Water quality associated public health risk in Bo, Sierra Leone.

Human health depends on reliable access to safe drinking water, but in many developing countries only a limited number of wells and boreholes are available. Many of these water resources are contaminated with biological or chemical pollutants. The goal of this study was to examine water access and quality in urban Bo, Sierra Leone. A health census and community mapping project in one neighborhood in Bo identified the 36 water sources used by the community. A water sample was taken from each water source and tested for a variety of microbiological and physicochemical substances. Only 38.9% of the water sources met World Health Organization (WHO) microbial safety requirements based on fecal coliform levels. Physiochemical analysis indicated that the majority (91.7%) of the water sources met the requirements set by the WHO. In combination, 25% of these water resources met safe drinking water criteria. No variables associated with wells were statistically significant predictors of contamination. This study indicated that fecal contamination is the greatest health risk associated with drinking water. There is a need to raise hygiene awareness and implement inexpensive methods to reduce fecal contamination and improve drinking water safety in Bo, Sierra Leone.

Leapfrog diagnostics: Demonstration of a broad spectrum pathogen identification platform in a resource-limited setting.

BACKGROUND: Resource-limited tropical countries are home to numerous infectious pathogens of both human and zoonotic origin. A capability for early detection to allow rapid outbreak containment and prevent spread to non-endemic regions is severely impaired by inadequate diagnostic laboratory capacity, the absence of a "cold chain" and the lack of highly trained personnel. Building up detection capacity in these countries by direct replication of the systems existing in developed countries is not a feasible approach and instead requires "leapfrogging" to the deployment of the newest diagnostic systems that do not have the infrastructure requirements of systems used in developed countries. METHODS: A laboratory for molecular diagnostics of infectious agents was established in Bo, Sierra Leone with a hybrid solar/diesel/battery system to ensure stable power supply and a satellite modem to enable efficient communication. An array of room temperature stabilization and refrigeration technologies for reliable transport and storage of reagents and biological samples were also tested to ensure sustainable laboratory supplies for diagnostic assays. RESULTS: The laboratory demonstrated its operational proficiency by conducting an investigation of a suspected avian influenza outbreak at a commercial poultry farm at Bo using broad range resequencing microarrays and real time RT-PCR. The results of the investigation excluded influenza viruses as a possible cause of the outbreak and indicated a link between the outbreak and the presence of Klebsiella pneumoniae. CONCLUSIONS: This study demonstrated that by application of a carefully selected set of technologies and sufficient personnel training, it is feasible to deploy and effectively use a broad-range infectious pathogen detection technology in a severely resource-limited setting.

The Potential of Strategic Environmental Assessment to Improve Urban Planning in Sierra Leone.

Strategic Environmental Assessment (SEA) is a proactive and collaborative method for environmental management designed to integrate environmental considerations into decision-making; and it is good for Sierra Leone. To understand whether SEA would be useful in the context of Sierra Leone, the authors interviewed 64 out of 78 experts face to face from March to July 2019. In addition, government policies and regulatory documents on environmental management and sustainable development, published articles served as secondary sources of data. Data were analyzed using descriptive statistics. These Sierra Leonean experts agreed that SEA would be useful for integration and achievement of improved sustainable urban planning strategies. However, the barriers identified to integrating SEA include: not addressing environmental issues during the preparation of policies and programs, insufficient political will, the absence of clear objectives, targets, principles and approaches, overlapping mandates among environmental institutions, and inadequate institutional coordination and non-integrated development framework as barriers to integrating SEA into their work. The study shows that SEA has the potential to have a positive impact on environmental concerns in decision-making, but it would need to be supported by stronger political will, legal frameworks, and improved technical guidance from the policy perspective. Moreover, we propose a conceptual framework for the inclusion of SEA into the urban planning process in Sierra Leone.

Considerations in the selection of healthcare providers for mothers and children in Bo, Sierra Leone: reputation, cost and location.

The factors that influence the selection of a healthcare provider once the decision to seek care has been made can be summarized using a triad of cost, location and reputation. The goal of this study was to identify which of these factors is the primary consideration when women in urban Bo, Sierra Leone, select a healthcare provider for themselves or their children. We interviewed 1091 mothers during a household census of two neighbourhoods of Bo in April 2010. Reputation was the top consideration for about half of the women, cost was the second most common priority, and the location of the healthcare facility was the primary consideration for less than 7% of the participants. The majority of women said they would select a new provider if cost was not a barrier. Socioeconomic characteristics were not significant predictors of whether cost, location or reputation was selected as the highest-ranked consideration. This evidence for the importance of reputation in healthcare decision-making even in low-resource areas highlights the need for health systems to address issues of quality and responsiveness, and not just cost, in order to increase access to and utilization of health services.