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1.
Pan Afr Med J ; 42: 256, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36338567

RESUMO

Introduction: the Kenema District Surveillance team in Sierra Leone received notifications of patients with suspected Lassa fever on February 20th and March 2nd, 2019. On that day, an investigation started to confirm the diagnosis and search for additional cases. Methods: we used the Lassa fever surveillance case definition and collected demographic and exposure information from suspected cases through interviews and clinical records. Blood samples were collected from the cases to confirm the diagnosis. Active case finding was conducted in the community and health facility. Results: on February 10, 2019, an eight-year-old male developed a fever (>39.5°C) and a sore throat. On February 18, 2019, he was admitted to a hospital and treated for malaria and pneumonia. On February 20, 2019, Lassa fever was suspected because the patient was bleeding from orifices and testing. On February 15, a 5-year-old female developed fever and headache and was treated with anti-malarial drugs. On February 26th the high fever re-emerged with severe bleeding from the orifices. She was admitted and treated with antibiotics, confirmed for Lassa fever, and died on March 2, 2019. Conclusion: the two children had Lassa fever, and no additional cases were identified. We sensitized clinicians on suspicion of Lassa fever to improve early detection and treatment.


Assuntos
Febre Lassa , Criança , Masculino , Feminino , Humanos , Pré-Escolar , Febre Lassa/diagnóstico , Febre Lassa/epidemiologia , Febre Lassa/tratamento farmacológico , Serra Leoa/epidemiologia , Diagnóstico Tardio , Surtos de Doenças , Febre/etiologia , Febre/epidemiologia
2.
BMJ Open ; 12(11): e060773, 2022 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-36414288

RESUMO

OBJECTIVES: Assisted vaginal births (AVD) can prevent unnecessary caesarean sections (CS). The number of CS is increasing rapidly in sub-Saharan Africa; these are still associated with high perioperative mortality rates. The aim of this study is to define the proportion of AVD in governmental hospitals in Sierra Leone and examine barriers to its use. DESIGN: Retrospective observational study of AVD between September 2016 and August 2017. SETTING: A representative selection of Sierra Leonean governmental hospitals (n=11). PARTICIPANT AND INTERVENTION: (a) Data were collected from labour ward records. (b) Health workers involved in labour management were questioned. PRIMARY AND SECONDARY OUTCOME MEASURES: (a) Number of spontaneous, assisted vaginal and caesarean births. (b) Potential barriers to use vacuum-assisted births. RESULTS: (a) Total annual numbers of registered births, AVD and CS were 16 833, 631 (3.7%) and 4642 (27.6%). The proportion of vacuum births ranged from 0.0% to 5.1% across facilities. The proportion of CS ranged from 6.5% to 33.4%. (b) The most frequently reported reasons for limited vacuum use were lack of equipment (25/72; 35%) and insufficient training (18/72; 25%). CONCLUSIONS: The proportion of AVD was particularly low in district facilities, and according to healthcare workers this was mostly due to lack of equipment and insufficient training. Implementing relevant training programmes on the use of vacuum devices and increasing the availability of working devices may increase the proportion of vacuum births in government hospitals in Sierra Leone. This could reduce the number of unnecessary CS.


Assuntos
Cesárea , Hospitais Públicos , Gravidez , Feminino , Humanos , Serra Leoa/epidemiologia , Estudos Retrospectivos
3.
BMC Health Serv Res ; 22(1): 1327, 2022 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-36348488

RESUMO

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.


Assuntos
Infecções por HIV , Adesão à Medicação , Humanos , Serra Leoa , Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Pesquisa Qualitativa , Pessoal de Saúde
4.
Int J Public Health ; 67: 1605113, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36213138

RESUMO

Objectives: This cross-sectional survey explored COVID-19 vaccine acceptability among public healthcare facility workers in Kambia (Sierra Leone), Goma (Democratic Republic of Congo) and Masaka (Uganda). Methods: Questionnaire-based interviews conducted between April-October 2021 explored participants' knowledge and perceptions of, and attitudes towards, the COVID-19 pandemic and COVID-19 vaccines, as well as COVID-19 vaccine acceptability (defined as uptake of ≥1 dose or intent to get vaccinated). Results: Whilst most (n = 444; 81.8%) of the 543 participants had one or more concerns about COVID-19 vaccines, 487 (89.7%) nonetheless perceived that they were important for pandemic control. Most participants from Kambia or Masaka either were vaccinated (n = 137/355; 38.6%) or intended to get vaccinated (n = 211/355; 59.4%) against COVID-19. In Goma, all 188 participants were unvaccinated; only 81 (43.1%) participants intended to get vaccinated, and this was associated with positive perceptions about COVID-19 vaccines. In Goma, the most common reasons for not wanting a COVID-19 vaccine were concerns that the vaccines were new (n = 75/107; 70.1%) and fear of side effects (n = 74/107; 69.2%). Conclusion: Reported COVID-19 vaccine acceptability was high among healthcare facility workers in Kambia and Masaka. The lower vaccine acceptability in Goma may highlight the importance of social mobilisation and accurate, accessible information that addresses specific concerns.


Assuntos
Vacinas contra COVID-19 , COVID-19 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Estudos Transversais , Atenção à Saúde , República Democrática do Congo , Humanos , Pandemias , Serra Leoa , Uganda , Vacinação
5.
BMC Infect Dis ; 22(1): 769, 2022 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-36192683

RESUMO

BACKGROUND: Protection by preventive Ebola vaccines has been demonstrated in clinical trials, but a complete picture of real-world effectiveness is lacking. Our previous study modeling the impact of preventively vaccinating healthcare workers (HCW) alone or with a proportion of the general population (GP) estimated significant reductions in incidence and mortality. The model assumed 100% vaccine efficacy, which is unlikely in the real world. We enhanced this model to account for lower vaccine efficacy and to factor in reduced infectiousness and lower case fatality rate in vaccinated individuals with breakthrough infections. METHODS: The previous model was enhanced to still permit a risk, although lower, for vaccinated individuals to become infected. The enhanced model, calibrated with data from epidemics in Sierra Leone (SL) and North Kivu, Democratic Republic of the Congo, helped evaluate the impact of preventive Ebola vaccination in different scenarios based on different vaccine efficacy rates (90% and 30% reductions in infection risk in the base and conservative scenarios, respectively; additionally, both scenarios with 50% reductions in infectiousness and mortality) and vaccination coverage among HCWs (30%, 90%) and GP (0%, 5%, and 10%). RESULTS: The base scenario estimated that, depending upon the proportions of vaccinated HCWs and GP, 33-85% of cases and 34-87% of deaths during the 2014 SL epidemic and 42-89% of cases and 41-89% of deaths during the 2018 North Kivu epidemic would be averted versus no vaccination. Corresponding estimates for the conservative scenario were: 23-74% of cases and 23-77% of deaths averted during the SL epidemic and 31-80% of both cases and deaths averted during the North Kivu epidemic. CONCLUSIONS: Preventive vaccination targeting HCW alone or with GP may significantly reduce the size and mortality of an EVD outbreak, even with modest efficacy and coverage. Vaccines may also confer additional benefits through reduced infectiousness and mortality in breakthrough cases.


Assuntos
Vacinas contra Ebola , Ebolavirus , Epidemias , Doença pelo Vírus Ebola , República Democrática do Congo/epidemiologia , Surtos de Doenças/prevenção & controle , Epidemias/prevenção & controle , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Serra Leoa/epidemiologia
6.
PLoS One ; 17(10): e0276102, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36228021

RESUMO

BACKGROUND: Sierra Leone is one of the countries with poor health outcomes. The country has made some progress in the uptake of maternal health services. Despite improvements in the national coverage rates, there is no evidence of how equal these improvements have been. OBJECTIVE: To estimate inequalities in maternal healthcare use in Sierra Leone. METHODS: Using cross-sectional study data from 2008, 2013, and 2019 Demographic and Health Surveys (DHS), we study inequalities in maternal health services by computing rate ratios, and concentration indices (as well as concentration curves) using selected inequality stratifiers such as household wealth index, maternal education, and rural/urban place of residence. RESULTS: We found that considerable progress has been made in increasing the uptake of maternal health services as well as reducing inequalities over time. We also found that inequalities in the selected health indicators favoured women from wealthy households, educated women, as well as women from urban areas. Although inequalities declined over time, the use of delivery services was highly unequal. However, of the selected health interventions, the use of four or more antenatal visits was almost at perfect equality in 2013 and 2019. CONCLUSION: Although efforts have been made to increase the use of maternal healthcare services among women with a lower socioeconomic status, the use of maternal health services remains favourable to women with a higher socioeconomic standing. Therefore, policy initiatives need to prioritise women of lower socioeconomic status through projects aimed at increasing women's educational levels as well as focusing on poverty reduction.


Assuntos
Serviços de Saúde Materna , Estudos Transversais , Atenção à Saúde , Demografia , Feminino , Inquéritos Epidemiológicos , Disparidades em Assistência à Saúde , Humanos , Gravidez , Cuidado Pré-Natal , Serra Leoa , Fatores Socioeconômicos
7.
PLoS One ; 17(10): e0274755, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36197875

RESUMO

The 2013-2016 Ebola virus (EBOV) outbreak in West Africa was the largest and most complex outbreak ever, with a total number of cases and deaths higher than in all previous EBOV outbreaks combined. The outbreak was characterized by rapid spread of the infection in nations that were weakly prepared to handle it. EBOV ribonucleic acid (RNA) is known to persist in body fluids following disease recovery, and studying this persistence is crucial for controlling such epidemics. Observational cohort studies investigating EBOV persistence in semen require following up recently recovered survivors of Ebola virus disease (EVD), from recruitment to the time when their semen tests negative for EBOV, the endpoint being time-to-event. Because recruitment of EVD survivors takes place weeks or months following disease recovery, the event of interest may have already occurred. Survival analysis methods are the best suited for the estimation of the virus persistence in body fluids but must account for left- and interval-censoring present in the data, which is a more complex problem than that of presence of right censoring alone. Using the Sierra Leone Ebola Virus Persistence Study, we discuss study design issues, endpoint of interest and statistical methodologies for interval- and right-censored non-parametric and parametric survival modelling. Using the data from 203 EVD recruited survivors, we illustrate the performance of five different survival models for estimation of persistence of EBOV in semen. The interval censored survival analytic methods produced more precise estimates of EBOV persistence in semen and were more representative of the source population than the right censored ones. The potential to apply these methods is enhanced by increased availability of statistical software to handle interval censored survival data. These methods may be applicable to diseases of a similar nature where persistence estimation of pathogens is of interest.


Assuntos
Líquidos Corporais , Ebolavirus , Doença pelo Vírus Ebola , Doença pelo Vírus Ebola/epidemiologia , Humanos , Masculino , RNA , Sêmen , Serra Leoa/epidemiologia , Sobreviventes
8.
PLoS Negl Trop Dis ; 16(10): e0010755, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36197925

RESUMO

BACKGROUND: In November 2019, an outbreak of Lassa Fever occurred among health workers in a non-endemic district in Sierra Leone. The outbreak resulted in five cases, including two that were exported to the Netherlands. The outbreak tested multiple technical capacities in the International Health Regulations (2005) in a real-life setting. As such, an after action review (AAR) was undertaken as recommended by World Health Organization. We report on the findings of the AAR including best practices and lessons learnt. METHODS: A two stage review process was employed. The first stage involved national pillar level reviews for each technical pillar and one review of the district level response. The second stage brought together all pillars, including participants from the national and sub-national level as well as health sector partners. National guidelines were used as references during the deliberations. A standardized template was used to report on the key findings on what happened, what was supposed to happen, what went well and lessons learnt. RESULTS: This was a hospital associated outbreak that likely occurred due to a breach in infection prevention and control (IPC) practices resulting in three health workers being infected during a surgical operation. There was a delay in detecting the outbreak on time due to low index of suspicion among clinicians. Once detected, the outbreak response contained the outbreak within one incubation period. Areas that worked well included coordination, contact tracing, active case search and ring IPC. Notable gaps included delays in accessing local emergency funding and late distribution of IPC and laboratory supplies. CONCLUSIONS: The incident management system worked optimally to contain this outbreak. The core technical gaps identified in surveillance, IPC and delay in deployment of resources should be addressed through systemic changes that can mitigate future outbreaks.


Assuntos
Doença pelo Vírus Ebola , Febre Lassa , Busca de Comunicante , Surtos de Doenças/prevenção & controle , Pessoal de Saúde , Doença pelo Vírus Ebola/epidemiologia , Humanos , Febre Lassa/diagnóstico , Febre Lassa/epidemiologia , Febre Lassa/prevenção & controle , Serra Leoa/epidemiologia
9.
BMC Health Serv Res ; 22(1): 1270, 2022 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-36266711

RESUMO

BACKGROUND: Supervision of healthcare workers improves performance if done in a supportive and objective manner. Regular supervision is a support function of Integrated Disease Surveillance and Response (IDSR) strategy and allows systematic monitoring of IDSR implementation. Starting 2015, WHO and other development partners supported the Ministry of Health and Sanitation (MoHS) to revitalize IDSR in Sierra Leone and to monitor progress through supportive supervision assessments. We report on the findings of these assessments. METHODS: This was a cross-sectional study where six longitudinal assessments were conducted in randomly selected health facilities. Health facilities assessed were 71 in February 2016, 99 in July 2016, 101 in May 2017, 126 in August 2018, 139 in February 2019 and 156 in August 2021. An electronic checklist based on selected core functions of IDSR was developed and uploaded onto tablets using the Open Data Kit (ODK) platform. Supervision teams interviewed health care workers, reviewed documents and made observations in health facilities. Supervision books were used to record feedback and corrective actions. Data from the supervisory visits was downloaded from ODK platform, cleaned and analysed. Categorical data was summarized using frequencies and proportions while means and medians were used for continuous variables. Z test was used to test for differences in proportions. RESULTS: Completeness of IDSR reporting improved from 84.5% in 2016 to 96% in 2021 (11.5% points; 95% CI 3.6, 21.9; P-value 0.003). Timeliness of IDSR reports improved from 80.3 to 92% (11.7% points; 95% CI 2.4, 22.9; P-value 0.01). There was significant improvement in health worker knowledge of IDSR concepts and tools, in availability of IDSR standard case definition posters and reporting tools and in data analysis practices. Availability of vaccines and temperature monitoring tools in health facilities also improved significantly but some indicators dropped such as availability of IDSR technical guidelines and malaria testing kits and drugs. CONCLUSION: Supervision using electronic tool contributed to health systems strengthening through longitudinal tracking of core IDSR indicators and other program indicators such as essential malaria commodities and availability and status of routine vaccines. Supervision using electronic tools should be extended to other programs.


Assuntos
Doença pelo Vírus Ebola , Humanos , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/prevenção & controle , Vigilância em Saúde Pública , Serra Leoa/epidemiologia , Estudos Transversais , Surtos de Doenças/prevenção & controle
10.
Artigo em Inglês | MEDLINE | ID: mdl-36293703

RESUMO

Ebola Virus Disease (EVD) epidemics have been extensively documented and have received large scientific and public attention since 1976. Until July 2022, 16 countries worldwide had reported at least one case of EVD, resulting in 43 epidemics. Most of the epidemics occurred in the Democratic Republic of Congo (DRC) but the largest epidemic occurred from 2014-2016 in Guinea, Sierra Leone and Liberia in West Africa. The indirect effects of EVD epidemics on these countries' health systems, i.e., the consequences beyond infected patients and deaths immediately related to EVD, can be significant. The objective of this review was to map and measure the indirect effects of the EVD epidemics on the health systems of DRC, Guinea, Sierra Leone and Liberia and, from thereon, draw lessons for strengthening their resilience vis-à-vis future EVD outbreaks and other similar health emergencies. A scoping review of published articles from the PubMed database and gray literature was conducted. It was supplemented by interviews with experts. Eighty-six articles were included in this review. The results were structured based on WHO's six building blocks of a health system. During the EVD outbreaks, several healthcare services and activities were disrupted. A significant decline in indicators of curative care utilization, immunization levels and disease control activities was noticeable. Shortages of health personnel, poor health data management, insufficient funding and shortages of essential drugs characterized the epidemics that occurred in the above-mentioned countries. The public health authorities had virtually lost their leadership in the management of an EVD response. Governance was characterized by the development of a range of new initiatives to ensure adequate response. The results of this review highlight the need for countries to invest in and strengthen their health systems, through the continuous reinforcement of the building blocks, even if there is no imminent risk of an epidemic.


Assuntos
Medicamentos Essenciais , Epidemias , Doença pelo Vírus Ebola , Humanos , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/prevenção & controle , República Democrática do Congo/epidemiologia , Serra Leoa/epidemiologia , Guiné/epidemiologia , Libéria/epidemiologia , Epidemias/prevenção & controle , Surtos de Doenças/prevenção & controle
11.
West Afr J Med ; 39(10): 997-1006, 2022 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-36260002

RESUMO

INTRODUCTION: In Sierra Leone, the lack of information on pulmonary embolism (PE) limits the access to evidence-based standard of diagnostic work-up and management of the disease. The objective of this study was to describe the clinical characteristics and management of acute pulmonary embolism in our setting and to determine whether the pre-test probability scoring algorithms were used prior to Computed Tomography Pulmonary Angiogram (CTPA) request. METHODS: This retrospective observational study was conducted on CTPA-confirmed PE patients admitted to the Intensive Care Unit, Choithrams Memorial Hospital, in Freetown, Sierra Leone between July 2014 to June 2019. Clinical data, and pertinent investigations related to PE were determined. CTPA findings were correlated with the patient's hemodynamic status. The calculated pretest clinical probability scores (PCPS) for each patient were compared to the CTPA results. RESULTS: CTPA-confirmed PE in the study cohort was 79, with a rate of 16 new PE per year. The frequency of PE was 1.9% of the total hospital admission per year. The mean age was 64.1 ± 17.9 years, median age was 63.3years (range: 23-89 years), with 55.7% of the cohort being females. Dyspnea (78.5%) and tachycardia (69.6%) were the commonest signs and symptoms documented, with immobilization (34.2%) being the prevalent risk factor, while hypertension (48.1%) was the most common co-morbidity. The PCPS algorithm was underutilized, as "Wells Score" was documented in only 9.5% while "modified Geneva score" was never used by hospital physicians. PE with hemodynamic stability was significantly more common than PE with unstable hemodynamic status [55 (69.6%) vs 24 (30.4%), p=0.015]. All patients were managed only with anticoagulants. The overall in-hospital mortality was 17.7%. CONCLUSION: Since PCPS was hardly calculated by doctors in the diagnosis of PE, the study showed that the diagnostic algorithm for suspected PE was infrequently used in clinical practice. The use of empirical judgement by doctors in requesting for CTPA may have accounted for low rate in the diagnosis of PE per year. The establishment of P.E registry in Sierra Leone is imperative.


INTRODUCTION: En Sierra Leone, le manque d'informations sur l'embolie pulmonaire (EP) limite l'accès à des normes de diagnostic et de prise en charge de la maladie fondées sur des preuves. L'objectif de cette étude était de décrire les caractéristiques cliniques et la prise en charge de l'embolie pulmonaire aiguë dans notre établissement et de déterminer si les algorithmes de notation de la probabilité pré-test étaient utilisés avant la demande d'angiographie pulmonaire par tomodensitométrie (CTPA). MÉTHODES: Cette étude observationnelle rétrospective a été menée sur des patients atteints d'EP confirmée par CTPA admis à l'unité de soins intensifs, Choithrams Memorial Hospital, à Freetown, Sierra Leone, entre juillet 2014 et juin 2019. Les données cliniques, et les investigations pertinentes liées à l'EP ont été déterminées. Les résultats du CTPA ont été corrélés avec l'état hémodynamique du patient. Les scores de probabilité clinique prétest (PCPS) calculés pour chaque patient ont été comparés aux résultats du CTPA. RÉSULTATS: Le nombre d'EP confirmées par CTPA dans la cohorte étudiée était de 79, avec un taux de 16 nouvelles EP par an. La fréquence de l'EP était de 1,9 % du nombre total d'hospitalisations par an. L'âge moyen était de 64,1 ± 17,9 ans, l'âge médian de 63,3 ans (fourchette : 23-89 ans), 55,7 % de la cohorte étant des femmes. La dyspnée (78,5 %) et la tachycardie (69,6 %) étaient les signes et symptômes les plus fréquemment documentés, l'immobilisation (34,2%) étant le facteur de risque prévalent, tandis que l'hypertension (48,1 %) était la comorbidité la plus courante. L'algorithme PCPS était sous-utilisé, le " score de Wells " n'étant documenté que dans 9,5 % des cas, tandis que le " score de Genève modifié " n'était jamais utilisé par les médecins hospitaliers. L'EP avec stabilité hémodynamique était significativement plus fréquente que l'EP avec état hémodynamique instable [55 (69,6 %) vs 24 (30,4 %), p=0,015]. Tous les patients ont été traités uniquement par anticoagulants. La mortalité globale à l'hôpital était de 17,7 %. CONCLUSION: Étant donné que le PCPS était rarement calculé par les médecins pour le diagnostic de l'EP, l'étude a montré que l'algorithme diagnostique pour l'EP suspectée était rarement utilisé dans la pratique clinique. L'utilisation d'un jugement empirique par les médecins pour demander un CTPA peut expliquer le faible taux de diagnostic de l'EP par an. L'établissement d'un registre de l'E.P. en Sierra Leone est impératif. Mots-clés: Embolie pulmonaire, caractéristiques cliniques, gestion, Sierra Leone.


Assuntos
Embolia Pulmonar , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Masculino , Serra Leoa/epidemiologia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Doença Aguda , Anticoagulantes , Unidades de Terapia Intensiva
12.
BMC Womens Health ; 22(1): 376, 2022 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-36114503

RESUMO

BACKGROUND: Access to sexual and reproductive health information enables young women to make appropriate decisions. We examined the association between exposure to family panning messages on different mass media and the use of modern contraceptives among young women in Sierra Leone. METHODS: This was a secondary analysis of the 2019 Sierra Leone Demographic and Health Survey data of young women aged 15-24 years. Multistage stratified sampling was used to select study participants in the survey. We used multivariable logistic regression to determine the association between exposure to family panning messages on different types mass media channels and utilization of modern contraceptives. All our analyses were done using SPSS version 25. RESULTS: Out of 6055 young women, 1506 (24.9%, 95% CI 24.0-26.2) were utilizing a modern contraceptive method with the prevalence higher among urban women (26.5%) compared to rural women (23.1%). Less than half (45.6%) had been exposed to family planning messages on mass media (radio 28.6%, television 10.6%, mobile phones 4.2% and newspapers or magazines 2.2%). Young women who had exposure to family planning messages on radio (AOR: 1.26, 95% CI 1.06-1.50) and mobile phones (AOR: 1.84, 95% CI 1.25-2.69) had higher odds of using modern contraceptives compared to their counterparts without the same exposure. Furthermore, having access to internet (AOR: 1.45, 95% CI 1.19-1.78), working (AOR: 1.49, 95% CI 1.27-1.74), being older (20-24 years) (AOR: 1.75, 95% CI 1.46-2.10), being married (AOR: 0.33, 95% CI 0.26-0.42), having visited a health facility within the last 12 months (AOR: 1.34, 95% CI 1.10-1.63), having secondary (AOR: 2.83, 95% CI 2.20-3.64) and tertiary levels of education (AOR: 3.35, 95% CI 1.83-6.13), higher parity (having above one child) AOR: 1.57, 95% CI 1.19-2.08) and residing in the southern (AOR: 2.11, 95% CI 1.61-2.79), northwestern (AOR: 1.87, 95% CI 1.39-2.52), northern (AOR: 2.11, 95% CI 1.59-2.82) and eastern (AOR: 1.68, 95% CI 1.27-2.22) regions of residence were associated with higher odds of modern contraceptives utilization. CONCLUSION: In Sierra Leon, only one in four young women were using modern contraception and more than half of them had not had any exposure to family planning messages on the different types of mass media channels. Behavior change communicators can prioritize family planning messages using radio, mobile phones and the internet. In order to publicize and encourage young women to adopt healthy behaviours and increase uptake of modern contraceptive.


Assuntos
Anticoncepcionais , Serviços de Planejamento Familiar , Criança , Comportamento Contraceptivo , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Casamento , Meios de Comunicação de Massa , Gravidez , Serra Leoa
13.
PLoS One ; 17(9): e0274242, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36084117

RESUMO

INTRODUCTION: Access to care for cardiovascular disease risk factors (CVDRFs) in low- and middle-income countries is limited. We aimed to describe the need and access to care for people with CVDRF and the preparedness of the health system to treat these in Bo, Sierra Leone. METHODS: Data from a 2018 household survey conducted in Bo, Sierra Leone, was analysed. Demographic, anthropometric and clinical data on CVDRF (hypertension, diabetes mellitus or dyslipidaemia) from randomly sampled individuals 40 years of age and above were collected. Future risk of CVD was calculated using the World Health Organisation-International Society of Hypertension (WHO-ISH) calculator with high risk defined as >20% risk over 10 years. Requirement for treatment was based on WHO package of essential non-communicable (PEN) disease guidelines (which use a risk-based approach) or requiring treatment for individual CVDRF; whether participants were on treatment was used to determine whether care needs were met. Multivariable regression was used to test associations between individual characteristics and outcomes. Data from the most recent WHO Service Availability and Readiness Assessment (SARA) were used to create a score reflecting health system preparedness to treat CVDRF, and compared to that for HIV. RESULTS: 2071 individual participants were included. Most participants (n = 1715 [94.0%]) had low CVD risk; 423 (20.6%) and 431 (52.3%) required treatment based upon WHO PEN guidelines or individual CVDRF, respectively. Sixty-eight (15.8%) had met-need for treatment determined by WHO guidelines, whilst 84 (19.3%) for individual CVDRF. Living in urban areas, having education, being older, single/widowed/divorced, or wealthy were independently associated with met need. Overall facility readiness scores for CVD/CVDRF care for all facilities in Bo district was 16.8%, compared to 41% for HIV. CONCLUSION: The number of people who require treatment for CVDRF in Sierra Leone is substantially lower based on WHO guidelines compared to CVDRF. CVDRF care needs are not met equitably, and facility readiness to provide care is low.


Assuntos
Doenças Cardiovasculares , Infecções por HIV , Hipertensão , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Estudos Transversais , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Humanos , Hipertensão/epidemiologia , Hipertensão/terapia , Serra Leoa/epidemiologia
14.
PLoS One ; 17(9): e0271886, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36048780

RESUMO

Zoonotic diseases spread through pathogens-infected animal carriers. In the case of Ebola Virus Disease (EVD), evidence supports that the main carriers are fruit bats and non-human primates. Further, EVD spread is a multi-factorial problem that depends on sociodemographic and economic (SDE) factors. Here we inquire into this phenomenon and aim at determining, quantitatively, the Ebola spillover infection exposure map and try to link it to SDE factors. To that end, we designed and conducted a survey in Sierra Leone and implement a pipeline to analyze data using regression and machine learning techniques. Our methodology is able (1) to identify the features that are best predictors of an individual's tendency to partake in behaviors that can expose them to Ebola infection, (2) to develop a predictive model about the spillover risk statistics that can be calibrated for different regions and future times, and (3) to compute a spillover exposure map for Sierra Leone. Our results and conclusions are relevant to identify the regions in Sierra Leone at risk of EVD spillover and, consequently, to design and implement policies for an effective deployment of resources (e.g., drug supplies) and other preventative measures (e.g., educational campaigns).


Assuntos
Ebolavirus , Doença pelo Vírus Ebola , Surtos de Doenças , Fatores Econômicos , Doença pelo Vírus Ebola/epidemiologia , Humanos , Serra Leoa/epidemiologia
15.
Zootaxa ; 5169(1): 61-70, 2022 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-36101254

RESUMO

Cytochrome b (Cytb) sequences from 23 specimens of Mastacembelus spp. from the Rokel River, Taia/Jong River basins, and Freetown Peninsula were used in this study. These sequences were used to perform a gene-based phylogenetic analysis along with closely allied congeneric species in the Upper Guinea Forest in Africa. The resulting phylogenies inferred from Cytb showed populations of M. liberiensis from the Rokel River basin clustered into an exclusive lineage being sister to the lineage formed by M. greshoffi from the Congo basin. The Freetown Peninsula population of M. liberiensis clustered with sequences previously identified as M. taiaensis from the Taia/Jong River basin, sister to sequences of M. taiaensis from the Rokel River basin. The paired lineages were sister to the lineage formed by sequences from samples of the Taia/Jong River basin. These findings lead to the following conclusions: (1) hidden species diversity of spiny eels exists in either the Rokel River or the Jong River basin; (2) a likely available name for this species from the Freetown Peninsula is M. laticauda distinct from M. liberiensis; (3) given the diversity within M. liberiensis observed in the rivers sampled in Sierra Leone, it seems likely that the remaining rivers of Liberia and Sierra Leone reported having M. liberiensis may also harbor undescribed diversity. It is difficult to elevate some available junior synonyms based solely on a phylogeny inferred from Cytochrome b. We suggest that more samples from the entire range of M. liberiensis are needed and an integrated approach is required.


Assuntos
Citocromos b , Rios , Animais , Citocromos b/genética , Enguias , Peixes , Filogenia , Serra Leoa
16.
BMC Public Health ; 22(1): 1801, 2022 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-36138457

RESUMO

BACKGROUND: Sierra Leone, in West Africa, is one of the poorest developing countries in the world. Sierra Leone has experienced several recent challenges namely, a civil war from 1991 to 2002, a massive Ebola outbreak from 2014 to 2016, followed by floods and landslides in 2017.In this study, we quantified the burden of disease in Sierra Leone over a 27-year period, from 1990 to 2017. METHODOLOGY: In this descriptive study, we analysed secondary data from the Institute of Health Metrics and Evaluation, Global Burden of Disease (GBD) study. We quantified patterns of burden of disease, injuries, and risk factors in Sierra Leone. We report GBD data and metrics including mortality rates, years of life lost and risk factors for all ages and both sexes from 1990 to 2017. RESULTS: From 1990 to 2017, trends of mortality rates for all ages and sexes have declined in Sierra Leone although mortality rates remain some of the highest when compared to other developing countries. The burden of communicable, maternal, neonatal, and nutritional (CMNN) diseases are greater than the burden of non-communicable diseases (NCDs) due to the prevalence of endemic diseases in Sierra Leone. The most important CMNNs associated with premature mortality included respiratory infections, neglected tropical diseases, malaria, and HIV-Aids. Life expectancy has increased from 37 to 52 years. CONCLUSION: Sierra Leone's health status is gradually improving following the civil war and Ebola outbreak. Sierra Leone has a double burden of disease with CMNNs leading and NCDs progressively increasing. Despite these challenges, Sierra Leone has promising initiatives and programs pursuing the Universal Health Coverage 2030 Sustainable Developmental Goals Agenda. There is need for accountability of available resources, clear rules and expected roles for non-governmental organisations to ensure a level playing field for all actors to rebuild the health system.


Assuntos
Doença pelo Vírus Ebola , Doenças não Transmissíveis , Distúrbios Nutricionais , Saúde da População , Causas de Morte , Feminino , Carga Global da Doença , Saúde Global , Doença pelo Vírus Ebola/epidemiologia , Humanos , Recém-Nascido , Masculino , Serra Leoa/epidemiologia
17.
Health Policy Plan ; 37(10): 1210-1220, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36052949

RESUMO

High under-five mortality rate remains one of the public health challenges, especially in Sub-Saharan Africa, accounting for more than half of all global cases. Sierra Leone was and is still one of the countries with the highest under-five mortality rate. Using the latest 2019 Sierra Leone Demographic and Health Survey data, we investigated factors associated with under-five mortality in Sierra Leone. A total of 9771 mothers aged 15-49 years in the country were interviewed and included in the analysis. The dependent variable is child status (dead = 1; alive = 0). A total of 871 (9%) children died before their fifth birthday. The maternal age of 20-24 years [adjusted odds ratios (AOR) = 0.46; 95% confidence interval (CI) = 0.33-0.64; P < 0.001] up to 40-44 years (AOR = 0.43; CI = 0.27-0.7; P = 0.001), currently breastfeeding (AOR = 0.20; CI = 0.17-0.24; P < 0.001), maternal media exposure and usage of reading newspapers/magazines less than once a week (AOR = 0.48; CI = 0.28-0.85; P = 0.011) were more likely to enhance child survivability through their fifth birthday. Also, the child sex being female (AOR = 0.68; CI = 0.59-0.79) was more likely to survive under-five mortality compared to their male counterpart. On the other hand, mothers who listened to radio at least once a week (AOR = 1.31; CI = 1.08-1.59; P = 0.007) watched television less than once a week (AOR = 1.48; CI = 1.16-1.90), had two (AOR = 3.4, CI = 2.78-4.16; P < 0.001) or three and above birth (AOR = 8.11; CI = 6.07-10.83; P < 0.001) in five years, had multiple birth children (AOR = 1.41; CI = 1.08-1.86) and very small-sized child at birth (AOR= 1.95; CI = 1.41-2.70) were more likely to lose their children below the age of 5 years. The factors contributing to under-five mortality in Sierra Leone are critical to ensuring child survival and improving maternal health. Breastfeeding, maternal age, media exposure, child's sex, multiple birth type, very small-sized child and the total number of births in 5 years were significant drivers of under-five mortality. The result affirms the need for attention to be focused on enhancing the survival rate of under-five children in Sierra Leone.


Assuntos
Aleitamento Materno , Mães , Criança , Recém-Nascido , Feminino , Masculino , Humanos , Pré-Escolar , Serra Leoa/epidemiologia , África ao Sul do Saara , Demografia
18.
Vet Med Sci ; 8(6): 2345-2350, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36163650

RESUMO

OBJECTIVE: This study determines the seroprevalence and associated factors of rabies in unvaccinated dogs in Sierra Leone. BACKGROUND: Rabies control is poorly coordinated in Sierra Leone which was ranked as the third hungriest country in the world. Due to limited access to rabies vaccines, the need for comprehensive serological data on dogs for control of the disease is expedient. METHODS: A random multistage technique considering high, medium and low incident areas of rabies cases in dog-populated communities was adopted. Samples were collected from dogs with owners which were at least 1-year old. Samples were analysed using a commercial ELISA in accordance to manufacturer's instructions. RESULTS: 25.2% of the total 270 samples tested positive for the presence of rabies antibodies. Kenema district had the highest number of positive samples, followed by the Bombali district and Moyamba district the least. Predisposing factors, including sex, the status of castration, the type of settlement, district and the availability of fences at locations where dogs are kept, had significant effects (p<0.05) on the exposure of dogs to rabies. The 25.2% antibody seroprevalence obtained is very low. CONCLUSIONS: Concerted effort should be made to enhance rabies vaccination through an awareness campaign and provision of vaccine to dog owners. Good waste disposal and management practices to reduce open garbage disposal in communities will go a long way to limit the stray-dog population and minimize rabies outbreaks especially in third-world countries where rabies vaccines are not accessible.


Assuntos
Doenças do Cão , Vacinas Antirrábicas , Raiva , Cães , Animais , Raiva/epidemiologia , Raiva/veterinária , Raiva/prevenção & controle , Estudos Soroepidemiológicos , Serra Leoa/epidemiologia , Doenças do Cão/epidemiologia , Doenças do Cão/prevenção & controle , Causalidade
19.
BMC Health Serv Res ; 22(1): 1208, 2022 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-36171575

RESUMO

BACKGROUND: Timely and increased frequency of quality antenatal care (ANC) contacts is one of the key strategies aimed at decreasing maternal and neonatal deaths. In 2016, the World Health Organization (WHO) revised the ANC guidelines to recommend at least eight ANC contacts instead of four. This study aimed to determine the proportion of women who received eight or more ANC contacts and associated factors in Sierra Leone. METHODS: We used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 5,432 women aged 15 to 49 years who had a live birth, within three years preceding the survey. Multistage stratified sampling was used to select study participants. We conducted multivariable logistic regression to identify factors associated with utilisation of eight or more ANC contacts using SPSS version 25 complex samples package. RESULTS: Out of 5,432 women, 2,399 (44.8%) (95% CI: 43.1-45.7) had their first ANC contact in the first trimester and 1,197 (22.0%) (95% CI: 21.2-23.4) had eight or more ANC contacts. Women who had their first ANC contact after first trimester (adjusted odds ratio, aOR, 0.58, 95% CI 0.49-0.68) and women aged 15 to 19 years had less odds of having eight or more contacts (aOR 0.64, 95% CI 0.45 to 0.91). Working (aOR 1.33, 95%CI 1.10 to 1.62) and wealthier women had higher odds of having eight or more contacts compared to poorer ones and those not working respectively. Women residing in the southern region, those using internet and less parous (less than five) women were associated with higher odds of having eight or more ANC contacts. Women who had no big problem obtaining permission to go health facilities also had higher odds of having eight or more ANC contacts compared to those who had big problems. CONCLUSION: Sierra Leone's adoption of eight or more ANC contacts is low and less than half of the women initiate ANC in the first trimester. To ensure increased access to recommended ANC visits, timely ANC should be encouraged. Attributes of women empowerment such as workings status, socio-economic status, and decision-making should also be emphasized.


Assuntos
Instalações de Saúde , Cuidado Pré-Natal , Feminino , Humanos , Recém-Nascido , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Serra Leoa/epidemiologia , Inquéritos e Questionários , Organização Mundial da Saúde
20.
World J Surg ; 46(11): 2585-2594, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36068404

RESUMO

BACKGROUND: Understanding the burden of diseases requiring surgical care at national levels is essential to advance universal health coverage. The PREvalence Study on Surgical COnditions (PRESSCO) 2020 is a cross-sectional household survey to estimate the prevalence of physical conditions needing surgical consultation, to investigate healthcare-seeking behavior, and to assess changes from before the West African Ebola epidemic. METHODS: This study (ISRCTN: 12353489) was built upon the Surgeons Overseas Surgical Needs Assessment (SOSAS) tool, including expansions. Seventy-five enumeration areas from 9671 nationwide clusters were sampled proportional to population size. In each cluster, 25 households were randomly assigned and visited. Need for surgical consultations was based on verbal responses and physical examination of selected household members. RESULTS: A total of 3,618 individuals from 1,854 households were surveyed. Compared to 2012, the prevalence of individuals reporting one or more relevant physical conditions was reduced from 25 to 6.2% (95% CI 5.4-7.0%) of the population. One-in-five conditions rendered respondents unemployed, disabled, or stigmatized. Adult males were predominantly prone to untreated surgical conditions (9.7 vs. 5.9% women; p < 0.001). Financial constraints were the predominant reason for not seeking care. Among those seeking professional health care, 86.7% underwent surgery. CONCLUSION: PRESSCO 2020 is the first surgical needs household survey which compares against earlier study data. Despite the 2013-2016 Ebola outbreak, which profoundly disrupted the national healthcare system, a substantial reduction in reported surgical conditions was observed. Compared to one-time measurements, repeated household surveys yield finer granular data on the characteristics and situations of populations in need of surgical treatment.


Assuntos
Doença pelo Vírus Ebola , Adulto , Estudos Transversais , Países em Desenvolvimento , Surtos de Doenças , Feminino , Necessidades e Demandas de Serviços de Saúde , Doença pelo Vírus Ebola/epidemiologia , Humanos , Masculino , Prevalência , Serra Leoa/epidemiologia
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