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Lakoh S, Bangura MM, Adekanmbi O, Barrie U, Jiba DF, Kamara MN, Sesay D, Jalloh AT, Deen GF, Russell JBW, Egesimba G, Yendewa GA, Firima E. Impact of COVID-19 on the Utilization of HIV Testing and Linkage Services in Sierra Leone: Experience from Three Public Health Facilities in Freetown. AIDS Behav 2024; 28:1235-1243. [PMID: 37642824 PMCID: PMC10940454 DOI: 10.1007/s10461-023-04149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/31/2023]
Abstract
The COVID-19 pandemic adversely affected the delivery of essential health services globally. In this study, we aimed to assess the impact of the pandemic on HIV testing and linkage services at three public health facilities in Freetown, Sierra Leone. We conducted a retrospective study to assess the impact of COVID-19 on HIV testing and linkage to treatment services (HTS) at Connaught Hospital (CH-tertiary), Lumley Government Hospital (LGH-secondary) and George Brooke Community Health Center (GBC-primary) in Freetown. Statistical analyses were conducted in Stata (16.1, StataCorp LLC, College Station, TX). Intra-pandemic HTS (2020) and HTS during recovery (2021) were compared with pre-pandemic HTS (2019). Of the 8538 people tested for HIV in the three facilities, 4929 (57.5%) visited CH. Only 2249 people were tested for HIV in 2020 compared to 3825 in 2019 (difference: - 41.2%, P < 0.001). Fewer people were also tested in 2021 (difference: - 35.6% P < 0.001). The largest reductions in testing in 2020 occurred in women (- 47.7%), children under 15 (- 95.2%), married people (- 42.6%), and CH (- 46.2%). Overall, 1369 (16.0%) people were positive for HIV; CH (878, 17.9%), LGH (469, 15.6%) and GBC (22, 3.5%). The likelihood of a positive HIV test was 26% lower in 2020 than 2019 (PR 0.74; 95% CI 0.64-0.85; P < 0.001), but 16% higher in 2021 than 2019 (PR 1.16; 95% CI 1.03-1.30; P < 0.05). Of the 1369 HIV diagnosis, 526 (38.4%) were linked to care. We found significant disruptions in HIV testing and linkage services at different levels of service delivery during the COVID-19 pandemic, underscoring the need to strengthen essential health services during public health emergencies.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
| | - Moses M Bangura
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Darlinda F Jiba
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Daniel Sesay
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Abdulai Tejan Jalloh
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Ginika Egesimba
- ICAP at Columbia University Mailman School of Public Health, Freetown, Sierra Leone
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emmanuel Firima
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland.
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria.
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Oljira H, Rata A, Mulatu B, Abera T. Partner notification service utilization and associated factors among clients attending anti-retroviral therapy clinics of public health facilities in Gimbi Town, West Ethiopia, 2023: a facility-based mixed-method cross-sectional study. BMC Public Health 2024; 24:687. [PMID: 38438988 PMCID: PMC10913634 DOI: 10.1186/s12889-024-18196-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/23/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Partner Notification Service is among the strategies used to conduct targeted Human Immunodeficiency Virus Testing Service by obtaining information about sexual contacts of index clients to refer for testing. But most people living with Human Immunodeficiency Virus are still unaware of their status, including Ethiopia. Limited studies are available on the magnitude of partner notification service utilization and associated factors in Ethiopia. OBJECTIVE The aim of this study was to assess the magnitude of partner notification service utilization and associated factors among people living with Human Immunodeficiency Virus attending anti-retroviral therapy clinics of public health facilities in Gimbi town, West Ethiopia. METHODS A facility-based mixed-method cross-sectional study design was used. Total of 455 study participants were selected by systematic random sampling for quantitative data and health workers were purposively selected for qualitative data until saturation of ideas was reached. The study was conducted from December 1, 2022 to January 30, 2023. Structured questionnaires and key informant interview guides were used for data collection. Quantitative data were analyzed using Statistical Package for Social Science version 25. Open code 4.02 software was used for qualitative data analysis. Frequencies and proportions were used to summarize descriptive statistics. Bivariable and multivariable logistic regression was used to identify associated factors then variables with a p value < 0.05 were declared to have an association with the dependent variable. RESULT Exactly 298 (65.5%) of the study participants were notified their HIV status to their sexual partners. Factors associated with Partner Notification Service Utilization were depression AOR: 0.12 (95% CI: 0.07, 0.20), urban settlers AOR: 2.21 (95% CI: 1.2, 3.83), fear of support loss AOR: 0.24 (95% CI: 0.14, 0.40) and intimate partner violence AOR: 0.55 (95% CI: 0.31, 0.97). From qualitative part of this study, factors associated to Partner Notification service utilization were fear of stigma, discrimination and fear of divorce. CONCLUSION Two-third of the study participants were utilized partner notification service, and efforts are important to prevent depression and intimate partner violence. Local government bodies and stakeholders should implement economic strengthening and strategies to address the rural community for HIV/AIDS prevention. Promotion of supportive and inclusive environment for PLHIV should also considered as way to increase PNS utilization.
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Affiliation(s)
- Habtamu Oljira
- Department of Biomedical Science, School of Medicine, Wallaga University, Nekemte, Oromia, Ethiopia.
| | - Abiriham Rata
- Nekemte Blood Bank, Oromia Health Beuareu, Nekemte, Oromia, Ethiopia
| | - Befirdu Mulatu
- Department of Public Health, Institute of Health Science, Wallaga University, Nekemte, Oromia, Ethiopia
| | - Tesfaye Abera
- Department of Nursing, School of Nursing and Midwifery, Wallaga University, Nekemte, Oromia, Ethiopia
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Lakoh S, Vamboi PL, Ouédraogo AR, Adekanmbi O, Deen GF, Russell JBW, Sankoh-Hughes A, Kamara JB, Kanu JE, Yendewa GA, Firima E, Amaral AFS. High prevalence of TB multimorbidity among adults of a tertiary hospital in Sierra Leone: a cross-sectional study. BMC Res Notes 2023; 16:337. [PMID: 37974272 PMCID: PMC10655410 DOI: 10.1186/s13104-023-06476-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/25/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Tuberculosis (TB) is a leading cause of death globally, with approximately 1.5 million deaths in 2020. TB often coexists with chronic communicable and non-communicable diseases, but data to determine the extent of comorbid diseases are limited. In this study, we aimed to assess the prevalence of TB multimorbidity and its risk factors in a tertiary hospital in Sierra Leone. This is a cross-sectional study of 240 adults with microbiologically-confirmed TB at Connaught Hospital in Freetown, between March and May 2022. Logistic regression analysis was used to identify factors associated with TB multimorbidity. RESULTS The mean age of the patients was 37 years. More than two-thirds were males and about the same number had two or more chronic diseases. The most common were hypertension (47.9%) and diabetes (24.2%). Patients under 35 years of age were less likely to have TB multimorbidity (< 25 years: adjusted OR 0.07, 95%CI 0.01-0.6; 25-34 years: adjusted OR 0.2, 95%CI 0.01-0.9). We report a high prevalence of comorbid diseases among TB patients in the largest treatment center in Sierra Leone, with hypertension and diabetes being the most common. These findings support the current call for addressing comorbid non-communicable diseases in TB patients through integrated care.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
| | - Patricia Lombeh Vamboi
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdoul Risgou Ouédraogo
- Division of Pulmonology, Training and Research Unit in Health Sciences, University Joseph KI-ZEBRO, Ouagadougou, Burkina Faso
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Ahmed Sankoh-Hughes
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joseph B Kamara
- Government of Sierra Leone, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Joseph Edwin Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
| | - André F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
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Baldeh M, Kizito S. Call to action: HIV among adolescents in Sierra Leone. Lancet 2023; 402:1240. [PMID: 37805214 PMCID: PMC11095044 DOI: 10.1016/s0140-6736(23)01788-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/21/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Mamadu Baldeh
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul 273, The Gambia; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Samuel Kizito
- International Center for Child Health and Development, Brown School, Washington University, St. Louis, MO, USA
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Abdul R, de Wit TFR, Martelli G, Costigan K, Katambi P, Mllacha P, Pozniak A, Maokola W, Mfinanga S, Hermans S. Effectiveness of provider-initiated versus client-initiated HIV testing by different health facility departments in Northern Tanzania. AIDS Res Ther 2023; 20:44. [PMID: 37420276 PMCID: PMC10329383 DOI: 10.1186/s12981-023-00541-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/25/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND HIV prevalence in Tanzania is still high at 4.7% among adults. Regular HIV testing is consistently advocated in the country to increase the level of awareness of HIV status, thus contributing to national HIV prevention. We report findings from three years of implementation of an HIV Test and Treat project utilizing provider-initiated and client-initiated testing and counselling (PITC and CITC). This study compared the effectiveness of PITC versus CITC in HIV case detection by the different departments of health facilities. METHOD This retrospective cross-sectional study used health facility-based HIV testing data collected from adults aged 18 years and above between June 2017 - July 2019 in the Shinyanga region, Tanzania. Chi-square and logistic regression analysis were used to assess determinants of yield (HIV positivity). RESULTS A total of 24,802 HIV tests were performed of which 15,814 (63.8%) were by PITC and 8,987 (36.2%) by CITC. Overall HIV positivity was 5.7%, higher among CITC at 6.6% than PITC at 5.2%. TB and IPD departments had the highest HIV positivity 11.8% and 7.8% respectively. Factors associated with a positive test were testing at a department in the facility compared to CITC, first-time test, and being or having been married compared to being single. CONCLUSION Success in identifying HIV + patients was highest among people visiting the clinic for HIV testing (CITC) and first-time testers. With PITC, HIV + patient detection differed between departments, suggesting divergent risk profiles of respective clients and/or divergent HIV alertness of staff. This underscores the importance of increased targeting for PITC to identify HIV + patients.
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Affiliation(s)
- Ramadhani Abdul
- Amsterdam UMC, Department University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands.
| | - Tobias F Rinke de Wit
- Amsterdam UMC, Department University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - Giulia Martelli
- Infectious Diseases Unit, AUSL Romagna, Morgagni Pierantoni Hospital Forlí, Doctors with Africa CUAMM IT, Forlí, Italy
| | | | | | - Peter Mllacha
- Shinyanga Regional Referal Hospital, Shinyanga, Tanzania
| | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust and LSHTM, London, UK
| | | | - Sayoki Mfinanga
- National Institute for Medical Research(NIMR)-Muhimbili centre, Dar es Salaam, Tanzania
- Alliance for Africa Health Research, Nairobi, Kenya
- School of Public Health, Department of Epidemiology and Statistics, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Sabine Hermans
- Amsterdam UMC, Department University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
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Lakoh S, Kamara JB, Orefuwa E, Sesay D, Jiba DF, Adekanmbi O, Deen GF, Russell JBW, Bah AB, Kargbo MJ, Firima E, Yendewa GA, Denning DW. Prevalence and predictors of Aspergillus seropositivity and chronic pulmonary aspergillosis in an urban tertiary hospital in Sierra Leone: A cross-sectional study. PLoS Negl Trop Dis 2023; 17:e0011284. [PMID: 37459359 PMCID: PMC10374077 DOI: 10.1371/journal.pntd.0011284] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/27/2023] [Accepted: 05/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND In the World Health Organization Global Tuberculosis (TB) Report 2022, 37% of pulmonary TB patients were clinically diagnosed and thus many people were treated for TB without evidence of the disease. Probably the most common TB misdiagnosis is chronic pulmonary aspergillosis (CPA). In this study, we aimed to assess the prevalence and predictors of Aspergillus seropositivity and CPA in patients with chronic respiratory symptoms in an urban tertiary hospital in Sierra Leone. METHODOLOGY/PRINCIPAL FINDINGS We used a cross-sectional study design to recruit adults (≥18 years) from the Chest Clinic of Connaught Hospital, Freetown between November 2021 and July 2022. Aspergillus antibody was detected using LDBio Aspergillus IgM/IgG. Logistic regression was performed to assess the independent predictors of Aspergillus seropositivity and CPA. Of the 197 patients with chronic respiratory symptoms, 147 (74.6%) were male. Mean age was 47.1 ± 16.4 years. More than half (104, 52.8%) had been diagnosed with TB in the past, while 53 (26.9%) were on TB treatment at the time of recruitment. Fifty-two (26.4%) patients were HIV positive, 41 (20.8%) were seropositive for Aspergillus and 23 (11.6%) had CPA, 2 (3.8%) with current TB and 18 (17.3%) with past TB. Common radiologic abnormalities reported were localized fibrotic changes 62 (31.5%), consolidation 54 (27.4%), infiltrates 46 (23.4%), hilar adenopathy 40 (20.3%) and pleural effusion 35 (17.85) and thickening 23 (11.7%). Common symptoms were weight loss 144 (73.1%), cough 135 (68.5%), fever 117 (59.4%) and dyspnea 90 (45.7%). Current or past TB infection {aOR 3.52, 95% CI (1.46, 8.97); p = 0.005} was an independent predictor of Aspergillus seropositivity and CPA. CONCLUSIONS/SIGNIFICANCE We report a high prevalence of Aspergillus antibody seropositivity and CPA, underscoring the need to integrate the prevention and management of pulmonary fungal infections with TB services and asthma care in order to reduce unnecessary morbidity and mortality.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
| | - Joseph B Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Emma Orefuwa
- Global Action For Fungal Infections, Geneva, Switzerland
| | - Daniel Sesay
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Abubakarr Bailor Bah
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Maxwell Joseph Kargbo
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Emmanuel Firima
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - David W Denning
- Global Action For Fungal Infections, Geneva, Switzerland
- Manchester Fungal Infection Group, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Kawuki J, Kamara K, Sserwanja Q. Prevalence of risk factors for human immunodeficiency virus among women of reproductive age in Sierra Leone: a 2019 nationwide survey. BMC Infect Dis 2022; 22:60. [PMID: 35039011 PMCID: PMC8764866 DOI: 10.1186/s12879-022-07037-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background and aim For over 40 years of the HIV/AIDS global epidemic, no effective cure nor vaccine is yet available, making the current control strategies focused on curbing new infections through risk reduction. The study aimed to determine the prevalence of HIV risk factors and their associated socio-demographics among women of reproductive age in Sierra Leone. Methods We used weighted data from the Sierra Leone Demographic and Health Survey (SLDHS) of 2019 for 12,005 women aged 15–49 years. Multistage sampling was used to select study participants. Exposure to HIV risk factors was considered if a woman reported at least one of the following; having multiple sexual partners, transactional sex, non-condom use for the unmarried, and having other sexually transmitted infections (STIs). We, then, conducted multivariable logistic regression to explore the associated socio-demographics. All the analyses were done using SPSS (version 25). Results Of the 12,005 women, 38.1% (4577/12005) (95% confidence interval (CI) 37.3–39.0) had at least one of the four risk factors. Women of 15 to 19 years (adjusted odds ratio (AOR) = 1.34, 95% CI 1.00–1.80) and 20 to 34 years (AOR = 1.25, 95% CI 1.05–1.49) had more odds of having HIV risk factors compared to those of 35 to 49 years. Urban residents (AOR = 1.49, 95% CI 1.17–1.89) and those from the Northwestern region (AOR = 1.81, 95% CI 1.26–2.60) were also more likely to encounter HIV risk factors compared to their respective counterparts. Moreover, unmarried women (AOR = 111.17, 95% CI 87.55–141.18) and those working (AOR = 1.38, 95% CI 1.14–1.67) also had higher odds of having HIV risk factors, compared to their respective counterparts. Sex of household head and parity were also significant associates. Conclusions More than a third of women in Sierra Leone had encountered at least one HIV risk factor, and this was associated with age, place of residence, region, marital status, working status, household head and parity. There is a need for strengthening HIV/AIDS education programs, laws and policies targeting the young, working, unmarried and urban-resident women. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07037-7.
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Affiliation(s)
- Joseph Kawuki
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kassim Kamara
- Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Sierra Leone, Freetown, Sierra Leone
| | - Quraish Sserwanja
- Programmes Department, GOAL, Arkaweet Block 65 House No. 227, Khartoum, Sudan.
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Lakoh S, Li L, Sevalie S, Guo X, Adekanmbi O, Yang G, Adebayo O, Yi L, Coker JM, Wang S, Wang T, Sun W, Habib AG, Klein EY. Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study. Antimicrob Resist Infect Control 2020; 9:38. [PMID: 32087751 PMCID: PMC7036224 DOI: 10.1186/s13756-020-0701-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/12/2020] [Indexed: 12/21/2022] Open
Abstract
Background Available data on antibiotic resistance in sub-Saharan Africa is limited despite its increasing threat to global public health. As there is no previous study on antibiotic resistance in patients with clinical features of healthcare-associated infections (HAIs) in Sierra Leone, research is needed to inform public health policies. Our study aimed to assess antibiotic resistance rates from isolates in the urine and sputum samples of patients with clinical features of HAIs. Methodology We conducted a cross-sectional study of adult inpatients aged ≥18 years at Connaught Hospital, an urban tertiary care hospital in Freetown between February and June 2018. Results Over the course of the study, we enrolled 164 patients. Risk factors for HAIs were previous antibiotic use (93.3%), comorbidities (58.5%) and age (≥65 years) (23.9%). Of the 164 samples, 89.6% were urine. Bacterial growth was recorded in 58.8% of cultured specimens; the type of specimen was an independent predictor of bacterial growth (p < 0.021). The most common isolates were Escherichia coli and Klebsiella pneumoniae; 29.2% and 19.0% in urine samples and 18.8% and 31.3% in sputum samples, respectively. The overall resistance rates were 58% for all extended-spectrum beta-lactamase (ESBL)-producing organisms, 13.4% for carbapenem-resistant non-lactose fermenting gram-negative bacilli, 8.7% for carbapenem-resistant Acinetobacter baumannii (CRAB) and 1.3% for carbapenem-resistant Enterobacteriaceae (CRE). There were no carbapenem-resistant P. aeruginosa (CRPA) isolates but all Staphylococcus aureus isolates were methicillin-resistant S. aureus. Conclusion We demonstrated a high prevalence rate of ESBL-producing organisms which are a significant burden at the main tertiary hospital in Sierra Leone. Urgent action is needed to strengthen microbiological diagnostic infrastructure, initiate surveillance on antibiotic resistance and develop and implement policy framework on antibiotic stewardship.
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Affiliation(s)
- Sulaiman Lakoh
- Department of Internal Medicine, University of Sierra Leone, Freetown, Sierra Leone. .,Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone. .,Sustainable Health Systems, Freetown, Sierra Leone.
| | - Letian Li
- Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, Jilin Province, 130122, China
| | - Stephen Sevalie
- Sustainable Health Systems, Freetown, Sierra Leone.,34 Military Hospital, Freetown, Sierra Leone
| | - Xuejun Guo
- Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, Jilin Province, 130122, China.
| | - Olukemi Adekanmbi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Guang Yang
- 302 Military Hospital of China, Beijing, 100039, China
| | - Oladimeji Adebayo
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Le Yi
- Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, Jilin Province, 130122, China
| | - Joshua M Coker
- Department of Internal Medicine, University of Sierra Leone, Freetown, Sierra Leone.,Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Shuchao Wang
- Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, Jilin Province, 130122, China
| | - Tiecheng Wang
- Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, Jilin Province, 130122, China
| | - Weiyang Sun
- Institute of Military Veterinary Medicine, Academy of Military Medical Science, Changchun, Jilin Province, 130122, China
| | - Abdulrazaq G Habib
- Department of Medicine, Bayero University, Kano, Nigeria.,Department of Medicine, Amino Kano Teaching Hospital, Kano, Nigeria
| | - Eili Y Klein
- Center for Disease Dynamics, Economics & Policy, Washington, DC, 20005, USA.,Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21209, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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