Browsing by Author "Osborne, Augustus"

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A qualitative participatory study on adolescent girls’ access to contraception and other sexual and reproductive health services in rural Sierra Leone
(BioMed Central, 2026-10-05) Osborne, Augustus; Osborne, Augustus
Sierra Leone has one of the highest adolescent birth rates globally (approximately 101 per 1000 girls aged 15–19 years). Despite documented barriers to sexual and reproductive health (SRH) service access in sub-Saharan Africa, qualitative evidence specific to rural Sierra Leone particularly evidence generated through participatory methods involving adolescent girls remains limited. This study explored how adolescent girls experience SRH service access in rural Sierra Leone, with specific attention to the social and institutional mechanisms that suppress help-seeking. A qualitative participatory design was employed across three rural districts (Koinadugu, Moyamba, Pujehun) between February and July 2024. Eighty-seven participants were engaged through in-depth interviews (IDIs), focus group discussions (FGDs), guided storytelling, and service-access journey mapping. The primary analytic group comprised 32 adolescent girls aged 15–19 years. These 32 girls were the primary analytic focus, while the remaining 55 participants (young mothers, parents and guardians, teachers, community health workers, nurses and midwives, youth leaders, and community and religious leaders) provided complementary perspectives that enabled triangulation. IDIs were conducted with adolescent girls and young mothers, FGDs with the community stakeholder groups, and guided storytelling and journey mapping with adolescent girls. Guided by the socio-ecological model, data were analysed using reflexive thematic analysis. Four themes, each encompassing specific findings, were generated: (1) internalised shame and community surveillance as co-constitutive barriers to help-seeking; (2) provider disclosure as a systemic confidentiality failure with community-wide deterrent effects; (3) compounding structural barriers including judgmental provider attitudes, contraceptive stockouts, provider-generated misinformation, and geographic inaccessibility; and (4) pregnancy as an effective terminator of educational trajectories despite formal policy protections. Journey mapping data distinctively illustrated how girls spatially navigate exposure risk at health facilities. Adolescent girls in rural Sierra Leone are excluded from contraceptive and other SRH services by four interlocking mechanisms identified here: internalised shame reinforced by community surveillance; provider disclosure that breaches confidentiality and deters entire peer networks; compounding structural barriers including judgmental provider attitudes, contraceptive stockouts, and provider-generated misinformation; and the effective loss of schooling following pregnancy. clear confidentiality protocols, provider behaviour change strategies that extend beyond training to enforceable service defaults, supportive supervision, and recognition of non-judgmental care. Other recommendations are reliable contraceptive supply, self-care and community-based delivery channels that lower the exposure cost of obtaining contraception, comprehensive sexual and reproductive health and rights literacy paired with peer advocacy, community engagement, and enforcement of the policy that allows pregnant girls to return to school.
A qualitative participatory study on adolescent mental health and well-being in Sierra Leone
(BioMed Central, 2026-08-16) Osborne, Augustus; Osborne, Augustus
Adolescents in Sierra Leone have endured successive crises including civil conflict, the 2014 to 2016 Ebola virus disease outbreak, and the COVID-19 pandemic, each compounding pre-existing vulnerabilities in mental health, education, and family stability. Despite growing global recognition of adolescent mental health as a public health priority, qualitative evidence documenting how young Sierra Leoneans experience distress, coping, and recovery remains limited. This study examined how adolescents in Sierra Leone experience mental health, well-being, coping, schooling, and post-crisis recovery. A qualitative participatory study was conducted across three districts in Sierra Leone between February and July 2024. Purposive sampling recruited 112 participants, including adolescents aged 13 to 19 years, caregivers, teachers, youth leaders, community health workers, counsellors, and child protection actors. Data were collected through in-depth interviews, focus group discussions, emotion mapping, personal timelines, and guided storytelling. Reflexive thematic analysis was applied. We identified four themes: (1) landscapes of distress, encompassing grief, fear, poverty-related shame, and school disruption; (2) gendered and intersecting vulnerabilities, including early marriage, sexual violence, and differential educational access; (3) coping, resilience, and meaning-making through faith, peer solidarity, creative expression, and aspiration; and (4) navigating support, revealing trust barriers, stigma, and the centrality of informal networks. Adolescent mental health in Sierra Leone is shaped by layered, intersecting crises that exceed individual-level coping. School-based psychosocial support, community-level stigma reduction, and gender-responsive services are urgently needed.
A study of vulnerable student populations, exclusion and marginalization in Sierra Leonean secondary schools: a social justice theory analysis
(BioMed Central, 2025-03-18) Osborne, Augustus
BACKGROUND: Sierra Leone faces challenges in ensuring equitable and inclusive education for all its citizens. Certain groups, including pregnant students, student mothers, students with disabilities, economically disadvantaged students, and those without family support, are particularly vulnerable to exclusion and marginalisation. These groups are identified as vulnerable based on criteria established by organisations such as the World Health Organisation and the United Nations Educational, Scientific and Cultural Organization, which highlight the interplay between health, socio-economic status, and access to education. This study explores the extent of exclusion and marginalisation experienced by these vulnerable groups within Sierra Leonean educational institutions. METHODS: Between November and December 2023, a participatory study design was utilised, employing purposive sampling to gather diverse perspectives from 127 key informant interviews with 366 participants, including teachers, parents, students with disabilities, pregnant students, students who are mothers, and economically disadvantaged students across 11 schools in six districts in Sierra Leone. The analysis was performed manually using Microsoft Word, with four researchers responsible for organising, coding, and identifying patterns and themes within the dataset. RESULTS: Pregnant students are often stigmatized, being perceived as immoral and a negative influence on their peers. This stigma results in social isolation, bullying, and derogatory comments from both peers, and at times, teachers. Students with disabilities frequently experience bullying and social exclusion; however, there are also positive examples of peer support that facilitate their inclusion in schools and the broader community. Economically disadvantaged students are often subjected to bullying and discrimination based on their socioeconomic status, which contributes to feelings of self-isolation, reduced self-esteem, and low participation in school activities. CONCLUSION: Our study revealed that pregnant students, students with disabilities, economically disadvantaged students, and those lacking family support face stigma, social isolation, and limited access to education in Sierra Leone. These challenges are deeply rooted in societal attitudes, parental expectations, and inadequate support from teachers. To address these systemic issues, policymakers and educators should adopt comprehensive strategies, including evidence-based community awareness campaigns to challenge harmful societal attitudes, the promotion of inclusive education practices through clear and targeted policies, and the establishment of robust support services within schools. Such measures are essential to create an equitable and inclusive educational environment for all students.
Advancing Toward the UNAIDS 95‑95‑95 Targets in Sierra Leone: A Narrative Review of Progress, Persistent Gaps, and Policy Priorities
(Elsevier BV, 2026-03-25) Osborne, Augustus; Osborne, Augustus
**Background:** Sierra Leone, with a low adult HIV prevalence (\~1.6–1.7%), faces uneven progress toward the UNAIDS 95‑95‑95 targets, with significant gaps in diagnosis, viral load (VL) coverage, and key population reach. **Methods:** A narrative review (January 2013–June 2024; final search 30 June 2024) synthesized national reports and peer‑reviewed articles on Sierra Leone’s HIV cascade and systemic determinants. Data focused on diagnosis, treatment, suppression, and cross‑cutting issues (e.g., stigma, supply chain). **Results:** In 2023, of an estimated 82,000 people living with HIV (PLHIV), 80% (65,600) were diagnosed. Of those diagnosed, 87% (57,072) were on antiretroviral therapy (ART), and 44% of those on ART (25,112) were virally suppressed. VL testing covered 68% of ART patients (38,812), suggesting incomplete coverage may underestimate true population‑level suppression if untested patients are less likely to be suppressed. Key bottlenecks include limited VL platforms, commodity stockouts of antiretrovirals, stigma (especially for female sex workers), adolescent retention gaps, absent drug resistance surveillance, fragmented data systems, and donor‑dependent financing. **Conclusions:** Progress is tangible but fragile. Prioritizing detection (first 95) through scaled testing, alongside VL network strengthening, differentiated service delivery (e.g., six‑month multi‑month dispensing), stigma monitoring, drug resistance surveillance, and sustainable financing roadmaps, is essential. Targeted research on implementation and cost‑effectiveness will support equitable attainment of HIV 2030 goals.
Alcohol use among in-school adolescents in Sierra Leone
(BMJ, 2024-04-01) Osborne, Augustus
OBJECTIVE: To examine the prevalence of alcohol use and its associated factors among in-school adolescents in Sierra Leone. DESIGN: Data for the study was sourced from the 2017 Sierra Leone Global School-Based Student Health Survey, a nationally representative survey conducted among in-school adolescents aged 10-19 years using a multistage sampling methodology. Percentages were used to present the prevalence of alcohol use among in-school adolescents. Multivariable binary logistic regression analysis was performed to examine the factors associated with alcohol use among in-school adolescents. The results were presented using adjusted odds ratios (aOR) with their respective 95% confidence interval (CI). SETTING: Sierra Leone. PARTICIPANTS: A weighted sample of 1730 in-school adolescents in Sierra Leone. OUTCOME MEASURE: Current alcohol use. RESULTS: The prevalence of alcohol use among in-school adolescents was 10.7% (7.3, 15.3). In-school adolescents in senior secondary schools were more likely to use alcohol compared with those in junior secondary school (aOR=2.13; 95% CI 1.37, 3.30). The odds of alcohol use was higher among in-school adolescents who were truant at school relative to those who were not (aOR=2.24; 95% CI 1.54, 3.26). Also, in-school adolescents who were bullied (aOR=1.85; 95% CI 1.24, 2.76), ever engaged in sexual intercourse (aOR=2.06; 95% CI 1.39, 3.06), and used marijuana (aOR=3.36; 95% CI 1.72, 6.53) were more likely to use alcohol compared with those who were not. However, in-school adolescents who reported that their parents understood their problems (aOR=0.52; 95% CI 0.33, 0.82) had a lower likelihood of consuming alcohol. CONCLUSION: Our study has shown that alcohol use is prevalent among in-school adolescents in Sierra Leone. Grade level, experiences of being bullied, history of sexual intercourse, truancy at school, and previous use of marijuana were the factors influencing alcohol use among in-school adolescents. The findings emphasise the necessity of creating school-based health interventions in Sierra Leone that can effectively identify in-school adolescents potentially vulnerable to alcohol-related issues. Also, existing policies and programmes aimed at reducing alcohol use among in-school adolescents need to be strengthened.
Assessment of Perceptions and Practices on Menstruation among Adolescent Girls in Five Schools in bo district, Sierra Leone
(Scientific Research and Community Ltd, 2020-06-26) Osborne, Augustus
Menstrual hygiene is essential as it promotes the health of women. Unhygienic menstrual practices can affect the health of girls and can lead to urinary tract infections. Many girls deficient of appropriate knowledge in menstruation and menstrual hygiene. It is therefore necessary to assess their perceptions, problems, and practices on menstruation. This Cross-sectional study was conducted amongst 103 secondary school girls from five schools in the southern part of Sierra Leone via structured questionnaire. Majority of the students, were aged 15-18 years. 29.1% of the girl’s attained menstruation at age 14 years. 57.3% of the girls believed that the normal monthly interval of menstruation is 28 days. 33% of the girls said Menstruation upsets them. Staining of dress and bad odor 30.1% were the most embarrassment faced by girls during menstruation. 64.1% of the girls said Scared was their reaction to Menstruation. 78.6% of the girls said Worried is how they feel when they don’t get their period on time. Menstrual problems were most commonly discussed with their mothers, (68%), and least commonly discussed with the fathers, 1.9%. Majority of the respondents had poor knowledge on menstruation, menstrual hygiene and practices. Menstruation perceptions are poor, and practices often incorrect. A multi-dimensional approach focusing on capacity building of mothers, and teachers on sexuality education skills; using religious organizations as avenues for sexuality education; and effectively using the Mass Media as reproductive health education channels are recommended towards improving adolescents’ perceptions and practices on menstruation. (Afr Reprod Health 2008; 12\[1\]:74-83).ISSN: 2634 - 680X
Bullying victimization among in-school adolescents in Sierra Leone: A cross-sectional analysis of the 2017 Sierra Leone Global School-Based Health Survey
(Public Library of Science, 2023-12-22) Osborne, Augustus
Adolescent bullying victimization is recognized as a public health and mental health problem in many countries. However, data on bullying victimization's prevalence and risk factors is scarce in sub-Saharan Africa Sierra Leone. This research aimed to determine bullying victimization prevalence and its associated factors among Sierra Leonean school-going adolescents. The Sierra Leone 2017 Global School-based Health Survey (GSHS) dataset was analyzed. The outcome variable was the respondent's self-report of bullying victimization ("How many days in the previous 30 days were you bullied?"). Descriptive, Pearson chi-square and binary logistic regression analyses were conducted. The regression analysis yielded adjusted odds ratios (aOR) with 95% confidence intervals (CIs) and a significance level of p 0.05. Bullying victimization was prevalent among 48.7% of the in-school adolescents. Adolescents who drank alcohol \[aOR = 2.48, 95% CI = 1.50-4.10\], who reported feelings of loneliness \[aOR = 1.51, 95% CI = 1.07-2.14\] and who had attempted suicide \[aOR = 1.72, 95% CI = 1.03-2.87\] were also more likely to be bullied. Also, school truancy \[aOR = 1.53, 95% CI = 1.24-1.88\] among teenagers was associated with an increased risk of being bullied. Our findings suggest that bullying is a widespread problem among Sierra Leonean school-aged youth, and alcohol drinking, loneliness, suicide attempt and school truancy are potential risk factors. In light of the aforementioned causes of bullying in schools, policymakers and school administrators in Sierra Leone need to develop and execute anti-bullying policies and initiatives that target the underlying risk factors of bullying among teenagers.
Cannabis use and its psychosocial correlates among school-going adolescents in Sierra Leone
(BioMed Central, 2024-04-08) Osborne, Augustus
BACKGROUND: In Sierra Leone, adolescents are increasingly engaging in risky activities, including cannabis use, which can lead to substance abuse, poor academic performance, and psychotic symptoms. This study aims to investigate the prevalence and associated factors of cannabis use among school-going adolescents in the country. METHOD: Data for the study was sourced from the 2017 Sierra Leone Global School-based Student Health Survey (GSHS), a nationally representative survey conducted among adolescents aged 10-19 years using a multistage sampling methodology. A weighted sample of 1,467 adolescents in Sierra Leone was included in the study. The study utilised bivariate and multivariable logistic regression analysis to identify factors linked to cannabis use, presenting results using adjusted odds ratios and 95% confidence intervals. RESULTS: The prevalence of cannabis use was 5.1% \[3.0,8.6\] among school-going adolescents in Sierra Leone. School-going adolescents who attempted suicide \[aOR = 6.34, 95% CI = 1.71-23.45\], used amphetamine \[aOR = 15.84, 95% CI = 7.94-31.62\] and were involved in sexual risk behaviour \[aOR = 5.56, 95% CI = 2.18-14.20\] were more likely to be associated with cannabis use. CONCLUSION: In Sierra Leone, a small but non-trivial minority of students use cannabis. Ever-used amphetamines or methamphetamines, suicidal attempts, and sexual risk behaviour were the factors associated with cannabis use in Sierra Leone. The development of school-based health intervention programmes is crucial to address the risk factors associated with cannabis use among school-going adolescents.
Community-driven responses to the Kush epidemic and health system resilience in Kailahun District Sierra Leone
(2026-08-07) Osborne, Augustus
Sierra Leone faces an escalating public health emergency driven by “Kush,” a locally available psychoactive substance often comprising a toxic mix of cannabis and synthetic adulterants. Its variable, often toxic composition and rapid proliferation among youth amplify public health risks. In Kailahun District, a rural border region with limited mental health infrastructure, health and social systems are under immense pressure to respond to rising demand amid chronic resource constraints, centralized service delivery, and fragmented care pathways. This study examined the community-driven responses to the Kush epidemic in Kailahun, Sierra Leone. We conducted a qualitative, exploratory study in Kailahun District between July and August 2025 to examine local system resilience. Using purposive and maximum-variation sampling, we engaged 10 diverse stakeholders, including frontline health workers, district managers, police officers, chiefs, youth leaders, teachers, and faith actors. Data were collected via semi-structured key informant interviews and focus group discussions, conducted in English or Krio, and analyzed thematically using a health systems resilience framework. This approach allowed us to map local responses, barriers, and community-identified priorities across absorptive, adaptive, and transformative capacities. Ethical approval was obtained from the Sierra Leone Ethics Review Scientific Committee. Thematic analysis revealed four interlinked themes mapped to health systems resilience capacities. First, structural determinants including unemployment, poverty, and post-conflict insecurity act as cross-cutting contextual constraints that drive Kush use and strain caregiving systems. Second, reactive clinical responsiveness and frontline ingenuity reflect absorptive capacity at the point of acute crisis, despite chronic medicine stockouts and bed shortages. Third, multiple barriers to adaptive responses including limited mental health expertise, high staff turnover, geographic centralization of services, policy ambiguity, and fragmented intersectoral coordination constrain the system’s ability to evolve beyond crisis management. Fourth, community and faith-based mobilization demonstrate latent adaptive and transformative potential, currently limited by the absence of formal integration, financing, and referral linkages. Stakeholders consistently prioritized decentralized outreach, sustained multi-sector training, reliable medicine supplies, coherent drug policy, structured rehabilitation pathways, and livelihood support as actionable priorities. Tackling the Kush epidemic demands integrated, district-level strategies that merge clinical interventions with social and economic supports. A recovery-oriented system, underpinned by pragmatic governance, interoperable data systems, and formalized community engagement, offers a sustainable pathway to impact in Sierra Leone and comparable low-resource settings facing similar substance use crises.
Determinants of Non-enrollment on Health Insurance among Women in Sierra Leone: a cross-sectional analysis of the 2019 Sierra Leone Demographic Health Survey
(Research Square Platform LLC, 2023-12-06) Osborne, Augustus
Background Health insurance enrollment is key to attaining universal health coverage. Yet, its enrollment in Sierra Leone remains persistently low, posing a public health challenge requiring attention. This study examined the factors associated with non-enrollment of health insurance among women aged 15–49 in Sierra Leone. Methods We analysed data from a weighted sample of 15,574 women aged 15–49 from the 2019 Sierra Leone Demographic and Health Survey. Percentages were used to present the proportion of health insurance enrollment among the women. Multivariable binary logistic regression analysis was used to examine the factors associated with health insurance non-enrollment among the women. The results were presented using adjusted odds ratios (aOR), with their respective 95% confidence interval (CI). Statistical significance was set at p < 0.05. Results The proportion of health insurance non-enrollment among the women was 96.0%. Women with higher education had lower odds of non-enrollment (aOR = 0.36, 95% CI = 0.20, 0.65) than women with no education. Women who are employed (aOR = 0.50, 95% CI = 0.38, 0.66) and those who listen to the radio less than once a week (aOR = 0.61, 95% CI = 0.46, 0.81) had lower odds of non-enrollment than those unemployed and those who do not listen to the radio, respectively. Women who lived in Northwestern (aOR = 0.07, 95% CI = 0.04, 0.15) and Northern regions (aOR = 0.29, 95% CI = 0.13, 0.67) have lower odds of non-enrollment than women living in the Eastern region. Women who watched television less than once a week (aOR = 1.766, 95% CI = 1.04, 3.01) and those who had a big problem with distance to health facilities (aOR = 2.46, 95% CI = 1.08, 5.59) had higher odds of non-enrollment than women who do not watch television at all and do not have a big problem with it. Conclusions Health insurance non-enrollment remains very high among women in Sierra Leone. Education, employment, exposure to media, distance to health facilities, and region are associated with low health insurance enrollment among women in Sierra Leone. Therefore, implementing targeted outreach programs involving community-based initiatives, workshops, and informational campaigns should be used to encourage women to enrol in health insurance. Again, efforts should be made to eliminate financial barriers that prevent women from being able to afford health insurance enrollment.
Determinants of poor access to health care among women of reproductive age in Sierra Leone: a cross-sectional study
(BioMed Central, 2025-02-05) Osborne, Augustus
BACKGROUND: Sierra Leone, like many developing countries, faces challenges in ensuring equitable access to healthcare, particularly for women of reproductive age. This women has specific healthcare needs related to sexual and reproductive health, maternal health, and family planning. Despite improvements in national healthcare coverage, disparities persist, with women of reproductive age, especially those in rural areas and lower socio-economic brackets, experiencing significant barriers to accessing essential services. The study examined the factors associated with poor access to healthcare among women in Sierra Leone. METHODS: The study utilised the cross-sectional 2019 Sierra Leone Demographic Health Survey. The study included 15,574 women of reproductive age (15-49 years) in Sierra Leone. A mixed-effect multilevel binary logistic regression analysis was conducted, determining the factors associated with poor access to healthcare using a four-modeled approach. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI). RESULTS: From our study the proportion of poor access to healthcare was 71.9% \[69.7,74.0\] in Sierra Leone. Previously married women(divorced, separated, or widowed) \[aOR = 1.74; 95% CI: 1.30, 2.34\] had higher odds of poor access to healthcare than those never in a union. Women living in rural areas \[aOR = 1.88; 95% CI: 1.30, 2.71\] had higher odds of poor access to healthcare than those living in urban areas. Women with secondary \[aOR = 0.74; 95% CI: 0.62, 0.89\] and higher education \[aOR = 0.48; 95% CI: 0.34, 0.68\] had lower odds of poor healthcare access than those without education. Women who watch television \[aOR = 0.70; 95% CI: 0.56, 0.86\] had lower odds of poor access to healthcare than those who did not. Richer \[aOR = 0.57; 95% CI: 0.42, 0.79\] and Richest quintile women \[aOR = 0.45; 95% CI: 0.32, 0.65\] have lower odds of poor access to healthcare than women in the poorest quintile. Women living in the Western region \[aOR = 0.38; 95% CI: 0.22, 0.65\] have lower odds of poor access to healthcare than those living in the Eastern region. CONCLUSION: Our study revealed that poor access to healthcare is a significant issue in Sierra Leone. Women who were previously married (divorced, separated, or widowed), lived in rural areas, or had lower education levels faced higher odds of poor healthcare access. Conversely, women with higher education, greater wealth, watch television, and those residing in the Western region had significantly lower odds of poor healthcare access. These findings underscore the need for targeted interventions addressing socioeconomic, educational, and provincial disparities to improve healthcare access for women in Sierra Leone.
Early childhood female genital mutilation in Sierra Leone, 2008–2019
(Public Library of Science, 2025-05-15) Osborne, Augustus
BACKGROUND: Female genital mutilation remains a public health concern and human rights violation affecting young girls in Sierra Leone, despite global efforts to eliminate the practice. With its diverse socio-cultural background and varying regional practices, Sierra Leone presents a unique context for examining how female genital mutilation practices have evolved across different population subgroups. This study examined the early childhood female genital mutilation among women of reproductive age (15-49 years) who reported having FGM before the age of five in Sierra Leone. METHODS: The study utilised data from the Sierra Leone Demographic Health Survey rounds conducted in 2008, 2013, and 2019. The World Health Organisation Health Equity Assessment Toolkit software calculated various measures, including difference, ratio, population-attributable risk, and population-attributable fraction. An assessment was calculated for five stratifiers: age, education level, economic status, place of residence, and sub-national province. RESULTS: The prevalence of female genital mutilation among women of reproductive age (15-49 years) who reported undergoing the practice before the age of five in Sierra Leone declined from 23.2% in 2008 to 12.3% in 2019. By 2019, female genital mutilation showed minimal variation between women aged 40-49 and 15-19, as well as in urban-rural differences. Economic variations in female genital mutilation decreased but continued to disadvantage women in the poorest quintile. Educational variations in female genital mutilation decreased but still impacted women without formal education. Provincial variations in female genital mutilation widened, with the ratio between the Western and Northwestern provinces increasing from 1.8 in 2008 to 2.6 in 2019. CONCLUSION: The results showed a decrease in early childhood female genital mutilationin Sierra Leone. While differences related to age groups and urban-rural residence have largely been eliminated, substantial differences persist across educational levels, economic status, and provinces. Most notably, the provincial differences between the Western and Northwestern provinces had widened, with the difference in ratio indicating that female genital mutilation practices remain disproportionately concentrated in some provincial areas. These results suggest that while national-level interventions have been partially successful, there is a critical need for targeted, context-specific approaches that address persistent socioeconomic and provincial variations to achieve a more equitable reduction in early childhood female genital mutilation across all population groups in Sierra Leone.
Early sexual debut among adolescent girls and young women in Sierra Leone: A multilevel analysis of prevalence and predictors
(BioMed Central, 2024-11-12) Osborne, Augustus
BACKGROUND: Early sexual debut among young women is associated with adverse sexual and reproductive health outcomes, including unintended pregnancies and sexually transmitted infections. Despite its negative impact, there is limited research on this issue in Sierra Leone. This study aims to address this gap by examining the prevalence of early sexual debut and its associated factors among adolescent girls and young women aged 15-24 years in Sierra Leone. METHODS: Data from the 2019 Sierra Leone Demographic and Health Survey was used for the study. Provincial variations in the proportion of early sexual debut were visualised using a spatial map. A mixed-effect multilevel binary logistic regression analysis was performed to examine the factors associated with early sexual debut. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI) and intraclass correlation coefficients. RESULTS: The prevalence of early sexual debut was 26.1% \[24.3, 28.0\]. Adolescent girls and young women aged 20-24 were less likely to engage in early sexual debut \[aOR = 0.52; 95% CI: 0.41, 0.65\] than those aged 15-19. The odds of early sexual debut was lower among adolescent girls and young women with secondary/higher education \[aOR = 0.62; 95% CI: 0.45, 0.85\] compared to those with no education. Adolescent girls and young women who used the internet in the last 12 months \[aOR = 0.50; 95% CI: 0.34, 0.73\] and those who belonged to the Fullah ethnic group \[aOR = 0.25; 95% CI: 0.07, 0.85\] were less likely to engage in early sexual debut relative to those who did not use the internet and those belonging to the Creole ethnic group respectively. Adolescent girls and young women who intend to use contraceptives \[aOR = 0.60; 95% CI: 0.46, 0.77\] and those who do not intend to use contraceptives \[aOR = 0.65; 95% CI: 0.49, 0.88\] were less likely to engage in early sexual debut than those who were using contraceptives. Conversely, adolescent girls and young women who were working \[aOR = 1.41; 95% CI: 1.12, 1.77\] had higher odds for early sexual debut than those not working. The odds of early sexual debut were higher among adolescent girls and young women who were married/cohabiting \[aOR = 1.72; 95% CI: 1.32, 2.22\] and previously married \[aOR = 3.26; 95% CI: 1.61, 6.56\] than those who were never married. Adolescent girls and young women living in the North Western area \[aOR = 1.81; 95% CI: 1.05, 3.13\] had higher odds for early sexual debut than those living in the Eastern province. CONCLUSION: Early sexual debut is prevalent among adolescent girls and young women in Sierra Leone. Age, education, internet use, ethnicity, contraceptive use intention, marital status, employment status, and province of residence were the factors associated with early sexual debut. The study underscores the need for policymakers, government, and non-governmental organisations to design and implement comprehensive and multifaceted interventions to promote informed decision-making and reproductive health among adolescent girls and young women in Sierra Leone.
Emergency contraception among female university students in Sierra Leone: An exploratory study of use, knowledge, attitudes, and associated factors
(SAGE Publishing, 2026-07-01) Osborne, Augustus
BackgroundUnintended pregnancy remains a major public health concern in Sierra Leone, where stigma, misconceptions, and access barriers hinder the timely use of emergency contraception (EC).ObjectivesTo estimate the prevalence of EC use, assess related knowledge and attitudes, and identify associated factors among female university students in Sierra Leone.DesignA cross-sectional study using convenience sampling.MethodsConducted in 2024 among 366 female undergraduate students at Njala University, Sierra Leone, using convenience sampling and a structured, self-administered questionnaire to assess sociodemographic characteristics, EC utilisation, knowledge, and attitudes. The knowledge and attitudes were scored and categorised based on the mean scores. Descriptive statistics, logistic regression, and Pearson's and Spearman's correlations were used for analysis.ResultsAmong participants, 68.3% (n=250) reported ever using EC, with 36.5% (n=91) of ever-users using it within the past four weeks and 29.5% (n=74) between one and three months prior to the survey. Of participants, 53.0% (n=194) had good knowledge, and 49.7% (n=182) had a positive attitude toward EC. Ever-use was more likely among students aged 26-30 years (AOR 3.58; 95% CI 1.42-8.90) and in year two (AOR 2.64; 95% CI 1.25-5.55), but less likely with poor knowledge (AOR 0.16; 95% CI 0.09-0.30) and negative attitudes (AOR 0.19; 95% CI 0.10-0.36). No prior history of EC use was associated with lower odds of both good knowledge (AOR 0.20; 95% CI 0.10-0.41; p < 0.001) and positive attitude (AOR 0.23; 95% CI 0.11-0.46; p < 0.001). Knowledge and attitudes were strongly correlated (r=0.659; rho=0.611; p<0.001).ConclusionEC use is widespread among sampled students but is influenced by knowledge and attitudes. These exploratory findings suggest that targeted, peer- and provider-led education to address misconceptions and improve service navigation could enhance informed contraceptive choices and reduce unintended pregnancies in this context.
Exploring the drivers of unmet need for contraception among adolescents and young women in Sierra Leone. a cross-sectional study
(BioMed Central, 2024-05-17) Osborne, Augustus
BACKGROUND: Sierra Leone grapples with a concerning reality: a high unmet need for contraception among adolescents and young women (AYW). This translates to a multitude of unintended pregnancies, jeopardising their health, education, and overall life trajectory. To effectively address this challenge, we aim to examine the factors associated with the unmet need for contraception among AYW in Sierra Leone. METHODS: The study analysed the 2019 Sierra Leone Demographic and Health Survey data. A total of 1,796 married and cohabiting AYW aged 15 to 24 years, representing the nationally representative sample, comprised the study. A multivariable binary regression analysis was used to explore the drivers of unmet needs for contraception. The regression results were presented using an adjusted odds ratio (AOR) with 95% confidence intervals (CI). RESULTS: The study found that 29% of Sierra Leonean AYW had an unmet need for contraception. AYW with three or more births(AOR = 6.80, 95% CI = 3.97, 11.65), two births (AOR = 4.11, 95% CI = 2.50, 6.76), one birth (AOR = 4.40, 95% CI = 2.81, 6.88), heard family planning on TV last few months (AOR = 1.94, 95% CI = 0.98, 3.83), and are cohabiting (AOR = 1.88, 95% CI = 1.29, 2.75) had higher odds of unmet need for contraception. AYW who read the newspaper or magazine at least once a week (AOR = 0.11, 95% CI = 0.01, 1.10) had lower odds of unmet need for contraception. CONCLUSIONS: The study found a high unmet need among AYW in Sierra Leone, which indicates a significant gap between desired and actual contraceptive use, leading to unintended pregnancies and potentially adverse health and socio-economic consequences. Parity, media exposure and cohabitation were associated with a higher unmet need for contraception and newspaper/magazine readership was associated with a lower unmet need for contraception. The study highlights the need to increase access to affordable and diverse contraceptive options, especially in rural areas. Expand educational campaigns beyond TV to include print media and community-based interventions. Provide AYWs with knowledge and authority to make well-informed decisions around their sexual and reproductive well-being.
From continental strategy to country implementation: a document-based scorecard for assessing health security and sovereignty readiness in Africa
(Taylor & Francis, 2026-09-28) Osborne, Augustus
BACKGROUND: The Africa Health Security and Sovereignty (AHSS) Agenda of the Africa Centres for Disease Control and Prevention (Africa CDC) provides a continental framework for strengthening health security and sovereignty. As implementation begins, no document-based readiness assessment instrument exists to monitor progress against AHSS pillars and goals, limiting efforts to identify bottlenecks and target assistance. OBJECTIVE(S): To develop and apply a document-based scorecard for assessing policy readiness for AHSS implementation across selected African countries. METHODS: We conducted a qualitative policy analysis using systematic document review, deductive framework development, structured coding, and scorecard synthesis. The corpus comprised 48 documents: the AHSS Agenda, the African Union Roadmap to 2030, WHO AFRO guidance, and national policies from 12 named African countries in 5 regional economic community zones. A 10-dimension scorecard based on AHSS pillars and WHO building blocks was applied on a 3-level scale. A second author recoded the corpus independently; materials are openly deposited. RESULTS: Readiness was most consistently reflected in governance and strategic planning and least in financing specificity, digital health architecture, and laboratory and pharmaceutical systems. AHSS-relevant provisions appeared in 3 of 12 financing strategies, 3 of 10 pharmaceutical policies, and 2 of 12 plans, indicating strategic intent but weak operational readiness across the 10 dimensions. CONCLUSIONS: The AHSS/WHO document-based scorecard is a feasible and replicable instrument for monitoring readiness. It identifies governance and implementation gaps and helps Africa CDC, WHO AFRO, governments, and partners target technical assistance. Periodic application would strengthen implementation monitoring, cross-setting comparison, and accountability.
Gender-based violence response and health system readiness during emergencies in Sierra Leone: a qualitative study of survivor experience, facility preparedness, and referral pathways
(Taylor & Francis, 2026-09-29) Osborne, Augustus
BACKGROUND: Gender-based violence (GBV) intensifies during emergencies, yet health and protection systems in Sierra Leone remain inadequately prepared to respond. Survivors face barriers including stigma, breaches of confidentiality, and weak referral pathways. OBJECTIVE: This study explored how health and protection systems in three districts of Sierra Leone respond to GBV during emergencies. METHODS: A qualitative descriptive study was conducted across three districts, integrating semi-structured interviews with referral pathway mapping. Purposive sampling recruited 54 participants: 48 key informants across eight stakeholder groups and 6 survivors identified through referral organisations. Data were analysed using the framework method. Data collection took place outside an active emergency; emergency-specific findings therefore reflect participant recollection rather than direct observation. RESULTS: Four themes emerged: fragmented and under-resourced clinical readiness; confidentiality failures and stigma as structural barriers; dysfunctional referral pathways and coordination gaps; and limited, inconsistent survivor-centred psychosocial care. Participants reported that emergency contraception was frequently unavailable and, in some accounts, withheld on moral grounds. Referrals to police and social welfare were described as ad hoc, reliant on personal relationships, and severely disrupted when GBV was excluded from emergency coordination structures. Counsellors were largely absent from peripheral facilities. A minority of participants reported functioning one-stop centre care. CONCLUSIONS: Participants described GBV response arrangements that were fragile in stable periods and, in their recollection of previous emergencies, substantially weakened, alongside a smaller set of components that functioned. Emergency preparedness planning would benefit from explicit attention to survivor-centred GBV care; the applicability of these district-level findings elsewhere requires further study.
Health insurance non-enrollment among women in Sierra Leone: A cross-sectional analysis of the 2019 Demographic and Health Survey
(Public Library of Science, 2025-07-31) Osborne, Augustus
BACKGROUND: Health insurance enrollment is a vital component of universal health coverage and access to essential healthcare services. However, in Sierra Leone, enrollment remains persistently low, posing a major public health challenge. Women of reproductive age (15-49 years) represent a critical population for health insurance enrollment due to their unique healthcare needs, particularly related to reproductive health, pregnancy, and childcare. Despite their importance, women face notable barriers to health insurance enrollment, including financial constraints, gender inequalities, and sociocultural challenges. This study examines the factors associated with health insurance non-enrollment among women aged 15-49 in Sierra Leone. METHODS: We analysed data from a weighted sample of 15,574 women aged 15-49 years from the 2019 Sierra Leone Demographic and Health Survey. Percentages were used to present the proportion of health insurance non-enrollment among the women. Multivariable binary logistic regression analysis was used to examine the factors associated with health insurance non-enrollment among the women. RESULTS: The proportion of health insurance non-enrollment among the women was 96.02%. Women with higher education were less likely to be uninsured (adjusted odds ratio \[aOR\]: 0.35, 95% CI: 0.18-0.64) compared to those with no education. Being employed also reduced the odds of being uninsured (aOR: 0.47, 95% CI: 0.36-0.62) compared to women who were employed. Listening to the radio less than once a week was associated with lower odds of being uninsured (aOR: 0.71, 95% CI: 0.53-0.97) compared to women who did not listen to the radio at all. On the other hand, women who reported distance to a health facility as a big problem were more likely to be uninsured (aOR: 2.21, 95% CI: 1.03-4.75) compared to those who did not consider it a problem. Regionally, women living in the Northwestern (aOR: 0.07, 95% CI: 0.03-0.14) and Northern (aOR: 0.28, 95% CI: 0.12-0.66) regions were less likely to be uninsured compared to those residing in the Eastern region. CONCLUSIONS: Health insurance non-enrollment was high among women in Sierra Leone. Education, employment, and exposure to listening to the radio were associated with increased health insurance enrollment, highlighting the need to address socioeconomic barriers and leveraging mass media campaigns to educate women on the importance of getting covered by health insurance. Geographic and regional disparities in health insurance enrollment underscore the importance of improving healthcare accessibility and implementing targeted, community-based interventions to promote health insurance uptake. Also, subsiding health insurance subscription fee could increase its enrollment, especially among women from low socioeconomic households.
Herbal medicine safety awareness among Healthcare Professionals in Freetown Sierra Leone
(African Journals OnLine, 2023-12-12) Osborne, Augustus
**Background:** There is a pressing need to incorporate herbal medicine preventaKve measures into the current pharmacovigilance system, as recent evidence from the World Health OrganizaKon (WHO) shows. However, medical professionals are generally unaware of the relaKve safety of herbal remedies. Therefore, this research aimed to determine the awareness of herbal safety among medical professionals in Sierra Leone. **Methodology:** In this study, we used a cross-secKonal survey of medical staff (n=309) working at three of Freetown, Sierra Leone's, leading medical centers between March and April 2022. The data analysis was performed using StaKsKcal Packages for Social Sciences (SPSS) version 28. We employed descripKve staKsKcs to count instances of a category and assign a percentage. We used a backwards stepwise binary logisKcs regression to find significant associaKons between awareness and predictors at the 5% significance level (p0.05). **Results:** Evidence from the study revealed that around 54.7% of respondents knew about herbal medicine safety. There is an associaKon between the knowledge about drug-herbal interacKon and the level of understanding, average observed risk (AOR) = 1.63; 95% confidence interval (CI): 1.00-2.66; however, no connecKon was found between years of experience and how well-knownherbal remedies are safe, and finally, no associaKon between the various departments and the level of understanding except for the outpaKent department \[Adjusted Odds RaKo (AOR) = 0.49; 95% Confidence Interval (CI):0.25-0.95\]. **Conclusion:** Our findings reveal that medical professionals' knowledge concerning the security of herbal medicine in Freetown, Sierra Leone is unsaKsfactory. Therefore, the regulatory bodies of the various healthcare cadre must promote standardised, coordinated educaKon for all medical personnel to establish an effecKve pharmacovigilance framework for tracking herbal medicaKon.
Inequalities in contraceptive prevalence among married women of reproductive age in Sierra Leone, 2008–2019
(BioMed Central, 2025-06-18) Osborne, Augustus
BACKGROUND: Family planning, through access to safe and effective contraception, empowers women to make informed choices about their reproductive health. It is crucial in reducing unintended pregnancies, maternal mortality, and improving overall well-being. However, achieving equitable access to contraception remains a challenge in many low- and middle-income countries, including Sierra Leone. This study investigated the inequalities in contraceptive prevalence among married women of reproductive age (15-49 years) in Sierra Leone in 2008, 2013 and 2019. METHODS: This study employed time-trend study design utilizing data from three rounds of the Sierra Leone Demographic Health Survey conducted in 2008, 2013, and 2019. The health equity assessment toolkit software, developed by the World Health Organisation, was utilised to calculate various inequality measures. These include simple measures such as difference and ratio, as well as complex measures such as population attributable risk and fraction. RESULTS: The prevalence of contraceptive use among reproductive-aged married women in Sierra Leone increased from 8.2% in 2008 to 21.2% in 2019. The inequality in married women's age in contraceptive prevalence between older and younger women decreased slightly from 7.5 percentage points in 2008 to 7.2 percentage points in 2019. The ratio also decreased, indicating a narrowing gap in contraceptive prevalence between the age groups over time. Inequality in economic status in contraceptive prevalence between married women in the richest and poorest wealth index decreased from 15.7 percentage points in 2008 to 9.9 percentage points in 2019. The population attributable fraction and population attributable risk decreased notably, suggesting that economic status became less of a determinant factor in contraceptive prevalence over time. The educational inequality in contraceptive prevalence between married women with secondary or higher education and those with no education experienced a decline from 16.5 percentage points in 2008 to 12.6 percentage points in 2019. Place of residence inequality in contraceptive prevalence between married women in urban and rural areas decreased from 11.2 percentage points in 2008 to 7.4 percentage points in 2019. Provincial inequality in contraceptive prevalence between married women in the Western area and Northwestern province decreased from 16.7 percentage points in 2008 to 8.6 percentage points in 2019. CONCLUSION: The prevalence of contraceptive use among reproductive-aged married women in Sierra Leone has notably increased over the past decade, accompanied by notable reductions in inequalities across age, economic status, education, place of residence, and geographic provinces. While inequalities persist, the narrowing gaps underscore progress in improving equitable access to contraceptive services. These findings underscore the importance of sustained efforts to address remaining inequalities and further enhance access to family planning resources for all women, particularly those in underserved populations.