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This paper describes the implementation of curricula for Liberia's first-ever psychiatry training programme in 2019 and the actions of the only two Liberian psychiatrists in the country at the time in developing and executing a first-year postgraduate psychiatry training programme (i.e. residency) with support from international collaborators. It explores cultural differences in training models among collaborators and strategies to synergise them best. It highlights the assessment of trainees' (residents') basic knowledge on entry into the programme and how it guided immediate and short-term priority teaching objectives, including integrated training in neuroscience and neurology. The paper describes the strengths and challenges of this approach as well as opportunities for continued growth. [ABSTRACT FROM AUTHOR]

Undernourishment is a persistent public health problem contributing to increased mortality in children under five in low-income countries, likely exacerbated by socio-economic disparities within communities. This paper aimed to examine the effect of wealth-related inequality on undernutrition in children under five in low, lower-middle, and upper-middle-income countries (LMICs). We analyzed cross-sectional data from the demographic and health survey program collected between 2017 and 2022 from 24 LMICs. Children born within 5 years preceding the survey were included in the analysis. Child undernutrition was the dependent variable (measured by stunting, wasting, and underweight) and country-level wealth-based inequality was the independent variable assessed by concentration index values stratified by the World Bank's income categories. Within country inequality of child undernutrition was determined by concentration index (C) values with 95% confidence intervals (95% CI) and sub-group analysis by place of residence and sex of the child. We then fit bootstrapped meta-regression to check the variation in inequality of child undernutrition across different income category countries. The analysis was controlled by potential confounding variables. From the total sample size of 334,502 children included in the study, 35% were undernourished. Wealth-related inequality in child undernutrition was observed in 11 countries, consistently across income categories. Child undernutrition was highly concentrated among the poor households of Türkiye [C: − 0.26, 95% CI − 0.31 to − 0.20], and Cameroon [C: − 0.19, 95% CI − 0.22 to − 0.17], and relatively it was less concentrated among the poor in Liberia [C: − 0.07, 95% CI − 0.11 to − 0.04], and Gambia [C: − 0.07, 95% CI − 0.11 to − 0.04]. There is no difference in undernutrition associated with inequality between the three broad LMIC categories. The wealth-related inequality in child undernutrition within many of the included countries is still very significant. However, the economic category of countries made no difference in explaining wealth-related inequality in child undernutrition. Inter-sectoral collaboration to fight poverty and render special attention to the disadvantaged population segments would potentially help to address the observed inequity. [ABSTRACT FROM AUTHOR]

Background: This study aimed at validating the updated DeLone and McLean's information systems success model (D&MISS) in a developing country's infectious disease pandemic preparedness and response context. The findings from this study are relevant to inform policies and actions for enhancing developing countries' the Health Information System's (HIS) performance, and specifically to improve their future pandemic readiness and response. The study sought to respond to a key research question: to what extent can the D&MISS model provide evidence to enhance the HIS's infectious disease pandemic readiness and response in developing countries? Method: A cross-sectional study design that involved a multi-stage probability sampling approach to select eligible healthcare workers was applied. Conducted in Nigeria and Liberia, 576 primary healthcare workers, out of the proposed 600, participated, representing a response rate of 96%. The D&MISS model served as the theoretical underpinning for this study, and nine hypothesized relationships were stated before the study based on the interconnectedness of the model's six dimensions. Structural Equation Modelling (SEM) data analysis using the Partial Least Square approach was used to determine if hypothesized relationships were supported. Results: 70% of the observed variance in the Net Benefit construct was explained by the predictive influence of the Use and User Satisfaction constructs. The Use construct had a slightly more substantial predictive influence than the User Satisfaction construct. Eight of the nine hypothesized relationships were supported, except for the relationship between Information Quality and Use. The relationships between System Quality and Use and User Satisfaction and Net Benefit had the highest beta coefficient, statistically significant at p < 0.05. Conclusion and relevance: The D&MISS model demonstrated its relevance in providing evidence on the gaps of the HISs regarding future pandemic preparedness and response. However, from a future research opportunity, its enhancement and modifications with context-specific dimensions peculiar to developing countries will improve its ability to provide more context-specific evidence to improve pandemic preparedness and response for developing countries. [ABSTRACT FROM AUTHOR]

Environmental policy integration is needed to ensure environmental policy goals are being realized, given their cross‐sectoral nature. Most of the published research has focused on integration and coherence of (inter)national policies, plans, and programs. The implementation practices for these policies, however, are at least as important. This paper therefore looks at policy implementation for the case of artisanal gold mining in Liberia. This is studied through a lens of frontline staff (street‐level bureaucrats) who operate in networks of local government agencies, civil society organizations, and communities. Results of interviews and field observations in Grand Gedeh county show how the policy context and local realities create specific dilemmas, resulting from the combination of limited resources of local frontline staff, low‐income security for local communities and traditional local practices around protected forest areas. In response local frontline bureaucrats use their discretionary power and network to mobilize support, pool resources, combine mandates, and find creative solutions to both regulate and support community residents. Although these implementation strategies are neither necessarily sufficient to realize the official policy goals, nor are guaranteed to have the desired effects, they do show how local frontline staff act as de facto policymakers. Recognizing frontline staff as environmental policy integrators therefore is a crucial element toward more successful policies for sustainable development. [ABSTRACT FROM AUTHOR]

Much of the literature on victimization looks at the effect of organized violence (OV) on civilian perceptions and behaviour. Yet citizens in countries experience quotidian crime (QC) on a daily basis. QC differs from OV, the former being more isolated, while the latter is more of a collective experience. As such we develop a theoretical framework that explores the effects of both types of violence on preferences for public goods. Victims of OV may prefer welfare public goods for the entire community, whereas victims of QC may prefer security for themselves. We also test the effects of compound victimization on public goods' preferences. We use original survey data from rural Liberia to test our hypotheses and find support for our argument. Our results show the importance of a disaggregated approach to understanding the effects of violence on preferences. [ABSTRACT FROM AUTHOR]

The initial outbreak response to the 2014–2016 Ebola Virus Disease (EVD) in West Africa was met with resistance in Liberia. In part, this was because responders failed to account for how the country's colonial history and sociocultural circumstances influenced attitudes and perceptions of the population. We argue that understanding the relationship between the broader structural influences and the subjective aspects–the lived experience of people in the region–is crucial to developing more effective outbreak measures. In this light, we adopt and refine the concept of "riskscape" to highlight how the resistance to response teams shifted as the EVD outbreak unfolded. To illustrate our argument, we consider how the particular historical, cultural, and political forces constituted a "postcolonial riskscape", influencing evolving perceptions of risk and trust in the context of the outbreak response in the West Point informal settlement located in Liberia's capital, Monrovia. As part of that discussion, we demonstrate how the adoption of a bottom-up community-based strategy by response officials, stimulated changes in the riskscape that helped pave the way for the adoption of an improved response strategy that resulted in a relatively swift decrease in EVD prevalence. [ABSTRACT FROM AUTHOR]

A recently proposed fractional-order mathematical model with Caputo derivatives was developed for Ebola disease. Here, we extend and generalize this model, beginning with its correction. A fractional optimal control (FOC) problem is then formulated and numerically solved with the rate of vaccination as the control measure. The research presented in this work addresses the problem of fitting real data from Guinea, Liberia, and Sierra Leone, available at the World Health Organization (WHO). A cost-effectiveness analysis is performed to assess the cost and effectiveness of the control measure during the intervention. We come to the conclusion that the fractional control is more efficient than the classical one only for a part of the time interval. Hence, we suggest a system where the derivative order changes over time, becoming fractional or classical when it makes more sense. This type of variable-order fractional model, known as piecewise derivative with fractional Caputo derivatives, is the most successful in managing the illness. [ABSTRACT FROM AUTHOR]

Robust, regular and integrated evidence on the environment and its relationship with the economy and human well-being is needed to deliver effective environmental policy. This paper highlights the role the United Nations System of Environmental-Economic Accounting Ecosystem Accounting (SEEA EA) can play in delivering this 'policy-ready' evidence. We demonstrate this using forest ecosystems as a policy theme of high international concern, via structured reviews of evidence needs for two case studies: the EU Green Deal; and, Liberia's forest policy framework. The EU Green Deal case study highlights evidence gaps in a proposed regulation on environmental-economic accounting that are policy relevant and could be met using the SEEA EA. These gaps concern old growth forest extent, carbon storage, biodiversity, water regulation and erosion control ecosystem services. The Liberia case study highlights evidence needs for policy concerning the extent of natural forests important for biodiversity and ecosystem services of timber provisioning, global climate regulation and non-wood forest products, which could be met by the SEEA EA. Starting from these policy perspectives is critical to establishing evidence needs that the SEEA EA should be compiled to meet. This address concerns that the compilation of SEEA EA accounts has often been an exercise in best organising available data, rather than a demand driven exercise in response to policy evidence needs. We argue that addressing clear policy needs is essential for the SEEA EA to deliver on its potential to mainstream the many benefits from natural, as well as managed forests, into development planning. • Illustrates possibilities and advantages of using environmental-economic accounting to deliver 'policy-ready' evidence. • Presents a structured approach for linking environmental-economic accounting to policy evidence needs. • EU Green Deal case study highlighting evidence gaps for forest policy in proposed environmental-economic accounts. • Liberia case study highlighting evidence needs for national forest policy environmental-economic accounts can meet. [ABSTRACT FROM AUTHOR]

The scale and pace of land tenure change for agricultural development, often known as 'land grabbing' or 'global land rush,' are historically unprecedented. Control over millions of hectares of land has shifted over the past decade for the production of food, fiber, and biofuel. However, the rapidly growing body of research on land tenure change provides few rigorous assessments of deforestation across multiple countries with distinct biophyisical and socioeconomic characteristics. In this paper, based on spatial boundaries of land transactions (LTs) in Cambodia, Ethiopia, Liberia, and Peru, we investigate their association with deforestation using a pixel-based matching approach. Our findings suggest that the context, size, and distribution of LTs and the associated deforestation patterns vary substantially across the four countries. Land tenure change significantly accelerates deforestation in Cambodia and Liberia, but such acceleration is insignificant in Ethiopia. In Peru, we observe the opposite trend, where areas adjacent to LTs experience higher deforestation than areas within. Our analysis reveals how patterns and outcomes of LTs are linked to country characteristics and contexts, and suggests that sweeping generalizations about positive or negative consequences of LTs on deforestation and possibly other socioenvironmental outcomes need to attend more closely to specific patterns and drivers of LTs. [ABSTRACT FROM AUTHOR]

Introduction: Liberia has a significant obstacle in terms of restricted power accessibility, as only 26.7% of its populace have access to electrical energy. To tackle this issue, there is a collaborative effort between the government and private sector to undertake energy projects aimed at enhancing the power supply of the grid. The purpose of this study is to evaluate the techno-economic feasibility and analyze the performance of a standalone biomass/solar photovoltaic (PV) hybrid energy system for a rural Liberian community that mostly relies on traditional biomass. Methods: HOMER pro program was used to configure the system, model the community's load over a year, and generate the resource data of the location. Results and Discussion: Four different configurations were obtained and analyzed both technically and economically to determine the most feasible configuration. This study has shown that a hybrid configuration incorporating Biomass Gasifier, Solar PV, and Battery storage is more feasible with annual output power of 77104 kWh/yr, LCOE ($/kwh) of 0.29 and NPC ($) of 0.3979 million. If implemented with external funding, it will enhance the education, economic and socio-economic status of rural settlements. The results will serve as a valuable resource for informing choices on the implementation of the hybrid energy solution and guaranteeing its sustained efficacy within the community. [ABSTRACT FROM AUTHOR]

Introduction: Acquired Immune Deficiency Syndrome (AIDS) continues to be a deadly pandemic and a serious threat to public health. Globally, reproductive age women are more likely to be infected with Human Immunodeficiency Virus (HIV). Comprehensive knowledge about HIV/AIDS is pivotal in the fight against AIDS. However, comprehensive HIV/AIDS knowledge is low in Sub-Saharan African (SSA) nations including Liberia, which contributes to the high incidence of HIV in these nations. This study assessed the level of comprehensive knowledge about HIV/AIDS and its associated factors among reproductive age women in Liberia. Methods: The prevalence and associated factors of comprehensive knowledge about HIV/AIDS among reproductive age women in Liberia were determined using secondary data analysis of 2019–2020 Liberia Demographic and Health Surveys (LDHS). Comprehensive knowledge about HIV/AIDS was a composite variable computed from six variables available in the Demographic and Health Survey (DHS). The study included 7,621 reproductive age women in weighted samples. A generalized linear mixed model with robust error variance was used. For the variables included in the final model, adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) were calculated. Results: The prevalence of comprehensive HIV/AIDS knowledge among Liberian women aged 15–49 was 33.5%. Women's age and education, and distance to health facility were positively associated with comprehensive knowledge about HIV/AIDS among Liberian reproductive age women. In contrast, community poverty level was negatively associated with comprehensive knowledge about HIV/AIDS. Conclusion and recommendations: This study demonstrates that the prevalence of good comprehensive HIV/AIDS knowledge was relatively low among reproductive age women in Liberia. Hence, health practitioners and policymakers should strengthen HIV/AIDS sensitization programmes to increase women's knowledge about HIV/AIDS. [ABSTRACT FROM AUTHOR]

Ebola is a highly infectious and often fatal zoonotic disease endemic to West and Central Africa. Local outbreaks of the disease are common, but the largest recorded Ebola epidemic originated in Guinea in December 2013, spreading to Liberia, and Sierra Leone in the following year and lasting until April 2016. The epidemic presented a serious challenge to local healthcare systems and foreign aid agencies: it degraded services, caused the loss of healthcare professionals, disrupted the economy, and reduced trust in modern healthcare. This study aims to estimate the extent to which variation in one long-term measure of the quality of local healthcare (the child vaccination rate) is a consequence of local variation in the intensity of the epidemic. Applying a "difference-in-differences" model to household survey data from before and after the epidemic, we show that in 2018–2019, overall rates of vaccination for BCG, DPT, measles, and polio are lower in Guinean and Sierra Leonean districts that had a relatively high incidence of Ebola; statistical analysis indicates that this is a causal effect. The effects of the epidemic on access to healthcare have been local effects, at least in part. [ABSTRACT FROM AUTHOR]

This study falls under the scope of the recent debate around UN peacekeeping transitions and exit strategies and highlights a critical gap in understanding the design and conceptualization of these strategies, especially for the long run as post-conflict societies consolidate peace. Using Liberia and Sierra Leone as case studies, the research aims to remedy the empirical gap and shed light on the complexities of framing UN transitions and exit strategies. A central argument posited in this study is that effective management of the entanglement between peacekeeping and peacebuilding is pivotal for enduring success in transition processes. Key contextual elements influencing this management include early planning and initiation of peacebuilding, coordination and integration with local actors, and alignment of benchmarks and needs with all stakeholders before concluding missions. The study applies a social constructivist perspective to examine the different trajectories both Liberia and Sierra Leone have taken in managing their transitions. This article uses qualitative research methods with data drawn from primary and secondary sources. [ABSTRACT FROM AUTHOR]

In recent decades, increased attention has been given to the hierarchical nature and intrinsic power dynamics of CSO capacity building programs. In a global context, international donors tend to design and implement capacity building programs, which then prioritize donors' objectives and employ Western concepts in the Global South. This research note aims to reframe capacity building around inclusive and equal partnerships centered on civil society leaders who participate in designing and delivering capacity building programs. We propose action research as a process for co-creating contextually appropriate models that enable local ownership for capacity building and thus equip civil society to improve the lives of people in communities. We apply this approach to the Liberian case to develop a process to engage local civil society organizations in developing participatory capacity building programs that address place-based needs in non-Western contexts. [ABSTRACT FROM AUTHOR]

Background: Research in low- and middle-income countries has shown that maternal mortality is directly related to inadequate or absent obstetric (OB) triage systems. Standard triage systems and knowledge on triaging for obstetric emergencies are often absent or lacking in most healthcare systems in Liberia., Objective: The objective of this research was to address the third delay defined as receiving adequate, quality care when a facility is reached by increasing knowledge through the establishment of a midwife-led, hospital-based OB triage system to stratify care based on risk and imminence of birth and to improve timely assessment at two district referral hospitals., Methods: A quasi-experimental study design using a pre/post survey was employed for a midwife-led OB triage training course. Using a train-the-trainer model, five midwives were trained as champions, who in turn trained an additional 62 providers. Test results were analyzed with the R statistical software using paired sample t-test and descriptive statistics., Results: Pretest results revealed a knowledge and practice gap among OB providers on key components of the standard triage package. However, post-test mean scores were significantly higher (M = 79.6, SD = 2.32) than pre-test mean scores (M = 59.0, SD = 2.30) for participants following a 2-day training (p = <0.001)., Discussion: Following a structured OB triage training, participants showed significant improvement in post-test OB triage scores., Conclusion: Standard OB triage protocols incorporated into the policies and procedures of obstetric wards have the potential to improve knowledge and practice, addressing the third delay and reducing preventable, obstetrics-related deaths., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Liberia developed an evidence-informed package of health services for Universal Health Coverage (UHC) based on the Disease Control Priorities 3 evidence. This paper describes the policy decisions, methods and processes adopted for prioritisation, key features of the package and lessons learnt, with special emphasis on feasibility of implementation. Package design was led by the Ministry of Health. Prioritisation of essential services was based on evidence on disease burden, cost-effectiveness, financial risk, equity, budget impact, and feasibility of implementation. Fiscal space analysis was used to assess package affordability and options for expanding the budget envelope. The final adopted package focuses on primary healthcare and comprises a core subpackage of 78 publicly financed interventions and a complementary subpackage of 50 interventions funded through cost-sharing. The estimated per capita cost to the government is US$12.28, averting around 1.2 million DALYs. Key lessons learnt are described: (1) priority setting is essential for designing affordable packages of essential services; (2) the most realistic and affordable option when domestic resources are critically limited is to focus on basic, high-impact primary health services; (3) Liberia and many other countries will continue to rely on donor funding to expand the range of essential services until more domestic resources become available; (4) national leadership and effective engagement of key stakeholders are critical for a successful package design; (5) effective implementation is less likely unless the package cost is affordable and the health system gaps are assessed and addressed. A framework of action was employed to assess the consistency with the prerequisites for an appropriate package design. Based on the framework, Liberia developed a transparent and affordable package for UHC, but the challenges to implementation require further action by the government., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Objectives: The InVITE study, starting in August 2021, was designed to examine the immunogenicity of different vaccine regimens in several countries including the Democratic Republic of Congo, Guinea, Liberia, and Mali. Prevaccination baseline samples were used to obtain estimates of previous SARS-CoV-2 infection in the study population., Methods: Adult participants were enrolled upon receipt of their initial COVID-19 vaccine from August 2021 to June 2022. Demographic and comorbidity data were collected at the time of baseline sample collection. SARS-CoV-2 serum anti-Spike and anti-Nucleocapsid antibody levels were measured., Results: Samples tested included 1016, 375, 663, and 776, from DRC, Guinea, Liberia, and Mali, respectively. Only 0.8% of participants reported a prior positive SARS-CoV-2 test, while 83% and 68% had anti-Spike and anti-Nucleocapsid antibodies, respectively., Conclusions: Overall SARS-CoV-2 seroprevalence was 86% over the accrual period, suggesting a high prevalence of SARS-CoV-2 infection. Low rates of prior positive test results may be explained by asymptomatic infections, limited access to SARS-CoV-2 test kits and health care, and inadequate surveillance. These seroprevalence rates are from a convenience sample and may not be representative of the population in general, underscoring the need for timely, well-conducted surveillance as part of global pandemic preparedness., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Ebola virus disease (Ebola) is highly pathogenic, transmissible, and often deadly, with debilitating consequences. Superspreading within a cluster is also possible. In this study, we aim to document Ebola basic reproduction number (R 0 ): the average number of new cases associated with an Ebola case in a completely susceptible population., Methods: We undertook a systematic review and meta-analysis. We searched PubMed, EMBASE, and Web of Science for studies published between 1976 and February 27, 2023. We also manually searched the reference lists of the reviewed studies to identify additional studies. We included studies that reported R 0 during Ebola outbreaks in Africa. We excluded studies that reported only the effective reproduction number (R t ). Abstracting data from included studies was performed using a pilot-tested standard form. Two investigators reviewed the studies, extracted the data, and assessed quality. The pooled R 0 was determined by a random-effects meta-analysis. R 0 was stratified by country. We also estimated the theoretically required immunization coverage to reach herd-immunity using the formula of (1-1/R 0 ) × 100 %., Results: The search yielded 2042 studies. We included 53 studies from six African countries in the systematic review providing 97 Ebola mean R 0 estimates. 27 (with 46 data points) studies were included in the meta-analysis. The overall pooled mean Ebola R 0 was 1.95 (95 % CI 1.74-2.15), with high heterogeneity (I 2  = 99.99 %; τ 2  = 0.38; and p < 0.001) and evidence of small-study effects (Egger's statistics: Z = 4.67; p < 0.001). Mean Ebola R 0 values ranged from 1.2 to 10.0 in Nigeria, 1.1 to 7 in Guinea, 1.14 to 8.33 in Sierra Leone, 1.13 to 5 in Liberia, 1.2 to 5.2 in DR Congo, 1.34 to 2.7 in Uganda, and from 1.40 to 2.55 for all West African countries combined. Pooled mean Ebola R 0 was 9.38 (95 % CI 4.16-14.59) in Nigeria, 3.31 (95 % CI 2.30-4.32) in DR Congo, 2.0 (95 % CI 1.25-2.76) in Uganda, 1.83 (95 % CI 1.61-2.05) in Liberia, 1.73 (95 % CI 1.47-2.0) in Sierra Leonne, and 1.44 (95 % CI 1.29-1.60) in Guinea. In theory, 50 % of the population needs to be vaccinated to achieve herd immunity, assuming that Ebola vaccine would be 100 % effective., Conclusions: Ebola R 0 varies widely across countries. Ebola has a much wider R 0 range than is often claimed (1.3-2.0). It is possible for an Ebola index case to infect more than two susceptible individuals., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)