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At least 19 recordsLinked to original sources
PubMed2001

The usefulness of defined clinical features in the diagnosis of HIV/AIDS infection in Sierra Leone.

Sierra Leone ranks at the bottom of the global World Bank Development Index based on multiple health and economic indices and lacks the resources to purchase HIV diagnostic kits. Our study has defined some common clinical features presenting HIV infection that could form clinical algorithms for the diagnosis and recognition of HIV infection by health workers in Sierra Leone. In a private clinic in Freetown, Sierra Leone, West Africa, 106 out of a total of 124 patients presenting with various symptoms and strong clinical suspicion of HIV infection within a two-year period (1999 and 2000), were deemed positive by two different ELISA tests. The prevalence of HIV infection seen in this private clinic in Freetown in 2000 was 14.89% as compared to 9.25% in 1999. The positive predictive value of our clinical diagnosis of HIV/AIDS infection was 85.5%. The male:female ratio of the patients in our series was 1:1.9, with a mean age of 39 years for males and 28 years for females. HIV infection was found in a cross-section of the population that we examined. Heterosexual contact appeared to be the major mode of transmission amongst our patients and there seemed to be a significant epidemiological risk of HIV infection amongst those who traveled to other countries in the West African sub region. Common clinical features in decreasing frequency were fever (92.5%), weight loss (84.1%), lymphadenopathy (78.3%), cough (48.1%), diarrhea (37.7%), candidiasis (32.1%) and body aches (30.1%).

Adolescent↗
PubMed2004

Changes in HIV/AIDS/STI knowledge, attitudes and practices among commercial sex workers and military forces in Port Loko, Sierra Leone.

Sierra Leone suffered from 11 years of civil war (1991-2002) resulting in tens of thousands of deaths and mutilations together with massive population displacement. In 2001, ARC International, Sierra Leone conducted a baseline survey of 201 commercial sex workers (CSWs) and 202 military respondents on the knowledge, attitudes and practices surrounding HIV/AIDS and STIs in Port Loko, Sierra Leone. In 2003, a comparable post-intervention survey of 202 CSWs and 205 military respondents was performed. Comparison of baseline and post-intervention results showed that HIV/AIDS knowledge increased among both groups, with those able to name three effective means of avoiding AIDS increasing from 5 per cent to 70 per cent among CSWs, and 11 to 75 per cent among the military. Reported condom use during last sex increased among CSWs from 38 to 68 per cent and among military from 39 to 68 per cent. These results demonstrate that, despite the challenges inherent in a post-conflict country, good-quality AIDS-prevention programmes can be effective.

Adolescent↗
PubMedDate not supplied

Prevalence of war-related sexual violence and other human rights abuses among internally displaced persons in Sierra Leone.

CONTEXT: Sierra Leone's decade-long conflict has cost tens of thousands of lives and all parties to the conflict have committed abuses. OBJECTIVE: To assess the prevalence and impact of war-related sexual violence and other human rights abuses among internally displaced persons (IDPs) in Sierra Leone. DESIGN AND SETTING: A cross-sectional, randomized survey, using structured interviews and questionnaires, of internally displaced Sierra Leone women who were living in 3 IDP camps and 1 town, which were conducted over a 4-week period in 2001. PARTICIPANTS: A total of 991 women provided information on 9166 household members. The mean (SE) age of the respondents was 34 (0.48) years (range, 14-80 years). The majority of the women sampled were poorly educated (mean [SE], 1.9 [0.11] years of formal education); 814 were Muslim (82%), and 622 were married (63%). MAIN OUTCOME MEASURES: Accounts of war-related sexual assault and other human rights abuses. RESULTS: Overall, 13% (1157) of household members reported incidents of war-related human rights abuses in the last 10 years, including abductions, beatings, killings, sexual assaults and other abuses. Ninety-four (9%) of 991 respondents and 396 (8%) of 5001 female household members reported war-related sexual assaults. The lifetime prevalence of non-war-related sexual assault committed by family members, friends, or civilians among these respondents was also 9%, which increased to 17% with the addition of war-related sexual assaults (excluding 1% of participants who reported both war-related and non-war-related sexual assault). Eighty-seven percent of women believed that there should be legal protection for women's human rights. More than 60% of respondents believed a man has a right to beat his wife if she disobeys, and that it is a wife's duty/obligation to have sex with her husband even if she does not want to. CONCLUSIONS: Sexual violence committed by combatants in Sierra Leone was widespread and was perpetrated in the context of a high level of human rights abuses against the civilian population.

Adolescent↗
PubMed1988

The effect of child fostering on feeding practices and access to health services in rural Sierra Leone.

In Sierra Leone, where infant and child mortality rates are quite high, a large proportion of small children from 1 to 5 yr are fostered: living away from their mothers. This paper examines the relationships between fosterage and child feeding practices and children's access to Western medical care. Ethnographic data from field studies in Sierra Leone are combined with quantitative data from Serabu Hospital, which show that fostered children are underrepresented in hospital admissions and that young fosters present more problems of malnutrition. (Fostered girls appear to be at more risk in both these categories than boys.) Unlike young fosters, however, older ones do not appear to be at more risk than children with mothers. We draw connections between these results and patterns of intra-household discrimination in food allocation and access to medical treatment for young fostered children: especially those sent to elderly rural caretakers. Finally, we examine the implications of the findings for applied issues, arguing that fostered children may slip through the cracks of maternal-child health care programs.

Child↗
PubMed1996

Maternal health, war, and religious tradition: authoritative knowledge in Pujehun District, Sierra Leone.

In Sierra Leone constraints to ideal maternal health require a primary health care approach that includes collaboration with traditional midwives. They are authoritative figures embedded within local political structures and a powerful women's religion. The local causes of maternal risk are described, including civil war and refugee camp life. Traditional midwives provide vital services in the camp, are respected for their social status, and learn additional skills. Biomedical and traditional systems of authoritative knowledge, based on different kinds of legitimacy to heal, are in a complementary relationship.

Adolescent↗
PubMed2002

Treatment of neuropathic pain in Sierra Leone.

During Sierra Leone's violent decade-long war, the warring parties used amputation, especially of arms, as a means of terror. In a camp for amputees in the capital city Freetown, Médecins Sans Frontières established a clinic and a treatment programme for neuropathic pain. Insecurity and cultural and language barriers have complicated this work, but medical and humanitarian benefits have been demonstrated. Pain services are virtually non-existent in less-developed countries. There have recently been no major treatment advances for neuropathic or phantom pain; however, the general body of knowledge about amputation pain can be increased by observations from these difficult settings.

Adolescent↗
PubMed1997

"Stepping-sticks" and "seat-sticks": new types of tools used by wild chimpanzees (Pan troglodytes) in Sierra Leone.

In Tenkere, Sierra Leone, a community of wild chimpanzees (Pan troglodytes verus) spent long hours eating the fruits and flowers of the Kapok (Ceiba pentandra) tree. The branches of this species are covered in sharp thorns which make movement in their high canopies problematic for the chimpanzees. In an apparent attempt to increase their mobility and to ease the discomfort of lengthy bouts of eating in these trees, some of the Tenkere chimpanzees have been observed using stick tools as foot ("stepping-sticks") and body ("seat-sticks") protection against the painful thorns. This form of tool-using is culturally unique to the Tenkere chimpanzees, as at other sites where these apes have been observed eating parts of kapok trees, there are no published records of this tool technology. In three of the stepping-stick tool use incidents, the chimpanzee used the tool(s), held between their greater and lesser toes, in locomotion. This form of tool use is the first recorded case of habitually used tools that can be justifiably categorized as being "worn" by any known wild population of Pan troglodytes.

Animals↗
PubMed2006

Low efficacy of the combination artesunate plus amodiaquine for uncomplicated falciparum malaria among children under 5 years in Kailahun, Sierra Leone.

OBJECTIVE: In 2004, Sierra Leone adopted artesunate plus amodiaquine as first-line antimalarial treatment. We evaluated the efficacy of this combination in Kailahun, where a previous study had shown 70.2% efficacy of amodiaquine in monotherapy. METHODS: Method and outcome classification of the study complied with WHO guidelines. Children 6-59 months with uncomplicated malaria were followed-up for 28 days. PCR genotyping was used to distinguish recrudescence from reinfection. Reinfections were reclassified as cured. RESULTS: Of 172 children who were referred to the study clinic, 126 satisfied inclusion criteria and were enrolled. No early treatment failures were reported. The day 14, efficacy was 98.2% (95% CI: 93.8-99.8). Of 65 recurrent parasitaemias analysed by PCR, 17 were recrudescences. The PCR-adjusted day 28 efficacy was 84.5% (95% CI: 76.4-90.7). All true failures occurred in the last 8 days of follow-up. Of 110 children who completed the 28-day follow-up, 54 (49.1%) experienced a novel infection. CONCLUSION: The efficacy of this combination was disappointing. The high reinfection rate suggested little prophylactic effect. In Kailahun a more efficacious combination might be necessary in the future. The efficacy of AS + AQ needs to be monitored in Kailahun and in the other regions of Sierra Leone.

Amodiaquine↗
PubMed1999

It all began with Ronald Ross: 100 years of malaria research and control in Sierra Leone (1899-1999).

It was in Sierra Leone, 100 years ago in 1899, that human malarial parasites were first observed in wild-caught Anopheles gambiae and An. funestus, the principal vectors of malaria in Africa. In the same year, Ronald Ross initiated the first antilarval measures for malaria control. This paper reviews 100 years of malaria field research and control in Sierra Leone, which became known as the 'White Man's Grave' in the 19th century largely because of the high malaria-related mortality amongst Europeans living there. The establishment of a field laboratory for the Liverpool School of Tropical Medicine in Freetown in 1920 made Sierra Leone the centre for malaria field research in Africa up to and during the Second World War. Eminent malariologists including Ronald Ross, Samuel Christophers, George Macdonald, Leonard Bruce-Chwatt, Brian Maegraith, Ian Macgregor, Brian Greenwood and Michael Service visited Sierra Leone for malaria-related activities. This review highlights the tremendous efforts made towards defining the epidemiological picture of the disease and the most effective means of combatting it. Malaria control in Sierra Leone, as in many other parts of the world, used to be based largely on mosquito eradication. However, experience gained over the past 100 years has shown that mosquito control is often not cost-effective in areas where the interruption of transmission cannot be sustained. Emphasis should now be on early diagnosis, treatment with effective antimalarials, and the selective use of preventive measures including vector control and insecticide-treated materials where they can be sustained.

History, 19th Century↗
PubMed1993

Diarrhoeal disease in early childhood: experiences from Sierra Leone.

In the Freetown area of Sierra Leone, the proportion of children under five years of age dying from diarrhoea-associated conditions has decreased since the 1970s from 4% to 3%. This reduction relates to children between 12 months and 5 years; deaths associated with diarrhoeal disease in infancy do not appear to have decreased significantly. Currently, 2% of children die in infancy and a further 1% before their fifth birthday from diarrhoeal diseases. Thirty-one percent of short-term growth-faltering in children under five years of age is attributed to diarrhoeal disease. Reasons for improvement in mortality may include the implementation of a National Diarrhoeal Diseases Control Programme and improved case management; some 55% of cases of acute diarrhoea in Freetown now receive oral rehydration therapy. Morbidity and mortality are influenced by the seasons. This is likely to be related to the fact that the nutritional status of children shows a significant deterioration in the early rainy season. At this time incidence of severe diarrhoea warranting hospital admission and diarrhoea mortality rates in hospital and at a Rehydration Center increased significantly. On the other hand, the presentation of dehydrating diarrhoea is greatest in the driest months of the year. Progress in the rural areas of Sierra Leone may not have been so evident although 60% of the population now have access to primary health units within 4 miles and efforts to increase host resistance have included the measles immunization programme which currently protects 60% of under-fives nation-wide. Efforts to reduce the transmission of pathogens have meant increasing access to safe water to 22% and to improved sanitation to 35% in rural areas of Sierra Leone. The sustainable prevention and control of diarrhoeal diseases in developing countries depends also upon increasing levels of adult literacy especially of women.

Child, Preschool↗
PubMed1982

Swamp rice development, schistosomiasis, and onchocerciasis in Southeast Sierra Leone.

Seventy-four villages in eastern Sierra Leone, West Africa, many having a recently developed rice swamp, were surveyed for the presence of schistosomiasis and onchocerciasis, and their vectors. Prevalence rates for Schistosoma haematobium and S. mansoni were low, although the infections were widespread. There is some evidence that S. mansoni is extending its range in Sierra Leone although this is problematical because of the apparent absence of Biomphalaria pfeifferi, the recognized snail vector, from areas where the disease now occurs. The characteristics of rice swamp environment now being created in Sierra Leone are described and results of snail collections, which were with few exceptions small, are presented. Reasons for the apparent unsuitability of the developed rice swamp as a snail habitat are discussed. Onchocerciasis was found in all villages and the prevalence rate, almost 50%, was high. The rice swamp is not a suitable breeding site for Simulium damnosum s.l., but the study area is crossed by several major rivers and all villages in the area are within flying distance of potential breeding sites. There was no positive evidence that expansion of swamp rice farming will increase the incidence of water based/related diseases but a control program for onchocerciasis, which is a major rural health problem, would seem to be a national priority.

Adolescent↗
PubMed2005

Mitochondrial DNA genetic diversity among four ethnic groups in Sierra Leone.

Although there are numerous ethnic groups in Sierra Leone, the Mende and Temne together account for approximately 60% of the total population. To see if genetic differences could be observed among ethnic groups in Sierra Leone, the nucleotide sequence of the hypervariable 1 (HV1) region of mitochondrial DNA (mtDNA) was determined from samples of the two major ethnic groups, the Mende (n=59) and Temne (n=121), and of two minor ethnic groups, the Loko (n=29) and Limba (n=67). Among these 276 HV1 sequences, 164 individual haplotypes were observed. An analysis of molecular variance indicated that the distribution of these haplotypes within the Limba sample was significantly different from that of the other ethnic groups. No significant genetic variation was seen between the Mende, Temne, and Loko. These results indicate that distinguishing genetic differences can be observed among ethnic groups residing in historically close proximity to one another. Furthermore, we observed some mitochondrial DNA haplotypes that are common among the Sierra Leone ethnic groups but that have not been observed in other published studies of West African ethnic groups. Therefore, we may have evidence for mtDNA lineages that are unique to this region of West Africa.

Black People↗
PubMed1991

Oral health among 15- and 35-44-year-olds in Sierra Leone.

In the West African country Sierra Leone a WHO-related research project has been launched, in order to evaluate oral health promoting activities for children and adolescents in an African developing country, and how primary health care workers and oral health personnel can be appropriately involved. The present report contains the main findings of an oral health survey implemented to establish the initial situation analysis. The study included 135 15-year-old secondary school children and 106 35-44-year-old persons. D3MFT of the two age groups was 2.1 and 5.3 respectively, 35% and 15% were caries-free. Only four fillings were found. Nineteen per cent of the 15-year-olds had over half of the affected surfaces in that age group. The CPITN-index showed that none in the study population were completely without periodontal disease, 9% of the students and 53% of the adults had at least one pocket of 6 mm or more. Among the students, 95% brushed their teeth every day, although relatively ineffective. Only 7% used local chewing sticks. Between 20 and 35% had manufactured sweets and/or cakes and biscuits at least twice a day. The prevalence of dental diseases found in the study is relatively high for the African region, calling for an increased emphasis on preventive strategies. However, up to now most of the dental personnel in Sierra Leone has had no traditions of oral health promotion. An action research project is being implemented in order to improve this situation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Why the poor pay more: household curative expenditures in rural Sierra Leone.

This paper draws on data from Sierra Leone, and secondary data from elsewhere, to show that the rural poor can be disproportionately disadvantaged by user charges for health care, paying a higher percentage of their incomes for health care than wealthier households. Cost sharing systems at primary care level should include exemptions for the poor, but rarely succeed in consistently protecting them. The regressivity of health expenditures also results from lack of protection from the higher costs of less-frequently used, expensive providers. In Sierra Leone, the burden of curative treatment costs for all groups came mainly from private and NGO providers. Proximity to facilities appeared a more important factor in their use than average price levels. Even if a perfect exemption system existed at government primary care facilities, it would not have had much overall effect because of their relatively small contribution to household health expenditures. The financial burden on households could be relieved by making basic health facilities more accessible and at hospital level using additional resources generated through improved efficiency and cross-subsidization to provide exemptions. Also, pricing policy should take into account local economic conditions. Insurance/prepayment schemes covering the cost of hospitalization would come closer to an ideal solution, but have been implemented in very few of the poorer countries.

Cost Sharing↗
PubMed1985

The distribution of the Simulium damnosum complex in Sierra Leone and its relation to onchocerciasis.

Because of the paucity of literature concerning onchocerciasis and its vectors in Sierra Leone, new information of the geographical distribution of the Simulium damnosum complex is presented in the context of a comprehensive review of what is known generally about S. damnosum s.l. in Sierra Leone, and how the data relate to the transmission of onchocerciasis. Neither biting adults nor breeding sites have been found on the coastal plain and Freetown peninsula, and these area seem to be free from infestation. Throughout the rest of the country S. damnosum s.l. breeds extensively in all the major river systems. The close proximity of the major rivers to one another facilitates inter-river migration, and ensures that most villages are well within the fly's dispersal range. In accordance with this, onchocerciasis is widespread throughout Sierra Leone and vector biting has been recorded away from riverine breeding sites. Seven cytospecies have been recorded in Sierra Leone but of these S. sirbanum and S. damnosum s.str. are rare outside the far north, in the narrow savanna belt. Simulium squamosum and S. yahense are widely distributed, although S. squamosum is somewhat less common than S. yahense which unexpectedly occurs in large rivers of the forest and savanna as well as small forest streams. Simulium sanctipauli has been found in the south-east of the country, where the forest is most dense, whereas S. soubrense occurs farther north. A new species referred to as S. soubrense 'B' is restricted to the south and west of the country. Over most of Sierra Leone onchocerciasis shows a 'forest' epidemiology and is transmitted by 'forest' vector cytospecies. However, data from the narrow savanna belt in the extreme north are sparse.

Animals↗
PubMed2003

Sierra Leone--investing in nutrition to reduce poverty: a call for action.

BACKGROUND: Malnutrition rates in Sierra Leone are among the highest in the world. However, policy-makers do not always recognise the fight against malnutrition as a policy priority to ensure the healthy human capital needed to fight poverty and achieve sustained positive economic growth. OBJECTIVE: The analysis presented here was conducted by an intersectoral and inter-agency group of Sierra Leonean senior policy advisors to quantify some of the potential human and economic benefits of improved policies and programmes to reduce malnutrition. FINDINGS: The analysis revealed that 46% of child deaths in Sierra Leone are attributable to malnutrition, the single greatest cause of child mortality in the country. In the absence of adequate policy and programme action, malnutrition will be the underlying cause of an estimated 74000 child deaths over the next five years. The analysis also revealed that if current levels of iodine deficiency remain unchanged over the next five years, 252000 children could be born with varying degrees of mental retardation as a result of intrauterine iodine deficiency. Finally, the analysis showed that, in the absence of adequate policy and programme action to reduce the unacceptable rates of anaemia in women, the monetary value of agricultural productivity losses associated with anaemia in the female labour force over the next five years will exceed dollars 94.5 million. CONCLUSION: Sustained investment in nutrition in Sierra Leone could bring about enormous human and economic benefits to develop the social sector, revitalise the economy, and attain the poverty reduction goals that Sierra Leone has set forth.

Child↗
PubMed1995

Drastic reduction of populations of Simulium sirbanum (Diptera: Simuliidae) in central Sierra Leone after 5 years of larviciding operations by the Onchocerciasis Control Programme.

The major vectors of the blinding form of human onchocerciasis in West Africa are two blackfly species, Simulium sirbanum and Simulium damnosum s.s. (Diptera: Simuliidae), identified at the adult stage as the 'savanna group' of the Simulium damnosum complex. In 1988, in the central part of Sierra Leone, the average daily biting rate (females/man/day) by savanna blackflies (mostly S. sirbanum) during the peak of the dry season (April-May) was 59.9, making up 69.1% of total captures on average. There was evidence of a strong long-range immigration of adult females of S. sirbanum through eastern Guinea in the dry season, with a reverse movement towards Guinea in the rainy season. Therefore, in 1989, the World Health Organization's Onchocerciasis Control Programme (OCP) extended its vector control operations from central West Africa to rivers of central and northern Sierra Leone, and to rivers of eastern Guinea. Four years of efficient larviciding drastically reduced adult populations of S. sirbanum in Sierra Leone. In the peak of the dry seasons of 1993 and 1994, the average biting rate by savanna blackflies in central Sierra Leone had dropped to 1.0, making up only 4.3% of total captures on average. Yearly biting rates by S. sirbanum in central Sierra Leone were therefore reduced to 2% of their pre-intervention levels. Based on larval samples, the S. sirbanum has been replaced by two forest species, S. leonense in the south and S. squamosum in the north. Since 1992, it has been possible to calculate accurate transmission rates for blinding onchocerciasis, based on DNA-probe identifications. From 1993, the risk of transmission has not only been reduced by vector control but also by mass distribution of ivermectin to rural communities. In terms of control strategy, the authors conclude that larviciding operations could be alleviated in central Sierra Leone without increasing the risk of blinding onchocerciasis transmission, as long as the migration of S. sirbanum through eastern Guinea and northern Sierra Leone is prevented.

Animals↗