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Objective To examine the prevalence of alcohol use and its associated factors among in-school adolescents in Sierra Leone.Design Data for the study was sourced from the 2017 Sierra Leone Global School-Based Student Health Survey, a nationally representative survey conducted among in-school adolescents aged 10–19 years using a multistage sampling methodology. Percentages were used to present the prevalence of alcohol use among in-school adolescents. Multivariable binary logistic regression analysis was performed to examine the factors associated with alcohol use among in-school adolescents. The results were presented using adjusted odds ratios (aOR) with their respective 95% confidence interval (CI).Setting Sierra Leone.Participants A weighted sample of 1730 in-school adolescents in Sierra Leone.Outcome measure Current alcohol use.Results The prevalence of alcohol use among in-school adolescents was 10.7% (7.3, 15.3). In-school adolescents in senior secondary schools were more likely to use alcohol compared with those in junior secondary school (aOR=2.13; 95% CI 1.37, 3.30). The odds of alcohol use was higher among in-school adolescents who were truant at school relative to those who were not (aOR=2.24; 95% CI 1.54, 3.26). Also, in-school adolescents who were bullied (aOR=1.85; 95% CI 1.24, 2.76), ever engaged in sexual intercourse (aOR=2.06; 95% CI 1.39, 3.06), and used marijuana (aOR=3.36; 95% CI 1.72, 6.53) were more likely to use alcohol compared with those who were not. However, in-school adolescents who reported that their parents understood their problems (aOR=0.52; 95% CI 0.33, 0.82) had a lower likelihood of consuming alcohol.Conclusion Our study has shown that alcohol use is prevalent among in-school adolescents in Sierra Leone. Grade level, experiences of being bullied, history of sexual intercourse, truancy at school, and previous use of marijuana were the factors influencing alcohol use among in-school adolescents. The findings emphasise the necessity of creating school-based health interventions in Sierra Leone that can effectively identify in-school adolescents potentially vulnerable to alcohol-related issues. Also, existing policies and programmes aimed at reducing alcohol use among in-school adolescents need to be strengthened.

Objective This study examined the prevalence of amphetamine use and its associated factors among in-school adolescents in Sierra Leone.Design Data for the study was sourced from the 2017 Sierra Leone Global School-based Health Survey. Percentages with confidence intervals (CIs) were used to present the prevalence of amphetamine use among in-school adolescents. A multivariable binary logistic regression analysis was employed to examine the factors associated with amphetamine use. The results were presented using adjusted odds ratios (aORs) with 95% CIs.Setting Sierra Leone.Participants A weighted sample of 1,314 in-school adolescents in Sierra Leone.Outcome measure Lifetime amphetamine use.Results The prevalence of amphetamine use was 6.1% (3.9%–9.5%). In-school adolescents who planned suicide were more likely to use amphetamine compared with those who did not (aOR 2.54; 95% CI 1.02 to 6.31). Also, the odds of amphetamine use were higher among in-school adolescents who received support from their peers (aOR 3.19, 95% CI 1.71 to 5.96), consumed alcohol (aOR 4.85, 95% CI 2.61 to 9.03), and those who had previously used marijuana (aOR 13.31, 95% CI 6.61 to 28.78) compared with those who did not receive any support, never consumed alcohol, and never used marijuana, respectively.Conclusion Amphetamine use is prevalent among in-school adolescents in Sierra Leone. There is a need to implement comprehensive public health policies that extend beyond school-based psychobehavioural therapies. These policies should specifically address the considerable risk factors associated with amphetamine use among in-school adolescents in Sierra Leone.

BackgroundSierra Leone, like many other sub-Saharan African countries, grapples with the challenge of high adolescent fertility rates. This study examines the socio-economic and geographical inequalities in adolescent fertility rates in Sierra Leone between 2008 and 2019.MethodsThree rounds of the Sierra Leone Demographic and Health Surveys (2008, 2013, and 2019) were analysed to examine inequalities in adolescent fertility rates. Descriptive analyses were performed using the online version of the World Health Organization's Health Equity Assessment Toolkit software. Adolescent fertility rate was stratified using four dimensions: economic status, education, place of residence, and province. Difference (D), ratio (R), population attributable risk (PAR) and population attributable fraction (PAF) were calculated as measures of inequality.ResultsThe adolescent fertility rates in Sierra Leone declined from 142.5 births per 1,000 women aged 15-19 years in 2008 to 103.5 births per 1,000 women aged 15-19 years in 2019. For economic status, inequality in adolescent fertility rates decreased from 117.3 births per 1,000 adolescent girls in 2008 to 110.6 in 2019. The PAF indicated that the national adolescent fertility rate could have been 46.8% lower in 2008, 42.5% lower in 2013, and 53.5% lower in 2019 if all wealth quintiles had the same fertility rates as the wealthiest quintile (quintile 5). Educational inequality in adolescent fertility rates decreased significantly, from 135.3 births per 1,000 adolescent girls in 2008 to 75.8 in 2019. The PAF showed that the setting average of adolescent fertility rate could have been 57.9% lower in 2008, 33.1% lower in 2013, and 23.9% lower in 2019 without education-related disparities. For place of residence, inequality between urban and rural areas decreased from 82.3 births per 1,000 adolescent girls in 2008 to 74.5 in 2019. The PAF indicated that the national adolescent fertility rate could have been 32.9% lower in 2008, 30.7% lower in 2013, and 33.9% lower in 2019 if rural girls had the same fertility rates as urban girls. Our results further showed that inequality based on province decreased from 77.9 births per 1,000 adolescent girls in 2008 to 64.0 in 2019. The PAF showed that the national average of adolescent fertility rates could have been 34.6% lower in 2008, 37.6% lower in 2013, and 35.8% lower in 2019 without provincial disparities.ConclusionOur study found a positive decline in AFR across socioeconomic and geographic groups in Sierra Leone, but significant inequalities remain. Economic status and education are key drivers, with the poorest quintile consistently showing higher AFR. Although AFR declined among girls across all levels of education over time, it increased between 2008 and 2019 for those with primary and higher education. Rural areas had a higher AFR than urban ones, though with less national impact. Policymakers should focus on improving economic opportunities, enhancing quality education, and expanding access to family planning services to reduce adolescent pregnancy and address socioeconomic and educational inequalities.