Peripheral facial paralysis (PFP ) is a neurological manifestation commonly encountered in neurosurgical consultation. The objective of this study was to correlate the disease and HIV AIDS. This is a retrospective study from October 2008 to September 2012 which involved all patients with PFP in consultation with neurosurgery. Patients had a complete neurological examination and blood diagnostic tests , biological and radiological . An otorhinolaryngologic consultation was carried out by all patients. Our series included 36 patients including 11 women . The ages ranged between 20 and 42 years . Facial paralysis was right in 22 patients ( 61.11 %) , paresis interested hemifacial . The review otorhinolaryngologic was normal in all patients as all brain CT-scan. In the series 28 patients ( 77.77 %) were seropositive The Elisa and Western blot confirmed the presence of HIV-1 in all patients and HIV 2 in 8 . The treatment consisted in the administration of prednisolone and antiretrovirals. The outcome was favorable in all patients with the gradual disappearance of facial paralysis in 20 patients in 8 weeks and 16 more in 6 months. The presence of HIV 1 and 2 in 77.77 % of patients due to facial paralysis is an indicator of HIV AIDS in the department of neurosurgery.
Land use changes study is an essential step for the monitoring and assessment of ecosystems.In Senegal River delta, ecosystem has experienced significant changes from 1970 to nowadays.Several natural and anthropic factors are at the origin of these modifications.The aim of this paper is to reconstruct the history of land use in the Senegal River delta and detect these changes.For this, Landsat images acquired in 1972 (MSS), 1984 and 1988 (TM), 1999 and 2006 (ETM) and 2014 (OLI) are used to make the diachronic study.We have first conducted a pretreatment of the image (relating to the geometrical and radiometric correction and the equalization of the histograms), calculated of pseudo-ACP bands and NDVI, classified and validated the images and finally detected changes by individual classification method.The results obtained, broadly show significant changes in terms of areas gain for the land plants (231%), growing areas (95%) and aquatic vegetation (75%).This dynamic is at the expense of saline lands, dune surfaces and the water areas.Interesting perspectives for authorities and decision makers in precise management of the ecosystem in the Senegal River delta are offered as well.
After a decade of civil war and the 2014–2016 West African Ebola outbreak, Sierra Leone now faces the COVID-19 pandemic with a fragile health system. As was demonstrated during Ebola, preparedness is key to limiting a health crisis’ spread and impact on health systems and ensuring continued care for vulnerable populations including people living with HIV (PLHIV). To assess COVID-19 preparedness and inform interventions to ensure continuity of HIV services at health facilities (HFs) and community service points (CSPs), we conducted site readiness assessments in Freetown, the epicenter of COVID-19 in Sierra Leone. Data were collected at nine high-volume HIV HFs and seven CSPs in April 2020, a month after COVID-19 was declared a pandemic. CSPs comprised three community drop-in centers providing HIV counseling and testing services as well as HIV prevention services (e.g., condoms and lubricants) for key and priority populations and four community-based support groups serving PLHIV. At the time of assessment, CSPs did not provide antiretroviral therapy (ART) but were considered potential sites for expansion of differentiated service delivery (DSD)—a client-centered approach to HIV care—in the context of COVID-19. Overall, 5/9 HFs had trained staff on use of personal protective equipment (PPE) and prevention of COVID-19 transmission. Most had access to masks (5/9) and gloves (7/9) for management of suspected/confirmed COVID-19 cases, and 4/9 HFs had triage procedures for isolation of suspected cases. Conversely, few CSPs had access to masks (2/7) or gloves (2/7) and no staff were trained on PPE use or COVID-19 transmission. 7/9 HFs had adequate ART stock for multi-month dispensing though few had procedures for (3/9) or had trained staff in providing DSD (2/9). Among CSPs where measures were applicable, 2/4 had procedures for DSD, 1/3 had staff trained on DSD and none had adequate ART stock. Identification of gaps in COVID-19 preparedness is a critical step in providing support for infection control and modified service delivery. Findings from this assessment highlight gaps in COVID-19 preparedness measures at sites supporting PLHIV in Sierra Leone and indicate CSPs may require intensive supervision and training to ensure HIV services are uninterrupted while minimizing COVID-19 risk, especially if used as sites to scale up DSD.
The double burden of malnutrition (DBM) is rising globally, particularly in sub-Saharan Africa. In Sierra Leone, the incidence of overweight, obesity (OWOB), and overnutrition among women has sharply increased. This finding accompanies the high incidence of undernutrition, which has been prevalent for decades. This study aimed to determine the prevalence of different malnutrition categories (underweight, overweight, obesity, and overnutrition) and associated factors among women of reproductive age (15-49 years) in Sierra Leone using secondary data analysis of the Sierra Leone Demographic Health Survey of 2019 (SLDHS-2019).We conducted secondary data analysis of the SLDHS-2019 of 7,514 women aged 15-49 years. We excluded pregnant, post-natal, lactating, and post-menopausal women. Data was collected using validated questionnaires, and respondents were selected through a multistage stratified sampling approach. A multivariable logistic regression analysis was used to determine factors associated with malnutrition among 15-49-year-old women in Sierra Leone.Among 15-49-year-old women in Sierra Leone, the prevalence of underweight was 6.7% (95%CI: 4.5-8.9%); overweight at 19.7% (95%CI: 17.7-21.7%); obesity was 7.4% (95% CI: 5.2-9.6%); and overnutrition, 27.1% (95%CI: 25.2-29.0%). Women aged 25-34 years were more likely to be underweight (adjusted Odds Ratios, aOR = 1.670, 95%CI: 1.254-2.224; p < 0.001) than those aged 15-24 years; women who were not married were less likely to be underweight (aOR = 0.594, 95%CI: 0.467-0.755; p < 0.001) than married women. Women from the North were less likely to be underweight (aOR = 0.734, 95%CI: 0.559-0.963; p = 0.026) than the East, and those who did not listen to the radio were less likely to be underweight (aOR = 0.673; 95%CI: 0.549-0.826; p < 0.001) than those who did. Overweight was less likely among 25-34 years (aOR = 0.609, 95%CI: 0.514-0.722; p < 0.001) and 35-49 years (aOR = 0.480, 95%CI: 0.403-0.571; p < 0.001) age-groups than 15-24 years; more likely among not married women (aOR = 1.470, 95%CI:1.249-1.730; p < 0.001) than married; less likely among working-class (aOR = 0.840, 95%CI: 0.720-0.980; p = 0.026) than not working-class; most likely in women from the North (aOR = 1.325, 95%CI:1.096-1.602; p = 0.004), and less likely among women from the South (aOR = 0.755, 95%CI: 0.631-0.903; p = 0.002) than the East; less likely among women of middle-wealth-index (aOR = 0.656, 95%CI: 0.535-0.804; p < 0.001), richer-wealth-index (aOR = 0.400, 95%CI: 0.309-0.517; p < 0.001), and richest-wealth-index (aOR = 0.317, 95%CI: 0.234-0.431; p < 0.001) than the poorest-wealth-index; and more likely among women who did not listen to radios (aOR = 1.149; 95%CI:1.002-1.317; p = 0.047) than those who did. The predictors of overweight among women 15-49 years are the same as obesity and overnutrition, except overnutrition and obesity were less likely in female-headed households (aOR = 0.717,95%CI: 0.578-0.889; p < 0.001).The prevalence of all categories of malnutrition among women of reproductive age in Sierra Leone is high, affirming a double burden of malnutrition in this study population. Underweight was more likely among the 25-34-year age group than 15-24-year. The predictors of overweight, obesity, and overnutrition were being unmarried/single, residing in the North, and not listening to the radio. There is an urgent need for policymakers in Sierra Leone to design comprehensive educational programs for women of reproductive age on healthy lifestyles and the dangers of being underweight or over-nourished.
Vaccination coverage for the second dose of the measles-containing vaccine (MCV2) among children has remained stagnant in Sierra Leone at nearly 67% since its introduction in 2015. Identifying community-specific barriers faced by caregivers in accessing MCV2 services for their children and by health workers in delivering MCV2 is key to informing strategies to improve vaccination coverage.We used Photovoice, a participatory method using photographs and narratives to understand community barriers to MCV2 uptake from March- September 2020. Six female and five male caregivers of MCV2-eligible children (15-24 months of age), and six health care workers (HCWs) in Freetown, Sierra Leone participated. After having an orientation to photovoice, they photographed barriers related to general immunization and MCV2 uptake in their community. This was followed by facilitated discussions where participants elaborated on the barriers captured in the photos. Transcripts from the six immunization-related discussions were analyzed to deduce themes through open-ended coding. A photo exhibition was held for participants to discuss the barriers and suggested solutions with decision-makers, such as the ministry of health.We identified and categorized nine themes into three groups: 1) individual or caregiver level barriers (e.g., caregivers' lack of knowledge on MCV2, concerns about vaccine side effects, and gender-related barriers); 2) health system barriers, such as HCWs' focus on children below one year and usage of old child health cards; and 3) contextual barriers, such as poverty, poor infrastructure, and the COVID-19 pandemic. Participants suggested the decision-makers to enhance community engagement with caregivers and HCW capacity including, increasing accountability of their work using performance-based approaches, among different strategies to improve MCV2 uptake.Photovoice can provide nuanced understanding of community issues affecting MCV2. As a methodology, it should be integrated in broader intervention planning activities to facilitate the translation of community-suggested strategies into action.
Abstract Background The double burden of Malnutrition globally, particularly in sub-Saharan Africa, is on the rise. In Sierra Leone, the incidence of overweight, obesity (OWOB), and overnutrition among women have recently sharply increased, in addition to undernutrition which has been prevalent for decades. This study aimed to determine the prevalence of the different Malnutrition categories (underweight, overweight, obesity, and overnutrition) with Malnutrition among women of reproductive age (15–49 years) in Sierra Leone and associated factors using secondary data analysis of the Demographic Health Survey of 2019 (SLDHS-2019). Methods We conducted a secondary data analysis of the Sierra Leone Demographic Health Survey (2019-SLDHS) of 7,514 women aged 15 to 49. We excluded pregnant, post-natal, lactating, and post-menopausal women. Data was collected using a validated questionnaire, and participants were selected through a multistage stratified sampling approach. A multivariable logistic regression analysis was performed to determine factors associated with the different Malnutrition categories among 15–49-year-old women in Sierra Leone. Results Among 15–49-year-old women in Sierra Leone, the prevalence of the different categories of Malnutrition was as follows: underweight, 6.7%(95%CI:4.5%-8.9%); overweight, 19.7%(95%CI:17.7%-21.7%); obesity, 7.4%(95% CI:5.2%-9.6%); and overnutrition, 27.1%(95%CI:25.2%-29.0%). The independent predictors of not being underweight included: age group of 25–34 years (AOR = 1.670, 95%CI:1.254–2.224;p < 0.001) unmarried (AOR = 0.594,95%CI:0.467–0.755;p < 0.001) women from the North (AOR = 0.734,95%CI:0.559–0.963;p = 0.026), and not listening to a radio (AOR = 0.673;95%CI:0.549–0.826;p < 0.001). The 25–34 years (AOR = 0.609,95%CI:0.514–0.722;p < 0.001) and 35–49 years (AOR = 0.480,95%CI:0.403–0.571;p < 0.001) age groups, unmarried women (AOR = 1.470,95%CI:1.249–1.730;p < 0.001), working-class (AOR = 0.840,95%CI:0.720–0.980;p = 0.026) coming from the North (AOR = 1.325,95%CI:1.096–1.602;p = 0.004) and South (AOR = 0.755,95%CI:0.631–0.903;p = 0.002), middle wealth index (AOR = 0.656,95%CI:0.535–0.804;p < 0.001), richer wealth index (AOR = 0.400,95%CI:0.309–0.517; p < 0.001), richest wealth index (AOR = 0.317,95%CI:0.234–0.431;p < 0.001), and not listening to a radio (AOR = 1.149; 95%CI:1.002–1.317;p = 0.047) were the independent predictors of overweight. The independent predictors of overweight among Sierra Leone women 15–49 years are the same as those of obesity or overnutrition, in addition to female-headed households (AOR = 0.717,95%CI:0.578–0.889;p < 0 .001). Conclusion The prevalence of all the Malnutrition categories among women of reproductive age in Sierra Leone was high, affirming the double burden of Malnutrition in this group. It was more likely to be underweight among the 15–24-year age group compared to the 25–34 and 35–49-year age groups. The independent predictors of overweight, obesity, and overnutrition were age groups of 25–34 and 35–49, unmarried/single women, working class, women from the North and South, female headed households, middle to richest wealth index, and do not listen to a radio. There is an urgent need for policymakers in Sierra Leone to design comprehensive educational campaigns for women in the reproductive age group on healthy lifestyles and the dangers of being underweight or over-nutrition.
Objective To gain in-depth understanding of the caregiver experience when navigating urban immunisation services for their children. Design An exploratory qualitative assessment comprising 16 in-depth interviews using an interpretative phenomenology approach. Setting Caregivers were purposively recruited from slums (n=8) and other urban communities (n=8) in the capital city of Sierra Leone. Participants Caregivers of children ages 6–36 months old who were fully vaccinated (n=8) or undervaccinated (n=8). Results Emotional enablers of vaccination were evident in caregivers’ sense of parental obligation to their children while also anticipating reciprocal benefits in children’s ability to take care of their parents later in life. Practical enablers were found in the diversity of immunisation reminders, information access, information trust, getting fathers more involved, positive experiences with health workers and postvaccination information sharing in the community. Underlying barriers to childhood vaccination were due to practical constraints such as overcrowding and long waiting times at the clinic, feeling disrespected by health workers, expecting to give money to health workers for free services and fear of serious vaccine side effects. To improve vaccination outcomes, caregivers desired more convenient and positive clinic experiences and deeper community engagement. Conclusions Health system interventions, community engagement and vaccination outreach need to be tailored for urban settings. Vaccine communication efforts may resonate more strongly with caregivers when vaccination is framed both around parental responsibilities to do the right thing for the child and the future benefits to the parent.
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