Artigos de revistas sobre o tema "Sierra Leone Adult Education Association"

Opening ParagraphThis article deals with the national languages of Sierra Leone and their use in education since 1978. Language information relevant to the period under review as well as language policy and its implementation are focal parts of our discussion.There exists in practice if not in theory a formal mother-tongue education programme at primary school level in specially selected pilot schools of all four geographical regions of Sierra Leone. This programme was initiated in 1978 within the framework of a national language policy later spelt out in a working UNESCO study of 1981. Similarly, adult literacy education has gained rapid expansion over the same period although this sector of indigenous language education is mostly handled by so-called nongovernmental agencies such as CUSO Sierra Leone, the People's Educational Association (PEA), and similar bodies. To this extent the recommendations and proposals of the Dalby report concerning the implementation of a national language policy for Sierra Leone have seen practical implementation as well as some degree of experimentation in formal and non-formal education. In short, the bare bones of this experimental framework are illuminated by practice.

Introduction: Lassa fever disease (LFD) is an acute viral haemorrhagic fever caused by Lassa virus. It is a disease of public health importance in West Africa and a global health threat. It is endemic in some West African countries like Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, and Nigeria, where an estimated 300,000 to 500,000 cases occur every year with an estimated 5000 annual deaths. Persons living in rural areas and health care workers are at greatest risk. Public awareness and knowledge of the LFD and its risk factors are some of the important factors that determine disease transmission and success of preventive/control efforts. This study was therefore conducted to assess LFD-related awareness and knowledge in Gangara, a rural agrarian community in Giwa Local Government Area of Kuduna State, NorthWest Nigeria. Methods: A cross-sectional, community based descriptive study conducted in Gangara community. An interviewer- administered questionnaire was used to collect data from 556 adult respondents, selected using systematic random sampling technique. Data was analyzed using SPSS (version 20). Results: A majority of the respondents were females (52.9%) with a mean age of 37.0 ± 15.2. The level of awareness of LFD was high (66.7%) among respondents and there was a statistically significant association between awareness of LFD and not having any form of education (P < 0.00). However, most of the respondents (79.0%) have poor knowledge of LFD. Knowledge of risk factors for LFD was also poor with 59.4% not knowing that drying grains and foodstuffs on the ground is a risk factor for LFD. Conclusions: Awareness of the disease was quite high but knowledge of the disease and its risk factors was poor. For effective prevention of future outbreaks, the community needs to be properly educated on LFD and its risk factors.

Background: The study’s aim is to examine adolescent girls’ attitudes toward the continuation or discontinuation of female genital mutilation (FGM) in association with their demographics in seven different countries in Africa. Methods: Data from the women’s survey of the Demographic and Health Surveys (DHS) conducted by the respective ministries (of Health and Family Welfare) in Egypt, Guinea, Kenya, Mali, Niger, Senegal and Sierra Leone were used. Adolescent girls (15–19 years) were included in the current analysis: Egypt (N=636), Guinea (N=1994), Kenya (N= 1767), Mali (N=2791), Niger (N=1835), Senegal (N=3604), Sierra Leone (N=1237). Results: Prevalence of supporting the continuation of FGM among adolescent girls was in Egypt 58%, Guinea 63%, Kenya 16%, Mali 72%, Niger 3%, Senegal 23%, and Sierra Leone 52%. Being Muslim and having low economic status were significantly associated with supporting the continuation of FGM in five of the participating countries. Girls having no education or only primary education in Guinea, Kenya, Mali and Sierra Leone exhibited a higher likelihood of supporting FGM than girls with secondary or higher education. In Egypt, Niger and Senegal there was no association between education and supporting FGM. The girls who stated that they had no exposure to media showed the higher likelihood of supporting FGM in Guinea, Kenya, and Senegal than those with exposure to media. Conclusions: The current study argues that increasing media coverage and education, and reducing poverty are of importance for shifting adolescent girls’ attitudes in favor of discontinuation of FGM.

This paper explores the generationing of education and development in five villages in Northern Sierra Leone. Understood as ‘fields’ governed by power dynamics, we consider how the interactive ‘fields’ of generation, education and development coalesce, re/structuring adult and child ‘being’ and ‘doing’. We explore the tensions that arise between transformation and preservation in the field in light of wider social, cultural and economic change, and the negotiation of the generational contract in contexts of high risk and inter-dependency.

Sierra Leone is a West African country with a population of over 8 million. With more than half of Sierra Leone’s population living in rural areas, it is important to understand rural populations’ access to and attitudes toward the COVID-19 vaccine. In November 2021, the rate of vaccination coverage in Sierra Leone was only 7% for one dose and 4% for two doses. Understanding perspectives of health facility staff and patients can help strengthen future vaccine campaigns. We conducted a cross-sectional study, between March 2022 and May 2022, of clinical staff, non-clinical staff, and adult (>18 years) patients/caregivers attending six Ministry of Health and Sanitation (MoHS) facilities supported by Partners In Health, four in the Kono district and two in the Western Urban Area district, the capital of Sierra Leone. We assessed the opportunity to vaccinate, vaccine uptake, and intention to vaccinate. Out of the 2015 participants, 11.4% were clinical staff, 18.8% were non-clinical staff, and 69.8% were patients/caregivers. Less than half of the patients/caregivers had the opportunity to be vaccinated (42%), and 22% of patients/caregivers were fully vaccinated. Among the unvaccinated population, 44% would refuse a vaccine if offered to them at no cost. Lack of access to COVID-19 vaccines and to official education messaging, especially for patients and caregivers, is still an underlying problem in Sierra Leone for vaccine uptake, rather than a lack of willingness to be vaccinated.

Abstract Objective Epilepsy is associated with a significant burden of psychiatric comorbidity, including depression and anxiety disorders. However, paucity of data exists regarding the impact of epilepsy on mental health of patients in the setting of sub-Saharan Africa, where these comorbidities are under-recognized and under-treated. We carried out a cross-sectional descriptive study to investigate the prevalence and determinants of depression and anxiety among people with epilepsy in Sierra Leone. Method A screening tool previously validated in the primary healthcare setting in Zambia was administered to adult patients in our epilepsy clinics in Freetown and Kenema, Sierra Leone. In addition, various socio-demographic and clinical characteristics were recorded for each patient. Results A total of 142 patients were included. The mean screening score was 16.3 out of 40, with 39 (27.5%) patients scoring above the diagnostic cut-off point for anxiety and/or depression. Variables showing a significant association with the presence of psychiatric comorbidity included female gender (p = 0.015), seizure frequency of >2 per month (p = 0.001), and self-reporting of sedation and/or dizziness as side effects of anti-epileptic medications (p = 0.006). Conclusion Symptoms of anxiety and depression are common in epilepsy patients in Sierra Leone. Given the significant negative impacts of such comorbidity on those affected, primary healthcare workers in sub-Saharan countries should be trained to inquire about anxiety and depression symptoms in epilepsy patients, and implementation of screening programs should be considered.

Malaria infection during pregnancy is a major public health problem in sub-Saharan Africa. The World Health Organization (WHO) recommends that gestational and congenital malaria can be prevented by using intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). IPTp-SP is a full therapeutic course of antimalarial medicine administered during pregnancy as a component of antenatal care. This study’s objective was to assess the prevalence and predictors of IPTp-SP uptake in pregnancy in Sierra Leone. This study was based on the fifth round of the Multiple Indicator Cluster Survey (MICS 5) conducted in Sierra Leone in 2016. Participants were 8526 women aged between 15–49 years. Outcome variables were uptake of IPTp-SP during the last pregnancy. Data were analysed using cross-tabulation and logistic regression methods. Results showed that the prevalence of taking IPTp-SP was 94.81% (92.40, 96.14), and that the prevalence of taking at least three doses was 93.24% (92.50, 94.81). In the multivariate logistic regression, education, parity, and antenatal care (ANC) use were significant predictors of IPTp-SP uptake. Women with higher education had lower odds of taking IPTp-SP (Odds Ratio = 0.647, 95%CI = 0.444, 0.943); having higher parity (>4) was associated with lower odds of taking IPTp-SP (OR = 0.663; 95%CI = 0.442, 0.994) and adequate ANC use increased the odds of taking IPTp-SP in both urban (OR = 1.450, 95%CI = 1.158, 3.128) and rural areas (OR = 1.903, 95%CI = 1.069, 1.966). In contrast, the positive association between ANC visits and adequate doses of taking IPTp-SP was true for rural women only (OR = 1.408, 95%CI = 1.174, 1.689). In conclusion, the use of IPTp-SP is close to being universal, with the prevalence being relatively higher in the rural areas. Based on our findings, promoting adequate antenatal care visits should be regarded as a key strategy to improve the use of IPTp-SP in Sierra Leone. Further studies could focus on exploring other predictors of IPTp-SP uptake that are not captured by MICS in Sierra Leone.

Sierra Leone’s educational system has made a remarkable recovery in several interventions over the years. The Government of Sierra Leone is firmly committed to building a solid foundation for quality education. With this priority given to the education sector, the Government is firmly committed and puts a premium on resource allocation to the education sector for sustainable development. Representatives of the ministry of education, universities authorities and communities, were also engaged in focus group discussion for an in-depth idea about the topic under review. Additional information was sought from literature published by the institutions, especially the Ministry of education and Universities. The research was limited to the Western Area. The instruments used to collect data include a questionnaire, interview and discussion. The data were analysed qualitatively. Various parameters were analysed, such as compulsory Education by law, Free Primary education, principles of Discrimination, the building of schools all over the country, Distance Education programs, Guidance and Counselling in Schools, Emphasis on Girl child education, and Quality education for quality life in Sierra Leone, Promoting accessibility and many more. This research yielded a very fruitful result in the development of the country over these years to the present. Compulsory Education with the strict conditions attached to it increased the roll of pupils in schools. Today illiterate parents can boast of literate children, wherein such children give birth to children that they can take care of in terms of basic needs such as education, food, morals, shelter, clothing etc. With adult education all over the country, there is a considerable reduction in illiteracy countrywide. Education is made accessible throughout the country, with at least a secondary school in all the chiefdoms. The teachers are made available in schools that are in remote areas. Guidance and Counselling help correctly place school pupils in their excellent careers in life, making education relevant and meaningful. The researcher recommended that the Government maintain continuity in its policies, continue to promote Guidance and Counselling in schools and establish a local languages department at the Ministry of Education, Science and Technology.

ObjectiveTo investigate the prevalence of cardiometabolic risk factors (CMRFs), target organ damage (TOD) and its associated factors among adults in Freetown, Sierra Leone.DesignThis community-based cross-sectional study used a stratified multistage random sampling method to recruit adult participants.SettingThe health screening study was conducted between October 2019 and October 2021 in Western Area Urban, Sierra Leone.ParticipantsA total of 2394 adult Sierra Leoneans aged 20 years or older were enrolled.Outcome measureAnthropometric data, fasting lipid profiles, fasting plasma glucose, TOD, clinical profiles and demographic characteristics of participants were described. The cardiometabolic risks were further related to TOD.ResultsThe prevalence of known CMRFs was 35.3% for hypertension, 8.3% for diabetes mellitus, 21.1% for dyslipidaemia, 10.0% for obesity, 13.4% for smoking and 37.9% for alcohol. Additionally, 16.1% had left ventricular hypertrophy (LVH) by ECG, 14.2% had LVH by two-dimensional echo and 11.4% had chronic kidney disease (CKD). The odds of developing ECG-LVH were higher with diabetes (OR=1.255, 95% CI (0.822 to 1.916) and dyslipidaemia (OR=1.449, 95% CI (0.834 to 2.518). Associated factors for higher odds of Left Ventricular Mass Index by echo were dyslipidaemia (OR=1.844, 95% CI (1.006 to 3.380)) and diabetes mellitus (OR=1.176, 95% CI (0.759 to 1.823)). The odds of having CKD were associated with diabetes mellitus (OR=1.212, 95% CI (0.741 to 1.983)) and hypertension (OR=1.163, 95% CI (0.887 to 1.525)). A low optimal cut-off point for ECG-LVH (male 24.5 mm vs female 27.5 mm) was required to maximise sensitivity and specificity by a receiver operating characteristics curve since the odds for LVH by ECG were low.ConclusionsThis study provides novel data-driven information on the burden of CMRF and its association with preclinical TOD in a resource-limited setting. It illustrates the need for interventions in improving cardiometabolic health screening and management in Sierra Leonean.

Farmers' perception on the severity and management practices on cassava has not been fully investigated particularly across agro-ecologies in Sierra Leone. This study assessed the perception of smallholder cassava farmers on the severity of Z. variegatus L., its impacts on yield and indigenous coping management practices utilized to mitigate the infestation of grasshoppers in their cassava farms. The population of the study comprised 300 cassava farmers sampled from the north, south and eastern provinces of Sierra Leone. The study involved questionnaire research instrument administered to smallholder farmers who were farming for household consumption, those producing for sale and household consumption and those who were mainly producing for sale because their primary goal was to produce for the market. Findings revealed that farmers had perceived abilities about agro-ecological distribution of grasshoppers, making them to be familiar with cassava crop damage severity pattern and easy identification. Farmers have ability to recognize and identify adult grasshoppers, and part(s) of cassava mostly affected by grasshoppers. Cassava leaves and stems are destroyed by the pest during either preferential feeding or as a result of ‘choice, no choice feeding’. The study established that smallholder farmers have perceived abilities to identify damage symptoms, stage(s) in the life cycle of the pest that is/are more destructive leading to crop losses and utilization of best practices to mitigate grasshopper infestation on cassava that could be exploited for increased production, management and conservation of cassava genetic resources. Moreover, 52.3% of variation in extent of crop loss by grasshopper infestation is attributable to life cycle stage(s) of the grasshoppers, identification of part(s) of cassava plant mostly destroyed by grasshoppers, cassava variety preference by grasshoppers and the best practices that contribute to increased cassava productivity.

OBJECTIVES/GOALS: Ebolavirus disease survivors report persistent, debilitating health concerns dubbed Post-Ebola Syndrome (PES). Attention to PES in young survivors is lacking, we describe PES in pediatric EVD survivors in Eastern Sierra Leone. Additionally, we introduce our proposal investigating differential presentations of PES in pediatric survivors. METHODS/STUDY POPULATION: EVD survivors were enrolled a median of 2.5 years after resolution of disease. Survivors were eligible if listed in a national register maintained by the Sierra Leone Association of Ebola Survivors. Household contacts (HCs) were identified by survivors. Participants were assigned into three comparison groups: pediatric (7-11), adolescent (12-17) and young adult (18-25). A self-reported symptom questionnaire, and a physical exam were conducted. Variables were clustered within organ system and compared across groups. RESULTS/ANTICIPATED RESULTS: Pediatric survivors had lower levels of long-term sequelae compared to adolescents and young adults. Symptoms and abnormal physical exam signs increase with age. Musculoskeletal, psychiatric, ophthalmologic, and GI signs and symptoms were significantly different between groups. Pediatric survivors had significantly more persistent sequelae than age-matched HCs with no history of EVD; particularly within the cardiac/GI (p=.006) and psychiatric/neurological (p=.025) clusters. PES is heterogeneous with respect to age, calling for a deeper understanding of age-based differences. Even the youngest group of survivors experienced significantly more sequelae than HCs, highlighting the elevated symptom burden in these children over their peers. DISCUSSION/SIGNIFICANCE: Understanding mechanistic drivers will ultimately improve targeted treatments for PES. We will characterize symptom groups defining PES in children, determine the relationship between accelerated aging and PES in this population, and test how immune profiles associated with accelerated aging relate to the development of PES in children.

Education in Africa has been in existence since time immemorial. This study sought to examine the activities of Lantana in Benin on their specialised training, Dogon of Mali in their world view, Futo Toro of Senegal in their various trades, Poro of Sierra Leone in the training of the youth, Takensi of Ghana in their social order and the Akan of Ghana. Also examined are the activities of the Chamba and Yoruba of Nigeria in their adult centred training and forecasting of the future respectively. The Chagga of Tanzania and the Abakwayaare were also examined on their initiative plays and economic activities. The paper also studied the Ndembu of Zambia on the past analysis and the activities of the Mijikenda of Kenya among other Kenyan tribes. The study used the theoretical framework of Emile Durkheim on the social and moral order, while the design of the study was on content analysis of available information and expectations. The study recommends positive approaches in the indigenouseducation that can be adapted, mainly for Kenya in its desire to achieve Vision 2030. However, further research should be done on specific values, foods, attitudes and the rule of law, how achieve social, political and economic progress in African nations and especially how the current economic integration blocks have followed the same pattern of the communities and their values.

Background : The number of the survivours of the Ebola Virus Disease (EVD) is increasing. They have reported health problems. Objective: This study aimed to document the health problems of EVD survivour in Bombali District Sierra Leone. Methods: This was a cross sectional study conducted at Bombali District, Sierra Leone in February, 2015. Participants were EVD survivours admitted and discharged from September, 2014 to February 2015. In all, 304 survivours participated in the study by filling an interviewer administered questionnaire. Data were analyzed with SPSS version 21.0 using descriptive statistics. Association between independent variables was explored with chi square test. The level of statistical significance was set at p <0.05. Results: The median age of survivour was 24 years (range 1-89 years), 105 (34.5%) were <18 years, and more than half of the total responders (60.9%) were females, 92 (30.3%) were discharged in November, 2014. All 189 (62%) had health problem: 65 (34%) and 124 (66%) had single and multiple complaints respectively. Joint pain was reported by 111(58.7%), generalized body pain – 91(48.1%), headache – 81(43%), eye problems – 65(34%), psychological problems – 63(33%). Only 2 (1.06%) survivours have sought for help. Among survivours of 18 years and above, 148(74.4%) had health problems p<0.001. Health problems were reported by 101(70.1%) of survivours with no formal education p=0.002. Also, 52(83.9%) widow(er) had health problems p<0.001. Conclusion: There is a need for the establishment of survivour’s clinic. Provision of specialized care for survivour is encouraged based on their identified needs. This can be done early to avoid complications.

Refugees experience traumatic life events with impacts amplified in regional and rural areas due to barriers accessing services. This study examined the factors influencing the lived experience of resettlement for former refugees in regional Launceston, Australia, including environmental, social, and health-related factors. Qualitative interviews and focus groups were conducted with adult and youth community members from Burma, Bhutan, Sierra Leone, Afghanistan, Iran, and Sudan, and essential service providers (n = 31). Thematic analysis revealed four factors as primarily influencing resettlement: English language proficiency; employment, education and housing environments and opportunities; health status and service access; and broader social factors and experiences. Participants suggested strategies to overcome barriers associated with these factors and improve overall quality of life throughout resettlement. These included flexible English language program delivery and employment support, including industry-specific language courses; the provision of interpreters; community events fostering cultural sharing, inclusivity and promoting well-being; and routine inclusion of nondiscriminatory, culturally sensitive, trauma-informed practices throughout a former refugee’s environment, including within education, employment, housing and service settings.

Goats and sheep production which significantly contributes to improving nutritional status, economic growth and socio-cultural practices in the rural settings of Sierra Leone are faced with several challenges. The survey on Peste des Petits Ruminants Virus (PPRV) was carried out to investigate the: current status of small ruminant production, and the presence of antibodies against PPRV. Information was obtained through Focus Group Discussion in the respondents’ local dialects from 150 participants. From the results obtained, 58.7% and 41.7% of the respondents were male and female while 77.3% and 22.7% were married and single respectively. 53.3% of the respondents never illiterate while 46.7% have some basic education. The main reasons for keeping goats and sheep were for traditional, economic, religious and food. Continuous disease outbreaks; high mortality; poor animal healthcare and extension services, lack of credit facility, theft, and poor marketing facility. Pestes des petits Ruminant, mange, Respiratory infection, and diarrhea were the main diseases affecting goats and sheep. A total of 356 serum samples from goats (264) and sheep (92) were collected in both districts and analyzed using the competitive ELISA kit for the detection of antibodies against PPRV. The result revealed an overall prevalence of 62.1% antibodies [goats, 73.1%, (193/264) and sheep, 30.4%, (28/92)]. Young goats (65.9%), and sheep (34.7%) showed the highest seropositivity of PPRV followed by adult males and females. There is a need to improve traditional practices of small ruminant production by designing disease control programs to ensure the full participation of the veterinary, animal husbandry and extension services for a good output.

This paper explores the issue of project sustainability through an analysis of the experiences of a Faith-Based Development Organisation (FBDO) in Bo, Sierra Leone. The FBDO in question was approached by members of their local Catholic Women Association (CWA) to help them with the planning and management of a farm that had been donated to them by a chief. They agreed to this, and a series of workshops were held in June 2014, along with follow-up discussions with local experts and businesses as to what could be done to help support the women in their endeavour. Amongst other priorities, the women identified the need for the farm to produce food, income and help with their development. However, an outbreak of the Ebola virus that occurred between 2014 and 2016, following as it did on the back of an 11-year (1991–2002) civil war in Sierra Leone, led to a re-evaluation of the farm project in the eyes of the FBDO as they decided to shift to earlier priorities in education and health care. Given the constraints regarding resources and personnel, community projects, such as the CWA farm project, became of much lesser importance even though it resonated strongly with the goals of the FBDO and government, and had garnered much support amongst international donors. The paper sets out that story, beginning with the workshops and discussions held in 2014, and the ramifications of these responses to various ‘shocks’, such as those presented by the civil war and disease outbreaks (Ebola and COVID-19); it also provides recommendations that might be of use regarding the interface between project and institutional sustainability within FBDOs and, indeed, the wider community of development organisations.

Background The West African Ebola epidemic of 2013–2016 killed nearly 4,000 Sierra Leoneans and devastated health infrastructure across West Africa. Changes in health seeking behavior (HSB) during the outbreak resulted in dramatic underreporting and substantial declines in hospital presentations to public health facilities, resulting in an estimated tens of thousands of additional maternal, infant, and adult deaths per year. Sierra Leone’s Kenema District, a major Ebola hotspot, is also endemic for Lassa fever (LF), another often-fatal hemorrhagic disease. Here we assess the impact of the West African Ebola epidemic on health seeking behaviors with respect to presentations to the Kenema Government Hospital (KGH) Lassa Ward, which serves as the primary health care referral center for suspected Lassa fever cases in the Eastern Province of Sierra Leone. Methodology/Principal findings Presentation frequencies for suspected Lassa fever presenting to KGH or one of its referral centers from 2011–2019 were analyzed to consider the potential impact of the West African Ebola epidemic on presentation patterns. There was a significant decline in suspected LF cases presenting to KGH following the epidemic, and a lower percentage of subjects were admitted to the KGH Lassa Ward following the epidemic. To assess general HSB, a questionnaire was developed and administered to 200 residents from 8 villages in Kenema District. Among 194 completed interviews, 151 (78%) of respondents stated they felt hospitals were safer post-epidemic with no significant differences noted among subjects according to religious background, age, gender, or education. However, 37 (19%) subjects reported decreased attendance at hospitals since the epidemic, which suggests that trust in the healthcare system has not fully rebounded. Cost was identified as a major deterrent to seeking healthcare. Conclusions/Significance Analysis of patient demographic data suggests that fewer individuals sought care for Lassa fever and other febrile illnesses in Kenema District after the West African Ebola epidemic. Re-establishing trust in health care services will require efforts beyond rebuilding infrastructure and require concerted efforts to rebuild the trust of local residents who may be wary of seeking healthcare post epidemic.

International cooperation projects aim to support populations in developing countries or affected by emergency situations and to promote their wellbeing in a coherent way and in line with the 10th Sustainable Development Goal and with the principles of the psychology of sustainability and sustainable development. This study analyzed the ways in which such projects influence two psychosocial variables, fatalism and self-efficacy, which are of great importance in determining the attitude of people to promoting change and improving their living conditions by themselves. The sample (N = 510) consists of adult users of Caritas Italiana projects in developing countries, namely, 161 individuals in Argentina, 123 in Bosnia, 96 in Sierra Leone, and 130 in Sri Lanka. The results indicate that the very fact of being involved in cooperation projects, both economic welfare and social promotion projects, favors a reduction in fatalistic attitudes and that greater perception of self-efficacy predicts a reduction in fatalism. Specific effects are presented in relation to the different cultures, and education levels of the countries analyzed.

Hepatitis B virus (HBV) is a major global health challenge. Emerging evidence suggests that poor knowledge and stigma are impacting HBV control efforts in sub-Saharan Africa (SSA), but their role is not well understood. We conducted a cross-sectional study of adults aged ≥18 years in a community and pharmacy setting in Freetown, Sierra Leone. A structured questionnaire was used to assess knowledge, stigmatizing attitudes and health-seeking behaviors regarding HBV. Logistic regression was used to identify predictors of HBV knowledge and related stigma. A total of 306 adult participants were enrolled (50.7% male, 7.5% HBV positive and 11.7% vaccinated). Overall, 52.2% had good HBV knowledge and 49.3% expressed a stigmatizing attitude towards people with HBV. Notwithstanding, 72.2% stated they would receive the HBV vaccine if offered, 80.4% would take anti-HBV medication and 78.8% would be willing to attend clinic regularly. Good HBV knowledge was associated with HBV positive status (aOR 4.41; p = 0.029) and being vaccinated against HBV (aOR 3.30; p = 0.034). HBV-related stigma was associated with secondary or higher level of education (aOR 2.36; p < 0.001), good HBV knowledge (aOR 2.05; p = 0.006) and pharmacy setting (aOR 1.74, p = 0.037). These findings suggest that education and stigma reduction may benefit HBV elimination efforts in SSA.

Intimate partner violence (IPV) is a public health issue, and the experience varies among population sub-groups in Africa. In the West African sub-region, IPV perpetrated against women remains high and is exacerbated by the pertaining cultural milieu. It affects women’s health, wellbeing, and nutritional status. We examined the association between women’s lifetime experiences of physical, sexual, and emotional IPV and undernutrition by quantifying the association at smaller geographical settings in West African countries. We used a bivariate probit geostatistical technique to explore the association between IPV and undernutrition, combining data from the latest Demographic and Health Survey conducted in ten Western African countries. Bayesian inference relies on Markov chain Monte Carlo simulation. The findings demonstrate spatial clustering in the likelihood of experiencing IPV and being underweight in the regions of Mali, Sierra Leone, Liberia and neighboring Cote d’Ivoire, Ghana, Togo, Benin, Cameroon, and Nigeria. The pattern of clustering was somewhat similar when physical violence was combined with underweight and emotional violence combined with underweight. The findings also indicate protective effects of education, wealth status, employment status, urban residence, and exposure to mass media. Further, the likelihood of experiencing IPV and the likelihood of being underweight or thin declined with age and age-gap between the woman and her partner. The findings provide insight into the location-specific variations that can aid targeted interventions, and underscore the importance of empowering women holistically, in the domains of education, socio-economic and socio-cultural empowerment, in addressing women’s vulnerability to IPV and malnutrition (underweight and thinness). Furthermore, IPV prevention programmes will need to address gender inequality and cultural factors such as male dominance that may heighten women’s risk of experiencing IPV.

Background. Childhood diarrhea remains a major public health problem in sub-Saharan Africa (SSA). Women empowerment reduces child mortality, and wife beating attitude is one of the indicators of women empowerment. There is a dearth of evidence about wife beating attitudes and childhood diarrhea in SSA. Therefore, the present study aimed to examine the association between attitude towards wife beating and diarrhea among under-five children. Methods. We used Demographic and Health Surveys from 25 countries in SSA that were conducted between 2010 and 2020. Using Stata version 14 software, we carried out the analysis on 153,864 children under five. Bivariate and multivariate logistic regression analyses were applied, and the results were presented using adjusted odd ratios (aOR) at 95% confidence interval (CI). Results. The pooled results show that 71.4% of married women disagreed with wife beating. About 20.5% of under-five children of married women had diarrhea. Childhood diarrhea varied from highest prevalence in Chad (27.9%) to the lowest prevalence in Sierra-Leone (8.5%). The study showed lower odds of diarrhea among children of married women who disagreed with wife beating (aOR = 0.66 95% CI; 0.54–0.80) compared to children of married women who agreed with wife beating. Moreover, the study results show that women’s age (35–39 years-aOR = 0.48, 95% CI; 0.31–0.74, 40–44 years-aOR = 0.57, 95% CI; 0.35–0.93, 45–49 years-aOR = 0.35, 95% CI; 0.16–0.79) was negatively associated with childhood diarrhea, while husband’s education (primary school-aOR = 1.36, 95% CI; 1.05–1.77), parity (ever born 3-4 children-aOR = 1.36, 95% CI; 1.09–1.70, and 5+ children-aOR = 1.56, 95% CI; 1.14–2.12), and religion (Muslim-aOR = 3.56, 95% CI; 1.44–8.83) were positively associated with diarrhea among under-five children. Conclusions. The study shows association between women attitude towards wife beating and childhood diarrhea. Therefore, empowering women, especially young women by increasing awareness about domestic violence, their rights, and empowering them through education and economic advancement need to be considered in order to reduce childhood diarrhea. Moreover, fertility control or birth spacing and working closely with religious leaders are important factors to consider in reducing childhood diarrhea.

This research analyses the training needs of cocoa farmers in eight chiefdoms in Kailahun District, Eastern Sierra Leone. The paper is an in depth examination of the training needs of the target population in order to bridge the information gap in the existing literature. The objectives of the research were to describe the socio-economic characteristics of cocoa farmers in Kailahun District, analyse their training preferences in areas of cultivation, harvest, post-harvest and marketing practices taking into consideration what knowledge and skills they need to have, when to have them, where and how to have them and ascertain the perception of cocoa farmers in the district on training. The findings reveal that cocoa is grown by both male and female cocoa farmers, more adults aged 36-55 than youth aged 18-36 and the aged, 55 and above were involved in cocoa production in the district, 85.4% of cocoa farmers in the district were married compared to the widowed, 10%; divorced, 1.9%; and single, 2.7%., almost all the male cocoa farmers were polygamous and had many children as labour sources required for work on the cocoa farms, majority of the farmers have been in cocoa farming for a minimum of five years. More than 50% of the farmers had more than one cocoa plantation, the combined acreage of the cocoa farms owned by more than 50% of the farmers was over five acres per farmer, more cocoa farmers (60%) as opposed to 39.7% accepted having received training on various aspects of cocoa farming, major sources of training received were dealers, colleague cocoa farmers, others like development partners interested in cash crop farming, most of the trainings conducted lasted between 1-4 days (29.8%) and 5-10 days (20.5%), a good number of the farmers claimed to have been trained in many of the areas of cocoa farming, though 31.3% of the farmers claimed not to have received any training, the most preferred training method identified by the farmers was on the farm demonstration, the most preferred time of training was in the morning, more youth and adults claimed to have received training in recent times than the aged, cocoa farmers needed training in sorting of dried cocoa beans, grading, cocoa certification, price determination of cocoa, standard number of shade trees per hectare of cocoa, preferable times for under-brushing, strategies for pest management and reasons for the low price of cocoa from Sierra Leone, cocoa farmers had a positive perception about the following: significance of training for cocoa farmers, appropriate spacing of cocoa trees to increase yield, regular under-brushing of cocoa farms to minimise competition with weeds for nutrients, promote easy movement across the farm, reduce pests and increase yield, cultural justification of child labour, gender imbalance tilted in favour of men, the need for women to know and have a say about the use of proceeds from the sale of cocoa, the need for farmers to produce quality cocoa to attract better prices, the need to ferment and thoroughly dry cocoa to attract better prices, the need for proper waste management on cocoa farms, the need to harvest and break the pods to remove the seeds using the right tools, the need to rehabilitate aging cocoa plantations, and the need to keep cocoa beans in jute bags instead of nylon bags, their perceptions about the following were however negative: child labour, the need to grow cocoa on suitable soil, waste management on cocoa farms and the need for care in harvesting and breaking of cocoa pods and the need to keep cocoa separate from other items among others. It is concluded that cocoa farmers in Kailahun District have had training in several aspects of cocoa farming, but still genuinely have training needs that should be addressed. This is because in the first place, a good number of the farmers have never had an opportunity to be trained in any aspect of cocoa farming. Second, even those who have benefitted from one training or the other still require refresher training or training in other aspects of cocoa farming that they have not received training in. Third, the world is dynamic and as such, new knowledge and farming techniques come up regularly that need to trickle down to farmers in the field so that the required impact is created on the sector. These can be done through training the cocoa farmers. It is recommended that farmers should enroll with adult education institutions for some form of adult education in Numeracy, Literacy, record keeping, soil conservation and other related areas for which training. This, coupled with the training by extension agents can enhance their knowledge and skills in cocoa production, increase the quantity and quality of the yield, raise the quantum of their earnings and their standard of living; the Ministry of Agriculture in collaboration with the Ministry of Technical and Higher Education and development partners in agriculture and technical and higher education should take the lead in providing the training opportunities for cocoa farmers by establishing adult education centres in rural communities so that farmers do not envisage many problems attending the classes; farmers who have proven to be resistant to accepting innovations should be encouraged to adopt new technics, new methods of cocoa production and cultivate new and high yielding cocoa varieties; the Amazon variety was found to be creating the desired impact of cultivation among cocoa farmers in the district.

Background Every 75 seconds, a child under five dies of malaria. Mainly children, aged between six months and five years, are at the highest risk for malaria. These children lost maternal immunity and did not yet developed specific immunity to the infection. Under the age of five, children bear the highest burden of malaria in Sub-Saharan Africa (SSA). Many individual and community level factors could contribute to malaria prevalence remaining high among under-five children in the region. Thus, this study aimed to assess the pooled prevalence of malaria among children aged 6–59 months and identify potential factors associated with malaria by using recent Malaria Indicator Surveys in 13 SSA countries. Methods Data for this study were drawn from recent 13 Sub-Saharan African countries Malaria Indicator Surveys (MIS). A total weighted sample of 60,541 children aged 6–59 months was included. STATA version 14.2 was used to clean, code and analyze the data. Multilevel logistic regression was employed to identify factors associated with malaria. Adjusted odds ratio with 95% CI and a P value <0.05 was reported to indicate statistical association. Model fitness and comparison were done using Inter cluster correlation coefficient, Median odds ratio, proportional change in variance, and deviance. Results The pooled prevalence of malaria among children aged 6–59 months was found to be 27.41% (95% CI: 17.94%-36.88%). It ranges from 5.04% in Senegal to 62.57% in Sierra Leone. Aged 36–47 months (AOR = 3.54, 95% CI 3.21–3.91), and 48–59 months (AOR = 4.32, 95% CI 3.91–4.77), mothers attended primary education (AOR = 0.78, 95% CI 0.73–0.84), richer (AOR = 0.35, 95% CI 0.32–0.39), and richest household (AOR = 0.16, 95% CI 0.14–0.19), number of three and more under-five children (AOR = 1.35, 95% CI 1.26–1.45), improved floor material (AOR = 0.65, 95% CI 0.57–0.73), improved wall material (AOR = 0.73, 95% CI 0.64–0.84), improved roof material (AOR = 0.70, 95% CI 0.51–0.93), insecticide-treated bed net (ITN) use (0.56, 95% CI 0.51–0.62), not anemic (AOR = 0.05, 95% CI 0.04–0.06), rural resident (AOR = 2.16, 95% CI 2.06–2.27), high community ITN use (AOR = 0.40, 95% CI 0.24–0.63) and high community poverty (AOR = 2.66, 95% CI 2.53–2.84) were strongly associated with malaria. Conclusions and recommendations Almost 3 out of 10 children were infected by malaria in 13 SSA countries. Malaria infection remains one of the main killers of children aged 6–59 months in the SSA. This study revealed that older under-five children living in large families with low incomes in rural areas are most vulnerable to malaria infection. Our results clearly indicate that ITN utilization and improved housing are promising means to effectively prevent malaria infection among children aged 6–59 months. It is therefore important to note that households with low wealth quintiles and rural residents should be prioritized in any mass distribution of ITNs. This has to be accompanied by education using mass media to enhance community awareness.

Abstract Introduction Antimicrobial resistance (AMR) is a global public health issue, which can be addressed through improved antimicrobial stewardship (AMS) knowledge and practice. The CwPAMS programme, launched in 2019, is funded by the UK aid Fleming Fund and managed by Commonwealth Pharmacists Association (CPA) and Tropical Health and Education Trust (THET).1,2,3 It expanded in 2021 to support 14 health partnerships to enhance AMS capacity by leveraging UK expertise between the UK and 8 Commonwealth countries: Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda, Zambia. CwPAMS was supported by UK and LMIC volunteers. Aim The aim of this study was to explore views and experiences of volunteers who took part in the CwPAMS Extension Programme. Methods A cross-sectional survey was developed using Survey Monkey by CPA internal AMS experts and programme managers. The questions explored the key benefits to health organisations and professionals, including the development of AMS skills and competencies, barriers to AMS, and personal/professional development opportunities. Open-ended questions were included to gather further insights into volunteers' views and experiences of volunteering and participating in CwPAMS. The survey was emailed to the 14 health partnerships who took part in the CwPAMS programme between October 2021-May 2022 to be disseminated to all volunteers. Data were collected between 14 April-1 June 2022, transferred to Microsoft Excel and analysed thematically, with frequency counting where appropriate. As it was an internal CPA programme evaluation, no ethical approval was required. Results A total of 83 survey responses were received. The majority respondents were female (60%) and were pharmacists (54%). Volunteers recognised the programme’s positive impact on a personal/professional and organisational level, by fostering knowledge exchange and enhancing AMS practices. Amongst volunteers, 87% noted that their organisation had benefited through their participation in CwPAMS, with 72% stating they had increased AMS capacity in their team. Volunteers highlighted several areas where they applied their newly acquired skills and experiences from their participation in CwPAMS. The most frequently mentioned impactful areas were: 1) Leadership and project management: Volunteers reported improved competencies in establishing local expertise in AMS and infection management, strengthening stakeholder and partnership engagement and improved confidence in project leadership, monitoring, and evaluation. 2) Use of new tools (digital/virtual) for training and AMS use 3) Mentoring, teaching and sharing their knowledge and experiences to support others in their professional development. In addition, volunteers reported they had the opportunity to network and form international partnerships, fostering multidisciplinary collaborations. They also experienced personal development by acquiring leadership, communication, problem-solving, grant application writing, and project management skills. Discussion/Conclusion CwPAMS offers volunteers within health partnerships a distinct opportunity for personal and professional growth, while simultaneously improving AMS related healthcare practices in their organisations. We will continue to expand upon the achievements of the programme by enhancing volunteer experiences, such as the Africa Leadership Fellowship-AMS offering as part of CwPAMS 2, to upskill and enable pharmacists in LMICs to develop leadership roles. Additionally, we aim to strengthen the evaluation of CwPAMS to showcase its impact to the UK and LMICs, respectively. References 1. Commonwealth Pharmacists Association – CwPAMS: Commonwealth Partnerships for Antimicrobial Stewardship. Available at: https://commonwealthpharmacy.org/cwpams (accessed 3 June 2023). 2. Ashiru-Oredope D, Langford BJ, Bonaconsa C, et al. Global collaborations in antimicrobial stewardship: All hands on deck. Antimicrob Steward Healthc Epidemiol, 2023; 3(1): e66. DOI: 10.1017/ash.2023.122. 3. Brandish C, Garraghan F, Ng BY, et al. Assessing the Impact of a Global Health Fellowship on Pharmacists' Leadership Skills and Consideration of Benefits to the National Health Service (NHS) in the United Kingdom. Healthcare (Basel) 2021; 9(7):890. DOI: 10.3390/healthcare9070890.

The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed. References World Health Organization (WHO) Coronavirus Disease (COVID-19) Dashboard. 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Abstract Background A nationwide assessment of the link between women’s empowerment and homebirth has not been fully examined in Sierra Leone. Our study examined the association between women’s empowerment and homebirth among childbearing women in Sierra Leone using the 2019 Sierra Leone Demographic Health Survey (2019 SLDHS) data. Method We used the individual file (IR) of the 2019 SLDHS dataset for our analysis. A total of 7377 women aged 15–49 years who gave birth in the five years preceding the survey were included. Outcome variable was “home birth of their last child among women in the five years preceding the 2019 SLDHS. Women’s empowerment parameters include women’s knowledge level, economic participation, decision-making ability and power to refuse the idea of intimate partner violence. We used the complex sample command on SPSS version 28 to conduct descriptive and multivariate logistic regression analyses. Results Three in every 20 women had home childbirth (n = 1177; 15.3%). Women with low [aOR 2.04; 95% CI 1.43–2.92] and medium [aOR 1.44; 95%CI 1.05–1.97] levels of knowledge had higher odds of giving birth at home compared to those with high levels of knowledge. Women who did not have power to refuse the idea of intimate partner violence against women were more likely to had given birth at home [aOR 1.38; 95% CI1.09-1.74]. In addition, women with no [aOR 2.71; 95% CI1.34-5.46) and less than four antenatal care visits [aOR 2.08; 95% CI:1.51–2.88] and for whom distance to a health facility was a major problem [aOR 1.95; 95% CI1.49-2.56] were more likely to have had a homebirth. However, no statistically significant association was observed between a women’s decision-making power and home birth [aOR 1.11; 95% CI 0.86–1.41]. Conclusion Despite improvements in maternal health indicators, homebirth by unskilled birth attendants is still a public health concern in Sierra Leone. Women with low knowledge levels, who did not have power to refuse the idea of intimate partner violence against women, had less than four ANC visits and considered distance to a health facility as a major problem had higher odds of giving birth at home. Our findings reflect the need to empower women by improving their knowledge level through girl child and adult education, increasing media exposure, changing societal norms and unequal power relations that promote gender-based violence against women, and improving roads and transport infrastructure.

Despite the Government effort of ensuring community direct involvement and ownership of development projects in their locality such as education, the extent of parents input in students discipline through the Parent Teachers Association (PTA) remains obscure in many secondary schools. This study was to determine the role of Parents Teachers Association (PTA) in enhancing discipline in Public Secondary Schools in Makeni City, Northern Sierra Leone. The study was guided by four research questions that investigated the following aspects: The activities of PTA in enhancing students‟ discipline, the extent to which PTA role enhances discipline, the challenges facing PTA in students discipline management and suggestions on how the PTA can be more effective in enhancing discipline. The study employed both quantitative and qualitative research methodologies with a cross-sectional survey and phenomenological design. The target population consisted of 4 Government assisted public secondary schools, principals, discipline masters, PTA members, class teachers, and all students of the 4 public secondary schools in Makeni City. The sample size consisted of 4 principals, 4 discipline masters, 36 class teachers, 36 PTA members and 160 students. Data was collected by use of interview guides, questionnaires, and document analysis guide, which were personally administered by the researcher. Quantitative data was analyzed in frequencies and percentages using SPSS version 20, while qualitative data was organized into themes and analyzed descriptively. Conclusions and recommendations were made based on the findings there of.

Abstract Background Access to sexual and reproductive health information enables young women to make appropriate decisions. We examined the association between exposure to family panning messages on different mass media and the use of modern contraceptives among young women in Sierra Leone. Methods This was a secondary analysis of the 2019 Sierra Leone Demographic and Health Survey data of young women aged 15–24 years. Multistage stratified sampling was used to select study participants in the survey. We used multivariable logistic regression to determine the association between exposure to family panning messages on different types mass media channels and utilization of modern contraceptives. All our analyses were done using SPSS version 25. Results Out of 6055 young women, 1506 (24.9%, 95% CI 24.0–26.2) were utilizing a modern contraceptive method with the prevalence higher among urban women (26.5%) compared to rural women (23.1%). Less than half (45.6%) had been exposed to family planning messages on mass media (radio 28.6%, television 10.6%, mobile phones 4.2% and newspapers or magazines 2.2%). Young women who had exposure to family planning messages on radio (AOR: 1.26, 95% CI 1.06–1.50) and mobile phones (AOR: 1.84, 95% CI 1.25–2.69) had higher odds of using modern contraceptives compared to their counterparts without the same exposure. Furthermore, having access to internet (AOR: 1.45, 95% CI 1.19–1.78), working (AOR: 1.49, 95% CI 1.27–1.74), being older (20–24 years) (AOR: 1.75, 95% CI 1.46–2.10), being married (AOR: 0.33, 95% CI 0.26–0.42), having visited a health facility within the last 12 months (AOR: 1.34, 95% CI 1.10–1.63), having secondary (AOR: 2.83, 95% CI 2.20–3.64) and tertiary levels of education (AOR: 3.35, 95% CI 1.83–6.13), higher parity (having above one child) AOR: 1.57, 95% CI 1.19–2.08) and residing in the southern (AOR: 2.11, 95% CI 1.61–2.79), northwestern (AOR: 1.87, 95% CI 1.39–2.52), northern (AOR: 2.11, 95% CI 1.59–2.82) and eastern (AOR: 1.68, 95% CI 1.27–2.22) regions of residence were associated with higher odds of modern contraceptives utilization. Conclusion In Sierra Leon, only one in four young women were using modern contraception and more than half of them had not had any exposure to family planning messages on the different types of mass media channels. Behavior change communicators can prioritize family planning messages using radio, mobile phones and the internet. In order to publicize and encourage young women to adopt healthy behaviours and increase uptake of modern contraceptive.

Abstract Background Women empowerment is recognized as a potential enabling factor to the utilization of health facilities during childbirth. However, the association between women empowerment and utilization of health facilities is poorly studied, especially in counties with high maternal mortality. Therefore, we investigated the association between women empowerment indices and the utilization of health facilities during childbirth in Sierra Leone. Methods We analyzed secondary data from the 2019 Sierra Leone Demographic and Health Survey (SLDHS). We included 5,997 married women who had given birth in the five years before the survey, and had been sampled for the women empowerment questionnaire. The study employed the gender roles framework developed by the Harvard Institute for International Development in the selection and classification of women empowerment indices, which include influencing, resource and decision-making factors. We conducted logistic regression analyses using SPSS version 25.0 complex samples package to determine the association between women empowerment indices and utilization of health facilities. Results The overall prevalence of health facility utilization during childbirth was 84.1% (5,042/5,997): 95% CI: 83.6 to 85.4. Among the influencer domain variables, women from the southern (aOR = 2.25, 95% CI: 1.34–3.78), northern (aOR = 1.69,95% CI: 1.01–2.82) and eastern regions (aOR = 3.71, 95% CI: 2.03–6.77) had higher odds of health facility utilization compared to women in the western region, while women in polygamous marriages (aOR = 0.82, 95% CI: 0.69–0.98) had lower odds of utilizing health facilities compared to their counterparts in monogamous marriages. Furthermore, women who had their first birth when they were less than 18 years, had higher odds of utilizing health facilities (aOR = 1.22, 95% CI: 1.02–1.45) compared to those who were 18 years and above. Among the resource domain variables, women with post-primary education (aOR = 1.58, 95% CI: 1.21–2.06) had higher odds of utilizing health facilities compared to their counterparts with no education and women who belonged to the richest wealth quintile (aOR = 2.42, 95% CI: 1.31–4.46) had higher odds of utilizing health facilities compared to their counterparts belonging in the poorest quintile. None of the variables in the decision making domain was significantly associated with health facility utilization. Conclusion These findings emphasize that, successful implementation of health facility utilization interventions should prioritize women empowerment with more pragmatic efforts. Policies and programme should aim at all women with more focus on those having lower education (primary and below), belonging to the poorest wealth quintile, give birth before reaching18 years and in polygamous marriages.

BackgroundComplementary feeding of infants and young children (IYC) 6–23 months is a critical factor for healthy growth and development. Dietary diversity (DD)‐‐the number of different food groups consumed‐‐is a proxy for micronutrient adequacy; minimum dietary diversity (MDD) is a WHO indicator used to assess the adequacy of complementary feeding in an IYC population. DD at the household level provides a measure of the food groups consumed in the home and thus potentially available for children. The comparison of household with child DD permits exploration of whether inadequate child DD is due to lack of availability in the home or intra‐household distribution to the child. Although a number of factors have been described in relation to child DD, the literature is limited regarding its relation with household DD.ObjectivesThis study examined firstly, the association between household and child DD in poor, mostly rural areas of 3 diverse countries: Peru—a middle income country, Bangladesh and Sierra Leone—both low‐income countries; and secondly, this same association across three IYC age groups (6–8 months, 9–11 months, 12–23 months) in each country.MethodsData were collected as part of the endline surveys following implementation of CARE's Window of Opportunity intervention which aimed to improve the diet and growth of children 0–23 months. Randomly sampled households in the intervention districts were selected (Peru n=402, Bangladesh n=1905, Sierra Leone n=585). DD was derived from 24 hour dietary recalls of the child's intake and HH food group consumption. The foods consumed in each case were assigned to 7 food groups (WHO): cereals/tubers/roots, flesh foods, eggs, dairy, legumes, vitamin A fruits/vegetables and other fruits/vegetables. Household and IYC consumption were compared in bivariate analysis. Generalized linear modeling (GLM) was used to examine MDD (a dichotomous variable)—which was met when IYC consumed 4 or more of the 7 groups.ResultsMDD was met by 89% of children in Peru, 61% in Bangladesh, and 53% in Sierra Leone. For each food group, with the exception of dairy, more households than IYC consumed them in all 3 countries. A clear and steep increase in consumption of each food group was seen by child's age group in all countries; youngest children had the lowest frequency of consumption (Table 1). In country specific GLM models, increasing household DD was significantly associated with meeting MDD (Odds Ratio (OR) range 2.0 to 3.0), controlling for mother's education, household food security and child's age group. In these same models, compared to IYC 6–8 months, older children had strong, independent associations with meeting MDD; 9–11 months (OR range 3.2 to 5.3), and 12–23 months (OR range 6.0 to 10.7).ConclusionsInfants 6–8 months were at significantly greater risk for not meeting MDD compared to children 9–11 and 12–23 months. While greater household DD decreased IYC risk for not meeting MDD, the comparison of foods consumed in the household versus the child's diet suggests that household DD, representing availability of foods, was not necessarily the main limiting factor. The variety of available food groups within the household, intra‐household distribution and/or caregiver selection of foods may all limit IYC DD. Future work should focus on understanding the barriers and facilitators for providing children with the full range of foods available so that DD among IYC, especially those in the youngest age group, can be improved.Support or Funding InformationCARE USA; The Catholic University of America Household and Child Consumption of Food Groups in 3 Countries image

Abstract Background Evidence of how social factors affect the health-related quality of life (HRQoL) of Ebola virus disease (EVD) survivors is limited. Our study explores the association between socio-demographic, health-related and psycho-social (stigma) factors and EVD survivors' health-related quality of life (HRQoL) in Sierra Leone. Methods We conducted a nationwide cross-sectional study among 358 EVD survivors between January and August 2018. We used a multistage sampling method to recruit EVD survivors, and the RAND 36-Item Health Survey item was used to assess the HRQoL. Data were analysed using descriptive statistics and multiple linear regression. Results When comparing by each dimension in relation to their respective summary scores, role limitation physical [0.00 (50.00)] and role limitation emotional [0.00 (33.33)] were the most affected physical health and mental health domains among EVD survivors respectively. EVD survivors who were older (β = − 3.90, 95% CI − 6.47 to − 1.32, p = 0.003), had no formal education (β = − 2.80, 95% CI − 5.16 to − 0.43, p = 0.021), experienced a unit increase in the number of post-Ebola symptoms (β = − 1.08, 95% CI − 1.74 to − 0.43, p < 0.001) and experienced a unit increase in enacted stigma (β = − 2.61, 95% CI − 4.02 to − 1.20, p < 0.001) were more likely to report a decreased level of physical health. EVD survivors who experienced a unit increase in the time spent in the Ebola treatment centre (β = − 0.60, 95% CI − 0.103 to − 0.18, p = 0.006) and those who experienced a unit increase in enacted Stigma were more likely to report decreased levels of mental health (β = − 1.50, 95% CI − 2.67 to − 0.33, p = 0.012). Conclusion Sociodemographic, health-related, and psycho-social factors were significantly associated with decrease levels of HRQoL. Our findings improve our understanding of the factors that might influence the HRQoL and suggest the need for EVD survivors to be provided with a comprehensive healthcare package that caters for their physical and mental health needs.

Abstract Background The World Health Organization (WHO) declared the West Africa Ebola epidemic as a Public Health Emergency of International Concern in August 2014. During the outbreak period, there were calls for the affected countries to construct Ebola treatment centres and reliable diagnostic laboratories closer to areas of transmission in order to improve the quality care of Ebola Virus Disease (EVD) patients. Delay in seeking treatment has been reported to have led to poor treatment outcome of EVD patients. Sierra Leone recorded more than 8000 probable and confirmed cases and more than 4000 EVD -related deaths nation-wide. Methods In this retrospective study, we investigated the effects of treatment delay, length of symptomatic period, EVD patients’ sex, age, occupation, region of residence, and clinical characteristics on the treatment outcome of 205 laboratory-confirmed EVD patients who were admitted at the Kenema Government Hospital Ebola Treatment Center (KGHETC) from 13/09/2014–26/11/2014; i.e. during the peak of 2013–2016 EVD outbreak in Sierra Leone. Specifically also, we determined the factors that were associated with the length of stay for EVD treatment for patients who were discharged alive. Results Majority (66.3%, n = 205/309) of the 309 suspected EVD patients with medical records at the KGHETC triage during the period under review were tested positive for EVD using reverse-transcriptase-polymerase chain reaction (RT-PCR) and had a definitive treatment outcome. Few (33.7%, n = 104/309) suspected EVD patients were not included in our analysis and were classified thus: 29.1% (n = 90/309) suspect EVD cases with negative RT-PCR results, 4.5% (n = 14/309) suspect cases with non-available RT-PCR result. Of the 205 patients, 99 (48.3%) had a fatal outcome. For EVD patients that survived, we recorded a significant association (− 0.06, 95% Confidence Interval (CI) = − 0.14 – - 0.02, p = 0.004) between the Length of Stay (LOS) and for each kilometer travelled to seek treatment at the KGHETC. However, the association between EVD patients that were low skilled workers (− 5.91, 95% CI = − 24.60 – 12.79, p = 0.73), EVD patients who were children and pupils in junior school (− 0.86, 95% CI = − 12.86 – 11.14, p = 0.73), health seeking delay for EVD patients who resided in Kenema District where the KGHETC was located (− 0.49, 95% CI = − 0.12 – 1.09, p = 0.24), sex (− 1.77, 95% CI = − 8.75 – 5.21, p = 0.50), age (0.21, 95% CI = − 0.36 – 0.77, p = 0.57), referral status (1.21, 95% CI = − 17.67 – 20.09, p = 0.89) and the LOS in surviving patients were not statistically significant. Conclusion The high LOS for either treatment outcome for EVD patients that resided in the district in which the EVD treatment facility was located compared to those patients from other districts implies that health authorities should consider intensive health education with high priority given to seeking early EVD treatment, and the construction of strategic ETCs as important components in their response strategy.

Abstract Background Low birth weight (LBW) remains a major health problem that affects newborns worldwide. However, there has been growing evidence that antenatal care (ANC) is associated with LBW. Yet, there is a dearth of research investigating the association between ANC attendance and LBW in sub-Saharan Africa (SSA). This study examined the association between the number of ANC visits and LBW using data from 10 sub-Saharan African countries. Methods This study pooled data from the recent Demographic and Health Survey (DHS) of 10 sub-Saharan African countries conducted from 2018 to 2020. A total of 33,585 women aged 15–49 who had live births in the five years preceding the survey were included in this study. Bivariable and multivariable multilevel regression models were fitted to show the association between the number of ANC visits and LBW. Crude odds ratio (cOR) and adjusted odds ratio (aOR) at 95% confidence intervals (CIs) were used in presenting the results of the regression analysis. Results The pooled prevalence of LBW was 5.7%. The highest prevalence of LBW was recorded in Gambia (7.2%) with the lowest found in Sierra Leone (2.9%). In terms of eight or more ANC visits, the overall prevalence was 14.5%. Nigeria had the highest prevalence of eight or more ANC visits (43.5%) with the lowest in Rwanda (0.2%). We found a statistically significant association between the number of ANC visits and LBW. Mothers who had eight or more ANC visits were less likely to have LBW children compared to mothers who had less than eight ANC visits [cOR = 0.66; CI = 0.55 – 0.79] and this persisted after controlling for the covariates [aOR = 0.68; CI = 0.56 – 0.82]. Covariates associated with LBW were maternal age, marital status, level of education, age of child, and wealth index. Conclusion This study has shown a statistically significant association between ANC and LBW in SSA, with women who had eight or more ANC visits being at lower risks of giving birth to children with LBW. We found that eight or more ANC attendance was a protective factor against LBW in SSA. Therefore, it is important for sub-Saharan African countries with low prevalence of eight or more ANC attendance and high LBW prevalence to channel their efforts towards promoting more ANC attendance.

Background: Bedbug infestation is the worldwide problem according to World Health Organization, and the infestation is characterized by biting reactions including systemic, cutaneous reactions and sometimes psychological disturbance. Prevalence of bedbug infestation is low (6%) in developed countries while in Sierra Leone is 98% and Tanzania is 56% in which is tremendously high. As the bedbug infestation is among neglected conditions and because of high prevalence in Tanzania, the studies to determine this burden, some risk factors (crowding) and awareness among specific populated communities especially schools is inevitable for planning strategies in eradication of bedbug. Objective: To determine the prevalence of bedbug infestation, crowding and awareness level among boarding government secondary school students in Moshi Urban. Methodology: A cross-sectional study was conducted from May to July 2018 at Moshi Urban in Kilimanjaro region. The structured standard questionnaire was used to obtain the demographics information of participants, asses awareness. Personal observation was used to determine prevalence and crowding in the corresponding student’s dormitories. Results: The prevalence of bedbug infestation was 58.1% (223) among 384 study participants. Logistic regression analysis showed that 72.6% of the students with bedbug infestation were found to be living in the overcrowded dormitories. There was association between overcrowd and bedbug infestation (OR=2.50, 95%CI (1.63-3.83). Only 32.7% of the infested students involved in this study were aware with bedbugs (OR=0.8795% CI (0.56-1.35) P=0.54. Conclusion: The overall prevalence of bedbug infestation was found to be high among students living in the overcrowded dormitories and those who were not aware on bedbug biology and behavior, transmission, control and prevention ways. Education concerning bedbugs is needed to increase the community awareness together with management of number of students in accordance to the available facilities and resources.

Abstract Background Over the past decade, an increasing number of low- and middle-income countries have reduced or removed user fees for pregnant women and/or children under five as a strategy to achieve universal health coverage. Despite the large number of studies (including meta-analyses and systematic reviews) that have shown this strategy’s positive effects impact on health-related indicators, the repercussions on women’s empowerment or gender equality has been overlooked in the literature. The aim of this study is to systematically review the evidence on the association between user fee policies in low- and middle-income countries and women’s empowerment. Methods A systematic scoping review was conducted. Two reviewers conducted the database search in six health-focused databases (Pubmed, CAB Abstracts, Embase, Medline, Global Health, EBM Reviews) using English key words. The database search was conducted on February 20, 2020, with no publication date limitation. Qualitative analysis of the included articles was conducted using a thematic analysis approach. The material was organized based on the Gender at Work analytical framework. Results Out of the 206 initial records, nine articles were included in the review. The study settings include three low-income countries (Burkina Faso, Mali, Sierra Leone) and two lower-middle countries (Kenya, India). Four of them examine a direct association between user fee policies and women’s empowerment, while the others address this issue indirectly —mostly by examining gender equality or women’s decision-making in the context of free healthcare. The evidence suggests that user fee removal contributes to improving women’s capability to make health decisions through different mechanisms, but that the impact is limited. In the context of free healthcare, women’s healthcare decision-making power remains undermined because of social norms that are prevalent in the household, the community and the healthcare centers. In addition, women continue to endure limited access to and control over resources (mainly education, information and economic resources). Conclusion User fee removal policies alone are not enough to improve women’s healthcare decision-making power. Comprehensive and multi-sectoral approaches are needed to bring sustainable change regarding women’s empowerment. A focus on “gender equitable access to healthcare” is needed to reconcile women’s empowerment and the efforts to achieve universal health coverage.

Abstract Background Violence against women is a major human rights violation, and the continuous occurrence of this can have many implications for women’s social and health outcomes. The experience of violence from an intimate partner could be more intriguing, especially if such women experienced their mother’s intimate partner violence (IPV) issues. Thus, this study examined the vertical transmission of IPV among women in sub-Saharan Africa (SSA). Methods A total of 97,542 eligible women were drawn from 27 countries in SSA using a retrospective secondary dataset from Demographic Health Surveys conducted between 2010 and 2019. Multivariable analysis was employed to determine the association between the vertical transmission of IPV from mother to daughter and the covariates associated with IPV in SSA at p < 0.05. Results The results showed that 40% of the respondents had experienced lifetime IPV, whilst 25% of those women reported that their mothers experienced it in childhood in SSA. Country-specific variations showed the highest prevalence of IPV experienced in Sierra Leone (60%) and the lowest in Comoros (9%). Results from model 1 showed that women who reported that their mothers experienced IPV were found to be significantly more than two times more likely to have experienced any form of IPV compared to those whose mothers did not (aOR = 2.66; 95% CI: 2.59–2.74), after adjusting for cofounders in Model 2, the result still showed that women who reported that their mothers experienced IPV were found to be significantly more than two times more likely to have experienced any form of IPV compared to those whose mothers did not (aOR = 2.56; 95% CI: 2.48–2.63). On the other hand, women with higher-educated partners, women in rural areas, and those from female-headed households were less likely to experience IPV. Conclusion This study concluded that women whose mothers experienced IPV were more likely to have experienced IPV. Our study also identified that education, rural areas, and female-headed households were protective factors against experiencing IPV. To address the groups of women at higher risk for experiencing IPV, we recommend ensuring that girls complete their education to promote greater wealth and resources.

Abstract Aim To evaluate the factors associated with alcohol abuse in the Peruvian population. Methods A secondary analysis was performed using data from the Demographic and Family Health Survey of Peru, 2019. We included 24 264 Peruvians between 18 and 59 years. For the analysis of association, the Poisson regression model with robust standard errors was used. Adjusted Prevalence Ratios (aPR) with their respective 95% confidence intervals (95% CI) were calculated. Results The prevalence of alcohol abuse was 5.2%. Having higher education (aPR:1.61; 95%CI:1.04–2.48), being widowed, separated or divorced (aPR:1.73; 95%CI:1.18–2.54), belonging to the third (aPR:1.70; 95%CI:1.12–2.60), fourth (aPR:2.08; 95%CI:1.33–3.23) or fifth socioeconomic quintile (aPR:2.16; 95%CI:1.33–3.50), being from the Sierra (aPR:1.45; 95%CI:1.12–1.87) or Selva (aPR:1.48; 95%CI:1.13–1.94), not having health insurance (aPR:1.25; 95%CI:1.04–1.50), being a current smoker (aPR:2.43; 95%CI:2.02–2.93) and having major depression (aPR:1.77; 95%CI:1.32–2.36) were associated with a higher prevalence of alcohol abuse. On the other hand being a middle-aged adult (aPR:0.73; 95%CI:0.60–0.88), female (aPR:0.16; 95%CI:0.12–0.22) and having started drinking alcohol after the age of 18 years (aPR:0.57; 95%CI:0.47–0.69) were associated with a lower prevalence. Conclusions One in 20 Peruvians between 18 and 59 years had alcohol abuse. Age, gender, education level, marital status, socioeconomic level, region, age of first drink, smoking and depression were associated with alcohol abuse.

Abstract Background Intimate partner violence (IPV) during pregnancy has negative physical and psychological health consequences on the pregnant women. As such, women who experience IPV during pregnancy are likely to have challenges accessing maternal healthcare services. In this study, we examined the influence of exposure to IPV on timely antenatal care (ANC) visits in sub-Saharan Africa. Methods Cross-sectional data from the most recent Demographic and Health Survey of twenty-two countries in sub-Saharan Africa between 2012 and 2020 were analysed. Data were obtained from 61,282 women with birth history in the five years prior to the survey. A multilevel logistic regression was used to determine the association between IPV and timely ANC visits while controlling for significant covariates. Adjusted odds ratios (aOR) with 95% Confidence Intervals (CI) were used to present results from the multilevel logistic regression analysis. Results The prevalence of timely ANC visit and IPV were 38.1% and 34.9% respectively. The highest and lowest prevalence of IPV were found in Sierra Leone (52.9%) and Comoros (8.1%), respectively. Timely ANC attendance among pregnant women was more prevalent in Liberia (74.9%) and lowest in DR Congo (19.0%). Women who experienced IPV during pregnancy were less likely to utilize timely ANC (aOR = 0.89, 95% CI = 0.86–0.92) compared to those who did not experience IPV. In terms of the covariates, the odds of timely ANC were higher among women aged 40–44 compared to those aged 15–19 (aOR = 1.35, 95% CI = 1.21–1.51). Higher odds of timely ANC was found among women who were cohabiting (aOR = 1.15, 95% CI = 1.10–1.20), those from the richest wealth quintile (aOR = 1.38, 95% CI = 1.28–1.48), those exposed to watching television (aOR = 1.24, 95% CI = 1.18–1.30), and those with health insurance (aOR = 1.46, 95% CI = 1.37–1.56). Conclusion Findings from the study indicate the role of IPV in timely ANC visit in sub-Saharan Africa. To enhance timely ANC visits, there is the need for policy makers to strengthen and enforce the implementation of policies that alleviate IPV during pregnancy. Education and sensitization of married and cohabiting women and men on the negative effects of IPV on timely ANC should be done using media sources such as television. Inequalities in timely ANC can be eliminated through the provision and strengthening of existing maternal health policies such as health insurance.

Introduction: The goal of this review is to investigate maternal mortality rates (MMR) in African countries. Because the MMR of Black women in the United States is 3-5x higher than in White women, this study aims to identify if a similar racial disparity is present in Africa where the majority of the birthing population identifies as Black. Methods: Four bibliographic databases were searched - PubMed, Web of Science Core Collection, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) – and a variety of search terms were identified, including “Maternal Mortality”, “Ethnic Groups”, “Minority Groups”, “Continental Population Groups”, “Medically Underserved Area”, “Race Factors” and “Racial Disparities”. Inclusion criteria were manuscripts with statistics on maternal mortality or severe maternal morbidity in African countries or regions; exclusion criteria included “wrong outcome”, “wrong study type”, and studies only discussing maternal morbidity without mention of mortality. Papers that were not written in or that did not include information about an African country or region were excluded. Results: Overwhelmingly, hypertension-related mortality was identified as a leading cause of death in nearly every study, followed closely by post-partum hemorrhage, often due to over- or underuse of anticoagulation therapy. Unsafe abortion contributed to higher rates of adolescent mortality (37% of adolescents in one study) while accounting for 9-27% of the overall mortality rate. MMR across the continent varied significantly. Countries with the highest average recorded MMRs include Tunisia (1,820/100,000), Sierra Leone (1,800/100,000), Guinea (1,600/100,000), and Somalia (1,600/100,000). The lowest average MMRs found in this study included Tanzania (120/100,000), Egypt (124.5/100,000), Algeria (160/100,000), and Libya (220/100,000). Factors contributing to higher rates of mortality included extremes in maternal age, with the highest rates being in those older than 40 and younger than 20. Educational status played a large role, with up to 68% of mortality in one study occurring in people considered to be illiterate. Low socioeconomic status and being a member of a minority religious and/or ethnic group within a population corresponded with higher mortality rates, in addition to either late or minimal access to antenatal care (up to 28x higher MMR). A common comorbidity related to maternal mortality was patients having an established HIV diagnosis. Though mortality rates were significant in both HIV-positive and HIV-negative patients, most deaths in HIV-positive patients were related to advanced disease as opposed to obstetric complications, with one study finding the MMR of HIV-infected patients to be 6.2 times higher than HIV-negative patients. Among these deaths, tuberculosis, pneumocystis jirovecii pneumonia, and meningitis were among the most common causes. One study investigated the association between antiretroviral (ART) therapy and decreased rates of HIV-positive mortality. The recorded MMR of both HIV-positive and HIV-negative women decreased over the 10 years in this study; however, the HIV-positive MMR in the third time period was still 3.2 times higher than that of HIV-negative women (4.1 times higher in the second period, 7.1 times higher in the first period) with HIV-positive patients making up 33.3% of maternal deaths. One 2021 study focused on the effects of a COVID-19 infection on maternal outcomes – identifying no statistically significant difference in MMR, except that HIV-positive patients were twice as likely to contract COVID than controls. Conclusion: According to US CDC, the 2020 US national MMR was 23.8 per 100,000 live births, compared with the lowest national MMR in this study - Tanzania at 120/100,000; 6-fold higher than the US national average. In this systematic review, multiple factors were found to contribute to higher MMR, including low socioeconomic status, poor access to trained medical professionals, and patients having untreated or severe comorbidities such as HIV or tuberculosis. Two studies used a data collection method called ‘The Sisterhood Method’ which gathered retrospective data via interviewing women about the maternal outcomes of their biological sisters. Though this method of collection is useful for countries and/or regions that have limited access to electronic medical records (EMR) or census data, it relies on the memory and the willingness of interviewees to provide information, which may create recall bias and alter the validity of those studies. Our work identifies a need for further maternal mortality research to identify differences in healthcare systems across countries (both in Africa and worldwide) leading to higher death rates in some nations. Additionally, training programs (such as “Human Resources for Health,” “Pan-African Academy of Christian Surgeons [PAACS]”, “East, Central, and Southern African Health Community [ECSA-HC]”, etc.) should be supported with funding and other resources to address this crisis, while also supporting ongoing initiatives to expand medical education and training in African countries. Efforts should also be made to increase patient education about early signs of obstetric complications. Though maternal mortality rates have trended downward in recent decades, further research is needed to highlight and address disparities across countries and populations to provide equitable care to all.