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Item 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, ShuoWhole-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) 106587Item The association of diet and physical inactivity with obesity, diabetes, and hypertension among older adults living in Sierra Leone(2024-11-01) Bockarie, TahirIntroduction Cardiovascular diseases (CVDs) are primarily driven by modifiable behavioural risk factors and are the leading cause of death globally. In low- and middle-income countries (LMICs), rapid urbanization and changes in behaviour are exacerbating the burden of CVDs but there is limited research into specific associations with CVDs in older adults in low-income countries, such as Sierra Leone. This study examines the association between behavioural risk factors and their physiological sequalae among adults aged 40 and above in Bo District, Sierra Leone. Methods A cross-sectional study design was used to collect data from 1,978 randomly sampled adults through a household survey. Survey questions were based on the validated WHO STEPs questionnaire. Multivariable logistic regression analysis was performed to determine the associations between behavioural risk factors (such as diet, physical activity, and salt intake) and the presence of hypertension, diabetes, and obesity, adjusting for socio-demographic variables. Results At least one physiological risk-factor for CVD was present in 43.5% of participants. Hypertension was associated with urban living (OR=1.46, 95% CI \[1.41-1.51\]), older age (OR for 80+=3.98, 95% CI \[3.70-4.28\]), insufficient fruit and vegetable intake (OR=1.52, 95% CI \[1.46-1.60\]), and low physical activity (OR=1.35, 95% CI \[1.27-1.43\]). Diabetes was associated with urban residence (OR=1.84, 95% CI \[1.66-2.05\]), older age (OR for 70-79 =3.82, 95% CI \[3.28-4.45\]), low fruit and vegetable consumption (OR=1.61, 95% CI \[1.36-1.90\]), high salt intake (OR=1.34, 95% CI \[1.21-1.49\]), and low physical activity (OR=1.47, 95% CI \[1.26-1.71\]). Obesity was less likely among males (OR=0.37, 95% CI \[0.36-0.38\]) and those aged 80+ (OR=0.39, 95% CI \[0.35-0.43\]). Conclusion This study highlights the need for evidence for targeted public health interventions in Bo District, Sierra Leone. Promoting healthier lifestyles to reduce poor diet, and physical inactivity, particularly in urban areas, could decrease CVD prevalence. Summary What is already known on this topic Cardiovascular diseases (CVDs) are the leading cause of global mortality, with a disproportionate burden in low- and middle-income countries. Modifiable risk factors, including diet and physical inactivity, significantly contribute to CVD prevalence. Limited research exists on the specific associations between these risk factors and CVDs in older adults in Sierra Leone. What this study adds This study provides evidence of significant associations between dietary habits, salt intake, physical activity levels, and physiological risk factors for CVD: hypertension, diabetes, and obesity among adults aged 40 and above in Bo District, Sierra Leone. It quantifies the increased odds of physiological CVD risk factors associated with inadequate fruit and vegetable intake, high salt consumption, and physical inactivity in this population. The study illuminates the links between behavioural and physiological risk factors in the context of rapid urbanisation in Sierra Leone. How this study might affect research, practice or policy These findings will directly inform the development of targeted public health interventions in Sierra Leone, prioritizing the promotion of fruit and vegetable consumption and increased physical activity among adults. The study results will drive policy changes to address urbanisation-related lifestyle factors, including initiatives to improve access to healthy foods and create environments conducive to physical activity. This research establishes a foundation for future studies on CVD risk factors in Sierra Leone, particularly focusing on age- and gender-specific interventionsItem Mpox global emergency: strengthening African leadership(Elsevier BV, 2024-09-20) Abubakar, IbrahimItem Modeling and Implementation of A Teleconsultant Application(RELX Group (Netherlands), 2024) Gassama, BillohItem Long-term physical and mental health outcomes of Ebola Virus Disease survivors in Kenema District, Sierra Leone: A cross-sectional survey(Public Library of Science, 2024-11-04) Bates, Jenna NThe 2013-2016 Ebola Virus Disease (EVD) epidemic in West Africa was the deadliest in history, with over 28,000 cases. Numerous physical and mental health symptoms have been reported in EVD survivors, although there is limited prior research on how the health of survivors compares to the general population. We conducted a survey of EVD survivors in Kenema District, Sierra Leone and a population-based sample of community members who lived in EVD-affected areas but were not diagnosed with EVD, and compared resulting data about self-reported symptoms, duration, and severity between EVD survivors and community members through multivariate regression models. This study found that more than six years after the epidemic, survivors were significantly more likely to experience both physical and mental health symptoms than community members, with respective adjusted incidence rate ratios (IRRs) of 2.65 (95% CI, 2.28-3.09), p < 0.001, and 11.95 (95% CI, 6.58-21.71), p < 0.001. The most highly reported physical health symptoms experienced by EVD survivors were joint pain (75.5%), headaches (67.3%), and vision problems (44.5%), and the most prevalent psychological symptoms were spells of terror and panic (25.5%) and difficulty falling asleep or staying asleep (20.0%). EVD survivors were significantly more likely than community members to report the symptoms as lasting for a longer period, a median of 6.0 (3.0-7.0) years, and with higher severity. The results indicated that six years after the epidemic, EVD survivors in Kenema District, Sierra Leone are experiencing worse physical and mental health than their peers. These findings of the long-term, debilitating health issues following EVD infection should be considered when designing and implementing future epidemic responses.Item Integrating mental health support into secondary school curriculum in sub-Saharan Africa: Challenges and Opportunities(GSC Online Press, 2024-12-20) Dumbuya, EmmanuelMental health issues are increasingly recognized as critical factors affecting adolescents' well-being and academic success. In Sub-Saharan Africa, secondary schools have the potential to play a pivotal role in addressing this challenge. However, efforts to integrate mental health support into school curriculums face several obstacles. This article explores the challenges and opportunities for embedding mental health initiatives into secondary education in the region, offering a framework for sustainable implementation.Item Innovative Approaches to Improve Knowledge of Zoonoses among Wildlife Hunters and Traders in Epe, Lagos, Nigeria: A Community Action Network-Based Intervention(2024-02-29) Cadmus, EniolaThe West Africa One Health project is a multi-country project designed to utilise the One Health approach and deploy the Community Action Networks (CAN) to improve knowledge of high-risk communities on zoonoses. Majority of emerging zoonoses occur at the human-wildlife interface, of which wildlife hunters and traders are critical stakeholders. We assessed the effectiveness of a CAN-based intervention involving the use of a video documentary and case studies as model tools in improving the knowledge of zoonoses among wildlife hunters and traders in Epe, an established hunting community in Lagos State, Nigeria. A quasi-experimental study design involving a total of 39 consenting registered wildlife stakeholders was adopted. A pre-tested, semi-structured, interviewer-administered questionnaire was used to obtain data on the participant’s sociodemographic characteristics, awareness level, and knowledge of zoonoses pre and post CAN-based intervention. Data were analysed using descriptive statistics McNemar and Wilcoxon Signed Ranks tests at a 5% level of significance. The mean age of the participants was 46.7 ± 10.9 years. Most (76.9%) identified as male and had at least secondary education (89.7%). The number of participants who were aware that diseases could be contracted from animals and that it could be through inhalation and close contact increased significantly from 13 (33.3%), 2 (5.1%), and 9 (23.1%) pre-intervention to 37 (94.9 %), 11 (28.2%), and 21 (53.8%) post-intervention, respectively. The overall median knowledge score increased significantly from 1 (Interquartile range (IQR): 0 – 2) pre-intervention to 3 (IQR: 2 – 4) post-intervention. The CAN-based intervention involving the use of a video documentary and case studies as model tools was effective in improving the knowledge of zoonoses among wildlife hunters and traders in the hunting community and may be beneficial for future practice.Item Incidence and prevalence of traumatic and non-traumatic wounds and burns and access to wound care in Sierra Leone; data from a nationwide household survey (PRESSCO) 2020(Elsevier BV, 2024-09-30) Vas Nunes, Jonathan H**Objectives:** This wound section of the PREvalence Study on Surgical COnditions (PRESSCO) determines the incidence and prevalence of wounds and burns in Sierra Leone. It further describes access to wound care and wound-related healthcare-seeking behaviour. **Methods:** Between October 2019 and March 2020, a nationwide cross-sectional household survey was performed. The survey was based on Surgeons OverSeas Assessment of Surgical Need (SOSAS). Additional questions relating to wounds and burns were added. Following randomization, 25 households in 75 clusters were sampled. Severe wounds were clinically examined. **Results:** Of the 3600 individuals included, 143 had developed 151 wounds, including burns (15.2 %) during the year preceding the interview (incidence 4.2 %). A total of 77 people had 83 wounds and burns at the time of the survey (prevalence 2.3 %), of which 23 were severe (prevalence 0.6 %). Burn incidence and prevalence were 0.6 % and 0.1 %, respectively. Most wounds were on extremities (73.5 %), often resulting from cuts (32.8 %), falls (22.4 %), or road traffic accidents (RTA; 16.4 %). Risk factors for developing a wound were male sex (p = 0.004), older age (p = 0.037) and smoking (p = 0.001). Severe wounds had a median duration of 18 months. For 70.2 % of wounds, care at a health facility was sought. Only 49.9 % of households reported financial capacity to visit a secondary health facility. For 56 (37.1 %) of wounds, the desired care was not obtainable. An estimated 44,000 (95 % CI 29,760-67,410) people in Sierra Leone suffer from a severe wound. An estimated 11,000 (95 % CI 6,416-18,268) annual deaths occur due to wounds, predominantly due to RTA's (66.7 %) and accidental injuries (20.0 %). **Conclusions:** Wounds and burns account for an extensive burden on the health and economics of the individual, the household, and the Sierra Leonean society. For over one-third of wounds, the desired surgical care was not obtainable.Item Identifying risk factors for Lassa fever infection in Sierra Leone, 2019-2021(2024-04-12) Sama, Daniel JumaBackground Lassa fever (LF) virus (LASV) is endemic in Sierra Leone and poses a significant public health threat to the region; however, no risk factors for LASV infection have been reported in Sierra Leone. The objective of this study was to identify the risk factors for LASV infection in an endemic community in Sierra Leone. Methods We conducted a case-control study by enrolling 37 laboratory-confirmed LF cases identified through the national LF surveillance system in Sierra Leone, and 140 controls resided within a one-kilometre radius of the case household. We performed conditional multiple logistic regression analysis to identify the risk factors for LASV infection. Results Of the 37 cases enrolled, 23 died (62% case fatality rate). Cases were younger than controls (19.5 years vs 28.9 years, p<0.05) and more frequently female (64.8% vs. 52.8%). Compared to the controls, LF cases had contact with rodents (rats or mice) in their households more frequently in the preceding three weeks (83.8% vs.47.8%). Households with a cat reported a lower presence of rodents (73% vs 38%, p<0.01) and contributed to a lower rate of LF (48.6% vs 55.7%) although not statistically significant (p=0.56). The presence of rodents in the households (Matched Adjusted Odds Ratio \[mAOR\]: 11.1), and younger age (mAOR: 0.99) were independently associated with LASV infection. Conclusion Rodent access to households is likely a key risk factor for LASV infection in rural Sierra Leone and potentially in other countries within the West African region. Controlling rodent access to households might help reduce household-level LASV infection in Sierra Leone.Item Identifying risk factors for clinical Lassa fever in Sierra Leone, 2019–2021(Cambridge University Press, 2024) Sama, Daniel JumaLassa fever (LF) virus (LASV) is endemic in Sierra Leone (SL) and poses a significant public health threat to the region; however, no risk factors for clinical LF have been reported in SL. The objective of this study was to identify the risk factors for clinical LF in an endemic community in SL. We conducted a case–control study by enrolling 37 laboratory-confirmed LF cases identified through the national LF surveillance system in SL and 140 controls resided within a one-kilometre radius of the case household. We performed a conditional multiple logistic regression analysis to identify the risk factors for clinical LF. Of the 37 cases enrolled, 23 died (62% case fatality rate). Cases were younger than controls (19.5 years vs 28.9 years, p < 0.05) and more frequently female (64.8% vs 52.8%). Compared to the controls, clinical LF cases had higher contact with rodents (rats or mice) in their households in the preceding three weeks (83.8% vs 47.8%). Households with a cat reported a lower presence of rodents (73% vs 38%, p < 0.01) and contributed to a lower rate of clinical LF (48.6% vs 55.7%) although not statistically significant (p = 0.56). The presence of rodents in the households (matched adjusted odds ratio (mAOR): 11.1) and younger age (mAOR: 0.99) were independently associated with clinical LF. Rodent access to households and younger age were independently associated with clinical LF. Rodent access to households is likely a key risk factor for clinical LF in rural SL and potentially in other countries within the West African region. Implementing measures to control rodents and their access to households could potentially decrease the number of clinical LF cases in rural SL and West Africa.