Antiretroviral Medication Adherence During The Ebola Epidemic In Sierra Leone

The 2014 Ebola outbreak is the largest in history and the first in West Africa. The outbreak affected multiple countries in West Africa. Worldwide, there have been 28,639 cases of Ebola virus disease and 11,316 deaths at 13 March 2016 in the world’s worst recorded Ebola epidemic in Guinea, Liberia, and Sierra Leone. In 2002, the National Plan for HIV and AIDS was approved by the Government of Sierra Leone. The Strategic Plan and the associated guidelines included Prevention of Mother-to-Child Transmission (PMTCT) and the provision of Antiretroviral Treatment (ART). During the Ebola outbreak in Sierra Leone, there has been a strong suspicion that people avoided the premises for drug administration such as hospitals, clinics and Community Health Centres. Health care service providers were terrified and reluctant to deliver services at the initial stage of the epidemic because of fear of becoming infected with Ebola, a time when the resources needed to prevent transmission were not available in the country. This study was carried out to establish ART medication adherence during the Ebola outbreak. A cross-sectional study in both the community and institutions was carried out at four locations within Government Hospitals, support groups, and youth service centers. The four sites represented the Western, Southern, Eastern and Northern regions of the country. Semi-structured interviews and focus group discussions were carried out among People Living with HIV & AIDS (PLHA). The study found that 90% of PLHAs missed at least one month’s supply of ARV drugs thus indicating an adherence rate of 10%. The study also established that about 50% of PLHAs on ART failed to collect their drugs due to fear of the mounted checkpoints where temperatures of people were taken or fear of the diseases itself

Seroepidemiology of HIV in Moyamba District, Sierra Leone, 2013-2016

HIV infection is one of the health problems plaguing resource-poor countries. There are limited data on the prevalence in remote towns and districts. In this study we aimed at investigating the seroprevalence of HIV in Moyamba District using data from voluntary counseling and testing(VCT), prevention of mother-to-child transmission of HIV(PMCT) and from blood donors from 2013 to 2016.The seroprevalence of HIV from VCT was 2.87%(357/12434) for the four years, 2013 to 2016. Seroprevalence from PMCT was 0.91%(153/16,745) while the prevalence from healthy blood donors was 1.53%(27/1756). Overall, 537 persons tested positive for HIV out of 30,935 persons tested in Moyamba from 2013 to 2016 with a prevalence of 1.74(95%CI:1.6-1.89%).Statistically, our result is significantly different from the results of the DHS where HIV seroprevalence was reported at 1.0% in Moyamba(P<0.001).Our result provide an update on the HIV situation in Moyamba and shows an epidemic that is consistent with the national seroprevalence of 1.5%

Re-analysing Ebola spread in Sierra Leone: The importance of local social dynamics.

BACKGROUND: The 2013-15 Ebola epidemic in West Africa was the largest so far recorded, and mainly affected three adjacent countries, Guinea, Liberia and Sierra Leone. The worst affected country (in terms of confirmed cases) was Sierra Leone. The present paper looks at the epidemic in Sierra Leone. The epidemic in this country was a concatenation of local outbreaks. These local outbreaks are not well characterized through analysis using standard numerical techniques. In part, this reflects difficulties in record collection at the height of the epidemic. This paper offers a different approach, based on application of field-based techniques of social investigation that provide a richer understanding of the epidemic. METHODS: In a post-epidemic study (2016-18) of two districts (Bo and Moyamba) we use ethnographic data to reconstruct local infection pathways from evidence provided by affected communities, cross-referenced to records of the epidemic retained by the National Ebola Response Commission, now lodged in the Ebola Museum and Archive at Njala University. Our study documents and discusses local social and contextual factors largely missing from previously published studies. RESULTS: Our major finding is that the epidemic in Sierra Leone was a series of local outbreaks, some of which were better contained than others. In those that were not well contained, a number of contingent factors helps explain loss of control. Several numerical studies have drawn attention to the importance of local heterogeneities in the Sierra Leone Ebola epidemic. Our qualitative study throws specific light on a number of elements that explain these heterogeneities: the role of externalities, health system deficiencies, cultural considerations and local coping capacities. CONCLUSIONS: Social issues and local contingencies explain the spread of Ebola in Sierra Leone and are key to understanding heterogeneities in epidemiological data. Integrating ethnographic research into epidemic-response is critical to properly understand the patterns of spread and the opportunities to intervene. This conclusion has significant implications for future interdisciplinary research and interpretation of standard numerical data, and consequently for control of epidemic outbreaks

Ebola and public authority: saving loved ones in Sierra Leone

It is unclear how public authorities shaped responses to Ebola in Sierra Leone. Focusing on one village, we analyze what happened when “staff, stuff, space, and systems” were absent. Mutuality between neighbors, linked to secret societies, necessitated collective care for infected loved ones, irrespective of the risks. Practical learning was quick. Numbers recovering were reported to be higher among people treated in hidden locations, compared to those taken to Ebola Treatment Centres. Our findings challenge positive post-Ebola narratives about international aid and military deployment. A morally appropriate people’s science emerged under the radar of external scrutiny, including that of a paramount chief

(Re)arranging "systems of care" in the early Ebola response in Sierra Leone: An interdisciplinary analysis.

Despite an expanding literature on Ebola-response, few studies detail or reflect on the responses of diverse systems of care. Little is known about how, why or in what ways, strategies of ill-health management were enacted locally, how health-systems power, authority and hierarchy were perceived and contested, or how other social systems, institutions and relationships shaped the response. This paper presents an interdisciplinary analysis of local responses in two early affected districts in Sierra Leone. Drawing on anthropological theories of social ordering and assemblage, we present an analysis of contrasting infection chains in three extended case studies from Bo and Moyamba districts. In contrast to previous scholarship which has understood local actions as being reactive (supporting or obstructing) to a national Ebola response, we show that local arrangements lead and shape responses. Our cases show how multiple, entangled, dynamic and co-existing systems of care influence these responses. Some individuals and communities collaborated with health authorities on measures like reporting and quarantine, others actively opposed them, or played an intermediary role. Collectively, formal health systems actors, local authorities and ordinary citizens negotiated and enacted new arrangements. These arrangements involved compromise and sometimes power was reconfigured. They were also shaped by wider political and historical contexts and by availability or absence of formal healthcare resources. Our research shows the critical importance of understanding how institutions and people involved in healthcare enact diverse "systems of care" and thereby shape Ebola response. Most importantly, our work underlines the need for alignment between formal health-systems and wider social, cultural, political and economic forms of organisation at family and community levels to improve crisis-response and promote sustainable care. In particular, health systems responders need to identify and engage with key brokers - or arrangers - in frontline care systems, with whom mutually acceptable, and effective, reconfigurations of care can be achieved

National Antibiotic Consumption for Human Use in Sierra Leone (2017-2019): A Cross-Sectional Study.

Monitoring antibiotic consumption is crucial to tackling antimicrobial resistance. However, currently there is no system in Sierra Leone for recording and reporting on antibiotic consumption. We therefore conducted a cross-sectional study to assess national antibiotic consumption expressed as defined daily dose (DDD) per 1000 inhabitants per day using all registered and imported antibiotics (categorized under the subgroup J01 under the anatomical and therapeutic classification (ATC) system) as a proxy. Between 2017-2019, total cumulative consumption of antibiotics was 19 DDD per 1000 inhabitants per day. The vast majority consisted of oral antibiotics (98.4%), while parenteral antibiotics made up 1.6%. According to therapeutic /pharmacological subgroups (ATC level 3), beta-lactam/penicillins, quinolones, and other antibacterials (mainly oral metronidazole) comprised 65% of total consumption. According to WHO Access, Watch, and Reserve (AWaRe), 65% of antibiotics consumed were Access, 31% were Watch, and no Reserve antibiotics were reported. The top ten oral antibiotics represented 97% of total oral antibiotics consumed, with metronidazole (35%) and ciprofloxacin (15%) together constituting half of the total. Of parenteral antibiotics consumed, procaine penicillin (32%) and ceftriaxone (19%) together comprised half of the total. Policy recommendations at global and national levels have been made to improve monitoring of antibiotic consumption and antibiotic stewardship

Engaging communities as partners in health crisis response: a realist-informed scoping review for research and policy

Background: Health is increasingly affected by multiple types of crises. Community engagement is recognised as being a critical element in successful crisis response, and a number of conceptual frameworks and global guideline documents have been produced. However, little is known about the usefulness of such documents and whether they contain sufficient information to guide effective community engagement in crisis response. We undertake a scoping review to examine the usefulness of conceptual literature and official guidelines on community engagement in crisis response using a realist-informed analysis [exploring contexts, mechanisms, and outcomes(CMOs)]. Specifically, we assess the extent to which sufficient detail is provided on specific health crisis contexts, the range of mechanisms (actions) that are developed and employed to engage communities in crisis response and the outcomes achieved. We also consider the extent of analysis of interactions between the mechanisms and contexts which can explain whether successful outcomes are achieved or not. Scope and findings: We retained 30 documents from a total of 10,780 initially identified. Our analysis found that available evidence on context, mechanism and outcomes on community engagement in crisis response, or some of their elements, was promising, but few documents provided details on all three and even fewer were able to show evidence of the interactions between these categories, thus leaving gaps in understanding how to successfully engage communities in crisis response to secure impactful outcomes. There is evidence that involving community members in all the steps of response increases community resilience and helps to build trust. Consistent communication with the communities in time of crisis is the key for effective responses and helps to improve health indicators by avoiding preventable deaths. Conclusions: Our analysis confirms the complexity of successful community engagement and the need for strategies that help to deal with this complexity to achieve good health outcomes. Further primary research is needed to answer questions of how and why specific mechanisms, in particular contexts, can lead to positive outcomes, including what works and what does not work and how to measure these processes

The Prevalence and Intensity of soil-transmitted helminths and Schistosomiasis (Schistosoma mansoni) among primary school children aged 9-14 years in Tonkolili district, Northern Sierra Leone.

Soil-Transmitted Helminths (STH) and Schistosomiasis (SCH) infections are public health problems in areas with less improved sanitary conditions and lack of basic social amenities. The human soil-transmitted helminthiasis infections have been reported in many rural communities of the developing world. Global estimates of STH and SCH is over 2 billion of which ascariasis accounts for 1.6 billion while trichuriasis and hookworms account for about 700 – 800 million. The aim of the study was to investigate the prevalence and intensity of soil-transmitted helminths and Schistosomiasis (Schistosoma mansoni) among primary school children in Tonkolili district. The study employed a cross-sectional study design in two chiefdoms within Tonkolili District. In each Chiefdom, one primary school was sampled and in each school, a random sample of 100 pupils was selected. Kato-Katz technique was used to determine prevalence and intensity of STH and SCH infections and data analysis were done using software version EPi info 3.5.3.The study revealed that the overall prevalence of STH parasites is: Ascaris lumbricoides- 5.0% [95%CI(2.1 – 8.4)] and S. Mansoni has a prevalence of 26.0% [95% CI (20.1 – 32.7)]. The overall intensity of STH parasites: Ascaris lumbricoides-5.4epg; Trichuriasis trichiura-0.6epg; Hookworm-22.0epg, and for schistosomiasis; S. Mansoni has an intensity of 47epg.The study concluded that there has been a decrease in the prevalence and intensity of soil-transmitted helminthiasis in the district over the years. The observed low prevalence could be partly due to the preventive chemotherapy that has been going on through mass drug administration’s since 2009 and the ongoing program of treating children under five with anthelminthic drugs during the Mother and Child Health Week twice annually in the entire country.The study recommends that if the observed decrease in low prevalence and intensity of the infections should be sustained, then mass drugs administration should be done every year

Teenage Pregnant Girls and the Rate of Antenatal Clinic (ANC) Attendance in Bo Town, Sierra Leone

Teenage pregnancy is one of the serious Sexual Reproductive Health (SRH) issues in developing countries including Sierra Leone. It is believed that teenage pregnancy in Sierra Leonean communities is becoming a public health problem because it is presently contributing to a lot of health-related issues including maternal and child mortalities, serious maternal complications (e.g. fistulae) among others. This study was a cross-sectional retrospective record review of antenatal registers from January to December 2016 at three functional community health centres in Bo town. These include the Teaching Health Centre at the Korwama location of the Bo Campus- Njala University, the Yemoh Town Community Health Centre and the Police Community Health Centre at the Eastern Police Barracks.It involved the identification of all teenage pregnant girls attending the ANC for the first time, from antennal registers. A total number of 100 teenage pregnant girls were identified in the ANC registers from the three PHUs, focusing on the ages and the gestational periods at the first ANC visit. The study found out that close to 50% of the pregnant teenagers made their first visit at the gestational period very close to the third trimester of the pregnancy. It was also found that 5% of these teenage girls only attended one ANC clinic in the whole pregnant period. In addition, more than 50% of the teenage pregnancies were between the ages of 17 and 18 years. The study also detected that 11% of the victims are pregnant for the second or third time.From this study, is apparent that teenage pregnant girls delay their first visit to the ANC. As such, risks related to the pregnancies will be either detected very late or not detected at all.