Neurological Symptoms and Cause of Death Among Young Children in Low- and Middle-Income Countries.

Importance: The emergence of acute neurological symptoms in children necessitates immediate intervention. Although low- and middle-income countries (LMICs) bear the highest burden of neurological diseases, there is a scarcity of diagnostic and therapeutic resources. Therefore, current understanding of the etiology of neurological emergencies in LMICs relies mainly on clinical diagnoses and verbal autopsies. Objective: To characterize the association of premortem neurological symptoms and their management with postmortem-confirmed cause of death among children aged younger than 5 years in LMICs and to identify current gaps and improve strategies to enhance child survival. Design, Setting, and Participants: This cross-sectional study was conducted between December 3, 2016, and July 22, 2022, at the 7 participating sites in the Child Health and Mortality Prevention Surveillance (CHAMPS) network (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa). Minimally invasive tissue sampling was performed at the CHAMPS sites with specimens from deceased children aged younger than 5 years. This study included deceased children who underwent a premortem neurological evaluation and had a postmortem-confirmed cause of death. Data analysis was performed between July 22, 2022, and January 15, 2023. Main Outcomes and Measures: Descriptive analysis was performed using neurological evaluations from premortem clinical records and from postmortem determination of cause of death (based on histopathology, microbiological testing, clinical records, and verbal autopsies). Results: Of the 2127 deaths of children codified during the study period, 1330 (62.5%) had neurological evaluations recorded and were included in this analysis. The 1330 children had a median age of 11 (IQR, 2-324) days; 745 (56.0%) were male and 727 (54.7%) presented with neurological symptoms during illness before death. The most common postmortem-confirmed neurological diagnoses related to death were hypoxic events (308 [23.2%]), meningoencephalitis (135 [10.2%]), and cerebral malaria (68 [5.1%]). There were 12 neonates with overlapping hypoxic events and meningoencephalitis, but there were no patients with overlapping meningoencephalitis and cerebral malaria. Neurological symptoms were similar among diagnoses, and no combination of symptoms was accurate in differentiating them without complementary tools. However, only 25 children (18.5%) with meningitis had a lumbar puncture performed before death. Nearly 90% of deaths (442 of 511 [86.5%]) with neurological diagnoses in the chain of events leading to death were considered preventable. Conclusions and Relevance: In this cross-sectional study of children aged younger than 5 years, neurological symptoms were frequent before death. However, clinical phenotypes were insufficient to differentiate the most common underlying neurological diagnoses. The low rate of lumbar punctures performed was especially worrying, suggesting a challenge in quality of care of children presenting with neurological symptoms. Improved diagnostic management of neurological emergencies is necessary to ultimately reduce mortality in this vulnerable population.

Evaluating the tolerability and acceptability of a locally produced alcohol-based handrub and hand hygiene behaviour among health workers in Sierra Leone: a longitudinal hospital-based intervention study.

BACKGROUND: Alcohol-based handrub (ABHR) is the gold standard for hand hygiene (HH) and is a cornerstone of infection prevention and control (IPC) strategies. However, several factors influence the efficient use of ABHR by health workers. This study evaluated the tolerability and acceptability of a locally produced ABHR product and HH behaviour among health workers. METHODS: A longitudinal hospital-based intervention study was conducted in accordance with the WHO's standardized protocol for evaluating ABHR tolerability and acceptability (Method 1). Sixty health workers across 4 hospitals in Sierra Leone were observed over a 30-day period at three separate visits (days 1, 3-5, and 30) by trained observers. The outcomes of interest included skin tolerability and product acceptabilityevaluated using subjective and objective measures. RESULTS: Objective and subjective evaluations demonstrated strong skin tolerability and high acceptability with the product. At all three visits, the skin tolerability score assessed by trained observers was < 2 in ≥ 97% of participants, exceeding the WHO benchmark score (BMS = < 2 in ≥ 75%). Participants' self-evaluations of overall skin integrity were 97% (visit 2) and 98% (visit 3) for scores > 4 (BMS = > 4 in ≥ 75%). The primary acceptability criteria increased up to 95% (colour) and 88% (smell) at visit 3 (BMS = > 4 in ≥ 50%). Despite high acceptability, the product's drying effect remained low at 52% and 58% during visits 2 and 3, respectively (BMS = > 4 in ≥ 75%). There were positive HH behaviours (n = 53, 88%), with more than half (n = 38, 63%) of them exhibiting HH at almost every HH moment. The mean ABHR was notably high (76.1 ml, SD ± 35), especially among nurses (mean = 80.1 ml) and doctors (mean = 74.0 ml). CONCLUSION: The WHO-formulated, locally produced ABHR was well tolerated and accepted by health workers. These findings support the continuous utilization of evidence-based, cost-effective hand hygiene interventions in resource-limited settings. High handrub consumption and frequent HH practices were noticeable HH behaviours. Further research is recommended to optimize product formulations for skin dryness and investigate the association between ABHR consumption and hand hygiene compliance.

Beyond the needle: a qualitative exploration of Sierra Leonean healthcare workers' post COVID-19 vaccination experiences.

The global health crisis precipitated by the COVID-19 pandemic underscored the necessity of swift vaccine development and distribution to curb virus transmission. However, discussions on vaccine acceptance and hesitancy have predominantly focused on pre-vaccination attitudes, often overlooking the significance of post-vaccination experiences in shaping individual and communal attitudes toward vaccines. This oversight is particularly critical among healthcare workers in low- and middle-income countries (LMICs), who play a dual role in combating the pandemic and influencing public vaccine sentiment. Using the theory of planned behavior, this study explores the post-vaccination experiences of healthcare workers in Sierra Leone and assesses how these experiences influence their attitudes toward vaccine safety, efficacy and their advocacy for vaccine uptake within their communities. Employing a qualitative design, the study interviewed 24 healthcare workers, 21 of whom were vaccinated against COVID-19. Semi-structured interviews, conducted in English or Krio, were audio recorded, transcribed verbatim and analyzed using thematic analysis to identify key themes. Three themes were identified: positive vaccination experiences exceeding initial expectations, strong belief in the vaccine's protective benefits and active roles in vaccine advocacy. Despite initial hesitations due to concerns over potential adverse effects, participants reported no significant issues post-vaccination, fostering trust in vaccine safety and effectiveness. Healthcare workers' positive post-vaccination experiences significantly bolster their vaccine advocacy, influencing their recommendations to patients, friends, families, colleagues and community members. This study highlights the importance of understanding and leveraging healthcare workers' experiences to enhance public trust and vaccine uptake, crucial for pandemic response efforts in LMICs.

Implementing the organizational readiness for change survey during a novel midwifery preceptor program in Sierra Leone: stakeholder results.

BACKGROUND: Sierra Leone has one of the world's highest maternal and infant mortality rates and suffers from a shortage of well-trained health professionals, including midwives. Prior to engaging in systematic interventions, it is critical to measure organizational readiness to gauge members' psychological and behavioral preparedness to implement change. We aimed to measure the organizational readiness for implementing change and compare results among midwives and administrative leaders at two schools of midwifery in Sierra Leone prior to the rollout of a midwifery preceptor program. METHODS: The Organizational Readiness for Implementing Change (ORIC) survey is a validated 12-item questionnaire designed to assess two domains of organizational readiness for change: change commitment (motivation) and change efficacy (capacity). All survey items begin with the same prompt and a five-item Likert scale response, with seven questions about change commitment and five about change efficacy. Data collection occurred in two schools of midwifery in Sierra Leone during two day-long meetings with stakeholders. Statistical analysis was conducted using descriptive statistics and Wilcoxon rank-sum test to compare independent samples: School 1 versus School 2 (site), midwife versus other roles (role). RESULTS: Participants included 42 respondents (mean age 41 years, 95% female). Surveys were distributed evenly between the two sites. Occupations included midwifery faculty (n = 8), administrators (n = 5), clinicians (n = 25), and clinical educators (n = 4). Domain 1 (change commitment) had a mean score of 4.72 (SD 0.47) while Domain 2 (change efficacy) had a mean score of 4.53 (SD 0.54) out of a total potential score of five. There were no statistically significant differences between site responses for Domain 1 (p = 0.5479) and Domain 2 (p = 0.1026) nor role responses for Domain 1 (p = 0.0627) and Domain 2 (p = 0.2520). CONCLUSION: Stakeholders had very high overall readiness for change across all ORIC questions for both change commitment and change efficacy. Mean scores for change commitment were slightly higher which is not surprising given the low-resourced settings stakeholders work in while training students. High mean scores across sites and roles is encouraging as this novel preceptor program is currently being rolled out.

Independent risk factors of left ventricular hypertrophy in non-diabetic individuals in Sierra Leone - a cross-sectional study.

BACKGROUND: Left ventricular hypertrophy (LVH) is a critical factor in heart failure and cardiovascular event-related mortality. While the prevalence of LVH in diabetic patients is well-documented, its occurrence and risk factors in non-diabetic populations remain largely unexplored. This study addresses this issue by investigating the independent risk factors of LVH in non-diabetic individuals. METHODS: This cross-sectional study, conducted meticulously, utilized data from a robust and comprehensive source, DATADRYAD, in the Sierra Leone database, collected between October 2019 and October 2021, including LVH and various variables. All variables were described and screened using univariate analysis, Spearman correlation, and principal component analysis (PCA). The lipid profile, including total cholesterols (TC), triglycerides (TG), high-density lipoprotein (HDL-C), non-high-density lipoprotein (Non-HDL-C), and low-density lipoprotein cholesterol (LDL-C), TC/HDL-C ratio, TG/HDL-C ratio, Non-HDL-C /HDL-C ratio and LDL-C/HDL-C ratio, which quartiles were treated as categorical variables, with the lowest quartile serving as the reference category. Three adjusted models were constructed to mitigate the influence of other variables. To ensure the robustness of the model, receiver operating characteristic (ROC) curves were used to calculate the cutoff values by analyzing the ROC curves. A sensitivity analysis was performed to validate the findings further. RESULTS: The dataset encompasses information from 2092 individuals. After adjusting for potential factors that could influence the results, we found that TC (OR = 2.773, 95%CI: 1.805-4.26), Non-HDL-C (OR = 2.74, 95%CI: 1.7723-4.236), TC/HDL-C ratio (OR = 2.237, 95%CI: 1.445-3.463), Non-HDL-C/HDL-C ratio (OR = 2.357, 95%CI: 1.548-3.588), TG/HDL-C ratio (OR = 1.513, 95%CI: 1.02-2.245) acts as independent risk factors of LVH. ROC curve analysis revealed the predictive ability of blood lipids for LVH, with Non-HDL-C exhibiting area under the curve (AUC = 0.6109), followed by TC (AUC = 0.6084). CONCLUSIONS: TC, non-HDL-C, TC/HDL-C ratio, Non-HDL-C/HDL-C ratio, and TG/HDL-C ratio were independent risk factors of LVH in non-diabetic people. Non-HDL-C and TC were found to be essential indicators for predicting the prevalence of LVH.

Trends, and patterns, of premarital sexual intercourse and its associated factors among never-married young women aged 15-24 in Sierra Leone.

BACKGROUND: Premarital sexual intercourse has essential implications for the sexual and reproductive health and rights of young women. These include increased sexual pleasure and satisfaction as well as exposure to the risks of unintended pregnancy and sexually transmitted infections, including HIV/AIDS. This study examined the trends, patterns, and associations of premarital sexual intercourse among young women aged 15-24 in Sierra Leone. METHODS: Nationally representative cross-sectional data from the 2008, 2013, and 2019 Demographic and Health Surveys in Sierra Leone were used for the study. A weighted sample of 9,675 never-married young women was used to estimate the pooled prevalence of premarital sexual intercourse in Sierra Leone. Percentages were used to present the results of the trends and patterns of premarital sexual intercourse. We employed a multilevel binary logistic regression modelling technique to examine the associations of premarital sexual intercourse. The results were presented using adjusted odds ratio with their respective 95% confidence interval. RESULTS: The pooled prevalence of premarital sexual intercourse among the young women in Sierra Leone was 62.9%. Over the survey years, premarital sexual intercourse increased from 59.8% in 2008 to 65.1% in 2013. However, it declined by 3.5% to 61.6% in 2019. Young women aged 20-24 (aOR = 12.47, 95% CI = 10.54-14.76) had higher odds of engaging in premarital sexual intercourse than those aged 15-19. Young women with higher educational levels (aOR = 1.87, 95% CI = 1.17-2.99), those who were working (aOR = 1.60, 95% CI = 1.44-1.78), those who listened to the radio (aOR = 1.33, 95% CI = 1.29-1.60), and those who lived in the Northwestern (aOR = 2.19, 95% CI = 1.68-2.84), Eastern (aOR = 1.47, 95% CI = 1.23-1.760, Northern (aOR = 1.48, 95% CI = 1.25 -, 1.76), and Southern (aOR = 1.63, 95% CI = 1.36-1.94) regions were more likely to engage in premarital sexual intercourse compared to those with no formal education, those not working, those who did not listen to the radio, and those who lived in the Western region, respectively. Young women in the richest wealth category (aOR = 0.62, 95% CI = 0.49-0.78), and residing in rural areas (aOR = 0.84, 95% CI = 0.72-0.98) had lower odds of engaging in premarital sexual intercourse relative to those from the poorest wealth quintile and those living in urban areas. CONCLUSION: Our study found a high prevalence of premarital sexual intercourse among young women in Sierra Leone. Premarital sexual intercourse was associated with age, educational level, wealth, employment, and region. This necessitates providing them with comprehensive information regarding sexual and reproductive health behaviours, specifically emphasising the benefits and adverse consequences of engaging in sexual experimentation. Additionally, it is crucial to promote the adoption of abstinence, injections, implants, and condom usage through consistent advocacy for youth-risk communication.

Post-Omicron SARS-CoV-2 serostatus in Sierra Leone: A cross-sectional study in a maternity hospital setting in Freetown, November/December 2022.

BACKGROUND: Spread of SARS-CoV-2 in Sub-Saharan African countries has been poorly investigated, especially in the later pandemic stages. We aimed to assess the post-Omicron situation in Sierra Leone in November/December 2022 considering SARS-CoV-2 serostatus, vaccinations, and behavioral factors. METHODS: In a cross-sectional study conducted in a maternity hospital in Freetown, Sierra Leone, both patients and staff provided dried blood spot samples for analysis of anti-S and anti-N IgG prevalence using Anti-SARS-CoV-2-ELISA. Additionally, we collected sociodemographic and infection-related information through questionnaires. Outcome parameters included seropositivity, infection-related seroprevalence, and self-reported vaccination status. We used logistic regression to identify associations with prior infection and with vaccination status. RESULTS: Out of 791 participants (389 patients, 402 staff), 670 (84.7 %) displayed a positive SARS-CoV-2 serostatus resulting from either infection or vaccination. Among a sub-sample of 514 participants within which determination of prior natural infection was possible, 441individuals (85.8 %) were affected. Prior infection was associated with female sex and tertiary education level. Overall, 60.3 % reported having been vaccinated. Staff as opposed to patients, and individuals with higher socioeconomic status were more likely to report vaccination. Individuals who assessed their risk of COVID-19 as either higher or lower compared to a medium-level risk were more likely to have contracted the virus and less likely to have received vaccination. CONCLUSION: Our findings suggest that since the Omicron wave in 2022, the Sierra Leonean population has almost universally been exposed to SARS-CoV-2. While this is encouraging in the light of relatively low excess mortality in the country, future investigations on the long-term effect of high viral exposure on epidemic resilience and public health impact will be crucial.

A retrospective study revealing complex viral diversity and a substantial burden of HPV infection in SARS-CoV-2 positive individuals, Sierra Leone.

BACKGROUND: The COVID-19 pandemic has underscored the critical role of sequencing technology in disease control and outbreak response. However, resource limitations and challenging environments often impede such efforts in low and middle-income countries. This study aimed to investigate the spectrum of viral co-infections, particularly with human viral pathogens, in SARS-CoV-2 positive individuals in Sierra Leone using metagenomic sequencing, evaluating the feasibility of utilizing this technology for epidemiological and evolutionary surveillance of pathogens related to public health in low-income environments. METHODS: We retrospectively collected and analyzed 98 nasopharyngeal swab specimens from SARS-CoV-2 positive individuals in Sierra Leone. Samples were pre-processed locally and transferred to China via FTA cards for metagenomic sequencing, which was performed using the Novaseq platform. The study focused on the identification of nasopharyngeal viruses co-infecting with SARS-CoV-2, with a deeper analysis of significant human viral pathogens such as HPV. RESULTS: The study identified 22 viral taxa from 20 families, including 4 human viruses. Notably, 19.4% of samples showed HPV co-infection with 34 distinct types, predominantly beta and gamma HPVs. Multiple HPV types were found in individual samples, indicating a high complexity of viral co-infections. CONCLUSIONS: The identification of a wide range of co-infecting viruses, particularly multiple HPV genotypes, highlights the complexity of viral interactions and their potential implications for public health. These findings enhance our understanding of viral co-infections and provide valuable insights for public health interventions in Sierra Leone. Further research is needed to explore the clinical significance of these findings and their impact on disease outcomes.

Risk factors for breast cancer among women in Freetown, Sierra Leone, 2017: a case-control study.

Introduction: breast cancer is the most commonly diagnosed malignancy and an important cause of cancer death among females worldwide. The disease accounted for 25% (1.67 million) of new cancer cases and the fifth cause of cancer deaths. Incidence of all types of cancers is approximately 25% in Sierra Leone. However, there was no documented evidence on risk factors for breast cancer among women in the country. The main aim of this study was to assess risk factors associated with breast cancer among women screened for breast cancer in Freetown Sierra Leone. Methods: we conducted a case-control study on breast cancer involving 116 confirmed breast cancer cases and 116 controls. Questionnaire was designed to collect data on socio-demographic, reproductive and behavioral risk factors. Analysis was carried using logistic regression to assess the associations between breast cancer and the risk factors. Results: in the final multiple logistic regression, had formal educational level, (aOR 0.1, 0.03-0.26, p= 0.001) physical activity for more than 30 minutes per week (aOR 0.5 (0.9- 0.7, p=0.001). Cigarette smoking (aOR 4.8, 1.2-18.5, p=0.023) and family history of breast cancer (aOR 9.9 cigarette smoking (OR 4.4, 1.2-18.5, p=0.023) and family history of breast cancer (OR 9.9, 2.7-36.45, p=0.040) were identified as the main risk factors for breast cancer. This study did not find any statistically significant associations between reproductive risk factors and breast cancer. Conclusion: risk factors for breast cancer among women in Sierra Leone include educational level, physical activity, cigarette smoking and family history of breast cancer. We recommended screening program for women above 40 years and had history of breast cancer. Also, to establish breast cancer registry.

Process Mapping Midwifery Students' Clinical Placement in Sierra Leone: Identifying Facilitators and Barriers.

Background: Improving midwifery education is critical to improving maternal and infant health outcomes in Sierra Leone. A significant priority within midwifery education is to strengthen the clinical teaching and students' hands-on experience in the clinical setting. Objectives: To identify facilitators and challenges within midwifery students' clinical placements and to highlight areas to strengthen the clinical midwifery education system as well as the role of preceptors. Methods: We conducted a participatory process mapping with two schools of midwifery in Sierra Leone to detail steps taken by practicing midwives and midwifery faculty when students are placed in clinical settings for midwifery rotations. Findings: There were 42 participants from the Bo and Makeni regions of Sierra Leone. Participants included midwifery faculty from the Schools of Midwifery in Makeni and Bo, clinical midwives from two regional government hospitals, clinical midwives from two affiliated community health centers, and midwives from the District Health Management Teams. Three recurring themes emerged in the process. First, there was always some element of preparing or teaching the student. Second, there were administrative tasks to coordinate between the schools, clinical sites, and students, before, during, and after clinical placements. And third, there were elements of communication and collaboration between schools and clinical sites/preceptors that could be improved through shared understanding and standardization. Additional themes were inconsistencies across activities before, during, and after students' clinical placement and limited opportunities and confusion around systems of evaluating all components of the clinical placement experience. Conclusions: This study provides insight into the process of midwifery students' clinical placement and highlights facilitators to be standardized and some modifiable barriers to be addressed. As Sierra Leone and many other similar countries in sub-Saharan Africa attempt to strengthen students' clinical education through educating and developing preceptors, processing mapping can be a useful tool.

Prevention and control of Ebola virus transmission: mathematical modelling and data fitting.

The Ebola virus disease (EVD) has been endemic since 1976, and the case fatality rate is extremely high. EVD is spread by infected animals, symptomatic individuals, dead bodies, and contaminated environment. In this paper, we formulate an EVD model with four transmission modes and a time delay describing the incubation period. Through dynamical analysis, we verify the importance of blocking the infection source of infected animals. We get the basic reproduction number without considering the infection source of infected animals. And, it is proven that the model has a globally attractive disease-free equilibrium when the basic reproduction number is less than unity; the disease eventually becomes endemic when the basic reproduction number is greater than unity. Taking the EVD epidemic in Sierra Leone in 2014-2016 as an example, we complete the data fitting by combining the effect of the media to obtain the unknown parameters, the basic reproduction number and its time-varying reproduction number. It is shown by parameter sensitivity analysis that the contact rate and the removal rate of infected group have the greatest influence on the prevalence of the disease. And, the disease-controlling thresholds of these two parameters are obtained. In addition, according to the existing vaccination strategy, only the inoculation ratio in high-risk areas is greater than 0.4, the effective reproduction number can be less than unity. And, the earlier the vaccination time, the greater the inoculation ratio, and the faster the disease can be controlled.

Prevalence and correlates of female genital mutilation among young women in selected sub-Saharan African countries: A pooled analysis.

A deeper understanding of the factors associated with female genital mutilation remains important in the fight against this practice, particularly in developing countries. This study focused on young women (15-35 years) and pooled analysis using DHS data (2015-2019) for selected sub-Saharan African countries was done. The weighted study sample was 26289 and the data were analysed using univariate, bivariate and multivariate regression analysis. The results are based on information at the time of the survey. The overall prevalence of FGM among young women from the selected countries was 71.5%. Sierra Leone had the highest prevalence (83.7%), followed by Tanzania (80.8%), Ethiopia (73.0%), and Gambia (72.4%). The prevalence in Senegal and Guinea were both below 60%. We found that age, level of education, age at first marriage, parity, employment status, media exposure, and type of place of residence were statistically associated with FGM. This calls for targeted interventions focusing on increasing awareness, education, and empowerment for young women with low socio-economic status.

Une compréhension plus approfondie des facteurs associés aux mutilations génitales féminines reste importante dans la lutte contre cette pratique, en particulier dans les pays en développement. Cette étude s'est concentrée sur les jeunes femmes (15-35 ans) et une analyse groupée utilisant les données DHS (2015-2019) pour certains pays d'Afrique subsaharienne a été réalisée. L'échantillon pondéré de l'étude était de 26 289 et les données ont été analysées à l'aide d'une analyse de régression univariée, bivariée et multivariée. Les résultats sont basés sur les informations disponibles au moment de l'enquête. La prévalence globale des MGF parmi les jeunes femmes des pays sélectionnés était de 71,5 %. La Sierra Leone avait la prévalence la plus élevée (83,7 %), suivie par la Tanzanie (80,8 %), l'Éthiopie (73,0 %) et la Gambie (72,4 %). La prévalence au Sénégal et en Guinée était inférieure à 60 %. Nous avons constaté que l'âge, le niveau d'éducation, l'âge au premier mariage, la parité, la situation professionnelle, l'exposition aux médias et le type de lieu de résidence étaient statistiquement associés aux MGF. Cela nécessite des interventions ciblées axées sur la sensibilisation, l'éducation et l'autonomisation des jeunes femmes ayant un statut socio-économique faible.

Assessing the impact of COVID-19 on routine immunization in Sierra Leone.

BACKGROUND: The COVID-19 pandemic had a profound impact on healthcare systems and services, including routine immunization (RI). To date, there is limited information on the effects of the COVID-19 pandemic on RI in West African countries such as Sierra Leone, which had already experienced public health emergencies that disrupted its healthcare system. Here, we describe the impact of the COVID-19 pandemic on the RI of key antigens in Sierra Leone. METHODS: We used vaccination data from the District Health Information System for BCG, measles-rubella 1 and 2, and pentavalent 1 and 3 antigens. We compared 2019, 2020, 2021, and 2022 annual coverage rates for the selected antigens at the national and district levels. We used the Pearson chi-square test to assess the difference between annual coverage rates between 2019 and 2020, 2020-2021, and 2021-2022. RESULTS: National coverage rates for all antigens declined in 2019-2020, notably measles-rubella 1 and pentavalent 3 (-5.4% and - 4.9%). Between 2020 and 2021, there was an overall increase in coverage (+ 0.2% to + 2.5%), except for measles-rubella 2 (-1.8%). Measles-rubella antigens rebounded in 2021-2022, while others decreased between - 0.5 and - 1.9% in coverage. Overall, all district-level coverage rates in 2022 were lower than those in 2019. Most districts decreased between 2019 and 2022, though a few had a continuous increase; some had an increase/recovery between 2020 and 2021; some districts had recovered 2019 levels by 2022. CONCLUSION: The COVID-19 pandemic impacted Sierra Leone's national BCG, measles-rubella, and pentavalent antigen immunization, which were not fully restored in 2022. Most districts experienced notable coverage declines during the pandemic, though a few reached or surpassed 2019 rates in 2022. Examining pandemic impact can benefit from a focus beyond the national level to identify vulnerable regions. Sierra Leone's post-pandemic RI reestablishment needs targeted strategies and continual investments for equitable access and coverage, as well as to prevent vaccine-preventable diseases.

Adolescent girls' perceptions of the COVID-19 infodemic in Sierra Leone: a qualitative study in urban, peri-urban and rural Sierra Leone.

OBJECTIVE: This study aimed to identify the primary sources of COVID-19 health information for adolescent girls in Sierra Leone and evaluate their perceived trustworthiness and influence on their behaviour. DESIGN: Using a convenience sampling strategy grounded in the social cognitive theory, the study explored adolescents' navigation and appraisal of health information sources, their understanding of COVID-19, and the impact of societal and observational influences on their health beliefs and actions. Data analysis involved thematic analysis using NVivo V.12 software, focusing on patterns within responses related to observational learning, trusted sources and behavioural outcomes. SETTING: Sierra Leone, July 2020. PARTICIPANTS: 16 focus group discussions were conducted among 86 adolescents (6-8 per group) aged 15-19 years in Sierra Leone. OUTCOME MEASURE: Primary sources of COVID-19 information. RESULTS: Adolescent girls identified a diverse range of health information sources, including schools, social media, health workers and radio, with notable differences in trust and preference based on geographical and social contexts. A noteworthy finding was the significant trust placed in health workers, marking a stark contrast to fear and mistrust during the Ebola emergency only 5 years previously. This renewed trust in health professionals emerged as a critical factor influencing adolescents' health behaviours and acceptance of COVID-19 preventive measures. CONCLUSION: This study underscores the complexity of navigating health information among adolescent girls during the COVID-19 pandemic. It highlights the importance of tailored public health messaging that accounts for local cultural contexts, addresses misconceptions and builds on trusted information sources to foster effective health behaviours. Future interventions could prioritise enhancing educational resources, leveraging trusted community figures, and ensuring that health communication is scientifically accurate and culturally sensitive.

Insights into canine rabies vaccination Disparities in Sierra Leone: A cross-sectional household study.

Annually, Sierra Leone records an estimated 301 human fatalities due to rabies. Canine vaccination is crucial for rabies prevention and control efforts. However, considerable variability exists in vaccination rates. Reasons for this variation remain unclear. We conducted a cross-sectional study across 2,558 dog-owning households (HHs) to provide insights into factors influencing canine vaccination for targeted prevention and control towards elimination by 2030. First, we described dog ownership practices, then built a probabilistic model to understand factors associated with dog vaccination, and finally used a spatial scan statistic to identify spatial clusters where vaccination rates were low. Our results indicated that only 14% (358/2,558) of participating HHs had fully vaccinated their dogs against rabies. The probability of dog vaccination increased when comparing civil servants to private workers/artisans, with an Odds Ratio(OR) of 1.14 (95% credible interval (Crl) of 0.82-1.56), residing in locations with a veterinary establishment vs. none (OR = 6.43, 95% Crl (4.97-8.35), providing care to dogs vs. allowing dogs to roam freely (OR = 2.38, 95% Crl(1.80-3.17) and owning a single dog vs multiple dogs (OR = 1.20, 95 Crl (0.92-1.56). Conversely, there was a decrease in the estimated probability of vaccination when comparing dog owners located in rural vs. urban areas (OR = 0.58, CrI 95% (0.43-0.78). Latent understanding, a measure of overall understanding of rabies virus, which we estimated using participant education levels and responses to questions about rabies epidemiology, was also an important predictor of vaccination probability (OR = 1.44, 95% Crl (1.04-2.07). The spatial analysis identified high-risk clusters for low vaccination in the cities of Moyamba, with a radius of 40 km, a relative risk (RR) of 1.10, and Bo, with a radius of 19.9 km with RR of 1.11. These data do not support Sierra Leone reaching the 2030 goal of human rabies elimination caused by dogs. Our study highlights a critical need for public outreach and education, improved vaccination rates, increased accessibility to veterinary services, and targeted interventions in Bo and Moyamba to support rabies prevention and control efforts.

SARS-CoV-2 seroprevalence and associated factors among people living with HIV in Sierra Leone.

BACKGROUND: Human immunodeficiency virus (HIV) infection is an important risk factor for Coronavirus Disease 2019 (COVID-19), but data on the prevalence of COVID-19 among people living with HIV (PLWH) is limited in low-income countries. Our aim was to assess the seroprevalence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) specific antibodies and associated factors among PLWH in Sierra Leone. METHODS: We conducted a cross-sectional survey of PLWH aged 18 years or older in Sierra Leone between August 2022 and January 2023. Participants were tested for SARS-CoV-2 antibodies using a rapid SARS-CoV-2 antibody (immunoglobulin M/immunoglobulin G [IgG]) kits. Stepwise logistic regression was used to explore factors associated with SARS-CoV-2 antibody seroprevalence with a significance level of p < .05. RESULTS: In our study, 33.4% (1031/3085) participants had received a COVID-19 vaccine, and 75.7% were SARS-CoV-2 IgG positive. Higher IgG seroprevalence was observed in females (77.2% vs. 71.4%, p = .001), adults over 60 years (88.2%), those with suppressed HIV RNA (80.7% vs. 51.7%, p < .001), antiretroviral therapy (ART)-experienced individuals (77.9% vs. 44.6%, p < .001), and vaccinated participants (80.7% vs. 73.2%, p < .001). Patients 60 years or older had the highest odds of IgG seroprevalence (adjusted odds ratio [aOR] = 2.73, 95% CI = 1.68-4.65). Female sex (aOR = 1.28, 95%CI = 1.05-1.56), COVID-19 vaccination (aOR = 1.54, 95% CI = 1.27-1.86), and ART (aOR = 2.20, 95% CI = 1.56-3.11) increased the odds, whereas HIV RNA ≥ 1000 copies/mL (aOR = 0.32, 95% CI = 0.26-0.40) reduced the odds of IgG seroprevalence. CONCLUSIONS: We observed a high seroprevalence of SARS-CoV-2 antibody among PLWH in Sierra Leone. We recommend the introduction of targeted vaccination for PLWH with a high risk of severe COVID-19, especially those with an unsuppressed HIV viral load.

Assessment of antimicrobial stewardship programmes and antibiotic use among children admitted to two hospitals in Sierra Leone: a cross-sectional study.

INTRODUCTION: Antimicrobial resistance (AMR) is a global public health concern and irrational use of antibiotics in hospitals is a key driver of AMR. Even though it is not preventable, antimicrobial stewardship (AMS) programmes will reduce or slow it down. Research evidence from Sierra Leone has demonstrated the high use of antibiotics in hospitals, but no study has assessed hospital AMS programmes and antibiotic use specifically among children. We conducted the first-ever study to assess the AMS programmes and antibiotics use in two tertiary hospitals in Sierra Leone. METHODS: This was a hospital-based cross-sectional survey using the World Health Organization (WHO) point prevalence survey (PPS) methodology. Data was collected from the medical records of eligible patients at the Ola During Children's Hospital (ODCH) and Makeni Regional Hospital (MRH) using the WHO PPS hospital questionnaire; and required data collection forms. The prescribed antibiotics were classified according to the WHO Access, Watch, and Reserve (AWaRe) classification. Ethics approval was obtained from the Sierra Leone Ethics and Scientific Review Committee. Statistical analysis was conducted using the SPSS version 22. RESULTS: Both ODCH and MRH did not have the required AMS infrastructure; policy and practice; and monitoring and feedback mechanisms to ensure rational antibiotic prescribing. Of the 150 patients included in the survey, 116 (77.3%) were admitted at ODCH and 34 (22.7%) to MRH, 77 (51.3%) were males and 73 (48.7%) were females. The mean age was 2 years (SD=3.5). The overall prevalence of antibiotic use was 84.7% (95% CI: 77.9% - 90.0%) and 77 (83.8%) of the children aged less than one year received an antibiotic. The proportion of males that received antibiotics was higher than that of females. Most (58, 47.2 %) of the patients received at least two antibiotics. The top five antibiotics prescribed were gentamycin (100, 27.4%), ceftriaxone (76, 20.3%), ampicillin (71, 19.5%), metronidazole (44, 12.1%), and cefotaxime (31, 8.5%). Community-acquired infections were the primary diagnoses for antibiotic prescription. CONCLUSION: The non-existence of AMS programmes might have contributed to the high use of antibiotics at ODCH and MRH. This has the potential to increase antibiotic selection pressure and in turn the AMR burden in the country. There is need to establish hospital AMS teams and train health workers on the rational use of antibiotics.

Factors associated with unfavorable treatment outcomes among multidrug-resistant tuberculosis patients, Sierra Leone: a cross-sectional secondary data analysis.

BACKGROUND: Globally, multidrug-resistant tuberculosis (MDR-TB) is a major public health problem. The tuberculosis rate in Sierra Leone is 298 per 100,000 people, and Sierra Leone is considered a country with a high burden of tuberculosis. In Sierra Leone, there are few studies on the outcomes of MDR-TB treatment, especially those exacerbated by COVID-19. We identified factors associated with unfavorable treatment outcomes among people with MDR-TB in Sierra Leone. METHODS: We conducted a cross-sectional study to analyze hospital-based MDR-TB data from 2017 to 2021. Demographic, clinical, and treatment outcome data were extracted from the main MDR-TB referral hospital database. We defined unfavorable outcomes as patients who died, were lost to follow-up, or defaulted. We calculated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to identify predictors of the outcomes of MDR-TB treatment. RESULTS: Between 2017 and 2021, 628 people with MDR-TB were reported at Lakka Hospital; 441 (71%) were male, with a median age of 25 years (interquartile ranges: 17-34). Clinically, 21% of the 628 MDR-TB patients were HIV positive, and 413 were underweight (66%). 70% (440) of MDR-TB patients received tuberculosis treatment. The majority of patients, 457 (73%), were treated with a short treatment regimen, and 126 (20%) experienced unfavorable outcomes. Age 45 years or younger (aOR = 5.08; CI:1.87-13.82), 21-45 years (aOR = 2.22; CI:140-3.54), tuberculosis retreatment (aOR = 3.23; CI:1.82-5.73), age group, HIV status (aOR = 2.16; CI:1.33-3.53), and malnourishment status (aOR = 1.79; CI:1.12-2.86) were significantly associated with unfavorable treatment outcomes for DR-TB patients. CONCLUSION: This analysis revealed a high proportion of unfavorable treatment outcomes among MDR-TB patients in Sierra Leone. Malnourishment, TB retreatment, HIV coinfection, and age 45 years or younger were associated with unfavorable outcomes of MDR-TB treatment. Increasing patients' awareness, mainly among young people, heightens treatment adherence and HIV monitoring by measuring the amount of HIV in patient blood, which can reduce adverse treatment outcomes in Sierra Leone and other sub-Saharan African countries.

Analysing the association between perceived knowledge, and attitudes on Lassa Fever infections and mortality risk factors in lower Bambara Chiefdom.

BACKGROUND: Lassa fever (LF) presents significant public health challenges in Sierra Leone, particularly in the Lower Bambara Chiefdom. This study aims to deeply understand how knowledge and attitudes towards LF correlate with community-driven prevention and control measures. METHODS: A descriptive cross-sectional quantitative approach was used to conduct the research. Data from 2167 participants were collected using an Android-based survey from 1st February 2022 to 14th February 2022. Respondents' knowledge of LF causes, risk factors, transmission modes, and preventive measures were evaluated through a multiple-choice questionnaire, and attitudes toward prevention and control were measured on a 5-point Likert scale. Quantitative data were analyzed using SPSS version 26.0 and frequencies were presented in count, percentage, and table. Chi-square statistics were used to test for associations. RESULTS: Among the 2167 participants, over half were males (1184, 54.60%), farmers (1406, 64.90%), married (monogamous) (1428, 65.90%), and had never attended school (1336, 61.70%). Respondents demonstrated high knowledge levels of LF across socio-demographic groups (33% to 100%) and shared a positive attitude towards prevention and control (mean score of 26.77 on a 5-40 scale). Educational level, religious beliefs, and occupational status significantly influenced LF knowledge (p < 0.05). Specifically, illiterates had a high knowledge score of 48.24%, while those with tertiary education had the highest score at 83.33%. Additionally, a Pearson correlation analysis revealed a positive linear relationship between the degree of knowledge and positive attitude towards LF infection and mortality risk factors (r = 0.090, p = 0.02). CONCLUSION: High LF knowledge in Lower Bambara Chiefdom positively influences prevention attitudes. Education, religion, and occupation are key factors. Tailored interventions enhance public health efforts.