Department of Public Health
Permanent URI for this collectionhttps://dspace.njala.edu.sl/handle/20.500.144402/167
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Item The Perspectives of Healthcare Professionals on the Strategies, Challenges, and Community Responses to Health System Response and Interventions Towards Lassa Fever Infections and Mortality in Sierra Leone(Dove Medical Press, 2024-05-01) Kamara, Abu-Bakarr Steven**Background:** Lassa fever is a critical public health issue in Sierra Leone that demands appropriate health system responses and interventions to mitigate infections and reduce mortality. **Methods:** A qualitative study was conducted to delve into healthcare workers' experiences with Lassa fever management and interventions across diverse healthcare settings in Sierra Leone, including the Eastern Province and Freetown's Directorate of Health Security and Emergency (DHSE). Engaging ten key informants through purposive sampling, the study employed NVivo version 10 for a detailed thematic analysis using Query and Coding to systematically identify, classify, and organize key themes regarding knowledge, diagnostics, management roles, and community impact. **Results:** The findings indicate a well-informed healthcare workforce but highlight gaps in early detection, diagnostic accuracy, and procedural standardization. Concerns were raised about the potential overestimation of disease incidence due to improved diagnostics, suggesting a historical under-detection of Lassa fever. The analysis underscores the need for a multifaceted management approach, emphasizing international collaboration and culturally sensitive community engagement to effectively tackle the disease. A significant concern identified is the high mortality rate resulting from delayed referrals and communication challenges within the health system, leading to actionable recommendations for enhancing Lassa fever response strategies. The study's thematic analysis provides a nuanced understanding of the challenges and areas for improvement, emphasizing the critical role of healthcare professionals in combating Lassa fever. **Conclusion:** Combating Lassa fever in Sierra Leone demands an integrative strategy that extends beyond medical interventions to encompass educational and infrastructural enhancements. This research pays homage to the commitment of healthcare professionals, underscoring the importance of sustained support and recognition of their essential contributions to advancing Lassa fever management and interventions.Item Public health system in post-pandemic Sierra Leone: a scoping review(BioMed Central, 2024-12-21) Kangbai, Jia BaingaBACKGROUND: Since the outbreak of the novel SARS-CoV-2 that caused COVID-19 in 2019, the government of Sierra Leone implemented immediate preventive measures to stop the disease from entering the country. On March 24, 2020, the country declared a state of emergency in response to the emerging global COVID-19 pandemic, even though no confirmed cases had been reported at that time. However, Sierra Leone recorded its first COVID-19 case later in March 2020. While there have been few scoping reviews to date, these primarily focuses on experiences from Western countries or expatriates. The main purpose of this scoping review is to document the various COVID-19 pandemic preparedness measures undertaken by the Sierra Leone health system, assess the impacts of the pandemic on health systems, and document the various responses of health systems implemented across different settings from a home-based perspective. METHODS: We searched peer-reviewed papers and articles under review or submitted for publication in Sierra Leone and the COVID-19 pandemic found in the Web of Science, Scopus, Pubmed, Google Scholar, MedRxiv, and Research Square databases. In addition, we examined gray literature, including Sierra Leone government reports and academic unpublished works on Sierra Leone's COVID-19 situation. Both quantitative and qualitative studies were analyzed, focusing on the Sierra Leone health system or on the essential health services provided by the Sierra Leone health system during the COVID-19 pandemic. RESULTS: Few (48.7%) studies were multi-country studies (i.e., involving different countries and Sierra Leone). The majority (83.7%) were original articles published either in peer-reviewed journals or were deposited in preprint repositories; 10.9% were editorials, commentaries, or news reports; 1 (2.7%) was a working paper; and 1 (2.7%) was personal correspondence. CONCLUSION: Sierra Leone's health system was partially prepared for the COVID-19 pandemic, largely due to its previous experience in managing the Ebola virus disease outbreaks from 2013 to 2016. However, the pandemic had significant impact on other health services. Although the country's response to the pandemic was swift, it fell below average in addressing the scale of the challenges posed by the crisis.Item Clinical health outcomes of Ebola virus disease survivors eight years post recovery: a cross-sectional study in Sierra Leone(2024-08-29) Schindell, Brayden G.**Background:** The West African Ebola virus disease (EVD) epidemic that occurred between 2013-2016 resulted in >28,000 confirmed cases and >11,000 fatalities. Thousands of survivors necessitate an understanding of the long-term health effects and future medical needs of these patients. **Methods:** =998). An in-person survey conducted between November 2021 and March 2022 included demographics, clinical health symptomology assessment of each organ system and a reproductive health assessment including sexual dysfunction question sets. The frequency of each disorder was examined and the association of each disorder with EVD survival was assessed. **Results:** Of 12 number of symptom types, five were reported by >50% of EVD survivors (Ocular, Neurological, Constitutional, Genitourinary, Dermatological), and all but one were reported by >40% of EVD survivors. Symptom types associated with EVD survival included ENT symptoms (AOR: 8.75, 95% CI: 5.63 - 13.60, p < 0.001), ocular symptoms (AOR: 7.18, 95% CI: 5.02 - 10.25, p < 0.001), dermatological symptoms (AOR: 4.16, 95% CI: 3.06 - 5.65, p < 0.001) and cardiovascular symptoms (AOR: 2.96, 95% CI: 2.12 - 4.13, p < 0.001). **Conclusion:** The West Africa EVD epidemic resulted in a high prevalence of persistent health issues among disease survivors. Continued support for survivor services in West Africa is crucial, and future outbreak response planning should include dedicated funding to ensure adequate care for survivors, both during the acute phase of infection and throughout the post recovery period.Item Assessing the Reasons and Adverse Effects of Self-Medication in the Context of the COVID-19 Pandemic in Sierra Leone. A Case Study of Moriba Town Section(Dove Medical Press, 2024) Moseray, Andrew**Background:** The impact of COVID-19 pandemic on healthcare resources has led to an increase in self-medication as a coping mechanism. The purpose of the study is to investigate the prevalence of self-medication, the reasons behind it, and its potential consequences during the pandemic. **Methods:** A community-based cross-sectional study was conducted in Moriba Town, Bo City, Southern Sierra Leone. Using a multistage systematic sampling technique, 246 adult participants were selected. Data were collected using Kobo collect electronic platform and analyzed using SPSS version 26.0. **Results:** Out of the 246 adult residents who were sampled, 63 (26%) practiced self-medication. Among them, females (33 or 52%) were more prevalent than males (30 or 48%). The most dominant age groups for self-medication were 38-47 (22 or 35%) and 28-37 (18 or 29%). The major reasons for self-medication were fear of infection (189 or 77%), fear of quarantine (199 or 81%), and stigma (189 or 77%). Delays in treatment (113 or 46%) and unavailability of Covid-19 medications (92 or 37%) were also cited. However, a majority of respondents (162 or 66%) denied the influence of friends or media (168 or 68%) on their decision to self-medicate. Reasons like "delay in receiving treatment" and "influence of friends" showed significant association with self-medication (pValue <0.05). More than half of the respondents 177 (72%) did not practice self-medication before the pandemic. Adverse reactions due to self-medication included skin rashes and blisters 29 (45%) and drowsiness 24 (38%). **Conclusion:** The prevalence of unsupervised medication before and after the pandemic was minimal suggesting little impact of the pandemic. Fear and social stigma were the main drivers for self-medication. To promote safety and informed health decisions, regulatory measures, and awareness campaigns are essential to control unsupervised medication sales, improve drug labeling, and educate the public about the dangers of self-medication.Item Ancient evolutionary origins of hepatitis E virus in rodents(National Academy of Sciences, 2024-12-09) Jo, Wendy K.copies/g. We recovered 24 near-complete hepeviral genomes from rodents, shrews, and bats, all showing three partially overlapping open reading frames (ORFs), some including putative late domains that may be associated with quasi-envelopment. Rodent-derived hepeviruses grouped into five clades clustering in basal sister relationship to human- (31 to 84% distance in translated ORF1-3) and rat-associated HEV. Parsimony-based analyses and cophylogenetic reconciliations revealed that rodents were predominant sources of hepeviral cross-order host shifts. Bayesian ancestral state reconstructions substantiated a direct origin of human-associated HEV in ungulates such as swine and camelids (posterior probability 0.8), whereas the nonrecent evolutionary origins of human- and ungulate-associated HEV were projected to rodent hosts (posterior probability > 0.9). Our results elucidate the genealogy of human HEV and warrant increased surveillance and experimental risk assessments for rodent-associated hepeviruses.Item Use of minimally invasive tissue sampling to determine the contribution of diarrheal diseases to under-five mortality and associated co-morbidities and co-infections in children with fatal diarrheal diseases in Africa and Bangladesh(Public Library of Science, 2025-06-25) Mutevedzi, Portia ChipoAchieving the Sustainable Development Goal of reducing child mortality to <25 deaths per 1000 live births by 2030 requires strategies to prevent diarrheal disease-related morbidity and mortality. Accurate etiological diagnosis is essential. This study used postmortem diagnostics to investigate the contribution of diarrhea to under-5 mortality and examine co-morbidities and co-infections in Africa and South Asia. Child Health and Mortality Prevention Surveillance (CHAMPS) generates data on child deaths through minimally invasive tissue sampling, clinical record review, and verbal autopsies. Multidisciplinary panels assign cause(s) of death using WHO International Classification of Diseases. This analysis included deaths among children aged 1-59 months enrolled from 18 December 2016-31 December 2023 across six African sites (Ethiopia, Mali, Kenya, Sierra Leone, Mozambique, South Africa) and Bangladesh. Of 1517 deaths assessed, diarrhea was in the causal pathway in 240 (15.8%). The proportion of diarrhea-related deaths was highest in Ethiopia (41.0%, 34/83), followed by Bangladesh, (30.0%, 3/10), Mozambique (21.7%, 56/258), Mali (17.5%, 18/103), Kenya (13.9%, 51/366), Sierra Leone (12.8%, 46/358), and South Africa (9.4%, 32/339). Diarrhea was underlying cause in 44.2% (106/240) of cases and immediate/antecedent cause in 58.3% (140/240), with some deaths involving multiple roles in the causal chain. When diarrhea was underlying cause, sepsis (33.0%) and lower respiratory infections (25.5%) were common downstream conditions; when an antecedent/immediate cause, leading underlying causes were malnutrition (64.3%) and HIV (13.6%). No pathogen was identified in 49.6% (119/240) of diarrhea-related deaths; among these, diarrhea was underlying cause in 42.9%. Among the 121 pathogen-attributed deaths, the most frequent were EAEC (34.7%), typical EPEC (15.7%), Shigella/EIEC (14.0%), ST-ETEC (12.4%), rotavirus (26.4%), and adenovirus (non-40/41: 19.0%; 40/41: 5.0%). These pathogens were frequently identified as co-infections. Diarrheal disease accounted for a substantial share of child deaths across CHAMPS sites. Reducing mortality will require preventing diarrhea and addressing key contributors such as malnutrition and HIV.Item Mpox in Africa: What we know and what is still lacking(Public Library of Science, 2025-06-12) Kangbai, Jia BaingaEmerging as a major global health threat, Mpox previously known as Monkeypox has drawn attention due to a worrying surge in cases. This zoonotic disease, native to Central and West Africa, is marked by fever, rash, and lymphadenopathy and is primarily spread through direct contact with infected animals or people and indirectly through contaminated objects. Recent studies have indicated possible sexual transmission, underscoring how human behavior and environmental changes are increasing its prevalence, even though human-to-human transmission is less efficient than that of smallpox. Mpox is endemic in several African countries, and currently, the infection has spread in non-endemic countries, including Rwanda, Uganda, and Kenya. Democratic Republic of Congo is the epicenter of the current Mpox outbreak. From January 1, 2022, to August 6, 2024, sixteen African countries reported Mpox outbreak. Several factors, including population immunity deficiencies and changes to the environment and ecology, have led to the widespread of Mpox in Africa. Challenges such as the fragile healthcare system, limited vaccine availability and access, weak surveillance, and low public awareness poses difficulty in containing the infection in affected countries. Given the potential of Mpox to disrupt several sectors including health systems, which may ultimately reverse progress in achieving the sustainable development goals by 2030. It is imperative for countries, both within and outside Africa, to extend financial aid and human resources to combat the infection effectively.Item Knowledge, attitude, and practices of pharmacy professionals in Freetown regarding antibiotic use and antimicrobial resistance(2025-07-01) Kamara, Kadiatu BaiAntimicrobial resistance, a growing global public health concern, is a growing issue affecting pharmacy professionals and patients. The WHO estimates that bacterial antimicrobial resistance led to 4.95 million deaths worldwide in 2019 and could lead to \$1 trillion in increased healthcare expenses by 2050. Pharmacy vendors, including pharmacists and non-pharmacists, play a crucial role in the fight against antimicrobial resistance, but there is low knowledge about antibiotic use and antimicrobial resistance among pharmacy professionals. This study aimed to assess the knowledge, attitude, and practices of pharmacy professionals regarding antibiotic use and antimicrobial resistance, finding that respondents had significant misconceptions about antimicrobial resistance and varied dispensing practices. Data collection was done using a 35-item online questionnaire, and sampling was done using a random sampling method. Excel 2016 was used for analysis, using a mixed method approach (qualitative and quantitative). Factors such as market competition, work experience, education levels, and attitude scores influenced practice scores. Further training and monitoring are needed to address antimicrobial resistance.Item Generation Z and the changing epidemiology of the African Mpox outbreak(Springer Nature, 2025-08-14) Kangbai, Jia BaingaIntroduction Mpox (formerly known as monkeypox) has re-emerged as a major global public health threat. The Mpox virus, which was previously confined to remote rural settlements, especially in Africa, has been spreading in urban populations. Sierra Leone became the latest country to confirm an Mpox outbreak on January 10, 2025. Since the global Mpox outbreak started in May 2022, over 142,151 laboratory-confirmed cases and 328 deaths have been reported from 133 countries as of May 2025. Africa alone accounted for most of the confirmed cases and deaths. Epidemiology and clade mutation of Mpox Mpox epidemiology has evolved, with two distinct viral clades: clade 1 (Central African) and clade 2 (West African). Both clades exhibit different virulence, transmissibility, and geographic spread. Recently, there has been a notable shift in Mpox epidemiology and transmission dynamics. Specifically, there has been an increase in the number of Mpox cases among commercial sex workers and immunocompromised people. Sexual transmission of Mpox Sexual transmission of Mpox, particularly among Generation Z individuals born between the early 1997 and 2012 poses additional challenges, exacerbating stigma and delaying treatment. Conclusion Children under 15 years have become increasingly affected, accounting for 75% of cases in the Democratic Republic of Congo. Effective Mpox containment requires heightened surveillance, cross-border collaboration, improved vaccination strategies, and education to address stigma and misclassification. The evolving epidemiology of Mpox underscores the need for robust public health responses to mitigate its global impact.Item EPIDEMIOLOGY: UNDERSTANDING DISEASE PATTERNS AND PUBLIC HEALTH(Lippincott Williams & Wilkins, 2025-05-01) Munu, Alpha Jose**Objective:** This study evaluates the scientific principles and practical applications of epidemiology in understanding the patterns and determinants of health and disease within populations. The focus is on advancing methodologies to monitor, prevent, and control health threats while addressing global health disparities Design and method: A mixed-methods approach was utilized, combining a review of epidemiological literature with case studies to highlight the application of different study designs cohort, case-control, and cross-sectional studies. Quantitative tools, including incidence and prevalence metrics, odds ratios, and relative risks, were employed to assess disease burden and risk factors. Data sources ranged from population-based health surveys to real-time surveillance systems, with statistical modeling used to predict trends and outcomes. Emphasis was placed on ethical considerations and the integration of modern technologies like GIS mapping and machine learning in epidemiological research. **Results:** Epidemiology has proven pivotal in addressing global health challenges. Vaccination programs informed by epidemiological studies eradicated smallpox and significantly reduced the incidence of polio and measles worldwide. Chronic disease epidemiology has revealed strong associations between lifestyle factors, such as smoking and diet, with conditions like cardiovascular diseases and diabetes, enabling targeted prevention strategies. Moreover, during the COVID-19 pandemic, epidemiological surveillance and modeling provided the basis for public health interventions such as lockdowns, vaccination prioritization, and resource allocation. **Conclusions:** Epidemiology remains a cornerstone of public health, underpinning efforts to mitigate disease risks, enhance health equity, and respond to emerging health threats. Future advancements, including the application of big data analytics and artificial intelligence, promise to enhance the precision and efficiency of epidemiological studies. Strengthened interdisciplinary collaborations and global partnerships are essential for addressing complex health challenges and achieving sustainable health improvements.