24 research outputs found
The social regulation of livelihoods in unplanned settlements in Freetown: implications for strategies of formalisation
This paper questions strategies of economic formalisation which prioritise the extension of state regulation as a means of extending access to labour protection and social protection. It draws on a research project on key livelihood systems and their associated governance arrangements in three unplanned urban settlements in Freetown, Sierra Leone. Our analysis of these fishing, and sand and stone-quarrying livelihood systems highlights the collective systems of regulation of these sectors by a range of different state and non-state actors. Reviewing the contributions of these various arrangements we suggest that, instead of focusing on formalisation as pursued primarily through the extension of state regulation, it is also crucial to explore means of working with the (informal) social arrangements through which these livelihood systems are governed
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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 ~2000Ă 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
Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone
Background
Limited clinical and laboratory data are available on patients with Ebola virus disease (EVD). The Kenema Government Hospital in Sierra Leone, which had an existing infrastructure for research regarding viral hemorrhagic fever, has received and cared for patients with EVD since the beginning of the outbreak in Sierra Leone in May 2014.
Methods
We reviewed available epidemiologic, clinical, and laboratory records of patients in whom EVD was diagnosed between May 25 and June 18, 2014. We used quantitative reverse-transcriptaseâpolymerase-chain-reaction assays to assess the load of Ebola virus (EBOV, Zaire species) in a subgroup of patients.
Results
Of 106 patients in whom EVD was diagnosed, 87 had a known outcome, and 44 had detailed clinical information available. The incubation period was estimated to be 6 to 12 days, and the case fatality rate was 74%. Common findings at presentation included fever (in 89% of the patients), headache (in 80%), weakness (in 66%), dizziness (in 60%), diarrhea (in 51%), abdominal pain (in 40%), and vomiting (in 34%). Clinical and laboratory factors at presentation that were associated with a fatal outcome included fever, weakness, dizziness, diarrhea, and elevated levels of blood urea nitrogen, aspartate aminotransferase, and creatinine. Exploratory analyses indicated that patients under the age of 21 years had a lower case fatality rate than those over the age of 45 years (57% vs. 94%, P=0.03), and patients presenting with fewer than 100,000 EBOV copies per milliliter had a lower case fatality rate than those with 10 million EBOV copies per milliliter or more (33% vs. 94%, P=0.003). Bleeding occurred in only 1 patient.
Conclusions
The incubation period and case fatality rate among patients with EVD in Sierra Leone are similar to those observed elsewhere in the 2014 outbreak and in previous outbreaks. Although bleeding was an infrequent finding, diarrhea and other gastrointestinal manifestations were common. (Funded by the National Institutes of Health and others.
Ebola virus epidemiology, transmission, and evolution during seven months in Sierra Leone
The 2013-2015 Ebola virus disease (EVD) epidemic is caused by the Makona variant of Ebola virus (EBOV). Early in the epidemic, genome sequencing provided insights into virus evolution and transmission and offered important information for outbreak response. Here, we analyze sequences from 232 patients sampled over 7 months in Sierra Leone, along with 86 previously released genomes from earlier in the epidemic. We confirm sustained human-to-human transmission within Sierra Leone and find no evidence for import or export of EBOV across national borders after its initial introduction. Using high-depth replicate sequencing, we observe both host-to-host transmission and recurrent emergence of intrahost genetic variants. We trace the increasing impact of purifying selection in suppressing the accumulation of nonsynonymous mutations over time. Finally, we note changes in the mucin-like domain of EBOV glycoprotein that merit further investigation. These findings clarify the movement of EBOV within the region and describe viral evolution during prolonged human-to-human transmission
Urban livelihoods in Freetownâs Informal Settlements
In Sierra Leone, there is a dearth of information on urban livelihoods, and in particular on livelihoods in informal settlements. The Sierra Leone Urban Research Centre (SLURC) has studied urban livelihoods in four informal settlementsâCockle Bay, Dwarzarck, Moyiba and Portee/Rokupaâacross Freetown to address this critical knowledge gap. This research focuses on a number of typical livelihood sectors in which informal settlement residents participate to enhance the understanding of livelihood strategies that women and men in informal settlements employ. It aims to inform policy interventions that build the capabilities, and respond to the needs and priorities, of informal settlement dwellers, and to assist them and other urban actors to develop appropriate, effective and practical interventions to strengthen the livelihoods of the informal settlements residents and the performance of the city economy. Specifically, the research will: generate a better understanding of some key livelihood systems in Freetownâs informal settlements; investigate and document the importance of different livelihoods for the wellbeing of women and men and for the city of Freetown more generally; produce knowledge to inform livelihood strategy development and help stakeholders to strategize on how best to support urban livelihoods activities, particularly of informal settlement residents, including policy recommendations