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Yendewa GA, James PB, Mohareb A, Barrie U, Massaquoi SPE, Yendewa SA, Ghazzawi M, Bockarie T, Cummings PE, Diallo IS, Johnson A, Vohnm B, Babawo LS, Deen GF, Kabba M, Sahr F, Lakoh S, Salata RA. Determinants of incomplete childhood hepatitis B vaccination in Sierra Leone, Liberia, and Guinea: Analysis of national surveys (2018-2020). Epidemiol Infect 2023; 151:e193. [PMID: 37920110 PMCID: PMC10728985 DOI: 10.1017/s0950268823001735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/10/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
Vaccination against hepatitis B virus (HBV) is effective at preventing vertical transmission. Sierra Leone, Liberia, and Guinea are hyperendemic West African countries; yet, childhood vaccination coverage is suboptimal, and the determinants of incomplete vaccination are poorly understood. We analyzed national survey data (2018-2020) of children aged 4-35 months to assess complete HBV vaccination (receiving 3 doses of the pentavalent vaccine) and incomplete vaccination (receiving <3 doses). Statistical analysis was conducted using the complex sample command in SPSS (version 28). Multivariate logistic regression was used to identify determinants of incomplete immunization. Overall, 11,181 mothers were analyzed (4,846 from Sierra Leone, 2,788 from Liberia, and 3,547 from Guinea). Sierra Leone had the highest HBV childhood vaccination coverage (70.3%), followed by Liberia (64.6%) and Guinea (39.3%). Within countries, HBV vaccination coverage varied by socioeconomic characteristics and healthcare access. In multivariate regression analysis, factors that were significantly associated with incomplete vaccination in at least one country included sex of the child, Muslim mothers, lower household wealth index, <4 antenatal visits, home delivery, and distance to health facility vaccination (all p < 0.05). Understanding and addressing modifiable determinants of incomplete vaccination will be essential to help achieve the 2030 viral hepatitis elimination goals.
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Affiliation(s)
- George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, Australia
| | - Amir Mohareb
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Umaru Barrie
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Tahir Bockarie
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Ambulai Johnson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Lawrence S. Babawo
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
| | - Gibrilla F. Deen
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mustapha Kabba
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Foday Sahr
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Cummings PE, Lakoh S, Yendewa SA, Massaquoi SPE, James PB, Sahr F, Deen GF, Salata RA, Gevao P, Yendewa GA. Understanding COVID-19 Vaccine Uptake and Hesitancy among People with HIV in Freetown, Sierra Leone: A Cross-Sectional Study. Vaccines (Basel) 2023; 11:1685. [PMID: 38006017 PMCID: PMC10674940 DOI: 10.3390/vaccines11111685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
People with HIV (PWH) incur a higher risk of COVID-19-related morbidity and mortality rates, yet less is known about COVID-19 vaccine uptake and hesitancy in this group. We conducted a cross-sectional study in Freetown, Sierra Leone, from April to June 2022, using the VAX scale, a validated instrument, to assess attitudes towards COVID-19 vaccination and calculate the hesitancy (VAX) scores. We used generalized linear models to identify the factors associated with vaccine hesitancy. Overall, 490 PWH were enrolled (71.4% female, median age: 38 years, median CD4 count: 412 cells/mm3). About 17.3% received ≥1 dose of a COVID-19 vaccine. The mean VAX score was 43.14 ± 7.05, corresponding to 59.9% participants being vaccine-hesitant. A preference for natural immunity (65.8%) and concerns about profiteering (64.4%) were the commonest reasons for hesitancy, followed by a mistrust of vaccine benefits (61.4%) and worries about future effects (48.0%). In the adjusted regression analysis, being a Muslim (β = 2.563, p < 0.001) and having an urban residence (β = 1.709, p = 0.010) were associated with greater vaccine hesitancy, while testing for COVID-19 was associated with reduced vaccine hesitancy (β = -3.417, p = 0.027). These findings underscore the importance of addressing vaccine hesitancy as a critical element boosting COVID-19 vaccine uptake among PWH.
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Affiliation(s)
- Peterlyn E. Cummings
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.A.Y.); (S.P.E.M.)
| | - Sahr A. Yendewa
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.A.Y.); (S.P.E.M.)
| | | | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia;
| | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
| | - Gibrilla F. Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.A.Y.); (S.P.E.M.)
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Pelema Gevao
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Republic of Sierra Leone Armed Forces, Department of Defense, Freetown 00232, Sierra Leone
| | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Yendewa GA, Kpaka RA, Sellu E, Yendewa SA, Massaquoi SPE, Cummings PE, Ghazzawi M, Barrie U, Dubé K, Lakoh S, James PB, Salata RA, Babawo LS. Perceived and Enacted HIV-Related Stigma in Eastern and Southern Sierra Leone: A Psychometric Study of an HIV Stigma Scale. medRxiv 2023:2023.07.07.23292152. [PMID: 37503110 PMCID: PMC10370221 DOI: 10.1101/2023.07.07.23292152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background HIV stigma continues to hinder the care of people with HIV (PWH), especially in low-resource settings. We aimed to adapt and validate a concise HIV stigma scale for perceived HIV stigma in Sierra Leone. Methods We enrolled participants in two HIV clinics in Eastern and Southern Sierra Leone in 2022. We assessed perceived stigma using a 12-item adaptation of Berger's HIV Stigma Scale and enacted stigma using select USAID indicators. We used ordinal logistic regression to identify predictors of perceived stigma and Pearson's correlation to examine associations between perceived and enacted stigma. Results 624 PWH were enrolled. The final adapted 6-item HIV stigma scale demonstrated acceptable internal consistency (Cronbach's α = 0.72) and a four-factor solution accounting for 84.8% of variance: concern about public attitude (2 items), personalized stigma (2 items), negative self-image (1 item), and disclosure concerns (1 item). The prevalence of perceived HIV stigma was 68.6%, with disclosure concerns as the most prominent contributor. Enacted HIV stigma was reported by only 6.7% of participants, with partner/spousal abandonment and workplace stigma being the most common discriminatory experiences. Employment (β = 0.525, p <0.001), residence in Eastern Sierra Leone (β = 3.215, p < 0.001), and experiencing enacted stigma (β = 0.804, p < 0.001) were significantly associated with perceived stigma. Having a family member or friend with HIV (β = -0.499, p < 0.001), and HIV disclosure (β = -0.710, p < 0.001) were protective against perceived stigma. Enacted stigma strongly correlated with partner abandonment and family isolation (r = 0.223, p < 0.001). Conclusion We found high levels of perceived HIV stigma, underscoring the need for targeted interventions to combat stigma and promote inclusivity for PWH in Sierra Leone.
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Affiliation(s)
- George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Edmond Sellu
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
| | - Sahr A Yendewa
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | | | - Umaru Barrie
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, California, USA
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Peter B James
- Faculty of Health, Southern Cross University, Lismore, Australia
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lawrence S Babawo
- Eastern Technical University, Kenema, Sierra Leone
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
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Yendewa GA, Wang GM, James PB, Massaquoi SPE, Yendewa SA, Ghazawi M, Babawo LS, Ocama P, Russell JBW, Deen GF, Sahr F, Kabba M, Tatsuoka C, Lakoh S, Salata RA. Prevalence of Chronic Hepatitis B Virus Infection in Sierra Leone, 1997-2022: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2023:tpmd220711. [PMID: 37217165 DOI: 10.4269/ajtmh.22-0711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/18/2023] [Indexed: 05/24/2023] Open
Abstract
Hepatitis B virus (HBV) infection is a major public health problem in Sierra Leone, yet reliable estimates of cases are lacking. This study aimed to provide an estimate of the national prevalence of chronic HBV infection in the general population and select groups in Sierra Leone. We used the electronic databases PubMed/MEDLINE, Embase, Scopus, ScienceDirect, Web of Science, Google Scholar, and African Journals Online to systematically review articles reporting hepatitis B infection surface antigen seroprevalence estimates in Sierra Leone during 1997-2022. We estimated pooled HBV seroprevalence rates and assessed potential sources of heterogeneity. Of 546 publications screened, 22 studies with a total sample size of 107,186 people were included in the systematic review and meta-analysis. The pooled prevalence of chronic HBV infection was 13.0% (95% CI, 10.0-16.0) (I2 = 99%; Pheterogeneity < 0.01). During the study period, the HBV prevalence rates were as follows: 17.9% (95% CI, 6.7-39.8) before 2015, 13.3% (95% CI, 10.4-16.9) during 2015-2019, and 10.7% (95% CI, 7.5-14.9) during 2020-2022. The use of the 2020-2022 HBV prevalence estimates corresponded to 870,000 cases of chronic HBV infection (uncertainty interval, 610,000-1,213,000), or approximately one in nine people. The highest HBV seroprevalence estimates were among adolescents aged 10-17 years (17.0%; 95% CI, 8.8-30.5), Ebola survivors (36.8%; 95% CI, 26.2-48.8), people living with HIV (15.9%; 95% CI, 10.6-23.0), and those in the Northern Province (19.0%; 95% CI, 6.4-44.7) and Southern Province (19.7%; 95% CI, 10.9-32.8) regions. These findings may help inform national HBV program implementation in Sierra Leone.
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Affiliation(s)
- George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gi-Ming Wang
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Peter B James
- Faculty of Health, Southern Cross University, Lismore, Australia
| | | | - Sahr A Yendewa
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Lawrence S Babawo
- Department of Nursing, School of Community Health Sciences, Njala University, Bo, Sierra Leone
| | - Ponsiano Ocama
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - James B W Russell
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Gibrilla F Deen
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Foday Sahr
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mustapha Kabba
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Curtis Tatsuoka
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Centers for AIDS Research, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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