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The distinction between weak and strong islands has been extensively explored in the literature from both a descriptive and analytical perspective. In this paper, I document and analyze island constructions and constraints in Mende, an understudied Mande language spoken in Sierra Leone. Mende has both weak islands (left branch and wh-islands) and strong islands (adjunct clauses, sentential subjects, and coordinate structures). Intriguingly, it has a third class of islands, that I call mixed islands which show a subject–non-subject asymmetry in allowing for movement out of relative clauses, only when they modify the subject. As such, subject-modifying RCs cannot be classified as (strong/weak) islands in Mende. This is the first systematic work on islands and island constraints in the Mande language family, and, as such, it brings novel data from an understudied language family to bear on our understanding of A-bar dependencies and the study of island escape in African languages. It also calls into question a neat paradigm of cross-linguistic island constraints. Importantly, this work also lays down a baseline for future research on island constraints in the broader Mande language family. In order to discuss island constraints, this paper also lays out the first analysis of relative clauses in Mende, while integrating new research on the left periphery, focus constructions, and wh-constructions. [ABSTRACT FROM AUTHOR]

The European Union (EU) provides both financial and expert support for sustainable forest management initiatives and also boosts compliance with such initiatives in Africa. Thus, there is a need to monitor the progress of implementing such initiatives. The objective of this paper is to describe the role of timber harvesting entities in environmental impact discussions, and to also identify the role of EU institutions in promoting forest sustainability in Sierra Leone. Data were collected in a controlled survey from four communities, using a questionnaire formulated according to guidelines recommended by Babbie and Mouton (2010). The reliability test shows a 0.68 internal consistency among the latent variables (Cronbach alpha test). The selected four communities were Bambawo, Dia, Basara, and Menima, with a population of 6 000, 5 400, 7 500, and 5 600 inhabitants, respectively (Stats SL 2021). A Confirmatory Factor Assessment (CFA) was used for a descriptive statistical analysis of the data. The results showed that the environmental impact has an eigenvalue of 1.08, where only variables with a factor loading exceeding 0.5 were used. The paper concludes with discussions and relevant recommendations on mitigating the impacts of timber harvesting on the environment within the study area. [ABSTRACT FROM AUTHOR]

Farmers’ awareness and the incidence of climate change are crucial inputs to effectively scale up interventions to mitigate the effects of climate change. This is because incidence leads to awareness due to observation of occurrences. The purpose of this paper is to examine the determinants of climate change awareness and incidence across farming systems and agroecological zones in Sierra Leone. An ex-post-facto research design was applied, while a multistage sampling procedure was used to select 865 smallholder farmers across agroecological zones and farming systems. Data were collected with a structured questionnaire subjected to face validity and split-half reliability tests. This data analyzed frequency counts, percentages, multiple regression, and principal component analysis. The results show that farmers in the coastal plain, savannah woodland, and transitional rainforest had greater awareness and incidence of climate change across the crop, livestock, and fishery farming systems. The significant determinants of awareness and incidence of climate change among farmers are the adoption of crop smart practices (t = 4.192; p < 0.01); information needs on water smart practices (t = –5.581; p < 0.01); adoption of nutrient smart practices (t = 10.592; p < 0.01); adoption of energy/carbon smart practices (t = 3.206 ; p < 0.01); adoption of livestock smart practices (t = 3.608; p < 0.01); information needs on weather smart practices (t = 3.505; p < 0.01); incidence of climate change (t = 16.282; p < 0.01); and constraints on nutrient smart practices (t = –2.669; p < 0.01). The Principal Component analysis identified four factors, namely Factor 1 (Impact), Factor 2 (Occurrence), Factor 3 (Evidence), and Factor 4 (Threat), and accounted for 14.96%, 8.27%, 6.41%, 3.50% of the variance, respectively, with a cumulative variance of 33.14%. The study concludes that farmers are aware of the incidence of climate change and are adopting different techniques in response to the different climate changes observed. This study also recommends the identification of specific climate change adaptations and the scaling of interventions for adaptation and mitigation. [ABSTRACT FROM AUTHOR]

Sierra Leone is an electricity-poor country with one of the lowest electricity consumption per capita rates across sub-Saharan Africa. Yet, with ambitious targets to transform and stimulate its economy in the coming decades, energy demand forecasting becomes an integral component of successful energy planning. Through applying the MAED-D (version 2.0.0) demand software, this research study aims to generate Sierra Leone's electricity demand forecasts from 2023 to 2050. Three novel scenarios (baseline-, high-, and low-demand) are developed based on socio-economic and technical parameters. The baseline scenario considers the current electricity sector as business-as-usual; the high-demand scenario examines an ambitious development future with increased economic diversification and mechanisation, and the low-demand scenario examines more reserved future development. The modelled scenario results project an increase in electricity demand ranging from 7.32 PJ and 12.23 PJ to 5.53 PJ for the baseline-, high-, and low-demand scenarios, respectively, by 2050. This paper provides a base set of best-available data needed to produce an electricity demand model for Sierra Leone which can be used as a capacity-building tool for in-country energy planning alongside further integration into data modelling pipelines. [ABSTRACT FROM AUTHOR]

In this paper, we studied the scandium adsorption from aqueous solutions on the surface of low-temperature-activated alumina products (GDAH). The GDAH samples are industrially manufactured, coming from the Bayer production cycle of the Sierra Leone bauxite as aluminium hydroxide, and further, by drying, milling, classifying and thermally treating up to dehydroxilated alumina products at low temperature. All experiments related to hydroxide aluminium activation were conducted at temperature values of 260, 300 and 400 °C on samples having the following particle sizes: <10 µm, 20 µm, <45 µm and <150 µm, respectively. The low-temperature-activated alumina products were characterised, and the results were published in our previous papers. In this paper, we studied the scandium adsorption process on the above materials and related thermodynamic and kinetic studies. [ABSTRACT FROM AUTHOR]

The paper examines the health system's response to COVID-19 in Sierra Leone. It aims to explore how the pandemic affected service delivery, health workers, patient access to services, leadership, and governance. It also examines to what extent the legacy of the 2013–16 Ebola outbreak influenced the COVID-19 response and public perception. Using the WHO Health System Building Blocks Framework, we conducted a qualitative study in Sierra Leone where semi-structured interviews were conducted with health workers, policymakers, and patients between Oct-Dec 2020. We applied thematic analysis using both deductive and inductive approaches. Twelve themes emerged from the analysis: nine on the WHO building blocks, two on patients' experiences, and one on Ebola. We found that routine services were impacted by enhanced infection prevention control measures. Health workers faced additional responsibilities and training needs. Communication and decision-making within facilities were reported to be coordinated and effective, although updates cascading from the national level to facilities were lacking. In contrast with previous health emergencies which were heavily influenced by international organisations, we found that the COVID-19 response was led by the national leadership. Experiences of Ebola resulted in less fear of COVID-19 and a greater understanding of public health measures. However, these measures also negatively affected patients' livelihoods and their willingness to visit facilities. We conclude, it is important to address existing challenges in the health system such as resources that affect the capacity of health systems to respond to emergencies. Prioritising the well-being of health workers and the continued provision of essential routine health services is important. The socio-economic impact of public health measures on the population needs to be considered before measures are implemented. [ABSTRACT FROM AUTHOR]

Background: COVID-19 vaccine coverage in low- and middle-income countries continues to be challenging. As supplies increase, coverage is increasingly becoming determined by rollout capacity. Methods: We developed a deterministic compartmental model of COVID-19 transmission to explore how age-, risk-, and dose-specific vaccine prioritisation strategies can minimise severe outcomes of COVID-19 in Sierra Leone. Results: Prioritising booster doses to older adults and adults with comorbidities could reduce the incidence of severe disease by 23% and deaths by 34% compared to the use of these doses as primary doses for all adults. Providing a booster dose to pregnant women who present to antenatal care could prevent 38% of neonatal deaths associated with COVID-19 infection during pregnancy. The vaccination of children is not justified unless there is sufficient supply to not affect doses delivered to adults. Conclusions: Our paper supports current WHO SAGE vaccine prioritisation guidelines (released January 2022). Individuals who are at the highest risk of developing severe outcomes should be prioritised, and opportunistic vaccination strategies considered in settings with limited rollout capacity. [ABSTRACT FROM AUTHOR]

Introduction: Act to End NTDs | West, a USAID-funded program that supports national governments to eliminate or control five neglected tropical diseases (NTDs) in West Africa including trachoma, lymphatic filariasis (LF), onchocerciasis, schistosomiasis and soil-transmitted helminthiasis, conducted a gender and social inclusion analysis to determine how NTDs differentially impact various populations and how gender and social norms impact NTD programs to inform future programming. Methods: The study used a mixed methods approach including a literature review; primary qualitative data collection; and monitoring data in Côte d'Ivoire, Sierra Leone, and Ghana. Results: Women and girls face additional health risks from many NTDs compared to men and boys. In addition to differential health burden, the social and economic impacts of NTD-related disability or infertility can be particularly dire for women and girls. Men were somewhat less likely to participate in mass drug administration (MDAs) due to: lack of information about campaigns, lack of access due to work, and higher levels of mistrust of the government and concerns about side effects of the medicines. Pregnant and breastfeeding women were sometimes excluded by community drug distributors (CDDs) from certain types of MDAs for which they are eligible. Training participation rates for CDDs and supervisors were universally higher for men than women, even though feedback on the effectiveness of female CDDs was overwhelmingly positive, and female CDDs often have more access to other women in conservative households. The role of a CDD can lead to career and social opportunities for women. However, challenges faced by CDDs were seen as a greater barrier for women, including transportation, safety, household responsibilities, lower education levels, and low or lack of wages. Discussion: Programs to address NTDs can promote equity and improve programming by increasing women's participation as CDDs and providing financial compensation. Additionally, programs should prioritize inclusive training for CDDs, and inclusive messaging about MDA for communities. Author summary: The Act to End NTDs | West program supports USAID's efforts to control or eliminate trachoma, lymphatic filariasis (LF), onchocerciasis, schistosomiasis and soil-transmitted helminthiasis in 11 West African countries using mass drug administration.Act | West conducted a gender and social inclusion analysis to inform a strategy for the program to improve outcomes and more meaningfully engage and empower women and marginalized individuals in program implementation. Our objective was to identify how gender and social norms and stigma differentially impact men's and women's adoption of healthy practices around NTD prevention, use of NTD services, participation in programing, and opportunities to engage in identifying solutions, using an intersectional lens inclusive of disability, ethnic identity, and geographic location. Several studies have looked at gender dimensions of staffing for NTD programming, analyzed differential risk factors and prevalence of NTDs between males and females, or presented data on gender and national mass drug administration (MDA) coverage to combat NTDs. This paper aims to consolidate these findings through a literature review as well as a qualitative study conducted in Côte d'Ivoire, Ghana, and Sierra Leone, to provide a comprehensive look at gender and social inclusion within NTD programming across various contexts and diseases. This study found that women and girls face additional health risks from five NTDs compared to men and boys. In addition to the health burden, the social and economic impacts of NTD-related disability or infertility can be particularly severe for women and girls. Additionally, men were somewhat less likely to participate in mass drug administration (MDAs) and pregnant and breastfeeding women were sometimes excluded by community drug distributors (CDDs) from certain types of MDAs for which they are eligible due to misunderstanding on the part of CDDs and community members on eligibility criteria. Training participation rates for CDDs and supervisors were universally higher for men than women, even though feedback on the effectiveness of female CDDs was overwhelmingly positive, and female CDDs often have more access to other women in conservative households. Additionally, challenges faced by CDDs were seen as a greater barrier for women to serve in that capacity. [ABSTRACT FROM AUTHOR]

At the height of the Ebola epidemic in Sierra Leone in November 2014, a new decentralized approach to ending infection chains was adopted. This approach was based on building local, small-scale Community Care Centres (CCC) intended to serve as triage units for safe handling of patients waiting for test results, with subsequent transfer to Ebola Treatment Centers (ETC) for those who tested positive for Ebola. This paper deals with local response to the CCC, and explains, through qualitative analysis of focus group data sets, why this development was seen, locally, in a positive light. The responses of 562 focus group participants in seven villages with CCC and seven neighbouring control villages without CCC are assessed. These data confirm that CCC are compatible with community values concerning access to, and family care for, the sick. Mixed reactions are reported in the case of "safe burial", a process that directly challenged ritual activity seen as vital to maintaining good relations between socially-enclaved rural families. Land acquisitions to build CCC prompted divided responses. This reflects problems about land ownership unresolved since colonial times between communities and government. The study provides insights into how gaps in understanding between international Ebola responders and local communities can be bridged. Author summary: Control of Ebola Virus Disease requires facilities where patients can be isolated and treated safely, without risk to medical personnel or family members. In the 2014–15 Ebola epidemic in Sierra Leone emphasis was at first placed on large field hospitals known as Ebola Treatment Centers (ETC). These were often located far from areas where new cases were being discovered. Patients were distrustful of their purpose and slow to report, and the disease continued to spread. Six months into the epidemic a new approach was tried, based on much smaller and more rapidly constructed centres (Community Care Centres (CCC) located where new cases were occurring. This paper examines community reactions to the CCC. There was a much greater sense of community ownership of these small, localised centres, and reporting times improved. Families were able easily to visit and observe activities, even though restricted from crossing red lines. The staff were often local and provided trustworthy information on the progress of patients. Families were able to prepare home food for patients, and this was thought to improve their morale and chances of survival. CCC were also appreciated for treating other disease, and not only Ebola. Referral of patients to ETC was easier to accept when the outcome of an Ebola blood test was known. There were some differences of opinion over "safe burial" procedures and acquisition of sites for the CCC, but on balance CCC were well accepted by communities, and were seen locally as a positive development in Ebola control. [ABSTRACT FROM AUTHOR]

Despite being critical responders in humanitarian crises, local youths are continually left out of the humanitarian action agenda. This paper used a qualitative methodology to investigate local youths' role in humanitarian response and their impacts and assessed how humanitarian actors influence the effectiveness of youth engagement. The data was collected through semi-structured interviews with local youths who participated in the Ebola response in Sierra Leone. Findings showed that young people are significantly contributing to crises response. However, they lack an enabling environment and support system to convert their skills into valuable humanitarian resources efficiently. Therefore, despite the rhetoric that many reports and policies reflect, this study establishes that the realities of youth engagement in humanitarian activities are often misunderstood and controlled for the self-interest of different actors other than youths themselves. It advocates for a renewed focus and support for young people's skills as paramount for effective humanitarian response and building back resilient communities after emergencies. Besides, engaging local youths in tackling crises empowers them with transferable skills and stimulates their passion for participating in development issues within their communities. [ABSTRACT FROM AUTHOR]

This paper explores the intricate relationship between macroeconomic indicators and imperfect competition in Sierra Leone, employing a prototype of an imperfect competition structural model within the New Keynesian framework. The model incorporates nominal and real rigidities, as well as market failures. Results indicate that Sierra Leone's imperfectly competitive market introduces inefficiencies, leading to a muted initial impact of productivity shocks on macroeconomic variables. Wages and real interest rates exhibit moderated adjustments due to deviations from perfect competition ideals, dampening the effects on investment, consumption, and output. Policy and transition functions reveal a lasting influence of past capital accumulation and external shocks on aggregate output. The analysis exposes inertia in investment decisions and strategic actions of dominant firms. Steady-state results affirm a stable equilibrium in Sierra Leone, and eigenvalues exceeding unity underscore the model's ability to capture anticipatory behavior in imperfect market competition. The correlation matrix highlights profound connections between economic activity, wages, and capital's role in growth. Theoretical moments demonstrate economic indicator variability, emphasizing dominant firms' influence on capital allocation and policy measures' role in stabilizing interest rates and labor markets. The covariance matrix of exogenous shocks underscores external influences' persistence and correlated impacts on Sierra Leone's economy. These findings stress the importance of tailored policy responses to address market imperfections, advocating for measures to promote competition, labor market flexibility, dynamic investment, and stabilization of interest rates and labor markets. [ABSTRACT FROM AUTHOR]

Background: The manifestation and spread of neuroinvasive circulating vaccine-derived polioviruses (cVDPVs) across several countries, which led to the emergency use of the novel oral polio vaccine type 2 (nOPV2), raised concerns about adverse events following immunization (AEFI) surveillance. We assessed the attributes of AEFI with nOPV2 and examined stakeholder experiences and challenges in AEFI surveillance in Sierra Leone. Methods: Using a mixed method approach, we retrospectively reviewed passive data collected during a 2021 immunization campaign, and conducted semi-structured, interviews with vaccinators, district AEFI focal persons, and key stakeholders at the national Expanded Program on Immunization and the National Medicines Regulatory Authority. AEFI were categorized using the Medical Dictionary for Regulatory Activities (MedDRA) Preferred Terms (PTs) and System Organ Class (SOC). Outcomes were stratified as recovered or not, with preventability and causality assessed using the Schumock and Thornton and World Health Organization (WHO) algorithms, respectively. Results: A total of 528 suspected AEFI were documented, predominantly affecting children aged 28 days to 23 months (63.3%). Most reported AEFI were administration site conditions and general disorders, with pyrexia being the predominant PT. Of 80 serious cases, 78 recovered, with 74 having an inconsistent causal relationship with the vaccine. Most serious cases (78) were deemed non-preventable, with only two being probably preventable. AEFI reporting was not routinely carried out across the group of people interviewed. AEFI reporting was not consistently performed, with discrepancies in defining reportable events and confusion over responsibility. Challenges with the open data kit (ODK) platform were noted, along with perceived inadequacies in training. Conclusion: While the nOPV2 is relatively new, the majority of AEFI were not serious, and most serious cases were not causally linked to the vaccine. Participants exhibited variations in experience and awareness of AEFI reporting. [ABSTRACT FROM AUTHOR]

Substandard and falsified (SF) medical products pose a major threat to public health and socioeconomic development, particularly in low- and middle-income countries. In response, public education campaigns have been developed to alert consumers about the risks of SF medicines and provide guidance on 'safer' practices, along with other demand- and supply-side measures. However, little is currently known about the potential effectiveness of such campaigns while structural constraints to accessing quality-assured medicines persist. This paper analyses survey data on medicine purchasing practices, information and constraints from four African countries (Ghana, Nigeria, Sierra Leone and Uganda; n  > 1000 per country). Using multivariate regression and structural equation modelling, we present what we believe to be the first attempt to tease apart, statistically, the effects of an information gap vs structural constraints in driving potential public exposure to SF medicines. The analysis confirms that less privileged groups (including, variously, those in rural settlements, with low levels of formal education, not in paid employment, often women and households with a disability or long-term sickness) are disproportionately potentially exposed to SF medicines; these same demographic groups also tend to have lower levels of awareness and experience greater levels of constraint. Despite the constraints, our models suggest that public health education may have an important role to play in modifying some (but not all) risky practices. Appropriately targeted public messaging can thus be a useful part of the toolbox in the fight against SF medicines, but it can only work effectively in combination with wider-reaching reforms to address higher-level vulnerabilities in pharmaceutical supply chains in Africa and expand access to quality-assured public-sector health services. [ABSTRACT FROM AUTHOR]

The patas monkey (Erythrocebus patas) is endemic to tropical Africa and includes three recognized subspecies (pyrrhonotus, patas, villiersi). This paper presents evidence to extend the geographic range of the western or West African patas monkey (Erythrocebus patas patas) 60 km southwest to include Outamba Kilimi National Park, central north Sierra Leone, West Africa. In 2018 and 2022 we conducted interviews with photo elicitation exercises with a total of 363 adult residents of Outamba Kilimi National Park to identify reported wildlife species present and inform camera trapping locations. Since May 2018, 25 camera traps have been placed throughout the Outamba Section of Outamba Kilimi National Park. Further research using both biological and social science methods is needed to accurately assess the conservation status of patas monkeys in Sierra Leone. [ABSTRACT FROM AUTHOR]

It is critical to have land policies that facilitate access to and effective control of land and other natural resources in order to achieve inclusive growth and eradicate poverty. It is well known that discrimination in land rights occurs globally, both in formal and customary settings. The reason for this is that land rights are either strong or weak and are held by a variety of groups of people. It is the weaker variants of the inequalities that stifle tenure security, reduce land use, and threaten the food security of those who depend on the land to survive. Goal and objectives: This study looks at improved land reforms to the benefit of women´s access to land to foster and support social norm change in Sierra Leone. Methodology: A Cross-sectional research design was used for data collection. Quantitative data was analyzed descriptively; while, qualitative data was analyzed using content analysis. A household's survey across the settlements for semi-structured questionnaire administration. In-depth interview of the various category of women and household heads through a purposive sampling technique. Key informant interviews (KII) consisted of local leaders, household heads, women leaders and community land owners. An unrefined search using keywords through JSTOR, Google Scholar, Research Gate and UNILAG database yielded search results of journals, book chapters and research reports on the subject. This was restricted to the utilization of accessible resources drawing on sources from different scholastic disciplines while performing an area audit. Results: The results of the study indicated that the principle that statutory reforms automatically take precedence over other laws in cases where there is a conflict between laws seems to remain on paper here. When it comes to land, informal and customary arrangements dominate and custom is seen to be powerful, authoritative and even unshakable. Even with the current gender-equitable legal framework, proper implementation of these laws is often lacking and enforcement institutions are weak. Therefore, it is recommended that increased efforts is needed to assist women in exercising their legal rights, such as addressing norms and customs regarding the manner in which women acquire land (such as through purchase or inheritance), the quality of the land they receive, and the manner in which land is transferred upon marriage or the death of a spouse. [ABSTRACT FROM AUTHOR]

In 2021, a patient died from Marburg virus (MARV) disease in Guinea and it was the first confirmed case in West Africa. The origin of the outbreak has not been identified. It was revealed that the patient didn't travel anywhere before the illness. Prior to outbreak, MARV had been found in bats in the neighboring Sierra Leone, but never in Guinea. Therefore, the origin of infection is unclear: was it an autochthonous case with spillover from a local population of bats or an imported case with spillover from fruit bats foraging/migrating from Sierra Leone? In this paper, we studied Rousettus aegyptiacus in Guinea as the possible source of MARV infection caused the patient death in 2021 in Guinea. We caught bats in 32 sites of Guéckédou prefecture, including seven caves and 25 locations of the flight path. A total of 501 fruit bats (Pteropodidae) were captured, including 66 R. aegyptiacus. The PCR screening showed three positive MARV R. aegyptiacus, roosting in two caves discovered in Guéckédou prefecture. After Sanger sequencing and phylogenetic analyses it was shown that found MARV belongs to the Angola-like lineage but it is not identical to the isolate obtained during the outbreak of 2021. Author summary: In 2020, MARV was first detected in fruit bats in Sierra Leone (West Africa). One year later, first outbreak of MARV in West Africa was registered in the neighboring Guinea after a man's death in the Temessadou M'bokét village. The source of the outbreak has not been identified. It is known, that the reservoir animal of MARV is the cave-dwelling bat Rousettus aegyptiacus, and typically, MARV disease outbreaks emerge after a visit of the index patient to a cave or mine. In our work, we studied bats in the vicinity of this village for the presence of the MARV. A cave hosting a colony of R. aegyptiacus was found close to the Temessadou M'bokét village (~4.5 km). Sampling and PCR screening of the bats from the colony identified three MARV-positive bats. The cave is inaccessible to humans; therefore, the index patient could not have been infected upon visit. We assume that the patient was infected outside the cave after direct or indirect contact with an infected bat of the same colony. These results provide the basis for preventive measures against new MARV outbreaks in Guinea. [ABSTRACT FROM AUTHOR]

Background: In recent years a growing number of manufacturers and medical abortion products have entered country markets and health systems, with varying degrees of quality and accessibility. An interplay of factors including pharmaceutical regulations, abortion laws, government policies and service delivery guidelines and provider's knowledge and practices influence the availability of medical abortion medicines. We assessed the availability of medical abortion in eight countries to increase understanding among policymakers of the need to improve availability and affordability of quality-assured medical abortion products at regional and national levels. Methods: Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines in Bangladesh, Liberia, Malawi, Nepal, Nigeria, Rwanda, Sierra Leone and South Africa between September 2019 and January 2020. Results: Registration of abortion medicines—misoprostol or a combination of mifepristone and misoprostol—was established in all countries assessed, except Rwanda. Mifepristone and misoprostol regimen for medical abortion was identified on the national essential medicines list/standard treatment guidelines for South Africa as well as in specific abortion care service and delivery guidelines for Bangladesh, Nepal, Nigeria, and Rwanda. In Liberia, Malawi, and Sierra Leone—countries with highly restrictive abortion laws and no abortion service delivery guidelines or training curricula—no government-supported training on medical abortion for public sector providers had occurred. Instead, training on medical abortion was either limited in scope to select private sector providers and pharmacists or prohibited. Community awareness activities on medical abortion have been limited in scope across the countries assessed and where abortion is broadly legal, most women do not know that it is an option. Conclusion: Understanding the factors that influence the availability of medical abortion medicines is important to support policymakers improve availability of these medicines. The landscape assessments documented that medical abortion commodities can be uniquely impacted by the laws, policies, values, and degree of restrictions placed on service delivery programs. Results of the assessments can guide actions to improve access. Plain Language Summary: Unsafe abortion is a leading cause of death and disability among women of reproductive age. Medical management of abortion with mifepristone and misoprostol pills, or just misoprostol, is a safe and effective way to end a pregnancy. Owing to an increase in the number of medical abortion products that have entered country health systems, we examined access to these medicines from supply to demand in selected countries. The overarching goal of the national landscape assessments was to produce evidence to support advocacy efforts and policymaking for improved access to quality medical abortion products that is appropriate to the needs of the country. This paper aims to describe key findings across eight country settings on the availability of medical abortion medicines and identify key opportunities to improve access to them across countries. [ABSTRACT FROM AUTHOR]

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Purpose: The purpose of this paper is to explore perceptions and lived experiences of Sierra Leonean chartered and aspiring accountants, vis-à-vis their professional identity with a particular focus on two elements of postcolonial theory, hybridity and diaspora. Design/methodology/approach: A qualitative methodological framework was employed. Semi-structured interviews were conducted with 18 participants about their perceptions of their professional identity and their professional experiences both within and outside Sierra Leone. Findings: The current professionalisation process is conceptualised as a postcolonial third space where hybrid professional accountants are constructed. Professional hybridity blurs the local/global praxis being positioned as both local and global accountants. Participants experience difficulty "fitting into" the local accountancy context as a consequence of their hybridisation. As such, a diaspora effect is induced which often culminates in emigration to advanced countries. The paper concludes that although the current model engenders emancipatory social movements for individuals through hybridity and diaspora, it is nonetheless counterproductive for Sierra Leone's economic development and the local profession in particular. Research limitations/implications: This study has significant implications for understanding how the intervention of global professional bodies in developing countries shapes the professionalisation process as well as perceptions and lived experiences of chartered and aspiring accountants in these countries. Originality/value: While extant literature implicates the legacies of colonialism/imperialism on the institutional development of accountancy (represented by recognised professional bodies), this paper employs the critical lens of postcolonial theory to conceptualise the lived experiences of individuals who are directly impacted by such institutional arrangements. [ABSTRACT FROM AUTHOR]

Background: Verbal autopsies (VAs) can provide important epidemiological information about the causes of child deaths. Though studies have been conducted to assess the validity of various types of VAs, the programmatic experience of engaging local communities in collecting and using VA has received little attention in the published literature. Concern Worldwide, an international non-governmental organization (NGO), in collaboration with the Ministry of Health and Sanitation (MOHS), has implemented a VA protocol in five urban slums of Freetown, Sierra Leone. This paper provides VA results and describes lessons learned from the VA process.Methods: Under-five child deaths were registered by Community Health Workers (CHWs) in five urban slums between 2014 and 2017, and a specially trained local clinician used a VA protocol to interview caretakers. Symptoms were analysed using InterVA-4 computerized algorithm, a probabilistic expert-driven model to determine the most likely cause of death. Themes in care-seeking were extracted from multiple-choice and open-ended questions. VAs were implemented in collaboration with the community and the results were shared with community stakeholders in participatory review meetings.Results: Main challenges included limitations in death notification and capacity to conduct VA for all notified deaths. A total of 215 VA were available for analysis. Among 79 neonatal deaths aged 0-27 days, the most common cause of death was neonatal pneumonia (55%); among 136 children deaths aged 1-4 years, the most common causes were malaria (56%) and pneumonia (41%). Key themes in care-seeking identified included use of traditional medicine (14% of deaths), absence of care-seeking (23% of deaths), and difficultly reaching the health facility (8% of deaths that occurred at home) during fatal illness.Conclusions: Conducting VAs as a collaborative process with communities is challenging but can provide valuable data that can be used for local-level decision-making. The findings have practical implications for engaging the community and CHWs in reducing the number of these preventable deaths through expanded efforts at prevention, early and appropriate treatment, and reduction of barriers to care-seeking. A functional end-to-end VA system can enhance meaningful routine vital events monitoring by community, national, and international stakeholders. [ABSTRACT FROM AUTHOR]

Concerns for human health and food safety are gaining momentum in emerging and developing nations as well as in food research due to the reputations that products have established over time. Understanding cross-cultural consumers' purchasing behaviour for chicken meat (CM) could provide valuable insights into the global food sector since it is the most consumed meat worldwide. This study examines the effect of buying features (BF), culture factors, behavioural attitudes (BA), subjective norms (SN) and perceived behavioural control (BC) on CM actual purchase behaviour (APB) in China and Sierra Leone. Primary data were sourced from 588 Chinese and 410 Sierra Leonean participants. We adopt structural equation modelling (SEM) to verify the model and test the associations between the variables. The SEM results confirm that BF, BA, SN and BC stimulate customers' intent and actual purchase of CM in both nations. The findings indicate that cultural factors (CF) significantly moderates the association between the independent constructs (BF, BA, SN and BC) and APB in Sierra Leonean markets. This study provides significant insights for chicken industry stakeholders that can help them increase CM sales along the supply chain via a marketing strategy focused on cultural and psychological factors. [ABSTRACT FROM AUTHOR]

Leadership by health professionals is key in any health system, but health leadership training programmes are varied in their conceptualisation, learning objectives, and design. This paper describes an undergraduate leadership and management module for health students at the University of Sierra Leone and provides lessons from the design process. Our methods included an initial scoping review and qualitative study, followed by a co-design process of 10 workshops and 17 consultation meetings. The result was a curriculum with learning outcomes emphasising leadership identity, proactiveness, management of people and of change, and the formation of peer relationships. Learning methods included group teaching, team quality improvement projects, mentoring, and reflective practice. Lessons from the design process included the importance of support from university leadership and extensive consultation. Virtual workshops enabled broader participation but limited relationship building. Integrating doctoral research into the process facilitated inclusion of evidence and theory but risked reducing ownership by faculty. The importance of interprofessionalism and management skills in leadership training emerged during the process, illustrating the effectiveness of a co-design approach. Our programme is broadly aligned with other health leadership frameworks and is distinctive due to its undergraduate focus, offering insights for leadership training design in other settings. [ABSTRACT FROM AUTHOR]

Disarmament, demobilisation and reintegration (DDR) programmes are necessary in states that experience armed conflict. Several post-conflict societies are usually characterised by the activities of individuals who undermine state building efforts and prefer to work against joint problem solving aimed at sustaining peace. The study explores the change and continuity in the DDR programme and prospects for sustainable peace in Sierra Leone. With primary and secondary sources, including key informant interview with a former Minister, the paper responds to these questions: To what extent did remobilisation undermine peace agreements? How were the weapons and ex-combatants controlled by the government? What were the lessons and challenges of the DDR programme? How are the stakeholders sustaining post-DDR peace at the community level? The success of the state building was occasioned by the joint problem solving approach adopted by the National Committee for Disarmament, Demobilisation and Reintegration (NCDDR), ECOMOG troops, the UN Observer Mission in Sierra Leon, and other stakeholders at the community level. This paper stresses that the remobilisation of ex-combatants increased the intensity of the war which necessitated more external intervention to create enabling environment for state building and security sector reforms. Sustaining peace in Sierra Leone demands continuous empowerment of youths and their active involvement in informal peace education. Post-DDR peacebuilding should be more youthfocused and development oriented to prevent the resurgence of armed conflicts. [ABSTRACT FROM AUTHOR]

Background: The 2013–15 Ebola epidemic in West Africa was the largest so far recorded, and mainly affected three adjacent countries, Guinea, Liberia and Sierra Leone. The worst affected country (in terms of confirmed cases) was Sierra Leone. The present paper looks at the epidemic in Sierra Leone. The epidemic in this country was a concatenation of local outbreaks. These local outbreaks are not well characterized through analysis using standard numerical techniques. In part, this reflects difficulties in record collection at the height of the epidemic. This paper offers a different approach, based on application of field-based techniques of social investigation that provide a richer understanding of the epidemic. Methods: In a post-epidemic study (2016–18) of two districts (Bo and Moyamba) we use ethnographic data to reconstruct local infection pathways from evidence provided by affected communities, cross-referenced to records of the epidemic retained by the National Ebola Response Commission, now lodged in the Ebola Museum and Archive at Njala University. Our study documents and discusses local social and contextual factors largely missing from previously published studies. Results: Our major finding is that the epidemic in Sierra Leone was a series of local outbreaks, some of which were better contained than others. In those that were not well contained, a number of contingent factors helps explain loss of control. Several numerical studies have drawn attention to the importance of local heterogeneities in the Sierra Leone Ebola epidemic. Our qualitative study throws specific light on a number of elements that explain these heterogeneities: the role of externalities, health system deficiencies, cultural considerations and local coping capacities. Conclusions: Social issues and local contingencies explain the spread of Ebola in Sierra Leone and are key to understanding heterogeneities in epidemiological data. Integrating ethnographic research into epidemic-response is critical to properly understand the patterns of spread and the opportunities to intervene. This conclusion has significant implications for future interdisciplinary research and interpretation of standard numerical data, and consequently for control of epidemic outbreaks. [ABSTRACT FROM AUTHOR]

In this paper we bring together ethnographic research carried out during two clinical prevention trials to explore identities, relations and political imaginations that were brought to life by these different technologies. We highlight the ways in which critical anthropological engagement in clinical trials can help us radically reconsider the parameters and standards of medical research. In the paper we analyse the very different circumstances that made these two trials possible, highlighting the different temporalities and politics of HIV and Ebola as epidemics. We then describe four themes revealed by ethnographic research with participants and their communities but mediated by the specific sociopolitical contexts in which the trials were taking place. In both countries we found materiality and notions of exchange to be important to participants' understanding of the value of medical research and their role within it. These dynamics were governed through social relations and moral economies that also underpinned challenges to Western notions of research ethics. The clinical trials offered a language to express both disaffection and disillusionment with the political status quo (often through rumours and anxieties) while at the same time setting the foundations for alternative visions of citizenship. Attached to these were expressions of 'uncertainty and hope' steeped in locally distinctive notions of destiny and expectations of the future. [ABSTRACT FROM AUTHOR]

Background: The 2014-2016 Ebola epidemic in West Africa was the largest Ebola epidemic to date. Contact tracing was a core surveillance activity. Challenges with paper-based contact tracing systems include incomplete identification of contacts, delays in communication and response, loss of contact lists, inadequate data collection and transcription errors. The aim of this study was to design and evaluate an electronic system for tracing contacts of Ebola cases in Port Loko District, Sierra Leone, and to compare this with the existing paper-based system. The electronic system featured data capture using a smartphone application, linked to an alert system to notify the District Ebola Response Centre of symptomatic contacts.Methods: The intervention was a customised three-tier smartphone application developed using Dimagi's CommCare platform known as the Ebola Contact Tracing application (ECT app). Eligible study participants were all 26 Contact Tracing Coordinators (CTCs) and 86 Contact Tracers (CTs) working in the 11 Chiefdoms of Port Loko District during the study period (April-August 2015). Case detection was from 13th April to 17th July 2015. The CTCs and their CTs were provided with smartphones installed with the ECT app which was used to conduct contact tracing activities. Completeness and timeliness of contact tracing using the app were compared with data from April 13th-June 7th 2015, when the standard paper-based system was used.Results: For 25 laboratory-confirmed cases for whom paper-based contact tracing was conducted, data for only 39% of 408 contacts were returned to the District, and data were often incomplete. For 16 cases for whom app-based contact tracing was conducted, 63% of 556 contacts were recorded as having been visited on the app, and the median recorded duration from case confirmation to first contact visit was 70 h.Conclusion: There were considerable challenges to conducting high-quality contact tracing in this setting using either the paper-based or the app-based system. However, the study demonstrated that it was possible to implement mobile health (mHealth) in this emergency setting. The app had the benefits of improved data completeness, storage and accuracy, but the challenges of using an app in this setting and epidemic context were substantial. [ABSTRACT FROM AUTHOR]

Remote area electrification is a crucial need in sub-Saharan Africa's drive to attain universal electrification. In Sierra Leone, with a rural population of over 5 million, the electrification rate accounts for less than 10% of the total inhabitants. This paper presents a comparative techno-economic analysis carried out to determine the most feasible of four individual options for off-grid mini-grid power generation system utilizing sources that include: Solar Photo Voltaic (SPV), Diesel Generator (DG), and Battery Storage (BS) system, to provide electricity for a rural and remote village located in the northwestern part of Sierra Leone (longitude 9.1°W and latitude 12.6°N), with an average daily solar irradiance between 4.6 and 6 kWh/m2/day. An assessment of the total electrical load estimated an expected daily consumption of 178 kWh. Simulation, optimization, and sensitivity analyses of each one of the individual power generation systems were carried out using HOMER software. Economic parameters such as Cost of Capital (CC), Net Present Cost (NPC), Levelized Cost of Electricity (LCOE)), technical parameters (energy production characteristics), and greenhouse gases emissions were compared and analyzed. Key findings from the simulation result indicate that systems consisting of DG only ($29,750) and SPV/BS ($110,131) obtained the least and highest CC, respectively. Similarly, in a respective manner, the highest and least NPC were obtained for systems with DG only ($496,336) and PV/DG/BS ($152,491) over a 25-year project lifetime. Furthermore, the least LCOE was obtained for the system comprising PV/DG/BS ($0.336/kWh). With an expected annual generation of (75,121 kWh), PV/DG/BS was obtained to be the most optimal solution. The sensitivity analysis observed that a reduction in the discount rate consequently reduces the LCOE of such a system. Furthermore, the model accounts for a 90% renewable energy fraction, with a significant reduction in the amount of annual GHG emissions, when compared with a generation system using diesel generator only. [ABSTRACT FROM AUTHOR]

Recycling of waste plastics has become vital due to the threat to the environment the huge piles of those wastes represent, with research revealing High-Density Polyethylene (HDPEs) as the most dominant waste plastics. Because of their dominance and significant environmental impact, this paper reports the economic potential of recycling HDPE waste plastic into liquid fuels via pyrolysis. A risk and benefit assessment are presented to highlight whether the process has reasonable potential prior to the analysis of its corresponding finances. Aspen HYSYS simulation models were used as the basis for the analysis. From this, preliminary cost estimations for the net present value (NPV) of the process, its economic viability, were determined. It is shown that 100 kg/h of waste is not financially sustainable. Retailing the fuel product at a competitive price of £60/barrel would ultimately bankrupt the business. This is a consequence of the extremely high production cost of £198.40/barrel inducing the complete absence of profitability. Furthermore, the operating expenditure is found to be the root cause of the consequential financial decline, totalling £1.46 million per annum. The two most detrimental expenditures for the production cost of the pyrolysis oils were the wages of the skilled operating labour and higher utility fees incurred by the extreme temperature conditions. In addition, an unrealistically optimistic sale price of £300/barrel was also applied to ascertain a positive economic incentive. Even with the increased retail price, the process' profits are negligible and further highlight the detrimental effect of the undesirably high operational expenditures, once more signifying that the process should not commence in its current state. However, executing such a project in developing countries such as Sierra Leone, Senegal, or Kenya where utilities and manpower, among other operational components, are cheaper, is believed to complement the immense opportunity underlying pyrolysis oil production regarding production quantity and quality. [ABSTRACT FROM AUTHOR]

Effective and culturally appropriate hand-hygiene education is essential to promote health-related practices to control and prevent diseases such as Diarrhoea, Ebola and COVID-19. In this paper we outline and evaluate the Co-Creation processes underpinning a handwashing intervention for young children (A Germ's Journey) developed and delivered in India, Sierra Leone and the UK, and consider the implications surrounding Imperialist/Colonial discourse and the White Saviour Complex. The paper focuses both on the ways Co-Creation was conceptualised by our collaborators in all three countries and the catalysts and challenges encountered. Qualitative data have been drawn from in-depth interviews with five key stakeholders, focus group data from 37 teachers in Sierra Leone and responses to open-ended questionnaires completed by teachers in India (N = 66) and UK (N = 63). Data were analysed using thematic analysis and three themes, each with three constituent subthemes are presented. In the theme 'Representations of and Unique Approaches to Co-Creation' we explore the ways in which Co-Creation was constructed in relation to teamwork, innovative practice and more continuous models of evaluation. In 'Advantages of Co-Creation' we consider issues around shared ownership, improved outcomes and more meaningful insights alongside the mitigation of risks and short-circuiting of problems. In 'Challenges of Co-Creation' we discuss issues around timing and organisation, attracting and working with appropriate partners and understanding the importance of local context with inherent social, economic and structural barriers, especially in low-and-middle-income countries. We consider how theoretical elements of Co-Creation can inform effective international public health interventions; crucial during a global pandemic in which handwashing is the most effective method to control the transmission of COVID-19. Finally we reflect on some of the methodological challenges of our own work and in managing the potentially conflicting goals of the ethical and participatory values of Co-Creation with pragmatic considerations about ensuring an effective final 'product'. [ABSTRACT FROM AUTHOR]

Gender-based crimes occur to this day in armed conflicts across the globe. Forced marriages were rife in Sierra Leone, Cambodia, and Uganda, and a debate has emerged as to how they should be categorised in international criminal law (ICL). The main question this paper examines is: should forced marriages be categorised as 'sexual slavery' or 'other inhumane acts' in ICL? The principle of nullum crimen sine lege (the NCSL principle), is used as a tool by which judgments from international criminal tribunals and the ICC can be objectively assessed. Judges have generally held that it is more appropriate, in line with the NCSL principle, to categorise forced marriages as 'other inhumane acts'. However, the paper finds that they are relying on authorities which are competent in an international human rights law (IHRL) context, but are not directly transferrable to ICL. The paper illuminates the broader debate between certainty and development in ICL and demonstrates how the tribunals and the ICC have attempted to strike a balance in cases involving forced marriages. It seeks to provide a solution which ensures that perpetrators of forced marriages in armed conflict are convicted and justice is served and respects both certainty and IHRL. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this paper is to examine biological, maternal and socioeconomic determinants of infant mortality in Sierra Leone. Design/methodology/approach: It uses an analytical framework and Cox proportional hazards regression to break down the effects of factors determining infant mortality. Factors utilized in the empirical investigation include sex of the child, birth size, birth spacing, mother's working status, age of mother, antenatal care, postnatal care, mother's anemia level, religion, mother's education and wealth status. Findings: Results suggest that birth spacing of three years and above associated with a reduced risk of infant mortality contrasted with short birth intervals. Children born to nonanemic mothers have a lower hazard (22%) of infant mortality compared to those born to anemic mothers (HR = 0.78; 95% CI: 0.64–0.96). At least one antenatal care visit by mothers lowers infant mortality rate by 41% compared to no antenatal visits at all (HR = 0.59; 95% CI: 0.36–0.96). Similarly, infants whose mothers have received postnatal care are at lower risk (31%) of dying than those whose mothers have not received (HR = 0.69; 95% CI: 0.52, 0.93). Infant mortality is likely to decrease with the increase in the birth order. Practical implications: The family health and planning programs should aim at educating men and women about the usefulness of birth spacing methods. Originality/value: This paper might be the first attempt to analyze the determinants of infant mortality by utilizing a methodological framework and Cox regression. Peer review: The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-08-2019-0478. [ABSTRACT FROM AUTHOR]

Background: The growing burden of non-communicable diseases in low- and middle-income countries presents substantive challenges for health systems. This is also the case in fragile, post-conflict and post-Ebola Sierra Leone, where NCDs represent an increasingly significant disease burden (around 30% of adult men and women have raised blood pressure). To date, documentation of health system challenges and opportunities for NCD prevention and control is limited in such settings. This paper aims to identify opportunities and challenges in provision of NCD prevention and care and highlight lessons for Sierra Leone and other fragile states in the battle against the growing NCD epidemic. Methods: This paper focuses on the case of Sierra Leone and uses a combination of participatory group model building at national and district level, in rural and urban districts, interviews with 28 key informants and review of secondary data and documents. Data is analysed using the WHO's health system assessment guide for NCDs. Results: We highlight multiple challenges typical to those encountered in other fragile settings to the delivery of preventive and curative NCD services. There is limited government and donor commitment to financing and implementation of the national NCD policy and strategy, limited and poorly distributed health workforce and pharmaceuticals, high financial barriers for users, and lack of access to quality-assured medicines with consequent high recourse to private and informal care seeking. We identify how to strengthen the system within existing (low) resources, including through improved clinical guides and tools, more effective engagement with communities, and regulatory and fiscal measures. Conclusion: Our study suggests that NCD prevention and control is of low but increasing priority in Sierra Leone; challenges to addressing this burden relate to huge numbers with NCDs (especially hypertension) requiring care, overall resource constraints and wider systemic issues, including poorly supported primary care services and access barriers. In addition to securing and strengthening political will and commitment and directing more resources and attention towards this area, there is a need for in-depth exploratory and implementation research to shape and test NCD interventions in fragile and post-conflict settings. [ABSTRACT FROM AUTHOR]

With an estimated population of 8.3 million, Sierra Leone has no existing pharmaceutical manufacturing company at present. The recent COVID-19 pandemic brought to the limelight the fragility and weakness of the Sierra Leonean pharmaceutical industry as it resulted in severe drug shortages and medicine insecurity in the country due to the restrictions imposed on importations, which validates the uncertainties if the country can sufficiently meet its local pharmaceutical needs and health demands. In this paper, we highlight the current situation of the Sierra Leonean pharmaceutical sector and provide recommendations for the country towards building a functional pharmaceutical industry based on lessons learnt from the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Sexual and reproductive health is a challenge worldwide, and much progress is needed to reach the relevant UN Sustainable Development Goals. This paper presents cross-sectional data collected in Sierra Leone on sexual and gender-based violence (SGBV), family planning (FP), child, early and forced marriage (CEFM), and female genital mutilation (FGM) using an innovative method of measurement: situational judgment tests (SJTs), as a subset of questions within a larger survey tool. For the SJTs, respondents saw hypothetical scenarios on these themes and had to indicate how they would react. The objective is to give an impression of beliefs and norms on specific behaviors, which provide insights for social and behavior change interventions. Data was collected by enumerators traveling to villages randomly selected in six districts of the country. The sample is composed of 566 respondents. Results show that FGM in particular seem to be a priority topic, in comparison to the other topics for which the norms seem to be stronger against those practices. Age differences emerged and suggest priority groups to be targeted (e.g., on the topic of female genital mutilation, younger female respondents, and older male respondents gave the lowest coded responses which reflected to less appropriate behavior in our coding). In terms of validity of the measurement methods, situational judgment test answers correlated positively with other items in the survey, but the magnitude of the association is often small, and sometimes not significant. Thus, more studies are needed to further explore the validity of this measure by comparing against a reference value. Using SJTs could complement other data collection tools to perform community assessment, and orient the direction of the program in its planning phase. [ABSTRACT FROM AUTHOR]

Background: Breast-feeding holds considerable potential to reduce infant mortality. Feeding choices, already complex, take on additional complexity against a backdrop of the risk of transmissible Ebola Virus. This review describes the factors that influence infant feeding and attitudes of pregnant women, mothers, family members and health practitioners, policy makers and providers (midwives) concerning infant feeding when there is a risk of Mother-to-Child (MTC) transmission of Ebola Virus Disease (EVD). Methodology: A systematic review of qualitative studies identified through rigorous searches of thirteen online databases and additional citation searches of included studies was undertaken. Search terms included breast-feeding, breast-feeding, infant feeding; Ebola; and qualitative, interview(s) and findings. Independent extraction of data by two reviewers using predefined extraction forms. Studies were assessed using the CASP Qualitative checklist. Principal findings: 5219 references were screened. 38 references related specifically to Ebola, and five papers met the inclusion criteria with data gathered from two settings: Guinea and Sierra Leone. The EVD outbreak had a significant impact on beliefs, attitudes, and resources to support infant feeding practices negatively affecting the nutritional status of children. The evidence from these studies highlight the need for guidance and appropriate psychosocial support need to be available to mothers who display symptoms and become infected and to front-line staff who are giving advice. Communities need to be engaged because stigma and fear may hinder uptake of appropriate interventions. The EVD outbreak caused multi-level system disruption akin to that seen following a natural disaster, meaning that logistics and coordination are critical and need adequate resourcing. Food production and distribution, and malnutrition screening are also disrupted and thereby compounding compromised nutritional status. The limited number of relevant studies highlights the need for further primary research, particularly in translation of messages to local settings. Conclusions: An EVD outbreak causes multi-level disruption that negatively impacts infant feeding and child care practices. Negative impacts have multiple causes and successful planning for Ebola outbreaks requires that nutrition of infants and young children is a priority. Lessons from the Ebola pandemic have wider applicability to other pandemic contexts including Covid-19. Author summary: An Ebola outbreak has been likened to a natural disaster in its devastating impact on child health and nutritional status. The ease of transmission of a disease with a 50% mortality rate for those once infected raises particular challenges for breast-feeding women. This systematic review explored the attitudes and preferences of pregnant women, mothers, family members, health practitioners and policy makers concerning infant feeding during an Ebola epidemic as documented in qualitative studies. Participants reported confusion and inconsistent guidance regarding breast-feeding practice, together with difficulties in conveying recommendations to separate mothers infected with Ebola from their breast-feeding infants. Disruption impacted on access to supplementary and complementary feeds, health systems monitoring child growth and support to child health. Widespread distrust and suspicion of health professionals hindered health care provision. Wider family assumed roles in feeding and caring for young children, within the context of reduced access to nutritious foods and supplementary feeds. The work of humanitarian agencies, while valuable, lacked coordination. Planning for an Ebola outbreak requires advance preparation of health messaging for mothers and caregivers, coordinated provision of complementary feeds and support for families who assume caring responsibilities. Strategies to ensure linked up working between government and humanitarian agencies are essential. [ABSTRACT FROM AUTHOR]

The Sierra Leonean Civil War (1991 - 2002) war was brutal and dastardly on both sides. It left an untold hardship and humiliation on all the segments of society. Oftentimes, society views wars as men's affair. In Sierra Leone, the war had its horrendous effects on women - wives, mothers, breadwinners and concubines to the soldiers. Sexual slavery, forced marriages and rape were consequences of the war as over 257,000 women were sexually assaulted by the Revolutionary United Front (RUF). Rape as an aspect of genocide was used by the soldiers to impregnate women in order to weaken and eliminate the opposing side. The victims faced with physical and psychological trauma and social ostracism. Using the qualitative method of historical inquiry applied to extant primary and secondary sources such as official documents, newspapers and magazine articles, this paper analyses the experiences of women in Sierra Leone civil war and interrogates how these experiences tampered with the pristine life and existence of the women. The paper will also make extrapolations from theories on gender-based violence to elucidate on the relationship between gender roles in civil conflicts. [ABSTRACT FROM AUTHOR]

Strong leadership capabilities are essential for effective health services, yet definitions of leadership remain contested. Despite the acknowledged contextual specificity of leadership styles, most leadership theories draw heavily from Western conceptualizations. This cultural bias may attenuate the effectiveness of programmes intended to transform healthcare practice in Sub-Saharan Africa, where few empirical studies on health leadership have been conducted. This paper examines how effective leadership by doctors was perceived by stakeholders in one particular context, Sierra Leone. Drawing together extensive experience of in-country healthcare provision with a series of in-depth interviews with 27 Sierra Leonean doctors, we extended a grounded-theory approach to come to grips with the reach and relevance of contemporary leadership models in capturing the local experiences and relevance of leadership. We found that participants conceptualized leadership according to established leadership models, such as transformational and relational theories. However, participants also pointed to distinctive challenges attendant to healthcare provision in Sierra Leone that required specific leadership capabilities. Context-specific factors included health system breakdown, politicization in the health sector and lack of accountability, placing importance on skills such as persistence, role modelling and taking initiative. Participants also described pressure to behave in ways they deemed antithetical to their personal and professional values and also necessary in order to continue a career in the public sector. The challenge of navigating such ethical dilemmas was a defining feature of leadership in Sierra Leone. Our research demonstrates that while international leadership models were relevant in this context, there is strong emphasis on contingent or situational leadership theories. We further contribute to policy and practice by informing design of leadership development programmes and the establishment of a more enabling environment for medical leadership by governments and international donors. [ABSTRACT FROM AUTHOR]

Objective: Standardized pretest–posttest experimental designs with quantitative surveys are frequently applied to evaluate the effectiveness of health programs. However, this method is strongly informed by research on samples from Western, Educated, Industralized, Rich, and Democratic (WEIRD) societies and may not produce meaningful results in a distinct cultural, educational and socioeconomic context. Results: This paper reports several methodological challenges encountered along the research process of collecting quantitative survey data (i.e., during recruitment, obtaining informed consent, matching pretest–posttest data and data collection) for a mixed-methods field experiment on domestic handwashing in Sierra Leone. Ethical dilemmas of certain research practices are pointed out and potential solutions or alternatives are recommended for each challenge. Analysis of these challenges highlights the importance of reflecting on the aptness of research methodologies for non-WEIRD samples. While this is not to say that quantitative surveys are not suitable in a non-WEIRD context, their employment require considerable time for extensive pilot testing, involving local interviewers and participants in designing research projects and the modification of data collection strategies. [ABSTRACT FROM AUTHOR]

Pandemics have been recognized as a serious global threat to humanity. To effectively prevent the spread and outbreak of the epidemic disease, theoretical models intended to depict the disease dynamics have served as the main tools to understand its underlying mechanisms and thus interrupt its transmission. Two commonly-used models are mean-field compartmental models and agent-based models (ABM). The former ones are analytically tractable for describing the dynamics of subpopulations by cannot explicitly consider the details of individual movements. The latter one is mainly used to the spread of epidemics at a microscopic level but have limited simulation scale for the randomness of the results. To overcome current limitations, a hierarchical hybrid modeling and simulation method, combining mean-field compartmental model and ABM, is proposed in this paper. Based on this method, we build a hybrid model, which takes both individual heterogeneity and the dynamics of sub-populations into account. The proposed model also investigates the impact of combined interventions (i. e. vaccination and pre-deployment training) for healthcare workers (HCWs) on the spread of disease. Taking the case of 2014-2015 Ebola Virus Disease (EVD) in Sierra Leone as an example, we examine its spreading mechanism and evaluate the effect of prevention by our parameterized and validated hybrid model. According to our simulation results, an optimal combination of pre-job training and vaccination deployment strategy has been identified. To conclude, our hybrid model helps informing the synergistic disease control strategies and the corresponding hierarchical hybrid modeling and simulation method can further be used to understand the individual dynamics during epidemic spreading in large scale population and help inform disease control strategies for different infectious disease. [ABSTRACT FROM AUTHOR]

Background: Global health agendas have in common the goal of contributing to population health outcome improvement. In theory therefore, whenever possible, country level policy and program agenda setting, formulation and implementation towards their attainment should be synergistic such that efforts towards one agenda promote efforts towards the other agendas. Observation suggests that this is not what happens in practice. Potential synergies are often unrealized and fragmentation is not uncommon. In this paper we present findings from an exploration of how and why synergies and fragmentation occur in country level policy and program agenda setting, formulation and implementation for the global health agendas of Universal Health Coverage (UHC), Health Security (HS) and Health Promotion (HP) in Ghana and Sierra Leone. Our study design was a two country case study. Data collection involved document reviews and Key Informant interviews with national and sub-national level decision makers in both countries between July and December 2019. Additionally, in Ghana a stakeholder workshop in December 2019 was used to validate the draft analysis and conclusions.Results: National and global context, country health systems leadership and structure including resources were drivers of synergies and fragmentation. How global as well as country level actors mobilized power and exercised agency in policy and program agenda setting and implementation processes within country were also important drivers.Conclusions: There is potential in both countries to pull towards synergies and push against fragmentation in agenda setting, formulation and implementation of global health agendas despite the resource and other structural constraints. It however requires political and bureaucratic prioritization of synergies, as well as skilled leadership. It also requires considerable mobilization of country level actor exercise of agency to counter sometimes daunting contextual, systems and structural constraints. [ABSTRACT FROM AUTHOR]

We evaluate the long-run effects of a decentralised approach to economic development called community-driven development—a prominent strategy for delivering foreign aid—by revisiting a randomised community-driven development program in Sierra Leone 11 years after launch. We estimate large persistent gains in local public goods and market activity, and modest positive effects on institutions. There is suggestive evidence that community-driven development may have slightly improved the communities' response to the 2014 Ebola epidemic. We compare estimates to the forecasts of experts from Sierra Leone and abroad, working in policy and academia, and find that local policymakers are overly optimistic about the effectiveness of community-driven development. [ABSTRACT FROM AUTHOR]

This paper uses the resource curse hypothesis to explore diamond exploitation in Sierra Leone during the period 1930–2010. Focusing on national and local level analysis, it examines whether the net impact of diamond exploitation was a ‘resource curse’ or ‘blessing’ during four time periods: colonial and early post-independence era, the APC era, the civil war period, and post-war era. The paper argues that the net impact of diamond exploitation in Sierra Leone has not been constant; rather it has changed between resource blessing and curse over different major periods of Sierra Leone’s history and at local and national scales since inception of diamond exploitation. This paper illustrates that during the period 1968–1992 patrimonial politics undermined official diamond exploitation and significantly contributed to a pendulum shift in the net effects of diamond exploitation from resource blessing to curse. The study shows that the net effect of diamond exploitation was: a resource blessing (especially at the national level) prior to 1968; more of a resource curse during the APC era; a full blown manifestation of the curse during the civil war period; and that governance of the diamond sector has improved sufficiently in post-civil war Sierra Leone to start the gradual transformation of diamonds to resource blessing, at national and local levels. [ABSTRACT FROM AUTHOR]

• The paper explores recent ASM reforms in Sierra Leone and their potential to contribute to the SDGs. • Entrenched informality in the ASM sector is making policy reforms challenging and unsustainable. • The paper explores the links between Chiefs and politicians, which perpetuates informality in the ASM sector. • The persistence of informality must be dismantled if ASM reforms are to succeed snd contribute to the SDGs. In recent years, governments, donors and policy makers across sub-Saharan Africa (SSA) have increasingly realised the potential of formalizing and supporting artisanal and small-scale mining (ASM) – low tech, labour-intensive mineral processing and extracting. A significant body of evidence suggests that ASM has become the most important rural non-farm activity across SSA, and by making it the centrepiece of new rural development strategies being launched across the continent, it could help governments meet a number of targets linked to the UN Sustainable Development Goals (SDGs). Focusing on the West African country of Sierra Leone, this paper explores recent reforms to ASM, examining both their potential to support a formalized sector, and to make contributions to the SDGs. In doing so, two broad sets of formalization reforms that have taken place, or are underway, are analysed. First, the paper examines Sierra Leone's legal, policy and regulatory reforms that have shaped the development of a number of laws and policies, including the Mines and Minerals Act of 2009. Second, it analyses institutional reforms resulting from the splitting of policy making and regulatory functions, especially the decentralization of the artisanal mining licencing process. The paper argues that beneath these changes, there exists intractable continuities of informality that make reforms in the sector superficial, unsustainable, and potentially a barrier to attaining the SDGs. Underlining these continuities, the paper suggests, is the role that ASM has traditionally played in a political economy that links powerful local Chieftains with national politicians in mutually beneficial relationships, which invariably render formal state regulators such as the National Minerals Agency and Environment Protection Agency largely uncoordinated, and operationally weak. The paper concludes by arguing that that the persistence of informality in the sector needs to first be dismantled as a rational strategy for those who profit from it, and only then can sustainable mining reforms be linked to broader development initiatives, such as attaining the SDGs. [ABSTRACT FROM AUTHOR]

Introduction: The Ebola virus disease (EVD) outbreak in 2014-2016 in West Africa was the largest on record and provided an opportunity for large clinical trials and accelerated efforts to develop an effective and safe preventative vaccine. Multiple questions regarding the safety, immunogenicity, and efficacy of EVD vaccines remain unanswered. To address these gaps in the evidence base, the Partnership for Research on Ebola Vaccines (PREVAC) trial was designed. This paper describes the design, methods, and baseline results of the PREVAC trial and discusses challenges that led to different protocol amendments.Methods: This is a randomized, double-blind, placebo-controlled phase 2 clinical trial of three vaccine strategies against the Ebola virus in healthy volunteers 1 year of age and above. The three vaccine strategies being studied are the rVSVΔG-ZEBOV-GP vaccine, with and without a booster dose at 56 days, and the Ad26.ZEBOV,MVA-FN-Filo vaccine regimen with Ad26.ZEBOV given as the first dose and the MVA-FN-Filo vaccination given 56 days later. There have been 4 versions of the protocol with those enrolled in Version 4.0 comprising the primary analysis cohort. The primary endpoint is based on the antibody titer against the Ebola virus surface glycoprotein measured 12 months following the final injection.Results: From April 2017 to December 2018, a total of 5002 volunteers were screened and 4789 enrolled. Participants were enrolled at 6 sites in four countries (Guinea, Liberia, Sierra Leone, and Mali). Of the 4789 participants, 2560 (53%) were adults and 2229 (47%) were children. Those < 18 years of age included 549 (12%) aged 1 to 4 years, 750 (16%) 5 to 11 years, and 930 (19%) aged 12-17 years. At baseline, the median (25th, 75th percentile) antibody titer to Ebola virus glycoprotein for 1090 participants was 72 (50, 116) EU/mL.Discussion: The PREVAC trial is evaluating-placebo-controlled-two promising Ebola candidate vaccines in advanced stages of development. The results will address unanswered questions related to short- and long-term safety and immunogenicity for three vaccine strategies in adults and children.Trial Registration: ClinicalTrials.gov NCT02876328 . Registered on 23 August 2016. [ABSTRACT FROM AUTHOR]

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Background: Communities have a key role to play in global health security. The Red Cross/Red Crescent epidemic preparedness programme empowers volunteers and communities to: identify risks; recognise and notify epidemic alerts; take early action to control disease. The programme set out to establish community-based surveillance (CBS) as a preparedness model – yielding earlier detection and action to halt outbreaks at the outset. This paper reports on the mid-stage CBS implementation experience and results in Indonesia, Kenya, Sierra Leone and Uganda. Methods: Volunteers detect potential epidemic alerts and report immediately by mobile apps. The receiving supervisor cross-checks the alert and enters in a real-time database triggering response actions. Supervisors report to local authorities, integrating CBS alerts as notifications into national disease surveillance systems. Results: To develop health literacy and trust, volunteers achieved over 390,000 instances of contact with people; 70,000 house visits; 547 school health activities; and 17 radio shows. Volunteers are placed with wide geographic coverage and their weekly 'zero' reporting of 63%-83% indicates maintenance of the CBS system. The average accuracy of volunteers to identify alerts matching community case definitions is high in Sierra Leone 96%, Indonesia 90%, and Uganda 73%, however low in Kenya at 35%. Timeliness rates were high across all countries. Alerts were detected and notified to authorities within the targeted 24 hours at an average of 94%. Challenges and risks have related to: securing free SMS channels for alerts, time required for contextualised design, ensuring response action, and managing expectations of the scope of CBS. Conclusion: Early-stage results show positive impact and feasibility of preparedness CBS in high-risk zones to prevent large-scale outbreaks. Community engagement, stage-wise capacity building, monitoring and response actions, and collaborative relationships with stakeholders are important programme components for effectiveness. Communities themselves can be central change agents in global health security. [ABSTRACT FROM AUTHOR]

This paper explores the links between the socio-cultural power structures of the Poro and Bondo secret societies and their interactions with internationalist human rights discourse in postconflict Sierra Leone. It argues that these secret societies offer gendered and cultural spaces that serve as social and political mobilizing symbols. These societies further provide forums as well as a stage for counter-discourses about gender-based violence and human rights violations, particularly with regards to the campaign against female circumcision. The paper concludes that despite internal tensions and squabbles, the Bondo secret societiy has gained most of its present-day solidarity by broadly disseminating to both members and non-members the highly charged narrative that the society's exposure leads to its destruction. The Bondo society has been able to maintain cohesion and defend its interests by appropriating and invoking traditional knowledge and ritual codes. [ABSTRACT FROM AUTHOR]