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Background: Recent reviews have highlighted the need for participatory research to design and evaluate inclusive, community-based interventions that address the diverse needs of people with lived experience of psychosis, within and beyond the health sector. The SUCCEED Africa consortium aims to co-produce a 6-year programme of research across four countries in West (Sierra Leone, Nigeria) and Southeast Africa (Zimbabwe and Malawi). This protocol describes the pilot study in which SUCCEED's intervention, research tools and processes will be tested on a small scale in each country in preparation for future evaluation research. Methods: The SUCCEED intervention comprises peer support, case management and livelihood activities for people with lived experience of psychosis. The pilot uses a before-and-after study design investigating change in subjective quality of life in adults diagnosed with a primary psychotic disorder or another mental disorder with psychotic symptoms who are offered the SUCCEED intervention over a 4-month period. Nested within this study are the following: a baseline assessment of the feasibility, acceptability and face validity of the selected measurement tool and validity of proxy versus self-completion; and a multi-method process evaluation examining key process indicators and implementation, service and client-level outcomes. Methods include the following: baseline cognitive interviews; semi-structed observation and routine monitoring and evaluation of service delivery; endline interviews and focus group discussions; and a comparison of provider competencies at endline. At each of the four pilot sites, participants will include the following: ten people with lived experience of psychosis, recruited from either health services or community settings using purposive sampling to maximise variation; up to ten adult family members (one per participant with lived experience) involved in their care; the peer support worker, community support worker and supervisor responsible for delivering the intervention; and the data collectors. Recruitment will take place in July and August 2023. Discussion: To the best of our knowledge, this will be the first study of a community-based intervention incorporating lay-delivered case management, formal peer support and livelihoods activities for people with lived experience of psychosis in sub-Saharan Africa. Findings will be relevant not only to SUCCEED but also to others interested in promoting rights-based approaches to community mental health in low-resource settings. Trial registration: US National Library of Medicine (ClinicalTrials.gov), Protocol reference ID 28346. Initially registered retrospectively July 20/2023: In review. [ABSTRACT FROM AUTHOR]

Addressing the need for curbing private motorization and car dependency while reducing inequalities associated with transport requires an in-depth understanding of the individual and collective practices, attitudes, and experiences of urban accessibility and mobility of populations across diverse socio-economic backgrounds. This paper builds on qualitative research methods and a framework of transitions to sustainable mobility to examine the links between travel needs, preferences, attitudes, and structural factors such as urban form, poverty, and informality at different scales. It proposes qualitative methods and evidence for accessibility-centred analysis to enrich policy and practice in cities across Sub-Saharan Africa (SSA), using Sierra Leone's capital, Freetown, as a case study. While the volume of literature on urban mobility, accessibility, and land-use in SSA is increasing, scholarship on cities in Western Africa remains limited. The study examines four neighborhoods with different levels of access and motorization. It interrogates participants' perceived accessibility, how they shape differentiated everyday mobility and land-use practices at the individual and collective level, and its implications for urban accessibility and sustainable mobility in the medium to long-term future. We found that perceived accessibility influences everyday mobility and land-use practices and the attitudes of individuals in diverse communities toward sustainable mobility by driving them to trade off immediate needs with long-term risks and exposures, imaginaries of motorized futures, as well as collectively transform the functional and physical configurations of the built environment to address their most critical needs in the absence of suitable top-down transport and land-use interventions. [ABSTRACT FROM AUTHOR]

Background: Noncommunicable diseases (NCDs), especially hypertension and diabetes mellitus are on the increase in sub-Saharan Africa (SSA). Informal settlement dwellers exhibit a high prevalence of behavioural risk factors and are highly vulnerable to hypertension and diabetes. However, no study has assessed the prevalence of hypertension, diabetes, and NCDrisk factors among informal settlement dwellers in Sierra Leone. We conducted a study in June 2019 to determine the prevalence of hypertension, diabetes, and NCD risk factors among adults living in the largest Sierra Leonean informal settlement (KrooBay). Methods and materials: We conducted a community-based cross-sectional survey among adults aged ≥ 35 years in the KrooBay community. Trained healthcare workers collected data on socio-demographic characteristics and self-reported health behaviours using the World Health Organization STEPwise surveillance questionnaire for chronic disease risk factors. Anthropometric, blood glucose, and blood pressure measurements were performed following standard procedures. Logistics regression was used for analysis and adjusted odd ratios with 95% confidence intervals were calculated to identify risk factors associated with hypertension. Results: Of the 418 participants, 242 (57%) were females and those below the age of 45 years accounted for over half (55.3%) of the participants. The prevalence of smoking was 18.2%, alcohol consumption was 18.8%, overweight was 28.2%, obesity was 17.9%, physical inactivity was 81.5%, and inadequate consumption of fruits and vegetables was 99%. The overall prevalence of hypertension was 45.7% (95% CI 41.0-50.5%), systolic hypertension was 34.2% (95% CI 29.6–38.8%), diastolic blood pressure was 39.9% (95% CI 35.2–44.6), and participants with diabetes were 2.2% (95% CI 0.7–3.6%). Being aged ≥ 55 years (AOR = 7.35, 95% CI 1.49–36.39) and > 60 years (AOR 8.05; 95% CI 2.22–29.12), separated (AOR = 1.34; 95% 1.02–7.00), cohabitating (AOR = 6.68; 95% CL1.03-14.35), vocational (AOR = 3.65; 95% CI 1.81–7.39) and having a university education (AOR = 4.62; 95% CI 3.09–6.91) were found to be independently associated with hypertension. Conclusion: The prevalence of hypertension,and NCD risk factors was high among the residents of the Kroobay informal settlement. We also noted a low prevalence of diabetes. There is an urgent need for the implementation of health education, promotion, and screening initiatives to reduce health risks so that these conditions will not overwhelm health services. [ABSTRACT FROM AUTHOR]

Background: The number of maternal deaths in sub-Saharan Africa continues to be overwhelmingly high. In West Africa, Sierra Leone leads the list, with the highest maternal mortality ratio. In 2010, financial barriers were removed as an incentive for more women to use available antenatal, delivery and postnatal services. Few published studies have examined the quality of free antenatal services and access to emergency obstetric care in Sierra Leone.Methods: A cross-sectional survey was conducted in 2014 in all 97 peripheral health facilities and three hospitals in Bombali District, Northern Region. One hundred antenatal care providers were interviewed, 276 observations were made and 486 pregnant women were interviewed. We assessed the adequacy of antenatal and delivery services provided using national standards. The distance was calculated between each facility providing delivery services and the nearest comprehensive emergency obstetric care (CEOC) facility, and the proportion of facilities in a chiefdom within 15 km of each CEOC facility was also calculated. A thematic map was developed to show inequities.Results: The quality of services was poor. Based on national standards, only 27% of women were examined, 2% were screened on their first antenatal visit and 47% received interventions as recommended. Although 94% of facilities provided delivery services, a minority had delivery rooms (40%), delivery kits (42%) or portable water (46%). Skilled attendants supervised 35% of deliveries, and in only 35% of these were processes adequately documented. None of the five basic emergency obstetric care facilities were fully compliant with national standards, and the central and northernmost parts of the district had the least access to comprehensive emergency obstetric care.Conclusion: The health sector needs to monitor the quality of antenatal interventions in addition to measuring coverage. The quality of delivery services is compromised by poor infrastructure, inadequate skilled staff, stock-outs of consumables, non-functional basic emergency obstetric care facilities, and geographic inequities in access to CEOC facilities. These findings suggest that the health sector needs to urgently investigate continuing inequities adversely influencing the uptake of these services, and explore more sustainable funding mechanisms. Without this, the country is unlikely to achieve its goal of reducing maternal deaths. [ABSTRACT FROM AUTHOR]

This article discusses the management of onchocerciasis, or river blindness, in Africa. The Onchocerciasis Control Programme in the Volta River Basin (OCP) was established in 1975 to combat the disease in seven West African countries. It later expanded to include four additional countries and changed its name to the Onchocerciasis Control Programme in West Africa (OCP). In 1995, the African Programme for Onchocerciasis Control (APOC) was launched to control the disease in all endemic countries in sub-Saharan Africa. APOC used community-directed treatment with ivermectin (CDTi) as its core strategy, leading to a significant decrease in infections and preventing millions of disability-adjusted life years (DALYs). The program also expanded its efforts to include other neglected tropical diseases (NTDs) susceptible to mass drug administration. APOC operates through a partnership between affected communities, governments, NGOs, and other stakeholders, with the World Health Organization (WHO) as the executing agency. APOC's success is attributed to its participative governance and engagement of communities through the CDTi strategy, empowering them to take responsibility for delivering treatment and expanding access to other health interventions. The document emphasizes the importance of community engagement, collaboration, and strengthening health systems at the community level in the planning, implementation, and monitoring of interventions for onchocerciasis control and other NTDs. The success [Extracted from the article]

This paper deconstructs everyday mobility practices from a perspective of accessibility and social and transport (dis)advantage in two capital port cities in sub-Saharan Africa (SSA) – Freetown, Sierra Leone and Maputo, Mozambique. The paper proposes a novel framework that interprets social and transport (dis)advantage conditions as critical drivers of mobility behaviours and the resulting (in)accessibility that circumscribes individuals’ experience. Building on its framework, the paper raises unique empirical qualitative evidence from eight neighbourhoods about mobility practices across populations facing different degrees of social and transport (dis)advantage. The study’s design is grounded in the in-depth understanding of accessibility using qualitative methods as a counterpoint to predominant quantitative and spatial approaches, filling critical data gaps in cities in SSA. The findings reveal a deep-seated aspiration for car ownership, tempered by the urgency of other immediate material needs, as well as the dynamic nature of travel behaviour due to changing conditions during the day and throughout the year. The findings also indicate informality plays a significant role in enabling access to critical opportunities and the need to strengthen trust in popular transport systems. [ABSTRACT FROM AUTHOR]

Introduction: Few countries in Sub-Saharan Africa have robust emergency medical services (EMS). The World Health Organization (WHO) recommends scaling-up lay first responder programs as the first step toward formal EMS development.Materials and Methods: We trained and equipped 4,529 lay first responders (LFRs) between June-December 2019 in Bombali District, Sierra Leone, with a 5-hour hands-on, contextually-adapted prehospital trauma course to cover 535,000 people. Instructors trained 1,029 LFRs and 50 local trainers in a training-of-trainers (TOT) model, who then trained an additional 3,500 LFRs. A validated, 23-question pre-/post-test measured knowledge improvement, while six- and nine-month follow-up tests measured knowledge retention. Incident reports tracked patient encounters to assess longitudinal impact.Results: Median pre-/post-test scores improved by 43.5 percentage points (34.8% vs. 78.3%, p<0.0001). Knowledge retention was assessed at six months, with median score dropping to 60.9%, while at nine months, median score dropped to 43.5%. Lay first responders participating in courses led by TOT trainers had a pre-/post-test median score improvement of 30.4 percentage points (21.7% vs. 52.2%, p<0.0001). LFRs treated 1,850 patients over six months, most frequently utilizing hemorrhage control skills in 61.2% of encounters (1,133/1,850). The plurality of patients were young adult males (36.8%) and 48.7% of encounters were motorcycle injury-related.Conclusion: A 5-hour first responder course targeting laypeople demonstrates significant emergency care knowledge improvement and retention. By training networks of transportation providers, lay first responder programs represent a robust and scalable prehospital emergency care alternative for low-resource settings. [ABSTRACT FROM AUTHOR]

In the context of still-low-but-rising levels of motorization and economic growth, increasing social and spatial inequalities, and growing concerns about air pollution and climate change, the formulation and implementation of policies, practices and partnerships that can support an accelerated implementation of sustainable mobility policies is an urgent concern for rapidly developing cities. This paper seeks to contribute to reframing some of the knowledge and methodologies produced in and about cities of Sub-Saharan Africa, through a comprehensive assessment of mobility patterns and accessibility needs within a larger debate about mobility transitions and sustainable development. By deploying a mixed-methods approach that builds upon case-study focus groups and city-wide accessibility and mobility analysis in the city of Freetown, Sierra Leone's capital, the paper maps travel patterns and their links with structural factors such as urban form, poverty, informality and social identities at the macro, meso and micro levels. The paper also presents evidence from a variety of methods that illustrate the significance of accessibility-centred information and analysis for establishing policy priorities for improving urban mobility and accessibility in the local, African and global contexts. [ABSTRACT FROM AUTHOR]