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Sesay U, Serna-Chavez HM, Gebru GN, Kangbai JB, Ogbonna U, Squire JS, Bakker MI. Assessing the impact of COVID-19 on routine immunization in Sierra Leone. BMC Public Health 2024; 24:1795. [PMID: 38970039 PMCID: PMC11225177 DOI: 10.1186/s12889-024-19221-2] [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: 05/25/2023] [Accepted: 06/21/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic had a profound impact on healthcare systems and services, including routine immunization (RI). To date, there is limited information on the effects of the COVID-19 pandemic on RI in West African countries such as Sierra Leone, which had already experienced public health emergencies that disrupted its healthcare system. Here, we describe the impact of the COVID-19 pandemic on the RI of key antigens in Sierra Leone. METHODS We used vaccination data from the District Health Information System for BCG, measles-rubella 1 and 2, and pentavalent 1 and 3 antigens. We compared 2019, 2020, 2021, and 2022 annual coverage rates for the selected antigens at the national and district levels. We used the Pearson chi-square test to assess the difference between annual coverage rates between 2019 and 2020, 2020-2021, and 2021-2022. RESULTS National coverage rates for all antigens declined in 2019-2020, notably measles-rubella 1 and pentavalent 3 (-5.4% and - 4.9%). Between 2020 and 2021, there was an overall increase in coverage (+ 0.2% to + 2.5%), except for measles-rubella 2 (-1.8%). Measles-rubella antigens rebounded in 2021-2022, while others decreased between - 0.5 and - 1.9% in coverage. Overall, all district-level coverage rates in 2022 were lower than those in 2019. Most districts decreased between 2019 and 2022, though a few had a continuous increase; some had an increase/recovery between 2020 and 2021; some districts had recovered 2019 levels by 2022. CONCLUSION The COVID-19 pandemic impacted Sierra Leone's national BCG, measles-rubella, and pentavalent antigen immunization, which were not fully restored in 2022. Most districts experienced notable coverage declines during the pandemic, though a few reached or surpassed 2019 rates in 2022. Examining pandemic impact can benefit from a focus beyond the national level to identify vulnerable regions. Sierra Leone's post-pandemic RI reestablishment needs targeted strategies and continual investments for equitable access and coverage, as well as to prevent vaccine-preventable diseases.
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Affiliation(s)
- Umaru Sesay
- KIT Royal Tropical Institute, Amsterdam, The Netherlands.
- National Surveillance Program, Directorate of Health Security and Emergencies, Emergency Operation Center, National Public Health Agency, Wilkinso Road, Freetown City, Sierra Leone.
- Sierra Leone Field Epidemiology Training Program, Emergency Operation Center, National Public Health Agency, Wilkinson Road, Freetown City, Sierra Leone.
| | | | - Gebrekrstos Negash Gebru
- Sierra Leone Field Epidemiology Training Program, Emergency Operation Center, National Public Health Agency, Wilkinson Road, Freetown City, Sierra Leone
- Africa Field Epidemiology Network, Freetown City, Sierra Leone
| | - Jia Bainga Kangbai
- Department of Environmental Health, Njala University, Bo City, Sierra Leone
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Uzoma Ogbonna
- Sierra Leone Field Epidemiology Training Program, Emergency Operation Center, National Public Health Agency, Wilkinson Road, Freetown City, Sierra Leone
| | - James Sylvester Squire
- National Surveillance Program, Directorate of Health Security and Emergencies, Emergency Operation Center, National Public Health Agency, Wilkinso Road, Freetown City, Sierra Leone
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Schindell BG, Fredborg B, Kowalec K, Shaw S, Kangbai JB, Kindrachuk J. The state of mental health among Ebola virus disease survivors through a cross-sectional study in Sierra Leone. BMJ Glob Health 2024; 9:e015098. [PMID: 38782464 PMCID: PMC11116873 DOI: 10.1136/bmjgh-2024-015098] [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] [Received: 01/17/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The West African Ebola virus disease (EVD) epidemic resulted in >28 000 disease cases and >11 000 fatalities. The unprecedented number of survivors from this epidemic has raised questions about the long-term mental health impacts of EVD survivorship and the capacity to meet these needs. OBJECTIVES Assess the frequency and factors associated with mental health consequences of EVD survivorship in Sierra Leone. METHODS A cross-sectional study of 595 EVD survivors and 403 close contacts (n=998) from Sierra Leone assessed via in-person survey between November 2021 and March 2022. The assessment included validated mental health screening tools (Patient Health Questionnaire-9, PTSD Checklist-5, Alcohol Use Disorders Identification Test, Drug Abuse Screening Test-20) to indicate the presence/absence of disorder. The frequency of each disorder and factors associated with each disorder were assessed. FINDINGS EVD-associated post-traumatic stress disorder (PTSD) was reported by 45.7% (n=257) of EVD survivors. Moreover, 3.9% (n=22) and 12.0% (n=67) of EVD survivors reported major depression (MD) and substance use, respectively; all mental health outcomes were higher than baseline rates in the region (PTSD: 6%-16%, MD: 1.1%, substance use: 2.2%). PTSD among EVD survivors was associated with acute EVD duration of ≥21 days (adjusted OR, AOR 2.24, 95% CI 1.16 to 4.43), 35-44 years of age (AOR 3.31, 95% CI 1.33 to 8.24; AOR 2.99, 95% CI 1.09 to 8.24) and residential mobility (AOR 4.16, 95% CI 2.35 to 7.35). CONCLUSIONS Concerningly, the levels of mental health disorders among EVD survivors in Sierra Leone remained elevated 6-8 years after recovery. CLINICAL IMPLICATIONS Results can be used to inform policy efforts and target resources to address mental health in EVD survivors.
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Affiliation(s)
- Brayden G Schindell
- Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bev Fredborg
- Psychology, The University of Winnipeg, Winnipeg, Manitoba, Canada
| | - Kaarina Kowalec
- Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Medical Epidemiology & Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Souradet Shaw
- Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Jia B Kangbai
- Public Health, Eastern Technical University of Sierra Leone, Kenema, Sierra Leone
| | - Jason Kindrachuk
- Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
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Are Working Children in Developing Countries Hidden Victims of Pandemics? SOCIAL SCIENCES-BASEL 2021. [DOI: 10.3390/socsci10090321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The consequences of the recent pandemic have been disproportionately disruptive to several social groups, including children. As developing economies have been firefighting the recent pandemic, the welfare of minors could be affected and children’s economic exploitation and abuse could increase. Therefore, the present research aims to shed light on and to investigate the association between child labour in developing countries and pandemics, including the coronavirus, through conducting a systematic literature review on previous empirical studies. The present research concludes that previous studies on non-COVID-19 pandemics have mainly focused on the African economies, while studies on the recent pandemic have focused on Asian countries. In addition, differences were observed in relation to the methodological approaches and the characteristics of minor employees and the protection services in certain countries have proven to be insufficient. Suggestions for future research and policy implications are presented.
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Yoder HNC, de Jong JTVM, Tol WA, Duncan JA, Bayoh A, Reis R. Child witchcraft confessions as an idiom of distress in Sierra Leone; results of a rapid qualitative inquiry and recommendations for mental health interventions. Child Adolesc Psychiatry Ment Health 2021; 15:18. [PMID: 33836783 PMCID: PMC8035751 DOI: 10.1186/s13034-021-00370-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reports about child witchcraft are not uncommon in sub-Saharan Africa. In this study we approach child witchcraft as an idiom of distress. In an environment that may prohibit children from openly expressing distress, the shared imagery of witchcraft can provide a cultural idiom to communicate about psychosocial suffering. We used an ecological approach to study how some children in distressing circumstances come to a witchcraft confession, with the aim to set out pathways for mental health interventions. METHODS We employed rapid qualitative inquiry methodology, with an inductive and iterative approach, combining emic and etic perspectives. We conducted 37 interviews and 12 focus group discussions with a total of 127 participants in Freetown, Sierra Leone. Inductive analysis was used to identify risk and protective factors related to witchcraft accusations and confessions. RESULTS We identified risk and protective factors related to the individual child, the family, peer relations, teachers and other professionals in a child's life, traditional healers, pastors and the wider society. We found that in the context of a macrosystem that supports witchcraft, suspicions of witchcraft are formed at the mesosystem level, where actors from the microsystem interact with each other and the child. The involvement of a traditional healer or pastor often forms a tipping point that leads to a confession of witchcraft. CONCLUSIONS Child witchcraft is an idiom of distress, not so much owned by the individual child as well as by the systems around the child. Mental health interventions should be systemic and multi-sectoral, to prevent accusations and confessions, and address the suffering of both the child and the systems surrounding the child. Interventions should be contextually relevant and service providers should be helped to address conscious and subconscious fears related to witchcraft. Beyond mental health interventions, advocacy, peacebuilding and legislation is needed to address the deeper systemic issues of poverty, conflict and abuse.
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Affiliation(s)
- Hélène N. C. Yoder
- grid.7177.60000000084992262University of Amsterdam, Amsterdam, The Netherlands
| | | | - Wietse A. Tol
- grid.7177.60000000084992262University of Amsterdam, Amsterdam, The Netherlands
| | | | - Amjata Bayoh
- Mental Health Coalition - Sierra Leone, Freetown, Sierra Leone
| | - Ria Reis
- grid.7177.60000000084992262University of Amsterdam, Amsterdam, The Netherlands
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Secor A, Macauley R, Stan L, Kagone M, Sidikiba S, Sow S, Aronovich D, Litvin K, Davis N, Alva S, Sanderson J. Mental health among Ebola survivors in Liberia, Sierra Leone and Guinea: results from a cross-sectional study. BMJ Open 2020; 10:e035217. [PMID: 32461296 PMCID: PMC7259862 DOI: 10.1136/bmjopen-2019-035217] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To describe the prevalence and correlates of depression and anxiety among adult Ebola virus disease (EVD) survivors in Liberia, Sierra Leone and Guinea. DESIGN Cross-sectional. SETTING One-on-one surveys were conducted in EVD-affected communities in Liberia, Sierra Leone and Guinea in early 2018. PARTICIPANTS 1495 adult EVD survivors (726 male, 769 female). PRIMARY AND SECONDARY OUTCOME MEASURES Patient Health Questionnaire-9 (PHQ-9) depression scores and Generalised Anxiety Disorder-7 (GAD-7) scores. RESULTS Prevalence and severity of depression and anxiety varied across the three countries. Sierra Leone had the highest prevalence of depression, with 22.0% of participants meeting the criteria for a tentative diagnosis of depression, compared with 20.2% in Liberia and 13.0% in Guinea. Sierra Leone also showed the highest prevalence of anxiety, with 10.7% of participants meeting criteria for generalized anxiety disorder (GAD-7 score ≥10), compared with 9.9% in Liberia and 4.2% in Guinea. Between one-third and one-half of respondents reported little interest or pleasure in doing things in the previous 2 weeks (range: 47.0% in Liberia to 37.6% in Sierra Leone), and more than 1 in 10 respondents reported ideation of self-harm or suicide (range: 19.4% in Sierra Leone to 10.4% in Guinea). Higher depression and anxiety scores were statistically significantly associated with each other and with experiences of health facility-based stigma in all three countries. Other associations between mental health scores and respondent characteristics varied across countries. CONCLUSIONS Our results indicate that both depression and anxiety are common among EVD survivors in Liberia, Sierra Leone and Guinea, but that there is country-level heterogeneity in prevalence, severity and correlates of these conditions. All three countries should work to make mental health services available for survivors, and governments and organisations should consider the intersection between EVD-related stigma and mental health when designing programmes and training healthcare providers.
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Affiliation(s)
- Andrew Secor
- JSI Research and Training Institute Inc, Monrovia, Liberia
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Rose Macauley
- JSI Research and Training Institute Inc, Monrovia, Liberia
| | - Laurentiu Stan
- JSI Research and Training Institute Inc, Freetown, Sierra Leone
| | - Meba Kagone
- JSI Research and Training Institute Inc, Conakry, Guinea
| | | | - Sadou Sow
- JSI Research and Training Institute Inc, Conakry, Guinea
| | - Dana Aronovich
- JSI Research and Training Institute Inc, Arlington, Virginia, USA
| | - Kate Litvin
- JSI Research and Training Institute Inc, Arlington, Virginia, USA
| | - Nikki Davis
- JSI Research and Training Institute Inc, Arlington, Virginia, USA
| | - Soumya Alva
- JSI Research and Training Institute Inc, Arlington, Virginia, USA
| | - Jeff Sanderson
- JSI Research and Training Institute Inc, Arlington, Virginia, USA
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