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1.
Nat Commun ; 12(1): 763, 2021 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-33536429

RESUMO

Human and animal infections with bacteria of the genus Sarcina (family Clostridiaceae) are associated with gastric dilation and emphysematous gastritis. However, the potential roles of sarcinae as commensals or pathogens remain unclear. Here, we investigate a lethal disease of unknown etiology that affects sanctuary chimpanzees (Pan troglodytes verus) in Sierra Leone. The disease, which we have named "epizootic neurologic and gastroenteric syndrome" (ENGS), is characterized by neurologic and gastrointestinal signs and results in death of the animals, even after medical treatment. Using a case-control study design, we show that ENGS is strongly associated with Sarcina infection. The microorganism is distinct from Sarcina ventriculi and other known members of its genus, based on bacterial morphology and growth characteristics. Whole-genome sequencing confirms this distinction and reveals the presence of genetic features that may account for the unusual virulence of the bacterium. Therefore, we propose that this organism be considered the representative of a new species, named "Candidatus Sarcina troglodytae". Our results suggest that a heretofore unrecognized complex of related sarcinae likely exists, some of which may be highly virulent. However, the potential role of "Ca. S. troglodytae" in the etiology of ENGS, alone or in combination with other factors, remains a topic for future research.


Assuntos
Doenças dos Símios Antropoides/diagnóstico , Enfisema/diagnóstico , Gastrite/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Sarcina/genética , Animais , Doenças dos Símios Antropoides/microbiologia , DNA Bacteriano/análise , DNA Bacteriano/genética , Enfisema/microbiologia , Gastrite/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/veterinária , Humanos , Pan troglodytes , Sarcina/classificação , Sarcina/patogenicidade , Serra Leoa , Virulência/genética , Sequenciamento Completo do Genoma/métodos
2.
Artigo em Inglês | MEDLINE | ID: mdl-33406601

RESUMO

Child survival and wellbeing remain a global health challenge despite vast development within the area and a significant decline in mortality rates of children under five years of age. This study investigates the perceived causes of ill health and childhood mortality in the context of five villages located in the Tonkolili district of Sierra Leone. Mixed method methodology was applied in this study consisting of both quantitative and qualitative data contribution. The quantitative part consisted of a household survey on child health, where 341 households, equivalent to 50.6% of the total number of households in the five villages, participated with a response rate of 100%. The qualitative part consisted of six semi structured interviews-one with a health care worker and five with mothers from each village. The main perceived reason for child morbidity was inadequate care of children related to personal hygiene of the child, hygiene and safety in the environment, in-sufficient nutrition, inadequate supervision and poor healthcare seeking behavior. Additionally, reasons given for disease included supernatural forces such as witchcraft. In relation to the survey, the perceived causes of child mortality for ill children in the villages were mainly malaria (33.6%), diarrhea (11.6%), pneumonia (8.6%), and unknown (26%). The observed symptoms of illness among children were fever (43.7%), cough and difficulty breathing (10.7%), frequent watery stool (10.3%) and no symptoms (20.3%). The perception of ill health in children was mainly associated with the parent's ability to cater for the child's physical needs, but also associated with external factors such as witchcraft and "God's will". In addition, biomedical causes for disease and supernatural causes for disease were seen to coexist.


Assuntos
Saúde da Criança , Mortalidade da Criança , Conhecimentos, Atitudes e Prática em Saúde , População Rural , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Higiene , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Serra Leoa/epidemiologia , Adulto Jovem
4.
PLoS Negl Trop Dis ; 14(12): e0008877, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33370270

RESUMO

BACKGROUND: Lymphatic filariasis (LF) is targeted for elimination in Sierra Leone. Epidemiological coverage of mass drug administration (MDA) with ivermectin and albendazole had been reported >65% in all 12 districts annually. Eight districts qualified to implement transmission assessment survey (TAS) in 2013 but were deferred until 2017 due to the Ebola outbreak (2014-2016). In 2017, four districts qualified for conducting a repeat pre-TAS after completing three more rounds of MDA and the final two districts were also eligible to implement a pre-TAS. METHODOLOGY/PRINCIPAL FINDINGS: For TAS, eight districts were surveyed as four evaluation units (EU). A school-based survey was conducted in children aged 6-7 years from 30 clusters per EU. For pre-TAS, one sentinel and one spot check site per district (with 2 spot check sites in Bombali) were selected and 300-350 persons aged 5 years and above were selected. For both surveys, finger prick blood samples were tested using the Filariasis Test Strips (FTS). For TAS, 7,143 children aged 6-7 years were surveyed across four EUs, and positives were found in three EUs, all below the critical cut-off value for each EU. For the repeat pre-TAS/pre-TAS, 3,994 persons over five years of age were surveyed. The Western Area Urban had FTS prevalence of 0.7% in two sites and qualified for TAS, while other five districts had sites with antigenemia prevalence >2%: 9.1-25.9% in Bombali, 7.5-19.4% in Koinadugu, 6.1-2.9% in Kailahun, 1.3-2.3% in Kenema and 1.7% - 3.7% in Western Area Rural. CONCLUSIONS/SIGNIFICANCE: Eight districts in Sierra Leone have successfully passed TAS1 and stopped MDA, with one more district qualified for conducting TAS1, a significant progress towards LF elimination. However, great challenges exist in eliminating LF from the whole country with repeated failure of pre-TAS in border districts. Effort needs to be intensified to achieve LF elimination.


Assuntos
Albendazol/uso terapêutico , Filariose Linfática/epidemiologia , Filariose Linfática/prevenção & controle , Filaricidas , Ivermectina/uso terapêutico , Administração Massiva de Medicamentos , Animais , Brugia Malayi/isolamento & purificação , Criança , Pré-Escolar , Erradicação de Doenças/métodos , Filariose Linfática/diagnóstico , Filariose Linfática/tratamento farmacológico , Filaricidas/uso terapêutico , Humanos , Serra Leoa/epidemiologia , Wuchereria bancrofti/isolamento & purificação
5.
Zootaxa ; 4766(3): zootaxa.4766.3.3, 2020 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33056590

RESUMO

Abacaecus n. gen. walterrossii n. sp., a notable blind species from Sierra Leone, is described. A. walterrossii n. sp. probably belongs to a separated phyletic lineage inside Abacetini sensu lato and is the first recorded blind African species of this tribe. It is also compared to Pterostillichus caecus Straneo, another African blind species of uncertain affinities, of which is given an integrative description enriched by illustration of a few characters.


Assuntos
Besouros , África Ocidental , Animais , Filogenia , Serra Leoa
7.
BMJ Open ; 10(9): e040328, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32948576

RESUMO

OBJECTIVES: To assess the public's knowledge, attitudes and practices about the novel coronavirus in Sierra Leone to inform an evidence-based communication strategy around COVID-19. DESIGN: Nationwide, cross-sectional Knowledge, Attitudes and Practices survey. SETTING: 56 randomly selected communities in all 14 districts in Sierra Leone. PARTICIPANTS: 1253 adults aged 18 years and older of which 52% were men. MAIN OUTCOME MEASURES: We calculated proportions of core indicators (awareness, knowledge, risk perception, practices). A composite variable for knowledge (based on seven variables) was created, and categorised into low (0-2 correct), medium (3-4) and high (5-7). Predictors of knowledge were analysed with multilevel ordinal regression models. Associations between information sources, knowledge and two practices (washing hands with soap and avoiding crowds) were analysed using multilevel logistic regression models. RESULTS: We found that 75% of the respondents felt at moderate or great risk of contracting coronavirus. A majority (70%) of women did not know you can survive COVID-19, compared with 61% of men. 60% of men and 54% of women had already taken action to avoid infection with the coronavirus, mostly washing hands with soap and water (87%). Radio (73%) was the most used source for COVID-19 information, followed by social media (39%). Having a medium or high level of knowledge was associated with higher odds of washing hands with soap (medium knowledge: adjusted OR (AOR) 2.1, 95% CI 1.0 to 4.4; high knowledge: AOR 4.6, 95% CI 2.1 to 10.2) and avoiding crowds (medium knowledge: AOR 2.0, 95% CI 1.1 to 3.6; high knowledge: AOR 2.3, 95% CI 1.2 to 4.3). CONCLUSIONS: This study shows that in the context of COVID-19 in Sierra Leone, there is a strong association between knowledge and practices. Because the knowledge gap differs between genders, regions, educational levels and age, it is important that messages are specifically targeted to these core audiences.


Assuntos
Infecções por Coronavirus , Conhecimentos, Atitudes e Prática em Saúde , Pandemias , Pneumonia Viral , Adulto , Betacoronavirus , Informação de Saúde ao Consumidor , Feminino , Desinfecção das Mãos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Rádio , Serra Leoa , Mídias Sociais , Inquéritos e Questionários , Adulto Jovem
8.
PLoS One ; 15(9): e0239234, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32931509

RESUMO

Effective and culturally appropriate hand-hygiene education is essential to promote health-related practices to control and prevent diseases such as Diarrhoea, Ebola and COVID-19. In this paper we outline and evaluate the Co-Creation processes underpinning a handwashing intervention for young children (A Germ's Journey) developed and delivered in India, Sierra Leone and the UK, and consider the implications surrounding Imperialist/Colonial discourse and the White Saviour Complex. The paper focuses both on the ways Co-Creation was conceptualised by our collaborators in all three countries and the catalysts and challenges encountered. Qualitative data have been drawn from in-depth interviews with five key stakeholders, focus group data from 37 teachers in Sierra Leone and responses to open-ended questionnaires completed by teachers in India (N = 66) and UK (N = 63). Data were analysed using thematic analysis and three themes, each with three constituent subthemes are presented. In the theme 'Representations of and Unique Approaches to Co-Creation' we explore the ways in which Co-Creation was constructed in relation to teamwork, innovative practice and more continuous models of evaluation. In 'Advantages of Co-Creation' we consider issues around shared ownership, improved outcomes and more meaningful insights alongside the mitigation of risks and short-circuiting of problems. In 'Challenges of Co-Creation' we discuss issues around timing and organisation, attracting and working with appropriate partners and understanding the importance of local context with inherent social, economic and structural barriers, especially in low-and-middle-income countries. We consider how theoretical elements of Co-Creation can inform effective international public health interventions; crucial during a global pandemic in which handwashing is the most effective method to control the transmission of COVID-19. Finally we reflect on some of the methodological challenges of our own work and in managing the potentially conflicting goals of the ethical and participatory values of Co-Creation with pragmatic considerations about ensuring an effective final 'product'.


Assuntos
Controle de Doenças Transmissíveis/métodos , Higiene das Mãos , Betacoronavirus , Criança , Doenças Transmissíveis/patologia , Doenças Transmissíveis/transmissão , Doenças Transmissíveis/virologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Grupos Focais , Humanos , Índia , Entrevistas como Assunto , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Professores Escolares/psicologia , Serra Leoa , Inquéritos e Questionários , Reino Unido
9.
PLoS Negl Trop Dis ; 14(7): e0008496, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32735587

RESUMO

BACKGROUND: The unprecedented 2013/16 outbreak of Zaire ebolavirus (Ebola virus) in West Africa has highighted the need for rapid, high-throughput and POC diagnostic assays to enable timely detection and appropriate triaging of Ebola Virus Disease (EVD) patients. Ebola virus is highly infectious and prompt diagnosis and triage is crucial in preventing further spread within community and healthcare settings. Moreover, due to the ecology of Ebola virus it is important that newly developed diagnostic assays are suitable for use in both the healthcare environment and low resource rural locations. METHODOLOGY/PRINCIPLE FINDINGS: A LAMP assay was successfully developed with three detection formats; a real-time intercalating dye-based assay, a real-time probe-based assay to enable multiplexing and an end-point colourimetric assay to simplify interpretation for the field. All assay formats were sensitive and specific, detecting a range of Ebola virus strains isolated in 1976-2014; with Probit analysis predicting limits of detection of 243, 290 and 75 copies/reaction respectively and no cross-detection of related strains or other viral haemorrhagic fevers (VHF's). The assays are rapid, (as fast as 5-7.25 mins for real-time formats) and robust, detecting Ebola virus RNA in presence of minimally diluted bodily fluids. Moreover, when tested on patient samples from the 2013/16 outbreak, there were no false positives and 93-96% of all new case positives were detected, with only a failure to detect very low copy number samples. CONCLUSION/SIGNIFICANCE: These are a set of robust and adaptable diagnostic solutions, which are fast, easy-to-perform-and-interpret and are suitable for use on a range of platforms including portable low-power devices. They can be readily transferred to field-laboratory settings, with no specific equipment needs and are therefore ideally placed for use in locations with limited resources.


Assuntos
Ebolavirus/isolamento & purificação , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/virologia , Técnicas de Amplificação de Ácido Nucleico/métodos , Surtos de Doenças , Doença pelo Vírus Ebola/sangue , Doença pelo Vírus Ebola/epidemiologia , Humanos , RNA Viral , Sensibilidade e Especificidade , Serra Leoa/epidemiologia
10.
West Afr J Med ; 37(4): 418-422, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32835406

RESUMO

BACKGROUND: Several stroke studies in West Africans have demonstrated a high proportion of haemorrhagic stroke and poor outcomes. This may be due to the socioeconomic status of patients and inadequate clinical care. Outcomes may well be different if more informed patients treated in better facilities are studied. OBJECTIVE: To study the pattern of stroke and stroke outcomes in African patients attending a private hospital in Sierra Leone METHODS: 150 consecutive African stroke patients admitted to a private hospital in Sierra Leone were studied. Demographic details, risk factors, clinical features including blood pressure were recorded. CT scans, ECG, serum cholesterol, and blood sugar were done. Patients were reviewed at day 30 and Rankin scores allocated. Two sample independent t-test was used to compare means, and chi square to compare variables. RESULTS: Hypertension was the most common risk factor present in 77.6% of patients prior to admission with diabetes in 29.5%. Other risk factors include previous stroke (11.7%), smoking (6.3%), hypercholesterolemia (23.4%), high alcohol intake (28.8%) and lack of exercise according to self-evaluation (87.5%). 76.3% of patients had ischaemic and 18.2% haemorrhagic stroke. 41% of patients aged 50 years or less had haemorrhagic stroke and 9.3% of patients had atrial fibrillation. In-patient mortality was 10.6%. CONCLUSION: Stroke types and outcomes are different from those generally reported from the sub-region. This may well be due to the population studied, and the level of care provided by a private facility. Socio-economic factors, literacy and clinical care are likely determinants of stroke types and outcomes in African patients. . More detailed studies to confirm the effects of socioeconomic factors on stroke pattern and outcomes in Africa are needed.


Assuntos
Acidente Vascular Cerebral , Instalações de Saúde , Humanos , Hipertensão , Pessoa de Meia-Idade , Instalações Privadas , Fatores de Risco , Serra Leoa
11.
Am J Trop Med Hyg ; 103(5): 2142-2148, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32840199

RESUMO

A better understanding of the context-specific epidemiology, outcomes, and risk factors for death of critically ill parturients in resource-poor hospitals is needed to tackle the still alarming in-hospital maternal mortality in African countries. From October 2017 to October 2018, we performed a 1-year retrospective cohort study in a referral maternity hospital in Freetown, Sierra Leone. The primary endpoint was the association between risk factors and high-dependency unit (HDU) mortality. Five hundred twenty-three patients (median age 25 years, interquartile range [IQR]: 21-30 years) were admitted to the HDU for a median of 2 (IQR: 1-3) days. Among them, 65% were referred with a red obstetric early warning score (OEWS) code, representing 1.17 cases per HDU bed per week; 11% of patients died in HDU, mostly in the first 24 hours from admission. The factors independently associated with HDU mortality were ward rather than postoperative referrals (odds ratio [OR]: 3.21; 95% CI: 1.48-7.01; P = 0.003); admissions with red (high impairment of patients' vital signs) versus yellow (impairment of vital signs) or green (little or no impairment of patients' vital signs) OEWS (OR: 3.66; 95% CI: 1.15-16.96; P = 0.04); responsiveness to pain or unresponsiveness on the alert, voice, pain unresponsive scale (OR: 5.25; 95% CI: 2.64-10.94; P ≤ 0.0001); and use of vasopressors (OR: 3.24; 95% CI: 1.32-7.66; P = 0.008). Critically ill parturients were predominantly referred with a red OEWS code and usually required intermediate care for 48 hours. Despite the provided interventions, death in the HDU was frequent, affecting one of 10 critically ill parturients. Medical admission, a red OEWS code, and a poor neurological and hemodynamic status were independently associated with mortality, whereas adequate oxygenation was associated with survival.


Assuntos
Cuidados Críticos/organização & administração , Estado Terminal/epidemiologia , Adulto , Estado Terminal/mortalidade , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Obstetrícia , Admissão do Paciente , Gravidez , Estudos Retrospectivos , Fatores de Risco , Serra Leoa/epidemiologia , Adulto Jovem
12.
PLoS Negl Trop Dis ; 14(8): e0008624, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32810138

RESUMO

BACKGROUND: Sierra Leone experienced the largest documented epidemic of Ebola Virus Disease in 2014-2015. The government implemented a national tollfree telephone line (1-1-7) for public reporting of illness and deaths to improve the detection of Ebola cases. Reporting of deaths declined substantially after the epidemic ended. To inform routine mortality surveillance, we aimed to describe the trends in deaths reported to the 1-1-7 system and to quantify people's motivations to continue reporting deaths after the epidemic. METHODS: First, we described the monthly trends in the number of deaths reported to the 1-1-7 system between September 2014 and September 2019. Second, we conducted a telephone survey in April 2017 with a national sample of individuals who reported a death to the 1-1-7 system between December 2016 and April 2017. We described the reported deaths and used ordered logistic regression modeling to examine the potential drivers of reporting motivations. FINDINGS: Analysis of the number of deaths reported to the 1-1-7 system showed that 12% of the expected deaths were captured in 2017 compared to approximately 34% in 2016 and over 100% in 2015. We interviewed 1,291 death reporters in the survey. Family members reported 56% of the deaths. Nearly every respondent (94%) expressed that they wanted the 1-1-7 system to continue. The most common motivation to report was to obey the government's mandate (82%). Respondents felt more motivated to report if the decedent exhibited Ebola-like symptoms (adjusted odds ratio 2.3; 95% confidence interval 1.8-2.9). CONCLUSIONS: Motivation to report deaths that resembled Ebola in the post-outbreak setting may have been influenced by knowledge and experiences from the prolonged epidemic. Transitioning the system to a routine mortality surveillance tool may require a robust social mobilization component to match the high reporting levels during the epidemic, which exceeded more than 100% of expected deaths in 2015.


Assuntos
Epidemias , Doença pelo Vírus Ebola/mortalidade , Vigilância da População , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Serra Leoa/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários , Telefone , Adulto Jovem
13.
Ann Epidemiol ; 49: 68-74, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32763341

RESUMO

PURPOSE: Sierra Leone recorded the highest incidence rate for the 2013-2016 West African Ebola outbreak. In this investigation, we used the medical records of Ebola patients with different sociodemographic and clinical features to determine the factors that are associated with Ebola treatment outcome during the 2013-2016 West African Ebola outbreak in Sierra Leone and constructed a predictive in-facility mortality score. METHODS: We used the anonymized medical records of 1077 laboratory-confirmed pediatric and adult patients with EVD who received treatment at the 34 Military Hospital and the Police Training School Ebola Treatment Centers in Sierra Leone between the period of June 2014 and April 2015. We later determined the in-facility case fatality rates for Ebola, the odds of dying during Ebola treatment, and later constructed a predictive in-facility mortality score for these patients based on their clinical and sociodemographic characteristics. RESULTS: We constructed a model that partitioned the study population into three mortality risk groups of equal patient numbers, based on risk scoring: low (score ≤ -5), medium (score -4 to 1), and high-risk group (score ≥ 2). The CFR of patients with EVD belonging to the low- (≤-5), medium (-4 to 1), and high- (≥2) risk groups were 0.56%, 9.75%, and 67.41%, respectively. CONCLUSIONS: We succeeded in designing an in-facility mortality risk score that reflects EVD clinical severity and can assist in the clinical prioritization of patients with EVD.


Assuntos
Doença pelo Vírus Ebola/terapia , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Surtos de Doenças , Epidemias , Feminino , Instalações de Saúde , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/mortalidade , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Serra Leoa/epidemiologia , Fatores Socioeconômicos , Resultado do Tratamento , Adulto Jovem
15.
Public Health ; 185: 270-274, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32707469

RESUMO

OBJECTIVE: The aim of this study was to examine New Jersey Sierra Leoneans' experiences, perceptions, and knowledge about the Ebola outbreak to better understand how to serve diaspora communities during disease outbreaks and improve international community engagement efforts. STUDY DESIGN: Five focus groups were conducted with a total of 34 members of a New Jersey Sierra Leonean community. A short demographic survey was also administered. METHODS: Focus groups were audio-taped, transcribed, and then analyzed using QSR NVIVO. Demographic data were analyzed using SPSS. RESULTS: Major themes emerged from the focus groups as related to the Ebola outbreak: (1) stigma and discrimination; (2) psycho-socio-economic impact; and (3) public health communication challenges. CONCLUSIONS: Novel findings reveal the impact of the Ebola virus on a West African diaspora community in the United States. These findings also advance existing literature. Diaspora communities are an underutilized resource in international disease education, management and prevention outreach research. It is vital that health professionals begin to find effective ways to fold them into relief efforts.


Assuntos
Atitude Frente a Saúde , Ebolavirus , Doença pelo Vírus Ebola/epidemiologia , Migração Humana , Adulto , Idoso , Comunicação , Participação da Comunidade , Surtos de Doenças/prevenção & controle , Feminino , Grupos Focais , Doença pelo Vírus Ebola/psicologia , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Saúde Pública/educação , Serra Leoa/epidemiologia , Estigma Social , Estados Unidos/epidemiologia
16.
BMC Public Health ; 20(1): 1185, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32727423

RESUMO

BACKGROUND: Sierra Leone, a fragile country, is facing an increasingly significant burden of non-communicable diseases (NCDs). Facilitated by an international partnership, a project was developed to adapt and pilot desktop guidelines and other clinical support tools to strengthen primary care-based hypertension and diabetes diagnosis and management in Bombali district, Sierra Leone between 2018 and 2019. This study assesses the feasibility of the project through analysis of the processes of intervention adaptation and development, delivery of training and implementation of a care improvement package and preliminary outcomes of the intervention. METHODS: A mixed-method approach was used for the assessment, including 51 semi-structured interviews, review of routine treatment cards (retrieved for newly registered hypertensive and diabetic patients from June 2018 to March 2019 followed up for three months) and mentoring data, and observation of training. Thematic analysis was used for qualitative data and descriptive trend analysis and t-test was used for quantitative data, wherever appropriate. RESULTS: A Technical Working Group, established at district and national level, helped to adapt and develop the context-specific desktop guidelines for clinical management and lifestyle interventions and associated training curriculum and modules for community health officers (CHOs). Following a four-day training of CHOs, focusing on communication skills, diagnosis and management of hypertension and diabetes, and thanks to a CHO-based mentorship strategy, there was observed improvement of NCD knowledge and care processes regarding diagnosis, treatment, lifestyle education and follow up. The intervention significantly improved the average diastolic blood pressure of hypertensive patients (n = 50) three months into treatment (98 mmHg at baseline vs. 86 mmHg in Month 3, P = 0.001). However, health systems barriers typical of fragile settings, such as cost of transport and medication for patients and lack of supply of medications and treatment equipment in facilities, hindered the optimal delivery of care for hypertensive and diabetic patients. CONCLUSION: Our study suggests the potential feasibility of this approach to strengthening primary care delivery of NCDs in fragile contexts. However, the approach needs to be built into routine supervision and pre-service training to be sustained. Key barriers in the health system and at community level also need to be addressed.


Assuntos
Agentes Comunitários de Saúde/educação , Assistência à Saúde , Diabetes Mellitus/terapia , Hipertensão/terapia , Atenção Primária à Saúde , Avaliação de Programas e Projetos de Saúde , Pressão Sanguínea , Estudos de Viabilidade , Feminino , Humanos , Masculino , Assistência Médica , Mentores , Pessoa de Meia-Idade , Doenças não Transmissíveis/terapia , Serra Leoa
17.
PLoS One ; 15(7): e0236358, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706810

RESUMO

BACKGROUND/SETTING: Only 47% of HIV-positive Sierra Leoneans knew their status in 2017, making expanded HIV testing a priority. National guidelines endorse provider-initiated HIV testing and counselling (PITC) to increase testing coverage, but PITC is rarely provided in Sierra Leone. In response, a Quality Improvement Collaborative (QIC) was implemented to improve PITC coverage amongst adult inpatients. METHODS: Ten hospitals received the intervention between October 2017 and August 2018; there were no control facilites. Each hospital aimed to improve PITC coverage to ≥ 95% of eligible patients. Staff received training on PITC and QIC methods and a package of PITC best practices and tools. They then worked to identify additional contextually-appropriate interventions, conducted rapid tests of change, and tracked performance using shared indicators and time-series data. Supportive supervision bolstered QI skills, and quarterly meetings enabled diffusion of innovations while spurring friendly competition. RESULTS: Baseline PITC coverage was 4%. The hospital teams tested diverse interventions using QI methods, including staff training; data review meetings; enhanced workflow processes and supervision; and patient education and sensitization activities Nine hospitals reached and sustained the 95% target, and all saw rapid and durable improvement, which was sustained for a median of six months. Of the 5,238 patients tested for HIV, 311 (6%) were found to be HIV-positive and were referred for treatment. HIV rapid test kit stockouts occurred during the project period, limiting PITC services in some cases. CONCLUSIONS: The intervention led to swift and sustained improvement in inpatient PITC coverage and to the diagnosis of hundreds of people living with HIV. Sierra Leone's Ministry of Health and Sanitation plans to take the initiative to national scale, with close attention to the issue of test kit stockouts.


Assuntos
Aconselhamento Diretivo/estatística & dados numéricos , Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Cooperação do Paciente/estatística & dados numéricos , Feminino , HIV-1 , Humanos , Pacientes Internados , Masculino , Serra Leoa/epidemiologia
18.
BMC Public Health ; 20(1): 855, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503478

RESUMO

BACKGROUND: Immunization of women during pregnancy to protect them and their infants against tetanus, pertussis and influenza is recommended by the World health Organization (WHO). However, there is limited information about the coverage rate and associated factors in low-income countries. The aim of this study was to measure the prevalence and predictors of taking tetanus toxoid among pregnant women in Sierra Leone. METHODS: This study was based on the fifth round of Multiple Indicator Cluster Survey (MICS 5) conducted in Sierra Leone in 2017. In total 8722 women aged between 15 and 49 years were included in this study. Outcome variable was taking of Tetanus Toxoid vaccination during the last pregnancy. Data were analyzed using cross-tabulation and logistic regression methods. RESULTS: The overall prevalence of receiving TT immunization during women's last pregnancy was 96.3% and that of taking at least two doses was 82.12%. In the regression analysis, women from Mende ethnicity had a 0.48 fold lower chance of being immunized (OR = 0.480, 95% CI = 0.385,0.59768) than those from the other ethnicity. In addition, women who attended at least four ANC visits had higher odds of receiving TT vaccine (OR = 1.919, 95% CI = 1.639,2.245) compared to those who attended less ANC visits. Stratified by areas, this association was observed in both urban (OR = 2.661, 95% CI = 1.924,3.679) and rural areas (OR = 1.716, 95% CI = 1.430,2.059). Attending at least four ANC visits showed a positive association with receiving at least two doses TT (OR = 2.434, 95% CI = 1.711,3.464) in both urban (OR = 2.815, 95% CI = 1.413,5.610) and rural areas (OR = 2.216, 95% CI = 1.463,3.356) as well. CONCLUSION: Higher number of ANC visits, mass media exposure and higher wealth quintile increased the odds of receiving TT immunization. In addition, minimum two doses which were identified to reduce neonatal mortality. Therefore, immunization campaigns targeting improved utilization of healthcare and immunization services by women of childbearing age in Sierra Leone are strongly recommended.


Assuntos
Cuidado Pré-Natal/estatística & dados numéricos , Toxoide Tetânico/administração & dosagem , Tétano/prevenção & controle , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Pobreza/estatística & dados numéricos , Gravidez , Prevalência , Serra Leoa/epidemiologia , Inquéritos e Questionários , Tétano/mortalidade , Adulto Jovem
19.
Int J Equity Health ; 19(1): 88, 2020 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503547

RESUMO

BACKGROUND: Comprehensive assessment of stunting disparity in Sierra-Leone has not been done so far. We aimed to document extent and over time dynamics of inequality in stunting in Sierra-Leone using approaches that facilitate implementation of interventions aim to eliminate non-justified stunting disparity in the country. METHODS: The data for the study were derived from two rounds of the Sierra Leone Demographic and Health Survey conducted in 2008 and 2013, and two rounds of the Sierra Leone Multiple Indicator Cluster Survey done in 2005 and 2010. We used the 2019 update WHO Health Equity Assessment Toolkit (HEAT) to do the analysis. The toolkit makes use of data stored in the WHO Health Equity Monitor database. We analyzed stunting inequality using summary measures: Population Attributable Risk, Population Attributable Fraction, Difference and Ratio. The summary measures were computed for five equity stratifers: wealth, education, child's sex, place of residence and subnational region. We computed 95% Confidence Interval (CI) for each point estimate to show whether or not observed stunting inequalities are statistically significant, and whether or not the disparity changed over time statistically significantly. RESULTS: The findings demonstrated stark inequalities in stunting in all the studied dimensions of inequality. While residence and subnational regional related inequalities remain unchanged over time, wealth and educational inequality had seen slight improvement during the same time period. Large sex related stunting inequality remained during the first three surveys time points, but it disappeared in 2013. CONCLUSIONS: Huge stunting disparities occurred in Sierra Leone, and the disparity disproportionately affects disadvantaged subpopulations and male children. Nutrition interventions that specifically target the subgroups which suffer more from the burden of stunting are required.


Assuntos
Transtornos do Crescimento/epidemiologia , Disparidades nos Níveis de Saúde , Pré-Escolar , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Masculino , Serra Leoa/epidemiologia , Fatores Socioeconômicos
20.
Int J Infect Dis ; 97: 23-26, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32497794

RESUMO

Economical and psychological consequences of the lockdown in low-resource setting in rural Africa are unknown. We drafted a survey in order to address the social impact of COVID-19 lockdown on a rural village in Sierra Leone. The survey developed by the study group and translated in the local language, distributed to the householders of the village on April 13th and responses collected on April 14th, when Sierra Leone was on day 11 of lockdown. The questions aimed to assess in the community the following items: age group, main activities before lockdown, change in income and ability to feed the family during lockdown, anxiety during lockdown. 78 householders (100% of Bureh Town) replied. All, expect one, declared a 51-80% (19.2%) to 81-100% (79.4%) reduction of weekly income compared with the pre-lockdown period, declaring difficulties in providing food for the family members (82%), and anxiety (60%). Our analyses showed that people lost their jobs and have difficulties in providing food for their families. Highlights: Our analyses in a low resource setting in rural Africa in Sierra Leone, West Africa, showed that people lost their jobs and have difficulties in providing food for their families, as a consequence of COVID-19 lockdown.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Infecções por Coronavirus/economia , Feminino , Recursos em Saúde , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Pandemias/economia , Pneumonia Viral/economia , População Rural , Serra Leoa , Adulto Jovem
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