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1.
BMC Health Serv Res ; 22(1): 1003, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35932077

RESUMO

BACKGROUND: In Sierra Leone persons with disabilities are at higher risk of living in poverty and have poor access to a fragile healthcare and rehabilitation services. The aim was to explore stakeholders' perceptions of access to health and rehabilitation services for persons with disabilities in Sierra Leone. METHODS: Seven focus group discussions, including stakeholders working within the field of disability was conducted. RESULTS: The subthemes were: continuous stigmatisation of persons with disabilities throughout life; long distances and transportation issues to access health and rehabilitation facilities; financial constraints; infrastructural barriers to healthcare and rehabilitation services and healthcare personnel's negative attitudes and inadequate knowledge towards persons with disabilities; rehabilitation and healthcare facilities lacking materials to provide quality services; lack of specialised services and rehabilitation personnel for complex rehabilitation and the need for continuous education of new and current rehabilitation personnel. CONCLUSION: Local actors need to take charge and renew efforts made by international organisations by providing trained rehabilitation staff and quality rehabilitation services. Rehabilitation services need to be affordable and transportation costs covered for persons with disabilities to access healthcare and rehabilitation services. Continuous education of the public and health personnel about disability is necessary to reduce negative attitudes towards persons with disabilities.


Assuntos
Pessoas com Deficiência , Acesso aos Serviços de Saúde , Pessoas com Deficiência/reabilitação , Grupos Focais , Pessoal de Saúde , Humanos , Serra Leoa
2.
Front Public Health ; 10: 949425, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35844842

RESUMO

Coronavirus disease 2019 (COVID-19), a serious public health challenge the world over, has led to significant health concerns in Sierra Leone. In the present study, epidemic indices, such as the number of cases, positivity rate, reproduction rate (R0), case fatality rate (CFR), age, and sex, were used to characterize the epidemiological trends of COVID-19. As of October 31, 2021, a total of 6,398 cases and 121 related deaths had been confirmed. The total number of COVID-19 reverse transcription polymerase chain reaction (RT-PCR) tests conducted to October 31, 2021, was 249,534, and the average positivity rate was 2.56%. Three waves of COVID-19 were recorded, occurring during weeks 15-46 in 2020 (2,369 cases), week 47 in 2020 to week 16 in 2021 (1,665 cases), and weeks 17-43 in 2021 (2,364 cases), respectively. Remarkably, there was no increase in the numbers of confirmed COVID-19 cases despite rising test numbers throughout the three waves. Moreover, three high R0 values were observed before each wave. The number of positive cases significantly correlated with positive numbers of international arrivals (P < 0.01), deaths (P < 0.01), and the positivity rate of tested samples (P < 0.01). Moreover, all of the deaths occurred during the peak of the three waves. Our results indicate that there was a low level of COVID-19 epidemic in Sierra Leone and that COVID-19's introduction led to local transmission. It is vital to fight against the spread of SARS-CoV-2 from the source of origin by strengthening testing and management of people entering the country. Our findings will provide important clues for expanding sample screening and will contribute to the reasonable allocation of medical resources.


Assuntos
COVID-19 , Epidemias , COVID-19/epidemiologia , Humanos , Saúde Pública , SARS-CoV-2 , Serra Leoa/epidemiologia
3.
BMC Infect Dis ; 22(1): 624, 2022 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-35850699

RESUMO

BACKGROUND: Globally, hearing loss is the second leading cause of disability, affecting approximately 18.7% of the world's population. However, the burden of hearing loss is unequally distributed, with the majority of affected individuals located in Asia or Sub-Saharan Africa. Following the 2014 West African Ebola Outbreak, disease survivors began to describe hearing loss as part of the constellation of symptoms known as Post-Ebola Syndrome. The goal of this study was to more fully characterize hearing loss among Ebola Virus Disease (EVD) survivors. METHODOLOGY AND PRINCIPAL FINDINGS: EVD survivors and their household contacts were recruited (n = 1,12) from Eastern Sierra Leone. Each individual completed a symptom questionnaire, physical exam, and a two-step audiometry process measuring both air and bone conduction thresholds. In comparison to contacts, EVD survivors were more likely to have complaints or abnormal findings affecting every organ system. A significantly greater percentage of EVD survivors were found to have hearing loss in comparison to contacts (23% vs. 9%, p < 0.001). Additionally, survivors were more likely to have bilateral hearing loss of a mixed etiology. Logistic regression revealed that the presence of any symptoms of middle or inner ear (p < 0.001), eye (p = 0.005), psychiatric (p = 0.019), and nervous system (p = 0.037) increased the odds of developing hearing loss. CONCLUSIONS AND SIGNIFICANCE: This study is the first to use an objective and standardized measurement to report hearing loss among EVD survivors in a clinically meaningful manner. In this study it was found that greater than 1/5th of EVD survivors develop hearing loss. The association between hearing impairment and symptoms affecting the eye and nervous system may indicate a similar mechanism of pathogenesis, which should be investigated further. Due to the quality of life and socioeconomic detriments associated with untreated hearing loss, a greater emphasis must be placed on understanding and mitigating hearing loss following survival to aid in economic recovery following infectious disease epidemics.


Assuntos
Perda Auditiva , Doença pelo Vírus Ebola , Sobreviventes , Surtos de Doenças , Perda Auditiva/epidemiologia , Doença pelo Vírus Ebola/complicações , Doença pelo Vírus Ebola/epidemiologia , Humanos , Prevalência , Serra Leoa/epidemiologia , Sobreviventes/estatística & dados numéricos
4.
Vet Rec ; 191(2): 67-69, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35866941

RESUMO

The number of dogs legally imported to the UK from Africa is on the rise, and so too, therefore, is the risk of co-importing currently exotic parasites. Here, Rebecca Dobinson and Ian Wright report the results of a small study carried out in Sierra Leone, in which visibly healthy dogs were screened for the presence of several bloodborne parasites.


Assuntos
Parasitos , África , Animais , Atenção à Saúde , Cães , Serra Leoa
5.
Emerg Infect Dis ; 28(8): 1559-1568, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35876478

RESUMO

Ribavirin has been used widely to treat Lassa fever in West Africa since the 1980s. However, few studies have systematically appraised the evidence for its use. We conducted a systematic review of published and unpublished literature retrieved from electronic databases and gray literature from inception to March 8, 2022. We identified 13 studies of the comparative effectiveness of ribavirin versus no ribavirin treatment on mortality outcomes, including unpublished data from a study in Sierra Leone provided through a US Freedom of Information Act request. Although ribavirin was associated with decreased mortality rates, results of these studies were at critical or serious risk for bias when appraised using the ROBINS-I tool. Important risks for bias related to lack of control for confounders, immortal time bias, and missing outcome data. Robust evidence supporting the use of ribavirin in Lassa fever is lacking. Well-conducted clinical trials to elucidate the effectiveness of ribavirin for Lassa fever are needed.


Assuntos
Febre Lassa , África Ocidental , Humanos , Febre Lassa/tratamento farmacológico , Febre Lassa/epidemiologia , Vírus Lassa/genética , Ribavirina/uso terapêutico , Serra Leoa
6.
Am J Trop Med Hyg ; 106(6): 1667-1669, 2022 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-35895430

RESUMO

Sierra Leone relies heavily on histidine-rich protein 2-based diagnostics for malaria because of the high transmission of Plasmodium falciparum. During the 2015 recombinant vesicular stomatitis virus (VSV)-Zaire Ebola virus envelope glycoprotein (GP) vaccine trial, 77 participants with asymptomatic Plasmodium infection were enrolled, with all but four having P. falciparum malaria. Of the 73 participants with P. falciparum malaria, one infection (1 of 73, 1.4%; 95% CI, 0.03-7.4) showed P. falciparum with a pfhrp3 single deletion, and two P. falciparum infections (2 of 73, 2.7%; 95% CI, 0.03-9.6) showed pfhrp2/pfhrp3 dual deletions. This study shows evidence of pfhrp2- and pfhrp3-deleted parasites in Freetown, Sierra Leone. Additional studies for more precise estimates of prevalence are warranted.


Assuntos
Malária Falciparum , Parasitos , Animais , Antígenos de Protozoários/genética , Infecções Assintomáticas , Testes Diagnósticos de Rotina , Deleção de Genes , Humanos , Malária Falciparum/parasitologia , Plasmodium falciparum/genética , Prevalência , Proteínas de Protozoários/genética , Serra Leoa/epidemiologia
7.
PLoS One ; 17(7): e0270968, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35793331

RESUMO

INTRODUCTION: Recurrent parasitic infections may influence the immune response to vaccines. In the Partnership for Research on Ebola VACcinations extended follow-UP and clinical research capacity build-UP (PREVAC-UP) study being undertaken in Mambolo, northern Sierra Leone, participants are being followed up to assess the potential impact of exposure to malaria and/or helminth infections on long-term immune response to two Ebola vaccines. To support the development of the assays that will be used in this evaluation, a parasitological survey was conducted in Mambolo between November 2019 and February 2020. METHODS: Healthy individuals aged ≥1 year who were resident in Mambolo Chiefdom were selected using a stratified sampling approach and questionnaires were administered to explore their sociodemographic characteristics. Microscopy was used to detect malaria parasites, intestinal helminths and urinary schistosome infections. Rapid blood tests were used to detect infections with Onchocerca volvulus and Wuchereria bancrofti. We estimated the overall prevalence of these infections and used adjusted logistic regression models to explore risk factors for malaria and hookworm infection. RESULTS: Eight hundred and fifteen (815) residents, 50.9% of whom were female were surveyed. Overall, 309 (39.1%) of 791 persons tested for malaria had a positive blood slide; Plasmodium falciparum was the dominant species. Helminth infection was detected in 122 (15.0%) of 815 stool samples including three mixed infections. The helminth infections comprised 102 (12.5%) cases of hookworm, 11 (1.3%) cases of Trichuris trichiura, 10 (1.2%) cases of Schistosoma mansoni and two (0.2%) cases of Ascaris lumbricoides. Being male (OR = 2.01, 95% CI 1.15-3.50) and residing in a non-riverine community (OR = 4.02, 95%CI 2.32-6.98) were the factors associated with hookworm infection. Onchocerca volvulus and Wuchereria bancrofti infections were found in 3.3% and 0.4% of participants respectively. CONCLUSION: Malaria and hookworm are the most prevalent parasite infections and those most likely to influence long-term immune response to Ebola vaccines among the trial participants.


Assuntos
Vacinas contra Ebola , Doença pelo Vírus Ebola , Malária , Animais , Ascaris lumbricoides , Feminino , Humanos , Malária/epidemiologia , Masculino , Prevalência , População Rural , Serra Leoa/epidemiologia
8.
Trials ; 23(1): 466, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35668457

RESUMO

Clinical trials during public health emergencies of novel medical products such as therapeutics and vaccines in resource-limited settings are daunting due to the limited capacity for regulatory assessment. Regulating clinical trials during the Ebola outbreak in Sierra Leone required expedited evaluation to identify medical products that could be promptly introduced to combat the epidemic in the absence of approved treatment or prevention. This article explored the decisions taken by the Pharmacy Board of Sierra Leone through its Expert Committee on Medicine Safety and Clinical Trials regarding clinical trials oversight during the Ebola epidemic and the lessons learned. This independent expert committee assessed and provided scientific opinions to the Pharmacy Board of Sierra Leone to inform approval of all clinical trials within 10-15 working days. We also requested for assisted review from the African Vaccine Regulatory Forum and support from the US Food and Drug Administration through a unilateral recognition and reliance memorandum of understanding. In addition, the Agency-ensured structures and systems were in place for reporting and reviewing adverse events and serious adverse events, management of biological samples, submission and review of progress reports, and good clinical practice inspections. Unfortunately, the Ebola epidemic revealed many weaknesses in the country's clinical trials regulatory structure and processes. Government and partners should further offer more resources to build the clinical trial structures and systems so that the Agency will be better poised to handle future public health emergencies.


Assuntos
Epidemias , Doença pelo Vírus Ebola , Emergências , Epidemias/prevenção & controle , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/terapia , Humanos , Saúde Pública , Serra Leoa/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-35682235

RESUMO

Water quality surveillance can help to reduce waterborne diseases. Despite better access to safe drinking water in Sierra Leone, about a third of the population (3 million people) drink water from unimproved sources. In this cross-sectional study, we collected water samples from 15 standpipes and 5 wells and measured the physicochemical and bacteriological water quality, and the antimicrobial sensitivity of Escherichia coli (E. coli) in two communities in Freetown, Sierra Leone in the dry and wet seasons in 2021. All water sources were contaminated with E. coli, and all five wells and 25% of standpipes had at least an intermediate risk level of E. coli. There was no antimicrobial resistance detected in the E. coli tested. The nitrate level exceeded the WHO's recommended standard (>10 parts per million) in 60% of the wells and in less than 20% of the standpipes. The proportion of samples from standpipes with high levels of total dissolved solids (>10 Nephelometric Turbidity Units) was much higher in the rainy season (73% vs. 7%). The level of water contamination is concerning. We suggest options to reduce E. coli contamination. Further research is required to identify where contamination of the water in standpipes is occurring.


Assuntos
Água Potável , Qualidade da Água , Antibacterianos/farmacologia , Bactérias , Estudos Transversais , Escherichia coli , Humanos , Serra Leoa , Microbiologia da Água , Abastecimento de Água , Poços de Água
10.
BMJ Open ; 12(5): e058203, 2022 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-35534060

RESUMO

OBJECTIVE: To gain in-depth understanding of the caregiver experience when navigating urban immunisation services for their children. DESIGN: An exploratory qualitative assessment comprising 16 in-depth interviews using an interpretative phenomenology approach. SETTING: Caregivers were purposively recruited from slums (n=8) and other urban communities (n=8) in the capital city of Sierra Leone. PARTICIPANTS: Caregivers of children ages 6-36 months old who were fully vaccinated (n=8) or undervaccinated (n=8). RESULTS: Emotional enablers of vaccination were evident in caregivers' sense of parental obligation to their children while also anticipating reciprocal benefits in children's ability to take care of their parents later in life. Practical enablers were found in the diversity of immunisation reminders, information access, information trust, getting fathers more involved, positive experiences with health workers and postvaccination information sharing in the community. Underlying barriers to childhood vaccination were due to practical constraints such as overcrowding and long waiting times at the clinic, feeling disrespected by health workers, expecting to give money to health workers for free services and fear of serious vaccine side effects. To improve vaccination outcomes, caregivers desired more convenient and positive clinic experiences and deeper community engagement. CONCLUSIONS: Health system interventions, community engagement and vaccination outreach need to be tailored for urban settings. Vaccine communication efforts may resonate more strongly with caregivers when vaccination is framed both around parental responsibilities to do the right thing for the child and the future benefits to the parent.


Assuntos
Cuidadores , Vacinas , Criança , Pré-Escolar , Humanos , Imunização , Lactente , Pesquisa Qualitativa , Serra Leoa , Vacinação
11.
Emerg Microbes Infect ; 11(1): 1416-1424, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35537043

RESUMO

Invasive Salmonella infection, which can cause typhoid/paratyphoid fever and invasive non-typhoidal salmonellosis, is a public health burden in Africa. Accurate diagnosis and etiological characterization are required to conduct prevalence and risk estimations for Salmonella infection; however, the utilization of optimal techniques and surveillance data are still insufficient. In this study, we performed a laboratory-based survey in Freetown, which is the biggest city in Sierra Leone with a high burden of typhoid fever, by using blood culture and molecular methods but not the Widal test, to estimate the prevalence and aetiology of invasive Salmonella infection among fever patients. We found a very low prevalence of typhoid fever in patients with fever during the investigation period, and this prevalence was clearly overestimated by the Widal test. Genome sequencing of the S. Typhi isolate from this work revealed that the strain carried multiple antibiotic resistance genes, and an epidemic clone that has existed in West Africa for years was also detected in Sierra Leone. By using metagenomic sequencing, one patient with invasive non-typhoidal salmonellosis was identified as having bacterial co-infections. Our data highlight that Salmonella surveillance based on accurate laboratory diagnosis and genome sequencing needs to be strengthened to provide a better estimation of the real epidemics and enable potential risk assessment by etiological analysis in Africa. Even in a laboratory with only basic equipment, it is possible to conduct next-generation sequencing for pathogen discovery in bloodstream infections and to determine the etiological characteristics of pathogene without complex combinations of laboratory methods.


Assuntos
Infecções por Salmonella , Febre Tifoide , Febre/epidemiologia , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Patologia Molecular , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/epidemiologia , Salmonella typhi , Serra Leoa/epidemiologia , Febre Tifoide/diagnóstico , Febre Tifoide/epidemiologia , Febre Tifoide/microbiologia
12.
Soc Sci Med ; 303: 114995, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35576766

RESUMO

INTRODUCTION: Covid-19 has highlighted the need to understand the long-term impact of epidemics on health systems. There is extensive evidence that the Ebola epidemic of 2014-16 dramatically reduced coverage of key reproductive, maternal, newborn, child and adolescent health (RMNCAH) indicators during the period of acute crisis in Sierra Leone. However, less is known about the longer lasting effects, and whether patients continue to be deterred from seeking care either through fear or cost some years after the end of the epidemic METHODS: We analysed nationally representative household surveys from before (2011) and after (2018) the Ebola epidemic to estimate the coverage of 11 indicators of access to RMNCAH, and affordability of care. We used a differences-in-differences analysis, exploiting the variation in epidemic intensity across chiefdoms, to identify the effect of epidemic intensity on access and affordability outcomes, with propensity score weighting to adjust for differences in underlying characteristics between chiefdoms. RESULTS: 13537 households were included across both datasets. Epidemic intensity was associated with a significant stalling in progress (-12.2 percentage points, 95% CI: 23.2 to -1.3, p = 0.029) in the proportion of births attended by a skilled provider. Epidemic intensity did not have a significant impact on any other indicator. CONCLUSION: While there is evidence that chiefdoms which experienced worse Ebola outbreaks had poorer coverage of attendance of skilled providers at birth than would have otherwise been expected, more broadly the intensity of the epidemic did not impact on most indicators. This suggests the measures to restore both staffing and trust were effective in supporting the health system to recover from Ebola.


Assuntos
COVID-19 , Epidemias , Doença pelo Vírus Ebola , Adolescente , Criança , Epidemias/prevenção & controle , Doença pelo Vírus Ebola/epidemiologia , Humanos , Recém-Nascido , Pontuação de Propensão , Serra Leoa/epidemiologia
13.
PLoS Negl Trop Dis ; 16(5): e0010410, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35594318

RESUMO

In Sierra Leone, nationally powered school-based surveys have documented significant progress in the control of soil-transmitted helminthiasis (STH) and schistosomiasis. In order to assess the district-level prevalence and intensity of infection among key at-risk groups outside of school age children (SAC), we conducted a multi-stage, cluster-sample household survey in Bo and Kenema districts in May 2018. From both districts, we examined 1,282 pre-school age children (PSAC), 730 school age children (SAC), and 517 adults over 14 years (including 387 women of reproductive age, or WRA) for STH and Schistosoma mansoni infection using Kato Katz technique. In Bo, STH prevalence was 8.0% (95% Upper Confidence Limit 10.2%) in PSAC, 6.4% (95% Upper Confidence Limit 9.0%) in SAC, 14.1% (95% Upper Confidence Limit 17.4%) in all adults and 11.9% (95% Upper Confidence Limit 17.4%) in WRA. In Kenema, STH prevalence was 18.1% (95% Upper Confidence Limit 20.5%) in PSAC, 17.3% (95% Upper Confidence Limit 20.7%) in SAC, and 16.9% (95% Upper Confidence Limit 20.5%) in all adults and 16.9% (95% Upper Confidence Limit 22.6%) in WRA. Hookworm species were the most prevalent of STH in both districts overall. The overall prevalence of S. mansoni was <10% in Bo and <20% in Kenema, and was similar across age groups. No moderate or heavy intensity STH infections or heavy intensity S. mansoni infections, as per World Health Organization (WHO) classification, were detected in either district. Sanitation variables, such as toilet access and quality, were independently associated with STH and S. mansoni infection. In Kenema, STH prevalence in SAC was within the WHO-defined range for annual treatment, whereas a previous nationally-powered survey estimated it to lie within the range of treatment once per two years. By utilizing community-based sampling, we were able to assess prevalence among WRA and make recommendations based on current guidance from WHO. To continue toward elimination of STH and S. mansoni as a public health problem, resources should be mobilized to increase access to and uptake of improved sanitation at community and household levels.


Assuntos
Helmintíase , Schistosoma mansoni , Adulto , Animais , Criança , Fezes , Feminino , Helmintíase/epidemiologia , Humanos , Prevalência , Serra Leoa/epidemiologia , Solo
14.
PLoS Negl Trop Dis ; 16(5): e0010423, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35587495

RESUMO

BACKGROUND: Lassa fever (LF) often presents clinically as undifferentiated febrile illness. Lassa Fever cases in Sierra Leone have been falling since the 2014-2016 Ebola epidemic. Data from other LF endemic countries suggest that this is not a true reflection of local epidemiological decline, but rather a function of either health seeking behaviour or the health/referral system. In Sierra Leone, many other diseases present with a similar early clinical picture, including COVID-19 and Marburg Disease (which has recently emerged in neighbouring Guinea). This empirical study explores the implementation of health system processes associated with International Health Regulations (IHR) requirements for early detection and timely and effective responses to the spread of febrile disease, through the case study of LF in Sierra Leone. METHODOLOGY/PRINCIPAL FINDINGS: This study used a qualitative approach to analyse local policy and guidance documents, key informant interviews with policy and practice actors, and focus group discussions and in-depth interviews with health care workers (HCWs) and community health workers (CHWs) in Kenema District to examine the ways in which undifferentiated fever surveillance and response policies and processes were implemented in the post-Ebola period. Multiple challenges were identified, including: issues with the LF case definition, approaches to differential diagnosis, specimen transport and the provision of results, and ownership of laboratory data. These issues lead to delays in diagnosis, and potentially worse outcomes for individual patients, as well as affecting the system's ability to respond to outbreak-prone disease. CONCLUSIONS/SIGNIFICANCE: Identification of ways to improve the system requires balancing vertical disease surveillance programmes against other population health needs. Therefore, health system challenges to early identification of LF specifically have implications for the effectiveness of the wider Integrated Disease Surveillance and Response (IDSR) system in Sierra Leone more generally. Sentinel surveillance or improved surveillance at maternity facilities would help improve viral haemorrhagic fever (VHF) surveillance, as well as knowledge of LF epidemiology. Strengthening surveillance for vertical disease programmes, if correctly targeted, could have downstream benefits for COVID-19 surveillance and response as well as the wider health system-and therefore patient outcomes more generally.


Assuntos
COVID-19 , Doença pelo Vírus Ebola , Febre Lassa , COVID-19/diagnóstico , COVID-19/epidemiologia , Surtos de Doenças , Feminino , Doença pelo Vírus Ebola/epidemiologia , Humanos , Febre Lassa/diagnóstico , Febre Lassa/epidemiologia , Gravidez , Serra Leoa/epidemiologia
15.
Comput Math Methods Med ; 2022: 4150043, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35602345

RESUMO

The role of human behaviour in the dynamics of infectious diseases cannot be underestimated. A clear understanding of how human behaviour influences the spread of infectious diseases is critical in establishing and designing control measures. To study the role that human behaviour plays in Ebola disease dynamics, in this paper, we design an Ebola virus disease model with disease transmission dynamics based on a new exponential nonlinear incidence function. This new incidence function that captures the reduction in disease transmission due to human behaviour innovatively considers the efficacy and the speed of behaviour change. The model's steady states are determined and suitable Lyapunov functions are built. The proofs of the global stability of equilibrium points are presented. To demonstrate the utility of the model, we fit the model to Ebola virus disease data from Liberia and Sierra Leone. The results which are comparable to existing findings from the outbreak of 2014 - 2016 show a better fit when the efficacy and the speed of behaviour change are higher. A rapid and efficacious behaviour change as a control measure to rapidly control an Ebola virus disease epidemic is advocated. Consequently, this model has implications for the management and control of future Ebola virus disease outbreaks.


Assuntos
Epidemias , Doença pelo Vírus Ebola , Surtos de Doenças/prevenção & controle , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Incidência , Serra Leoa/epidemiologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-35565037

RESUMO

INTRODUCTION: Good Infection prevention and control (IPC) is vital for tackling antimicrobial resistance and limiting health care-associated infections. We compared IPC performance before (2019) and during the COVID-19 (2021) era at the national IPC unit and all regional (4) and district hospitals (8) in Sierra Leone. METHODS: Cross-sectional assessments using standardized World Health Organizations IPC checklists. IPC performance scores were graded as inadequate = 0-25%, basic = 25.1-50%, intermediate = 50.1-75%, and advanced = 75.1-100%. RESULTS: Overall performance improved from 'basic' to 'intermediate' at the national IPC unit (41% in 2019 to 58% in 2021) and at regional hospitals (37% in 2019 to 54% in 2021) but remained 'basic' at district hospitals (37% in 2019 to 50% in 2021). Priority gaps at the national IPC unit included lack of: a dedicated IPC budget, monitoring the effectiveness of IPC trainings and health care-associated infection surveillance. Gaps at hospitals included no assessment of hospital staffing needs, inadequate infrastructure for IPC and lack of a well-defined monitoring plan with clear goals, targets and activities. CONCLUSION: Although there is encouraging progress in IPC performance, it is slower than desired in light of the COVID-19 pandemic. There is urgent need to mobilize political will, leadership and resources and make a quantum leap forward.


Assuntos
COVID-19 , Infecção Hospitalar , COVID-19/epidemiologia , COVID-19/prevenção & controle , Infecção Hospitalar/prevenção & controle , Estudos Transversais , Humanos , Controle de Infecções , Pandemias/prevenção & controle , Serra Leoa/epidemiologia
18.
BMJ Glob Health ; 7(5)2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35589152

RESUMO

BACKGROUND: Little is known about strategies for optimising the scale and deployment of community health workers (CHWs) to maximise geographic accessibility of primary healthcare services. METHODS: We used data from a national georeferenced census of CHWs and other spatial datasets in Sierra Leone to undertake a geospatial analysis exploring optimisation of the scale and deployment of CHWs, with the aim of informing implementation of current CHW policy and future plans of the Ministry of Health and Sanitation. RESULTS: The per cent of the population within 30 min walking to the nearest CHW with preservice training increased from 16.1% to 80.4% between 2000 and 2015. Contrary to current national policy, most of this increase occurred in areas within 3 km of a health facility where nearly two-thirds (64.5%) of CHWs were deployed. Ministry of Health and Sanitation-defined 'easy-to-reach' and 'hard-to-reach' areas, geographic areas that should be targeted for CHW deployment, were less well covered, with 19.2% and 34.6% of the population in 2015 beyond a 30 min walk to a CHW, respectively. Optimised CHW networks in these areas were more efficiently deployed than existing networks by 22.4%-71.9%, depending on targeting metric. INTERPRETATIONS: Our analysis supports the Ministry of Health and Sanitation plan to rightsize and retarget the CHW workforce. Other countries in sub-Saharan Africa interested in optimising the scale and deployment of their CHW workforce in the context of broader human resources for health and health sector planning may look to Sierra Leone as an exemplar model from which to learn.


Assuntos
Agentes Comunitários de Saúde , África ao Sul do Saara , Humanos , Serra Leoa
19.
BMC Nephrol ; 23(1): 167, 2022 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-35501816

RESUMO

BACKGROUND: The burden of both acute kidney injury and chronic kidney disease is on the rise globally. In sierra Leone, there has been no data on renal patients or admissions. This study intends to close this gap in knowledge and give preliminary data on the burden of renal disease in this country. METHODS: The study was a retrospective review of the case notes of patients admitted at Connaught Hospital, Freetown over a 2 year period. Data extraction was done using a well- structured proforma. RESULTS: A 2.7% renal admission burden was obtained; mean duration of hospital stay was 15.1 ± 14.7; mean age of patients was 47.2 ± 17.5 with a female preponderance. The common risk factors for chronic kidney disease were systemic hypertension (43%) and diabetes mellitus (24%). The common risk factors for acute kidney injury were sepsis (77%) and hypovolemia (15%). The in- hospital mortality rate was 47% and 73% were non-compliant with haemodialysis probably due to financial reasons. CONCLUSION: There is a significant burden of kidney disease in our environment, affecting mainly our young and middle-aged population. A rational approach is to embark on kidney disease prevention programs.


Assuntos
Injúria Renal Aguda , Insuficiência Renal Crônica , Injúria Renal Aguda/epidemiologia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Serra Leoa/epidemiologia , Centros de Atenção Terciária
20.
Artigo em Inglês | MEDLINE | ID: mdl-35627473

RESUMO

Implementing and monitoring infection prevention and control (IPC) measures at immigration points of entry (PoEs) is key to preventing infections, reducing excessive use of antimicrobials, and tackling antimicrobial resistance (AMR). Sierra Leone has been implementing IPC measures at four PoEs (Queen Elizabeth II Quay port, Lungi International Airport, and the Jendema and Gbalamuya ground crossings) since the last Ebola outbreak in 2014-2015. We adapted the World Health Organization IPC Assessment Framework tool to assess these measures and identify any gaps in their components at each PoE through a cross-sectional study in May 2021. IPC measures were Inadequate (0-25%) at Queen Elizabeth II Quay port (21%; 11/53) and Jendema (25%; 13/53) and Basic (26-50%) at Lungi International Airport (40%; 21/53) and Gbalamuya (49%; 26/53). IPC components with the highest scores were: having a referral system (85%; 17/20), cleaning and sanitation (63%; 15/24), and having a screening station (59%; 19/32). The lowest scores (0% each) were reported for the availability of IPC guidelines and monitoring of IPC practices. This was the first study in Sierra Leone highlighting significant gaps in the implementation of IPC measures at PoEs. We call on the AMR multisectoral coordinating committee to enhance IPC measures at all PoEs.


Assuntos
Doença pelo Vírus Ebola , Estudos Transversais , Surtos de Doenças/prevenção & controle , Doença pelo Vírus Ebola/epidemiologia , Humanos , Serra Leoa/epidemiologia , Organização Mundial da Saúde
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