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Obesity is a growing public health concern in Africa, with evidence suggesting pronounced disparities between men and women. Understanding the prevalence and sex differences in obesity across African countries is critical for informing equity-focused interventions. This study examined the prevalence of adult obesity (body mass index [BMI] ≥30) across 47 African countries using sex-disaggregated data to assess the magnitude of sex disparities in obesity prevalence as a basis for equity-focused public health interventions. This study is a cross-sectional descriptive study using nationally representative, sex-disaggregated data from 47 African countries, primarily for the year 2022, obtained from the World Health Organization Health Equity Assessment Toolkit (HEAT). Adults aged 18 years and older who had recent, available data were included in the study. The primary outcome was the country-level prevalence of adult obesity (body mass index [BMI] ≥30) disaggregated by sex. The secondary outcome was the absolute difference in obesity prevalence between women and men within each country. Obesity prevalence among adults varied widely across African countries. South Africa had the highest prevalence at 30.8%, followed by Eswatini (30.1%) and Seychelles (29.4%), while Ethiopia (2.8%), Madagascar (4.3%), and Eritrea (4.8%) reported the lowest rates. Across nearly all countries, women exhibited considerably higher obesity prevalence than men. In South Africa, female obesity prevalence was 45.8%, compared to 13.9% in men a difference of 31.8 percentage points. Large sex disparities were also observed in Eswatini (difference: 28.8), Mauritania (26.1), Lesotho (24.2), Equatorial Guinea (21.8), and Seychelles (19.4). In contrast, only a few countries, such as Burundi, Chad, and Madagascar, showed negligible or slightly higher obesity prevalence among men. The findings reveal that adult obesity is a pronounced and growing public health concern in Africa, with marked heterogeneity in prevalence between countries and an overwhelming burden among women. These disparities reflect the sociocultural, economic, and biological factors influencing obesity risk, including urbanization, dietary transitions, and gender norms. The pronounced sex disparity points to the need for context-specific, sex-sensitive interventions and policies to effectively address obesity and its health consequences. Policymakers and health practitioners should prioritize multisectoral strategies that promote healthy diets and physical activity and address the unique barriers faced by women. Enhanced surveillance and research are also needed to further elucidate the determinants of obesity and to monitor progress toward reducing health inequities across the continent, including fiscal, regulatory, and community-based actions tailored to women's needs.

Rapidly propagating false and misleading health claims do not strike all societies evenly. Structural digital inequalities, uneven platform governance leverage, gaps in multilingual health literacy, and divergent political information climates have combined to produce what is argued here as an infodemic equity gap: a patterned disparity in exposure to, resilience against, and recoverability from health misinformation between and within countries. This viewpoint advances a pragmatic equity-centered framework that dissects that gap into layered capacities (structural infrastructure, ecosystem governance, sociocultural trust and literacy, and adaptive intervention capability) and shows how their interaction generates differential outcomes. Using a purposive comparative lens across 5 archetypal settings (Finland, Taiwan, the United States, Brazil, and India), it shows distinct causal pathways linking technological architectures, governance choices, and social context to measurable process metrics (detection latency, rumor half-life, and multilingual coverage) and outcome indicators (trust trajectories, vaccination differentials, and equity-sensitive gaps). Rather than revisiting broad definitional terrain already synthesized elsewhere, the focus is on isolating disparities that are specifically actionable through digital health policy, measurement standardization, and investment strategies. A forward agenda is outlined for harmonized indicators, evaluation methods, and ethical safeguards needed to reduce inequities in future health emergency information ecologies. The intended audiences are digital health researchers, platform governance teams, public health decision-makers, and funding bodies shaping cross-border preparedness.

Background Breast cancer is the most common cancer among women globally, with rising prevalence in low- and middle-income countries, including Sierra Leone. Despite this growing burden, sex-disaggregated data on breast cancer prevalence and inequality measures remain limited in sub-Saharan Africa. This study examined the trends in breast cancer prevalence in Sierra Leone from 2000 to 2019, with a focus on sex-based disparities. Methods Using age-standardized data from the World Health Organization equity datasets, breast cancer prevalence (per 100,000 population) in Sierra Leone was analysed for the years 2000, 2005, 2010, 2015, and 2019. Sex-disaggregated trends were assessed, and inequality measures, including difference, ratio, population attributable fraction, and population attributable risk, were calculated to quantify disparities. A 95% confidence intervals was used to reflect uncertainty in prevalence estimates. Results The prevalence of breast cancer in Sierra Leone increased from 52.4 cases per 100,000 in 2000 to 78.3 cases per 100,000 in 2019. Among females, prevalence increased from 102.7 cases per 100,000 (95% CI: 80.0–129.7) in 2000 to 157.9 cases per 100,000 (95% CI: 117.3–218.3) in 2019. In contrast, prevalence among males remained consistently low and stable, ranging from 0.7 cases per 100,000 (95% CI: 0.5–1.0) in 2000 to 0.8 cases per 100,000 (95% CI: 0.5–1.1) in 2019. Inequality measures showed disparities, with the absolute difference among females and males increasing from 102.0 cases per 100,000 in 2000 to 157.1 cases per 100,000 in 2019. Furthermore, the prevalence ratio of females to males increased from 143.5 in 2000 to 198.1 in 2019, indicating that female prevalence was higher than male prevalence and that this disparity has increased over time. Conclusion The study underscore the growing burden of breast cancer in Sierra Leone and the disparities between sexes with females having a higher burden than men. The findings underscore the need for strengthening cancer registries, improving access to early detection and treatment, and addressing structural barriers to equitable healthcare are critical for reducing the burden of breast cancer in Sierra Leone.

The COVID-19 pandemic intensified adolescents reliance on social media for connection, education, and entertainment, presenting both opportunities and risks for mental health. This viewpoint explores the dual nature of social media as a lifeline offering peer support and access to resources, especially for marginalized teens and a stressor, linked to anxiety, depression, and cyberbullying. Drawing on global evidence, including WHO and UNICEF data, it shows disparities in impact across socioeconomic, cultural, and gender contexts, with low-resource settings facing unique challenges like digital poverty amidst persistent post-pandemic effects. A multi-stakeholder framework is proposed to balance these dynamics, emphasizing parental and educator empowerment through digital literacy, tech industry accountability via adolescent-specific safeguards, clinical integration of social media screening in healthcare, and robust policy regulation for online safety. The urgency of action is underscored, with specific calls to governments, tech companies, clinicians, and researchers to collaborate on protecting adolescent well-being. This viewpoint argues that transforming social media into a safe space for mental health is a moral imperative, essential to prevent a generational crisis and ensure equity in the digital age.

Background Asthma is a major public health concern globally, with notable disparities in prevalence across regions and demographic groups. In Sierra Leone, a country with limited healthcare infrastructure, asthma is a challenge. Sex-based disparities in asthma prevalence have been documented globally, yet their impact in Sierra Leone remains poorly understood. This study aims to provide age-standardized estimates of asthma prevalence in 2000, 2005, 2010, 2015, and 2019, focusing on trends and inequalities by sex. Methods The study utilized data from the World Health Organization equity data repository to estimate age-standardized asthma prevalence in Sierra Leone. Sex-disaggregated analyses was conducted to assess disparities in prevalence rates. Inequality measures, including absolute difference (D), prevalence ratio (R), population attributable fraction (PAF), and population attributable risk (PAR), were calculated to quantify sex-related disparities in asthma prevalence. Results In 2000, the age-standardized asthma prevalence in Sierra Leone was 2,807.2 per 100,000, increasing slightly to 2,855.5 per 100,000 in 2005, followed by a decline to 2,682.7 per 100,000 in 2010. Prevalence rose again to 2,709.8 per 100,000 in 2015 and reached 2,768.1 per 100,000 in 2019. Across all years, females consistently had higher asthma prevalence rates than males. In 2019, female asthma prevalence was 3,104.7 per 100,000 compared to 2,427.8 per 100,000 for males, with an absolute difference of 677.0 per 100,000 and a prevalence ratio of 1.3. Inequality measures revealed a gap over time, with negative PAF values (-5.9% in 2000 to -12.3% in 2019) and negative PAR values (-164.7 per 100,000 in 2000 to -340.3 per 100,000 in 2019). Conclusion The study points out the burden of asthma in Sierra Leone and the sex-based disparities in prevalence. The disproportionate burden among females underscores the need for interventions to address biological, behavioural, and environmental factors contributing to these inequalities. Policymakers should prioritize sex-disaggregated surveillance and implement sex-sensitive strategies to reduce asthma prevalence. Future research should investigate the underlying causes of sex-based disparities, including the role of environmental exposures and healthcare access, to inform more effective and equitable asthma control measures in Sierra Leone.

Background Substance use disorders (SUDs) pose notable public health challenge worldwide, with disparities often observed across demographic groups. However, there is limited evidence on the prevalence and sex-based inequalities of SUDs in Sierra Leone. This study aimed to analyze the prevalence of SUDs in Sierra Leone from 2000 to 2019, with a focus on sex-disaggregated trends and inequalities using data from the World Health Organization (WHO) equity data repository. Methods This cross-sectional study used age-standardized prevalence estimates of substance use disorders per 100,000 population from the WHO equity data repository accessed via the Health Equity Assessment Toolkit (HEAT). The WHO repository compiles and harmonizes data from multiple sources (e.g., national surveys, censuses, administrative records) and produces standardized, model-based estimates aligned with ICD-10 diagnostic categories. The study extracted sex-disaggregated estimates for Sierra Leone from 2000 to 2019, along with inequality measures (absolute difference, prevalence ratio, population attributable fraction, population attributable risk) that are pre-computed within HEAT. It conducted no independent statistical computations outside HEAT; my role involved defining the analytic scope, extracting, verifying, and interpreting HEAT outputs. Results The prevalence of SUDs in Sierra Leone remained relatively stable from 2000 to 2015, fluctuating between 821.6 and 824.5 per 100,000 population. However, a notable increase was observed between 2015 and 2019, with the prevalence rising to 845.1 per 100,000 population in 2019. Across all years, males consistently exhibited higher prevalence rates compared to females. In 2019, the prevalence among males was 975.6 per 100,000 (95% CI: 844.2–1112.6), while the prevalence among females was 718.3 per 100,000 (95% CI: 612.9–848.5). The absolute difference (D) in prevalence between males and females ranged from − 234.7 in 2005 to -257.3 in 2019, and the prevalence ratio (R) remained stable at approximately 0.7, indicating that males were 1.3 to 1.4 times more likely to experience SUDs than females. Despite this persistent disparity, the population attributable fraction (PAF) and population attributable risk (PAR) were consistently recorded as 0.0, suggesting that sex-based differences did not significantly impact the overall burden of SUDs in the population. Conclusions The findings show a consistent sex-based disparity in the prevalence of SUDs in Sierra Leone, with males bearing a significantly higher burden than females. While the overall prevalence remained stable over two decades, the recent increase underscores the need for targeted public health interventions to address the rising burden of SUDs. Policymakers should prioritize sex-specific strategies to mitigate these disparities and strengthen prevention and treatment programs. Future research should explore the underlying factors driving these trends and disparities to inform more effective policies and interventions.

Background Fertility rates in Sierra Leone remain high, with an average woman having around four children in her lifetime. This high fertility rate impacts population growth, straining resources like healthcare and education. It can also have consequences for women's health and well-being. This study, therefore, examined the desire for more children and its predictors among women in Sierra Leone. Methods The study analysed the 2019 Sierra Leone Demographic and Health Survey data. A total of 8,031 married and cohabiting women comprised the study . Mixed-effect regression analysis examined the predictors of the desire for more children. The regression results were presented using an adjusted odds ratio (aOR) with 95% confidence intervals (CI). Results The proportion of desire for more children was 68.4% [66.8, 70.0] among married and cohabiting women in Sierra Leone. Married and cohabiting women aged 25 and above had lower odds of desiring more children than those aged 15–19, with the lowest odds among those aged 40 + [aOR = 0.01; 95% CI 0.00, 0.02]. Married and cohabiting women with four or more children [aOR = 0.37; 95% CI: 0.26, 0.52] had lower odds of desiring more children than those with fewer than four children. Married and cohabiting women with 1–3 living children [aOR = 0.06; 95% CI: 0.02, 0.17] and 4 + living children [aOR = 0.01; 95% CI 0.00, 0.04] had lower odds of desiring more children than those without children. Married and cohabiting women who use contraceptives [aOR = 0.73; 95% CI 0.59, 0.90] had lower odds of desiring more children than those who don’t. Married and cohabiting women who use the internet [aOR = 1.61; 95% CI 1.07, 2.42] had higher odds of desiring more children than those who don’t. Married and cohabiting women with 4–5 ideal number of children [aOR = 1.80; 95% CI 1.27, 2.55] and 6 + ideal number of children [aOR = 5.26; 95% CI 3.65, 7.58] had higher odds for desiring more children than those with 0–3 ideal number of children. Married and cohabiting women living in the northern province [aOR = 1.85; 95% CI 1.23, 2.81] had higher odds of desiring more children than those living in the Eastern province. Conclusion The results suggest that fertility desires among married and cohabiting women in Sierra Leone are shaped by social, demographic, and behavioural contexts. The reduced desire for more children among older women and those with larger families highlights the importance of tailoring reproductive health services to meet the needs of different life stages and family sizes. The association between contraceptive use and lower fertility desires underscores the role of access to and education about contraception in shaping family planning decisions. Meanwhile, the higher fertility desires among women who use the internet or reside in the northern province point to potential cultural or informational influences, suggesting that targeted communication strategies could address provincial and behavioural variations in fertility preferences. .

Background Malaria remains a significant public health threat in Sierra Leone, particularly for pregnant women and their unborn children. Infection during pregnancy can lead to severe consequences, including maternal anaemia, low birth weight, premature birth, and even death. Therefore, preventing malaria during pregnancy is crucial for improving maternal and child health outcomes. This study investigated the predictors of insecticide-treated bed net (ITN) use among pregnant women in Sierra Leone. Methods The study analysed the 2019 Sierra Leone Demographic and Health Survey data (SLDHS). The study comprised a total of 900 pregnant women aged 15–49 years, representing the nationally representative sample . A multivariable binary regression analysis was used to explore the predictors of ITN use. The regression results were presented using an adjusted odds ratio (AOR) with 95% confidence intervals (CI). Results The study found that the prevalence of ITN use among pregnant women was 64.2 [60.4, 67.9] in Sierra Leone. Pregnant women who were married [aOR = 2.02, 95% CI 1.32, 3.07] had higher odds of bed net use than those who were unmarried. Pregnant women with five or more children [aOR = 1.69, 95% CI 1.01, 2.84] had higher odds of mosquito bed net use than those with four and below children. Pregnant women living in the Northern, Northwestern, Southern and Western regions all had lower odds of bed net use than those in the Eastern region, with the lowest odds among those living in the western region [aOR = 0.19, 95% CI 0.09, 0.40]. Pregnant women who were Muslims [aOR = 0.63, 95% CI 0.41, 0.95] had lower odds of mosquito bed net use than Christians. Pregnant women with female household heads [aOR = 0.65, 95% CI 0.44, 0.95] had lower odds of mosquito bed net use than those with male household heads. Conclusion ITN use among pregnant women in Sierra Leone remains suboptimal. Marital status, parity, sex of household head, region and religion were associated with bed net use. The government and policymakers in Sierra Leone should integrate ITN education and distribution into prenatal care services, emphasizing the benefits for both mother and baby—partnering with healthcare providers to raise awareness and encourage consistent use. Involve local leaders, religious figures, and mothers' groups to promote the benefits of ITN during pregnancy. Educate husbands and partners on the importance of ITN use during pregnancy and encourage their support in its consistent use.

Female genital mutilation remains a public health concern and human rights violation affecting young girls in Sierra Leone, despite global efforts to eliminate the practice. With its diverse socio-cultural background and varying regional practices, Sierra Leone presents a unique context for examining how female genital mutilation practices have evolved across different population subgroups. This study examined the early childhood female genital mutilation among women of reproductive age (15-49 years) who reported having FGM before the age of five in Sierra Leone. The study utilised data from the Sierra Leone Demographic Health Survey rounds conducted in 2008, 2013, and 2019. The World Health Organisation Health Equity Assessment Toolkit software calculated various measures, including difference, ratio, population-attributable risk, and population-attributable fraction. An assessment was calculated for five stratifiers: age, education level, economic status, place of residence, and sub-national province. The prevalence of female genital mutilation among women of reproductive age (15-49 years) who reported undergoing the practice before the age of five in Sierra Leone declined from 23.2% in 2008 to 12.3% in 2019. By 2019, female genital mutilation showed minimal variation between women aged 40-49 and 15-19, as well as in urban-rural differences. Economic variations in female genital mutilation decreased but continued to disadvantage women in the poorest quintile. Educational variations in female genital mutilation decreased but still impacted women without formal education. Provincial variations in female genital mutilation widened, with the ratio between the Western and Northwestern provinces increasing from 1.8 in 2008 to 2.6 in 2019. The results showed a decrease in early childhood female genital mutilationin Sierra Leone. While differences related to age groups and urban-rural residence have largely been eliminated, substantial differences persist across educational levels, economic status, and provinces. Most notably, the provincial differences between the Western and Northwestern provinces had widened, with the difference in ratio indicating that female genital mutilation practices remain disproportionately concentrated in some provincial areas. These results suggest that while national-level interventions have been partially successful, there is a critical need for targeted, context-specific approaches that address persistent socioeconomic and provincial variations to achieve a more equitable reduction in early childhood female genital mutilation across all population groups in Sierra Leone.