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Antiretroviral Medication Adherence During The Ebola Epidemic In Sierra Leone
(African Journals OnLine, 2016-12-31) Vandi, Ahmed
The 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.
Can public education campaigns equitably counter the use of substandard and falsified medical products in African countries?
(Oxford University Press, 2025-01-18) Wagnild, Janelle M
Substandard and falsified (SF) medical products are a serious health and economic concern that disproportionately impact low- and middle-income countries and marginalized groups. Public education campaigns are demand-side interventions that may reduce the risk of SF exposure, but the effectiveness of such campaigns, and their likelihood of benefitting everybody, is unclear. Nationwide pilot risk communication campaigns, involving multiple media, were deployed in Ghana, Nigeria, Sierra Leone, and Uganda in 2020-21. Focus group discussions (n = 73 with n = 611 total participants) and key informant interviews (n = 80 individual interviews and n = 4 group interviews with n = 111 total informants) were conducted within each of the four countries to ascertain the reach and effectiveness of the campaign. Small proportions of focus group discussants (8.0-13.9%) and key informants (12.5-31.4%) had previously encountered the campaign materials. Understandability varied: the use of English and select local languages, combined with high rates of illiteracy, meant that some were not able to understand the campaign. The capacity for people to act on the messages was extremely limited: inaccessibility, unavailability, and unaffordability of quality-assured medicines from official sources, as well as illiteracy, constrained what people could realistically do in response to the campaign. Importantly, reach, understandability, and capacity to respond were especially limited among marginalized groups, who are already at the greatest risk of exposure to SF products. These findings suggest that there may be potential for public education campaigns to help combat the issue of SF medicines through prevention, but that the impact of public education is likely to be limited and may even inadvertently widen health inequities. This indicates that public education campaigns are not a single solution; they can only be properly effective if accompanied by health system strengthening and supply-side interventions that aim to increase the effectiveness of regulation.
Changing Epidemiology of West Africa Ebola Outbreaks 1994-2014
(Sciencedomain International, 2015-01-07) Kangbai, Jia Bainga
The 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.
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, Kangbai
BACKGROUND: 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.
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.
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, Rashid
The 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.
Logics of acquiring medicines from informal retailers in four African countries
(Taylor & Francis, 2025-10-29) Wagnild, Janelle M.
BACKGROUND: In sub-Saharan Africa and other low-income contexts, informal medicine markets are widespread. Understanding the drivers of consumer demand is important, especially given the concerns and risks associated with medicines in the informal sector. OBJECTIVES: This study aims to 1) describe the informal medicine sector in four anglophone African countries, and 2) understand why people patronize informal medicine sellers. METHODS: = 111), in which we discussed where participants got medicines in their communities and underlying reasons. RESULTS: We identified four distinct groups of actors in the informal medicine sector: sellers at weekly markets, itinerant peddlers, roadside sellers, and operators of general provision shops. There were multiple rationales for patronage of informal sellers that varied depending on the context, including flexibility in payment options, convenience and accessibility, and social/cultural drivers. Importantly, there were tradeoffs and tensions between these drivers that participants had to negotiate within the contexts of their current circumstances. CONCLUSIONS: These findings suggest that the informal medicine market is segmented and complex, and that patronage is driven by multiple logics that are rooted in gaps in formal healthcare provision. Regulatory measures therefore need to go hand-in-hand with efforts to address these gaps and expand effective access to quality-assured medicines through \[inter alia\] offering more flexible modes of payment, reducing public-sector medicine stock-outs, and improving patient-physician trust and communication.
Prevalence of markers of HIV infection among febrile adults and children in Bo, Sierra Leone, 2012–2013
(BioMed Central, 2017-11-06) Ansumana, Rashid
OBJECTIVE: The goal of this study was to examine the prevalence of HIV among febrile patients seeking care in Mercy Hospital, Bo, Sierra Leone, in 2012-2013. RESULTS: A total of 1207 febrile persons were tested for HIV with Determine™ and SD Bioline rapid diagnostic tests kits that detect the presence of HIV antibodies and HIV p24 antigens. The overall prevalence of HIV among the tested patients was 8.9%, which is considerably higher than the < 2% prevalence of HIV reported previously in the general population. While these results are not sufficient to prove a causal relationship, the obtained data imply that HIV positive individuals may be more likely to suffer from febrile infectious diseases than individuals without HIV infection. Increasing the availability and use of HIV testing services will allow antiretroviral therapy to be accessed in a timely manner and improve health status among people living with HIV.
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.
Seroprevalence of hepatitis B surface antigen (HBsAg) in Bo, Sierra Leone, 2012–2013
(BioMed Central, 2018-02-08) Ansumana, Rashid
OBJECTIVE: The aim of this study was to determine the prevalence of hepatitis B surface antigen (HBsAg) among febrile individuals tested at Mercy Hospital Research Laboratory (MHRL) in Bo, Sierra Leone. RESULTS: A total of 860 febrile individuals ages 5 years and older were tested by MHRL between July 2012 and June 2013 with a Standard Diagnostics Bioline HBsAg rapid diagnostic test. The overall HBsAg prevalence rate was 13.7%, including a rate of 15.5% among males and 12.6% among females. The HBsAg rate did not differ by child or adult age group (p > 0.5). The prevalence rate in Bo was similar to the 11-15% HBsAg prevalence rates reported in the past decade from other studies across West Africa. Scaling up the infant hepatitis B vaccination program in Sierra Leone will be important for reducing the future burden of disease and premature death attributable to chronic viral hepatitis B disease.
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 \[...\]
Socio-Demographic and Health Characteristics Associated with Maternal Malnutrition Among Pregnant Women in Kenema District, Sierra Leone
(2026-03-19) F., Moiforay W.
This study examines the socio-economic, cultural, and health system characteristics associated with maternal malnutrition among pregnant women in Kenema, Sierra Leone. Using a descriptive cross-sectional design, 127 pregnant women attending antenatal clinics were surveyed between January and July 2025. Data were collected through structured questionnaires administered in local languages and analyzed using descriptive statistics. The findings reveal that poverty is the dominant driver of malnutrition, with 63.8% of respondents earning less than Le5, 000 monthly (approximately \$0.25 USD per day), 75.6% skipping meals due to financial constraints, and 66.1% experiencing hunger during pregnancy. Dietary patterns were heavily carbohydrate-based (90.6%), with limited access to protein and micronutrient-rich foods. Adolescent pregnancy was prevalent (43.4%), and most women were single (72.4%), unemployed, or students. Despite high antenatal care attendance (94.5%) and supplement provision (93.7%), adherence to supplementation and nutrition education remained suboptimal. Cultural and religious food restrictions affected a minority, but poverty overshadowed these as the primary barrier. The study concludes that maternal malnutrition in Kenema is a multidimensional issue requiring integrated interventions that address economic vulnerability, food insecurity, adolescent health, and health system strengthening. These findings provide critical evidence for policymakers and health practitioners designing context-specific nutrition programs in similar low-resource settings.
Teenage Pregnant Girls and the Rate of Antenatal Clinic (ANC) Attendance in Bo Town, Sierra Leone
(African Journals OnLine, 2017-12-31) Vandi, Ahmed
Teenage 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.
The 2022 dengue outbreak in Bangladesh: hypotheses for the late resurgence of cases and fatalities
(Oxford University Press, 2023-05-18) Haider, Najmul
Bangladesh 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.
The effects of bullying behaviours among nursing students in Sierra Leone: a qualitative exploratory study
(BioMed Central, 2024-12-23) Johnson, Jedidah Olayinka
BACKGROUND: Bullying can have profound negative effects on nursing students who often contend with psychological trauma because of repeated acts of mistreatment. This study was done to explore the effects of bullying behaviours among nursing students with above average and below average academic performance in two nursing schools in Sierra Leone. METHODS: A qualitative exploratory study involved six rounds of data collection and analysis over a one month period. 48 nursing students recruited from Njala University School of Nursing and Mattru School of Nursing participated in semi structured interviews. Recruitment was done using a purposive sampling method and students with higher than average and lower than average Grade point average (GPA) were selected to participate in the interviews. Interviews were audiotaped recorded and transcribed verbatim for analysis. An inductive approach with line-by-line coding to identify themes and subthemes was done for the first set of interviews, following this the researchers took a deductive approach to analysis to evaluate if subsequent themes were consistent with initial analysis. RESULTS: Sensitization and apathy were the two broad themes regarding the effects of bullying behaviour demonstrated by students with higher than average and lower than average GPA respectively. Both groups of students had come to accept the inevitability of bullying as nursing students despite the distress it caused them. However, students with lower-than-average GPA also demonstrated resentment and a loss of interest in their studies because of the bullying they had encountered. CONCLUSION: The findings of this study demonstrate that bullying negative affects nursing students regardless of their academic performance. There is an urgent need for policy makers to prioritise the deterrence of bullying of nursing students through implementation of strategies that protect students and punish perpetrators of abuse in nursing schools nationwide.
“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 A
BACKGROUND: 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.