Department of Public Health
Permanent URI for this collectionhttps://dspace.njala.edu.sl/handle/20.500.144402/167
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Item 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.Item 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.Item Knowledge, attitude, and practices of pharmacy professionals in Freetown regarding antibiotic use and antimicrobial resistance(2025-07-01) Kamara, Kadiatu BaiAntimicrobial 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.Item 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.Item Comparative analysis of Aloe vera gel, epidermis, and whole leaf extracts for antimicrobial activity(European Organization for Nuclear Research, 2025-11-01) Fallah, MarkThe 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.Item 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.Item 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 EdwinaMicronutrient 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.Item Design and method considerations for equity-centered implementation science and practice: A PEDALs approach(BioMed Central, 2026-06-22) Wang, Run SherryThe 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.Item 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.