Browsing by Author "Moseray, Augustine Bob"

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Environmental nuisance exposure mediates the relationship between abattoir proximity and household enteric dermatological morbidity: a GPS-anchored cross-sectional study in Bo and Kenema Cities, Sierra Leone
(Springer Science and Business Media LLC, 2026-10-16) Moseray, Augustine Bob
Background Urban abattoirs across sub-Saharan Africa commonly operate within residential neighborhoods(Adeniyi et al. 2025), exposing surrounding households to odor, effluent, vectors and noise(Ibegbu et al. 2024). The community-health consequences are poorly quantified in Sierra Leone, and the common assumption that harm is a direct function of physical distance has not been tested against measured exposure. We assessed whether environmental nuisance exposure mediates the relationship between abattoir proximity and household enteric–dermatological morbidity in Bo and Kenema Cities. Methods We conducted a community-based analytical cross-sectional study among 950 residents (Bo = 497; Kenema = 453) living around confirmed abattoirs, using a GPS-enabled questionnaire. A five-item nuisance exposure index was constructed (Cronbach’s α = 0.802), and metric distance to the nearest abattoir was computed from field coordinates. We used multivariable logistic regression and a bootstrapped causal-mediation analysis (5,000 resamples), with malaria/vector-borne illness as a pre-specified negative-control outcome. Results Nuisance exposure declined monotonically with distance (Spearman ρ = −.40, p < .001) and independently predicted enteric dermatological morbidity (adjusted OR ≈ 1.24 per index point; p < .001). Distance had no independent association with morbidity once exposure was included. Mediation analysis showed that abattoir proximity influenced enteric–dermatological morbidity entirely through nuisance exposure (natural indirect effect = -0.31, 95% CI \[-0.45 to -0.21\]; direct effect non-significant), indicating complete mediation. In contrast, malaria rose with distance (OR ≈ 1.6; p = 0.006), the opposite direction, arguing against generalised deprivation as a confounder. Conclusions The health burden of urban abattoirs in this setting is driven by measurable environmental nuisance load rather than physical distance, with exposure completely mediating the proximity morbidity relationship. Interventions should prioritise nuisance abatement effluent control, waste management and vector control over relocation alone.
Exposure, perception and institutional response at the abattoir community interface: quantifying the environmental-justice gap in complaint driven regulation in Bo and Kenema Cities, Sierra Leone
(Springer Science and Business Media LLC, 2026-09-11) Moseray, Augustine Bob
Background Communities living around urban abattoirs in sub-Saharan Africa bear a substantial environmental burden, yet whether residents accurately perceive that burden, and whether regulatory systems respond to it, is poorly understood. We examined the relationship between measured environmental exposure and perceived health risk, and the performance of the community complaint-and-response system, at the abattoir community interface in Bo and Kenema Cities, Sierra Leone. Methods In a community-based cross-sectional study of 950 residents (Bo = 497; Kenema = 453) living around confirmed abattoirs, we measured a five-item nuisance exposure index (Cronbach’s α = 0.802), perceived health risk, awareness, complaint behavior and satisfaction with authorities, together with a facility assessment of 16 abattoir operators. Associations were tested with chi-square and Cramér’s V, and the exposure perception relationship with Spearman correlation. Results Perceived risk correlated closely with measured exposure (Spearman ρ = 0.723, p < .001), indicating that residents were, in aggregate, accurate risk detectors. However, exposure and attribution decoupled for a substantial minority: 29.8% of highly odour-exposed residents were unaware of the nearby abattoir. Complaint propensity rose steeply across exposure tertiles (3.8% to 27.1%; p < .001), but so did the probability of institutional response among complainants (7.7% in the lowest to 56.8% in the highest exposure tertile). Thus, both complaint and response concentrated in the most-exposed, vocal households, leaving the quietly-exposed and the unaware doubly excluded. Facility assessment revealed pervasive deficiencies (PPE absent at 13 of 16 facilities; open dumping at 14 of 16). Conclusions Residents accurately perceive their environmental burden, but a complaint-driven regulatory system channels institutional response toward the most vocal, most-exposed households while systematically excluding the unaware and the quietly-exposed. Shifting regulatory triggers from citizen complaint to monitored exposure indicators would better align institutional response with actual environmental burden.
Onchocerciasis community survey, Bo District, Sierra Leone: a de-identified dataset of 1,500 adults across five endemic chiefdoms (knowledge, causal beliefs, treatment-seeking, socio-economic and psychological impact, and coping)
(European Organization for Nuclear Research, 2026-06-16) Moseray, Augustine Bob
This dataset contains the de-identified quantitative survey data underlying a series of explanatory sequential mixed-methods studies of onchocerciasis (river blindness) in Bo District, Southern Province, Sierra Leone. A cross-sectional household survey of 1,500 adults aged 18 years and older was conducted across twenty-six rural villages in five endemic chiefdoms (Bagbwe, Baoma, Gbo, Selenga and Tikonko), selected with the Bo District Health Management Team on the basis of documented endemicity, mass drug administration (MDA) history and ecological diversity. Respondents were selected using a four-stage cluster design (chiefdoms purposively; villages by stratification; households systematically; one adult per household by the Kish grid). The Excel workbook contains three sheets. "Data" holds 1,500 records across 128 variables covering socio-demographic and asset characteristics; biomedical knowledge and causal beliefs (including transmission views and supernatural/traditional attributions); symptom recognition; healthcare-seeking and traditional-remedy use; risk and preventive behaviours; socio-economic and psychological impact; and individual, community and economic coping. "Codebook" documents every variable with its questionnaire number, label, survey section and data type. "Chiefdom\_Summary" gives the sample distribution by chiefdom. Data were collected on tablets using Open Data Kit (ODK) Collect with instruments translated into Mende and piloted prior to fieldwork. All direct identifiers have been removed: respondents are identified only by sequential codes, age is recorded in five-year brackets, and the finest geographic unit reported is the chiefdom. Ethical approval was granted by the Njala University Postgraduate Review Board, with additional permissions from the Bo District Health Management Team and the relevant chiefdom authorities; all participants provided informed consent. The qualitative data (key informant interviews and focus group discussions) are not included here because they contain potentially identifying information from small communities. These data underlie manuscripts currently under peer review; the article DOI(s) will be linked to this record upon publication. Researchers reusing the data are asked to cite this dataset.
Pluralistic coping and the impact–coping disconnect: how households in onchocerciasis-endemic communities of Bo District, Sierra Leone respond to disease — an explanatory sequential mixed-methods study
(Springer Science and Business Media LLC, 2026-06-23) Moseray, Augustine Bob
Background How households living with onchocerciasis cope with the disease and whether their coping effort tracks the burden they bear is central to designing supportive interventions, yet it is rarely measured at scale in endemic African settings. We characterised the coping repertoire of communities in Bo District, Sierra Leone, tested whether coping is driven by disease impact, and examined how it varies across chiefdoms. Methods In an explanatory sequential mixed-methods design, 1,500 adults across five endemic chiefdoms were surveyed using multistage cluster sampling. Coping was measured at three levels and summarised by an individual-coping index (0–3), a community-coping index (0–3) and an economic-coping index (0–2); disease impact was summarised by composite socio-economic and psychological indices. Analyses in JASP used descriptive statistics, Spearman correlations, one-way ANOVA with Tukey post-hoc tests, and binary logistic regression. Eleven key informant interviews and eight focus group discussions were analysed thematically. Results Coping was active and pluralistic. Deliberate disease-management methods were used by 64.2% of respondents, lifestyle alterations by 57.1% and traditional or alternative therapies by 55.9%; about half affirmed each community-coping indicator, while economic-coping resources were scarcest (45–47%). Coping was strongest at the individual level (mean 1.77/3), then community (1.52/3), then economic (0.92/2). Crucially, none of the three coping indices was correlated with disease impact (all \|ρ\| ≤ .042, all p > .10). Individual and community coping were uniform across chiefdoms; only economic coping varied (F(4,1495) = 2.48, p = .042), driven by higher coping in Gbo than Tikonko (Tukey p = .021). Traditional-therapy use was not predicted by any socio-demographic variable (likelihood-ratio p = .598). Qualitative themes described livelihood diversification, concurrent traditional–biomedical pathways and indigenous osusu mutual-aid networks. Conclusions Communities in Bo District respond to onchocerciasis through a pluralistic, resource-dependent coping system in which coping effort is governed by what households can mobilise rather than by how severely the disease affects them. Because therapeutic pluralism is a population-wide norm and economic coping is the binding constraint, support should strengthen indigenous financing mechanisms and engage the whole pluralistic health system rather than target demographic subgroups.
The near-universal socio-economic and psychological burden of onchocerciasis in endemic communities of Bo District, Sierra Leone: an explanatory sequential mixed-methods study
(Springer Science and Business Media LLC, 2026-06-24) Moseray, Augustine Bob
**Background:** Onchocerciasis (river blindness) persists in Bo District, Sierra Leone, despite decades of ivermectin-based mass drug administration (MDA). Previous programmatic efforts prioritized parasitological and ocular outcomes. The socio-economic and psychological burden within affected communities remains poorly quantified. We quantified the magnitude and multidimensionality of this burden using two composite indices socio-economic and psychological which revealed a near-universal impact, with 89.9% and 95.8% of respondents affected in each respective dimension. Statistical analysis demonstrated that these dimensions are independent (ρ=.026,p=.311), confirming the multidimensional nature of the burden. Furthermore, we found the distribution to be remarkably uniform, with no significant variation across the five chiefdoms (F=1.91,p=.106) or between sexes (t=0.26,p=.796), suggesting that onchocerciasis-related distress is a generalized community condition rather than one patterned by demographic or geographic factors." Methods : We used an explanatory sequential mixed-methods design. In the quantitative phase, we used multistage cluster sampling to survey 1,500 adults across five endemic chiefdoms (Bagbwe, Baoma, Gbo, Selenga, Tikonko).We operationalized the non-clinical burden of onchocerciasis using two formative composite indices. The socio-economic impact index (0–2) was calculated by summing two binary items (yes/no): experienced economic hardship, such as income loss or reduced work capacity, and encountered obstacles to education or employment. The psychological impact index (0–3) was calculated by summing three binary items: impaired emotional well-being (anxiety/sadness) social stigma or isolation, and negative shifts in self-esteem. A formative measurement approach was selected because these items represent distinct, non-interchangeable components of the burden that collectively contribute to the construct rather than being manifestations of a single latent trait. The choice of indicators specifically stigma and economic productivity is supported by established models of the social burden of neglected tropical diseases, which identify these as core dimensions of patient experience. Similar research in endemic settings has successfully utilized such categorical impacts to quantify the welfare assault of onchocerciasis. To ensure linguistic and cultural validity, all instruments were forward- and back-translated into Mende and reviewed by an expert panel. We conducted cognitive testing and a pilot study (N=30) to establish reliability. Our pilot results demonstrated adequate internal consistency (Cronbach’s α=0.76 for knowledge and 0.81 for stigma items) and strong stability over time (test–retest intraclass correlation: 0.79"-" 0.85). Data were collected on Android tablets using Open Data Kit Collect. We performed descriptive statistics, chi-square tests, one-way ANOVA, independent-samples t-tests, and Spearman correlations in JASP. We performed thematic analysis on eleven key informant interviews and eight focus group discussions to explain quantitative findings. **Results:** The burden was extensive and multidimensional. Economic hardship affected 71.7% of respondents, emotional well-being 65.9%, social stigma or isolation 69.6%, and self-esteem 59.1%. Composite indices showed that 89.9% experienced at least one socio-economic impact and 95.8% at least one psychological impact. The two burden dimensions were statistically independent (ρ = .026, p = .311). Socio-economic impact did not differ across chiefdoms (F(4,1495) = 1.91, p = .106) and psychological impact did not differ by sex (t(1498) = 0.26, p = .796); no specific impact was associated with chiefdom, sex or education (all effect sizes trivial). Qualitative themes described a productivity poverty cycle, stigma experienced as “social death,” and an unrecognized gendered caregiving load. **Conclusions:** Onchocerciasis imposes a near-universal, uniformly distributed dual burden in Bo District that is invisible to parasitological surveillance. Because the burden is community-wide rather than concentrated in identifiable subgroups, morbidity-management, stigma-reduction, and psychosocial support should be delivered population-wide and integrated into primary healthcare and MDA delivery rather than targeted at demographic risk groups.
The pervasive socio-economic and psychological burden of onchocerciasis in endemic communities of Bo District, Sierra Leone: an explanatory sequential mixed-methods study
(BioMed Central, 2026-07-27) Moseray, Augustine Bob
**Background:** Onchocerciasis (river blindness) persists in Bo District, Sierra Leone, despite decades of ivermectin-based mass drug administration (MDA). Previous programmatic efforts prioritized parasitological and ocular outcomes. The socio-economic and psychological burden within affected communities remains poorly quantified. We quantified the magnitude and multidimensionality of this burden using two composite indices socio-economic and psychological which revealed a near-universal impact, with 89.9% and 95.8% of respondents affected in each respective dimension. Statistical analysis demonstrated that these dimensions are independent (ρ=.026,p=.311), confirming the multidimensional nature of the burden. Furthermore, we found the distribution to be remarkably uniform, with no significant variation across the five chiefdoms (F=1.91,p=.106) or between sexes (t=0.26,p=.796), suggesting that onchocerciasis-related distress is a generalized community condition rather than one patterned by demographic or geographic factors." Methods : We used an explanatory sequential mixed-methods design. In the quantitative phase, we used multistage cluster sampling to survey 1,500 adults across five endemic chiefdoms (Bagbwe, Baoma, Gbo, Selenga, Tikonko).We operationalized the non-clinical burden of onchocerciasis using two formative composite indices. The socio-economic impact index (0–2) was calculated by summing two binary items (yes/no): experienced economic hardship, such as income loss or reduced work capacity, and encountered obstacles to education or employment. The psychological impact index (0–3) was calculated by summing three binary items: impaired emotional well-being (anxiety/sadness) social stigma or isolation, and negative shifts in self-esteem. A formative measurement approach was selected because these items represent distinct, non-interchangeable components of the burden that collectively contribute to the construct rather than being manifestations of a single latent trait. The choice of indicators specifically stigma and economic productivity is supported by established models of the social burden of neglected tropical diseases, which identify these as core dimensions of patient experience. Similar research in endemic settings has successfully utilized such categorical impacts to quantify the welfare assault of onchocerciasis. To ensure linguistic and cultural validity, all instruments were forward- and back-translated into Mende and reviewed by an expert panel. We conducted cognitive testing and a pilot study (N=30) to establish reliability. Our pilot results demonstrated adequate internal consistency (Cronbach’s α=0.76 for knowledge and 0.81 for stigma items) and strong stability over time (test–retest intraclass correlation: 0.79"-" 0.85). Data were collected on Android tablets using Open Data Kit Collect. We performed descriptive statistics, chi-square tests, one-way ANOVA, independent-samples t-tests, and Spearman correlations in JASP. We performed thematic analysis on eleven key informant interviews and eight focus group discussions to explain quantitative findings. **Results:** The burden was extensive and multidimensional. Economic hardship affected 71.7% of respondents, emotional well-being 65.9%, social stigma or isolation 69.6%, and self-esteem 59.1%. Composite indices showed that 89.9% experienced at least one socio-economic impact and 95.8% at least one psychological impact. The two burden dimensions were statistically independent (ρ = .026, p = .311). Socio-economic impact did not differ across chiefdoms (F(4,1495) = 1.91, p = .106) and psychological impact did not differ by sex (t(1498) = 0.26, p = .796); no specific impact was associated with chiefdom, sex or education (all effect sizes trivial). Qualitative themes described a productivity poverty cycle, stigma experienced as “social death,” and an unrecognized gendered caregiving load. **Conclusions:** Onchocerciasis imposes a near-universal, uniformly distributed dual burden in Bo District that is invisible to parasitological surveillance. Because the burden is community-wide rather than concentrated in identifiable subgroups, morbidity-management, stigma-reduction, and psychosocial support should be delivered population-wide and integrated into primary healthcare and MDA delivery rather than targeted at demographic risk groups.