Fighting COVID-19 in Freetown, Sierra Leone: the critical role of community organisations in a growing pandemic

As the COVID-19 pandemic spreads in Africa, attention is increasingly shifting to the potential and ongoing impact on informal settlements, which face considerable challenges around the implementation of conventional control measures of social distancing, hand washing and self-isolation. In Freetown, Sierra Leone, residents of informal settlements have relied on local community organisations and groups, and their resourcefulness to provide essential preparedness, response and on-going support to alleviate the public health and economic risks associated with the effects of the COVID-19 outbreak. This is also premised on lessons drawn from dealing with previous epidemics, notably the Ebola virus disease in 2014–2015. This paper will explain the nature and form of community organisation that can be galvanised and leveraged for COVID-19 preparedness and responses that are suited for informal settlements. Secondly, it highlights the critical contribution of community organisations in social protection measures that tackle deeply entrenched inequalities in rapidly urbanising contexts. Finally, the cases examined seek to provide evidence of the value of processes of continuous learning within community organisation that are essential for both humanitarian assistance and emergency management. Although situated in Freetown, the broad lessons drawn are relevant for urban-poor communities and informal settlements in many urban African centres

Combined targeting of TGF-beta, EGFR and HER2 suppresses lymphangiogenesis and metastasis in a pancreatic cancer model

Pancreatic ductal adenocarcinomas (PDAC) are aggressive with frequent lymphatic spread. By analysis of data from The Cancer Genome Atlas, we determined that ∼35% of PDACs have a pro-angiogenic gene signature. We now show that the same PDACs exhibit increased expression of lymphangiogenic genes and lymphatic endothelial cell (LEC) markers, and that LEC abundance in human PDACs correlates with endothelial cell microvessel density. Lymphangiogenic genes and LECs are also elevated in murine PDACs arising in the KRC (mutated Kras; deleted RB) and KIC (mutated Kras; deleted INK4a) genetic models. Moreover, pancreatic cancer cells (PCCs) derived from KRC tumors express and secrete high levels of lymphangiogenic factors, including the EGF receptor ligand, amphiregulin. Importantly, TGF-β1 increases lymphangiogenic genes and amphiregulin expression in KRC PCCs but not in murine PCCs that lack SMAD4, and combinatorial targeting of the TGF-β type I receptor (TβRI) with LY2157299 and EGFR/HER2 with lapatanib suppresses tumor growth and metastasis in a syngeneic orthotopic model, and attenuates tumor lymphangiogenesis and angiogenesis while reducing lymphangiogenic genes and amphiregulin and enhancing apoptosis. Therefore, this combination could be beneficial in PDACs with lymphangiogenic or angiogenic gene signatures

Requirements for global elimination of hepatitis B: a modelling study

Background Despite the existence of effective prevention and treatment interventions, hepatitis B virus (HBV) infection continues to cause nearly 1 million deaths each year. WHO aspires to global control and elimination of HBV infection. We aimed to evaluate the potential impact of public health interventions against HBV, propose targets for reducing incidence and mortality, and identify the key developments required to achieve them. Methods We developed a simulation model of the global HBV epidemic, incorporating data on the natural history of HBV, prevalence, mortality, vaccine coverage, treatment dynamics, and demographics. We estimate the impact of current interventions and scaling up of existing interventions for prevention of infection and introducing wide-scale population screening and treatment interventions on the worldwide epidemic. Findings Vaccination of infants and neonates is already driving a large decrease in new infections; vaccination has already prevented 210 million new chronic infections by 2015 and will have averted 1·1 million deaths by 2030. However, without scale-up of existing interventions, our model showed that there will be a cumulative 63 million new cases of chronic infection and 17 million HBV-related deaths between 2015 and 2030 because of ongoing transmission in some regions and poor access to treatment for people already infected. A target of a 90% reduction in new chronic infections and 65% reduction in mortality could be achieved by scaling up the coverage of infant vaccination (to 90% of infants), birth-dose vaccination (to 80% of neonates), use of peripartum antivirals (to 80% of hepatitis B e antigen-positive mothers), and population-wide testing and treatment (to 80% of eligible people). These interventions would avert 7·3 million deaths between 2015 and 2030, including 1·5 million cases of cancer deaths. An elimination threshold for incidence of new chronic infections would be reached by 2090 worldwide. The annual cost would peak at US$7·5 billion worldwide ($3·4 billion in low-income and lower-middle-income countries), but decrease rapidly and this would be accelerated if a cure is developed. Interpretation Scale-up of vaccination coverage, innovations in scalable options for prevention of mother-to-child transmission, and ambitious population-wide testing and treatment are needed to eliminate HBV as a major public health threat. Achievement of these targets could make a major contribution to one of the Sustainable Development Goals of combating hepatitis

Computer-assisted revision total knee arthroplasty does not improve postoperative knee prosthesis alignment compared to the conventional technique

PURPOSE: Computer-assisted surgery (CAS) during primary total knee arthroplasty (TKA) prosthesis alignment. However, literature on its use during revision TKA (rTKA) is scarce. Moreover, the effect of CAS during rTKA on rotational alignment of the prosthesis has not been described yet. The purpose of this study was to assess the effect of CAS during rTKA, focusing on the number of outliers and coronal, sagittal and rotational prosthetic alignment compared to conventional rTKA.METHODS: A prospective cohort study comparing CAS-rTKA with a historical control group (CON-rTKA). The CAS-rTKA group (54 patients/62 knees) underwent rTKA using imageless CAS between 2012 and 2017. The CON-rTKA group (13 patients/23 knees) was operated using the conventional technique between 2002 and 2012. Postoperative alignment was measured using the EOS-2D/3D system (coronal and sagittal planes) and computed tomography scan (rotation).RESULTS: No significant differences between the CAS-rTKA and CON-rTKA groups were found for coronal and sagittal alignment regarding the mechanical angle of the leg ( p  = 0.08), mechanical lateral distal femoral angle ( p  = 0.87), mechanical medial proximal tibial angle ( p  = 0.40), anatomical proximal posterior tibial angle ( p  = 0.43) nor femoral ( p  = 0.80) and tibial rotation ( p  = 0.15). For the proportions of coronal, sagittal and rotational outliers, no significant differences were found either. CONCLUSION: This study showed no evidence that use of CAS during rTKA leads to improved coronal, sagittal or rotational alignment of knee prostheses or a difference of outliers between the groups.LEVEL OF EVIDENCE: Level III, therapeutic.</p

Where there is no psychiatrist: A mental health programme in Sierra Leone

Background. For most low- and middle-income countries, mental health remains a neglected area, despite the recognised burden associated with neuropsychiatric conditions and the inextricable link to other public health priorities. Objectives To describe the results of a free outpatient mental health programme delivered by non specialist health workers in Makeni, Sierra Leone between July 2008 and May 2012. Methods. A nurse and two counsellors completed an 8-week training course focused on the identification and management of seven priority conditions: psychosis, bipolar disorder, depression, mental disorders due to medical conditions, developmental and behavioural disorders, alcohol and drug use disorders and dementia The World Health Organization recommendations on basic mental healthcare packages were followed to establish treatment for each condition. Results. A total of 549 patients was assessed and diagnosed as suffering from psychotic disorders (n=295, 53.7%), manic episodes (n=69, 12.5%), depressive episodes (n=53, 9.6%), drug use disorders (n=182, 33.1%), dementia (n=30, 54%), mental disorders due to medical conditions (n=39, 7.1%), and developmental disorders (n=46, 8.3%). Of these, 417 patients received pharmacological therapy and 70.7% were rated as much or very much improved Of those who could not be offered medication, 934% dropped out of the programme after the first visit. Conclusions. The identification and treatment of mental disorders must be considered an urgent public health priority in low- and middle income countries Trained primary health workers can deliver safe and effective treatment for mental disorders as a feasible alternative to ease the scarcity of mental health specialists in developing countries

Genetic diversity of provitamin-A cassava (Manihot esculenta Crantz) in Sierra Leone

Open Access Article; Published online: 04 Mar 2020Understanding the genetic diversity among accessions and germplasm is an important requirement for crop development as it allows for the selection of diverse parental combinations for enhancing genetic gain in varietal selection, advancement and release. The study aimed to characterize 183 provitamin A cassava (Manihot esculenta Crantz) accessions and five Sierra Leonean varieties using morphological traits, total carotenoid content and SNP markers to develop a collection for conservation and further use in the cassava breeding program. Both morphological parameters and 5634 SNP markers were used to assess the diversity among the provitamin-A cassava accessions and varieties. Significant differences were observed among the accessions for most of the traits measured. The first five PCs together accounted for 70.44% of the total phenotypic variation based on yield and yield components among the 183 provitamin-A cassava accessions and five Sierra Leonean varieties. The present study showed that provitamin-A cassava accessions in Sierra Leone have moderate to high diversity based on morphological and molecular assessment studies. The similarity index among the 187 and 185 cassava accessions grouped them into 6 and 9 distinct clusters based on morphological and molecular analyses, respectively. A significant positive, but low correlation (r = 0.104; p\0.034), was observed between the two dendrograms. The results obtained will serve as a guide and basis of germplasm management and improvement for total carotenoid content, yield and African cassava mosaic disease resistance in Sierra Leone

High levels of surgical antibiotic prophylaxis: implications for hospital-based antibiotic stewardship in Sierra Leone

OBJECTIVE: Despite the impact of inappropriate prescribing on antibiotic resistance, data on surgical antibiotic prophylaxis in sub-Saharan Africa are limited. In this study, we evaluated antibiotic use and consumption in surgical prophylaxis in 4 hospitals located in 2 geographic regions of Sierra Leone. METHODS: We used a prospective cohort design to collect data from surgical patients aged 18 years or older between February and October 2021. Data were analyzed using Stata version 16 software. RESULTS: Of the 753 surgical patients, 439 (58.3%) were females, and 723 (96%) had received at least 1 dose of antibiotics. Only 410 (54.4%) patients had indications for surgical antibiotic prophylaxis consistent with local guidelines. Factors associated with preoperative antibiotic prophylaxis were the type of surgery, wound class, and consistency of surgical antibiotic prophylaxis with local guidelines. Postoperatively, type of surgery, wound class, and consistency of antibiotic use with local guidelines were important factors associated with antibiotic use. Of the 2,482 doses administered, 1,410 (56.8%) were given postoperatively. Preoperative and intraoperative antibiotic use was reported in 645 (26%) and 427 (17.2%) cases, respectively. The most commonly used antibiotic was ceftriaxone 949 (38.2%) with a consumption of 41.6 defined daily doses (DDD) per 100 bed days. Overall, antibiotic consumption was 117.9 DDD per 100 bed days. The Access antibiotics had 72.7 DDD per 100 bed days (61.7%). CONCLUSIONS: We report a high rate of antibiotic consumption for surgical prophylaxis, most of which was not based on local guidelines. To address this growing threat, urgent action is needed to reduce irrational antibiotic prescribing for surgical prophylaxis

Primacy of effective communication and its influence on adherence to artemether-lumefantrine treatment for children under five years of age: a qualitative study.

BACKGROUND\ud \ud Prompt access to artemesinin-combination therapy (ACT) is not adequate unless the drug is taken according to treatment guidelines. Adherence to the treatment schedule is important to preserve efficacy of the drug. Although some community based studies have reported fairly high levels of adherence, data on factors influencing adherence to artemether-lumefantrine (AL) treatment schedule remain inadequate. This study was carried-out to explore the provider's instructions to caretakers, caretakers' understanding of the instructions and how that understanding was likely to influence their practice with regard to adhering to AL treatment schedule.\ud \ud METHODS\ud \ud A qualitative study was conducted in five villages in Kilosa district, Tanzania. In-depth interviews were held with providers that included prescribers and dispensers; and caretakers whose children had just received AL treatment. Information was collected on providers' instructions to caretakers regarding dose timing and how to administer AL; and caretakers' understanding of providers' instructions.\ud \ud RESULTS\ud \ud Mismatch was found on providers' instructions as regards to dose timing. Some providers' (dogmatists) instructions were based on strict hourly schedule (conventional) which was likely to lead to administering some doses in awkward hours and completing treatment several hours before the scheduled time. Other providers (pragmatists) based their instruction on the existing circumstances (contextual) which was likely to lead to delays in administering the initial dose with serious treatment outcomes. Findings suggest that, the national treatment guidelines do not provide explicit information on how to address the various scenarios found in the field. A communication gap was also noted in which some important instructions on how to administer the doses were sometimes not provided or were given with false reasons.\ud \ud CONCLUSIONS\ud \ud There is need for a review of the national malaria treatment guidelines to address local context. In the review, emphasis should be put on on-the-job training to address practical problems faced by providers in the course of their work. Further research is needed to determine the implication of completing AL treatment prior to scheduled time

Translanguaging in mainstream education:a sociocultural approach

Due to the monolingual self-understanding of European nation-states, migration-induced multilingualism and the language mixing practices it triggers are not usually acknowledged as resources for learning within mainstream classrooms. The term translanguaging has recently been put forward as both a way of describing the flexible ways in which bilinguals draw upon their multiple languages to enhance their communicative potential and a pedagogical approach in which teachers and pupils use these practices for learning. However, little research has been conducted in how the translanguaging approach can be used in mainstream education to enhance knowledge. This study draws on videographic data recorded in 59 10th grade (15-year-olds) subject-matter classes in 4 secondary schools. Applying sociocultural discourse analysis to peer–peer interaction and therefore considering how learners scaffold one another as they participate in collaborative talk and in the co-construction of knowledge, results describe several functions of translanguaging for ‘exploratory talk’ leading to content-matter learning. Multilingual adolescents in naturalistic settings thus use their multilingualism to cognitively engage with content-based tasks and produce high-order speech acts embedded in complex talk