Risk factors for preeclampsia and eclampsia at a main referral maternity hospital in Freetown, Sierra Leone: a case-control study

Background: In the African region, 5.6% of pregnancies are estimated to be complicated by preeclampsia and 2.9% by eclampsia, with almost one in ten maternal deaths being associated with hypertensive disorders. In Sierra Leone, representing one of the countries with the highest maternal mortality rates in the world, 16% of maternal deaths were caused by pregnancy-induced hypertension in 2016. In the light of the high burden of preeclampsia and eclampsia (PrE/E) in Sierra Leone, we aimed at assessing population-based risk factors for PrE/E to offer improved management for women at risk. Methods: A facility-based, unmatched observational case-control study was conducted in Princess Christian Maternity Hospital (PCMH). PCMH is situated in Freetown and is the only health care facility providing 'Comprehensive Emergency Obstetric and Neonatal Care services' throughout the entire country. Cases were defined as pregnant or postpartum women diagnosed with PrE/E, and controls as normotensive postpartum women. Data collection was performed with a questionnaire assessing a wide spectrum of factors influencing pregnant women's health. Statistical analysis was performed by estimating a binary logistic regression model. Results: We analyzed data of 672 women, 214 cases and 458 controls. The analysis yielded several independent predictors for PrE/E, including family predisposition for PrE/E (AOR=2.72, 95% CI: 1.46-5.07), preexisting hypertension (AOR=3.64, 95% CI: 1.32-10.06), a high mid-upper arm circumflex (AOR=3.09, 95% CI: 1.83-5.22), presence of urinary tract infection during pregnancy (AOR=2.02, 95% CI: 1.28-3.19), presence of prolonged diarrhoea during pregnancy (AOR=2.81, 95% CI: 1.63-4.86), low maternal assets (AOR=2.56, 95% CI: 1.63-4.02), inadequate fruit intake (AOR=2.58, 95% CI: 1.64-4.06), well or borehole water as the main source of drinking water (AOR=2.05, 95% CI: 1.31-3.23) and living close to a waste deposit (AOR=1.94, 95% CI: 1.15-3.25). Conclusion: Our findings suggest that systematic assessment of identified PrE/E risk factors, including a family predisposition for PrE/E, preexisting hypertension, or obesity, should be performed early on in ANC, followed by continued close monitoring of first signs and symptoms of PrE/E. Additionally, counseling on nutrition, exercise, and water safety is needed throughout pregnancy as well as education on improved hygiene behavior. Further research on sources of environmental pollution in Freetown is urgently required

Genotype by environment interaction and stability of extra-early maize hybrids (Zea Mays L.) for yield evaluated under irrigation.

Maize (Zea mays L.) is the most important cereal crop produced in Ghana. However the change in environmental conditions, the expansion of maize to new agro-ecologies coupled with inadequate maize varieties available for the different environments affects yield improvement programmes in Ghana. Hence, the study is to investigate the influence of genotype by environment interaction on the maize hybrids and to identify stable and high yielding hybrids with superior agronomic for famers use in the country. The objectives of the study was to investigate the influence of genotype by environment interaction on the maize hybrids and to identify stable and high yielding hybrids with superior agronomic performance for famers use in Ghana. Thus, fifteen extra-early maize hybrids and three locally released checks were evaluated in a randomized complete block design with three replications in two locations in Ghana. The experiment was carried out at KNUST and Akomadan which represent the forest and forest transition zones of Ghana. Nine of the hybrids out of the fifteen hybrids evaluated produce above the average yield and the effect of genotype, location and genotype by location interaction was significant for grain yield. The GGE biplot used in this study revealed that TZEEI-1 x TZEEI-21, TZEEI-6 x TZEEI-21, TZEEI-15 x TZEEI-1 and TZEEI-29 x TZEEI-21 were high yielding and stable hybrids because they were closer to the ideal. The GGE biplot also identified Akomadan as the most ideal testing environment for these hybrids under irrigation

Introducing medical parasitology at the University of Makeni, Sierra Leone

The file attached to this record is the author's final peer reviewed version.Capacity building in Sierra Leone (West Africa) is critical to prevent potential future outbreaks similar to the 2013-16 Ebola outbreak that had devastating effects for the country and its poorly developed healthcare system. De Montfort University (DMU) in the United Kingdom (UK), in collaboration with parasitologists from the Spanish Universities of San Pablo CEU and Miguel Hernández de Elche, is leading a project to build the teaching and research capabilities of medical parasitology at the University of Makeni (UniMak, Sierra Leone). This project has two objectives: a) to introduce and enhance the teaching of medical parasitology, both theoretical and practical; and b) to implement and develop parasitology research related to important emerging human parasites such as Cryptosporidium spp. due to their public health significance. Two UniMak academics, hired to help initiate and implement the research part of the project, shared their culturally sensitive public health expertise to broker parasitology research in communities and perform a comprehensive environmental monitoring study for the detection of different emerging human parasites. The presence of targeted parasites are being studied microscopically using different staining techniques, which in turn have allowed UniMak’s academics to learn these techniques to develop new practicals in parasitology. To train UniMak’s academics and develop both parts of our project, a DMU researcher visited UniMak for two weeks in April 2019 and provided a voluntary short training course in basic parasitology, which is currently not taught in any of their programmes, and was attended by 31 students. These sessions covered basic introduction to medical parasitology and life-cycle, pathogenesis, detection, treatment and prevention of: a) coccidian parasites (Cryptosporidium, Cyclospora and Cystoisospora); b) Giardia intestinalis, Entamoeba and free-living amoebas; c) malaria and d) microsporidia. A theoretical session on common staining techniques was also provided. To facilitate the teaching and learning of these parasites, the novel resource DMU e-Parasitology was used, a package developed by the above participating universities and biomedical scientists from the UK National Health Service (NHS): http://parasitology.dmu.ac.uk/ index.htm. Following the two weeks of training, UniMak’s academics performed different curriculum modifications to the undergraduate programme ‘Public Health: Medical Laboratory Sciences’, which includes the introduction of new practicals in parasitology and changes to enhance the content of medical parasitology that will be subjected to examination. Thus, a new voluntary practical on Kinyoun stain for the detection of coccidian parasites was introduced in the final year module of ‘Medical Bacteriology and Parasitology’; eighteen students in pairs processed faecal samples from pigs provided by the Department of Agriculture and Food Security from a nearby farm. Academics at UniMak used the Kinyoun staining unit (available at http://parasitology.dmu.ac.uk/learn/lab/Kinyoun/story_html5.html; [1]) to deliver this practical. Although our project is at a preliminary stage, it has been shown to be effective in promoting the introduction and establishment of medical parasitology at UniMak and could be viewed as a case-study for other universities in low-income countries to promote the United Nations (UN) Sustainable Development Goals (SDGs) and improve public health understanding of infectious diseases

Current status of schistosomiasis and soil-transmitted helminthiasis in Beyla and Macenta Prefectures, Forest Guinea

A cross-sectional survey was undertaken in children aged 9-14 years in Beyla and Macenta Prefectures, Forest Guinea. Stool samples were examined by Kato-Katz and urine samples were examined by the centrifugation method. The overall prevalence and intensity of infection was 66.2% and 462.4 eggs per gram of faeces (epg) for Schistosoma mansoni, 21.0% and 17.8 eggs per 10ml of urine for S. haematobium, 51.2% and 507.5 epg for hookworm, 8.1% and 89.1 epg for Ascaris lumbricoides and 2.4% and 16.7 epg for Trichuris trichiura. The overall prevalence of schistosomiasis (S. mansoni and/or S. haematobium) was 70.7%. The prevalence of schistosomiasis was similar to those reported in the 1990s in the region; however, the prevalence of soil-transmitted helminths has since fallen. These findings illustrate the need for schistosomiasis control in Guine

An experimental evaluation of fracture movement in two alternative tibial fracture fixation models using a vibrating platform

Several studies have investigated the effect of low-magnitude-high-frequency vibration on the 30 outcome of fracture healing in animal models. The aim of this study was to quantify and 31 compare the micromovement at the fracture gap in a tibial fracture fixed with an external fixator 32 in both a surrogate model of a tibial fracture and a cadaver human leg under static loading, 33 both subjected to vibration. The constructs were loaded under static axial loads of 50, 100, 34 150 and 200 N and then subjected to vibration at each load using a commercial vibration 35 platform, using a DVRT sensor to quantify static and dynamic fracture movement. The overall 36 stiffness of the cadaver leg was significantly higher than the surrogate model under static 37 loading. This resulted in a significantly higher facture movement in the surrogate model. Under 38 vibration the fracture movements induced at the fracture gap in the surrogate model and the 39 cadaver leg were 0.024±0.009 mm and 0.016±0.002 mm respectively, at 200N loading. Soft 40 tissues can alter the overall stiffness and fracture movement recorded in biomechanical 41 studies investigating the effect of various devices or therapies. While the relative comparison 42 between the devices or therapies may remain valid, absolute magnitude of recordings 43 measured externally must be interpreted with caution

Geographical Distribution of Intestinal Schistosomiasis and Soil-Transmitted Helminthiasis and Preventive Chemotherapy Strategies in Sierra Leone

The common intestinal roundworm, whipworm and hookworm (together known as soil-transmitted helminthes - STHs) together with schistosomes or bilharzia are responsible for extensive ill health, reduced life expectancy and death in sub-Saharan Africa. These diseases are transmitted in areas of poor water supply and sanitation. In order to implement an appropriate national control program, knowledge of the prevalence and geographical distribution of these diseases is required. A national survey was performed in Sierra Leone in 2008. Overall prevalence of intestinal schistosomiasis was 18.4% and that of STHs was 39.1%. Intestinal schistosomiasis was mainly prevalent in the northern and eastern regions while STH is widespread in the country. The results justify routine de-worming for pre-school children, school age children, women of childbearing age, and adults at high risk twice a year. The results also justify using anti-schistosomiasis drug (praziquantel) in school age children, all women of childbearing age, and adults at high risk annually or biennially depending upon the prevalence in the areas

Combined Spatial Prediction of Schistosomiasis and Soil-Transmitted Helminthiasis in Sierra Leone: A Tool for Integrated Disease Control

Two forms of schistosomiasis or bilharzia (intestinal and urogenital) exist in Sierra Leone. The main control strategy for this disease currently is through mass drug administration (MDA) according to the World Health Organization recommended anthelminthic chemotherapy guidelines, and others include snail control, behavior change, and safe water, sanitation and hygiene. Survey on distribution and prevalence of the disease is vital to the planning of MDA in each district. The distribution of intestinal schistosomiasis in the country has been reported previously. The current national survey showed that urogenital schistosomiasis has a specific focal distribution particularly in the central and eastern regions of the country, most prevalent in Bo (24.6%), Koinadugu (20.4%) and Kono (25.3%) districts. Using a simple probabilistic model, this map was combined with the previously reported maps on intestinal schistosomiasis and the combined schistosomiasis prevalence was estimated. The combined schistosomiasis map highlights the presence of high-risk communities in an extensive area in the northeastern half of the country, which provides a tool for planning the national MDA activities