Sierra Leone Journal of Biomedical Research

BUILDING A NEW GENERATION OF RESEARCHERS THROUGH THE FIELD EPIDEMIOLOGY TRAINING PROGRAM

Gebrekrstos Negash Gebru1 — 2024-12-26

SCHISTOSOMIASIS OUTBREAK AND RISK FACTORS OF INFECTION AMONG SCHOOL CHILDREN IN KOINADUGU DISTRICT, SIERRA LEONE, MARCH 2023

Binta Bah — 2024-12-26

Schistosomiasis, a parasitic infection caused by Schistosoma species, is among the neglected tropical diseases and is a public health problem, particularly in sub-Saharan Africa. On the 6th of March 2023, the Community Health Officer in Alkalia Community Health Center, Koinadugu district, reported an increased number of school children complaining of blood in their urine and stool. We investigated the cases to identify risk factors associated with the outbreak.

We described the outbreak and conducted an unmatched case-control study (138 cases and 138 controls) to identify risk factors associated with it. We reviewed clinical records and interviewed cases and relatives to collect demographic, clinical, and epidemiological data. Urine and stool samples were collected to investigate the presence of Schistosoma haematobium and Schistosoma mansoni. Multivariate analysis was used to calculate adjusted odd ratios (aOR) at the 95% Confidence level to identify risk factors associated with the outbreak.

A total of 421 suspected cases were identified; 71.7% (302) were males, and median age was 10 years (range: 2 to 50 years). Of the total, 62.7% (264) were positive for Schistosomiasis (S. heamatobium and mansoni), and 98.5% (260) were positive for Schistosomiasis haematobium. Almost 98% (260) of the positive cases were school children. Of the positive cases, 95% (252) were presented with bloody urine. The case-control study identified bathing 5.4 (1.8-16.1), and drinking river/stream water 6.6 (2.4-18.2) factors associated with Schistosomiasis outbreak at the multivariate level.

This study confirmed a Schistosomiasis outbreak in the Koinadugu district, particularly among school-aged children. Risk factors associated with Schistosomiasis infection included drinking water from rivers or streams, bathing in rivers or streams, and exposure to the Teria River. We recommend providing clean and safe drinking water sources to limit exposure to rivers or streams, promote health education, and effectively distribute drugs.

keywords: Assessment, risk factors, Schistosomiasis outbreak, school children, Koinadugu, Sierra Leone

LASSA FEVER OUTBREAK INVESTIGATION IN TONKOLILI DISTRICT, MARCH 2022

Mohamed Salieu Bah — 2024-12-26

Background: Lassa fever is an endemic zoonotic disease in West African countries, including Sierra Leone. On March 3, 2022, Tonkolili District Surveillance Unit received notification of suspected Lassa fever cases from a hospital. The Sierra Leone Field Epidemiology Training Program (SLFETP) trainees and mentors responded within 24 hours to confirm the diagnosis, identify sources, and institute control measures.

Methods: We interviewed case patients and families using a case investigation form; reviewed patients’ records; collected blood specimens and sent them to the Reference Laboratory. Environmental assessment, rodent trapping, and an active case search were conducted, and 29 contacts were line-listed and monitored for 21 days.

Result: Two suspected cases tested positive for Lassa fever. On February 25, 2022, a 5-year-old male (Case 1) developed fever, abdominal pain, and diarrhea, he was admitted to the hospital on March 1, 2022, and treated for malaria. He died on March 3, 2022, Lassa fever was suspected and later confirmed by Polymerase Chain Reaction (PCR) testing. An 8-year-old girl (Case 2) who developed skin rashes and fever on February 25, 2022, was treated with traditional herbs at home. She was admitted to the hospital on March 1, 2022, as her symptoms persisted and was treated for malaria. Two days later, Lassa fever was suspected, and the diagnosis was confirmed four days after admission. She died on the same day of laboratory confirmation. Both patients lived in the same household with no travel history. Poor environmental sanitation was observed around the patients’ households. No rodents were found, and no additional cases or symptomatic contacts were discovered.

Conclusion: Two Lassa fever cases were confirmed in Tonkolili District. Late detection by healthcare workers likely contributed to the patient's deaths. We sensitized healthcare workers on the Lassa fever case definition and recommended community education on early healthcare seeking.

Keywords: Lassa fever, Disease outbreak, Zoonoses, Polymerase chain reaction, Sierra Leone.

EPIDEMIOLOGICAL ANALYSIS OF MENINGITIS, SUNYANI MUNICIPALITY, BONO REGION OF GHANA, 2019-2019: (A SECONDARY DATA ANALYSIS)

Solomon Aiah Sogbeh — 2024-12-26

Background: Meningitis is a vaccine-preventable disease yet it remains a global public health issue that causes long-term disability and death. Ghana being located within the meningitis belt of African, the occurence of consistent outbreaks of Meningitis in different parts of Ghana has been a peculiar surveillance challenge. We analyzed the Sunyani Municipal meninigitis surveillance data to determine the incidence, describe disease pattern, fatality, and identify the Meningitis strain.

Methods: We extracted meningitis surveillance data for January 2015 to December 2019 from the District Health Information Management System. We reviewed the annual meningitis line-list of the Sunyani Municipality Bono Region. Data were identified, cleaned and analysed using Microsoft Excel. We performed descriptive statistics on quantitative variables and estimated incidence rate and case fatality rates and determined the predominant strains.

Results: From 2015-2019, 84 suspected cases were recorded with 17 laboratory confirmed in Sunyani and seven meningitis deaths. The overall incidence rate was 2/100,000 population, with a 7/17 (41.2%) case fatality rate. the highest incidence rate (8 per 100,000 population) was reported in 2016 while 2018 recorded the highest fatality rate of 2/2 (100%). We identified 12/17(70.6.%) of Streptococcus pneumoniae as the predominant Meningitis strain. Weekly reporting timeliness and completeness were below the World Health Organization recommended 80% reporting target.

Conclusions: There was a high case fatality rate of Meningitis among the residents in Sunyani Municipality, and Streptococcus pneumoniaee was the predominant strain identified. The highest incidence was recorded in 2016 within the period studied. The timeliness and completeness of weekly reporting for the five years was also below the World Health Organization target. The Sunyani Municipal Health Directorate intensify their active case search of Meningitis, implement vaccination campaigns in high-risk areas and ensure prompt reporting to prevent future epidemics.

Keywords: Meningitis, Sunyani Municipality, Streptococcus pneumonia

EPIDEMIOLOGICAL CHARACTERISTICS, VACCINATION COVERAGE AND FACTORS ASSOCIATED WITH MEASLES INFECTION IN SIERRA LEONE FROM 2017 TO 2021; CASE BASED SURVEILLANCE DATA

Alpha Umaru Bai-Sesay — 2024-12-26

Despite the availability of safe and effective vaccines, measles outbreaks continue to occur in Sierra Leone. There is still limited information on the epidemiological pattern and vaccination coverage of measles in the country. This research aims at describing the epidemiological characteristics, vaccination coverage and identify factors associated with measles infection. We employed a cross-sectional study to analyze measles secondary data generated from 2017 to 2021. We extracted data on measles-containing vaccine (MCV) coverage and dropout. We analyzed the spatial distribution of measles cases by person, place, and time, calculated incidence, MCV coverage, and drop-out rate. Statistical analyses were performed using Epi Info 7. A multiple logistic regression model was used to calculate the adjusted odds ratio (aOR) with a 95% Confidence Interval (CI) to assess factors associated with measles infection. Results showed that a total of 1,305 suspected measles cases were reported. Of the total, 1,133 were confirmed as measles cases, of which 270 (24%) were IgM positive and 863 (76%) were Epi-linked or clinically confirmed. The mean age was 3.9-year 4.5 SD. Of the total confirmed measles cases, 575 (51%) were between 1 to 4 years, females accounted for 580 (51%), and 699 (62%) were not vaccinated. Non-border districts accounted for 54% (614) measles cases. The national measles incidence per 100,000 population was 203.8 in 2017 and 26.9 in 2021. The MCV1 national coverage ranged from 243,525/269,981 (90%) in 2017 to 238,505/307,022 78% in 2021, with the highest coverage in 2019, which is 266,684/284,452 (94%) and the lowest coverage in 2021 (78%). Children less than 5years old (aOR 2.28, 95% CI: 1.56 to 3.33), not vaccinated (aOR 3.42, 95% CI: 2.41 to 4.86), and border districts (aOR 0.37, 95% CI: 0.26 to 0.53) are factors associated with measles infection. We observed a high measles incidence rate in 2017. The country did not meet its national target for MCV-1 and MCV-2 in all years under study Children under five, those living in border districts, and unvaccinated individuals were more likely to contract measles. We recommend strengthening routing and supplementary immunization campaigns, prioritizing outreach services, and heightening social mobilization activities.

Keywords: Measles, Measles-Containing-Vaccine (MCV), factors of measles infection, Sierra Leone.

FACTORS ASSOCIATED WITH MEASLES INFECTION IN BORDER AND NON-BORDER DISTRICTS OF SIERRA LEONE

Mohamed S. Bah — 2024-12-26

Background: Sierra Leone has recorded multiple outbreaks of measles, and the last three outbreaks (2018, 2019, 2022) were reported from point-of-entry communities. Until now, limited information exists on the burden of measles in border and non-border districts. This study aimed to describe the epidemiological trend, vaccination status, incidence, and factors associated with measles infection in border and non-border districts of Sierra Leone.

Methods: We conducted a retrospective secondary data analysis on measles case-based surveillance data from 2018 to 2021 extracted from the national line list and the District Health Information System database. We use the measles standard case definition to classify cases across border districts and non-border districts. Logistic regression was used to identify factors associated with measles infection.

Result: A total of 3,054 suspected measles cases were recorded, of which 1147 (38%) were positive for measles infection with a median age of 9 years (6 months to 37 years). Among the positive cases, 448 (39%) were vaccinated and border districts accounted for 438 (38.1%). The measles incidence in border districts ranges from 3 to 11 per 100,000 population, whilst in non-border districts it ranges from 1 to 3 per 100,000 population.

Conclusion: A high incidence of measles cases were recorded in border districts and the vaccination status among susceptible was low. We recommend intensifying regular and supplemental immunization activities targeting border and non-border districts in Sierra Leone.

Keywords: Measles, Incidence, vaccination, Border and non-border districts, Sierra Leone.

EPIDEMIOLOGICAL CHARACTERISTICS OF LASSA FEVER IN SIERRA LEONE, 2018 TO 2022: A RETROSPECTIVE ANALYSIS OF NATIONAL SURVEILLANCE DATA

Samuel Sama Turay — 2024-12-26

Background: The Eastern region of Sierra Leone is known to be endemic to Lassa fever. However, in recent years there has been an observed geographical shift in the disease epidemiology with frequent outbreaks reported in non-endemic regions of the country. This study aims to describe the epidemiological characteristics of reported Lassa fever cases in Sierra Leone from 2018 – 2022.

Methods: A retrospective analysis of Lassa fever cases reported from January 2018 to December 2022 was carried out. We extracted data from the National Reference Laboratory/surveillance database to compute descriptive analysis on key variables including age, sex, and districts. Frequencies, proportions, and rates were computed.

Result: A total of 1,127 suspected and 63 confirmed cases of Lassa fever with 40 deaths (CFR-63%) were reported. Of the confirmed cases, the median age was 19 years (range: 1 to 82 years); females accounted for 57% (36/63), and the age group ≤9 years accounted for the highest, 40% (25/63). The average number of confirmed cases reported per year was 13, with the lowest, 8 cases reported in 2020 and the highest, 16 reported in 2021. The cumulative incidence rate was 1 per 100,000 populations. Kenema district accounted for 81% (51/63), followed by Tonkolili and Bo Districts with 10% (6/63) and 5% (3/63) respectively. The peak of infection was in 2021 with 25% (16/63) cases.

Conclusion: The trend of Lassa fever cases was almost constant for the period under study. Kenema District accounted for most Lassa fever cases and persons aged 20 – 29 years accounted for the highest incidence. We recommend the Ministry of Health to conduct community sensitizations to improve early health-seeking behavior in high-incidence districts and intensify community-based surveillance.

Keywords: Lassa fever, hemorrhagic, Sierra Leone, Kenema.

DESCRIPTIVE ANALYSIS OF ACUTE FLACCID PARALYSIS (AFP) SURVEILLANCE DATA, SIERRA LEONE, 2018 TO 2022.

Kemoh Andrew Kekura — 2024-12-26

Background: In 2020, Sierra Leone confirmed an outbreak of circulating Vaccine Derived Poliovirus type 2. However, information on the country’s performance on AFP surveillance indicators is limited. We aimed to describe incidence of AFP and assess the AFP surveillance performance in Sierra Leone using the World Health Organization (WHO) performance indicators.

Methods: We conducted a descriptive analysis of the national AFP surveillance data, for 2018-2022. Data were extracted from the national AFP surveillance database and analyzed using Epi Info 7. Key AFP surveillance performance indicators reviewed include non-polio AFP rate (WHO target: ≥2/100,000), case notification within 7 days of symptom onset (Target: ≥80%), case investigation within 48 hrs. after notification (≥80%), stool condition and adequacy (≥80%). We compared the system’s performance on those indicators and compared them with WHO targets.

Results: There were 668 cases of AFP reported, of which 55% (368/668) were males and 78% (521/668) were under 5 years of age. Of the total cases, 2% (15/668) were confirmed as cVDPV with zero WPV. The average annual non-polio AFP rate was 4 per 100,000 <15-year populations. The Proportion of cases notified ≤7 days of symptom onset was 70% (468/668), and cases investigated ≤48 hours was 90% (601/668). Though stool condition was 90% (601/668) good, the adequacy was 77% (450/585) and only 7% (41/585) arrived at the national laboratory within 3 days after collection. Majority of the cases, 91% (609/668), including confirmed cVDPV2, had received three or more doses of oral poliovirus vaccine (OPV).

Conclusion: The performance of the AFP surveillance system in Sierra Leone surpassed WHO indicators for annualized non-polio AFP rate, case investigation, and stool condition but failed to achieve the minimal target for stool adequacy, case notification, and sample transportation indicating the likelihood of missing a case. We recommend that the Ministry of Health strengthen the sample referral system.

Keywords: Acute flaccid paralysis, data, surveillance, Sierra Leone, poliovirus

SIERRA LEONE REDUCING MATERNAL MORTALITY IN THE LAST SIX YEARS, 2016 – 2021: A SECONDARY DATA ANALYSIS ON MATERNAL DEATH SURVEILLANCE AND RESPONSE SYSTEM

Zainab JuhehBah — 2024-12-26

Globally, Sierra Leone is among the countries with a high maternal mortality ratio (MMR) at 717 per 100,000 live births (DHS 2019). Since then, anecdotal reports show a rapid decline in the MMR. This study to determine the magnitude and trend of maternal deaths, to describe maternal deaths by person, place, and time, and to identify the leading cause (s) of maternal deaths in Sierra Leone. A retrospective descriptive analysis was conducted using data from 2016 ─ 2021 extracted from the National Electronic MDSR line-listing System database. We analyzed key variables including age, place and time of death, gravidity, and cause of death. We calculated frequencies, proportions, and ratios using Microsoft Excel. Overall, 3,491 maternal deaths were recorded out of 1,312,951 live births during the study period, with an average MMR of 266 deaths per 100,000 live births ranging from 319 per 100, 000 live births in 2016 to 255 per 100,000 live births in 2021. The median age of decedent mothers was 27 years (range: 12 to 50 years). The age group 25-34 years accounted for almost half, 45% (1,552/3,491), of the deaths. The deaths were more common in multi-gravida women with 41% (1,353/3,491) of the total deaths. Of the total maternal deaths, 79% (2,767/3,491) occurred at health facilities of these, 75% (2,065/2,767) were from referral hospitals. Hemorrhage was reported the leading cause of maternal deaths at 43% (1,489/3,491), followed by hypertensive disorder at 17% (577/3,491), indirect causes at 13% (437/3,491), and the least was from abortion/ectopic 3% (97/3,491).

There was a decline in maternal death from 2016 to 2021. Hemorrhage was the leading cause of maternal death. We recommend the Ministry of Health implement targeted strategies on hemorrhage prevention and control for further reduction of maternal mortality in Sierra Leone.

Keywords: Maternal Death Surveillance Data Analysis, Sierra Leone, 2016 - 2021.

EVALUATION OF THE HIV SURVEILLANCE SYSTEM WITHIN THE PREVENTION OF MOTHER-TO-CHILD TRANSMISSION PROGRAM, WESTERN AREA URBAN DISTRICT, SIERRA LEONE, 2022

Saidu Hesseinberg Mansaray — 2024-12-26

In 2015, the HIV surveillance system was established within the Prevention of Mother-to-Child Transmission (PMTCT) Program to monitor HIV epidemiological trends. To date, no studies have evaluated its performance in the Western Area Urban District. This study describes the operation of the HIV surveillance system; assess its performance on key system attributes and usefulness within the PMTCT program in the district. A descriptive cross-sectional study was conducted from October to December 2022.

Eighteen healthcare workers were purposively selected and interviewed using a semi-structured questionnaire to describe the system operations and evaluate qualitative attributes. Health facility registers and the District Health Information System (DHIS2) data were reviewed to assess quantitative attributes. The performance status of each attribute was interpreted using the following scoring system: <40% (poor), 40%-70% (average), and >70% (good).

The HIV surveillance system within the PMTCT program operates as a passive surveillance system. Data reporting is done monthly, and feedback and supervision are conducted quarterly. Simplicity was rated as good; with 73.23% (13/18) of respondents stating that they understood the HIV Testing Algorithm and can perform the test for pregnant women with ease. Acceptability was good, with 96% overall rank indicating willingness of staff to participate.

Stability was rated average, with 65.5% stating the system did not experience breakdowns. Representativeness was poor, with limited participation from private health facilities. Sensitivity was ranked good being that the test kits used to confirm cases are over 95% sensitive. Overall usefulness was average with score of 65.7%. The HIV surveillance system is useful in meeting its objectives. However, the lack of participation from private health facilities suggests that the system may miss cases. It is recommended that private health facilities receive tools and capacity-building training to enhance their participation in the HIV surveillance system.

Keywords: HIV/AIDS, PMTCT, Surveillance, Sierra Leone.

ASSESSING THE ATTRIBUTES AND EFFECTIVENESS ON THE IMPLEMENTATION OF ELECTRONIC CASE-BASED SURVEILLANCE SYSTEM FROM 2018-2020 IN BOMBALI DISTRICT, SIERRA LEONE

Salieu Jalloh — 2024-12-26

During the EVD 2014 outbreak, Sierra Leone lacked an effective infectious disease reporting system. To address this challenge, Sierra Leone introduced the electronic Case-Based Disease Surveillance (eCBDS) in 2018 as a tool for early notification and response to outbreaks and public health concerns. However, there is limited knowledge of the effectiveness of eCBDS system. We, therefore, evaluated the system’s performance in line with its objectives. We conducted a mixed qualitative and quantitative descriptive cross-sectional study in Bombali District using the updated CDC guidelines for evaluating surveillance systems. We purposively selected 23 stakeholders and 10 health facilities. A semi-structured questionnaire adapted from updated CDC guidelines was used for data collection through face-to-face interviews and record reviews for the period 2018 to 2020. The major qualitative findings were narrated and summarized based on their contents to determine usefulness, simplicity, flexibility, acceptability, stability, and representativeness of the surveillance system. The quantitative findings were summarized into frequencies, proportion, median, and range using Microsoft Excel. All 23 (100%) respondents indicated that the eCBDS is useful for timely detection of epidemic diseases. Most of the staff 20 (87 %) indicated that the eCBDS is simple, easy to input data, to do timely reporting. None of the facilities were doing descriptive analysis by person, place, or time. There was a lack of internet data in one facility. Two (20%) of 10 facilities reported faulty device and disappearance of the application on the tablet have interrupted the full operation of the eCBDS. Our evaluation of the eCBDS system in the Bombali district shows that the system is simple, useful, and acceptable to users. The stability was affected by lack of internet data and faulty devices have interrupted the full operation of the system. Therefore, we recommend that the DHMT orientate staff in troubleshooting the devices and data analysis.

Keywords: eCBDS early, notification, prompt response.

ENHANCING INTEGRATED DISEASE SURVEILLANCE AND RESPONSE SYSTEM THROUGH DATA QUALITY ASSESSMENT: LESSONS FROM SIERRA LEONE, NOVEMBER 2022

James Amal Myers Khobi — 2024-12-26

The Sierra Leone Ministry of Health in collaboration with the US Centers for Disease Control and Prevention, the African Field Epidemiology Network, and the World Health Organization assessed the quality of data generated by the Integrated Disease Surveillance and Response (IDSR) system. The assessment aim to determine the quality of the IDSR data in Sierra Leone through evaluating the accuracy of data compilation, data entry and transmission, and the overall precision of surveillance data at health facility and district levels.

The assessment included 160 randomly selected health facilities in the 16 districts. Surveillance data stored electronically in the eIDSR platform were extracted and compared across the facility registers and IDSR summary forms. Data was collected from March 6 to March 18, 2023using an electronic checklist on the Open Data Kit (ODK) platform. The data reviewed covered the period from October 23 to November 26, 2022. Specific disease conditions/events targeted included Acute Flaccid Paralysis, Acute Viral Haemorrhagic Fever, suspected COVID-19, Dysentery, Tested Malaria, Positive Malaria, Maternal Death, and Measles.

The assessment showed that 79% (127/160) of the facilities had IDSR case definition tools, with a decreased accuracy reporting from 90% in May 2022 to 86% in November 2022 assessment. However, the assessment revealed strengths: notably the availability of registers at all levels. Majority, 74% (118/160) of the assessed facilities conduct data analysis and display results using tables and graphs. The proportion of assessed facilities with weekly reporting forms decreased to 94.4% from 98.1% in the May 2022 assessment, while case-based reporting forms increased to 95.6% from 88.1%. Five diseases conditions/events (AFP, suspected COVID-19, Malaria tested & positive, Maternal death and Measles) exhibited data disparities between the number of cases identified during register review and those reported in eIDSR.

The assessment uncovered both strengths and challenges in facility reporting practices. Therefore, we recommend the Ministry of Health implement targeted interventions such as prioritising the conduct of routine DQA and supportive supervision, to strengthen weaker areas of the assessment and maintain progress in areas that shows improvement. It is critical to strengthen the skills of the healthcare workers on data accuracy reporting, as well as to enhance data quality feedback sharing from national to facility level to address data discrepancies for better surveillance and response outcomes. Furthermore, replacing the faulty/lost tablets at facility level would improve the overall quality and dependability of surveillance data.

Keywords: Data Quality Assessment, Sierra Leone, Integrated Disease Surveillance and Response.

PREVALENCE AND FACTORS ASSOCIATED WITH FEMALE GENITAL MUTILATION IN SIERRA LEONE, 2024

Umaru Sesay — 2024-12-26

Background: Female Genital Mutilation (FGM) is a major public health problem in Sierra Leone. However, its prevalence and related factors are not documented. We conducted this study to determine the prevalence and factors associated with FGM in Sierra Leone.

Method: We used the FGM data of Sierra Leone, 2017, extracted from the United Nations International Children Emergency Fund multiple indicator cluster survey. We conducted descriptive analysis to determine the frequencies and proportion of demographic and female circumcision variables. Multivariable binary logistic regression was used to determine the association between circumcision and explanatory variables.

Result: Of the 18,194 women aged 18-49 years surveyed, 84.7% (15,406) were married, 69.4% (12,630) lived in rural areas, and 71.8% (13,062) had pre-primary education. The prevalence of FGM was 96.7% (17,598) among women aged 18-49 years, and 99.7% (18139) of the respondents have heard of FGM. Of the circumcised women, 82% (14,409) were living in rural areas and 97.9% (17,225) had no functional difficulty as a result of female circumcision. In Multivariable binary logistic regression, high level of education (aOR= 5.4, 95% CI:4.81, 7.06) and p-value ˂0.001), single women (aOR= 3.0, 95% CI:2.54, 3.82) and p-value ˂0.001), and richest women (aOR= 2.2, 95% CI:1.51, 3.59) and p-value ˂0.001) were factors associated with FGM.

Conclusion: We found a high prevalence of FGM in Sierra Leone. FGM is prevalent among single women, rich in the wealth index women, and women with high education levels. We recommend developing policies, community sensitization, and including FGM in school curricula to end FGM in Sierra Leone.

Keywords: Female genital mutilation; Prevalence; Public Health; Multivariable binary regression models; Surveys and questionnaires, Sierra Leone