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Chiyembekezo Kachimanga,1,2 Anu Jegede Williams,3 Musa Bangura,1 Marta Lado,4 Sahr Kanawa,5 Daniel Lavallie,5 Michael Mhango,1 Haja Isatta Wurie,6 Marta Patiño Rodriguez1 1Partners in Health Sierra Leone, Koidu City, Sierra Leone; 2Partners in Health Malawi, Neno, Malawi; 3Central Public Health Reference Laboratory, Ministry of Health and Sanitation, Freetown, Sierra Leone; 4World Health Organization, Geneva, Switzerland; 5Koidu Government Hospital, Ministry of Health and Sanitation, Koidu City, Sierra Leone; 6Laboratory Science Unit, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra LeoneCorrespondence: Chiyembekezo Kachimanga Tel +265 887247777Email chembekachimanga@yahoo.co.ukIntroduction: Currently, there are no data on prevalence and associated risk factors of chronic kidney disease (CKD) among patients with hypertension in rural Sierra Leone.Purpose: To estimate the prevalence and associated risk factors of CKD in rural Sierra Leone.Patients and Methods: A cross-sectional study of hypertension patients aged between 18 and 75 years attending a non-communicable disease clinic at Koidu Government Hospital, Kono District, Sierra Leone was conducted between February and December 2020. Using systematic random sampling, a structured questionnaire, which comprised of questions on social demographic characteristics and past and current clinical history, was administered followed by measurement of creatinine and urinary protein and glucose. Estimated glomerular filtration rate (eGFR) was estimated using CKD-epidemiology formula without race as a factor. Baseline eGFR between 60– 89 min/mL/1.73m2 and < 60 min/mL/1.73m2 defined reduced eGFR and renal impairment, respectively. Estimated GFR less than 60 min/mL/1.73m2 measured two times at least 3 months apart was used to define CKD.Results: Ninety-six percent (n = 304) patients out of 317 patients were included in the study. Among all included patients, only 3.9% (n = 12) had eGFR of 90 min/mL/1.73m2 and above. The prevalence of renal impairment and CKD was 52% (158/304, CI 46.2– 57.7) and 29.9% (91/304, CI 24.8– 34.5), respectively. In adjusted logistic regression analysis, currently taking herbal medications as treatment of hypertension (OR 4.11 (CI 1.14– 14.80), p = 0.03) and being overweight and/or obese (OR 2.16 (CI 1.24– 3.78), p < 0.001) was associated with CKD. Additionally, receiving some education was associated with a 48% (OR 0.52 (CI 0.29– 0.91), p = 0.02) reduced likelihood of CKD.Conclusion: The prevalence of renal impairment and CKD is high among hypertensive patients in rural Sierra Leone. CKD was associated with current history of taking herbal medications and being overweight and/or obese. Additionally, CKD was associated with reduced likelihood in patients who received some education.Keywords: hypertension, non-communicable diseases, CKD, renal impairment, screening, Sierra Leone

This study is an evaluation of the first cohort of patients enrolled in an outpatient non-communicable disease clinic in Kono, Sierra Leone. In the first year, the clinic enrolled 916 patients. Eight months after the enrollment of the last patient, 53% were still active in care, 43% had been lost to follow-up (LTFU) and 4% had defaulted. Of the LTFU patients, 47% only came for the initial enrollment visit and never returned. Treatment outcomes of three patient groups [HTN only (n = 720), DM only (n = 51), and HTN/DM (n = 96)] were analyzed through a retrospective chart review. On average, all groups experienced reductions in blood pressure and/or blood glucose of approximately 10% and 20%, respectively. The proportions of patients with their condition controlled also increased. As NCDs remain underfunded and under-prioritized in low-income countries, the integrated program in Kono demonstrates the possibility of improving outpatient NCD care in Sierra Leone and similar settings.

Background: This study aimed at describing the changes in the completeness of documentation and changes in decision to incision time interval of emergency cesarean sections after an audit and feedback project a rural hospital in Sierra Leone. Methods: We documented and monitored the decision and incision times for emergency cesarean sections over the course of two years. Year one focused on the introduction of the project and year two focused on the continuous monitoring of the project. We compared the completeness of decision to incision data and used the 30-min benchmark as target for the decision to incision time interval. Results: A total of 762 emergency cesarean sections were included. While the completion of decision time data (72%) did not change between the two reporting periods, documentation of incision time increased from 95% to 98% (p &lt, 0.001). Complete documentation for both decision and incision time was available for 540 (70.9%) emergency cesarean sections. The decision to incision time interval decreased from 105 min to 42 min (p &lt, 0.001). The proportion of cesarean sections started within 30 min increased from 8.5% to 37% (p &lt, 0.001). Conclusion: Although not all cesarean sections were performed within the 30-min threshold, the decision to incision interval decreased significantly. Improvements in documentation and routine reporting of the decision to incision time interval is recommended.