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  • 11
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    SARS-CoV-2 antibody prevalence in Sierra Leone, March 2021: a cross-sectional, nationally representative, age-stratified serosurvey
    BMJ ; 2021
    In:  BMJ Global Health Vol. 6, No. 11 ( 2021-11), p. e007271-
    Details
    In: BMJ Global Health, BMJ, Vol. 6, No. 11 ( 2021-11), p. e007271-
    Abstract: As of 26 March 2021, the Africa Centres for Disease Control and Prevention had reported 4 159 055 cases of COVID-19 and 111 357 deaths among the 55 African Union member states; however, no country has published a nationally representative serosurvey as of October 2021. Such data are vital for understanding the pandemic’s progression on the continent, evaluating containment measures, and policy planning. Methods We conducted a cross-sectional, nationally representative, age-stratified serosurvey in Sierra Leone in March 2021 by randomly selecting 120 Enumeration Areas throughout the country and 10 randomly selected households in each of these. One to two persons per selected household were interviewed to collect information on sociodemographics, symptoms suggestive of COVID-19, exposure history to laboratory-confirmed COVID-19 cases, and history of COVID-19 illness. Capillary blood was collected by fingerstick, and blood samples were tested using the Hangzhou Biotest Biotech RightSign COVID-19 IgG/IgM Rapid Test Cassette. Total seroprevalence was estimated after applying sampling weights. Results The overall weighted seroprevalence was 2.6% (95% CI 1.9% to 3.4%). This was 43 times higher than the reported number of cases. Rural seropositivity was 1.8% (95% CI 1.0% to 2.5%), and urban seropositivity was 4.2% (95% CI 2.6% to 5.7%). Discussion Overall seroprevalence was low compared with countries in Europe and the Americas (suggesting relatively successful containment in Sierra Leone). This has ramifications for the country’s third wave (which started in June 2021), during which the average number of daily reported cases was 87 by the end of the month:this could potentially be on the order of 3700 actual infections per day, calling for stronger containment measures in a country with only 0.2% of people fully vaccinated. It may also reflect significant under-reporting of incidence and mortality across the continent.
    Type of Medium: Online Resource
    ISSN: 2059-7908
    URL: Article
    DOI: 10.1136/bmjgh-2021-007271
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2851843-3
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  • 12
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    What are the trends in seeking health care for fever in children under-five in Sierra Leone? evidence from four population-based studies before and after the free health care initiative
    Public Library of Science (PLoS) ; 2022
    In:  PLOS ONE Vol. 17, No. 2 ( 2022-2-2), p. e0263364-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 17, No. 2 ( 2022-2-2), p. e0263364-
    Abstract: In 2010, the government of Sierra Leone implemented the Free Health Care Initiative (FHCI) in the country with the objective of reducing the high maternal, infant, and child mortality rates and improving general health indicators. The objective of this study was to assess the trends in the prevalence of health care-seeking and to identify the determinants of healthcare service utilization by caregivers of children younger than five years. Methods The analysis of health-care-seeking behavior was done using data from four population-based surveys in Sierra Leone before (2008) and after (2013, 2016, 2019) the FHCI was implemented. Care-seeking behavior was assessed with regard to caregivers seeking care for children under-five in the two weeks prior to each survey. We compared the percentages of healthcare-seeking behavior change and identify factors associated with healthcare-seeking using a modified Poisson regression model with generalized estimating equations. Results In 2008, a total of 1208 children with fever were recorded, compared with 2823 children in 2013, 1633 in 2016, and 1464 in 2019. Care-seeking for children with fever was lowest in 2008 (51%; 95% CI (46.4−55.5)) than in 2013 (71.5%; 95% CI (68.4−74.5)), 2016 (70.3%; 95% CI (66.6−73.8)), and 2019 (74.6%; 95% CI (71.6−77.3)) (p 〈 0.001). Care-seeking in 2013, 2016 and 2019 was at least 1.4 time higher than in 2008 (p 〈 0.001) after adjusting for mother’s age, wealth, religion, education level, household head and the child’s age. Care-seeking was lowest for children older than 12 months, mothers older than 35 years, children living in the poorest households, and in the northern region. A trend was observed for the sex of the household head. The level of care-seeking was lowest when the household head was a man. Conclusions The increase in healthcare-seeking for children under-five with fever followed the introduction of the FHCI in Sierra Leone. Care-seeking for fever varied by the child’s age, caregiver’s age, household wealth, the sex of the household head and region. Maintaining the FHCI with adequate strategies to address other barriers beyond financial ones is essential to reduce disparities between age groups, regions and, households.
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1371/journal.pone.0263364
    DOI: 10.1371/journal.pone.0263364.g001
    DOI: 10.1371/journal.pone.0263364.g002
    DOI: 10.1371/journal.pone.0263364.g003
    DOI: 10.1371/journal.pone.0263364.t001
    DOI: 10.1371/journal.pone.0263364.t002
    DOI: 10.1371/journal.pone.0263364.t003
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2022
    detail.hit.zdb_id: 2267670-3
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  • 13
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    Measuring coverage of maternal and child health services using routine health facility data: a Sierra Leone case study
    Springer Science and Business Media LLC ; 2021
    In:  BMC Health Services Research Vol. 21, No. S1 ( 2021-09)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 21, No. S1 ( 2021-09)
    Abstract: There are limited existing approaches to generate estimates from Routine Health Information Systems (RHIS) data, despite the growing interest to these data. We calculated and assessed the consistency of maternal and child health service coverage estimates from RHIS data, using census-based and health service-based denominators in Sierra Leone. Methods We used Sierra Leone 2016 RHIS data to calculate coverage of first antenatal care contact (ANC1), institutional delivery and diphtheria-pertussis-tetanus 3 (DPT3) immunization service provision. For each indicator, national and district level coverages were calculated using denominators derived from two census-based and three health service-based methods. We compared the coverage estimates from RHIS data to estimates from MICS 2017. We considered the agreement adequate when estimates from RHIS fell within the 95% confidence interval of the survey estimate. Results We found an overall poor consistency of the coverage estimates calculated from the census-based methods. ANC1 and institutional delivery coverage estimates from these methods were greater than 100% in about half of the fourteen districts, and only 3 of the 14 districts had estimates consistent with the survey data. Health service-based methods generated better estimates. For institutional delivery coverage, five districts met the agreement criteria using BCG service-based method. We found better agreement for DPT3 coverage estimates using DPT1 service-based method as national coverage was close to survey data, and estimates were consistent for 8 out of 14 districts. DPT3 estimates were consistent in almost half of the districts (6/14) using ANC1 service-based method. Conclusion The study highlighted the challenge in determining an appropriate denominator for RHIS-based coverage estimates. Systematic and transparent data quality check and correction, as well as rigorous approaches to determining denominators are key considerations to generate accurate coverage statistics using RHIS data.
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/s12913-021-06529-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2050434-2
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  • 14
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    The state of enrollment on the National Health Insurance Scheme in rural Ghana after eight years of implementation
    Springer Science and Business Media LLC ; 2020
    In:  International Journal for Equity in Health Vol. 19, No. 1 ( 2020-12)
    Details
    In: International Journal for Equity in Health, Springer Science and Business Media LLC, Vol. 19, No. 1 ( 2020-12)
    Abstract: In 2004, Ghana implemented a national health insurance scheme (NHIS) as a step towards achieving universal health coverage. In this paper, we assessed the level of enrollment and factors associated with NHIS membership in two predominantly rural districts of northern Ghana after eight years of implementation, with focus on the poor and vulnerable populations. Methods A cross-sectional survey was conducted from July 2012 to December 2012 among 11,175 randomly sampled households with their heads as respondents. Information on NHIS status, category of membership and socio-demographic characteristics of household members was obtained using a structured questionnaire. Principal component analysis was used to compute wealth index from household assets as estimates of socio-economic status (SES). The factors associated with NHIS enrollment were assessed using logistic regression models. The reasons behind enrollment decisions of each household member were further investigated against their SES. Results Approximately half of the sampled population of 39,262 were registered with a valid NHIS card; 53.2% of these were through voluntary subscriptions by payment of premium whilst the remaining (46.8%) comprising of children below the ages of 18 years, elderly 70 years and above, pregnant women and formal sector workers were exempt from premium payment. Despite an exemption policy to ameliorate the poor and vulnerable households against catastrophic health care expenditures, only 0.5% of NHIS membership representing 1.2% of total exemptions granted on accounts of poverty and other social vulnerabilities was applied for the poor. Yet, cost of premium was the main barrier to NHIS registration (92.6%) and non-renewal (78.8%), with members of the lowest SES being worst affected. Children below the ages of 18 years, females, urban residents and those with higher education and SES were significantly more likely to be enrolled with the scheme. Conclusions Despite the introduction of policy exemptions as an equity measure, the poorest of the poor were rarely identified for exemption. The government must urgently resource the Department of Social Welfare to identify the poor for NHIS enrollment.
    Type of Medium: Online Resource
    ISSN: 1475-9276
    URL: Article
    DOI: 10.1186/s12939-019-1113-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2092056-8
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  • 15
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    Surveillance of COVID-19 in Cameroon: Implications for policymakers and the healthcare system
    PAGEPress Publications ; 2021
    In:  Journal of Public Health in Africa ( 2021-01-29)
    Details
    In: Journal of Public Health in Africa, PAGEPress Publications, ( 2021-01-29)
    Abstract: Background: At first less impacted than the rest of the world, African countries, including Cameroon, are also facing the spread of COVID-19. Objective: This study aimed to analyze the spread of the COVID-19 in Cameroon, one of the most affected countries in sub-Saharan Africa. Methods: We used the data from the Africa Centre for Disease Control and Prevention, reporting the number of confirmed cases and deaths, and analyzed the regularity of tests and confirmed cases and compared those numbers with neighboring countries. We tested different phenomenological models to model the early phase of the outbreak. Results: Since the first reported cases on the 7th of March, 18,662 people have been diagnosed with COVID-19 as of the 24th of August, 186,243 tests have been performed, and 408 deaths have been recorded. New cases have been recorded only in 50% of the days since the first reported cases. There are considerable disparities in the reporting of daily cases, making it difficult to interpret these numbers and to model the evolution of the pandemic with the phenomenological models. Conclusion: Currently, following the finding from this study, it is challenging to predict the evolution of the pandemic and to make comparisons between countries as screening measures are so sparse. Monitoring should be performed regularly to provide a more accurate estimate of the situation and allocate healthcare resources more efficiently.
    Type of Medium: Online Resource
    ISSN: 2038-9930 , 2038-9922
    URL: Article
    DOI: 10.4081/jphia.2021.1415
    Language: Unknown
    Publisher: PAGEPress Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2574977-8
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  • 16
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    Short- and long-read metagenomics of urban and rural South African gut microbiomes reveal a transitional composition and undescribed taxa
    Springer Science and Business Media LLC ; 2022
    In:  Nature Communications Vol. 13, No. 1 ( 2022-02-22)
    Details
    In: Nature Communications, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2022-02-22)
    Abstract: Human gut microbiome research focuses on populations living in high-income countries and to a lesser extent, non-urban agriculturalist and hunter-gatherer societies. The scarcity of research between these extremes limits our understanding of how the gut microbiota relates to health and disease in the majority of the world’s population. Here, we evaluate gut microbiome composition in transitioning South African populations using short- and long-read sequencing. We analyze stool from adult females living in rural Bushbuckridge ( n  = 118) or urban Soweto ( n  = 51) and find that these microbiomes are taxonomically intermediate between those of individuals living in high-income countries and traditional communities. We demonstrate that reference collections are incomplete for characterizing microbiomes of individuals living outside high-income countries, yielding artificially low beta diversity measurements, and generate complete genomes of undescribed taxa, including Treponema , Lentisphaerae, and Succinatimonas . Our results suggest that the gut microbiome of South Africans does not conform to a simple “western-nonwestern” axis and contains undescribed microbial diversity.
    Type of Medium: Online Resource
    ISSN: 2041-1723
    URL: Article
    DOI: 10.1038/s41467-021-27917-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2553671-0
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  • 17
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    What influences antibiotic sales in rural Bangladesh? A drug dispensers’ perspective
    Springer Science and Business Media LLC ; 2020
    In:  Journal of Pharmaceutical Policy and Practice Vol. 13, No. 1 ( 2020-12)
    Details
    In: Journal of Pharmaceutical Policy and Practice, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2020-12)
    Abstract: Antibiotic resistance poses a great threat to global health, especially in low- and middle-income countries with a high infectious disease burden and limited resources. In spite of regulations, antibiotics are sold in many settings as non-prescription medicines, resulting in inappropriate use and resistance. Objective This study aimed to investigate the current status of access and use of antibiotics in rural Bangladesh, by exploring the perspectives and sales practices of antibiotic drug dispensers. Methods We used a mixed methods approach (qualitative and quantitative). We mapped and characterized antibiotic purchasing and dispensing sites in the Matlab Health and Demographic Surveillance System catchment area. Furthermore, we investigated the volume of provision of systemic antibiotics in 10 drug outlets. We held 16 in-depth interviews with randomly selected antibiotics dispensers. Interviews explored factors associated with antibiotic selling. Responses were transcribed, coded for themes, and summarized. We used ATLAS.ti 5.2 for conducting a thematic analysis. Results A total of 301 antibiotic dispensers were identified, of whom 92% ( n  = 278) were private and 8% ( n  = 23) public. 52% ( n  = 155) operated informally (i.e. without legal authorization). In order to promote and survive in their business, dispensers sell antibiotics for a range of conditions without a qualified physician’s prescription. Factors that facilitate these inappropriate sales include lack of access to healthcare in the rural community, inadequate doctor: population ratio, limited dispenser knowledge, poor pharmacovigilance concerning safety of self medication, lack of enforcement of policies, financial benefits for both customers and dispensers, and high dependency on pharmaceutical companies’ information. Conclusion Dispensers in rural Bangladesh sell antibiotics inappropriately by ignoring existing national regulations. They operate the antibiotic sales without facing any legal barriers and primarily with a view to sustain their business, resulting in inappropriate sales of antibiotics to the rural community. The influence of the drug industry needs to be replaced with evidence-based, not commercially driven information. Awareness programs for antibiotic providers that promote understanding of antibiotics and antibiotic resistance through tailored interventions may be helpful in changing current antibiotic sales practices.
    Type of Medium: Online Resource
    ISSN: 2052-3211
    URL: Article
    DOI: 10.1186/s40545-020-00212-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2734772-2
    SSG: 15,3
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  • 18
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    Examining the relationship between armed conflict and coverage of maternal and child health services in 35 countries in sub-Saharan Africa: a geospatial analysis
    Elsevier BV ; 2023
    In:  The Lancet Global Health Vol. 11, No. 6 ( 2023-06), p. e843-e853
    Details
    In: The Lancet Global Health, Elsevier BV, Vol. 11, No. 6 ( 2023-06), p. e843-e853
    Type of Medium: Online Resource
    ISSN: 2214-109X
    URL: Article
    DOI: 10.1016/S2214-109X(23)00152-3
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2723488-5
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  • 19
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    Maximising human health and development through synergistic partnerships: the African Biobank and Longitudinal Epidemiological Ecosystem
    Elsevier BV ; 2023
    In:  The Lancet Global Health Vol. 11, No. 9 ( 2023-09), p. e1333-e1334
    Details
    In: The Lancet Global Health, Elsevier BV, Vol. 11, No. 9 ( 2023-09), p. e1333-e1334
    Type of Medium: Online Resource
    ISSN: 2214-109X
    URL: Article
    DOI: 10.1016/S2214-109X(23)00303-0
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2723488-5
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  • 20
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    Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach
    Elsevier BV ; 2021
    In:  The Lancet Global Health Vol. 9, No. 5 ( 2021-05), p. e610-e619
    Details
    In: The Lancet Global Health, Elsevier BV, Vol. 9, No. 5 ( 2021-05), p. e610-e619
    Type of Medium: Online Resource
    ISSN: 2214-109X
    URL: Article
    DOI: 10.1016/S2214-109X(21)00024-3
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2723488-5
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