Health Indicators of Pregnant Women in Tonkolili District, Rural Sierra Leone

Despite having reported one of the highest maternal mortality ratios and neonatal mortality rates in the world, surprisingly little is known about the general health status of pregnant women in rural parts of Sierra Leone. Malaria, anaemia and malnutrition are known contributors to adverse pregnancy outcomes. Although their prevalence is known to be high, the burden of these conditions in the rural pregnant population remains unknown. Our study aimed to gain more insight into the health status of pregnant women. An observational retrospective descriptive study was conducted at the Lion Heart Medical Centre using antenatal care (ANC) registers. The study revealed high prevalence of malaria (35.2%), maternal undernutrition (10.4%) and anaemia (65.9%). The proportion of teenage pregnancies in the ANC population was 16.4%. Both malaria and anaemia were more prevalent in this group, with odds ratios of 2.1 and 1.7, respectively. The findings reveal alarming high rates of anaemia, acute undernutrition and malaria among pregnant women and high numbers of pregnancy among adolescents, with increased health risks. These results will be used to advocate for a malnutrition program, specifically for pregnant women. Our study further emphasises the importance of preventing malaria and anaemia in pregnant women

Complicated Odontogenic Infections at 2 District Hospitals in Tonkolili District, Sierra Leone:Protocol for a Prospective Observational Cohort Study (DELAY)

BACKGROUND: Deficits in global oral health care are paramount, and complications of odontogenic infections constitute a considerable global health problem, particularly in low-income countries. A high mortality rate has been observed for patients who have been admitted with complicated odontogenic infections to our facilities in Tonkolili District, Sierra Leone, although exact data have not been published yet. Data regarding who in this region is at risk and why are lacking. OBJECTIVE: The Dental Abscess Study (DELAY) aims to prospectively investigate morbidity and mortality from complicated dental abscesses and to analyze patients’ characteristics and microbial findings to examine predisposing factors for poor outcomes. In particular, the incidence and the clinical and microbial characteristics of complicated odontogenic infections, as well as the sociodemographic data and comorbidities of affected patients, will be studied to develop improved management algorithms based on circumstance-specific factors. METHODS: Patients who present with complicated dental infections requiring hospital admission in Masanga Hospital or Lion Heart Medical Centre will be consecutively selected for possible inclusion in the study (starting on September 4, 2021) over a study period of 1 year, and individual routine follow-ups will be conducted at least 3 months after discharge. The results of standardized questionnaires will be obtained, and clinical measurements as well as medical photos will be taken. Standard laboratory tests (eg, full blood count and HIV status tests) will be performed, and pus specimens will be examined. Local treatment guidelines will be adhered to, and data on medical and surgical treatment as well as data on outcomes will be collected. The study results will be reported according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria. Routine follow-ups will take place at 1 and 3 months postdischarge. RESULTS: The DELAY protocol was endorsed by the Masanga Medical Research Unit’s Scientific Review Committee on June 16, 2021, and ethical approval was granted on July 5, 2021, by the Sierra Leone National Ethics Committee. The funding of the budgeted study costs was approved by Dental Health International Netherlands in August 2021. The projected start date of data collection was September 4, 2021, and the study period will most likely last for 1 year. As such, data collection is expected to be complete in November 2022. CONCLUSIONS: The aim of our prospective observational cohort study is to gain more knowledge about complicated odontogenic infections in Tonkolili District, Sierra Leone, to further improve treatment strategies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/3367

Perspectives of health workers on the referral of women with obstetric complications: a qualitative study in rural Sierra Leone

Objectives Sierra Leone has one of the highest maternal mortality ratios in the world. Timely and well-coordinated referrals are necessary to reduce delays in providing adequate care for women with obstetric complications. This study describes factors affecting timely and adequate referral of women with obstetric complications in rural areas of Sierra Leone as viewed by health workers in rural health facilities.Design Qualitative research with semi-structured interviews using open-ended questions. Data were analysed by systematic text condensation.Setting Interviews were held in nine peripheral health units in rural Sierra Leone.Participants 19 health workers including nurses, midwives and clinical health officers participated in nine interviews.Results From the interviews, four major themes describing possible factors of delay in referral of women in need of emergency obstetric care emerged: (1) communication between healthcare workers; (2) underlying influences on decision-making; (3) women’s compliance to referral and (4) logistic constraints.Several factors in rural Sierra Leone are perceived to complicate timely and adequate referral of women in need of emergency obstetric care. Notable among these factors are fear among women for being referred and fear among healthcare workers for having maternal deaths or severe obstetric complications occurring at their own facilities. Furthermore, decision-making of healthcare workers whether to refer a woman or not is negatively influenced by a hierarchical culture with high power distance between healthcare workers.Conclusion Factors identified that complicate timely and adequate referral of women in need of emergency obstetric care must be considered in efforts to reduce maternal mortality. Possible interventions that may reduce delay in referral include increased communication by mobile phones between health workers for advice and feedback regarding referrals, involvement of influential stakeholders to increase women’s compliance to referral, and consistent use of standardised management protocols

Perspectives of health workers on the referral of women with obstetric complications: A qualitative study in rural Sierra Leone

Objectives: Sierra Leone has one of the highest maternal mortality ratios in the world. Timely and well-coordinated referrals are necessary to reduce delays in providing adequate care for women with obstetric complications. This study describes factors affecting timely and adequate referral of women with obstetric complications in rural areas of Sierra Leone as viewed by health workers in rural health facilities. Design: Qualitative research with semi-structured interviews using open-ended questions. Data were analysed by systematic text condensation. Setting: Interviews were held in nine peripheral health units in rural Sierra Leone. Participants: 19 health workers including nurses, midwives and clinical health officers participated in nine interviews. Results: From the interviews, four major themes describing possible factors of delay in referral of women in need of emergency obstetric care emerged: (1) communication between healthcare workers; (2) underlying influences on decision-making; (3) women's compliance to referral and (4) logistic constraints. Several factors in rural Sierra Leone are perceived to complicate timely and adequate referral of women in need of emergency obstetric care. Notable among these factors are fear among women for being referred and fear among healthcare workers for having maternal deaths or severe obstetric complications occurring at their own facilities. Furthermore, decision-making of healthcare workers whether to refer a woman or not is negatively influenced by a hierarchical culture with high power distance between healthcare workers. Conclusion: Factors identified that complicate timely and adequate referral of women in need of emergency obstetric care must be considered in efforts to reduce maternal mortality. Possible interventions that may reduce delay in referral include increased communication by mobile phones between health workers for advice and feedback regarding referrals, involvement of influential stakeholders to increase women's compliance to referral, and consistent use of standardised management protocols

Perspectives of health workers on the referral of women with obstetric complications:A qualitative study in rural Sierra Leone

Objectives: Sierra Leone has one of the highest maternal mortality ratios in the world. Timely and well-coordinated referrals are necessary to reduce delays in providing adequate care for women with obstetric complications. This study describes factors affecting timely and adequate referral of women with obstetric complications in rural areas of Sierra Leone as viewed by health workers in rural health facilities. Design: Qualitative research with semi-structured interviews using open-ended questions. Data were analysed by systematic text condensation. Setting: Interviews were held in nine peripheral health units in rural Sierra Leone. Participants: 19 health workers including nurses, midwives and clinical health officers participated in nine interviews. Results: From the interviews, four major themes describing possible factors of delay in referral of women in need of emergency obstetric care emerged: (1) communication between healthcare workers; (2) underlying influences on decision-making; (3) women's compliance to referral and (4) logistic constraints. Several factors in rural Sierra Leone are perceived to complicate timely and adequate referral of women in need of emergency obstetric care. Notable among these factors are fear among women for being referred and fear among healthcare workers for having maternal deaths or severe obstetric complications occurring at their own facilities. Furthermore, decision-making of healthcare workers whether to refer a woman or not is negatively influenced by a hierarchical culture with high power distance between healthcare workers. Conclusion: Factors identified that complicate timely and adequate referral of women in need of emergency obstetric care must be considered in efforts to reduce maternal mortality. Possible interventions that may reduce delay in referral include increased communication by mobile phones between health workers for advice and feedback regarding referrals, involvement of influential stakeholders to increase women's compliance to referral, and consistent use of standardised management protocols

Chronic wounds in Sierra Leone: pathogen spectrum and antimicrobial susceptibility

Purpose: Chronic wounds are frequently caused by, or super-infected with, a broad spectrum of bacteria. To guide treatment, healthcare providers need to know the bacterial spectrum and antimicrobial resistance rates to be anticipated. As these data are largely missing for Sierra Leone, we performed a microbiological study on chronic wound infections. Methods: Wound swabs were analysed for bacteria using culture-based methods. Antimicrobial susceptibility testing was done with Vitek2® automated system and EUCAST clinical breakpoints. Selected resistance phenotypes were confirmed by molecular methods (e.g. mecA/C) and genotyping. Results: Of 163 included patients, 156 (95.7%) had a positive wound culture. Pseudomonas aeruginosa (n = 75), Klebsiella pneumoniae (n = 42), Proteus mirabilis (n = 31), Staphylococcus aureus-related complex (n = 31) were predominant. Among Gram-negative rods, resistance rates were high for piperacillin/tazobactam (3–67%), cefotaxime (19–71%), and ciprofloxacin (13–60%). Among isolates of the S. aureus-related complex, 55% were methicillin resistant (CC8, PVL-negative). Conclusion: The high antimicrobial resistance rates in bacteria from chronic wounds strongly speaks against the use of empirical systemic antibiotic therapy if patients do not show signs of systemic infections, and supports the strategy of local wound care

COVID-19 treatment in sub-Saharan Africa: If the best is not available, the available becomes the best

© 2020 Elsevier Ltd. All rights reserved.Community transmission of COVID-19 is ongoing in the majority of countries in sub-Saharan Africa (SSA), threatening, as elsewhere, the capacity of national healthcare systems (HCS) in low- and middle-income countries (LMIC). While the epidemic started slowly and late in SSA, currently - subject to often rapid changes - around 20,000 cases per day are reported, despite limited testing. Shortages of personal protective equipment (PPE), as well as sophisticated and expensive molecular diagnostic tests are of concern. However, the biggest worry is the lack of health care workers (HCW) and health care infrastructure as a few figures compellingly illustrate. SSA has only 0.2 physicians per 1000 inhabitants (Europe 3.7, North America 2.6), while 10,000 HCW across the continent were infected by the 23rd of July. In April, the WHO reported less than 2000 ventilators in 43, and only 5000 intensive care unit (ICU) beds in 41 African countries, respectively. Worst though, their distribution is highly skewed. While many countries in SSA having just a few, if any; in countries which govern such resources, like South Africa, they are mainly located in the private sector, creating corresponding access problems. Non-profit organisations help with the procurement of materials at lower prices, like the African Medical Supply Platform; yet, a single N95 mask still costs 2 USD a piece on this platform.info:eu-repo/semantics/publishedVersio