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    “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.
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    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.
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    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.
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    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.
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    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.