How Well Are Hand Hygiene Practices and Promotion Implemented in Sierra Leone? A Cross-Sectional Study in 13 Public Hospitals.

From Europe PMC via Jisc Publications RouterHistory: ppub 2022-03-01, epub 2022-03-23Publication status: PublishedFunder: World Health Organization; Grant(s): 001Healthcare-associated infections (HAIs) result in millions of avoidable deaths or prolonged lengths of stay in hospitals and cause huge economic loss to health systems and communities. Primarily, HAIs spread through the hands of healthcare workers, so improving hand hygiene can reduce their spread. We evaluated hand hygiene practices and promotion across 13 public health hospitals (six secondary and seven tertiary hospitals) in the Western Area of Sierra Leone in a cross-sectional study using the WHO hand hygiene self-Assessment framework in May 2021. The mean score for all hospitals was 273 ± 46, indicating an intermediate level of hand hygiene. Nine hospitals achieved an intermediate level and four a basic level. More secondary hospitals 5 (83%) were at the intermediate level, compared to tertiary hospitals 4 (57%). Tertiary hospitals were poorly rated in the reminders in workplace and institutional safety climate domains but excelled in training and education. Lack of budgets to support hand hygiene implementation is a priority gap underlying this poor performance. These gaps hinder hand hygiene practice and promotion, contributing to the continued spread of HAIs. Enhancing the distribution of hand hygiene resources and encouraging an embedded culture of hand hygiene practice in hospitals will reduce HAIs

Climate-smart fisheries: CO2 emissions reduction and food security are complementary

In the global north, climate-smart fisheries (CSF) policies prioritise steps to combat CO2 emissions from SSF, in a response to the fact that globally, CO2 emissions from small-scale fisheries (SSFs) increased by over 5.8 times between 1950 and 2016. However, in the global south, CSF policies on SSF prioritise food and income security over CO2 emission reduction. In this paper, we examine this apparently contrasting interpretation of CSF as a conceptual framework to interpret the case study of Sierra Leone, one of Africa's poorest countries where we found that small-scale coastal fishers are preoccupied with mitigating the impact of climate change on their food and income security rather than with lowering their CO2 emissions. The self-image of SSF in Sierra Leone is that of being victims of climate change rather than perpetrators of it, and they justify this stance by claiming their livelihoods are being threatened by climate change. However, it could be argued that the best way to keep Sierra Leonean SSF CO2 emissions low is to prioritise their food and income security: in other words, that food security and CO2 reductions are complementary not contradictory. This, at any rate, is the argument of the current paper. The fieldwork for this study entailed co-created research in Sierra Leone and it involved 103 stakeholders who met face-to-face and online between January and March 2022 and through village meetings. The results of this fieldwork showed that food and income security and not CO2 emissions are the priorities in the stakeholders’ interpretation of CSF. However, if food and income security are not prioritised, communities are likely to adopt maladaptive strategies which undermine marine protected areas (MPAs) and exacerbate overfishing, thereby increasing CO2 emissions. Moreover, investment in aquaculture as a supplementary or alternative livelihood can directly increase food security and incomes and at the same time indirectly serve as a CO2 mitigation measure. In addition, weather information communication is an important CSF measure which both protects fishers from the impact of climate change and reduces their CO2 emissions. Accordingly, we argue that the contrast between reducing CO2 emissions and protecting food security from climate change may be more apparent than real in Sierra Leone coastal fisheries, since both policies may work in tandem together. This study therefore contributes a new interpretation of CSF in the global south: instead of seeing it as posing a conflict between CO2 emissions reductions and food security, we have shown the two objectives can be complementary. The wider implication of this paper is that CSF strategies for SSFs do not have to be polarised between the global north's focus on the reduction of CO2 emissions from fishing vessels and the global south's focus on the mitigation of the impact of global warming on SSFs. There are circumstances when the two objectives may be in harmony

Evaluation of Drinking Water Quality and Bacterial Antibiotic Sensitivity in Wells and Standpipes at Household Water Points in Freetown, Sierra Leone

From MDPI via Jisc Publications RouterHistory: accepted 2022-04-27, pub-electronic 2022-05-29Publication status: PublishedWater quality surveillance can help to reduce waterborne diseases. Despite better access to safe drinking water in Sierra Leone, about a third of the population (3 million people) drink water from unimproved sources. In this cross-sectional study, we collected water samples from 15 standpipes and 5 wells and measured the physicochemical and bacteriological water quality, and the antimicrobial sensitivity of Escherichia coli (E. coli) in two communities in Freetown, Sierra Leone in the dry and wet seasons in 2021. All water sources were contaminated with E. coli, and all five wells and 25% of standpipes had at least an intermediate risk level of E. coli. There was no antimicrobial resistance detected in the E. coli tested. The nitrate level exceeded the WHO’s recommended standard (>10 parts per million) in 60% of the wells and in less than 20% of the standpipes. The proportion of samples from standpipes with high levels of total dissolved solids (>10 Nephelometric Turbidity Units) was much higher in the rainy season (73% vs. 7%). The level of water contamination is concerning. We suggest options to reduce E. coli contamination. Further research is required to identify where contamination of the water in standpipes is occurring

Achieving minimum standards for infection prevention and control in Sierra Leone: Urgent need for a quantum leap in progress in the COVID-19 era!

From MDPI via Jisc Publications RouterHistory: accepted 2022-04-20, pub-electronic 2022-05-06Publication status: PublishedIntroduction: Good Infection prevention and control (IPC) is vital for tackling antimicrobial resistance and limiting health care-associated infections. We compared IPC performance before (2019) and during the COVID-19 (2021) era at the national IPC unit and all regional (4) and district hospitals (8) in Sierra Leone. Methods: Cross-sectional assessments using standardized World Health Organizations IPC checklists. IPC performance scores were graded as inadequate = 0−25%, basic = 25.1−50%, intermediate = 50.1−75%, and advanced = 75.1−100%. Results: Overall performance improved from ‘basic’ to ‘intermediate’ at the national IPC unit (41% in 2019 to 58% in 2021) and at regional hospitals (37% in 2019 to 54% in 2021) but remained ‘basic’ at district hospitals (37% in 2019 to 50% in 2021). Priority gaps at the national IPC unit included lack of: a dedicated IPC budget, monitoring the effectiveness of IPC trainings and health care-associated infection surveillance. Gaps at hospitals included no assessment of hospital staffing needs, inadequate infrastructure for IPC and lack of a well-defined monitoring plan with clear goals, targets and activities. Conclusion: Although there is encouraging progress in IPC performance, it is slower than desired in light of the COVID-19 pandemic. There is urgent need to mobilize political will, leadership and resources and make a quantum leap forward.19pubpub

How Well Are Hand Hygiene Practices and Promotion Implemented in Sierra Leone? A Cross-Sectional Study in 13 Public Hospitals

From MDPI via Jisc Publications RouterHistory: accepted 2022-03-17, pub-electronic 2022-03-23Publication status: PublishedHealthcare-associated infections (HAIs) result in millions of avoidable deaths or prolonged lengths of stay in hospitals and cause huge economic loss to health systems and communities. Primarily, HAIs spread through the hands of healthcare workers, so improving hand hygiene can reduce their spread. We evaluated hand hygiene practices and promotion across 13 public health hospitals (six secondary and seven tertiary hospitals) in the Western Area of Sierra Leone in a cross-sectional study using the WHO hand hygiene self-Assessment framework in May 2021. The mean score for all hospitals was 273 ± 46, indicating an intermediate level of hand hygiene. Nine hospitals achieved an intermediate level and four a basic level. More secondary hospitals 5 (83%) were at the intermediate level, compared to tertiary hospitals 4 (57%). Tertiary hospitals were poorly rated in the reminders in workplace and institutional safety climate domains but excelled in training and education. Lack of budgets to support hand hygiene implementation is a priority gap underlying this poor performance. These gaps hinder hand hygiene practice and promotion, contributing to the continued spread of HAIs. Enhancing the distribution of hand hygiene resources and encouraging an embedded culture of hand hygiene practice in hospitals will reduce HAIs

South African Ebola diagnostic response in Sierra Leone : a modular high biosafety field laboratory

BACKGROUND : In August 2014, the National Institute for Communicable Diseases (NICD) in South Africa established a modular high-biosafety field Ebola diagnostic laboratory (SA FEDL) near Freetown, Sierra Leone in response to the rapidly increasing number of Ebola virus disease (EVD) cases. METHODS AND FINDINGS : The SA FEDL operated in the Western Area of Sierra Leone, which remained a ªhotspotº of the EVD epidemic for months. The FEDL was the only diagnostic capacity available to respond to the overwhelming demand for rapid EVD laboratory diagnosis for several weeks in the initial stages of the EVD crisis in the capital of Sierra Leone. Furthermore, the NICD set out to establish local capacity amongst Sierra Leonean nationals in all aspects of the FEDL functions from the outset. This led to the successful hand-over of the FEDL to the Sierra Leone Ministry of Health and Sanitation in March 2015. Between 25 August 2014 and 22 June 2016, the laboratory tested 11,250 specimens mostly from the Western Urban and Western Rural regions of Sierra Leone, of which 2,379 (21.14%) tested positive for Ebola virus RNA. CONCLUSIONS : he bio-safety standards and the portability of the SA FEDL, offered a cost-effective and practical alternative for the rapid deployment of a field-operated high biocontainment facility. The SA FEDL teams demonstrated that it is highly beneficial to train the national staff in the course of formidable disease outbreak and accomplished their full integration into all operational and diagnostic aspects of the laboratory. This initiative contributed to the international efforts in bringing the EVD outbreak under control in Sierra Leone, as well as capacitating local African scientists and technologists to respond to diagnostic needs that might be required in future outbreaks of highly contagious pathogens.S1 Video. ªHotº processing of Ebola clinical specimens, PPE and decontamination procedures in South African modular, field-operated biocontainment facility in Sierra Leone.Janusz T Paweska was supported by funding from National Research Foundation and the Global Disease Detection Programmehttp://www.plosntds.orgam2017Microbiology and Plant Patholog

Lion Mountain Landslide in Non-urbanized Terrain: Changing the Myth of Landslide Occurrence in Western Sierra Leone

Freetown has documented one of the most devastating landslides in the world in 2017. Many debates in the media, few scientific papers and technical documents, have argued with eloquence ascertaining human factors, particularly deforestation and urbanization, as the dominant causative factor. This notion seems to be widely accepted for all other slides by the communities, government agencies and departments. Therefore, this work attempts to expand on existing public knowledge by demonstrating the less influential or insignificant human factors which can have impacts on certain landslide occurrences in the Freetown Layered-Complex. The representative landslide considered for this study occurred beyond the vicinity of urbanized zone. Therefore, to establish a clear understanding of the actual causative factors, fieldwork and laboratory investigations were undertaken. During the field survey, we assessed the rock type, discontinuities, geomorphology and hydrological influence of the landslide. The specific rock series underlying the landslide was confirmed through thin section analysis at the National Minerals Agency (NMA). DCP tests and laboratory analyses enhanced the derivation of geotechnical properties of the residual soil/regolith.This work systematically presented how natural conditions, such as: geology (rock types and tectonic signatures), geomorphology, hydrology and the geotechnical properties of the slope soil, have interplayed in the occurrence of the landslide event. In addition, the slip surface of the landslide occurred at a depth below the reach of plant activities (2.6 m). This information may help modify public messages by institutions and can be a source of useful information for the country’s Landslide Disaster Management Department (LDMD)

Have Hand Hygiene Practices in Two Tertiary Care Hospitals, Freetown, Sierra Leone, Improved in 2023 following Operational Research in 2021?

In 2021, an operational research study in two tertiary hospitals in Freetown showed poor hand hygiene compliance. Recommended actions were taken to improve the situation. Between February–April 2023, a cross-sectional study was conducted in the same two hospitals using the World Health Organization hand hygiene tool to assess and compare hand hygiene compliance with that observed between June–August 2021. In Connaught hospital, overall hand hygiene compliance improved from 51% to 60% (p p < 0.001), with significant decreases observed in all departments and amongst nurses and nursing students. The improvements in Connaught Hospital were probably because of more hand hygiene reminders, better handwash infrastructure and more frequent supervision assessments, compared with 34MH where interventions were less well applied, possibly due to the extensive hospital reconstruction at the time. In conclusion, recommendations from operational research in 2021 contributed towards the improved distribution of hand hygiene reminders, better handwash infrastructure and frequent supervision assessments, which possibly led to improved hand hygiene compliance in one of the two hospitals. These actions need to be strengthened, scaled-up and guided by ongoing operational research to promote good hand hygiene practices elsewhere in the country

Climate-smart fisheries: CO2 emissions reduction and food security are complementary

In the global north, climate-smart fisheries (CSF) policies prioritise steps to combat CO2 emissions from SSF, in a response to the fact that globally, CO2 emissions from small-scale fisheries (SSFs) increased by 5.8 times between 1950-2016. However, in the global south, CSF policies on SSF prioritise food and income security over CO2 emission reduction. In this paper, we examine this apparently contrasting interpretation of CSF as a conceptual framework to interpret the case study of Sierra Leone, one of Africa’s poorest countries where we found that small-scale coastal fishers are preoccupied with mitigating the impact of climate change on their food and income security rather than with lowering their CO2 emissions. The self-image of SSF in Sierra Leone is that of being victims of climate change rather than perpetrators of it, and they justify this stance by claiming their livelihoods are being threatened by climate change. However, it could be argued that the best way to keep Sierra Leonean SSF CO2 emissions low is to prioritise their food and income security: in other words, that food security and CO2 reductions are complementary not contradictory. This, at any rate, is the argument of the current paper. The fieldwork for this study entailed co-created research in Sierra Leone which involved 103 stakeholders who met face-to-face and online between January and March 2022 and through village meetings. The results of this fieldwork showed that food and income security and not CO2 emissions are the priorities in the stakeholders’ interpretation of CSF. However, if food and income security are not prioritised, communities are likely to adopt maladaptive strategies which undermine marine protected areas (MPAs) and exacerbate overfishing, thereby increasing CO2 emissions. Moreover, investment in aquaculture as a supplementary or alternative livelihood can directly increase food security and incomes and at the same time indirectly serve as a CO2 mitigation measure. In addition, weather information communication is an important CSF measure which both protects fishers from the impact of climate change and reduces their CO2 emissions. Accordingly, we argue that the contrast between reducing CO2 emissions and protecting food security from climate change may be more apparent than real in Sierra Leone coastal fisheries, since both policies may work in tandem together This study therefore contributes a new interpretation of CSF in the global south: instead of seeing it as posing a conflict between CO2 emissions reductions and food security, we have shown the two objectives can be complementary. The wider implication of this paper is that CSF strategies for SSFs do not have to be polarised between the global north’s focus on the reduction of CO2 emissions from fishing vessels and the global south’s focus on the mitigation of the impact of global warming on SSFs. There are circumstances when the two objectives may be in harmony