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Start date: 2020Has files: No

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    Whole-genome sequencing and phylogenetic analysis of the first and second confirmed cases of human infection with Monkeypox virus from Sierra Leone
    (Elsevier BV, 2025-08-12) Yu, Shuo
    Whole-genome sequencing and phylogenetic analysis of the first and second confirmed cases of human infection with Monkeypox virus from Sierra LeoneTo the Editor, We read with great interest the letter by Yadav and colleagues, which detailed the need to focus on understanding the evolutionary trajectory of monkeypox virus. 1 The monkeypox virus (MPXV) is genetically classified into four primary clades (Ia, Ib, IIa, IIb).Notably, the newly identified clade Ib has emerged as the dominant strain in the current Public Health Emergency of International Concern (PHEIC), exemplified by the ongoing outbreak in the Democratic Republic of the Congo. 2 Concurrently, global transmission of clade IIb MPXV persists, underscoring that the ongoing epidemic warrants serious attention.On January 10-11, 2025, Sierra Leone released the case reports of its first two human infections with monkeypox virus during the PHEIC, becoming the final member of the Mano River Alliance to document such cases.Here, we present the two case studies with viral sequencing insights, shedding light on MPXV evolution in West Africa.Case 1 was a male in his twenties working as a car dealer who presented to the hospital in early January.He had traveled to Lungi (Port Loko District) from 26 December 2024 to 5 January 2025 (Fig. 1A).Symptom onset occurred on 6 January.Case 2, a male staff at a restaurant over 20 years old, developed symptoms on 6 January and sought hospital care in January.Both of the vesicle samples were confirmed MPXV-positive by real-time PCR using Monkeypox Virus Nucleic Acid Detection Kit at the Molecular Laboratory of 34th Military Hospital in Sierra Leone on January 10 and 11, respectively (Fig. 1A; Fig. S1 in the Appendix).Mean cycle threshold values were 20.29 for Case 1 and 15.14 for Case 2. The patients were admitted to the infectious disease isolation unit and were managed appropriately.Pre-rash symptoms included fever and headache, with rash involvement of the face, palms, and other cutaneous sites (Fig. S2 in the Appendix).Case 2 additionally presented with genital rashes with dysuria.Both patients denied animal/known case exposure, blood transfusions, travel (except for Case 1's documented trip, Journal of Infection 91 (2025) 106587
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    Prevalence and access to care for cardiovascular risk factors in older people in Sierra Leone: a cross-sectional survey
    (BMJ, 2020-09-01) Odland, Maria Lisa
    INTRODUCTION: Prevalence of cardiovascular disease risk factors (CVDRFs) is increasing, especially in low-income countries. In Sierra Leone, there is limited empirical data on the prevalence of CVDRFs, and there are no previous studies on the access to care for these conditions. METHODS: This study in rural and urban Sierra Leone collected demographic, anthropometric measurements and clinical data from randomly sampled individuals over 40 years old using a household survey. We describe the prevalence of the following risk factors: diabetes, hypertension, dyslipidaemia, overweight or obesity, smoking and having at least one of these risk factors. Cascades of care were constructed for diabetes and hypertension using % of the population with the disease who had previously been tested ('screened'), knew of their condition ('diagnosed'), were on treatment ('treated') or were controlled to target ('controlled'). Multivariable regression was used to test associations between prevalence of CVDRFs and progress through the cascade for hypertension with demographic and socioeconomic variables. In those with recognised disease who did not seek care, reasons for not accessing care were recorded. RESULTS: Of 2071 people, 49.6% (95% CI 49.3% to 50.0%) of the population had hypertension, 3.5% (3.4% to 3.6%) had diabetes, 6.7% (6.5% to 7.0%) had dyslipidaemia, 25.6% (25.4% to 25.9%) smoked and 26.5% (26.3% to 26.8%) were overweight/obese; a total of 77.1% (76.6% to 77.5%) had at least one CVDRF. People in urban areas were more likely to have diabetes and be overweight than those living in rural areas. Moreover, being female, more educated or wealthier increased the risk of having all CVDRFs except for smoking. There is a substantial loss of patients at each step of the care cascade for both diabetes and hypertension, with less than 10% of the total population with the conditions being screened, diagnosed, treated and controlled. The most common reasons for not seeking care were lack of knowledge and cost. CONCLUSIONS: In Sierra Leone, CVDRFs are prevalent and access to care is low. Health system strengthening with a focus on increased access to quality care for CVDRFs is urgently needed.
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    Knowledge and understanding of cardiovascular disease risk factors in Sierra Leone: a qualitative study of patients’ and community leaders’ perceptions
    (BMJ, 2020-12-01) Ignatowicz, Agnieszka
    OBJECTIVES: Prevalence of cardiovascular disease risk factors (CVDRF) is increasing, especially in low-income countries. In Sierra Leone, there are no previous studies on the knowledge and the awareness of these conditions in the community. This study aimed to explore the knowledge and understanding of CVDRF, as well as the perceptions of the barriers and facilitators to accessing care for these conditions, among patients and community leaders in Sierra Leone. DESIGN: Qualitative study employing semistructured interviews and focus group discussions. SETTING: Urban and rural Bo District, Sierra Leone. PARTICIPANTS: Interviews with a purposive sample of 37 patients and two focus groups with six to nine community leaders. RESULTS: While participants possessed general knowledge of their conditions, the level and complexity of this knowledge varied widely. There were clear gaps in knowledge regarding the coexistence of CVDRF and their consequences, as well as the link between behavioural factors and CVDRF. An overarching theme from the data was the need to create an understanding and awareness of CVDRF in the community in order to prevent and improve management of these conditions. Cost was also seen as a major barrier to accessing care for CVDRFs. CONCLUSIONS: The knowledge gaps identified in this study highlight the need to design strategies and interventions that improve knowledge and recognition of CVDRF in the community. Interventions should specifically consider how to develop and enhance awareness about CVDRF and their consequences. They should also consider how patients seek help and where they access it.
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    Effects of disruption from COVID-19 on antimalarial strategies
    (Nature Portfolio, 2020-08-17) Ansumana, Rashid
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    Ebola and COVID-19 in Sierra Leone: comparative lessons of epidemics for society
    (Cambridge University Press, 2020-11-01) Richards, Paul
    This case study focuses on two epidemic diseases in Sierra Leone. Ebola in 2014–15 drew international response, but was contained within the Upper West African region. COVID-19 reached Sierra Leone in April 2020 as part of a global pandemic. Local social knowledge has been an important factor in shaping responses to both diseases. In the case of Ebola, infection was concentrated in families, and responders needed a good knowledge of family interactional dynamics. COVID-19 is a more public disease. Responders have to assess risk factors in workplaces, markets, and places of worship. Comparing and contrasting the two cases also draws attention to different aspects of the historical context. Ebola response indexes Sierra Leone’s history as a humanitarian project associated with the abolition of the slave trade. The pandemic challenge of COVID-19 draws attention to Sierra Leone’s nodal position within a global diaspora rooted in Atlantic slavery and emancipation. Responders are forced to consider the ways in which the two infections articulate different aspects of calls for global social justice.
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    The burden of serious fungal infections in Sierra Leone: a national estimate
    (SAGE Publishing, 2021) Lakoh, Sulaiman
    Sierra Leone is a small, resource-limited country that has a low national prevalence of human immunodeficiency virus (HIV) and a very high burden of tuberculosis (TB). Fungal diseases are probably common, but poorly documented. In this article, we reviewed the existing literature on fungal epidemiology in Sierra Leone using national, regional, and international data, identified knowledge gaps, and propose solutions to address the challenges on the prevention and control of fungal diseases in Sierra Leone and similar countries. In advanced HIV disease, we estimate 300 cryptococcal meningitis, 640 Pneumocystis pneumonia, and over 4000 esophageal candidiasis cases annually. Chronic lung disease is common, with an estimated 6000 cases of chronic pulmonary aspergillosis, many mistaken for TB, 5000 adults with allergic bronchopulmonary aspergillosis complicating asthma, and probably over 6600 cases of severe asthma with fungal sensitization. Invasive aspergillosis is estimated at 478 cases. None of these diagnoses are made in Sierra Leone at present. Major burdens are recurrent vulvovaginal candidiasis (85,400) and tinea capitis in children (266,450). Improvement in fungal disease diagnosis in Sierra Leone will enable better estimates to be made and reduce morbidity and mortality.
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    (Re)arranging “systems of care” in the early Ebola response in Sierra Leone: An interdisciplinary analysis
    (Elsevier BV, 2021-07-05) Mayhew, Susannah H
    Despite an expanding literature on Ebola-response, few studies detail or reflect on the responses of diverse systems of care. Little is known about how, why or in what ways, strategies of ill-health management were enacted locally, how health-systems power, authority and hierarchy were perceived and contested, or how other social systems, institutions and relationships shaped the response. This paper presents an interdisciplinary analysis of local responses in two early affected districts in Sierra Leone. Drawing on anthropological theories of social ordering and assemblage, we present an analysis of contrasting infection chains in three extended case studies from Bo and Moyamba districts. In contrast to previous scholarship which has understood local actions as being reactive (supporting or obstructing) to a national Ebola response, we show that local arrangements lead and shape responses. Our cases show how multiple, entangled, dynamic and co-existing systems of care influence these responses. Some individuals and communities collaborated with health authorities on measures like reporting and quarantine, others actively opposed them, or played an intermediary role. Collectively, formal health systems actors, local authorities and ordinary citizens negotiated and enacted new arrangements. These arrangements involved compromise and sometimes power was reconfigured. They were also shaped by wider political and historical contexts and by availability or absence of formal healthcare resources. Our research shows the critical importance of understanding how institutions and people involved in healthcare enact diverse "systems of care" and thereby shape Ebola response. Most importantly, our work underlines the need for alignment between formal health-systems and wider social, cultural, political and economic forms of organisation at family and community levels to improve crisis-response and promote sustainable care. In particular, health systems responders need to identify and engage with key brokers - or arrangers - in frontline care systems, with whom mutually acceptable, and effective, reconfigurations of care can be achieved.
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    OP10 Prevalence and socio-demographic associations of diet and exercise risk-factors for non-communicable diseases in Bo, Sierra Leone
    (BMJ Publishing Group Ltd, 2021-09-01) Bockarie, Tahir
    Background Little is known about modifiable dietary and physical activity risk factors for non-communicable diseases (NCDs) in Sierra Leone. This information is critical to the development of health improvement interventions to reduce the prevalence of these diseases. Methods Adults aged 40+ were recruited from 10 urban and 30 rural sub-districts in Bo. We examined risk factors including: 3 hours daily, 3 hours daily. Multivariable analysis showed that urban individuals were more likely than rural individuals to consume 3hours. Generally, people in lower wealth quintiles had higher odds of any of the risk factors than those in the highest wealth quintile. Conclusion Dietary risk factors for NCDs are highly prevalent, particularly among urban residents in Sierra Leone. Our findings show that forthcoming policies in Sierra Leone need to consider modifiable risk factors for NCDs in the context of urbanisation. This study used data from Cardiovascular Disease (CVD) Risk Factors in Sierra Leone, which was supported by a Small Grant from the Wellcome Trust, grant number 209921/Z/17/Z.
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    No evidence of lymphatic filariasis transmission in Bamako urban setting after three mass drug administration rounds
    (Springer Science+Business Media, 2022-09-06) Coulibaly, Yaya Ibrahim
    Lymphatic filariasis (LF) elimination activities started in Mali in 2005 in the most endemic areas and reached countrywide coverage in 2009. In 2004, the district of Bamako was endemic for LF with a prevalence of 1.5%. The current study was designed to determine LF endemicity level in the urban area of Bamako after three rounds of ivermectin and albendazole mass drug administration (MDA). A cross-sectional study was conducted in 2011 in Bamako city, consisting of human prevalence and entomological surveys. Volunteers aged 14 years and above were invited to participate and tested for evidence of Wuchereria bancrofti using night time blood thick smear microfilarial count and blood spots for LF antibodies using the SD BIOLINE Oncho/LF IgG4 Biplex rapid test (Ov16/Wb123). Mosquitoes were collected using CDC light and gravid traps and tested using molecular methods. Poolscreen software v2.0 was used to estimate vector transmission potential. Of the 899 volunteers, one (0.11%) was found to be positive for LF using the Oncho/LF IgG4 Biplex rapid test, and none was found to have Wuchereria bancrofti microfilariae. No mosquitoes were found infected among 6174 Culex spp. (85.2%), 16 Anopheles gambiae s.l. (An. gambiae s.l.) (0.2%), 26 Aedes spp. (0.4%), 858 Ceratopogonidae (11.8%) and 170 other insects not identified (2.3%) tested. Our data indicate that there was no active LF transmission in the low prevalence urban district of Bamako after three MDA rounds. These data helped the National LF programme move forward towards the elimination goal.