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Abstract Pre-eclampsia is a leading cause of maternal and neonatal mortality; 30,000 pre-eclampsia-related maternal deaths occur annually, with 70% in Sub-Saharan Africa (SSA) and 16% in South Asia. We have shown that early, accurate detection of hypertension combined with planned early delivery in women with late preterm pre-eclampsia significantly reduces stillbirth and severe maternal hypertension. We describe co-development and delivery of policy labs, working with The Policy Institute (King’s College London), and local stakeholders in Sierra Leone and Zambia, to expedite integration of new knowledge into pre-eclampsia care pathways, to improve care for women and babies with the worst outcomes. Policy labs are a unique, user-centric engagement approach, bringing diverse stakeholders together in co-designing strategies for translation of evidence into policy and impact. Both labs were facilitated by local, well-respected female team members, and addressed co-developed questions: ‘How can we improve timely detection and appropriate action in women with pre-eclampsia?’ (Sierra Leone); ‘What are enablers and barriers to offering planned early delivery between 34 and 37 weeks?’(Zambia). Participants at both labs identified lack of pre-eclampsia awareness as a key barrier, and recommended local co-design of community-based strategies to increase access to timely pre-eclampsia management. We demonstrated policy labs as an effective approach in two low-and middle income settings to facilitate transfer of new knowledge into policy and action.

IntroductionResponse to public health emergencies is a big challenge in African countries due to inadequate workforce. Integrated Disease Surveillance and Response (IDSR) is a strategy implemented by African member states of WHO to strengthen capacity for disease surveillance and response at all levels. Despite successful implementation of IDSR in most countries, one of the challenges that persists is that of inadequate trained workforce competent enough for public health surveillance. Introducing IDSR pre-service curriculum in public health training institutions has therefore been recommended by WHO as one of the strategies to sustainably address the human resource challenge. We report on the process and lessons learnt in Sierra Leone which was the first country to implement the recommendation.MethodsThis was a descriptive study where the process of introducing and implementing IDSR pre-service curriculum in Sierra Leone was documented from 2018 to 2024. Data was collected through observation, documentation and analysis of key processes that took place. These processes included, inter alia, advocacy with public health training institutions, development of the IDSR pre-service curriculum and incorporation of the curriculum into the existing training programs of colleges and universities.ResultsIDSR preservice curriculum was developed and successfully introduced in eight targeted public health training institutions in Sierra Leone from September 2021. Training content was adapted from the 3rd Edition of IDSR technical guidelines developed by WHO in 2019. As at February 2024, more than 4,200 students had started taking IDSR modules in the eight institutions with 2,108 having completed and graduated. During the process, we learned that key enablers to success were government support, good advocacy with the training institutions and training of lecturers on IDSR. Main challenges were the long process of curriculum approval by training institutions and handling of big classes of students without adequate training materials.ConclusionIntroducing IDSR into the preservice curricula of public health training institutions is feasible and can provide a reliable and continuous supply of a trained workforce ready to be utilized for IDSR in Africa. Successful implementation requires advocacy with training institutions as well as regular monitoring of the implementation to maintain good quality.

Maternal ready-to-use supplementary foods (M-RUSF) have been shown to improve birth outcomes among undernourished pregnant women. Docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and choline have been hypothesized to further improve gestational duration and cognitive development. The primary objective of this study was to determine the acceptability and feasibility of a new formulation of M-RUSF, referred to as M-RUSF+, that included fish oil, containing about 400 to 500 mg DHA and EPA, and 550 mg choline among pregnant women in the Pujehun District of Sierra Leone. Both the control and the experimental supplementary foods contained 18 g of high quality protein and 580 kcal, with generous amounts of all essential micronutrients. The ration size was 100 g/d. Both intervention and control recipes were locally produced using peanut paste by the Project Peanut Butter Factory in Freetown, Sierra Leone. The fish oil was added to the M-RUSF+ after all the grinding had been accomplished to limit degardation. The study used a 2x2 crossover design to assess the acceptability of the M-RUSF and M-RUSF+formulations. Pregnant women were assigned to one of two sequences of foods: either M-RUSF+followed by M-RUSF, or M-RUSF followed by M-RUSF+. Each food was given for one week. Fifty-one pregnant women were enrolled (day 0), with data collection occurring on days 3, 7, 10 and 14 after enrollment. At each visit, women returned the packets, either empty or partially consumed. Acceptability was assessed at all follow-up visits based on overall consumption, likeability, and adverse events reported. Consumption of M-RUSF and M-RUSF+ averaged 99%. The likability scores averaged 4.8 and 4.9 out of 5 for M-RUSF and M-RUSF+, respectively. For 85/90 visits during which M-RUSF+was being consumed and 77/83 visits during which M-RUSF was being consumed, the foods were rated with a likability score of 5. Adverse events, defined as diarrhea, vomiting or rash were infrequent ( Key words: Maternal undernutrition, supplementary food, docosahexaennoic acid (DHA), eicosapentaenoic acid (EPA), choline, INTRODUCTION Maternal undernutrition occurs in nearly one-quarter of pregnancies in sub-Saharan Africa and has been associated with adverse outcomes including anemia, hemorrhages, and maternal death, as well as preterm birth, [...]

Ninety-seven percent of Sierra Leonean households prepare food over wood or charcoal, a practice that leads to adverse health and environmental consequences. In this pilot study, we introduced ethanol cookstoves to households in Bo, Sierra Leone. We assessed their potential as an alternative to biomass fuels and the only existing improved cookstove, butane gas. Ethanol cookstoves were economically competitive with butane stoves, but could not outcompete biomass fuel (wood and charcoal). The cookstoves displayed significant benefits to women in time savings and comfort, but raised concerns around alcoholism, unequal access to technologies, and other gendered constraints in the cultural context.

Introduction The escalating consumption of ultra-processed foods (UPFs) among school-aged children in developing countries poses a significant threat to public health, contributing to the dual burden of malnutrition. In Malawi, where undernutrition coexists with a burgeoning obesity epidemic, understanding the determinants of UPF consumption and its impact on children’s nutritional status is imperative. This study, conducted in Lilongwe, Malawi, aimed to investigate the association between UPF consumption, sociodemographic factors and the nutritional status of school-aged children.Materials and methods 511 children aged 7–14 were recruited from 2 densely populated townships using systematic random sampling. Data on sociodemographic factors, UPF consumption and nutritional status were collected through face-to-face interviews and anthropometric measurements. UPF consumption was assessed using a validated Food Frequency Questionnaire while multinomial logistic regression was employed to analyse associations.Results Results revealed alarmingly high UPF consumption among children, particularly those high in sugar. Multinomial logistic regression identified significant predictors of malnutrition outcomes. Notably, children consuming UPFs more than three times a week were more likely to be malnourished. Overweight status was positively associated with sausage intake (β=0.226, adjusted OR 1.254, 95% CI 1.004 to 1.566, p=0.046) and age (β=0.020, adjusted OR=0.257, 95% CI 0.156 to 0.28, p=0.003). Conversely, underweight status was linked with residential location (β=4.507, adjusted OR 0.01, 95% CI 0.000 to 0.281, p=0.006) and fizzy drinks (β=1.071, adjusted OR 2.919, 95% CI 1.413 to 6.028, p=0.004).Conclusion The high prevalence of UPF consumption among school-aged children is significantly associated with malnutrition. Moreover, sociodemographic factors influence UPF consumption, highlighting the need for targeted interventions to reduce malnutrition. These findings may inform public health policies to mitigate malnutrition among children in Malawi’s urban communities.

BackgroundBaseline mapping showed that schistosomiasis was highly/moderately endemic in nine districts in Sierra Leone. Mass drug administration (MDA) with praziquantel started in 2009, and after multiple rounds of treatment, an impact assessment was conducted in 2016 followed by a second re-assessment in 2022 using cluster sampling to provide more granular data for refining chiefdom (sub-district) treatment strategies.MethodsOn average, 20 rural villages were systematically selected per district by probability proportional to population size across the nine districts. Surveys were conducted in schools, and 24 school children aged between 5 and 14 years were randomly selected, with an equal number of boys and girls. One stool sample and one urine sample were collected per child. Two Kato-Katz slides were examined per stool for Schistosoma mansoni infection. Hemastix strips were used as a proxy for S. haematobium infection with urine filtration used for egg counts on hematuria-positive samples.ResultsIn total, 4,736 stool samples and 4,618 urine samples were examined across 200 schools in 125 chiefdoms. Overall, the prevalence of S. mansoni was 16.3% (95% CI: 15.3–17.4%), while the overall prevalence of S. haematobium was 2.0% (95% CI: 1.6–2.4%) by hematuria. The prevalence of heavy infections for S. mansoni and S. haematobium was 1.5% (95% CI: 1.1–1.9%) and 0.02% (95% CI: 0.0–0.14%), respectively. Among 125 chiefdoms surveyed, the overall schistosomiasis prevalence was

ObjectiveThe objective of this study was to examine the impact of the introduction of the Universal Anaesthesia Machine (UAM), a device designed for use in clinical environments with limited clinical perioperative resources, on the choice of general anesthesia technique and safe anesthesia practice in a tertiary-care hospital in Sierra Leone.MethodsWe introduced an anesthesia machine (UAM) into Connaught Hospital, Freetown, Sierra Leone. We conducted a prospective observational study of anesthesia practice and an examination of perioperative clinical parameters among surgical patients at the hospital to determine the usability of the device, its impact on anesthesia capacity, and changes in general anesthesia technique.FindingsWe observed a shift from the use of ketamine total intravenous anesthesia to inhalational anesthesia. This shift was most demonstrable in anesthesia care for appendectomies and surgical wound management. In 10 of 17 power outages that occurred during inhalational general anesthesia, anesthesia delivery was uninterrupted because inhalational anesthesia was being delivered with the UAM.ConclusionAnesthesia technologies tailored to overcome austere environmental conditions can support the delivery of safe anesthesia care while maintaining fidelity to recommended international anesthesia practice standards.

Uncertainty in economic policy is one of many factors that can have an impact on the relationship between working capital and profitability. The corporate sector places a higher priority on working capital management that employs its working capital resources to have an advantage over rivals. The objective of our study is to determine how economic policy uncertainty (EPU) index for UK, as measured based on newspaper coverage frequency, affects the relationship between working capital management (CCC), return on operating assets, and other profitability measures across several businesses listed on the UK stock exchange for the years 2006 to 2021. To analyze the data for 199 UK manufacturing companies, we applied the Fixed Effect Method, Random Effect Method, and two-stage Generalized Method of Moments (GMM) to tackle the endogeneity problem and report robust findings. The findings of the study revealed that EPU statistically significantly affected the relationship between CCC and profitability. When uncertainty is high, companies may be hesitant to make investments or develop new products, which can lead to a reduction in working capital and lower profitability. Companies that can effectively manage their working capital in the face of uncertainty may be better positioned to maintain their profitability over the long term. This study can provide valuable insights for both companies and investors, helping to improve financial performance and enhance strategic decision-making regarding their working capital management policies in the face of economic policy uncertainty.

A pressing issue in the food industry is providing the population with adequate nutrition. According to the concept of healthy eating, a person needs to increase the consumption of plant foods without reducing the consumption of foods containing complete protein. We have created dry fish and plant products, in the form of food concentrates, containing all the necessary macro- and micronutrients. The purpose of the research was to study the influence of plant components on the microbiological and oxidative processes of dry fish and fish-plant products during storage. To achieve the intended goal, the tasks of determining microbiological indicators and oxidation products at the beginning and end of the storage period were solved. Storage of dry fish and plant products was carried out for 12 months in polymer packaging at a temperature of plus 20±5℃. All analyses were carried out using generally accepted standard methods. As a result of the studies, it was established that the microbiological indicators of a dry fish-plant product, due to the addition of vegetables and corn flour, were higher than those of a dry fish product (0.5x104 and 0.2x104 CFU per 1 g, respectively), but during storage the bacterial contamination of dry of fish and plant products decreased from 0.5x104 to 0.1x104 CFU per 1 g of product. Also, plant components affected the oxidative processes in dry fish and vegetable products. The acid number in samples of dry fish product increased from 0.71 to 2.67 mg of KOH, and in samples of dry fish-plant product – from 0.65 to 1.87 mg of KOH after 12 months of storage. Thus, plant components inhibited the oxidation process and maintain the quality of the product during storage.

Kebonagung Village, a Sukodono District area, is home to a growing number of Micro, Small, and Medium Enterprises (MSMEs) but lacks effective product marketing management. The lack of a Business Incubator Center (BIC) hinders MSMEs from developing their marketing strategies. This study aims to map MSMEs' existing potential and development needs in Kebonagung Village through various BIC networks. The research methodology combines Participatory Rural Appraisal (PRA) and Asset-Based Community Development (ABCD), with the active involvement of MSME actors. The program stages involve field observations, preparation, implementation, and socialization activities. The results show that the existing potential of MSMEs falls into the "micro" category, with a weighted score of 76.23%. The BIC network provides effective support with a "good" rating of 64.21%. The MSME development program has yielded outcomes such as the formation of the "Forum Asosiasi UMKM Bonagung" and opportunities for further collaboration with BIC.

This study presents a comprehensive flood vulnerability assessment for Freetown, Sierra Leone, spanning the period from 2001 to 2022. The objective of this research was to assess the temporal and spatial changes in the flood vulnerability using Geographic Information System (GIS) tools and AHP-based Multi-Criteria Decision-Making (MCDM) analysis. This study identified the flood-vulnerable zones (FVZs) by integrating critical factors such as the rainfall, NDVI, elevation, slope, drainage density, TWI, distance to road, distance to river, and LULC. The analysis reveals that approximately 60% of the study area is classified as having medium to high vulnerability, with a significant 20% increase in the flood risk observed over the past two decades. In 2001, very-high-vulnerability zones covered about 68.84 km2 (10% of the total area), with high-vulnerability areas encompassing 137.68 km2 (20%). By 2020, very-high-vulnerability zones remained constant at 68.84 km2 (10%), while high-vulnerability areas decreased to 103.26 km2 (15%), and medium-vulnerability zones expanded from 206.51 km2 (30%) in 2001 to 240.93 km2 (35%). The AHP model-derived weights reflect the varied significance of the flood-inducing factors, with rainfall (0.27) being the most critical and elevation (0.04) being the least. A consistency ratio (CR) of 0.068 (< 0.1) confirms the reliability of these weights. The spatial–temporal analysis highlights the east and southeast regions of Freetown as consistently vulnerable over the years, while infrastructure improvements in other areas have contributed to a general decrease in very-high-vulnerability zones. This research highlights the urgent need for resilient urban planning and targeted interventions to mitigate future flood impacts, offering clear insights into the natural and human-induced drivers of the flood risk for effective hazard mitigation and sustainable urban development.

Objective Inappropriate use of antibiotics is a major driver of antibiotic resistance. A few studies conducted in Africa have documented that about half of hospitalised patients who receive antibiotics should not have received them. A few hospital-based studies that have been conducted in Sierra Leone have documented a high usage of antibiotics in hospitals. Therefore, we conducted a nationwide point prevalence survey on antibiotic use among hospitalised patients in Sierra Leone.Design We conducted a hospital-based, cross-sectional survey on the use of antibiotics using the WHO point prevalence survey methodology.Setting The study was conducted in 26 public and private hospitals that are providing inpatient healthcare services.Participants All patients admitted to paediatric and adult inpatient wards before or at 08:00 on the survey date were enrolled.Outcome measures Prevalence of antibiotic use, antibiotics Access, Watch and Reserve (AWaRe) categorisation, indication for antibiotic use prevalence and proportion of bacteria culture done.Results Of the 1198 patient records reviewed, 883 (73.7%, 95% CI 71.1% to 76.2%) were on antibiotics. Antibiotic use was highest in the paediatric wards (306, 85.7%), followed by medical wards (158, 71.2%), surgical wards (146, 69.5%), mixed wards (97, 68.8%) and lowest in the obstetrics and gynaecology wards (176, 65.7%). The most widely prescribed antibiotics were metronidazole (404, 22.2%), ceftriaxone (373, 20.5%), ampicillin (337, 18.5%), gentamicin (221, 12.1%) and amoxicillin (90, 5.0%). Blood culture was only done for one patient and antibiotic treatments were given empirically. The most common indication for antibiotic use was community-acquired infection (484, 51.9%) followed by surgical prophylaxis (222, 23.8%).Conclusion There was high usage of antibiotics in hospitals in Sierra Leone as the majority of patients admitted received an antibiotic. This has the potential to increase the burden of antibiotic resistance in the country. We, therefore, recommend the establishment of hospital antimicrobial stewardship programmes according to the WHO core components.

Introduction This paper presents the study protocol for a feasibility study of a manualised mental health awareness and stigma reduction intervention for Black faith communities, as part of the Outcomes and Needs of Traditional Religious And Complementary practitioners (ON TRAC) project. The primary objective is to assess the feasibility and acceptability of the intervention and the secondary objectives include assessment of the feasibility of: recruiting participants to take part in the intervention, delivering the intervention, and conducting qualitative assessments, and use of the selected scales. The findings from this study will be used to inform the development of a subsequent trial which will focus on exploring the potential impact of the intervention on stigma-related knowledge, attitudes, and behaviour.Methods and analysis The study uses a mixed-methods approach. A total of 80 participants from four Black Majority Churches in South London will be recruited. Randomisation of the participants will be at an individual level to either the intervention group (who will participate in the 10 week Mental Health Awareness Course intervention) or to the waiting list control group (who will receive the same intervention, 8 weeks after the intervention group). Outcomes for both arms will be collected at baseline, postintervention, and at 4 week follow-up. In addition, focus group discussions will be conducted with participants in the intervention group, a week following the end of the 10 week session course, to investigate the feasibility and acceptability of the mental health awareness course.Ethics and dissemination The results of this research will be disseminated at local, national, and international levels.Trial registration number ISRCTN12253092.

While investigating a signal of adaptive evolution in humans at the gene LARGE, we encountered an intriguing finding by Dr. Stefan Kunz that the gene plays a critical role in Lassa virus binding and entry. This led us to pursue field work to test our hypothesis that natural selection acting on LARGE-detected in the Yoruba population of Nigeria-conferred resistance to Lassa Fever in some West African populations. As we delved further, we conjectured that the emerging nature of recently discovered diseases like Lassa fever is related to a newfound capacity for detection, rather than a novel viral presence, and that humans have in fact been exposed to the viruses that cause such diseases for much longer than previously suspected. Dr. Stefan Kunzs critical efforts not only laid the groundwork for this discovery, but also inspired and catalyzed a series of events that birthed Sentinel, an ambitious and large-scale pandemic prevention effort in West Africa. Sentinel aims to detect and characterize deadly pathogens before they spread across the globe, through implementation of its three fundamental pillars: Detect, Connect, and Empower. More specifically, Sentinel is designed to detect known and novel infections rapidly, connect and share information in real time to identify emerging threats, and empower the public health community to improve pandemic preparedness and response anywhere in the world. We are proud to dedicate this work to Stefan Kunz, and eagerly invite new collaborators, experts, and others to join us in our efforts.

As part of the formative work of the SUCCEED Africa consortium, we followed a participatory process to identify existing gaps and resources needed for the development and implementation of a rights-based intervention for people with lived experience of psychosis in Malawi, Nigeria, Sierra Leone and Zimbabwe.

Despite global and Rwandan progress in reducing under-five mortality, the risk of children dying before their fifth birthday persists, necessitating intensified research on determinants. Thus, this study analyzed the birth history data to shed light on the underlying causes of under-five mortality in Rwanda. The study is a secondary analysis of data sourced from the 2020 Rwanda Demographic and Health Survey (RDHS) cross-sectional design. Using SPSS, the data was cleaned, recoded, and weighted, with descriptive and inferential statistics applied. The dependent variable was the child's living status, while independent variables included socio-demographic, media exposure status of mothers, child, and environmental factors. A total of 10267 under-five children of all interviewed mothers were included in the final analysis, of which 12.3% (1260) died. Maternal age (25-34 years: AOR = 1.514, 95% CI = 1.130-2.029, p = 0.005; 45+: AOR = 13.226, 95% CI = 9.253-18.905, p

AbstractDiarrhoea is the second-leading cause of death in Liberia, a sub-Saharan African country of 4.8 million people, with a majority living in rural villages. Diarrhoea has often been linked with poor water quality and malnutrition. Three organisations partnered to distribute point-of-use (POU) water filters to every household in Liberia without other access to safe water, documenting the distribution of filters to 101,706 households. Each such household was surveyed at a baseline, two weeks, and eight weeks. In addition to household characteristics, the prevalence of diarrhoea was reported at each survey. Our goal was to determine the extent of the impact that POU filter use had on diarrhoea prevalence by age group, controlling for effects of water source, location, and household size. Overall, there was a 94.2% decrease in diarrhoea cases from baseline to the 8-week follow-up. We discuss the success of the intervention in decreasing diarrhoea prevalence. The filter distribution focused on reaching remote villages, and providing access to clean water where there was none before. This study confirms that community-wide access to clean drinking water can reduce diarrhoea prevalence.

IntroductionHerd immunity against norovirus (NoV) is poorly understood in terms of its serological properties and vaccine designs. The precise neutralizing serological features of genotype I (GI) NoV have not been studied.MethodsTo expand insights on vaccine design and herd immunity of NoVs, seroprevalence and seroincidence of NoV genotypes GI.2, GI.3, and GI.9 were determined using blockade antibodies based on a 5-year longitudinal serosurveillance among 449 residents in Jidong community.ResultsCorrelation between human histo-blood group antigens (HBGAs) and GI NoV, and dynamic and persistency of antibodies were also analyzed. Seroprevalence of GI.2, GI.3, and GI.9 NoV were 15.1%–18.0%, 35.0%–38.8%, and 17.6%–22.0%; seroincidences were 10.0, 21.0, and 11.0 per 100.0 person-year from 2014 to 2018, respectively. Blockade antibodies positive to GI.2 and GI.3 NoV were significantly associated with HBGA phenotypes, including blood types A, B (excluding GI.3), and O+; Lewis phenotypes Leb+/Ley+ and Lea+b+/Lex+y+; and secretors. The overall decay rate of anti-GI.2 antibody was -5.9%/year (95% CI: -7.1% to -4.8%/year), which was significantly faster than that of GI.3 [-3.6%/year (95% CI: -4.6% to -2.6%/year)] and GI.9 strains [-4.0%/year (95% CI: -4.7% to -3.3%/year)]. The duration of anti-GI.2, GI.3, and GI.9 NoV antibodies estimated by generalized linear model (GLM) was approximately 2.3, 4.2, and 4.8 years, respectively.DiscussionIn conclusion, enhanced community surveillance of GI NoV is needed, and even one-shot vaccine may provide coast-efficient health benefits against GI NoV infection.