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Background Human immunodeficiency virus/acquired immune deficiency syndrome and sexually transmitted infections remain critical public health challenges in Sierra Leone, with major implications for morbidity and mortality. Understanding the trends in the prevalence of these infections and identifying sex-based disparities are essential for designing effective, evidence-based interventions. This study examined the trends in age-standardized prevalence of human immunodeficiency virus/acquired immune deficiency syndrome and sexually transmitted infections in Sierra Leone in 2000, 2005, 2010, 2015, and 2019. Methods A cross-sectional study design was conducted using age-standardized prevalence rates (per 100,000 population) of human immunodeficiency virus/acquired immune deficiency syndrome and sexually transmitted infections from the World Health Organization health equity assessment toolkit database at five time points (2000, 2005, 2010, 2015, and 2019). Inequality measures, including Difference (D), Ratio (R), Population Attributable Fraction (PAF), and Population Attributable Risk (PAR), were calculated to assess absolute and relative disparities between sexes. Confidence intervals (CI) were reported for all estimates to ensure robustness of results. Results The age-standardized prevalence of human immunodeficiency virus/acquired immune deficiency syndrome and sexually transmitted infections in Sierra Leone showed a steady decline, from 25,995.3 per 100,000 population in 2000 to 25,705.5 in 2019. However, sex-disaggregated analysis revealed disparities, with females consistently experiencing higher prevalence rates than males across all years. In 2019, the prevalence for females was 34,548.5 per 100,000 population (95% CI: 30,887.3–38,496.7), compared to 16,734.0 per 100,000 population for males (95% CI: 14,674.0–19,020.4). The inequality ratio remained constant at 2.1, indicating that females consistently bore more than twice the burden compared to males. The absolute difference between sexes decreased slightly over time, from 17,962.9 per 100,000 population in 2000 to 17,814.5 per 100,000 population in 2019. Conclusions Despite the decline in the prevalence of human immunodeficiency virus/acquired immune deficiency syndrome and sexually transmitted infections in Sierra Leone between 2000 to 2019, sex-based disparities remain substantial, with females consistently experiencing a higher burden than males. These findings underscore the need for sex-sensitive policies and interventions to address the causes of these disparities. Strengthening health systems, promoting gender equity, and implementing targeted prevention programs are essential to reducing the overall prevalence and achieving health equity in Sierra Leone.

Background Noncommunicable diseases (NCDs), especially hypertension and diabetes mellitus are on the increase in sub-Saharan Africa (SSA). Informal settlement dwellers exhibit a high prevalence of behavioural risk factors and are highly vulnerable to hypertension and diabetes. However, no study has assessed the prevalence of hypertension, diabetes, and NCDrisk factors among informal settlement dwellers in Sierra Leone. We conducted a study in June 2019 to determine the prevalence of hypertension, diabetes, and NCD risk factors among adults living in the largest Sierra Leonean informal settlement (KrooBay). Methods and materials We conducted a community-based cross-sectional survey among adults aged ≥ 35 years in the KrooBay community. Trained healthcare workers collected data on socio-demographic characteristics and self-reported health behaviours using the World Health Organization STEPwise surveillance questionnaire for chronic disease risk factors. Anthropometric, blood glucose, and blood pressure measurements were performed following standard procedures. Logistics regression was used for analysis and adjusted odd ratios with 95% confidence intervals were calculated to identify risk factors associated with hypertension. Results Of the 418 participants, 242 (57%) were females and those below the age of 45 years accounted for over half (55.3%) of the participants. The prevalence of smoking was 18.2%, alcohol consumption was 18.8%, overweight was 28.2%, obesity was 17.9%, physical inactivity was 81.5%, and inadequate consumption of fruits and vegetables was 99%. The overall prevalence of hypertension was 45.7% (95% CI 41.0-50.5%), systolic hypertension was 34.2% (95% CI 29.6–38.8%), diastolic blood pressure was 39.9% (95% CI 35.2–44.6), and participants with diabetes were 2.2% (95% CI 0.7–3.6%). Being aged ≥ 55 years (AOR = 7.35, 95% CI 1.49–36.39) and > 60 years (AOR 8.05; 95% CI 2.22–29.12), separated (AOR = 1.34; 95% 1.02–7.00), cohabitating (AOR = 6.68; 95% CL1.03-14.35), vocational (AOR = 3.65; 95% CI 1.81–7.39 ) and having a university education (AOR = 4.62; 95% CI 3.09–6.91) were found to be independently associated with hypertension. Conclusion The prevalence of hypertension,and NCD risk factors was high among the residents of the Kroobay informal settlement. We also noted a low prevalence of diabetes. There is an urgent need for the implementation of health education, promotion, and screening initiatives to reduce health risks so that these conditions will not overwhelm health services.

Background The studies on knowledge, attitudes, and practices of Antimicrobial resistance (AMR) and use among adolescents and young people are largely from Europe and the Asia region. All such studies reported a low level of understanding of antibiotic resistance and the rational use of antibiotics among adolescents and young people who are at a formative stage when health behaviours are being shaped. There are limited such studies from West Africa, despite a high AMR burden in the region. We therefore conducted a study to assess the knowledge, attitude, and practice on antibiotic use and resistance among adolescents and young people in Sierra Leone. Methods This cross-sectional study was conducted among adolescents and young people (15–29 years) who participated in the National Girls Summit-2024 in Sierra Leone. A validated self-administered questionnaire with 29 questions was used to collect data: demography (4 questions); knowledge (14 questions); attitude (3 questions); and practice (8 questions). Data were analyzed using Stata version 15, with results presented using frequencies and percentages. Results Of the 235 participants, over half (133, 56.6%) had attained university education, and a smaller proportion (14, 6.0%) had completed vocational training. The majority (144, 61.3%) of the adolescents and young people had used an antibiotic within the last 30 days before the study. Over two-thirds (180, 76.6%) of adolescents and young people had heard about antibiotic resistance, and most of them got the information from their academic institutions (67, 37.2%) and the radio (15.0%). Almost half (110, 46.8%) had poor knowledge about antibiotic use and resistance. The majority (139, 59.1%) had a negative attitude towards antibiotic use and resistance, and most (205, 87.2%) of them demonstrated poor practices in antibiotic use. Conclusion Our study revealed that adolescents and young people in Sierra Leone have a limited understanding of antibiotic resistance. Limited knowledge may drive inappropriate antibiotic use, further increasing the AMR burden in the country. We recommend implementing school and university-based antimicrobial stewardship initiatives to enhance awareness and understanding of antibiotic resistance and promote rational use of antibiotics.

ObjectiveInappropriate use of antibiotics is a major driver of antibiotic resistance. A few studies conducted in Africa have documented that about half of hospitalised patients who receive antibiotics should not have received them. A few hospital-based studies that have been conducted in Sierra Leone have documented a high usage of antibiotics in hospitals. Therefore, we conducted a nationwide point prevalence survey on antibiotic use among hospitalised patients in Sierra Leone.DesignWe conducted a hospital-based, cross-sectional survey on the use of antibiotics using the WHO point prevalence survey methodology.SettingThe study was conducted in 26 public and private hospitals that are providing inpatient healthcare services.ParticipantsAll patients admitted to paediatric and adult inpatient wards before or at 08:00 on the survey date were enrolled.Outcome measuresPrevalence of antibiotic use, antibiotics Access, Watch and Reserve (AWaRe) categorisation, indication for antibiotic use prevalence and proportion of bacteria culture done.ResultsOf the 1198 patient records reviewed, 883 (73.7%, 95% CI 71.1% to 76.2%) were on antibiotics. Antibiotic use was highest in the paediatric wards (306, 85.7%), followed by medical wards (158, 71.2%), surgical wards (146, 69.5%), mixed wards (97, 68.8%) and lowest in the obstetrics and gynaecology wards (176, 65.7%). The most widely prescribed antibiotics were metronidazole (404, 22.2%), ceftriaxone (373, 20.5%), ampicillin (337, 18.5%), gentamicin (221, 12.1%) and amoxicillin (90, 5.0%). Blood culture was only done for one patient and antibiotic treatments were given empirically. The most common indication for antibiotic use was community-acquired infection (484, 51.9%) followed by surgical prophylaxis (222, 23.8%).ConclusionThere was high usage of antibiotics in hospitals in Sierra Leone as the majority of patients admitted received an antibiotic. This has the potential to increase the burden of antibiotic resistance in the country. We, therefore, recommend the establishment of hospital antimicrobial stewardship programmes according to the WHO core components.

Background Childhood vaccination coverage in Sierra Leone remains unsatisfactory despite multiple efforts made by health authorities to enhance collective immunity of the population, especially for children aged 12 to 23 months. This study aimed at identifying the factors associated with incomplete vaccination or non-vaccination among children aged 12 to 23 months in Sierra Leone in 2019. Methods This was a cross-sectional study that used the 2019 Sierra Leone Demographic and Health Survey data. Descriptive statistics was performed to describe the sample, ascending hierarchical classification following a multiple correspondence analysis was employed to establish the profile of children with incomplete vaccination or non-vaccination status, and a binary logistic regression was used to identify the factors associated with incomplete vaccination or non-vaccination. Results Of the 966 children aged 12 to 23 months involved in the study, 42.9% (95% CI[39.2; 46.6]) were incompletely vaccinated or unvaccinated, of which, 43.5% (95% CI[37.9; 49]) among male children and 42.4% (95% CI[37.3; 47.4]) among their female counterparts. The Northern (AOR 1.683, 95% CI[1.131; 2.503]) and the North Western (AOR 1.847, 95% CI[1.208; 2.825]) survey regions, delivery in a place other than a health facility (AOR 1.404, 95% CI[1.001; 2.042]), the mother’s age group 35 to 49 years (AOR 0.437, 95% CI[0.251; 0.762]) and the child’s birth order 7th or higher (AOR 2.640, 95% CI[1.452; 4.800]) turned out to be significant factors of incomplete vaccination or non-vaccination. Conclusion Incomplete vaccination or non-vaccination among children was high in Sierra Leone in 2019. In order to increase childhood vaccine uptake, we recommend the development of initiatives geared towards optimizing facility-based service delivery, intensifying health education focusing more on vaccination, enhancing community engagement, addressing barriers to vaccine access, establishing and ensuring proper functioning of immunization defaulter tracking systems.

Background Alcohol-based handrub (ABHR) is the gold standard for hand hygiene (HH) and is a cornerstone of infection prevention and control (IPC) strategies. However, several factors influence the efficient use of ABHR by health workers. This study evaluated the tolerability and acceptability of a locally produced ABHR product and HH behaviour among health workers. Methods A longitudinal hospital-based intervention study was conducted in accordance with the WHO’s standardized protocol for evaluating ABHR tolerability and acceptability (Method 1). Sixty health workers across 4 hospitals in Sierra Leone were observed over a 30-day period at three separate visits (days 1, 3–5, and 30) by trained observers. The outcomes of interest included skin tolerability and product acceptabilityevaluated using subjective and objective measures. Results Objective and subjective evaluations demonstrated strong skin tolerability and high acceptability with the product. At all three visits, the skin tolerability score assessed by trained observers was < 2 in ≥  97% of participants, exceeding the WHO benchmark score (BMS = < 2 in ≥  75%). Participants’ self-evaluations of overall skin integrity were 97% (visit 2) and 98% (visit 3) for scores > 4 (BMS = > 4 in ≥  75%). The primary acceptability criteria increased up to 95% (colour) and 88% (smell) at visit 3 (BMS = > 4 in ≥  50%). Despite high acceptability, the product’s drying effect remained low at 52% and 58% during visits 2 and 3, respectively (BMS = > 4 in ≥  75%). There were positive HH behaviours ( n  = 53, 88%), with more than half ( n  = 38, 63%) of them exhibiting HH at almost every HH moment. The mean ABHR was notably high (76.1 ml, SD ± 35), especially among nurses (mean = 80.1 ml) and doctors (mean = 74.0 ml). Conclusion The WHO-formulated, locally produced ABHR was well tolerated and accepted by health workers. These findings support the continuous utilization of evidence-based, cost-effective hand hygiene interventions in resource-limited settings. High handrub consumption and frequent HH practices were noticeable HH behaviours. Further research is recommended to optimize product formulations for skin dryness and investigate the association between ABHR consumption and hand hygiene compliance.

Background Although pre-exposure prophylaxis (PrEP) is prioritised for men at heightened risk of HIV, examining the determinants of PrEP awareness and acceptability among men in the general population is essential for informing inclusive and effective HIV prevention strategies in Kenya. Methods We analyzed secondary data from the 2022 Kenya Demographic and Health Survey (KDHS), which comprised 14,402 men aged 18–54 years who were selected using a two-stage stratified sampling. Data were analysed using univariable and multivariable logistic regression analyses using SPSS (version 29). Results Overall, 49.3% (95% CI: 47.4–51.2) of men were aware of PrEP. Among those who were aware of PrEP, 68.7% (95% CI: 66.4–70.9) approved its use for HIV prevention. Factors independently associated with higher odds of PrEP awareness included completion of tertiary education (aOR 4.56, 95% CI: 2.89–7.18), belonging to the richest wealth quintile (aOR 2.36, 95% CI: 1.30–4.28), being HIV-positive (aOR 1.95, 95% CI: 1.36–4.45), and joint healthcare decision-making (aOR 14.18, 95% CI: 2.46–81.70). In contrast, living in Northeastern Kenya (aOR 0.19, 95% CI: 0.04–0.86) and belonging to other tribes in Kenya (aOR 0.50, 95% CI: 0.27–0.91) were associated with lower odds of PrEP awareness. On the other hand, having more than ten lifetime sexual partners (aOR 1.58, 95% CI: 1.02–2.44), not desiring more children (aOR 1.56, 95% CI: 1.08–2.27), and joint healthcare decision-making (aOR 25.69, 95% CI: 1.89–349.36) were associated with higher odds of PrEP acceptability/approval. Men who experienced controlling intimate partner violence (aOR 0.56, 95% CI: 0.39–0.79), those from the Kalenjin (aOR 0.23, 95% CI: 0.11–0.46), and those living in Northeastern region (aOR 0.19, 95% CI: 0.07–0.50) had lower odds of PrEP approval (aOR 5.39, 95% CI: 1.54–18.91). Conclusion Although acceptability was high, PrEP awareness among men in Kenya remains lower compared to the acceptability level. These findings underscore the need for targeted, multi-level interventions, such as community-based education, culturally tailored messaging, expanded outreach in underserved regions, integration of IPV screening into PrEP services, and support for shared healthcare decision-making, to enhance PrEP awareness and equitable uptake among all men in Kenya.

IntroductionThe COVID-19 pandemic has wide-reaching health and non-health consequences, especially on mental health and psychosocial well-being. Healthcare workers involved in COVID-19 patient care are particularly vulnerable to psychosocial distress due to increased pressure on healthcare systems. We explored the psychosocial experiences of front-line healthcare workers during the COVID-19 pandemic in Sierra Leone.MethodsThis qualitative study used purposive sampling to recruit 13 healthcare workers from different cadres across 5 designated COVID-19 treatment centres in Freetown, Sierra Leone. In-depth interviews were conducted remotely in July and August 2020, transcribed verbatim and analysed using the framework approach.ResultsThis study identified three overarching themes: vulnerability, resilience and support structures. Participants expressed vulnerability relating to the challenging work environment and lack of medications as key stressors resulting in anxiety, stress, anger, isolation and stigmatisation. Signs of resilience with experiences drawn from the 2014 Ebola outbreak, teamwork and a sense of duty were also seen. Peer support was the main support structure with no professional psychosocial support services available to healthcare workers.ConclusionsThis is the first study to provide evidence of the psychosocial impacts of COVID-19 among front-line healthcare workers in Sierra Leone. Despite signs of resilience and coping mechanisms displayed, they also experienced adverse psychosocial outcomes. There is a need to focus on enhancing strategies such as psychosocial support for healthcare workers and those that overall strengthen the health system to protect healthcare workers, promote resilience and guide recommendations for interventions during future outbreaks.

Introduction Antimicrobial resistance (AMR) is a global public health concern and irrational use of antibiotics in hospitals is a key driver of AMR. Even though it is not preventable, antimicrobial stewardship (AMS) programmes will reduce or slow it down. Research evidence from Sierra Leone has demonstrated the high use of antibiotics in hospitals, but no study has assessed hospital AMS programmes and antibiotic use specifically among children. We conducted the first-ever study to assess the AMS programmes and antibiotics use in two tertiary hospitals in Sierra Leone. Methods This was a hospital-based cross-sectional survey using the World Health Organization (WHO) point prevalence survey (PPS) methodology. Data was collected from the medical records of eligible patients at the Ola During Children’s Hospital (ODCH) and Makeni Regional Hospital (MRH) using the WHO PPS hospital questionnaire; and required data collection forms. The prescribed antibiotics were classified according to the WHO Access, Watch, and Reserve (AWaRe) classification. Ethics approval was obtained from the Sierra Leone Ethics and Scientific Review Committee. Statistical analysis was conducted using the SPSS version 22. Results Both ODCH and MRH did not have the required AMS infrastructure; policy and practice; and monitoring and feedback mechanisms to ensure rational antibiotic prescribing. Of the 150 patients included in the survey, 116 (77.3%) were admitted at ODCH and 34 (22.7%) to MRH, 77 (51.3%) were males and 73 (48.7%) were females. The mean age was 2 years (SD=3.5). The overall prevalence of antibiotic use was 84.7% (95% CI: 77.9% – 90.0%) and 77 (83.8%) of the children aged less than one year received an antibiotic. The proportion of males that received antibiotics was higher than that of females. Most (58, 47.2 %) of the patients received at least two antibiotics. The top five antibiotics prescribed were gentamycin (100, 27.4%), ceftriaxone (76, 20.3%), ampicillin (71, 19.5%), metronidazole (44, 12.1%), and cefotaxime (31, 8.5%). Community-acquired infections were the primary diagnoses for antibiotic prescription. Conclusion The non-existence of AMS programmes might have contributed to the high use of antibiotics at ODCH and MRH. This has the potential to increase antibiotic selection pressure and in turn the AMR burden in the country. There is need to establish hospital AMS teams and train health workers on the rational use of antibiotics.

Background: Infection prevention and control (IPC) is a clinical and public health discipline based on a scientific approach and practical preventive and control measures. During the 2014–2016 West African Ebola outbreak, the high number of healthcare worker infections was attributed to inadequate IPC in Sierra Leone. This stimulated the establishment of national and subnational IPC programs. Since then, IPC has remained a priority to improve the health systems and strategic interventions during public health emergencies. Therefore, we conducted a detailed review to assess the status of the IPC programs. Methods: A descriptive analysis of the status of IPC programs in Sierra Leone was done using data from IPC assessments conducted in 2022 by the national IPC team, reviews of reports on program implementation, and experts’ objective opinions. Results: Performance. The national IPC assessment revealed strengths in 4 of 6 WHO IPC core components, with an overall score of 61% positioned at the ‘intermediate’ level of implementation. The best-performing component was ‘IPC guidelines’ (92%) with evidenced-based guidelines being developed and implemented over the years. Secondly, ‘Education and training’ (71%) made progress in basic and advanced IPC training, including the development of a preservice training curriculum. Also, ‘monitoring and audit and feedback’ (69%) and ‘IPC program’ (61%) met the basic requirements of an established Monitoring & Evaluation (M&E) system. Similar progress was made at the healthcare facility level, but with major gaps in ‘workload, staffing, bed-occupancy’ and ‘safe or built environment.’ Sustainability efforts. Evidence-based data on IPC have always been scarce due to a limited capacity to conduct IPC research. The Structured Operational Research and Training Initiative (SORT-IT) on antimicrobial resistance has helped promote evidence-informed decisions and build OR capacity that is relevant to improving program performance. In 2019, Sierra Leone instituted in-country production of alcohol-based handrub and liquid soap as a strategic intervention for providing hand hygiene products for use in healthcare facilities. This intervention was essential during the peak of the COVID-19 pandemic. Although most aspects of IPC implementation are government led with strong leadership support, stable funding and sustainability planning are yet to be achieved and will be crucial for long-term success. Conclusions: Most aspects of the IPC core components have been well implemented at the national level since the establishment of the IPC program. However, the program should continue improving the scope and quality of implementation and focus on the development of long-term plans to sustain existing gains and further improve on gap areas at the national level and especially the healthcare-facility level. Disclosures: None