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The irrational use of antibiotics to treat infections in children is a crucial contributing factor to bacterial antimicrobial resistance (AMR), which can have economic and health consequences, such as morbidity and mortality. This study aims to evaluate antibiotic use and AMR in children under five years of age in Sierra Leone. This study will be conducted in three hospitals: Ola During Children, Kenema Government, and Magburaka Government Hospitals in Sierra Leone, among healthcare professionals and patients. A mixed-method (qualitative and quantitative) approach will be used to evaluate paediatric health professionals' knowledge, perceptions, and antibiotic prescription practices. Additionally, two cross-sectional sub-studies will assess inpatient and outpatient trends in antibiotic use and consumption in children, and a cross-sectional observational sub-study will investigate bacterial profiles and AMR among children with bloodstream infections. The anatomical therapeutic chemical (ATC) and the World Health Organisation Access, Watch and Reserve (WHO AWaRe) classifications, days of therapy per 1,000 patient days (DOT/1000PDs), and days of therapy per 100 bed days (DOT/100BDs) will be used to determine the use and consumption. The DOT/1,000PDs and DOT/100BDs will be compared with the defined daily dose/1,000 patient days (DDD/1000PDs) and defined daily dose/100 bed days (DDD/100BDs), respectively. A pre-tested interview guide, interviewer-administered questionnaire and data collection tools adapted from previous studies will be employed for data collection. The sample sizes will be determined, and appropriate sampling methods will be used. Data will be analysed thematically using NVivo 15, and descriptive and inferential statistics using the R software. The results of this study will inform policymakers and healthcare professionals in developing and/or implementing policies, guidelines, and educational initiatives that will promote antibiotic stewardship among children in Sierra Leone.

The impact of the 2013-2016 Ebola virus disease outbreak in the Mano River Union region, which includes Liberia, Sierra Leone and Guinea, is a direct indicator of the acute limitations in national healthcare systems and the critical role played by diagnostic and public health laboratories. Despite having a Central Public Health Reference Laboratory, Sierra Leone lacked the capacity to provide the Biosafety Level 3 laboratory support that is required to effectively direct responses and that could have offset such a prolonged and costly health systems war against the outbreak.

Rebuilding transformation strategies in post-Ebola epidemics in West Africa requires long-term surveillance and strengthening health system preparedness to disease outbreak. This paper assesses reconstruction efforts from socio-cultural, economic and ecological transformation response approaches and strategies in improving sustainable survivors and affected communities livelihood and wellbeing. A comprehensive approach is required in the recovery and rebuilding processes. Investing in rebuilding transformation requires fostering evidence-based and effective engaging new investors partnership strengthening, financing community-based programmes ownership, novel socio-economic innovations strategies and tools against the evolving and future Ebola epidemics. Thus, there should be improved community partnership, health and economic rebuilding programmes to address mistrust and care underutilization, poverty and care access inequity at all levels. Implementing effective post-Ebola national ‘One Health’ approach coupled with climate change mitigation and adaptations strategies is urgent public health needs aiming at improving the quality healthcare access, delivery trust and uptake in anticipation of EVD immunization program, productivity and emerging economy.

The Post-Ebola era (2017–2019) presented an opportunity for laboratory investments in Sierra Leone. US CDC supported the Ministry of Health and Sanitation to establish a microbiological unit for routine antimicrobial sensitivity testing in two referral (pediatric and maternity) hospitals in Freetown. This study describes resistance patterns among patients’ laboratory samples from 2017 to 2019 using routine data. Samples included urine, stool, cerebrospinal fluid, pus-wound, pleural fluid, and high vaginal swabs. Selected Gram-positive and Gram-negative bacterial isolates were tested for antimicrobial susceptibility. Of 200 samples received by the laboratory, 89 returned positive bacterial isolates with urine and pus-wound swabs accounting for 75% of positive isolates. The number of positive isolates increased annually from one in 2017 to 42 in 2018 and 46 in 2019. Resistance of the cultures to at least one antibiotic was high (91%), and even higher in the pediatric hospital (94%). Resistance was highest with penicillin (81%) for Gram-positive bacteria and lowest with nitrofurantoin (13%). Gram-negative bacteria were most resistant to ampicillin, gentamycin, streptomycin, tetracycline, cephalothin and penicillin (100%) and least resistant to novobiocin (0%). Antibiotic resistance for commonly prescribed antibiotics was high in two referral hospitals, highlighting the urgent need for antimicrobial stewardship and access to reserve antibiotics.

The 2014–2016 Ebola Virus Disease (EVD) outbreak highlighted the vital importance of investing in West Africa’s laboratory infrastructure and systems. In the absence of facilities capable of handling highly infectious pathogens, the national response across the region was hamstrung by costly delays in case identification and blind spots in epidemiological surveillance. The rapid development of EVD diagnostic tools that could speed up testing and be used at or near the point of care became a public health priority. To expedite their deployment, a series of crosssectional research and development initiatives were launched including innovative financing mechanisms, data-sharing platforms, public-private partnerships and accelerated regulatory pathways.

Human immunodeficiency virus (HIV) and the re-emerging Ebola virus disease (EVD) are closely intertwined and remain a persistent public health threat and global challenge. Their origin and rapid transmission and spread have similar boundaries and share overlapping impact characteristics, including related symptoms and other interactions. The controversies and global threat of these viruses require rapid response policy and evidence-based implementation findings. The constraints and dual burden inflicted by Ebola and HIV infections are highly characterized by similar socio-demographics, socio-economic and political factors. EVD has similar effects and burdens to HIV infection. This study seeks to understand EVD in the context of HIV epidemic despite the challenges in developing an effective vaccine against HIV and EVD. Our findings show that early understanding, prevention and treatment of these diseases a global health threat mainly in Africa is important and valuable. The lessons learned so far from HIV and Ebola epidemics are crucial in health programming and execution of rapid response interventions and continued vigilance against EVD before it become another worldwide health menace. Therefore, the current regional West Africa EVD requires strengthening healthcare systems and building preparedness and response capacity. Importantly, appropriate community participation, health education and resilience coupled with deployment of effective novel diagnostic approaches in early warning and surveillance of threats and emerging diseases. Therefore, there is an urgent need to develop novel key strategies are crucial in curbing the constant viral resurgence, persistence transmission dynamics and spread, as well in accelerating Ebola vaccines regimen (immunization) development and national implementation plans in achieving sustained control, and eventual elimination.

Currently, there are no data on prevalence and associated risk factors of chronic kidney disease (CKD) among patients with hypertension in rural Sierra Leone. To estimate the prevalence and associated risk factors of CKD in rural Sierra Leone. A cross-sectional study of hypertension patients aged between 18 and 75 years attending a non-communicable disease clinic at Koidu Government Hospital, Kono District, Sierra Leone was conducted between February and December 2020. Using systematic random sampling, a structured questionnaire, which comprised of questions on social demographic characteristics and past and current clinical history, was administered followed by measurement of creatinine and urinary protein and glucose. Estimated glomerular filtration rate (eGFR) was estimated using CKD-epidemiology formula without race as a factor. Baseline eGFR between 60-89 min/mL/1.73m and <60 min/mL/1.73m defined reduced eGFR and renal impairment, respectively. Estimated GFR less than 60 min/mL/1.73m measured two times at least 3 months apart was used to define CKD. Ninety-six percent (n = 304) patients out of 317 patients were included in the study. Among all included patients, only 3.9% (n = 12) had eGFR of 90 min/mL/1.73m and above. The prevalence of renal impairment and CKD was 52% (158/304, CI 46.2-57.7) and 29.9% (91/304, CI 24.8-34.5), respectively. In adjusted logistic regression analysis, currently taking herbal medications as treatment of hypertension (OR 4.11 (CI 1.14-14.80), p = 0.03) and being overweight and/or obese (OR 2.16 (CI 1.24-3.78), p < 0.001) was associated with CKD. Additionally, receiving some education was associated with a 48% (OR 0.52 (CI 0.29-0.91), p = 0.02) reduced likelihood of CKD. The prevalence of renal impairment and CKD is high among hypertensive patients in rural Sierra Leone. CKD was associated with current history of taking herbal medications and being overweight and/or obese. Additionally, CKD was associated with reduced likelihood in patients who received some education.

Introduction: Armed conflict comes with a baggage envisaged to enhance the spread of HIV. The goal of this researchw as to explore and describe the associations between war-related risk factors and HIV prevalence among women attending antenatal care in the Western Area of Sierra Leone. The war-related influences observed were -: 1) displacement causing disruption of social and sexual networks; 2) exposure to blood and blood products through nosocomial, iatrogenic or war wounds and 3) sexual coercion and violence with rape used as a form of warfare and sex as a commodity in exchange for basic survival (food and money). The prevalences of antibodies for other sexually transmitted infections (STis) (Herpes Simplex Virus Type 2 (HSV2), Hepatitis B Virus (HBV) and Syphilis) were investigated as secondary outcomes affected by the war-related factors and as potential risk factors for HIV infection. Methodology: - The research preparatory stages involved two pilot surveys - Pilot I was to ascertain the feasibility of the research and evaluate the biological survey assays. Pilot 2 was employed to develop, evaluate, and validate the qualitative and quantitative instruments used in the research. The study was conducted in the Western Area of Sierra Leone. This area recorded the highest infrastructural damage as a result of the war and also housed the largest number of internally displaced persons. Given the sensitivity of the research theme and other feasibility considerations, a cross-sectional design was deemed appropriate for the study. A conceptual research framework was developed upon which the questionnaire was sequenced and also on which the analyses were based. Crude and adjusted associations were examined using logistic regression models. Results-:. The study revealed that the three war-related risk factor themes, directly and indirectly affected HIV prevalence, and also a strong positive association was found between HIV and other STIs (HSV2 and HBV). The adjusted odds of HIV infection among women with HSV2 was over twice that of women without HSV2 (adjusted odds ratio (aOR) =2.15,95%Cl 1.14.3, P=0.018). The association with HBV was even stronger (aOR=2.81,950/oCl 1.64.9, P=0.008). There was no association between syphilis and HIV infection. Amongst the war-related factors, there was a strong positive association between having a surgical operation with blood transfusion and a higher prevalence of HIV (aOR=5.48,95%CI 1.9-15.9, P=0.02). For HSV2, all participants exposed to this variable were found to be positive. The displacement variables showed an association between frequency of movements and STIs (HSV2 (aOR=2.44,95%CI 1.6- 3.8, P= < 0.001) and also between those who moved primarily because of the war and HBV (aOR=I. 16,95%CI 0.7-1.8, P=O0. 2). Among the sexual coercion variables, women who had a sexual relationship with members of the peacekeeping forces had higher odds of being HSV2 positive (aOR=I 1.67,95%CI 1.5-97.3, P= < 0.001), and women raped by family members or other persons in the community were found to have a higher prevalence of syphilis (aOR=1 1.4,95%CI 2.8-45.7, P=0.04). The sociodemographic and economic related variables examined included loss of an infant within the war years, gravidity (pregnancy frequencies), age and marital status. The women, who had lost an infant, were found to have higher HIV infection levels (aOR=2.43,95%CI 1.5-3.9, P=0.01) than others. Increased gravidity and age were found to be associated with HSV2, but HBV was only positively associated with gravidity. Syphilis was higher in women who were in cohabiting relationships than in their counterpart married or single status women. Associations with the antenatal services accessed by the women (which to some extent reflected their financial status) indicated that women who used rural government cost recovery services showed a higher prevalence of HSV2 (aOR=1.34,95%CI 0.7-2.4, P=0.02) than others. Sociocultural practices such as skin and gum tattooing showed a significant association with syphilis infection levels (aOR--2.9,95%CI 1.4-6.2, P--0.03). Conclusion:- Armed conflict affects HIV in a complex multidivisional context. HIV prevalence was seen to be affected directly and indirectly through existing pathways such as endemic STIs. The study concluded that armed conflict does affect I-HV prevalence and could influence existing risk factors such as STIs and depressed social living standard. Therefore, factors which affect STIs and related socio-demographic and socioeconomic factors would ultimately influence HIV prevalence.