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Background: Metabolic syndrome (MetS) is a global health concern, especially for low and middle-income countries with limited resources and information. The study's objective was to assess the prevalence of MetS in Freetown, Sierra Leone, using the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III), International Diabetes Federation (IDF) and Harmonize ATP III. Additionally, we aimed to establish the concordance between these three different criteria used. Methods: This community-based health screening survey was conducted from October 2019 to October 2022. A multistage stratified random design was used to select adults aged 20 years and above. Mean, interquartile range (IQR), and logistic regression were used for statistical analysis. The kappa coefficient statistics resolved the agreement between these defined criteria. Results: The prevalence for NCEP ATP III, Harmonize ATP III and IDF criteria was 11.8 % (95 % CI: 9.0–15.15), 14.3 % (95 % CI: 11.3–18.0), and 8.5 % (95 % CI: 6.2–11.2), respectively for the 2394 selected adults. The kappa coefficient (κ) agreement between the MetS is: Harmonized ATP III and IDF criteria = [(208 (60.8 %); (κ = 0.62)]; Harmonized ATP III and NCEP ATP III = [(201 (58.7 %); (κ = 0.71)]; while IDF and NCEP ATP III was [(132 (38.6 %); (κ = 0.52)]. In the multivariable regression analysis, waist circumference correlated with all three MetS criteria: ATP III [AOR = 0.85; C.I 95 %: (0.40–1.78), p = 0.032], Harmonized ATP III [AOR = 1.14; C.I 95 %: (0.62–2.11), p = 0.024], IDF [AOR = 1.06; C.I 95 % (0.52–2.16), p = 0.018] Conclusion: We reported a high prevalence of MetS in Freetown, Sierra Leone and identified waist circumference as a major risk factor for MetS. This underscores the crucial role of health education and effective management of MetS in Sierra Leone.

Objective To investigate the prevalence of cardiometabolic risk factors (CMRFs), target organ damage (TOD) and its associated factors among adults in Freetown, Sierra Leone.Design This community-based cross-sectional study used a stratified multistage random sampling method to recruit adult participants.Setting The health screening study was conducted between October 2019 and October 2021 in Western Area Urban, Sierra Leone.Participants A total of 2394 adult Sierra Leoneans aged 20 years or older were enrolled.Outcome measure Anthropometric data, fasting lipid profiles, fasting plasma glucose, TOD, clinical profiles and demographic characteristics of participants were described. The cardiometabolic risks were further related to TOD.Results The prevalence of known CMRFs was 35.3% for hypertension, 8.3% for diabetes mellitus, 21.1% for dyslipidaemia, 10.0% for obesity, 13.4% for smoking and 37.9% for alcohol. Additionally, 16.1% had left ventricular hypertrophy (LVH) by ECG, 14.2% had LVH by two-dimensional echo and 11.4% had chronic kidney disease (CKD). The odds of developing ECG-LVH were higher with diabetes (OR=1.255, 95% CI (0.822 to 1.916) and dyslipidaemia (OR=1.449, 95% CI (0.834 to 2.518). Associated factors for higher odds of Left Ventricular Mass Index by echo were dyslipidaemia (OR=1.844, 95% CI (1.006 to 3.380)) and diabetes mellitus (OR=1.176, 95% CI (0.759 to 1.823)). The odds of having CKD were associated with diabetes mellitus (OR=1.212, 95% CI (0.741 to 1.983)) and hypertension (OR=1.163, 95% CI (0.887 to 1.525)). A low optimal cut-off point for ECG-LVH (male 24.5 mm vs female 27.5 mm) was required to maximise sensitivity and specificity by a receiver operating characteristics curve since the odds for LVH by ECG were low.Conclusions This study provides novel data-driven information on the burden of CMRF and its association with preclinical TOD in a resource-limited setting. It illustrates the need for interventions in improving cardiometabolic health screening and management in Sierra Leonean.

INTRODUCTION: Chronic subdural hematoma is not uncommon in sub-Saharan Africa and has a striking morbidity and mortality if not managed adequately. With the limited number of neurosurgeons in resource poor countries, general surgeons should be trained in the skills of craniotomy and burr-hole craniostomy. METHODS: we conducted a retrospective review of all medical records of patients with CSHD, who underwent flap craniotomy at the Choithrams Memorial Hospital, Sierra Leone, between January 2016 and March 2018. The case notes, operative records and computerized axial tomography (CT) scans were reviewed and all pertinent data extracted. RESULTS: a total of 23 patients had surgical drainage of the CSHD. The mean age of the patients was 65.8 years (ranging from 54 -78) with a male: female ratio of 3.2:1. The main predisposing risk factors were head trauma (60.9%) and antiplatelet medications (39.1%). Hypertension was the most common comorbid disease, followed by diabetes mellitus. Ten (62.5%) out of sixteen patients referred for Head CT-scan by the primary physicians, had an initial missed clinical diagnosis until CT scan confirmation report of CSDH was obtained. Flap craniotomy under general anesthesia with a subdural drainage left in situ (100%) was done for all patients. Duration of Intensive Care Unit admission was a mean of 10.6 days (range 6-16 days with twenty-one (91.3%) patients recovering fully. There was a favorable outcome in 95.6% of patients with a recurrence rate of 4.3% and mortality of 0%. CONCLUSION: flap craniotomy for CSDH was safely performed by a trauma general surgeon in a developing country where there is no neuro-surgical service. The outcome of the patients was favorable as there was co-management with the surgical and medical team.