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Sulaiman Kanu,1,* Peter Bai James,2,3,* Abdulai Jawo Bah,2,4,5 John Alimamy Kabba,6 Musa Salieu Kamara,1 Christine Ellen Elleanor Williams,7 Joseph Sam Kanu8 1University of Sierra Leone Teaching Hospital Complex, Connaught Hospital, Freetown, Sierra Leone; 2Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; 3Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007, Australia; 4Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; 5Institute for Global Health and Development, Queen Margaret University Edinburg, Musselburgh, Scotland, UK; 6Department of Pharmacy Administration and Clinical Pharmacy, Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, People’s Republic of China; 7Sierra Leone–China Friendship Hospital, Ministry of Health and Sanitation, Freetown, Sierra Leone; 8Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone*These authors contributed equally to this workCorrespondence: Peter Bai JamesFaculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra LeoneEmail jamepeb@yahoo.comBackground: Healthcare workers (HCWs) are known to spearhead the fight against the COVID-19 pandemic. As such, their knowledge, attitude, and practice (KAP) toward coronavirus disease 2019 (COVID-19) are considered critical to the success of the current COVID-19 response efforts. This study aims to determine HCWs’ KAP toward COVID-19 and assesses their perception of their healthcare facilities preparedness to respond appropriately to the ongoing COVID-19 pandemic in Sierra Leone.Methods: We conducted an online cross-sectional study among HCWs (n=516) between 1st May 2020 and 30th June 2020. We collected our data using a self-administered structured questionnaire via email and online social media platforms. We analyzed our data using descriptive statistics and regression analysis (p< 0.05).Results: Close to three-fourth of HCWs (n=375, 72.7%) were knowledgeable regarding COVID-19. Doctors were more knowledgeable than community health workers and laboratory technicians (AOR= 2.48, 95% CI: 1.16– 5.31, p=0.019) regarding COVID-19. Close to two-thirds of HCWs (n=301, 58.3%) HCWs show positive attitudes toward COVID-19. Being male (AOR=2.08, 95% CI: 1.36– 3.20, p=0.001) and directly involved in COVID-19 patient care (AOR=3.21, 95% CI: 1.88– 5.48, p< 0.001) were identified as predictors of positive attitude towards COVID-19. HCWs are generally adhering to COVID-19 safe practices with majority indicating that they regularly wash or sanitize their hands (n=510, 98.8%) and used facemask at point of care (n=499, 96.7%). Majority of HCWs are of the view that their healthcare facilities are ill-prepared to adequately respond to COVID-19 with majority (n= 400, 77.5%) of them stating that their facilities lack enough personal protective equipment.Conclusion: HCWs in Sierra Leone showed good knowledge, positive attitude and practice regarding COVID-19. However, HCWs are of the view that their healthcare facilities are ill-prepared to respond adequately to the COVID-19 outbreak. Health authorities and policymakers need to provide the necessary resources to allow HCWs to work in a safe environment.Keywords: COVID-19, knowledge, attitude, practice, healthcare workers, Sierra Leone

John Alimamy Kabba,1– 3 Peter Bai James,4,5 Zongjie Li,1– 3 Christian Hanson,6,7 Jie Chang,1– 3 Chenai Kitchen,1– 3 Minghuan Jiang,1– 3 Mingyue Zhao,1– 3 Caijun Yang,1– 3 Yu Fang1– 3 1Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, People’s Republic of China; 3Shaanxi Center for Health Reform and Development Research, Xi’an, People’s Republic of China; 4Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; 5Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney 2007, Australia; 6Pharmacy Board, Ministry of Health and Sanitation New England, Freetown, Sierra Leone; 7Pharmacy Department, Well Star Atlanta Medical Centre South, East Point, GA, USACorrespondence: Yu FangDepartment of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, People’s Republic of ChinaTel +86 29 82655132Email yufang@mail.xjtu.edu.cnPurpose: Rational use of medicines is a necessary constrict towards increasing access for those that desperately need them in society. In this study, we assess medicines prescribing patterns in healthcare facilities implementing free healthcare policy for pregnant women, lactating mothers and children under the age of five in Sierra Leone.Materials and Methods: Using WHO drug use indicators, we evaluated prescription records from the pharmacies of four hospitals; one from each of the four regions in Sierra Leone. To study prescribing indicators, we systematically sampled 1200 prescriptions overall (300/hospital) retrospectively spanning a year, from June 2017 to July 2018. In evaluating patients care indicators, we randomly sampled 120 (30/hospital) patients encounter prospectively. We used MS Excel 2016 and IMB SPSS in data analysis, and p< 0.05 was considered significant for associational analysis.Results: The average drug per prescription was 3.6 (SD=1.3) overall, 3.5 (1.3) for children under five and 3.4 (1.4) for pregnant women/lactating mothers. Eighty-seven percent of prescriptions for under-five children contains antibiotics as opposed to 68.4% of prescriptions for pregnant women/lactating mothers. More injections were prescribed per encounter for pregnant women/lactating mothers 23.2% than for children under five 18.1%. Overall, generic prescribing and prescribing from the National Essential Medicines List were 74.9% and 73.8%, respectively. None of the studied health facilities dispensed all of the prescribed medicines. The most prescribed pharmacological class of drugs were antibiotics, and paracetamol was the most commonly prescribed drug.Conclusion: Following WHO drug use indicators used in this study, drugs were irrationally prescribed within government hospitals providing free healthcare in Sierra Leone. Sustainability of the free healthcare scheme will require efficient medicine supply and management strategies. Therefore, the formulation of stewardship programs and/or an active Drug and Therapeutics Committee may be necessary to optimise drug use in these hospitals.Keywords: prescribing pattern, rational drug use, drug utilisation, free healthcare, Sierra Leone

Radiomics has the potential to improve the management of cancer patients, but further research is required before it can be adopted into routine clinical practice.