'Once there is life, there is hope' Ebola survivors' experiences, behaviours and attitudes in Sierra Leone, 2015.

BACKGROUND: In Sierra Leone, over 4000 individuals survived Ebola since the outbreak began in 2014. Because Ebola survivorship was largely unprecedented prior to this outbreak, little is known about survivor experiences during and post illness. METHODS: To assess survivors' experiences and attitudes related to Ebola, 28 in-depth interviews and short quantitative surveys with survivors from all four geographic regions of Sierra Leone were conducted in May 2015. RESULTS: Survivor experiences, emotions and attitudes changed over time as they moved from disease onset to treatment, discharge and life post-discharge. Survivors mentioned experiencing acute fear and depression when they fell ill. Only half reported positive experiences in holding centres but nearly all were positive about their treatment centre experiences. Survivor euphoria on discharge was followed by concerns about their financial situation and future. While all reported supportive attitudes from family members, about a third described discrimination and stigma from their communities. Over a third became unemployed, especially those previously engaged in petty trade. Survivor knowledge about sexual transmission risk reflected counselling messages. Many expressed altruistic motivations for abstinence or condom use. In addition, survivors were strongly motivated to help end Ebola and to improve the healthcare system. Key recommendations from survivors included improved counselling in holding centres and long-term government support for survivors, including opportunities for participation in Ebola response efforts. CONCLUSIONS: Survivors face myriad economic, social and health challenges. Addressing survivor concerns, including the discrimination they face, could facilitate their reintegration into communities and their contributions to future Ebola responses

Deletion of Neurturin Impairs Development of Cholinergic Nerves and Heart Rate Control in Postnatal Mouse Hearts

The neurotrophic factor neurturin is required for normal cholinergic innervation of adult mouse heart and bradycardic responses to vagal stimulation. Our goals were to determine effects of neurturin deletion on development of cardiac chronotropic and dromotropic functions, vagal baroreflex response, and cholinergic nerve density in nodal regions of postnatal mice. Experiments were performed on postnatal C57BL/6 wild-type (WT) and neurturin knockout (KO) mice. Serial electrocardiograms were recorded noninvasively from conscious pups using an ECGenie apparatus. Mice were treated with atenolol to evaluate and block sympathetic effects on heart rate (HR) and phenylephrine (PE) to stimulate the baroreflex. Immunohistochemistry was used to label cholinergic nerves in paraffin sections. WT and KO mice showed similar age-dependent increases in HR and decreases in PR interval between postnatal days (P) 2.5 and 21. Treatment with atenolol reduced HR significantly in WT and KO pups at P7.5. PE caused a reflex bradycardia that was significantly smaller in KO pups. Cholinergic nerve density was significantly less in nodal regions of P7.5 KO mice. We conclude that cholinergic nerves have minimal influence on developmental changes in HR and PR, QRS, and QTc intervals in mouse pups. However, cholinergic nerves mediate reflex bradycardia by 1 week postnatally. Deletion of neurturin impairs cholinergic innervation of the heart and the vagal efferent component of the baroreflex early during postnatal development

Establishing an antimicrobial stewardship program in Sierra Leone: a report of the experience of a low-income country in West Africa

Antimicrobial Resistance (AMR) is a growing global health challenge that threatens to undo gains in human and animal health. Prevention and control of AMR requires functional antimicrobial stewardship (AMS) program, which is complex and often difficult to implement in low- and middle-income countries. We aimed to describe the processes of establishing and implementing an AMS program at Connaught Hospital in Sierra Leone. The project involved the setting up of an AMS program, capacity building and performing a global point prevalence survey (GPPS) at Sierra Leone's national referral hospital. Connaught Hospital established a multidisciplinary AMS subcommittee in 2021 to provide AMS services such as awareness campaigns, education and training and review of guidelines. We performed a GPPS on 175 patients, of whom more than half (98, 56.0%) were prescribed an antibiotic: 63 (69.2%) in the surgical wards and 53 (51.2%) in the medical wards. Ceftriaxone (60, 34.3%) and metronidazole (53, 30.3%) were the most common antibiotics prescribed to patients. In conclusion, it is feasible to establish and implement an AMS program in low-income countries, where most hospitalized patients were prescribed an antibiotic

Summary and conclusions

Climate variability is a reality that is affecting rural livelihoods in West Africa today and presenting a growing challenge in the region, as in many other parts of the African continent and elsewhere. Climate change will have far-reaching consequences for the poor and marginalized groups among which the majority depend on agriculture for their livelihoods and have a lower capacity to adapt. Weather-related crop failures, fishery collapses, and livestock deaths in addition to losses of property are already causing economic losses and undermining food security in West Africa. This situation is likely to become more desperate and to threaten the survival of the majority of poor farmers as global warming continues. Feeding the increasing populations in a subregion with one of the highest rates of population growth in the world requires radical transformation of a largely underdeveloped agriculture over the next four decades. A major challenge is increasing agricultural production among resource-poor farmers without exacerbating environmental problems and simultaneously coping with climate change..

Overview

The part of Africa designated as West Africa is made up of 16 countries— Benin, Burkina Faso, Cape Verde, Côte d’Ivoire, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, and Togo. Its land area is about 5 million square kilometers, and its population in 2010 was about 290 million. With the exception of Mauritania, these countries are members of the Economic Community of West African States (ECOWAS). The subregion comprises a diversified agricultural base spread over a wide range of agroecological zones with significant potential for improved agricultural productivity. Agriculture is the major source of livelihood for the majority of West Africans. The agricultural sector employs 60 percent of the active labor force but contributes only 35 percent of gross domestic product (GDP). The disparity between contribution to GDP and share of population means that many West African farmers are very poor, producing close to subsistence levels and facing numerous constraints such as droughts, soil acidity, and nutrientdepleted and degraded soils that impinge on agricultural development. The most important foodcrops grown and consumed in West Africa are cereals— sorghum, millet, maize, and rice; roots and tubers—cassava, sweet potatoes, and yams; and legumes—cowpeas and groundnuts. Major cash crops are cocoa, coffee, and cotton..

Combining ability analysis in bitter gourd (Momordica charantia L.) for potential quality improvement

Combining ability analysis provides useful information for the selection of parents, also information regarding the nature and magnitude of involved gene actions. Crops improvement involves strategies for enhancing yield potentiality and quality components. Targeting the improvement of respective characters in bitter gourd, combining ability and genetic parameters for 19 characters were estimated from a 6×6 full diallel analysis technique. The results revealed that the variances due to general combining ability (GCA) and specific combining ability (SCA) were highly significant for most of the important characters. It indicated the importance of both additive and non-additive gene actions. GCA variances were higher in magnitude than SCA variances for all the characters studied indicating the predominance of the additive gene effects in their inheritance. The parent P2 (BG 009) appeared as the best general combiner for earliness; P1 (BG 006) for number of fruits, average single fruit weight and fruit yield; P4 (BG 027) for node number of first female flower and days to seed fruit maturity; P3 (BG 011) for fruit length and thickness of the fruit flesh; P5 (BG 033) for 100-seed weight; and P6 for number of nodes per main vine. The SCA effect as well as reciprocal effect was also significant for most of the important characters in different crosses

Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak

In its largest outbreak, Ebola virus disease is spreading through Guinea, Liberia, Sierra Leone, and Nigeria. We sequenced 99 Ebola virus genomes from 78 patients in Sierra Leone to ~2000× coverage. We observed a rapid accumulation of interhost and intrahost genetic variation, allowing us to characterize patterns of viral transmission over the initial weeks of the epidemic. This West African variant likely diverged from central African lineages around 2004, crossed from Guinea to Sierra Leone in May 2014, and has exhibited sustained human-to-human transmission subsequently, with no evidence of additional zoonotic sources. Because many of the mutations alter protein sequences and other biologically meaningful targets, they should be monitored for impact on diagnostics, vaccines, and therapies critical to outbreak response.Organismic and Evolutionary Biolog

An intra-COVID-19 assessment of hand hygiene facility, policy and staff compliance in two hospitals in Sierra Leone: is there a difference between regional and capital city hospitals?

Although hand hygiene (HH) is the most effective intervention to reduce the spread of infections, there are limited data on HH facilities, policy, and compliance in sub-Saharan Africa. This cross-sectional study is aimed at assessing HH using the WHO HH self-assessment framework, HH technical reference manual, and a modified infection control self-assessment tool in two hospitals in Sierra Leone. Only 10% and 9% of regional and capital city hospitals had running tap water, respectively. Veronica buckets were the resources for HH in 89% of units in the regional hospital and 92% of units in capital city hospital. Constant supply of soap and alcohol-based hand rub was available in 82% and 68%; and 74% and 79% of units in the capital city and regional hospitals, respectively. Only 10% of the units in both hospitals had hand-drying facilities and functional sinks. Overall HH compliance for the two hospitals was 18.6% and was higher in the regional (20.8%) than the capital city (17.0%) hospitals. The HH levels for the capital city and regional hospitals were 277.5 and 262.5 respectively. Despite the COVID-19 pandemic, there are still challenges with HH compliance in Sierra Leone. It is, therefore, necessary to strengthen the HH multi-modal strategy

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

The future of food security, environments and livelihoods in Western Africa: Four socio-economic scenarios

This working paper examines the development of regional socioeconomic scenarios for West Africa’s development, agriculture, food security and climate impacts. We present four globally consistent regional scenarios framed and outlined by regional experts who crafted narratives and determined key drivers of change. Stakeholders identified the type of actors driving change and the timeline of strategic planning as the most uncertain and most relevant factors of change affecting food security, livelihoods and environments in the region. The scenarios were linked to the IPCC community’s global Shared Socio-economic Pathways (SSPs) and quantified using two agricultural economic models, GLOBIOM and IMPACT, in interaction with drivers outlined by the SSPs and guided by semi-quantitative information from the stakeholders. The quantification of the scenarios has provided additional insights into the possible development of Western Africa in the context of a global economy as well as how the agricultural sector may be affected by climate change. The scenarios process highlights the need to combine socio-economic and climate scenarios, to base these scenarios in regional expertise, and ways to make scenarios useful for policy design. The objective of this working paper is to provide scenarios for future regional development for West Africa on the future of food security, environment, and rural livelihoods as well as offer details of the multi-stakeholder scenarios development process. Using both qualitative and quantitative scenarios we provide insights into the possible development of West Africa as well as a scalable framework for regional decision makers and the scientific community to use scenarios to build and test policies to make them more robust in the face of future uncertainty. In these scenarios, strong economic development increases food security and agricultural development. Increased crop and livestock productivity may lead to an expansion of agricultural areas within the region but productivity improvements may reduce the pressure on land elsewhere. In the context of a global economy, West Africa remains a large consumer and producer of a selection of commodities. However, the growth in population in combination with rising incomes may lead to increases in the region’s imports. For West Africa, climate change is likely to have negative effects on both crop yields and grassland productivity, and lack of investment in agriculture may exacerbate them. The aim of the regional scenarios is provide challenging contexts for policy makers to test and develop a range of national and regional policies. To date, the scenarios have been used in a number of policy design processes which include collaborations with ECOWAS priority setting, the National Plan for the Rural Sector for Burkina Faso (PNSR), and district and national level policy processes in Ghana