi
- Department of Psychiatry, University of OttawaOntarioCanada,Department of Mental HealthThe Ottawa HospitalOntarioCanada,Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa Ottawa Ontario,Department of Child and Adolescent Psychiatry, Charité UniversitätsmedizinBerlinGermany
| | - kalthoum Tizaoui
- Laboratory of Microorganisms and Actives Biomolecules, Faculty of Sciences of TunisUniversity Tunis El Manar
| | | | - Julio Torales
- National University of Asunción, School of Medical SciencesParaguay
| | - Smith Torres‐Roman
- South American Center for Education and Research in Public Health, Universidad Norbert WienerLima15108Peru
| | - Dimitrios Tsartsalis
- Department of Emergency Medicine, Hippokration Hospital, Address: Leof Vasilissis Sofias 8011527AthensGreece
| | | | | | - Guy Wanghi
- University of Kinshasa Faculty of Medicine
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden – Academic Teaching HospitalDresdenGermany
| | - Ren‐He Xu
- Faculty of Health Sciences, University of Macau
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services; School of Medicine, University of CalgaryCalgaryCanada
| | - Kashif Zia
- School of Health and Wellbeing, University of Glasgow, U.K
| | | | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of MedicineSeoulRepublic of Korea
| | - Lee Smith
- Centre for Health Performance and WellbeingAnglia Ruskin University, Cambridge, UK, CB1 1PT
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Park SH, Hong SH, Kim K, Lee SW, Yon DK, Jung SJ, Abdeen Z, Brahim Ahmed MLC, Serouri AA, Al‐Herz W, Subbaram K, Shaik Syed P, Ali S, ALI KOSAR, Al‐Shamsi HO, Baatarkhuu O, Nielsen HB, BERNINI‐CARRI E, Bondarenko A, Cassell A, Cham A, Chua MLK, Dadabhai S, Darre T, Davtyan H, Dragioti E, East B, Jeffrey Edwards R, Ferioli M, Georgiev T, Ghandour L, Harapan H, Hsueh P, Ikram A, Inoue S, Jacob L, Janković S, Jayarajah U, Jesenak M, Kakodkar P, Kapata N, Kebede Y, Khader Y, Kifle M, Koh D, Maleš VK, Kotfis K, Koyanagi A, Kretchy J, Lakoh S, Lee J, Lee JY, Mendonça MDLL, Ling L, Llibre‐Guerra J, Machida M, Makurumidze R, Mallah S, Memish ZA, MENDOZA IVAN, Moiseev S, Nadasdy T, Nahshon C, ÑAMENDYS‐SILVA SILVIOA, Yongsi BN, Nicolasora AD, Nugmanova Z, Oh H, Oksanen A, OWOPETU OLUWATOMI, Ozguler ZO, Perez GE, Pongpirul K, Rademaker M, Radojevic N, Roca A, Rodriguez‐Morales AJ, Viveiros Rosa SG, Roshi E, SAEED KMI, Sah R, Sakakushev B, Sallam DE, SATHIAN BRIJESH, Schober P, Simonović Z, Singhal T, Skhvitaridze N, Solmi M, Tizaoui K, TLHAKANELO JOHNTHATO, Torales J, Torres‐Roman S, Tsartsalis D, Tsolmon J, Vieira DN, Wanghi G, Wollina U, Xu R, Yang L, Zia K, Zildzic M, Il Shin J, Smith L. Non‐Pharmaceutical Interventions Reduce the Incidence, and Mortality of COVID‐19: A Study based on the Survey from the International COVID‐19 Research Network (ICRN). J Med Virol 2022. [DOI: https://doi.org/10.1002/jmv.28354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
| | - Sung Hwi Hong
- Yonsei University College of MedicineSeoulRepublic of Korea
| | - Kwanghyun Kim
- Department of Preventive Medicine, Yonsei University College of MedicineSeoulKorea
- Department of Public HealthYonsei UniversitySeoulKorea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software ConvergenceSeoulSouth Korea
- Department of Precision Medicine, Sungkyunkwan University School of MedicineSuwonRepublic of Korea
| | - Dong Keon Yon
- Medical Science Research Institute, Kyung Hee University College of MedicineSeoulSouth Korea
| | - Sun Jae Jung
- Department of Public HealthYonsei UniversitySeoulKorea
| | - Ziad Abdeen
- Department of Emergency Medicine, Augusta Victoria Hospital, Address: Al Tour, East Jerusalem
| | | | | | | | - Kannan Subbaram
- School of Medicine, The Maldives National University School of MedicineMaldives
| | - P. Shaik Syed
- School of Medicine, The Maldives National University School of MedicineMaldives
| | - Sheeza Ali
- School of Medicine, The Maldives National University School of MedicineMaldives
| | - KOSAR ALI
- University of Sulaimani college of medicine
| | - Humaid O. Al‐Shamsi
- Burjeel Cancer Institute, Burjeel Medical City, Abu DhabiUnited Arab Emirates
| | - Oidov Baatarkhuu
- Department of Infectious Diseases, Mongolian National University of Medical Sciences
| | - Henning Bay Nielsen
- Department of Anesthesia and Intensive Care, Zealand University Hospital RoskildeRoskildeDenmark
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of CopenhagenDenmark
| | | | | | | | | | | | - Sufia Dadabhai
- Johns Hopkins Bloomberg School of Public Health; BlantyreMalawi
| | - Tchin Darre
- Department of Pathology, University of LoméTogo
| | | | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping UniversityLinköpingSweden
| | - Barbora East
- 3rd, Department of Surgery, 1st Medical Faculty of Charles University, Motol University HospitalPrague, Czech Republic
| | | | - Martina Ferioli
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care UnitBolognaItaly
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum UniversityBolognaItaly
| | | | | | - Harapan Harapan
- Medical Research UnitUniversitas Syiah KualaBanda AcehIndonesia
| | - Po‐Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, China Medical University HospitalChina Medical UniversityTaichungTaiwan
| | | | - Shigeru Inoue
- Tokyo Medical University, Department of Preventive Medicine and Public Health
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de LlobregatBarcelona08830Spain
- Faculty of Medicine, University of Versailles Saint‐Quentin‐en‐Yvelines78180Montigny‐le‐BretonneuxFrance
| | | | - Umesh Jayarajah
- Postgraduate Institute of Medicine, University of ColomboSri Lanka
| | - Milos Jesenak
- Department of Pediatrics, Jessenius Faculty of Medicine in MartinComenius University in Bratislava, University Teaching Hospital in Martin
| | | | | | - Yohannes Kebede
- Department of Health, Behavior and Society, Jimma UniversityEthiopia
| | | | - Meron Kifle
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of OxfordOxfordUK
| | - David Koh
- Saw Swee Hock School of Public Health, National University of Singapore
| | | | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in SzczecinPoland
| | - Ai Koyanagi
- Parc Sanitari San Joan de Deu, ICREA, CIBERSAM, ISCIII
| | - James‐Paul Kretchy
- Public Health Unit, School of Medicine and Health Sciences, Central University, P. O. Box2305AccraGhana
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone
| | - Jinhee Lee
- Yonsei University Wonju College of Medicine
| | | | | | | | | | - Masaki Machida
- Tokyo Medical University, Department of Preventive Medicine and Public Health
| | - Richard Makurumidze
- University of Zimbabwe Faculty of Medicine and Health Sciences; Family Medicine, Global and Public Health Unit
| | - Saad Mallah
- Royal College of Surgeons in Ireland ‐Bahrain
| | - Ziad A Memish
- Director Research and Innovation Center, King Saud Medical City, Ministry of health
| | - IVAN MENDOZA
- Tropical Cardiology. Central University of Venezuela
| | | | | | - Chen Nahshon
- Department of Gynecologic Surgery & Oncology, Carmel Medical Center, HaifaIsrael
| | - SILVIO A. ÑAMENDYS‐SILVA
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran; Instituto Nacional de CancerologiaMexico CityMexico
| | | | - Amalea Dulcene Nicolasora
- Molecular Biology Laboratory, Research Institute for Tropical Medicine, Alabang, Muntinlupa CityPhilippines1781
| | | | - Hans Oh
- University of Southern California
| | - Atte Oksanen
- Faculty of social sciencesTampere UniversityFinland
| | - OLUWATOMI OWOPETU
- Department of Community Medicine, University College HospitalIbadanNigeria
| | | | | | | | - Marius Rademaker
- Marius Rademaker Waikato Clinical Campus, University of Auckland Medical SchoolHamiltonNew Zealand
| | | | - Anna Roca
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia
| | - Alfonso J. Rodriguez‐Morales
- Grupo de Investigación BiomedicinaFaculty of Medicine, Fundación Universitaria Autónoma de las AmericasPereiraColombia
- Universidad Cientifica del SurLimaPeru
| | | | | | | | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Institute of Medicine
| | - Boris Sakakushev
- RIMU/Research Institute of Medical University Plovdiv
- Chair of Propedeutics of Surgical Diseases
- University Hospital St George Plovdiv
| | - Dina Ebrahem Sallam
- Pediatrics & Pediatric Nephrology Department, Faculty of MedicineAin Shams UniversityCairoEgypt
| | - BRIJESH SATHIAN
- Geriatrics and long term care department, Rumailah HospitalDohaQatar
| | - Patrick Schober
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of AnesthesiologyAmsterdamThe Netherlands
| | | | - Tanu Singhal
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute
| | | | - Marco Solmi
- Department of Psychiatry, University of OttawaOntarioCanada
- Department of Mental HealthThe Ottawa HospitalOntarioCanada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa Ottawa Ontario
- Department of Child and Adolescent Psychiatry, Charité UniversitätsmedizinBerlinGermany
| | - kalthoum Tizaoui
- Laboratory of Microorganisms and Actives Biomolecules, Faculty of Sciences of TunisUniversity Tunis El Manar
| | | | - Julio Torales
- National University of Asunción, School of Medical SciencesParaguay
| | - Smith Torres‐Roman
- South American Center for Education and Research in Public Health, Universidad Norbert WienerLima15108Peru
| | - Dimitrios Tsartsalis
- Department of Emergency Medicine, Hippokration Hospital, Address: Leof Vasilissis Sofias 8011527AthensGreece
| | | | | | - Guy Wanghi
- University of Kinshasa Faculty of Medicine
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden – Academic Teaching HospitalDresdenGermany
| | - Ren‐He Xu
- Faculty of Health Sciences, University of Macau
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services; School of Medicine, University of CalgaryCalgaryCanada
| | - Kashif Zia
- School of Health and Wellbeing, University of Glasgow, U.K
| | | | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of MedicineSeoulRepublic of Korea
| | - Lee Smith
- Centre for Health Performance and WellbeingAnglia Ruskin University, Cambridge, UK, CB1 1PT
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Lahai M, Theobald S, Wurie HR, Lakoh S, Erah PO, Samai M, Raven J. Factors influencing adherence to antiretroviral therapy from the experience of people living with HIV and their healthcare providers in Sierra Leone: a qualitative study. BMC Health Serv Res 2022; 22:1327. [PMID: 36348488 PMCID: PMC9644013 DOI: 10.1186/s12913-022-08606-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/20/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) is the primary mode of treatment for Human Immunodeficiency Virus (HIV). It slows disease progression and reduces the spread of infection. HIV treatment is also known to require a high level of adherence of over 90% to achieve good treatment outcomes and viral load suppression. In Sierra Leone, about 70% of People Living with HIV (PLHIV) are non-adherent in their first year of treatment. Understanding the reasons behind this high rate of non-adherence from the perspectives of both PLHIV and health workers is critical for developing strategies to improve adherence. This qualitative study is rooted in the field of public health services. It identifies the barriers and facilitators influencing adherence to antiretroviral treatment in Sierra Leone. METHODS: A qualitative study design using in-depth interviews of four healthcare workers and 16 PLHIV in two districts in Sierra Leone- Freetown and Bo. The interviews were analyzed using a grounded theory approach to identify emerging themes from the data. RESULTS The study identified several facilitators and barriers to ART adherence at the personal, community, and health system levels. The facilitators included perceived benefits of ART, family support, having an informal caregiver, receiving free ART medicines, and belonging to peer support groups. The identified barriers were stigma and discrimination, frequency of medication, use of traditional medicine, lack of money for food and transport, work barriers, inadequate medicines and test kits, limited health workers, and long distances to clinics. CONCLUSIONS Our study emphasized the need for implementing behavioural change communication programmes and activities to reduce stigma and discrimination in the community. Knowledge of the facilitators and barriers to antiretroviral therapy could provide relevant information for more responsive and equitable programmes supporting adherence implementation in low- and middle-income countries. This study also identifies the vital need for community integration of HIV treatment services.
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Affiliation(s)
- Michael Lahai
- grid.442296.f0000 0001 2290 9707Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, 00232 Sierra Leone
| | - Sally Theobald
- grid.48004.380000 0004 1936 9764Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Haja R. Wurie
- grid.442296.f0000 0001 2290 9707College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- grid.442296.f0000 0001 2290 9707College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Patrick O. Erah
- grid.413068.80000 0001 2218 219XFaculty of Pharmacy, University of Benin, Benin City, Nigeria
| | - Mohamed Samai
- grid.442296.f0000 0001 2290 9707College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joanna Raven
- grid.48004.380000 0004 1936 9764Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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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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Yendewa GA, Lakoh S, Jiba DF, Yendewa SA, Barrie U, Deen GF, Samai M, Jacobson JM, Sahr F, Salata RA. Hepatitis B Virus and Tuberculosis Are Associated with Increased Noncommunicable Disease Risk among Treatment-Naïve People with HIV: Opportunities for Prevention, Early Detection and Management of Comorbidities in Sierra Leone. J Clin Med 2022; 11:jcm11123466. [PMID: 35743539 PMCID: PMC9225550 DOI: 10.3390/jcm11123466] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/18/2022] [Accepted: 06/15/2022] [Indexed: 02/01/2023] Open
Abstract
Noncommunicable diseases (NCDs) are a growing public health concern in low- and middle-income countries and disproportionately affect people living with HIV (PWH). Hepatitis B virus (HBV) and tuberculosis (TB) coinfection are presumed risk factors in endemic settings; however, supporting evidence is conflicting. We analyzed baseline data of newly diagnosed PWH prospectively enrolled in the Sierra Leone HIV Cohort Study in Freetown, Sierra Leone, from March to September 2021. Logistic regression was used to identify associations between NCDs, HBV and TB. A total of 275 PWH aged ≥18 years were studied (55% female, median age 33 years, median CD4 307 cells/mm3, 15.3% HIV/HBV, 8.7% HIV/TB). NCDs were bimodally distributed, with 1 in 4 PWH clustered around liver disease (fibrosis/cirrhosis), diabetes/prediabetes and obesity/preobesity, while 1 in 8 had renal impairment or hypertension (HTN). Overall, 41.5% had ≥1 NCD, while 17.5% were multimorbid (≥2 NCDs). After adjusting for age, sex, sociodemographic factors and CD4 count, liver fibrosis/cirrhosis was strongly associated with HBV (aOR 8.80, 95% CI [2.46−31.45]; p < 0.001) and diabetes/prediabetes (aOR 9.89, 95% CI [1.14−85.67]; p < 0.037). TB independently predicted diabetes/prediabetes (aOR 7.34, 95% CI [1.87−28.74]; p < 0.004), while renal impairment was associated with proteinuria (aOR 9.34, 95% CI [2.01−43.78]; p < 0.004) and HTN (aOR 6.00, 95% CI [1.10−35.39]; p < 0.049). Our findings warrant the implementation of NCD-aware HIV programs for the prevention, early detection and management of comorbidities.
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Affiliation(s)
- George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; (J.M.J.); (R.A.S.)
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Correspondence:
| | - Sulaiman Lakoh
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (S.L.); (G.F.D.); (M.S.); (F.S.)
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (D.F.J.); (S.A.Y.)
| | - Darlinda F. Jiba
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (D.F.J.); (S.A.Y.)
| | - Sahr A. Yendewa
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (D.F.J.); (S.A.Y.)
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone;
| | - Gibrilla F. Deen
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (S.L.); (G.F.D.); (M.S.); (F.S.)
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (D.F.J.); (S.A.Y.)
| | - Mohamed Samai
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (S.L.); (G.F.D.); (M.S.); (F.S.)
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (D.F.J.); (S.A.Y.)
| | - Jeffrey M. Jacobson
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; (J.M.J.); (R.A.S.)
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Foday Sahr
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (S.L.); (G.F.D.); (M.S.); (F.S.)
- Ministry of Health and Sanitation, Freetown, Sierra Leone; (D.F.J.); (S.A.Y.)
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA; (J.M.J.); (R.A.S.)
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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Kamara D, Bah D, Sesay M, Maruta A, Sesay BP, Fofanah BD, Kamara IF, Kanu JS, Lakoh S, Molleh B, Guth J, Sagili KD, Tavernor S, Wilkinson E. Evaluation of Drinking Water Quality and Bacterial Antibiotic Sensitivity in Wells and Standpipes at Household Water Points in Freetown, Sierra Leone. Int J Environ Res Public Health 2022; 19:ijerph19116650. [PMID: 35682235 PMCID: PMC9180853 DOI: 10.3390/ijerph19116650] [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] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022]
Abstract
Water quality surveillance can help to reduce waterborne diseases. Despite better access to safe drinking water in Sierra Leone, about a third of the population (3 million people) drink water from unimproved sources. In this cross-sectional study, we collected water samples from 15 standpipes and 5 wells and measured the physicochemical and bacteriological water quality, and the antimicrobial sensitivity of Escherichia coli (E. coli) in two communities in Freetown, Sierra Leone in the dry and wet seasons in 2021. All water sources were contaminated with E. coli, and all five wells and 25% of standpipes had at least an intermediate risk level of E. coli. There was no antimicrobial resistance detected in the E. coli tested. The nitrate level exceeded the WHO’s recommended standard (>10 parts per million) in 60% of the wells and in less than 20% of the standpipes. The proportion of samples from standpipes with high levels of total dissolved solids (>10 Nephelometric Turbidity Units) was much higher in the rainy season (73% vs. 7%). The level of water contamination is concerning. We suggest options to reduce E. coli contamination. Further research is required to identify where contamination of the water in standpipes is occurring.
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Affiliation(s)
- Dauda Kamara
- Water Sanitation and Hygiene (WASH) Program, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
- Directorate of Environmental Health & Sanitation, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (D.B.); (M.S.)
- Correspondence: ; Tel.: +232-78-893-760
| | - Doris Bah
- Directorate of Environmental Health & Sanitation, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (D.B.); (M.S.)
| | - Momodu Sesay
- Directorate of Environmental Health & Sanitation, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (D.B.); (M.S.)
| | - Anna Maruta
- World Health Organization (WHO) Country Office, Freetown 00232, Sierra Leone; (A.M.); (B.P.S.); (B.D.F.); (I.F.K.)
| | - Bockarie Pompey Sesay
- World Health Organization (WHO) Country Office, Freetown 00232, Sierra Leone; (A.M.); (B.P.S.); (B.D.F.); (I.F.K.)
| | - Bobson Derrick Fofanah
- World Health Organization (WHO) Country Office, Freetown 00232, Sierra Leone; (A.M.); (B.P.S.); (B.D.F.); (I.F.K.)
| | - Ibrahim Franklyn Kamara
- World Health Organization (WHO) Country Office, Freetown 00232, Sierra Leone; (A.M.); (B.P.S.); (B.D.F.); (I.F.K.)
| | - Joseph Sam Kanu
- National Disease Surveillance Program, Ministry of Health and Sanitation, Sierra Leone National Public Health Emergency Operations Centre, Freetown 00232, Sierra Leone;
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown 00232, Sierra Leone
| | - Sulaiman Lakoh
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
- Department of Community Health, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
- Sustainable Health Systems Sierra Leone, 34 Military Research Center, Freetown 00232, Sierra Leone;
| | - Bailah Molleh
- Sustainable Health Systems Sierra Leone, 34 Military Research Center, Freetown 00232, Sierra Leone;
| | - Jamie Guth
- Global Health Connections, Center Barnstead, Barnstead, NH 03225, USA;
| | - Karuna D. Sagili
- International Union Against Tuberculosis and Lung Disease (The Union), South East Asia Office, New Delhi 110016, India;
| | - Simon Tavernor
- School of Medicine, University of Liverpool, Liverpool L69 3GE, UK;
| | - Ewan Wilkinson
- Institute of Medicine, University of Chester, Chester CH2 1BR, UK;
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Fofanah BD, Abrahamyan A, Maruta A, Kallon C, Thekkur P, Kamara IF, Njuguna CK, Squire JS, Kanu JS, Bah AJ, Lakoh S, Kamara D, Hermans V, Zachariah R. Achieving Minimum Standards for Infection Prevention and Control in Sierra Leone: Urgent Need for a Quantum Leap in Progress in the COVID-19 Era! Int J Environ Res Public Health 2022; 19:5642. [PMID: 35565037 PMCID: PMC9102022 DOI: 10.3390/ijerph19095642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/11/2022] [Accepted: 04/20/2022] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Good Infection prevention and control (IPC) is vital for tackling antimicrobial resistance and limiting health care-associated infections. We compared IPC performance before (2019) and during the COVID-19 (2021) era at the national IPC unit and all regional (4) and district hospitals (8) in Sierra Leone. METHODS Cross-sectional assessments using standardized World Health Organizations IPC checklists. IPC performance scores were graded as inadequate = 0-25%, basic = 25.1-50%, intermediate = 50.1-75%, and advanced = 75.1-100%. RESULTS Overall performance improved from 'basic' to 'intermediate' at the national IPC unit (41% in 2019 to 58% in 2021) and at regional hospitals (37% in 2019 to 54% in 2021) but remained 'basic' at district hospitals (37% in 2019 to 50% in 2021). Priority gaps at the national IPC unit included lack of: a dedicated IPC budget, monitoring the effectiveness of IPC trainings and health care-associated infection surveillance. Gaps at hospitals included no assessment of hospital staffing needs, inadequate infrastructure for IPC and lack of a well-defined monitoring plan with clear goals, targets and activities. CONCLUSION Although there is encouraging progress in IPC performance, it is slower than desired in light of the COVID-19 pandemic. There is urgent need to mobilize political will, leadership and resources and make a quantum leap forward.
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Affiliation(s)
- Bobson Derrick Fofanah
- World Health Organization Country Office, 21A-B Riverside Drive, Brookfields, Freetown 00232, Sierra Leone; (A.M.); (I.F.K.); (C.K.N.)
| | - Arpine Abrahamyan
- Tuberculosis Research and Prevention Center (TBRPC), Yerevan 0014, Armenia;
| | - Anna Maruta
- World Health Organization Country Office, 21A-B Riverside Drive, Brookfields, Freetown 00232, Sierra Leone; (A.M.); (I.F.K.); (C.K.N.)
| | - Christiana Kallon
- National Infection Prevention and Control Coordinating Unit, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone;
| | - Pruthu Thekkur
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease, 75001 Paris, France;
| | - Ibrahim Franklyn Kamara
- World Health Organization Country Office, 21A-B Riverside Drive, Brookfields, Freetown 00232, Sierra Leone; (A.M.); (I.F.K.); (C.K.N.)
| | - Charles Kuria Njuguna
- World Health Organization Country Office, 21A-B Riverside Drive, Brookfields, Freetown 00232, Sierra Leone; (A.M.); (I.F.K.); (C.K.N.)
| | - James Sylvester Squire
- Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (J.S.S.); (J.S.K.)
| | - Joseph Sam Kanu
- Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (J.S.S.); (J.S.K.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (A.J.B.); (S.L.)
| | - Abdulai Jawo Bah
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (A.J.B.); (S.L.)
- Institute of Global Health and Development, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (A.J.B.); (S.L.)
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown 00232, Sierra Leone
| | - Dauda Kamara
- Water, Sanitation, and Hygiene (WASH) Program, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone;
| | - Veerle Hermans
- Médecins Sans Frontières, Operational Centre Brussels, 68, Rue de Gasperich, 1617 Luxembourg, Belgium;
| | - Rony Zachariah
- UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Diseases (TDR), Avenue Appia 20, 1211 Geneva, Switzerland;
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Lakoh S, Yendewa GA. Multidrug-resistant tuberculosis in Sierra Leone. The Lancet Global Health 2022; 10:e459-e460. [PMID: 35303445 PMCID: PMC8923690 DOI: 10.1016/s2214-109x(22)00045-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 11/24/2022] Open
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Kamara IF, Kumar AMV, Maruta A, Fofanah BD, Njuguna CK, Shongwe S, Moses F, Tengbe SM, Kanu JS, Lakoh S, Mansaray AHD, Selvaraj K, Khogali M, Zachariah R. Antibiotic Use in Suspected and Confirmed COVID-19 Patients Admitted to Health Facilities in Sierra Leone in 2020-2021: Practice Does Not Follow Policy. Int J Environ Res Public Health 2022; 19:ijerph19074005. [PMID: 35409687 PMCID: PMC8998021 DOI: 10.3390/ijerph19074005] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 02/06/2023]
Abstract
Inappropriate use of antibiotics during the COVID-19 pandemic has the potential to increase the burden of antimicrobial resistance. In this study, we report on the prevalence of antibiotic use and its associated factors among suspected and confirmed COVID-19 patients admitted to 35 health facilities in Sierra Leone from March 2020-March 2021. This was a cross-sectional study using routinely collected patient data. Of 700 confirmed COVID-19 patients, 47% received antibiotics. The majority (73%) of the antibiotics belonged to the 'WATCH' group of antibiotics, which are highly toxic and prone to resistance. The most frequently prescribed antibiotics were azithromycin, ceftriaxone, amoxicillin, metronidazole, and amoxicillin-clavulanic acid. Antibiotic use was significantly higher in patients aged 25-34 years than in those with severe disease. Of 755 suspected COVID-19 patients, 61% received antibiotics, of which the majority (58%) belonged to the 'WATCH' category. The most frequently prescribed antibiotics were ceftriaxone, metronidazole, azithromycin, ciprofloxacin, and amoxycillin. The prevalence of antibiotic use among suspected and confirmed COVID-19 patients admitted to healthcare facilities in Sierra Leone was high and not in line with national and WHO case management guidelines. Training of health care providers, strengthening of antimicrobial stewardship programs, and microbiological laboratory capacity are urgently needed.
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Affiliation(s)
- Ibrahim Franklyn Kamara
- World Health Organization, 21A-B Riverside, Off King Harman Road Freetown, Freetown 00232, Sierra Leone; (A.M.); (B.D.F.); (C.K.N.); (S.S.)
- Correspondence: or ; Tel.: +232-763-45757
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France;
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore 575018, India
| | - Anna Maruta
- World Health Organization, 21A-B Riverside, Off King Harman Road Freetown, Freetown 00232, Sierra Leone; (A.M.); (B.D.F.); (C.K.N.); (S.S.)
| | - Bobson Derrick Fofanah
- World Health Organization, 21A-B Riverside, Off King Harman Road Freetown, Freetown 00232, Sierra Leone; (A.M.); (B.D.F.); (C.K.N.); (S.S.)
| | - Charles Kuria Njuguna
- World Health Organization, 21A-B Riverside, Off King Harman Road Freetown, Freetown 00232, Sierra Leone; (A.M.); (B.D.F.); (C.K.N.); (S.S.)
| | - Steven Shongwe
- World Health Organization, 21A-B Riverside, Off King Harman Road Freetown, Freetown 00232, Sierra Leone; (A.M.); (B.D.F.); (C.K.N.); (S.S.)
| | - Francis Moses
- Ministry of Health and Sanitation, 4th Floor, Youyi Building, Brookfields, Freetown 00232, Sierra Leone; (F.M.); (S.M.T.); (S.L.)
| | - Sia Morenike Tengbe
- Ministry of Health and Sanitation, 4th Floor, Youyi Building, Brookfields, Freetown 00232, Sierra Leone; (F.M.); (S.M.T.); (S.L.)
| | - Joseph Sam Kanu
- National Disease Surveillance Program, Ministry of Health and Sanitation, Sierra Leone National Public Health Emergency Operations Centre, Cockerill, Wilkinson Road, Freetown 00232, Sierra Leone;
- Department of Community Health, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, 4th Floor, Youyi Building, Brookfields, Freetown 00232, Sierra Leone; (F.M.); (S.M.T.); (S.L.)
| | - Alie H. D. Mansaray
- Crops Division, Ministry of Agriculture and Forestry, Youyi Building, Brookfields, Freetown 00232, Sierra Leone;
| | | | - Mohammed Khogali
- Special Program for Research and Training in Tropical Diseases (TDR), World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland; (M.K.); (R.Z.)
| | - Rony Zachariah
- Special Program for Research and Training in Tropical Diseases (TDR), World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland; (M.K.); (R.Z.)
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Lakoh S, Maruta A, Kallon C, Deen GF, Russell JBW, Fofanah BD, Kamara IF, Kanu JS, Kamara D, Molleh B, Adekanmbi O, Tavernor S, Guth J, Sagili KD, Wilkinson E. How Well Are Hand Hygiene Practices and Promotion Implemented in Sierra Leone? A Cross-Sectional Study in 13 Public Hospitals. Int J Environ Res Public Health 2022; 19:ijerph19073787. [PMID: 35409471 PMCID: PMC8997996 DOI: 10.3390/ijerph19073787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 02/01/2023]
Abstract
Healthcare-associated infections (HAIs) result in millions of avoidable deaths or prolonged lengths of stay in hospitals and cause huge economic loss to health systems and communities. Primarily, HAIs spread through the hands of healthcare workers, so improving hand hygiene can reduce their spread. We evaluated hand hygiene practices and promotion across 13 public health hospitals (six secondary and seven tertiary hospitals) in the Western Area of Sierra Leone in a cross-sectional study using the WHO hand hygiene self-Assessment framework in May 2021. The mean score for all hospitals was 273 ± 46, indicating an intermediate level of hand hygiene. Nine hospitals achieved an intermediate level and four a basic level. More secondary hospitals 5 (83%) were at the intermediate level, compared to tertiary hospitals 4 (57%). Tertiary hospitals were poorly rated in the reminders in workplace and institutional safety climate domains but excelled in training and education. Lack of budgets to support hand hygiene implementation is a priority gap underlying this poor performance. These gaps hinder hand hygiene practice and promotion, contributing to the continued spread of HAIs. Enhancing the distribution of hand hygiene resources and encouraging an embedded culture of hand hygiene practice in hospitals will reduce HAIs.
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Affiliation(s)
- Sulaiman Lakoh
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (G.F.D.); (J.S.K.); (J.B.W.R.)
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone;
- Correspondence: ; Tel.: +232-78-287-492
| | - Anna Maruta
- World Health Organization Country Office, Freetown, Sierra Leone; (A.M.); (B.D.F.); (I.F.K.)
| | - Christiana Kallon
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.K.); (D.K.)
| | - Gibrilla F. Deen
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (G.F.D.); (J.S.K.); (J.B.W.R.)
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - James B. W. Russell
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (G.F.D.); (J.S.K.); (J.B.W.R.)
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Bobson Derrick Fofanah
- World Health Organization Country Office, Freetown, Sierra Leone; (A.M.); (B.D.F.); (I.F.K.)
| | - Ibrahim Franklyn Kamara
- World Health Organization Country Office, Freetown, Sierra Leone; (A.M.); (B.D.F.); (I.F.K.)
| | - Joseph Sam Kanu
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (G.F.D.); (J.S.K.); (J.B.W.R.)
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.K.); (D.K.)
| | - Dauda Kamara
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.K.); (D.K.)
| | - Bailah Molleh
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone;
| | - Olukemi Adekanmbi
- Department of Medicine, University of Ibadan, Ibadan 200005, Nigeria;
- Department of Medicine, University College Hospital, Ibadan 200005, Nigeria
| | - Simon Tavernor
- School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool L69 3GE, UK;
| | - Jamie Guth
- Global Health Connections, Center Barnstead, Barnstead, NH 03225, USA;
| | - Karuna D. Sagili
- International Union Against Tuberculosis and Lung Disease (The Union), Southeast Asia Office, New Delhi 110016, India;
| | - Ewan Wilkinson
- Institute of Medicine, University of Chester, Countess Way, Chester CH2 1BR, UK;
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Lakoh S, Yi L, Sevalie S, Guo X, Adekanmbi O, Smalle IO, Williams N, Barrie U, Koroma C, Zhao Y, Kamara MN, Cummings-John C, Jiba DF, Namanaga ES, Deen B, Zhang J, Maruta A, Kallon C, Liu P, Wurie HR, Kanu JS, Deen GF, Samai M, Sahr F, Firima E. Incidence and risk factors of surgical site infections and related antibiotic resistance in Freetown, Sierra Leone: a prospective cohort study. Antimicrob Resist Infect Control 2022; 11:39. [PMID: 35189952 PMCID: PMC8862228 DOI: 10.1186/s13756-022-01078-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/09/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There is limited information on surgical site infections (SSI) and the related antibiotic resistance needed to guide their management and prevention in Sierra Leone. In this study, we aimed to establish the incidence and risk factors of SSI and the related antibiotic resistance among adults attending a tertiary hospital, and a secondary health facility in Freetown, Sierra Leone. METHODS This is a prospective cohort study designed to collect data from adult (18 years or older) patients who attended elective and emergency surgeries at two hospitals in Freetown between February and July, 2021. Data analysis was done using STATA version 16. RESULTS Of 338 patients, 245 (72.5%) and 93 (27.5%) had their surgeries at the tertiary and secondary hospitals, respectively. Many were males 192 (56.8%), less than 35 years 164 (48.5%), and 39 (11.5%) developed an SSI. Of the 39 patients who acquired an SSI, 7 (17.9%) and 32 (82.1%) had their surgeries at the secondary and tertiary hospitals, respectively. The incidence of SSI is higher in contaminated 17 (43.6%) than in clean-contaminated 12 (30.8%) and clean 10 (25.6%) wounds. Wound swabs were collected in 29 (74.4%) patients, of which 18 (62.1%) had bacterial growth. In total, 49 isolates of 14 different bacteria including gram-negative 41 (83.7%) and gram-positive 8 (16.3%) isolates were identified. Of these, 32 (65.3%) were Enterobacteriaceae, 9 (18.4%) were Non-fermenting gram-negative bacilli and 10 (12.2%) were Enterococci. The most common isolates were Escherichia coli (12, 24.5%), Klebsiella pneumoniae (10, 20.4%), Acinetobacter baumannii (5, 10.2%), Klebsiella oxytoca (4, 8.2%) and Enterococcus faecalis (4, 8.2%). The Enterobacteriaceae were either resistance to carbapenems (4, 8.2%) or were extended-spectrum beta-lactamase (ESBL) producing organisms (29, 59.2%). Male sex [p = 0.031], an ASA score ≥ 2 [p = 0.020), administration of general anaesthesia [p = 0.018] and elevated fasting glucose [p = 0.033] were predictive of SSI. CONCLUSION The incidence of SSI in this study is comparable to other low- and middle-income countries, but a substantial proportion of these postoperative wounds have an ESBL-producing Enterobacteriaceae. Therefore, routine surveillance of SSI and related antibiotic resistance is required in resource-limited settings.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone. .,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone. .,Infectious Disease Research Network, Freetown, Sierra Leone.
| | - Le Yi
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, 130000, China
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,34 Military Hospital, Freetown, Sierra Leone
| | - Xuejun Guo
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, 130000, China.
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Isaac O Smalle
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Nathaniel Williams
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | | | - Yongkun Zhao
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, 130000, China
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Constance Cummings-John
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Enanga Sonia Namanaga
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Betsy Deen
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Juling Zhang
- Department of Clinical Laboratory, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Anna Maruta
- World Health Organization Country Office, Freetown, Sierra Leone
| | - Christiana Kallon
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Peng Liu
- Department of Emergency Medicine, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Haja Ramatulai Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Mohamed Samai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,34 Military Hospital, Freetown, Sierra Leone
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,SolidarMed, Butha-Buthe, Lesotho.,Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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Abou Ghayda R, Lee KH, Han YJ, Ryu S, Hong SH, Yoon S, Jeong GH, Yang JW, Lee HJ, Lee J, Lee JY, Effenberger M, Eisenhut M, Kronbichler A, Solmi M, Li H, Jacob L, Koyanagi A, Radua J, Park MB, Aghayeva S, Ahmed MLCB, Al Serouri A, Al-Shamsi HO, Amir-Behghadami M, Baatarkhuu O, Bashour H, Bondarenko A, Camacho-Ortiz A, Castro F, Cox H, Davtyan H, Douglas K, Dragioti E, Ebrahim S, Ferioli M, Harapan H, Mallah SI, Ikram A, Inoue S, Jankovic S, Jayarajah U, Jesenak M, Kakodkar P, Kebede Y, Kifle M, Koh D, Males VK, Kotfis K, Lakoh S, Ling L, Llibre-Guerra J, Machida M, Makurumidze R, Mamun MA, Masic I, Van Minh H, Moiseev S, Nadasdy T, Nahshon C, Ñamendys-Silva SA, Yongsi BN, Nielsen HB, Nodjikouambaye ZA, Ohnmar O, Oksanen A, Owopetu O, Parperis K, Perez GE, Pongpirul K, Rademaker M, Rosa S, Sah R, Sallam D, Schober P, Singhal T, Tafaj S, Torres I, Torres-Roman JS, Tsartsalis D, Tsolmon J, Tuychiev L, Vukcevic B, Wanghi G, Wollina U, Xu RH, Yang L, Zaidi Z, Smith L, Shin JI. The global case fatality rate of coronavirus disease 2019 by continents and national income: A meta-analysis. J Med Virol 2022; 94:2402-2413. [PMID: 35099819 PMCID: PMC9015248 DOI: 10.1002/jmv.27610] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 09/22/2021] [Revised: 12/20/2021] [Accepted: 01/18/2022] [Indexed: 02/05/2023]
Abstract
The aim of this study is to provide a more accurate representation of COVID‐19's case fatality rate (CFR) by performing meta‐analyses by continents and income, and by comparing the result with pooled estimates. We used multiple worldwide data sources on COVID‐19 for every country reporting COVID‐19 cases. On the basis of data, we performed random and fixed meta‐analyses for CFR of COVID‐19 by continents and income according to each individual calendar date. CFR was estimated based on the different geographical regions and levels of income using three models: pooled estimates, fixed‐ and random‐model. In Asia, all three types of CFR initially remained approximately between 2.0% and 3.0%. In the case of pooled estimates and the fixed model results, CFR increased to 4.0%, by then gradually decreasing, while in the case of random‐model, CFR remained under 2.0%. Similarly, in Europe, initially, the two types of CFR peaked at 9.0% and 10.0%, respectively. The random‐model results showed an increase near 5.0%. In high‐income countries, pooled estimates and fixed‐model showed gradually increasing trends with a final pooled estimates and random‐model reached about 8.0% and 4.0%, respectively. In middle‐income, the pooled estimates and fixed‐model have gradually increased reaching up to 4.5%. in low‐income countries, CFRs remained similar between 1.5% and 3.0%. Our study emphasizes that COVID‐19 CFR is not a fixed or static value. Rather, it is a dynamic estimate that changes with time, population, socioeconomic factors, and the mitigatory efforts of individual countries. Europe showed the highest COVID‐19 case fatality rate (CFR) until mid‐October 2020, and North America and South America follows. Asia showed the highest CFR since the first confirmed case of COVID‐19 emerged, however, it had shown a declining tendency since March 2020. CFRs in high‐income countries showed an explosive increase compared with those in low‐income countries, which can be interpreted as due to the under‐reporting of mortality cases from COVID‐19.
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Affiliation(s)
- Ramy Abou Ghayda
- Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Joo Han
- Hospital Medicine Center, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Seohyun Ryu
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Hwi Hong
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sojung Yoon
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gwang Hum Jeong
- College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Jae Won Yang
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Hyo Jeong Lee
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinhee Lee
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jun Young Lee
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Maria Effenberger
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Eisenhut
- Luton & Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Andreas Kronbichler
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada.,Department of Mental Health, The Ottawa Hospital, Ontario, Canada.,Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Han Li
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France.,Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain.,ICREA, Barcelona, Spain
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
| | - Myung Bae Park
- Department of Gerontology Health and Welfare, Pai Chai University, Daejeon, Republic of Korea
| | - Sevda Aghayeva
- Department of Gastroenterology, Azerbaijan Medical University School of Medicine, Baku, Azerbaijan
| | - Mohamed L C B Ahmed
- Research Unit in Epidemiology and Diversity of Microorganisms, Department of Biology, University of Nouakchott Al Aasriya, Nouakchott, Mauritania
| | | | - Humaid O Al-Shamsi
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Burjeel Cancer Institute, Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | - Mehrdad Amir-Behghadami
- Iranian Center of Excellence in Health Management (IceHM), School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee (SRC), Tabriz University of Medical Sciences, Tabriz, Iran.,Road Traffic Injury Research Center, Iranian International Safe Community Support Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Oidov Baatarkhuu
- School of Medicine, Mongolian National University of Medical Sciences, Ulan Bator, Mongolia
| | - Hyam Bashour
- Department of Family and Community Medicine, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Adrian Camacho-Ortiz
- Servicio de Infectología, Hospital Universitario "Dr José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Franz Castro
- Department of Research and Health Technology Assessment, Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Horace Cox
- Ministry of Health Guyana, Georgetown, Guyana
| | - Hayk Davtyan
- Tuberculosis Research and Prevention Center NGO, Yerevan, Armenia
| | - Kirk Douglas
- Centre for Biosecurity Studies, University of the West Indies, Cave Hill, St. Michael, Barbados
| | - Elena Dragioti
- Department of Health, Medicine and Caring Sciences, Pain and Rehabilitation Centre, Linkoping University, Linkoping, Sweden
| | - Shahul Ebrahim
- Faculty of Medicine, University of Sciences, Techniques, and Technology, Bamako, Mali
| | - Martina Ferioli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Harapan Harapan
- Medical Research Unit, School of Medicine Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Saad I Mallah
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Kingdom of Bahrain
| | - Aamer Ikram
- National Institute of Health, Islamabad, Pakistan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
| | - Slobodan Jankovic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Umesh Jayarajah
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Milos Jesenak
- Department of Pediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Pramath Kakodkar
- School of Medicine, National University of Galway Ireland, Galway, Ireland
| | - Yohannes Kebede
- Department of Health, Behavior, and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Meron Kifle
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - David Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Siangapore
| | - Visnja K Males
- Division of Endocrinology, Diabetes and Metabolic Disease in Split, Clinical Hospital Centre Split, School of Medicine Split, Šoltanska 1, Split, Croatia
| | - Katarzyna Kotfis
- Department Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Lowell Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jorge Llibre-Guerra
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Masaki Machida
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
| | - Richard Makurumidze
- Department of Community Medicine, Department of Primary Care Sciences, University of Zimbabwe, Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Mohammed A Mamun
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh.,Department of Public Health, Daffodil International University, Dhaka, Bangladesh.,CHINTA Research Bangladesh, Dhaka, Bangladesh
| | - Izet Masic
- Academy of Medical Sciences of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Hoang Van Minh
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Sergey Moiseev
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Thomas Nadasdy
- Department of Dermatology, "St. Parascheva" Clinical Hospital of Infectious Diseases, Galati, Romania
| | - Chen Nahshon
- Department of Gynecologic Surgery and Oncology, Carmel Medical Center, Haifa, Israel
| | - Silvio A Ñamendys-Silva
- Instituto Nacional de Cancerología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Blaise N Yongsi
- Institute for Training & Research in Population Studies (IFORD), The University of Yaoundé II, Soa, Cameroon
| | - Henning B Nielsen
- Department of Anaesthesia and Intensive Care, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Zita A Nodjikouambaye
- Mobile Laboratory for Hemorrhagic and Respiratory Viruses in Ndjamena, Ndjamena, Chad
| | - Ohnmar Ohnmar
- Department of Medical Research (Lower Myanmar), Myanmar Health Ministry, Yangon, Myanmar
| | | | - Oluwatomi Owopetu
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Konstantinos Parperis
- Department of Internal Medicine, University of Cyprus Medical School, Nicosia, Cyprus
| | - Gonzalo E Perez
- Division of Cardiology, Clínica Olivos, Buenos Aires, Argentina
| | - Krit Pongpirul
- Department of Preventive Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Marius Rademaker
- Waikato Clinical School, Auckland University Medical School, Hamilton, New Zealand
| | - Sandro Rosa
- College of Pharmacy, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil.,Pharmacy Division, National Institute of Industrial Property, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ranjit Sah
- National Public Health Laboratory, Kathmandu, Nepal
| | - Dina Sallam
- Department of Pediatrics & pediatric nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Patrick Schober
- Department of Anesthesiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tanu Singhal
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Silva Tafaj
- University Hospital Shefqet Ndroqi, Tirana, Albania
| | | | | | | | - Jadamba Tsolmon
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Batric Vukcevic
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Guy Wanghi
- Unit of Physiology, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | - Ren-He Xu
- Centre of Reproduction, Development and Aging, Faculty of Health Sciences, Institute of Translational Medicine, University of Macau, Taipa, Macau, China
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada.,Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Zoubida Zaidi
- Faculty of Medicine, University Ferhat Abbas, Setif, Algeria
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
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47
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Azeez TA, Lakoh S, Adeleke AA, Balogun OT, Olanipekun BJ, Olusola FI. Chemoprophylaxis against COVID-19 among health-care workers using Ivermectin in low- and middle-income countries: A systematic review and meta-analysis. Indian J Pharmacol 2022; 53:493-498. [PMID: 34975139 PMCID: PMC8764977 DOI: 10.4103/ijp.ijp_117_21] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19) is a novel viral infectious disease that the World Health Organization (WHO) has announced to be a pandemic. This meta-analysis was aimed at providing evidence for the use of ivermectin to prevent COVID-19 among hospital workers in low-resource countries. Medical databases including African Journals online, Google Scholar, PubMed, Cochrane library, EMBASE, COVID-19 research database (WHO), Clinicaltrials.gov, and SCOPUS were searched for studies on Ivermectin as a chemoprophylactic drug against COVID-19 among hospital personnel in settings with limited resources. Preprint servers such as bioRxiv and medRxiv as well as the gray literature were also searched. Studies adjudged to be eligible were identified using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses algorithm. Statistical analyses were done using Stata version 14.3. Seven studies were selected for the meta-analysis. The total sample size was 2652. There were two randomized controlled trials and five nonrandomized studies. Some studies dosed Ivermectin daily while some dosed it weekly. However, one of the studies dosed it monthly. The studies reported variable clinical benefits. I2 statistic was 92%, and random effect model was used. The pooled odd ratio was 0.11 (95% confidence interval 0.09–0.13). This implies that 89% of the participants benefited from taking Ivermectin as a form of preexposure chemoprophylaxis. Ivermectin has a significant clinical benefit as a preventive drug against COVID-19 for hospital personnel in settings with limited resources.
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Affiliation(s)
- Taoreed Adegoke Azeez
- Department of Medicine, Endocrinology Unit, University College Hospital, Ibadan, Nigeria
| | - Sulaiman Lakoh
- Department of Medicine, Infectious Diseases Unit, College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
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48
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Adekanmbi O, Ilesanmi S, Ogunbosi B, Moradeyo D, Lakoh S. Retention in Care among Patients Attending a Large HIV Clinic in Nigeria Who Were Treated for Tuberculosis. J Int Assoc Provid AIDS Care 2022; 21:23259582221124826. [PMID: 36083172 PMCID: PMC9465612 DOI: 10.1177/23259582221124826] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A retrospective study of 2764 patients was conducted at an HIV clinic in Nigeria
to evaluate retention in care in patients treated for TB. At 6 and 12 months
after commencement of TB treatment, 1842(66.6%) and 1624(58.8%) participants
remained in care. Of the 922 and 1140 not in care at 6 and 12 months, 814(88.3%)
and 1006(88.2%) respectively were lost to follow-up (LTFU).
VL < 1000copies/ml was associated with higher odds of retention in care at 6
and 12 months (OR = 2.351 and 2.393) than VL > 1000 copies/ml. HAART use
was associated with high likelihood of being in care at 12 months
(OR = 3.980). CD4 counts of 200–350 and >350 cells/mm3 were
associated with increased odds of remaining in care at 12 months compared with
CD4 < 200 cells/mm3 (p = 0.005 and p = 0.001). Targeted
interventions such as early HAART and close follow-up for high risk groups are
likely to improve retention in care.
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Affiliation(s)
- Olukemi Adekanmbi
- Department of Medicine, 113092College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Stephen Ilesanmi
- Department of Community Medicine, 113092College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Babatunde Ogunbosi
- Department of Paediatrics, 113092College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Dasola Moradeyo
- Infectious Disease Institute, 113092College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Sulaiman Lakoh
- Department of Medicine, 256445College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Liberia
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49
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Lakoh S, Firima E, Williams CEE, Conteh SK, Jalloh MB, Sheku MG, Adekanmbi O, Sevalie S, Kamara SA, Kamara MAS, Barrie U, Kamara GN, Yi L, Guo X, Haffner C, Kamara MN, Jiba DF, Namanaga ES, Maruta A, Kallon C, Kanu JS, Deen GF, Samai M, Okeibunor JC, Russell JBW. An Intra-COVID-19 Assessment of Hand Hygiene Facility, Policy and Staff Compliance in Two Hospitals in Sierra Leone: Is There a Difference between Regional and Capital City Hospitals? Trop Med Infect Dis 2021; 6:tropicalmed6040204. [PMID: 34941660 PMCID: PMC8705290 DOI: 10.3390/tropicalmed6040204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/21/2021] [Accepted: 11/26/2021] [Indexed: 12/12/2022] Open
Abstract
Although hand hygiene (HH) is the most effective intervention to reduce the spread of infections, there are limited data on HH facilities, policy, and compliance in sub-Saharan Africa. This cross-sectional study is aimed at assessing HH using the WHO HH self-assessment framework, HH technical reference manual, and a modified infection control self-assessment tool in two hospitals in Sierra Leone. Only 10% and 9% of regional and capital city hospitals had running tap water, respectively. Veronica buckets were the resources for HH in 89% of units in the regional hospital and 92% of units in capital city hospital. Constant supply of soap and alcohol-based hand rub was available in 82% and 68%; and 74% and 79% of units in the capital city and regional hospitals, respectively. Only 10% of the units in both hospitals had hand-drying facilities and functional sinks. Overall HH compliance for the two hospitals was 18.6% and was higher in the regional (20.8%) than the capital city (17.0%) hospitals. The HH levels for the capital city and regional hospitals were 277.5 and 262.5 respectively. Despite the COVID-19 pandemic, there are still challenges with HH compliance in Sierra Leone. It is, therefore, necessary to strengthen the HH multi-modal strategy.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
- Correspondence: (S.L.); (E.F.)
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, CH-4051 Basel, Switzerland
- University of Basel, CH-4001 Basel, Switzerland
- SolidarMed, Christie House 3rd Floor, Orpen Road, Old Europa, P.O. Box 0254, Maseru West 105, Lesotho
- Correspondence: (S.L.); (E.F.)
| | - Christine Ellen Elleanor Williams
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Sarah K. Conteh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Mohamed Boie Jalloh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
- 34 Military Hospital, Freetown, Sierra Leone; (S.A.K.); (M.A.S.K.); (G.N.K.)
| | - Mohamed Gbeshay Sheku
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan 200005, Nigeria;
- Department of Medicine, University College Hospital, Ibadan 200005, Nigeria
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
- 34 Military Hospital, Freetown, Sierra Leone; (S.A.K.); (M.A.S.K.); (G.N.K.)
| | - Sylvia Adama Kamara
- 34 Military Hospital, Freetown, Sierra Leone; (S.A.K.); (M.A.S.K.); (G.N.K.)
| | | | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone;
| | | | - Le Yi
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun 130122, China; (L.Y.); (X.G.)
| | - Xuejun Guo
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun 130122, China; (L.Y.); (X.G.)
| | - Chukwuemeka Haffner
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Matilda N. Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
| | - Darlinda F. Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Enanga Sonia Namanaga
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Anna Maruta
- World Health Organization Country Office, Freetown, Sierra Leone;
| | - Christiana Kallon
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Gibrilla F. Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Mohamed Samai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | | | - James B. W. Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
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50
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Barrie MB, Lakoh S, Kelly JD, Kanu JS, Squire JS, Koroma Z, Bah S, Sankoh O, Brima A, Ansumana R, Goldberg SA, Chitre S, Osuagwu C, Frankfurter R, Maeda J, Barekye B, Numbere TW, Abdulaziz M, Mounts A, Blanton C, Singh T, Samai M, Vandi M, Richardson ET. SARS-CoV-2 antibody prevalence in Sierra Leone, March 2021: a cross-sectional, nationally representative, age-stratified serosurvey. BMJ Glob Health 2021; 6:e007271. [PMID: 34764148 PMCID: PMC8587532 DOI: 10.1136/bmjgh-2021-007271] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 08/25/2021] [Accepted: 10/20/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION As of 26 March 2021, the Africa Centres for Disease Control and Prevention had reported 4 159 055 cases of COVID-19 and 111 357 deaths among the 55 African Union member states; however, no country has published a nationally representative serosurvey as of October 2021. Such data are vital for understanding the pandemic's progression on the continent, evaluating containment measures, and policy planning. METHODS We conducted a cross-sectional, nationally representative, age-stratified serosurvey in Sierra Leone in March 2021 by randomly selecting 120 Enumeration Areas throughout the country and 10 randomly selected households in each of these. One to two persons per selected household were interviewed to collect information on sociodemographics, symptoms suggestive of COVID-19, exposure history to laboratory-confirmed COVID-19 cases, and history of COVID-19 illness. Capillary blood was collected by fingerstick, and blood samples were tested using the Hangzhou Biotest Biotech RightSign COVID-19 IgG/IgM Rapid Test Cassette. Total seroprevalence was estimated after applying sampling weights. RESULTS The overall weighted seroprevalence was 2.6% (95% CI 1.9% to 3.4%). This was 43 times higher than the reported number of cases. Rural seropositivity was 1.8% (95% CI 1.0% to 2.5%), and urban seropositivity was 4.2% (95% CI 2.6% to 5.7%). DISCUSSION Overall seroprevalence was low compared with countries in Europe and the Americas (suggesting relatively successful containment in Sierra Leone). This has ramifications for the country's third wave (which started in June 2021), during which the average number of daily reported cases was 87 by the end of the month:this could potentially be on the order of 3700 actual infections per day, calling for stronger containment measures in a country with only 0.2% of people fully vaccinated. It may also reflect significant under-reporting of incidence and mortality across the continent.
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Affiliation(s)
- Mohamed Bailor Barrie
- Institute for Global Health Sciences, UCSF, San Francisco, California, USA
- Partners In Health, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area Urban, Sierra Leone
| | - J Daniel Kelly
- Institute for Global Health Sciences, UCSF, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
| | - Joseph Sam Kanu
- Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area Urban, Sierra Leone
| | - James Sylvester Squire
- Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area Urban, Sierra Leone
| | - Zikan Koroma
- Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area Urban, Sierra Leone
| | - Silleh Bah
- Statistics Sierra Leone, Freetown, Sierra Leone
| | - Osman Sankoh
- Statistics Sierra Leone, Freetown, Sierra Leone
- Njala University, Bo, Sierra Leone
- HIGH, University of Heidelberg, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Sarah A Goldberg
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
| | - Smit Chitre
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Chidinma Osuagwu
- Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Raphael Frankfurter
- Department of Humanities and Social Sciences, UCSF, San Francisco, California, USA
| | - Justin Maeda
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Bernard Barekye
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | - Mohammed Abdulaziz
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Anthony Mounts
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Curtis Blanton
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tushar Singh
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Mohamed Vandi
- Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area Urban, Sierra Leone
| | - Eugene T Richardson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
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