School of Medicine
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Item Teenage Pregnant Girls and the Rate of Antenatal Clinic (ANC) Attendance in Bo Town, Sierra Leone(African Journals OnLine, 2017-12-31) Vandi, AhmedTeenage pregnancy is one of the serious Sexual Reproductive Health (SRH) issues in developing countries including Sierra Leone. It is believed that teenage pregnancy in Sierra Leonean communities is becoming a public health problem because it is presently contributing to a lot of health-related issues including maternal and child mortalities, serious maternal complications (e.g. fistulae) among others. This study was a cross-sectional retrospective record review of antenatal registers from January to December 2016 at three functional community health centres in Bo town. These include the Teaching Health Centre at the Korwama location of the Bo Campus- Njala University, the Yemoh Town Community Health Centre and the Police Community Health Centre at the Eastern Police Barracks. It involved the identification of all teenage pregnant girls attending the ANC for the first time, from antennal registers. A total number of 100 teenage pregnant girls were identified in the ANC registers from the three PHUs, focusing on the ages and the gestational periods at the first ANC visit. The study found out that close to 50% of the pregnant teenagers made their first visit at the gestational period very close to the third trimester of the pregnancy. It was also found that 5% of these teenage girls only attended one ANC clinic in the whole pregnant period. In addition, more than 50% of the teenage pregnancies were between the ages of 17 and 18 years. The study also detected that 11% of the victims are pregnant for the second or third time. From this study, is apparent that teenage pregnant girls delay their first visit to the ANC. As such, risks related to the pregnancies will be either detected very late or not detected at all.Item Seroprevalence of HBsAg among Female Patients Seeking Healthcare in Bo Government Hospital, Southern Sierra Leone: 14-Months Database Study(Sciencedomain International, 2014-01-10) Koroma, Mohamed**Background:** Chronic hepatitis B virus (HBV) seroprevalence varies globally but is positively correlated with the prevalence of HIV since both have the same route of transmission-contact with infected body fluids. Sierra Leone has a nascent hepatitis B epidemic and there is a paucity of research data and public health awareness about the infection. Bo where this research is done is the second largest city of Sierra Leone and is the regional headquarters of southern Sierra Leone. **Aim:** To determine the seroprevalence of hepatitis B surface antigen (HBsAg) among female healthcare seekers who used the main government referral hospital in Bo, southern Sierra Leone. **Methodology:** We retrospectively analysed the serological diagnostic results of HBsAg for female healthcare seekers at the Bo Government Hospital. We later determined the HBsAg seroprevalence for various categories of the study subjects; pregnant women, lactating mothers, girls 5-18years and adults >18years for the period under review. Place and Duration of Study: This study is a multicenter investigation conducted at the Bo Government Hospital laboratory, the Departments of Community Health and Clinical Sciences and Environmental Health Sciences at Njala University in Bo southern Sierra Leone. All laboratory diagnostic tests for HBsAg diagnosis were conducted at the Bo Government Hospital laboratories from May 2012 to June 2013. Literature review and data analysis were done at Departments of Community Health and Clinical Sciences and Environmental Health Sciences at Njala University Study Subjects: A total of 2,218 female subjects took part in this investigation; girls 5-18yrs (15.2%), adults females >18yrs (48.9%), pregnant women (17.4%), and lactating women (18.3%). Study subjects were between 5-45yrs; mean age 26yrs; HBsAg+ mean age was 24yrs; HBsAg- mean age was 29yrs. **Results:** One thousand and fifty four (47.5%) of all females who sought healthcare service at the Bo Government Hospital laboratory during the period under review were tested positive for HBsAg; 159(7.1%) pregnant women, 168 (7.5%) lactating mothers, 154 (6.9%) were girls 5-18yrs and 573 (25.8%) were >18yrs. Forty-five percent (154/339) of all girls between 5-18years who took part in this study were HBV seropositive. Discussions: Few independent investigations in Sierra Leone have estimated the national HBsAg seroprevalence at 2.6%-5.1%. One import of this study is the high 154/2218(6.9%) HBsAg seroprevalence rate among girls 5-18 years which can be attributed to multiple sex partners, unsafe sex practice and other socioeconomic and behavioral factors that might have been prevailing during the period under review. The generally high HBsAg seroprevalence rate in our study can also be as a result of our large cohort size and the low sensitivity and specificity of the Rapid Determine diagnostic test kits used in our study compared to previous similar studies conducted in Sierra Leone. **Conclusions:** The high seroprevalence rate of HBsAg among girl between 5-18years in this study emphasizes the need for a robust public health preventive and control measures for HBsAg including HBsAg vaccination, routine blood screening, and safe sex practice as a means of reducing the spread and prevalence of HBV infection in Bo.Item Antiretroviral Medication Adherence During The Ebola Epidemic In Sierra Leone(African Journals OnLine, 2016-12-31) Vandi, AhmedThe 2014 Ebola outbreak is the largest in history and the first in West Africa. The outbreak affected multiple countries in West Africa. Worldwide, there have been 28,639 cases of Ebola virus disease and 11,316 deaths at 13 March 2016 in the world’s worst recorded Ebola epidemic in Guinea, Liberia, and Sierra Leone. In 2002, the National Plan for HIV and AIDS was approved by the Government of Sierra Leone. The Strategic Plan and the associated guidelines included Prevention of Mother-to-Child Transmission (PMTCT) and the provision of Antiretroviral Treatment (ART). During the Ebola outbreak in Sierra Leone, there has been a strong suspicion that people avoided the premises for drug administration such as hospitals, clinics and Community Health Centres. Health care service providers were terrified and reluctant to deliver services at the initial stage of the epidemic because of fear of becoming infected with Ebola, a time when the resources needed to prevent transmission were not available in the country. This study was carried out to establish ART medication adherence during the Ebola outbreak. A cross-sectional study in both the community and institutions was carried out at four locations within Government Hospitals, support groups, and youth service centers. The four sites represented the Western, Southern, Eastern and Northern regions of the country. Semi-structured interviews and focus group discussions were carried out among People Living with HIV & AIDS (PLHA). The study found that 90% of PLHAs missed at least one month’s supply of ARV drugs thus indicating an adherence rate of 10%. The study also established that about 50% of PLHAs on ART failed to collect their drugs due to fear of the mounted checkpoints where temperatures of people were taken or fear of the diseases itself.Item “We and the nurses are now working with one voice”: How community leaders and health committee members describe their role in Sierra Leone’s Ebola response(BioMed Central, 2017-07-18) McMahon, Shannon ABACKGROUND: Across low-income settings, community volunteers and health committee members support the formal health system - both routinely and amid emergencies - by engaging in health services such as referrals and health education. During the 2014-2015 Ebola epidemic, emerging reports suggest that community engagement was instrumental in interrupting transmission. Nevertheless, literature regarding community volunteers' roles during emergencies generally, and Ebola specifically, is scarce. This research outlines what this cadre of the workforce did, how they coped, and the facilitators and barriers they faced to providing care in Sierra Leone. METHODS: Thirteen focus group discussions (FGD) were conducted with community members (including members of Health Management Committees (HMC)) near the height of the Ebola epidemic in two districts of Sierra Leone: Bo and Kenema. Conducted in either Krio or Mende, each FGD lasted an average of two hours and was led by a trained moderator who was accompanied by a note taker. All FGDs were audio recorded, transcribed, and translated into English by the data collection team. Analysis followed a modified framework approach, which entailed coding (both inductive and deductive), arrangement of codes into themes, and drafting, distribution and discussion of analytic summaries across the study team. RESULTS: Community volunteers and HMC members described engaging in labor-related tasks (e.g. building isolation structures, digging graves) and administrative/community-outreach tasks (e.g. screening, contact tracing, and encouraging care seeking within facilities). Through their dual orientation as community members and as individuals linked to the health system, respondents described building community trust and support for Ebola prevention and treatment, while also enabling formal health workers to better understand and address people's fears and needs. Community volunteers' main concerns included inadequate communication with - and a sense of being forgotten by - the health system, negative perceptions of their role within their communities, and concerns regarding the amount and nature of their compensation. DISCUSSION & CONCLUSION: Respondents described commitment to supporting their health system and their communities during the Ebola crisis. The health system could more effectively harness the potential of local responders by recognizing community strengths and weaknesses, as well as community volunteers' motivations and limitations. Clarifying the roles, responsibilities, and remuneration of health volunteers to the recipients themselves, facility-based staff, and the wider community will enable organizations that partner with health committees to bolster trust, manage expectations, and reinforce collaboration.Item Changing Epidemiology of West Africa Ebola Outbreaks 1994-2014(Sciencedomain International, 2015-01-07) Kangbai, Jia BaingaThe severity, epidemic duration and general epidemiology of viral epidemic depends on determinants such as viral strain, ecological, environmental and socioeconomic factors.The West Africa Ebola outbreaks in Guinea, Sierra Leone and Liberia in 2014 and in Ivory Coast, Liberia and Gabon in 1994 were reviewed and compared because of their similarity in terms of their geographic location, proximity to each other, pre-outbreak Preparedness status, mortality, epidemic duration, as well as access to international health aid by the affected countries.Data for this study were obtained from the health ministries of Sierra Leone, Guinea, Gabon and Liberia, the United States Center for Disease Control and Prevention (CDC), the World Health Organisation (WHO) published data on Ebola virus disease outbreaks in Guinea, Liberia, Gabon, and Sierra Leone.Sierra Leone recorded its first confirmed Ebola outbreak in 27th May 2014.Both Guinea and Liberia recorded confirmed Ebola outbreaks in March 2014.The 2014 Ebola outbreak in West Africa has a long epidemic duration compared to the 1994 and 1996 outbreaks in Ivory Review Article Kangbai and Koroma; BJMMR, 6(6): 538-546, 2015; Article no.BJMMR.2015.231539 Coast and Gabon respectively partly because of the misdiagnosis of earlier cases and the poor containment measures of the 2014 Ebola outbreak.Item The 2022 dengue outbreak in Bangladesh: hypotheses for the late resurgence of cases and fatalities(Oxford University Press, 2023-05-18) Haider, NajmulBangladesh reported the highest number of annual deaths (n = 281) related to dengue virus infection in 2022 since the virus reappeared in the country in 2000. Earlier studies showed that >92% of the annual cases occurred between the months of August and September. The 2022 outbreak is characterized by late onset of dengue cases with unusually higher deaths in colder months, that is, October-December. Here we present possible hypotheses and explanations for this late resurgence of dengue cases. First, in 2022, the rainfall started late in the season. Compared to the monthly average rainfall for September and October between 2003 and 2021, there was 137 mm of additional monthly rainfall recorded in September and October 2022. Furthermore, the year 2022 was relatively warmer with a 0.71°C increased temperature than the mean annual temperature of the past 20 yr. Second, a new dengue virus serotype, DENV-4, had recently reintroduced/reappeared in 2022 and become the dominant serotype in the country for a large naïve population. Third, the post-pandemic return of normalcy after 2 yr of nonpharmaceutical social measures facilitates extra mosquito breeding habitats, especially in construction sites. Community engagement and regular monitoring and destruction of Aedes mosquitoes' habitats should be prioritized to control dengue virus outbreaks in Bangladesh.Item Impact of infectious disease epidemics on tuberculosis diagnostic, management, and prevention services: experiences and lessons from the 2014–2015 Ebola virus disease outbreak in West Africa(Elsevier BV, 2016-11-03) Ansumana, RashidThe World Health Organization (WHO) Global Tuberculosis Report 2015 states that 28% of the world's 9.6 million new tuberculosis (TB) cases are in the WHO Africa Region. The Mano River Union (MRU) countries of West Africa-Guinea, Sierra Leone, and Liberia-have made incremental sustained investments into TB control programmes over the past two decades. The devastating Ebola virus disease (EVD) outbreak of 2014-2015 in West Africa impacted significantly on all sectors of the healthcare systems in the MRU countries, including the TB prevention and control programmes. The EVD outbreak also had an adverse impact on the healthcare workforce and healthcare service delivery. At the height of the EVD outbreak, numerous staff members in all MRU countries contracted EBV at the Ebola treatment units and died. Many healthcare workers were also infected in healthcare facilities that were not Ebola treatment units but were national hospitals and peripheral health units that were unprepared for receiving patients with EVD. In all three MRU countries, the disruption to TB services due to the EVD epidemic will no doubt have increased Mycobacterium tuberculosis transmission, TB morbidity and mortality, and decreased patient adherence to TB treatment, and the likely impact will not be known for several years to come. In this viewpoint, the impact that the EVD outbreak had on TB diagnostic, management, and prevention services is described. Vaccination against TB with BCG in children under 5 years of age was affected adversely by the EVD epidemic. The EVD outbreak was a result of global failure and represents yet another 'wake-up call' to the international community, and particularly to African governments, to reach a consensus on new ways of thinking at the national, regional, and global levels for building healthcare systems that can sustain their function during outbreaks. This is necessary so that other disease control programmes (like those for TB, malaria, and HIV) are not compromised during the emergency measures of a severe epidemic.Item Finished Genome Sequence of the Highly Multidrug-Resistant Human Urine Isolate Citrobacter freundii Strain SL151(American Society for Microbiology, 2016-11-04) Łęski, Tomasz A.Citrobacter freundii is a Gram-negative opportunistic pathogen that is increasingly being recognized as a causative agent of hospital-acquired urinary tract infections and an important reservoir of antimicrobial resistance determinants. In this report, we describe the finished genome sequence of C. freundii strain SL151, a highly multidrug-resistant human urine isolate.Item Evaluating the use of cell phone messaging for community Ebola syndromic surveillance in high risked settings in Southern Sierra(Makerere University, 2015-09-09) Jia, KangbaiBACKGROUND: Most underdeveloped countries do not meet core disease outbreak surveillance because of the lack of human resources, laboratory and infrastructural facilities. The use of cell phone technology for disease outbreak syndromic surveillance is a new phenomenon in Sierra Leone despite its successes in other developing countries like Sri Lanka. In this study we set to evaluate the effectiveness of using cell phone technology for Ebola hemorrhagic fever syndromic surveillance in a high risked community in Sierra Leone. OBJECTIVES: This study evaluated the effectiveness of using cell phone messaging (text and calls) for community Ebola hemorrhagic fever syndromic surveillance in high risked community in southern Sierra Leone. METHOD: All cell phone syndromic surveillance data used for this study was reported as cell phone alert messages-texts and voice calls; by the Moyamba District Health Management Team for both Ebola hemorrhagic fever suspect and mortalities. We conducted a longitudinal data analysis of the monthly cumulative confirmed Ebola hemorrhagic fever cases and mortalities collected by both the traditional sentinel and community cell phone syndromic surveillance from August 2014 to October 2014. RESULTS: A total of 129 and 49 Ebola hemorrhagic fever suspect and confirmed cases respectively were recorded using the community Ebola syndromic surveillance cell phone alert system by the Moyamba District Health Management Team in October 2014. The average number of Ebola hemorrhagic fever suspects and confirmed cases for October 2014 were 4.16 (Std.dev 3.76) and 1.58 (Std.dev 1.43) respectively. Thirty-four percent (n=76) of the community Ebola syndromic surveillance cell phone alerts that were followed-up within 24 hours reported Ebola hemorrhagic fever suspect cases while 65.92% (n=147) reported mortality. CONCLUSION: Our study suggests some form of underreporting by the traditional sentinel Ebola hemorrhagic fever disease surveillance system in Moyamba District southern Sierra Leone for August-September 2014. Cell phone messaging technology can be effectively use as a tool for community epidemic surveillance from peripheral health care facilities to higher levels.Item Seroprevalence of hepatitis B surface antigen in urban Bo, Sierra Leone(Medknow, 2017) Jacobsen, Kathryn H.EDITOR –IN – CHIEF J.C Orakwe ASSISTANT EDITORS – IN – CHIEF G.O Udigwe C.O Akosile EDITORIAL SECRETARIAL ASSISTANT O.N Ifediora EDITORIAL BOARD MEMBERS O.O Udemezue C.C Onyenekwe O.C Oguejiofor K.C Oranusi C.I Okafor C.A Akujobi I.V Onyiaorah K.C Eze P.I Adogu E. Ugochukwu EDITORIAL ADVISERS O.O Mbonu F.E Emele J.E \[...\]