A 7-Month Review of Clinical and Demographic Predictors of Childhood Mortality in a Tertiary Children Hospital in Freetown, Sierra Leone.

BACKGROUND: Sierra Leone ranks among nations with unacceptably high infant and under-5 mortality rates. Understanding the clinical and demographic dynamics that underpin paediatric mortalities is not only essential but fundamental to the formulation and implementation of effective healthcare interventions that would enhance child survival. SUBJECTS AND MATERIAL: This was a 7-month review of all mortalities from May 24th 2021 to December 31st 2021 at Ola During Children's Hospital in Freetown, Sierra Leone. Information on biodata, presenting complaints, illness duration, diagnoses, treatment given inclusive of point-of-care investigations, and duration of hospital stay retrieved from all mortalities were entered into Excel spreadsheets and were analyzed using SPSS version 25.0 for IBM. Multivariable regression analysis was done to determine factors independently associated with mortalities within 24 hours of admission. All associations were considered significant if p < 0.05. RESULTS: There were 840 deaths out of 5920 children admitted during the period giving a mortality of 14.2% with a male-to-female ratio of 1:1. Three hundred and four (36.2%) of these deaths occurred in the neonatal age group while 63.8% occurred in the post neonatal age group. Perinatal asphyxia was the leading cause of neonatal deaths while acute respiratory infections and severe malaria were the leading causes of post neonatal deaths. The majority (64.8%) of the mortalities occurred within the first 24 hours of admission. In a multivariable regression, only transfusion status and use of respiratory support were independently associated with mortality within 24 hours of admission (P<0.05). CONCLUSION: Paediatric mortality in Sierra Leone is high and is caused mainly by preventable morbidities such as perinatal asphyxia and infections. Most of the deaths occurred within 24 hours of admission. It is recommended that patients should be brought to the hospital early and preventive measures be instituted to address these causes.

CONTEXTE: La Sierra Leone se classe parmi les nations ayant des taux de mortalité infantile et des moins de cinq ans inacceptables. Comprendre la dynamique clinique et démographique qui sous-tend les mortalités pédiatriques est non seulement essentiel mais fondamental pour la formulation et la mise en œuvre d'interventions efficaces en matière de santé qui amélioreraient la survie des enfants. SUJETS ET MATÉRIEL: Il s'agissait d'une revue de sept mois de toutes les mortalités du 24 mai 2021 au 31 décembre 2021 à l'Hôpital Ola During Children's à Freetown, Sierra Leone. Les informations sur les données biométriques, les plaintes de présentation, la durée de la maladie, les diagnostics, les traitements administrés, y compris les investigations sur le lieu de soins, et la durée du séjour à l'hôpital ont été saisies dans des feuilles de calcul Excel et analysées à l'aide de SPSS version 25.0 pour IBM. Une analyse de régression multivariée a été effectuée pour déterminer les facteurs indépendamment associés aux mortalités dans les 24 heures suivant l'admission. Toutes les associations étaient considérées comme significatives si p < 0,05. RÉSULTATS: Il y a eu 840 décès sur 5920 enfants admis pendant la période, ce qui donne une mortalité de 14,2 % avec un rapport hommefemme de 1:1. Trois cent quatre (36,2 %) de ces décès sont survenus dans le groupe d'âge néonatal, tandis que 63,8 % sont survenus dans le groupe d'âge post-néonatal. L'asphyxie périnatale était la principale cause de décès néonatal, tandis que les infections respiratoires aiguës et le paludisme grave étaient les principales causes de décès post-néonatal. La majorité (64,8 %) des mortalités sont survenues dans les premières 24 heures suivant l'admission. Dans une régression multivariée, seul le statut transfusionnel et l'utilisation d'un support respiratoire étaient indépendamment associés à la mortalité dans les 24 heures suivant l'admission (P<0,05). CONCLUSION: La mortalité pédiatrique en Sierra Leone est élevée et est principalement causée par des morbidités évitables telles que l'asphyxie périnatale et les infections. La plupart des décès surviennent dans les 24 heures suivant l'admission. Il est recommandé que les patients soient amenés à l'hôpital tôt et que des mesures préventives soient mises en place pour traiter ces causes. MOTS CLÉS: Mortalité pédiatrique, Profil clinique, Déterminants, Freetown.

Prevalence, Awareness and Risk Factors of Hypertension among Health Workers at the Connaught Teaching Hospital, Sierra Leone.

BACKGROUND: Hypertension among the health workforce is a major public health problem due to its high prevalence and dire consequences. This study aimed to determine the prevalence of hypertension, awareness, and related cardiovascular risk factors among health workers in a Teaching Hospital in Sierra Leone. METHODS: This was a cross-sectional descriptive study conducted among 250 health workers. A modified World Health Organization Non-Communicable Disease (WHO NCD) questionnaire was used to collect information on the socio-demographic characteristics, anthropometric, and lifestyle variables. RESULTS: The prevalences of hypertension and pre-hypertension were 37.2% and 22.4% respectively. The level of hypertension awareness was 36.6 %. The univariate logistic regression showed a significant crude odds ratio for gender, age, marital status, smokers, alcohol, extra sugar to tea/coffee, years of employment, weight, Waist Circumference, Hip Circumference, and Waist-Hip-Ratio (WHR) in the prediction of hypertension. The multivariate logistic regression revealed that male sex (AOR = 1.89; C.I 95%: [0.01- >20], p = 0.002), duration of employment (AOR = 0.36; C.I 95%: [0.17- 0.94], p = 0.01), and Waist Circumference (WC) (AOR = 1.46; C.I 95%: [0.58 - 3.68], p = 0.017), were positive predictors of hypertension. Males were about 2 times more likely to have hypertension, (AOR = 1.89; C.I 95%: [0.01- >20]). Participants with abnormal Waist Circumference (WC) were 1.5 times more likely to have hypertension (AOR = 1.46; C.I 95%: [0.58 - 3.68]). CONCLUSION: The prevalence of hypertension in this study population was slightly higher than the 34.8% reported for the general population even though this study population is relatively younger. The level of awareness was low. This calls for the implementation of an effective workplace health education program to improve lifestyle and reduce the risk of cardiovascular diseases.

Looking back and moving forward: 50 years of soil and soil fertility management research in sub-Saharan Africa.

Low and declining soil fertility has been recognized for a long time as a major impediment to intensifying agriculture in sub-Saharan Africa (SSA). Consequently, from the inception of international agricultural research, centres operating in SSA have had a research programme focusing on soil and soil fertility management, including the International Institute of Tropical Agriculture (IITA). The scope, content, and approaches of soil and soil fertility management research have changed over the past decades in response to lessons learnt and internal and external drivers and this paper uses IITA as a case study to document and analyse the consequences of strategic decisions taken on technology development, validation, and ultimately uptake by smallholder farmers in SSA. After an initial section describing the external environment within which soil and soil fertility management research is operating, various dimensions of this research area are covered: (i) 'strategic research', 'Research for Development', partnerships, and balancing acts, (ii) changing role of characterization due to the expansion in geographical scope and shift from soils to farms and livelihoods, (iii) technology development: changes in vision, content, and scale of intervention, (iv) technology validation and delivery to farming communities, and (v) impact and feedback to the technology development and validation process. Each of the above sections follows a chronological approach, covering the last five decades (from the late 1960s till today). The paper ends with a number of lessons learnt which could be considered for future initiatives aiming at developing and delivering improved soil and soil fertility management practices to smallholder farming communities in SSA.

Rapid epidemiologic assessment of glucose-6-phosphate dehydrogenase deficiency in malaria-endemic areas in Southeast Asia using a novel diagnostic kit.

We recently reported a new rapid screening method for glucose-6-phosphate dehydrogenase (G6PD) deficiency. This method incorporates a new formazan substrate (WST-8) and is capable of detecting heterozygous females both qualitatively and quantitatively. Here, we report its evaluation during field surveys at three malaria centres and in malaria-endemic villages of Myanmar and Indonesia, either alone or in combination with a rapid on-site diagnosis of malaria. A total of 57 severe (45 males and 12 females) and 34 mild (five males and 29 females) cases of G6PD deficiency were detected among 855 subjects in Myanmar whilst 30 severe (25 males and five females) and 23 mild (six males and 17 females) cases were found among 1286 subjects in Indonesia. In all cases, severe deficiency was confirmed with another formazan method but due to limitations in its detection threshold, mild cases were misdiagnosed as G6PD-normal by this latter method. Our results indicate that the novel method can qualitatively detect both severely deficient subjects as well as heterozygous females in the field. The antimalarial drug, primaquine, was safely prescribed to Plasmodium vivax-infected patients in Myanmar. Our new, rapid screening method may be essential for the diagnosis of G6PD deficiency particularly in rural areas without electricity, and can be recommended for use in malaria control programmes.