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Concept: Ernest Bai Koroma


The West African Ebola epidemic of 2013-2016 was by far the largest outbreak of the disease on record. Sierra Leone suffered nearly half of the 28,646 reported cases. This paper presents a set of culturally contextualized Ebola messages that are based on the findings of qualitative interviews and focus group discussions conducted in ‘hotspot’ areas of rural Bombali District and urban Freetown in Sierra Leone, between January and March 2015. An iterative approach was taken in the message development process, whereby (i) data from formative research was subjected to thematic analysis to identify areas of community concern about Ebola and the national response; (ii) draft messages to address these concerns were produced; (iii) the messages were field tested; (iv) the messages were refined; and (v) a final set of messages on 14 topics was disseminated to relevant national and international stakeholders. Each message included details of its rationale, audience, dissemination channels, messengers, and associated operational issues that need to be taken into account. While developing the 14 messages, a set of recommendations emerged that could be adopted in future public health emergencies. These included the importance of embedding systematic, iterative qualitative research fully into the message development process; communication of the subsequent messages through a two-way dialogue with communities, using trusted messengers, and not only through a one-way, top-down communication process; provision of good, parallel operational services; and engagement with senior policy makers and managers as well as people in key operational positions to ensure national ownership of the messages, and to maximize the chance of their being utilised. The methodological approach that we used to develop our messages along with our suggested recommendations constitute a set of tools that could be incorporated into international and national public health emergency preparedness and response plans.

Concepts: Focus group, Communication, Sierra Leone, Freetown, Ernest Bai Koroma, Temne people, Bombali District, Makeni


Convalescent blood therapy has been a promising form of treatment for Ebola Virus Disease (EVD), but less attention has been focused on it for treatment.

Concepts: Viral hemorrhagic fever, Incubation period, Sierra Leone, Freetown, Western Area, Ahmad Tejan Kabbah, All People's Congress, Ernest Bai Koroma


Diagnostic tools available in low-income countries are often really basic even if patients can be as sick as those of the richer countries. Point-of-care ultrasound could be a solution for this problem. We studied the impact of ultrasound at the Holy Spirit Hospital, Makeni, Sierra Leone.

Concepts: Sierra Leone, Freetown, Ernest Bai Koroma, Holy Spirit, Makeni


Packaged drinking water (PW) sold in bottles and plastic bags/sachets is widely consumed in low- and middle-income countries (LMICs), and many urban users in sub-Saharan Africa (SSA) rely on packaged sachet water (PSW) as their primary source of water for consumption. However, few rigorous studies have investigated PSW quality in SSA, and none have compared PSW to stored household water for consumption (HWC). A clearer understanding of PSW quality in the context of alternative sources is needed to inform policy and regulation. As elsewhere in SSA, PSW is widely consumed in Sierra Leone, but government oversight is nearly nonexistent. This study examined the microbiological and chemical quality of a representative sample of PSW products in Freetown, Sierra Leone at packaged water manufacturing facilities (PWMFs) and at points of sale (POSs). Samples of HWC were also analyzed for comparison. The study did not find evidence of serious chemical contamination among the parameters studied. However, 19% of 45 PSW products sampled at the PWMF contained detectable Escherichia coli (EC), although only two samples exceeded 10 CFU/100 mL. Concentrations of total coliforms (TC) in PSW (but not EC) increased along the supply chain. Samples of HWC from 60 households in Freetown were significantly more likely to contain EC and TC than PSW at the point of production (p<0.01), and had significantly higher concentrations of both bacterial indicators (p<0.01). These results highlight the need for additional PSW regulation and surveillance, while demonstrating the need to prioritize the safety of HWC. At present, PSW may be the least unsafe option for many households.

Concepts: Escherichia coli, West Africa, Sierra Leone, Freetown, Western Area, Ahmad Tejan Kabbah, All People's Congress, Ernest Bai Koroma


The demand for high quality hospital care for children in low resource countries is not being met. This paper describes a number of strategies to improve emergency care at a children’s hospital and evaluates the impact of these on inpatient mortality. In addition, the cost-effectiveness of improving emergency care is estimated.

Concepts: Hospital, Sierra Leone, Freetown, Western Area, Ahmad Tejan Kabbah, All People's Congress, Ernest Bai Koroma, Temne people


Knowing risk factors for household transmission of Ebola virus is important to guide preventive measures during Ebola outbreaks.

Concepts: Ebola, Sierra Leone, Freetown, Western Area, Ahmad Tejan Kabbah, All People's Congress, Ernest Bai Koroma, Temne people


To describe a site assessment of the Princess Christian Maternity Hospital (PCMH; Freetown, Sierra Leone), the national referral center for reproductive, maternal, newborn, child and adolescent health (RMNCAH) services and logical site for focused efforts to train and expand the RMNCAH workforce in Sierra Leone.

Concepts: Obstetrics and gynaecology, Sierra Leone, Freetown, Western Area, Ahmad Tejan Kabbah, All People's Congress, Ernest Bai Koroma, Temne people


Mortality surveillance and vital registration are limited in Sierra Leone, a country with one of the highest mortality rates among children aged <5 years worldwide, approximately 120 deaths per 1,000 live births (1,2). To inform efforts to strengthen surveillance, stillbirths and deaths in children aged <5 years from multiple surveillance streams in Bombali Sebora chiefdom were retrospectively reviewed. In total, during January 2015-November 2016, 930 deaths in children aged <5 years were identified, representing 73.3% of the 1,269 deaths that were expected based on modeled estimates. The "117" telephone alert system established during the Ebola virus disease (Ebola) epidemic captured 683 (73.4%) of all reported deaths in children aged <5 years, and was the predominant reporting source for stillbirths (n = 172). In the absence of complete vital events registration, 117 call alerts markedly improved the completeness of reporting of stillbirths and deaths in children aged <5 years.

Concepts: Death, Sierra Leone, Ernest Bai Koroma, Temne people, Northern Province, Sierra Leone, Bombali District, Makeni, Joseph Saidu Momoh


to explore the factors influencing women’s use of birth waiting homes in the Northern Bombali district, Sierra Leone.

Concepts: Sierra Leone, Ernest Bai Koroma, Bombali District, Joseph Saidu Momoh


Freetown, the capital of Sierra Leone has experienced vast land-cover changes over the past three decades. In Sierra Leone, however, availability of updated land-cover data is still a problem even for environmental managers. This study was therefore, conducted to provide up-to-date land-cover data for Freetown. Multi-temporal Landsat data at 1986, 2001, and 2015 were obtained, and a maximum likelihood supervised classification was employed. Eight land-cover classes or categories were recognized as follows: water, wetland, built-up, dense forest, sparse forest, grassland, barren, and mangrove. Land-cover changes were mapped via post-classification change detection. The persistence, gain, and loss of each land-cover class, and selected land conversions were also quantified. An overall classification accuracy of 87.3 % and a Kappa statistic of 0.85 were obtained for the 2015 map. From 1986 to 2015, water, built-up, grassland, and barren had net gains, whereas forests, wetlands, and mangrove had net loses. Conversion analyses among forests, grassland, and built-up show that built-up had targeted grassland and avoided forests. This study also revealed that, the overall land-cover change at 2001-2015 was higher (28.5 %) than that recorded at 1986-2001 (20.9 %). This is attributable to the population increase in Freetown and the high economic growth and infrastructural development recorded countrywide after the civil war. In view of the rapid land-cover change and its associated environmental impacts, this study recommends the enactment of policies that would strike a balance between urbanization and environmental sustainability in Freetown.

Concepts: Forest, Sustainability, Sierra Leone, Freetown, Western Area, Ahmad Tejan Kabbah, All People's Congress, Ernest Bai Koroma