Department of Public Health

Permanent URI for this collectionhttps://dspace.njala.edu.sl/handle/20.500.144402/167

Browse

Now showing 1 - 19 of 19

Assessing the Reasons and Adverse Effects of Self-Medication in the Context of the COVID-19 Pandemic in Sierra Leone. A Case Study of Moriba Town Section
(Dove Medical Press, 2024) Moseray, Andrew
**Background:** The impact of COVID-19 pandemic on healthcare resources has led to an increase in self-medication as a coping mechanism. The purpose of the study is to investigate the prevalence of self-medication, the reasons behind it, and its potential consequences during the pandemic. **Methods:** A community-based cross-sectional study was conducted in Moriba Town, Bo City, Southern Sierra Leone. Using a multistage systematic sampling technique, 246 adult participants were selected. Data were collected using Kobo collect electronic platform and analyzed using SPSS version 26.0. **Results:** Out of the 246 adult residents who were sampled, 63 (26%) practiced self-medication. Among them, females (33 or 52%) were more prevalent than males (30 or 48%). The most dominant age groups for self-medication were 38-47 (22 or 35%) and 28-37 (18 or 29%). The major reasons for self-medication were fear of infection (189 or 77%), fear of quarantine (199 or 81%), and stigma (189 or 77%). Delays in treatment (113 or 46%) and unavailability of Covid-19 medications (92 or 37%) were also cited. However, a majority of respondents (162 or 66%) denied the influence of friends or media (168 or 68%) on their decision to self-medicate. Reasons like "delay in receiving treatment" and "influence of friends" showed significant association with self-medication (pValue <0.05). More than half of the respondents 177 (72%) did not practice self-medication before the pandemic. Adverse reactions due to self-medication included skin rashes and blisters 29 (45%) and drowsiness 24 (38%). **Conclusion:** The prevalence of unsupervised medication before and after the pandemic was minimal suggesting little impact of the pandemic. Fear and social stigma were the main drivers for self-medication. To promote safety and informed health decisions, regulatory measures, and awareness campaigns are essential to control unsupervised medication sales, improve drug labeling, and educate the public about the dangers of self-medication.
The Perspectives of Healthcare Professionals on the Strategies, Challenges, and Community Responses to Health System Response and Interventions Towards Lassa Fever Infections and Mortality in Sierra Leone
(Dove Medical Press, 2024-05-01) Kamara, Abu-Bakarr Steven
**Background:** Lassa fever is a critical public health issue in Sierra Leone that demands appropriate health system responses and interventions to mitigate infections and reduce mortality. **Methods:** A qualitative study was conducted to delve into healthcare workers' experiences with Lassa fever management and interventions across diverse healthcare settings in Sierra Leone, including the Eastern Province and Freetown's Directorate of Health Security and Emergency (DHSE). Engaging ten key informants through purposive sampling, the study employed NVivo version 10 for a detailed thematic analysis using Query and Coding to systematically identify, classify, and organize key themes regarding knowledge, diagnostics, management roles, and community impact. **Results:** The findings indicate a well-informed healthcare workforce but highlight gaps in early detection, diagnostic accuracy, and procedural standardization. Concerns were raised about the potential overestimation of disease incidence due to improved diagnostics, suggesting a historical under-detection of Lassa fever. The analysis underscores the need for a multifaceted management approach, emphasizing international collaboration and culturally sensitive community engagement to effectively tackle the disease. A significant concern identified is the high mortality rate resulting from delayed referrals and communication challenges within the health system, leading to actionable recommendations for enhancing Lassa fever response strategies. The study's thematic analysis provides a nuanced understanding of the challenges and areas for improvement, emphasizing the critical role of healthcare professionals in combating Lassa fever. **Conclusion:** Combating Lassa fever in Sierra Leone demands an integrative strategy that extends beyond medical interventions to encompass educational and infrastructural enhancements. This research pays homage to the commitment of healthcare professionals, underscoring the importance of sustained support and recognition of their essential contributions to advancing Lassa fever management and interventions.
Clinical health outcomes of Ebola virus disease survivors eight years post recovery: a cross-sectional study in Sierra Leone
(2024-08-29) Schindell, Brayden G.
**Background:** The West African Ebola virus disease (EVD) epidemic that occurred between 2013-2016 resulted in >28,000 confirmed cases and >11,000 fatalities. Thousands of survivors necessitate an understanding of the long-term health effects and future medical needs of these patients. **Methods:** =998). An in-person survey conducted between November 2021 and March 2022 included demographics, clinical health symptomology assessment of each organ system and a reproductive health assessment including sexual dysfunction question sets. The frequency of each disorder was examined and the association of each disorder with EVD survival was assessed. **Results:** Of 12 number of symptom types, five were reported by >50% of EVD survivors (Ocular, Neurological, Constitutional, Genitourinary, Dermatological), and all but one were reported by >40% of EVD survivors. Symptom types associated with EVD survival included ENT symptoms (AOR: 8.75, 95% CI: 5.63 - 13.60, p < 0.001), ocular symptoms (AOR: 7.18, 95% CI: 5.02 - 10.25, p < 0.001), dermatological symptoms (AOR: 4.16, 95% CI: 3.06 - 5.65, p < 0.001) and cardiovascular symptoms (AOR: 2.96, 95% CI: 2.12 - 4.13, p < 0.001). **Conclusion:** The West Africa EVD epidemic resulted in a high prevalence of persistent health issues among disease survivors. Continued support for survivor services in West Africa is crucial, and future outbreak response planning should include dedicated funding to ensure adequate care for survivors, both during the acute phase of infection and throughout the post recovery period.
Ancient evolutionary origins of hepatitis E virus in rodents
(National Academy of Sciences, 2024-12-09) Jo, Wendy K.
copies/g. We recovered 24 near-complete hepeviral genomes from rodents, shrews, and bats, all showing three partially overlapping open reading frames (ORFs), some including putative late domains that may be associated with quasi-envelopment. Rodent-derived hepeviruses grouped into five clades clustering in basal sister relationship to human- (31 to 84% distance in translated ORF1-3) and rat-associated HEV. Parsimony-based analyses and cophylogenetic reconciliations revealed that rodents were predominant sources of hepeviral cross-order host shifts. Bayesian ancestral state reconstructions substantiated a direct origin of human-associated HEV in ungulates such as swine and camelids (posterior probability 0.8), whereas the nonrecent evolutionary origins of human- and ungulate-associated HEV were projected to rodent hosts (posterior probability > 0.9). Our results elucidate the genealogy of human HEV and warrant increased surveillance and experimental risk assessments for rodent-associated hepeviruses.
Public health system in post-pandemic Sierra Leone: a scoping review
(BioMed Central, 2024-12-21) Kangbai, Jia Bainga
BACKGROUND: Since the outbreak of the novel SARS-CoV-2 that caused COVID-19 in 2019, the government of Sierra Leone implemented immediate preventive measures to stop the disease from entering the country. On March 24, 2020, the country declared a state of emergency in response to the emerging global COVID-19 pandemic, even though no confirmed cases had been reported at that time. However, Sierra Leone recorded its first COVID-19 case later in March 2020. While there have been few scoping reviews to date, these primarily focuses on experiences from Western countries or expatriates. The main purpose of this scoping review is to document the various COVID-19 pandemic preparedness measures undertaken by the Sierra Leone health system, assess the impacts of the pandemic on health systems, and document the various responses of health systems implemented across different settings from a home-based perspective. METHODS: We searched peer-reviewed papers and articles under review or submitted for publication in Sierra Leone and the COVID-19 pandemic found in the Web of Science, Scopus, Pubmed, Google Scholar, MedRxiv, and Research Square databases. In addition, we examined gray literature, including Sierra Leone government reports and academic unpublished works on Sierra Leone's COVID-19 situation. Both quantitative and qualitative studies were analyzed, focusing on the Sierra Leone health system or on the essential health services provided by the Sierra Leone health system during the COVID-19 pandemic. RESULTS: Few (48.7%) studies were multi-country studies (i.e., involving different countries and Sierra Leone). The majority (83.7%) were original articles published either in peer-reviewed journals or were deposited in preprint repositories; 10.9% were editorials, commentaries, or news reports; 1 (2.7%) was a working paper; and 1 (2.7%) was personal correspondence. CONCLUSION: Sierra Leone's health system was partially prepared for the COVID-19 pandemic, largely due to its previous experience in managing the Ebola virus disease outbreaks from 2013 to 2016. However, the pandemic had significant impact on other health services. Although the country's response to the pandemic was swift, it fell below average in addressing the scale of the challenges posed by the crisis.
EPIDEMIOLOGY: UNDERSTANDING DISEASE PATTERNS AND PUBLIC HEALTH
(Lippincott Williams & Wilkins, 2025-05-01) Munu, Alpha Jose
**Objective:** This study evaluates the scientific principles and practical applications of epidemiology in understanding the patterns and determinants of health and disease within populations. The focus is on advancing methodologies to monitor, prevent, and control health threats while addressing global health disparities Design and method: A mixed-methods approach was utilized, combining a review of epidemiological literature with case studies to highlight the application of different study designs cohort, case-control, and cross-sectional studies. Quantitative tools, including incidence and prevalence metrics, odds ratios, and relative risks, were employed to assess disease burden and risk factors. Data sources ranged from population-based health surveys to real-time surveillance systems, with statistical modeling used to predict trends and outcomes. Emphasis was placed on ethical considerations and the integration of modern technologies like GIS mapping and machine learning in epidemiological research. **Results:** Epidemiology has proven pivotal in addressing global health challenges. Vaccination programs informed by epidemiological studies eradicated smallpox and significantly reduced the incidence of polio and measles worldwide. Chronic disease epidemiology has revealed strong associations between lifestyle factors, such as smoking and diet, with conditions like cardiovascular diseases and diabetes, enabling targeted prevention strategies. Moreover, during the COVID-19 pandemic, epidemiological surveillance and modeling provided the basis for public health interventions such as lockdowns, vaccination prioritization, and resource allocation. **Conclusions:** Epidemiology remains a cornerstone of public health, underpinning efforts to mitigate disease risks, enhance health equity, and respond to emerging health threats. Future advancements, including the application of big data analytics and artificial intelligence, promise to enhance the precision and efficiency of epidemiological studies. Strengthened interdisciplinary collaborations and global partnerships are essential for addressing complex health challenges and achieving sustainable health improvements.
Clinical and epidemiological characteristics among probable and confirmed patients with mpox in Sierra Leone reported from January to May 2025
(2025-06-01) Kangbai, Jia Bainga
We analyzed available mpox cases reports in Sierra Leone from January to June 2025 following a historic increase in mpox cases across multiple urban and rural regions in the country. Here, we assessed demographic and clinical data from 187 case reports. Mpox case reports in this study were primarily from Bo (86/187; 46.0%) and Freetown (48/124; 25.7%). Most case reports were from male patients (101/187; 54.0%) as compared to females (86/187; 46.0%), with an overall median age of 26 years (IQR 22-34). The median age was higher among males (30 years; IQR 25-39) then females (24 years; IQR 21-27). Rash, fever, headache, lesions, and generalized pain were reported for all patients, where data was reported. Lymphadenopathy, muscle pain, sore throat, and cough were reported less commonly. Age- and sex-specific interventions, as well as community engagement that includes historically stigmatized groups are critical for mpox containment and mitigation measures in Sierra Leone.
Mpox in Africa: What we know and what is still lacking
(Public Library of Science, 2025-06-12) Kangbai, Jia Bainga
Emerging as a major global health threat, Mpox previously known as Monkeypox has drawn attention due to a worrying surge in cases. This zoonotic disease, native to Central and West Africa, is marked by fever, rash, and lymphadenopathy and is primarily spread through direct contact with infected animals or people and indirectly through contaminated objects. Recent studies have indicated possible sexual transmission, underscoring how human behavior and environmental changes are increasing its prevalence, even though human-to-human transmission is less efficient than that of smallpox. Mpox is endemic in several African countries, and currently, the infection has spread in non-endemic countries, including Rwanda, Uganda, and Kenya. Democratic Republic of Congo is the epicenter of the current Mpox outbreak. From January 1, 2022, to August 6, 2024, sixteen African countries reported Mpox outbreak. Several factors, including population immunity deficiencies and changes to the environment and ecology, have led to the widespread of Mpox in Africa. Challenges such as the fragile healthcare system, limited vaccine availability and access, weak surveillance, and low public awareness poses difficulty in containing the infection in affected countries. Given the potential of Mpox to disrupt several sectors including health systems, which may ultimately reverse progress in achieving the sustainable development goals by 2030. It is imperative for countries, both within and outside Africa, to extend financial aid and human resources to combat the infection effectively.
Use of minimally invasive tissue sampling to determine the contribution of diarrheal diseases to under-five mortality and associated co-morbidities and co-infections in children with fatal diarrheal diseases in Africa and Bangladesh
(Public Library of Science, 2025-06-25) Mutevedzi, Portia Chipo
Achieving the Sustainable Development Goal of reducing child mortality to <25 deaths per 1000 live births by 2030 requires strategies to prevent diarrheal disease-related morbidity and mortality. Accurate etiological diagnosis is essential. This study used postmortem diagnostics to investigate the contribution of diarrhea to under-5 mortality and examine co-morbidities and co-infections in Africa and South Asia. Child Health and Mortality Prevention Surveillance (CHAMPS) generates data on child deaths through minimally invasive tissue sampling, clinical record review, and verbal autopsies. Multidisciplinary panels assign cause(s) of death using WHO International Classification of Diseases. This analysis included deaths among children aged 1-59 months enrolled from 18 December 2016-31 December 2023 across six African sites (Ethiopia, Mali, Kenya, Sierra Leone, Mozambique, South Africa) and Bangladesh. Of 1517 deaths assessed, diarrhea was in the causal pathway in 240 (15.8%). The proportion of diarrhea-related deaths was highest in Ethiopia (41.0%, 34/83), followed by Bangladesh, (30.0%, 3/10), Mozambique (21.7%, 56/258), Mali (17.5%, 18/103), Kenya (13.9%, 51/366), Sierra Leone (12.8%, 46/358), and South Africa (9.4%, 32/339). Diarrhea was underlying cause in 44.2% (106/240) of cases and immediate/antecedent cause in 58.3% (140/240), with some deaths involving multiple roles in the causal chain. When diarrhea was underlying cause, sepsis (33.0%) and lower respiratory infections (25.5%) were common downstream conditions; when an antecedent/immediate cause, leading underlying causes were malnutrition (64.3%) and HIV (13.6%). No pathogen was identified in 49.6% (119/240) of diarrhea-related deaths; among these, diarrhea was underlying cause in 42.9%. Among the 121 pathogen-attributed deaths, the most frequent were EAEC (34.7%), typical EPEC (15.7%), Shigella/EIEC (14.0%), ST-ETEC (12.4%), rotavirus (26.4%), and adenovirus (non-40/41: 19.0%; 40/41: 5.0%). These pathogens were frequently identified as co-infections. Diarrheal disease accounted for a substantial share of child deaths across CHAMPS sites. Reducing mortality will require preventing diarrhea and addressing key contributors such as malnutrition and HIV.
Knowledge, attitude, and practices of pharmacy professionals in Freetown regarding antibiotic use and antimicrobial resistance
(2025-07-01) Kamara, Kadiatu Bai
Antimicrobial resistance, a growing global public health concern, is a growing issue affecting pharmacy professionals and patients. The WHO estimates that bacterial antimicrobial resistance led to 4.95 million deaths worldwide in 2019 and could lead to \$1 trillion in increased healthcare expenses by 2050. Pharmacy vendors, including pharmacists and non-pharmacists, play a crucial role in the fight against antimicrobial resistance, but there is low knowledge about antibiotic use and antimicrobial resistance among pharmacy professionals. This study aimed to assess the knowledge, attitude, and practices of pharmacy professionals regarding antibiotic use and antimicrobial resistance, finding that respondents had significant misconceptions about antimicrobial resistance and varied dispensing practices. Data collection was done using a 35-item online questionnaire, and sampling was done using a random sampling method. Excel 2016 was used for analysis, using a mixed method approach (qualitative and quantitative). Factors such as market competition, work experience, education levels, and attitude scores influenced practice scores. Further training and monitoring are needed to address antimicrobial resistance.
Generation Z and the changing epidemiology of the African Mpox outbreak
(Springer Nature, 2025-08-14) Kangbai, Jia Bainga
Introduction Mpox (formerly known as monkeypox) has re-emerged as a major global public health threat. The Mpox virus, which was previously confined to remote rural settlements, especially in Africa, has been spreading in urban populations. Sierra Leone became the latest country to confirm an Mpox outbreak on January 10, 2025. Since the global Mpox outbreak started in May 2022, over 142,151 laboratory-confirmed cases and 328 deaths have been reported from 133 countries as of May 2025. Africa alone accounted for most of the confirmed cases and deaths. Epidemiology and clade mutation of Mpox Mpox epidemiology has evolved, with two distinct viral clades: clade 1 (Central African) and clade 2 (West African). Both clades exhibit different virulence, transmissibility, and geographic spread. Recently, there has been a notable shift in Mpox epidemiology and transmission dynamics. Specifically, there has been an increase in the number of Mpox cases among commercial sex workers and immunocompromised people. Sexual transmission of Mpox Sexual transmission of Mpox, particularly among Generation Z individuals born between the early 1997 and 2012 poses additional challenges, exacerbating stigma and delaying treatment. Conclusion Children under 15 years have become increasingly affected, accounting for 75% of cases in the Democratic Republic of Congo. Effective Mpox containment requires heightened surveillance, cross-border collaboration, improved vaccination strategies, and education to address stigma and misclassification. The evolving epidemiology of Mpox underscores the need for robust public health responses to mitigate its global impact.
Comparative analysis of Aloe vera gel, epidermis, and whole leaf extracts for antimicrobial activity
(European Organization for Nuclear Research, 2025-11-01) Fallah, Mark
The study examines the antimicrobial potential of ethanolic extracts from Aloe vera gel, epidermis, and whole leaf, using Thin Layer Chromatography. Aloe vera, a plant with medicinal and cosmetic properties, is gaining popularity due to its anti-inflammatory, antimicrobial, and wound healing properties. Its natural health benefits are particularly important in the context of antibiotic infections. The study extracted Aloe vera gel, epidermis, and leaf from 90% ethanol and air-dried for analysis. The extracts were screened for alkaloids, flavonoids, saponins, and terpenoids, and tested for antimicrobial activity. The gel extract showed no significant inhibition zones against all organisms, while the epidermis extract was most effective against Escherichia coli. This supports the therapeutic potential of Aloe vera epidermis as a natural antimicrobial agent. Further research is needed to determine Aloe vera's antimicrobial properties as a single active component, isolate and purify it, evaluate its activity in live creatures, and compare dried extracts.
Assessment of Hepatitis B Surface Antibody Levels and Post-Vaccination Immunity among Healthcare Workers in Rural Hospitals in Bo District, Sierra Leone
(2026) Zoker, Exton Mohamed
Hepatitis B virus (HBV) infection is a major occupational hazard among healthcare workers (HCWs), particularly in sub-Saharan Africa, where high endemicity and low vaccination coverage increase transmission risk.
Screening and Seroprotection against Hepatitis B among Healthcare Workers in Rural Healthcare Facilities in Bo District, Sierra Leone
(2026) Zoker, Exton Mohamed
Hepatitis B virus (HBV) infection remains a major occupational hazard among healthcare workers (HCWs), particularly in sub-Saharan Africa, where high endemicity, low vaccination coverage, and inadequate occupational health systems increase the risk of transmission. Sierra Leone is a highly HBV-endemic country, yet comprehensive information on the serological status of HCWs in rural healthcare settings remains limited. This study assessed the HBV serological profiles, vaccination status, and occupational determinants of HBV infection among HCWs at Bo Government Hospital and Mercy United Methodist (UMC) Hospital in Bo District, Sierra Leone. An analytical cross-sectional study was conducted among 296 HCWs selected through proportionate stratified random sampling, including 267 from Bo Government Hospital and 29 from Mercy UMC Hospital. Data were collected using a structured questionnaire covering socio-demographic characteristics, professional cadre, occupational exposure, duration of employment, and HBV vaccination history. Venous blood samples were analyzed using chemiluminescence immunoassay (CLIA) on the MAGLUMI 4000 Plus platform for HBsAg, total anti-HBc, and anti-HBs. Data were analyzed using descriptive statistics and Pearson’s chi-square test at a 5% significance level. The findings showed substantial occupational vulnerability to HBV infection. Overall, 64.5% (n = 191) of HCWs were susceptible to infection, 10.8% (n = 32) had active HBV infection, 10.8% (n = 32) had naturally acquired immunity following previous infection, and only 13.9% (n = 41) had vaccine-induced immunity. Vaccination coverage was critically low, with 75.7% (n = 224) reporting no previous HBV vaccination and only 18.9% (n = 56) having completed the recommended three-dose schedule. All HBsAg-positive cases occurred among unvaccinated or partially vaccinated HCWs. HBsAg prevalence increased significantly with duration of employment, from 4.5% among HCWs employed for less than one year to 6.7% among those with one to five years of service and 14.8% among those employed for more than five years (χ² = 8.94, p = 0.003), demonstrating cumulative occupational risk. Although females had a slightly higher HBsAg prevalence than males (11.8% vs. 9.3%), comparable infection rates among State Registered Nurses indicated that professional role, rather than biological sex, was more important in explaining occupational risk. The study demonstrates a critical gap in occupational HBV protection among HCWs in rural Bo District, characterized by high susceptibility, low vaccination uptake, inadequate vaccine-induced immunity, and continued occupational exposure. The findings highlight the urgent need for mandatory pre-employment HBV screening, universal vaccination of HCWs, routine post-vaccination serological testing, strengthened infection prevention and control measures, and effective institutional occupational health policies. These interventions are essential for protecting HCWs and supporting HBV elimination strategies in Sierra Leone and other high-endemic, resource-constrained settings.
A Decade of Progress: Description of Ebola Vaccination Strategy and its Associated Factors in Sierra Leone
(RELX Group (Netherlands), 2026) Kangbai, Desmond M.; Kangbai, Desmond M.
Background The 2013-2016 Ebola virus disease outbreak in West Africa profoundly affected Sierra Leone’s health financing, health delivery, health governance, and health workforce. The country becomes the first among those most severely affected ten years ago by the West Africa Ebola outbreak, to launch nationwide preventive Ebola vaccination, targeting 20,000 frontline workers who received a single dose of the Ebola Vaccine. Methods A mixed-method study design that analysed administrative vaccination data, field supervision reports, and electronic records from all 16 districts in Sierra Leone was used. The following indicators were analysed: vaccination coverage and logistical regression. Qualitative information from stakeholder debriefings and community feedback complemented the findings from the quantitative analysis. Quantitative data were analysed using Statistical Package for the Social Sciences (SPSS) version 27. Results A total of 17,454 (vaccine coverage= 84.5%) frontline workers and high-risk populations for EVD infection were vaccinated. Healthcare workers accounted for 35% of all vaccinations. Multivariate analysis showed that females had an AOR of 1.507 (95% CI: 1.293-1.756, P < 0.001) and individuals with tertiary education had an AOR of 1.900 (95% CI: 1.371-2.633, P < 0.001), were more likely to be vaccinated. Western and Southern regions achieved the highest coverage due to superior cold-chain readiness and community mobilisation. No serious adverse events following immunisation were reported. Conclusion Sierra Leone’s decade-long journey from outbreak response to preventive vaccination demonstrates the transformative impact of sustained investment, multisectoral coordination, and community trust. High coverage and operational success affirm the feasibility of nationwide Ebola immunisation in resource-limited settings.
Integrated Determinants of Maternal Healthcare Decisions: A Cross-Sectional Analysis of Predisposing, Enabling, and Illness-Level Factors in Bo District, Sierra Leone
(Elsevier BV, 2026-06-18) Viah, Rennie
**Background:** Maternal and child outcomes in Sierra Leone continue to reflect rural–urban inequities in access to care and timely healthcare-seeking. Understanding how predisposing, enabling, and illness-level determinants interact across settings is essential for explaining these disparities. **Objectives:** To examine how predisposing, enabling, and illness-level factors influence maternal and child healthcare-seeking decisions in Bo District, and to quantify rural–urban differences in these determinants. **Methods:** We conducted a facility-based cross-sectional study among 500 women attending antenatal, postnatal, or child health services at an urban tertiary hospital and a rural maternity facility. Descriptive statistics summarized participant characteristics. Rural–urban differences were assessed using Pearson’s chi-square tests, odds ratios with 95% confidence intervals, Mann–Whitney U tests for ordinal outcomes, and Cramér’s V to estimate effect sizes. **Findings:** Predisposing influences on maternal healthcare-seeking were ubiquitous (97.4%), with knowledge and health awareness most frequently reported. Predisposing influences didn’t differ by residence; however, cultural factors were significantly prominent among rural women (p = 0.004; Cramér’s V = 0.14). Enabling factors showed the strongest rural–urban differentiation, with small-to-moderate effect sizes. Urban respondents more often reported health insurance coverage, financial stability, proximity to facilities, and transportation availability, whereas rural respondents more frequently reported traditional social, language, and communication support, perceived infrastructure adequacy, preventive service availability, and community engagement. Pregnancy-/childbirth-related complications were common (68.2%) and didn’t differ by residence; however, the perceived influence of illness on care-seeking differed significantly between settings (p < 0.001; Cramér’s V ≈ 0.21). For childcare-seeking, knowledge and awareness were foundational across settings, while financial protection and prior healthcare experience exerted greater influence among urban caregivers. **Conclusions:** Rural–urban differences in maternal and child healthcare-seeking in Bo District appear driven less by awareness or illness occurrence and more by context-specific enabling conditions and differences in how illness is interpreted and acted upon.
Design and method considerations for equity-centered implementation science and practice: A PEDALs approach
(BioMed Central, 2026-06-22) Wang, Run Sherry
The persistent "know-do gap"-the lag between the development of evidence-based practices (EBPs) and their routine use in health systems-remains a barrier to achieving global health equity. Implementation science offers a pathway to bridge this gap, but without an explicit equity focus, it risks reinforcing existing disparities. In this perspective, we propose an equity-centered adaptation of the PEDALs model (Problem, Evidence-based practice, Determinants, Action, Long-term use, and scale) to guide more just and context-sensitive implementation efforts in global health. We describe how each stage of PEDALs can be used to embed equity considerations in implementation research and practice. These include identifying root causes of inequity-linked health problems (P), using both scientific and practice-based evidence while adapting or de-implementing interventions (E), engaging marginalized voices when analyzing barriers and facilitators (D), co-designing contextually grounded implementation strategies (A), and measuring long-term implementation outcomes through an equity lens (L), including attention to scalability, iterative learning, and proper design and methods (s). We highlight methodological considerations-such as hybrid designs, embedded and workflow-based research, and rapid and participatory methods-that support timely, relevant, and equitable implementation. Our model builds on the concept of "radical incrementalism" to emphasize steady, equity-driven change that is responsive to diverse settings, especially in low- and middle-income countries. This modified PEDALs-based approach offers a practical structure for design and methodological considerations in advancing equity-centered implementation science.
Effects of Small-scale Processing on Shelf Life, Vitamin A Retention, and Sensory Acceptability of Mango, Orange-fleshed Sweet Potato, and Pumpkin in Northern Sierra Leone
(Sciencedomain International, 2026-07-16) Koroma, Beatrice Edwina
Micronutrient deficiency, particularly vitamin A deficiency, persists among women and young children in rural Sierra Leone despite the local availability of nutrient-rich indigenous foods, whose dietary contribution is constrained by extreme seasonality, high perishability, and low acceptability of raw forms. This study evaluated how simple, community-level processing affects the vitamin A content, shelf life, and sensory acceptability of three locally available species — mango (Mangifera indica), orange-fleshed sweet potato (OFSP; Ipomoea batatas), and pumpkin (Cucurbita spp.) — in Bombali and Tonkolili Districts, Northern Sierra Leone. The core process was controlled low-temperature drying (solar and cabinet) of all three species into shelf-stable snacks; two blended products were additionally formulated, namely mango juice and a pumpkin–mango purée intended as a complementary food, which is why two final products were derived from three raw materials. Shelf life was defined as the number of days a product remained organoleptically acceptable under ambient storage. Vitamin A content was estimated from food-composition baselines adjusted by published nutrient-retention factors; acceptability was rated by a community sensory panel on 5-point and 9-point hedonic scales, and qualitative data from focus group discussions and key-informant interviews were analysed thematically. Processing extended mean shelf life more than tenfold (6.1 to 66.4 days) while reducing estimated mean vitamin A by 12.1% (701 to 616 µg). Acceptability rose significantly for all three product types (p < 0.001; Cohen’s d = 0.32–0.37), and the two final products achieved high willingness-to-consume (mango juice 78%; purée 64%). The large gains in availability and acceptability outweigh the modest vitamin A loss; because the loss was sensitive to drying conditions, controlled low-temperature drying could narrow it further. These findings support embedding low-cost processing in nutrition programming for vulnerable rural populations.
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.