School-wide publications
Permanent URI for this collectionhttps://dspace.njala.edu.sl/handle/20.500.144402/169
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Item Healthcare providers on the frontlines: a qualitative investigation of the social and emotional impact of delivering health services during Sierra Leone’s Ebola epidemic(Oxford University Press, 2016-06-08) McMahon, Shannon AAlthough research on the epidemiology and ecology of Ebola has expanded since the 2014-15 outbreak in West Africa, less attention has been paid to the mental health implications and the psychosocial context of the disease for providers working in primary health facilities (rather than Ebola-specific treatment units). This study draws on 54 qualitative interviews with 35 providers working in eight peripheral health units of Sierra Leone's Bo and Kenema Districts. Data collection started near the height of the outbreak in December 2014 and lasted 1 month. Providers recounted changes in their professional, personal and social lives as they became de facto first responders in the outbreak. A theme articulated across interviews was Ebola's destruction of social connectedness and sense of trust within and across health facilities, communities and families. Providers described feeling lonely, ostracized, unloved, afraid, saddened and no longer respected. They also discussed restrictions on behaviors that enhance coping including attending burials and engaging in physical touch (hugging, handshaking, sitting near, or eating with colleagues, patients and family members). Providers described infection prevention measures as necessary but divisive because screening booths and protective equipment inhibited bonding or 'suffering with' patients. To mitigate psychiatric morbidities and maladaptive coping mechanisms-and to prevent the spread of Ebola-researchers and program planners must consider the psychosocial context of this disease and mechanisms to enhance psychological first aid to all health providers, including those in peripheral health settings.Item Ebola and COVID-19 in Sierra Leone: comparative lessons of epidemics for society(Cambridge University Press, 2020-11-01) Richards, PaulThis 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.Item A mixed-methods investigation to understand and improve the scaled-up infection prevention and control in primary care health facilities during the Ebola virus disease epidemic in Sierra Leone(BioMed Central, 2021-08-31) Ho, Lara Shiu-YiBACKGROUND: The 2014-2015 Ebola epidemic in West Africa became a humanitarian crisis that exposed significant gaps in infection prevention and control (IPC) capacity in primary care facilities in Sierra Leone. Operational partners recognized the national gap and rapidly scaled-up an IPC training and infrastructure package. This prompted us to carry out a mixed-methods research study which aimed to evaluate adherence to IPC practices and understand how to improve IPC at the primary care level, where most cases of Ebola were initially presenting. The study was carried out during the national peak of the epidemic. DISCUSSION: We successfully carried out a rapid response research study that produced several expected and unexpected findings that were used to guide IPC measures during the epidemic. Although many research challenges were similar to those found when conducting research in low-resource settings, the presence of Ebola added risks to safety and security of data collectors, as well as a need to balance research activities with the imperative of response to a humanitarian crisis. A participatory approach that attempted to unify levels of the response from community upwards helped overcome the risk of lack of trust in an environment where Ebola had damaged relations between communities and the health system. CONCLUSION: In the context of a national epidemic, research needs to be focused, appropriately resourced, and responsive to needs. The partnership between local academics and a humanitarian organization helped facilitate access to study sites and approvals that allowed the research to be carried out quickly and safely, and for findings to be shared in response forums with the best chance of being taken up in real-time.Item Human preparedness: Relational infrastructures and medical countermeasures in Sierra Leone(Taylor & Francis, 2022-09-27) Lee, Shona J.This paper examines health worker experiences in two areas of post-epidemic preparedness in Sierra Leone - vaccine trials and laboratory strengthening - to reflect on the place of people in current models of epidemic response. Drawing on ethnographic research and interviews with health workers in the aftermath of Ebola, it explores the hopes and expectations that interventions foster for frontline workers in under-resourced health systems, and describes the unseen work involved in sustaining robust response infrastructures. Our analysis focuses on what it means for the people who sustain health systems in an emergency to be 'prepared' for an epidemic. Human preparedness entails more than the presence of a labour force; it involves building and maintaining 'relational infrastructures', often fragile social and moral relationships between health workers, publics, governments, and international organisations. The COVID-19 pandemic has underscored the value of rethinking human resources from an anthropological perspective, and investing in the safety and support of people at the forefront of response. In describing the labour, personal losses, and social risks undertaken by frontline workers for protocols and practicality to meet in an emergency context, we describe the social process of preparedness; that is, the contextual engineering and investment that make response systems work.Item Surgical Volume in Sierra Leone: A Comparison Between Population and Facility‐Based Data Collection(Springer Science+Business Media, 2025-08-15) Martens, Janine P. J.INTRODUCTION: Surgical volume obtained from health facility records is one of the six indicators proposed by the Lancet Commission on Global Surgery. An alternative approach to assess surgical volume is from household surveys, which might be more suitable for low-income settings. The aim of this study was to describe the annual surgical volume in Sierra Leone through a population-based approach and compare this with health facility data. METHODS: This study is part of the PRESSCO 2020 (PREvalence Study on Surgical COnditions) study, a cross-sectional countrywide descriptive study based on a randomly selected national representative sample. Data on surgeries performed annually, including type and location, were collected through interviews and compared with facility-based data. RESULTS: In total, 10,001 household members were included from 1854 households, who reported 152 major surgical procedures the year preceding the interview. Amounting an annual nation-wide surgical volume of 1520 (95% CI 1300-1780) per 100,000 population. The most common procedures were hernia repairs (30.9%), caesarean sections (23.7%), and appendicectomies (13.8%). The population-based data collection identified 4.1 times more procedures compared with 372 procedures in facility-based study from the same year. CONCLUSION: The substantial difference between population- and facility-based data reveals a likely underreporting in facilities and possible overreporting in the household survey. Interpretation of facility-based surgical volume data should be carried out with caution and rigorous description of methodology is essential for proper interpretation. Independent of the method of data collection, the surgical volume in Sierra Leone is far below the recommended global benchmark. TRIAL REGISTRATION: ISRCTN registry under no 12353489.Item Physical and insecticidal durability of PermaNet® 3.0 and Olyset® plus piperonyl butoxide-synergist insecticide-treated nets in Sierra Leone: results of durability monitoring from 2020 to 2023(BioMed Central, 2025-07-13) Sudoi, Raymond KipropThe performance of two piperonyl butoxide (PBO-synergist) insecticide-treated net (ITN) brands, PermaNet ® 3.0 and Olyset ® Plus, were evaluated under field conditions in two neighboring districts in Sierra Leone over 36 months to estimate median ITN survival, understand insecticidal efficacy, and identify factors influencing ITN durability. This assessment can help guide future PBO-synergist ITN procurement and replacement strategies. This prospective study tracked 370 households and 652 campaign-distributed ITNs from 2020, followed annually for 36 months. Districts were purposefully selected based on shared characteristics. Household surveys were conducted, and 30 ITNs per round were tested for bioefficacy and chemical residue. Key indicators included ITN survival, 24-h mosquito mortality, and chemical content reduction compared to manufacturer targets doses. Cox proportional hazard models identified factors influencing ITN survival. Median useful life was 3.0 (95% CI 2.7–3.5) years for PermaNet ® 3.0 ITNs in Bo and 2.2 (95% CI 2.0–2.4) years for Olyset ® Plus ITNs in Moyamba. PermaNet ® 3.0 ITNs displayed 13% 24-h mortality against pyrethroid-resistant mosquitoes on roof panels, with a 46% reduction in PBO content 34 months post-distribution. Olyset ® Plus ITNs had 3% f24-hour mortality against pyrethroid-resistant mosquitoes, with a 77% reduction in PBO content. Several factors were associated with improved ITN survival, including cohort ITNs from Bo (adjusted hazard ratio \[aHR\] = 0.33, p < 0.001), households without children under five (CU5) (aHR = 0.64, p = 0.003), highest socio-economic status tertile (aHR = 0.63, p = 0.016), exposure to social and behaviour change (SBC) messages combined with positive net attitudes (aHR = 0.63, p = 0.008), lack of food storage in sleeping spaces (aHR = 0.56, p = 0.006), exclusive adult use of ITNs (aHR = 0.72, p = 0.048), net folding when not in use (aHR = 0.67, p = 0.015), and drying nets outside (aHR = 0.44, p = 0.008). ITNs in Bo outperformed those in Moyamba in both physical and insecticidal performance. However, ITN survival is highly context specific, and further investigation into field performance of new ITN types is necessary across diverse epidemiological settings.