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Introduction Severe acute malnutrition accounts for a significant proportion of admission into the tertiary children’s hospital in Freetown. However, adequate breastfeeding is supposed to protect against severe malnutrition. Against this background, the knowledge, attitude and practice of mothers of children admitted into the hospital, were assed to determine the current state of breastfeeding in Sierra Leone. Methods: A structured questionnaire specifically designed and pretested was used to gather information on the knowledge, attitude and practice of breastfeeding of mothers with children aged 3 years and below admitted into ODCH between January and April 2021. Result: Of the 206 mothers studied, 168 (81.6%) were aged 18 to 35 years, 145 (70.4%) married. Thirty-five (17%) respondents had inadequate knowledge, while 61 (29.6%) had poor attitude and 115 (55.8%) poor practice. Factors associated with poor breastfeeding practice include age below 18 years, unmarried mothers and delivery by Caesarian section. Exclusive breastfeeding for 6 months was associated with being married (ρ-0.002). Initiation of breast feeding within 1 hour was associated with being married (ρ-0.001) and vaginal delivery (ρ-0.005) while prelacteal feeding was associated with preterm delivery (ρ-0.020). Conclusion: Despite a high prevalence of adequate knowledge among mothers of children presenting in the facility, the practice of breast feeding remain poor. There is need to provide support to mothers to appropriately carry out good breast feeding practices especially for younger and unmarried mothers and those who deliver via ceasarean section.

Although Pentecostalism is a major stream within Christianity in Sierra Leone, the first field where Protestant missionaries were active in tropical Africa, this ecclesial development remains marginally represented in research. The Pentecostalisation of Sierra Leone points to the nation's continuous recontextualization of Christianity from its inherited missionary vestiges to meet local cultural needs. In this paper, I discuss the retreat by Pentecostal clerics to nature (forests, rivers, and mountains) from where they expect to connect with the transcendent God and receive spiritual power. To do so, I first discuss Sierra Leone's traditional conceptualization of forests, rivers, and mountains as sites for the acquisition of spiritual power. Second, I briefly survey the emergence of Pentecostalism in Sierra Leone, probing the specific uses by Pentecostals of natural spaces. Finally, I conclude with an intercultural theological assessment of Sierra Leone's emerging Pentecostal uses and interpretations of natural spaces. [ABSTRACT FROM AUTHOR]

Abstract Background Globally, there were an estimated 7.1 million new syphilis infections in 2020, with more than 30% of these new infections reported in African countries such as Sierra Leone. Despite this, there is no HIV-specific syphilis screening program in Sierra Leone. Thus, data are needed to inform public health practice. In this study, we aimed to determine the prevalence of syphilis seropositivity and factors associated with syphilis seropositivity among people living with HIV (PLHIV). Methods A cross-sectional study was conducted at 10 health facilities in Sierra Leone, among adults with HIV, aged 18 years or older, from September 2022 to January 2023. Parameters of interest were collected including age, sex, marriage, antiretroviral therapy (ART) regimen, HIV viral load, duration of ART treatment, and hospital level of care. The syphilis antibody was detected by a rapid test based on immunochromatography assay. Data were analyzed using R-software version 4.2.3 (R Core Team, Vienna, Austria). Pearson’s χ2 test, Fisher’s exact test and Kruskal–Wallis H test were applied to assess the differences in syphilis seropositivity between groups as appropriate. Univariate logistic regression and multivariate logistic regression analysis was used to assess factors associated with syphilis seropositivity. The level of statistical significance was set at P

Paracetamol is a widely used over-the-counter drug for managing fever and pain, but its quality may vary among different brands, especially in low- and middle-income countries, where counterfeit and substandard medicines are prevalent. This study evaluated the physicochemical properties of fifteen brands of 500 mg paracetamol tablets sold in various pharmacies in Freetown, Sierra Leone using identification tests, friability tests, assay, dissolution tests, and mass variation.The results showed that three brands were not registered with the Pharmacy Board of Sierra Leone, and two brands did not meet the requirement for labelling (no manufacturing date). All the brands met the requirement for mass variation, friability tests and assays. The percentage assay of the different brands ranged from 96.17 %w/w to 101.97 %w/w. However, two brands did not meet the specification for dissolution, with P012 releasing about 21.23 % ± 5.76 of the drug within 45min.Most of the paracetamol brands evaluated met the physicochemical test specification. However, two brands failed the dissolution test, two brands did not meet the labelling requirement and three brands were identified as unregistered products with the National Medicines Regulatory Authority in Sierra Leone. This study underscores the necessity of enhancing monitoring and post-market surveillance of pharmaceuticals in Sierra Leone to ensure they comply with regulatory requirements.

Fourah Bay College was the first Western-style university to be established along the West African coast in 1827. Primarily used to train missionaries and traders operating in British West Africa, it remained one of the premier educational establishments, overlooking the docks of Cline Town in Freetown, Sierra Leone. Following the Colonial Development and Welfare Acts and civil unrest in the aftermath of World War II, British colonial policy began to fund a series of secondary and tertiary education institutions. Modeled on the new University of the West Indies, these new universities adopted the residential college dorm typology coupled with the latest modernist architecture designed to enhance climatic comfort. A new campus was proposed for Fourah Bay, and in contrast to earlier precedents, the architectural approach was to be more humble and less monumental. Following a masterplan by London-based architects Norman and Dawbarn, the much smaller and relatively unknown British practice of Frank Rutter was appointed to design most of the campus buildings. The centerpiece is a large concrete tower named after John F. Kennedy, symbolic of the shifting political posturing for control and influence. Following Independence in 1961 and with increasing technical aid offered to neighboring Ghana and Nigeria from Socialist Eastern European powers, Fourah Bay College demonstrated how these political attempts for influence were directly played out through these newly formed institutions. Fourah Bay College also reveals the African agency in appointing architects and who was able to control the procurement processes and design teams. Rutter was dismissed as ‘college architect’ by a small contingent of newly qualified Sierra Leonean architects eager to ensure local appointments and architectural expressions were given opportunity. The campus, with its impressive architectural structures and innovative solutions, mirrors the political flux and shifting global power structures of the late 1950s and early 1960s, along with the local agency of Freetown architects and their quest to shape the future.

Background: Globally, there were an estimated 7.1 million new syphilis infections in 2020, with more than 30% of these new infections reported in African countries such as Sierra Leone. Despite this, there is no HIV-specific syphilis screening program in Sierra Leone. Thus, data are needed to inform public health practice. In this study, we aimed to determine the prevalence of syphilis seropositivity and factors associated with syphilis seropositivity among people living with HIV (PLHIV). Methods: A cross-sectional study was conducted at 10 health facilities in Sierra Leone, among adults with HIV, aged 18 years or older, from September 2022 to January 2023. Parameters of interest were collected including age, sex, marriage, antiretroviral therapy (ART) regimen, HIV viral load, duration of ART treatment, and hospital level of care. The syphilis antibody was detected by a rapid test based on immunochromatography assay. Data were analyzed using R-software version 4.2.3 (R Core Team, Vienna, Austria). Pearson's χ2 test, Fisher's exact test and Kruskal–Wallis H test were applied to assess the differences in syphilis seropositivity between groups as appropriate. Univariate logistic regression and multivariate logistic regression analysis was used to assess factors associated with syphilis seropositivity. The level of statistical significance was set at P < 0.05. Results: Of the 3082 PLHIV individuals in our study, 2294 (74.4%) were female and 2867 (93.0%) were receiving ART. With a median age of 36 years, 211 (6.8%, 95% CI 6.0–7.7) were positive for syphilis. The prevalence of syphilis was highest in people aged 60 years and over (21.1%, 95%CI 14.7–29.2), followed by people aged 50–60 years (15.5%, 95%CI 11.9–19.9) and in the widowed population (11.9%, 95%CI 8.9–15.8). There were no differences in syphilis seropositivity between gender, ART status, ART regimen, duration of ART, HIV viral load and hospital level of care. Older age (50–60 years: adjusted OR 3.49, 95%CI 2.09–5.85 P < 0.001; 60–100 years: adjusted OR 4.28, 95%CI 2.21–8.17, P < 0.001) was an independent predictor of seropositive syphilis. Conclusions: We observed a high prevalence of syphilis among PLHIV. Older people and widowed population have higher syphilis seropositivity. Older age was an independent predictor of syphilis positivity. Therefore, we call for the integration of syphilis screening, treatment and prevention in HIV services. [ABSTRACT FROM AUTHOR]

Fourah Bay College was the first Western-style university to be established along the West African coast in 1827. Primarily used to train missionaries and traders operating in British West Africa, it remained one of the premier educational establishments, overlooking the docks of Cline Town in Freetown, Sierra Leone. Following the Colonial Development and Welfare Acts and civil unrest in the aftermath of World War II, British colonial policy began to fund a series of secondary and tertiary education institutions. Modeled on the new University of the West Indies, these new universities adopted the residential college dorm typology coupled with the latest modernist architecture designed to enhance climatic comfort. A new campus was proposed for Fourah Bay, and in contrast to earlier precedents, the architectural approach was to be more humble and less monumental. Following a masterplan by London-based architects Norman and Dawbarn, the much smaller and relatively unknown British practice of Frank Rutter was appointed to design most of the campus buildings. The centerpiece is a large concrete tower named after John F. Kennedy, symbolic of the shifting political posturing for control and influence. Following Independence in 1961 and with increasing technical aid offered to neighboring Ghana and Nigeria from Socialist Eastern European powers, Fourah Bay College demonstrated how these political attempts for influence were directly played out through these newly formed institutions. Fourah Bay College also reveals the African agency in appointing architects and who was able to control the procurement processes and design teams. Rutter was dismissed as 'college architect' by a small contingent of newly qualified Sierra Leonean architects eager to ensure local appointments and architectural expressions were given opportunity. The campus, with its impressive architectural structures and innovative solutions, mirrors the political flux and shifting global power structures of the late 1950s and early 1960s, along with the local agency of Freetown architects and their quest to shape the future. [ABSTRACT FROM AUTHOR]

Antimicrobial Resistance (AMR) is a growing global health challenge that threatens to undo gains in human and animal health. Prevention and control of AMR requires functional antimicrobial stewardship (AMS) program, which is complex and often difficult to implement in low- and middle-income countries. We aimed to describe the processes of establishing and implementing an AMS program at Connaught Hospital in Sierra Leone. The project involved the setting up of an AMS program, capacity building and performing a global point prevalence survey (GPPS) at Sierra Leone's national referral hospital. Connaught Hospital established a multidisciplinary AMS subcommittee in 2021 to provide AMS services such as awareness campaigns, education and training and review of guidelines. We performed a GPPS on 175 patients, of whom more than half (98, 56.0%) were prescribed an antibiotic: 63 (69.2%) in the surgical wards and 53 (51.2%) in the medical wards. Ceftriaxone (60, 34.3%) and metronidazole (53, 30.3%) were the most common antibiotics prescribed to patients. In conclusion, it is feasible to establish and implement an AMS program in low-income countries, where most hospitalized patients were prescribed an antibiotic. [ABSTRACT FROM AUTHOR]

Ecosystems provide a number of functions that are essential to human existence and well-being. However, anthropogenic activities and climate change are severely pressuring these ecosystem services. Changes in land use/cover (LU/LC) induced by human activities affect the environment's ecosystem and alter the ecosystem services value (ESV). Decision-making on development based on ecosystem services value (ESV) assessment is significant for the sustainable utilization of resources. In the current study, Beijing in China from 1995 to 2015 and Freetown in Sierra Leone from 2000 to 2018 were used for monitoring the change in (LU/LC) and ecosystem services. To investigate the changes in ESV utilizing an ESV model, cross-sectional field research, GIS technology and economic valuation of natural capital were all combined. In Beijing, land use and land cover (LU/LC) were as follows: forest > farm > urban > water in all periods of the investigated sites. Furthermore, LULC in Freetown was as follows: dense vegetation > spare vegetation > urban > bare > water in 2018. Changes in LU/LC in two areas reflect the trend toward the agriculture sector. Prediction of LU/LC showed a significant decrease in the agriculture areas in Beijing and Freetown that negatively affected the ecosystem. Results showed a lower ESV after prediction than before prediction in Beijing and Freetown, with loss and decrease in ESV caused by excessive economic benefits. Results showed that dense vegetation contributed the most to ecosystem services overall. The finding from this work indicated that for better sustainable ecosystem services, effective land-use regulations should be taken to control vegetation deterioration and protect water bodies. [ABSTRACT FROM AUTHOR]

Background: Glaucoma is a significant cause of blindness worldwide. It is more common, presents earlier and is more aggressive in those of African descent. Non-adherence and poor knowledge of glaucoma is a significant barrier to treatment and has been associated with low health literacy. We aim to establish the factors contributing to late presentation, treatment non-adherence and disease progression in glaucoma patients in Sierra Leone. This will help better understand the challenges eye services face, highlight fields requiring development in patient–clinician interaction and identify areas or specific vulnerable patient groups in which resources should be focused. Methods: Prospective, consecutive recruitment of 120 patients with POAG attending the Lowell and Ruth Gess Eye Hospital and the Connaught Government Teaching Hospital, Freetown, Sierra Leone between February and April 2020. Data were collected from 3 sources: (1) review of clinical notes since first attendance, (2) semi-structured interviews and (3) assessment of study participant's drop instillation technique using a structured checklist. Descriptive statistics was performed for demographic data and other relevant data points. Logistic regression was used for analysis of target variables. Results: The average age was 62 years with more males (52.6%). Agricultural workers and informal street traders represented 13.2% of participants' occupation. 25.8% of participants had no formal school, and 47.4% had either a degree or a diploma. This is out of proportion with the general population and may represent a hidden demographic of glaucoma patients. Drop instillation technique was successful in 52% of study participants. Notable responses to the questionnaire were 30% of patients did not know the name of their eye condition and 22% had no knowledge of glaucoma. Conclusion: Investment in a wide-ranging and robust screening programme and public health campaigns targeting these vulnerable groups and high-risk individuals, for example with a positive family history, alongside improved patient education and staff training is required to improve glaucoma care. Support from government, international organisations and the private sector is required to reduce the economic burden of blindness in Sierra Leone. [ABSTRACT FROM AUTHOR]

Freetown, Sierra Leone, is confronted with health risks that are compounded by rapid unplanned urbanisation and weak capacities of local government institutions. Addressing them implies a shared responsibility between government and non‐state actors. In low‐income areas, the role of community‐based organisations (CBOs) in combating health disasters is well‐recognised. Yet, empirical evidence on how they have utilised their networks and coordinated community‐level strategies in responding to the COVID‐19 pandemic is scant. This paper, based on a qualitative study in two informal settlements in Freetown, employs actor‐network theory to understand how CBOs problematise COVID‐19 as a health risk, interact with other entities, and the subsequent tensions that arise. The findings show that community vulnerabilities and past experiences of health disasters informed CBOs' perception of COVID‐19 as a communal emergency. In response, they coordinated sensitisation and mobilisation programmes by relying on a network of actors to support COVID‐19 risk reduction strategies. Nonetheless, misunderstandings among them caused friction. [ABSTRACT FROM AUTHOR]

This paper examines the dominant knowledge paradigms that have underpinned planning over time in Freetown, Sierra Leone and their implications for urban equality. Looking at the history of the informal settlement upgrading agenda, it presents this analysis through a historical mapping, outlining the knowledge paradigms that have informed planning approaches from the colonial era to the present day. It then outlines three strategic moments over the past 13 years, in which organized informal settlement residents and wider coalitions have mobilized diverse forms of knowledge. By engaging both with long-term trajectories and the intimacy of more recent experiences, it outlines what we refer to as the "slow anatomy of change" through which diverse knowledges have been consolidated. The paper offers reflections on the temporalities and geographies of change; the role of knowledge production as a historical site of power disparities; and what these strategies tell us about the negotiation of power and knowledge through planning towards urban equality. [ABSTRACT FROM AUTHOR]

Ophthalmic diseases are common among people living with HIV (PLHIV) in developing countries. However, there are currently no published studies on ophthalmic complications among PLHIV in Sierra Leone. We conducted a cross-sectional study of PLHIV presenting at Connaught Hospital in Freetown, Sierra Leone from January through March 2020. Logistic regression was used to identify associations between ophthalmic manifestations and potential risk factors. A total of 103 PLHIV were studied (78.6% female, median age 41 years, 100% treatment-experienced). The median CD4 cell count was 374 cells/mm3 and 76.7% were virologically suppressed. Overall, 44.7% of study participants had at least one ophthalmic complication and 51.5% had poor visual acuity in at least one eye. The most common conditions were dry eye (21.4%), cataract (20.4%), blepharitis (10.7%), nucleosclerosis (6.8%), conjunctivitis (5.8%), penguecula (5.8%), toxoplasmic retinochoroiditis (3.9%), and posterior vitreous detachment (2.9%). In multivariate logistic regression analysis, poor visual acuity (adjusted odds (aOR) 2.75, 95% confidence interval (CI) [1.12–6.78]; p = 0.040) and CD4 cell count < 100 cells/mm3 (aOR 3.91, 95% CI [1.07–14.31]; p = 0.028) were independently associated with ophthalmic disease. A high proportion of PLHIV in this study had ophthalmic complications. This calls for greater integration of HIV and ophthalmologic care. [ABSTRACT FROM AUTHOR]

Feminist, Southern, and decolonial thinkers have long argued that epistemological questions about how knowledge is produced and whose knowledge is valued and actioned are crucial in addressing inequalities, and a key challenge for planning. This collaborative article interrogates how knowledge is mobilised in urban planning and practice, discussing three experiences which have actively centred often-excluded voices, as a way of disrupting knowledge hierarchies in planning. We term these "emancipatory circuits of knowledge'--processes whereby diverse, situated, and marginalised forms of knowledge are co-produced and mobilised across urban research and planning, to address inequalities. We discuss experiences from the Technological University José Antonio Echeverría (CUJAE), a university in Havana, Cuba, that privileges a fluid and collaborative understanding of universities as social actors; the Sierra Leone Urban Research Centre, a research institute in the city of Freetown, which curates collective and inclusive spaces for community action planning, to challenge the legacies of colonial-era planning; and the Asian Coalition for Housing Rights, a regional network across Asia, which facilitates processes of exchange and co-learning which are highly strategic and situated in context, to advance community-led development. Shared across these "emancipatory circuits' are three "sites of impact' through which these partners have generated changes: encouraging inclusive policy and planning outcomes; shifting the planning praxis of authorities, bureaucrats, and researchers; and nurturing collective trajectories through building solidarities. Examining these three sites and their challenges, we query how urban knowledge is produced and translated towards epistemic justice, examining the tensions and the possibilities for building pathways to urban equality. [ABSTRACT FROM AUTHOR]

Abstract 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.

Feminist, Southern, and decolonial thinkers have long argued that epistemological questions about how knowledge is produced and whose knowledge is valued and actioned are crucial in addressing inequalities, and a key challenge for planning. This collaborative article interrogates how knowledge is mobilised in urban planning and practice, discussing three experiences which have actively centred often-excluded voices, as a way of disrupting knowledge hierarchies in planning. We term these “emancipatory circuits of knowledge”—processes whereby diverse, situated, and marginalised forms of knowledge are co-produced and mobilised across urban research and planning, to address inequalities. We discuss experiences from the Technological University José Antonio Echeverría (CUJAE), a university in Havana, Cuba, that privileges a fluid and collaborative understanding of universities as social actors; the Sierra Leone Urban Research Centre, a research institute in the city of Freetown, which curates collective and inclusive spaces for community action planning, to challenge the legacies of colonial-era planning; and the Asian Coalition for Housing Rights, a regional network across Asia, which facilitates processes of exchange and co-learning which are highly strategic and situated in context, to advance community-led development. Shared across these “emancipatory circuits” are three “sites of impact” through which these partners have generated changes: encouraging inclusive policy and planning outcomes; shifting the planning praxis of authorities, bureaucrats, and researchers; and nurturing collective trajectories through building solidarities. Examining these three sites and their challenges, we query how urban knowledge is produced and translated towards epistemic justice, examining the tensions and the possibilities for building pathways to urban equality.

The difficulties in tackling COVID-19 have shown with unparalleled strength the need to acknowledge alternative epistemologies in planning. Pandemic responses that seem to have been met with relative success were based upon the guidance, knowledge, and embodied experience of communities on the ground. While some recognize the key role of alternative or ‘non-expert’ knowledge in addressing current planning challenges, most have struggled to broaden their definition to include different ways in which community-based organizations generated data, shared knowledge, collaborated with other development actors, and learned from past experiences. This paper studies the response in Freetown´s slum communities to the unprecedented crisis brought by the COVID-19 outbreak. It analyzes how community-based organizations were able to leverage their situated knowledge to negotiate, develop, and occupy spaces of power in their city´s crisis management systems during the first months of the pandemic. Data was collected through semi-structured interviews and personal communications with residents of Freetown’s slum communities, workers of international non-governmental organizations (INGO) based in Freetown, researchers, and local government officials. This research discusses what knowledge is, where and by whom it is generated, and how it can be collectively leveraged in crisis situations. We also offer a reflection on what this may mean for the future of planning, in terms of transforming structures of exclusion and sustaining that transformation.

This article reviews the book by Professor Charles C. Jalloh, The Legal Legacy of the Special Court for Sierra Leone, published in 2020 by Cambridge University Press. In this book, the author examines the "hybrid" international/national criminal tribunal, known as the Special Court for Sierra Leone (SCSL), which was created under a pathbreaking bilateral treaty between the United Nations (UN) and the country of Sierra Leone as a UN member state. Jalloh seeks to evaluate the contributions made by SCSL to the development of international criminal law. In particular, he assesses the scope and significance of SCSL legal contributions from its solutions to problems arising between its opening and the completion of its work in 2013, having to do with personal and temporal jurisdiction; gender crimes as crimes against humanity; recruitment of children as war crimes; head-of-state immunity; amnesty; and tensions between criminal tribunals and truth commissions. [ABSTRACT FROM AUTHOR]

Antimicrobial Resistance (AMR) is a growing global health challenge that threatens to undo gains in human and animal health. Prevention and control of AMR requires functional antimicrobial stewardship (AMS) program, which is complex and often difficult to implement in low- and middle-income countries. We aimed to describe the processes of establishing and implementing an AMS program at Connaught Hospital in Sierra Leone. The project involved the setting up of an AMS program, capacity building and performing a global point prevalence survey (GPPS) at Sierra Leone’s national referral hospital. Connaught Hospital established a multidisciplinary AMS subcommittee in 2021 to provide AMS services such as awareness campaigns, education and training and review of guidelines. We performed a GPPS on 175 patients, of whom more than half (98, 56.0%) were prescribed an antibiotic: 63 (69.2%) in the surgical wards and 53 (51.2%) in the medical wards. Ceftriaxone (60, 34.3%) and metronidazole (53, 30.3%) were the most common antibiotics prescribed to patients. In conclusion, it is feasible to establish and implement an AMS program in low-income countries, where most hospitalized patients were prescribed an antibiotic.

Background: Sierra Leone ranks among nations with unacceptably high infant and under-5 mortality rates. Understanding the clinical and demographic dynamics that underpin paediatric mortalities is not only essential but fundamental to the formulation and implementation of effective healthcare interventions that would enhance child survival., Subjects and Material: This was a 7-month review of all mortalities from May 24th 2021 to December 31st 2021 at Ola During Children's Hospital in Freetown, Sierra Leone. Information on biodata, presenting complaints, illness duration, diagnoses, treatment given inclusive of point-of-care investigations, and duration of hospital stay retrieved from all mortalities were entered into Excel spreadsheets and were analyzed using SPSS version 25.0 for IBM. Multivariable regression analysis was done to determine factors independently associated with mortalities within 24 hours of admission. All associations were considered significant if p < 0.05., Results: There were 840 deaths out of 5920 children admitted during the period giving a mortality of 14.2% with a male-to-female ratio of 1:1. Three hundred and four (36.2%) of these deaths occurred in the neonatal age group while 63.8% occurred in the post neonatal age group. Perinatal asphyxia was the leading cause of neonatal deaths while acute respiratory infections and severe malaria were the leading causes of post neonatal deaths. The majority (64.8%) of the mortalities occurred within the first 24 hours of admission. In a multivariable regression, only transfusion status and use of respiratory support were independently associated with mortality within 24 hours of admission (P<0.05)., Conclusion: Paediatric mortality in Sierra Leone is high and is caused mainly by preventable morbidities such as perinatal asphyxia and infections. Most of the deaths occurred within 24 hours of admission. It is recommended that patients should be brought to the hospital early and preventive measures be instituted to address these causes., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2024 by West African Journal of Medicine.)

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. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Health care data accuracy feeds the development of sound healthcare policy and the prioritisation of interventions in scarce resource environments. We designed a retrospective study at the sole paediatric government hospital in Sierra Leone to examine mortality statistics, specifically: the accuracy of mortality data collected in 2017; and the quality of cause of death (CoD) reporting for 2017. METHODS: the retrospective audit included all available mortality statistics collected at the hospital during the 2017 calendar year. For the purpose of calculating a mortality rate, admission data was additionally gathered. Four different hospital entities were identified that collected mortality data (the Monitoring and Evaluation (MandE) office; the nurse ledgers; the office of births and deaths; and the mortuary). Data from each hospital entity were used the comparative analysis. RESULTS: striking differences were found in the rate of hospital mortality reported by different entities. The M and E office (responsible for providing data to the ministry of health and sanitation) reported a hospital mortality rate of 2.94% in 2017. Mortuary and nursing admissions records showed a hospital mortality rate of 18.7%. Discrepancies and issues of quality in CoD reporting between hospital entities were identified. CONCLUSION: significant variations were found in the generation of official hospital mortality data. Mortality data informs health service prioritisation, resource distribution, outcome measures and epidemiological surveillance. Resources to support quality improvement initiatives are needed in the creation of an in-hospital system that reports accurate data with a process for real-time institutional data feedback.

Land use changes associated with urbanization may increase ecological risk and subsequent geohazard risk. Africa is particularly vulnerable at preset as, since 2005, the highest rates of rapid urbanization-associated forest degradation have occurred there. On August 14, 2017, a compound geohazard in Freetown, Sierra Leone, caused thousands of fatalities and destroyed hundreds of houses. Land use change is considered the main factor contributing to geohazard initiation. Here, we use Freetown as a case study to quantitatively assess the magnitude of the increase in ecological risk associated with land use changes. To achieve the aim, satellite images are used in the case study area from 2007 to 2017, the data are integrated into a geographic information system. A series of indices are then used based on the processed images to describe land use and ecological risk, including dynamic index, trend and state index, and ecological risk index. The results show that Freetown experienced a rapid urbanization process, together with an unbalanced increase in urban land and complex conversion of bare and grass land, from 2007 to 2017. Significantly degenerated forest was converted into urban land (2.77%), bare land (6.47%), and grassland (10.27%), while the ecological risk level increased from low to high. The ecological risk in the affected area of geohazard is found higher than that of the surrounding mountainous area. It indicates that vegetation may reduce the risk of disaster. This result is helpful for the trade-off between urban development and ecological protection and rational urban planning. For disaster resilience and sustainable development of Freetown, and also other rapidly urbanizing cities in mountainous areas, ecological protection must be incorporated into development planning. [ABSTRACT FROM AUTHOR]

Introduction: health care data accuracy feeds the development of sound healthcare policy and the prioritisation of interventions in scarce resource environments. We designed a retrospective study at the sole paediatric government hospital in Sierra Leone to examine mortality statistics, specifically: the accuracy of mortality data collected in 2017; and the quality of cause of death (CoD) reporting for 2017. Methods: the retrospective audit included all available mortality statistics collected at the hospital during the 2017 calendar year. For the purpose of calculating a mortality rate, admission data was additionally gathered. Four different hospital entities were identified that collected mortality data (the Monitoring and Evaluation (M&E) office; the nurse ledgers; the office of births and deaths; and the mortuary). Data from each hospital entity were used for the comparative analysis. Results: striking differences were found in the rate of hospital mortality reported by different entities. The M&E office (responsible for providing data to the ministry of health and sanitation) reported a hospital mortality rate of 2.94% in 2017. Mortuary and nursing admissions records showed a hospital mortality rate of 18.7%. Discrepancies and issues of quality in CoD reporting between hospital entities were identified. Conclusion: significant variations were found in the generation of official hospital mortality data. Mortality data informs health service prioritisation, resource distribution, outcome measures and epidemiological surveillance. Resources to support quality improvement initiatives are needed in the creation of an in-hospital system that reports accurate data with a process for real-time institutional data feedback. [ABSTRACT FROM AUTHOR]

Paracetamol is a widely used over-the-counter drug for managing fever and pain, but its quality may vary among different brands, especially in low- and middle-income countries, where counterfeit and substandard medicines are prevalent. This study evaluated the physicochemical properties of fifteen brands of 500 mg paracetamol tablets sold in various pharmacies in Freetown, Sierra Leone using identification tests, friability tests, assay, dissolution tests, and mass variation. The results showed that three brands were not registered with the Pharmacy Board of Sierra Leone, and two brands did not meet the requirement for labelling (no manufacturing date). All the brands met the requirement for mass variation, friability tests and assays. The percentage assay of the different brands ranged from 96.17 %w/w to 101.97 %w/w. However, two brands did not meet the specification for dissolution, with P012 releasing about 21.23 % ± 5.76 of the drug within 45min. Most of the paracetamol brands evaluated met the physicochemical test specification. However, two brands failed the dissolution test, two brands did not meet the labelling requirement and three brands were identified as unregistered products with the National Medicines Regulatory Authority in Sierra Leone. This study underscores the necessity of enhancing monitoring and post-market surveillance of pharmaceuticals in Sierra Leone to ensure they comply with regulatory requirements., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Ensuring a sustainable urban water supply for developing/low-income countries requires an understanding of the factors affecting water consumption and technical evidence of individual consumption which can be used to design an improved water demand projection. This paper compared dry and rainy season water sources available for consumption and the end-use volume by each person in the different income groups. The study used a questionnaire survey to gather household data for a total of 398 households, which was analysed to develop the relationship between per capita water consumption characteristics: Socio-economic status, demographics, water use behaviour around indoor and outdoor water use activities. In the per capita water consumption patterns of Freetown, a seasonal variation was found: In the rainy season, per capita water consumption was found to be about 7% higher than the consumption for the full sample, whilst in the dry season, per capita water consumption was almost 14% lower than the full survey. The statistical analysis of the data shows that the average per capita water consumption for both households increases with income for informal slum-, low-, middle- and high-income households without piped connection (73, 78, 94 and 112 L/capita/day) and with connection (91, 97, 113 and 133 L/capita/day), respectively. The collected data have been used to develop 20 statistical models using the multiple linear stepwise regression method for selecting the best predictor variable from the data set. It can be seen from the values that the strongest significant relationships of per capita consumption are with the number of occupants (R = −0.728) in the household and time spent to fetch water for use (R = −0.711). Furthermore, the results reveal that the highest fraction of end use is showering (18%), then bathing (16%), followed by toilet use (14%). This is not in agreement with many developing countries where toilet use represents the largest component of indoor end use.

The specificity of Freetown as urban locality has allowed for the invention of unique masquerades, mobilised for political or social goals. This paper considers youth urban masquerade in Freetown, Sierra Leone as an essential aspect to the lived experience of the city’s extreme political and economic landscape since the early days of its founding. It hypothesises that masquerades, which are publicly performed by Ordehlay societies, are designed by the city’s youth to access and control the fabric of the cityscape. Further, this public aspect was once banned by the government. Yet, as masquerades transform regularly, so does public perception. Ordehlay is now recognised as an integral thread of the city’s vast interconnected web. In contradiction to their previous banning, Ordehlay masks have recently joined the Sierra Leone National Museum’s collection, and are financially supported by politicians, corporate entities, and NGOs, demonstrating their migration from clandestine activity to national emblem. The study contributes to and builds on previous scholarship, offering new sources to debate the society’s historical origin and illustrate the changing contributions of youth amidst questions of political party affiliation and patronage. Politics are embedded in the very fabric of these societies - indeed in the fabric of the masks themselves. [ABSTRACT FROM AUTHOR]

We describe a case series of 35 Ebola virus disease (EVD) survivors during the epidemic in West Africa who had neurologic and accompanying psychiatric sequelae. Survivors meeting neurologic criteria were invited from a cohort of 361 EVD survivors to attend a preliminary clinic. Those whose severe neurologic features were documented in the preliminary clinic were referred for specialist neurologic evaluation, ophthalmologic examination, and psychiatric assessment. Of 35 survivors with neurologic sequelae, 13 had migraine headache, 2 stroke, 2 peripheral sensory neuropathy, and 2 peripheral nerve lesions. Of brain computed tomography scans of 17 patients, 3 showed cerebral and/or cerebellar atrophy and 2 confirmed strokes. Sixteen patients required mental health followup; psychiatric disorders were diagnosed in 5. The 10 patients who experienced greatest disability had co-existing physical and mental health conditions. EVD survivors may have ongoing central and peripheral nervous system disorders, including previously unrecognized migraine headaches and stroke. [ABSTRACT FROM AUTHOR]

'Achieving sustained environmental health improvements in Freetown through faecal sludge management enterprises' was a partnership project between Freetown City Council (FCC), International Water Association (IWA), and GOAL. This project aimed to improve faecal sludge management (FSM) through public - private partnerships and improved financial flows to ensure viability of businesses. A market assessment was conducted in Freetown which considered demand and supply for FSM services. This paper discusses findings from the household survey which was a key component of the market assessment. While the households felt that they were getting value for money for existing services, they were not satisfied with existing services and hence were willing to pay higher prices for improved services. This highlights the importance of quality service provision in relation to revenue generation. Improved pit emptying services was noted to be of high priority to households. In order to improve pit emptying services the FSM strategy proposed intermediate transfer stations and formation of a Sanitation Unit and Contact Centre within FCC. [ABSTRACT FROM AUTHOR]