Family structure and sexual and reproductive health outcomes among adolescents in rural Sierra Leone

Orphanhood is common in sub-Saharan Africa, and is a critical issue shaping global assistance for children. Care arrangements for children are often fluid, and many ‘orphaned’ children have a surviving biological parent. This study examines the protective effects of family-level factors on early sex and pregnancy in rural Sierra Leone. A survey of 530 adolescents in 2 districts in Sierra Leone was analysed to evaluate associations between living arrangement and orphanhood on recent sexual activity and pregnancies out of wedlock. After controlling for confounders, living with one's mother (AOR = 0.46, 95% CI: 0.22–1.00) and living with both parents (AOR = 0.36, 95% CI: 0.17–0.73) were protective against recent sexual activity. Orphan status was not significantly associated with recent sexual activity. Among 164 sexually active adolescents, neither living arrangement nor orphanhood was associated with pregnancy. This study demonstrates the protective effect of living with a surviving biological parent to delay early sexual debut. Once an adolescent becomes sexually active; however, living arrangement is not associated with the risk of pregnancy out of wedlock. The findings suggest that supporting family connectedness and preventing unnecessary family separation may benefit at least some aspects of adolescent sexual and reproductive health in Sierra Leone.     

The free healthcare initiative in Sierra Leone: Evaluating a health system reform, 2010‐2015

This article presents the findings of a theory‐based evaluation of the Sierra Leone Free Health Care Initiative (FHCI), using mixed methods. Analytical approaches included time‐series analysis of national survey data to examine mortality and morbidity trends, as well as modelling of impact using the Lives Saved Tool and expenditure trend analysis. We find that the FHCI responded to a clear need in Sierra Leone, was well designed to bring about needed changes in the health system to deliver services to the target beneficiaries, and did indeed bring funds and momentum to produce important systemic reforms. However, its ambition was also a risk, and weaknesses in implementation have been evident in a number of core areas, such as drugs supply. We conclude that the FHCI was one important factor contributing to improvements in coverage and equity of coverage of essential services for mothers and children. Modelled cost‐effectiveness is high—in the region of US$ 420 to US$ 444 per life year saved. The findings suggest that even—or perhaps especially—in a weak health system, a reform‐like fee removal, if tackled in a systematic way, can bring about important health system gains that benefit vulnerable groups in particular.     

无锡市成年男性生育健康状况和生育保健服务需求

目的了解无锡市成年男性的生育健康现状和生育保健服务需求。方法以无锡市市区20岁以上的成年男性为调查对象,分层抽取1 200人进行问卷调查。结果1 133名完成问卷的成年男性中,17．2％在过去一年中患有一种或多种生殖系统疾病;总的患病率随着年龄增加而增加;不同年龄男性常见的问题不同;62．7％的成年男性希望了解更多的生育保健知识。62．2％的成年男性认为有必要进行生育健康教育;大多数男性认为宜在婚前教育和初中阶段开展生育健康教育;不同年龄男性对生育保健服务的内容、方式和时间的需求不同,但对服务人员的需求基本相同。结论无锡市成年男性中存在一定的生育健康问题,对生育保健服务有着强烈的需求,不同年龄男性的需求有所不同。因此,应针对不同年龄男性的需求开展生育健康教育和生育保健服务。     

Reemergence of Chikungunya Virus in Bo,Sierra Leone

We diagnosed 400 possible IgM-positive cases of chikungunya virus in Bo, Sierra Leone, during July 2012–January 2013 by using lateral flow immunoassays. Cases detected likely represent only a small fraction of total cases. Further laboratory testing is required to confirm this outbreak and characterize the virus.     

Non-adherence to standard treatment guidelines in a rural paediatric hospital in Sierra Leone

Setting:

A rural paediatric hospital in Bo, Sierra Leone.

Objectives:

To assess the level of adherence to standard treatment guidelines among clinicians prescribing treatment for children admitted with a diagnosis of malaria and/or lower respiratory tract infection (LRTI), and determine the association between (non) adherence and hospital outcomes, given that non-rational use of medicines is a serious global problem.

Design:

Secondary analysis of routine programme data.

Results:

Data were collected for 865 children admitted with an entry diagnosis of malaria and 690 children with LRTI during the period January to April 2011; some patients were classified in both categories. Non-adherence to guidelines comprised use of non-standard drug regimens, dosage variations, non-standard frequency of administration and treatment duration. Cumulative non-adherence to guidelines for LRTI cases was 86%. For malaria, this involved 12% of patients. Potentially harmful non-adherence was significantly associated with an unfavourable hospital outcome, both for malaria and for LRTI cases.

Conclusions:

Overall non-adherence to standard treatment guidelines by clinicians in a routine hospital setting is very high and influences hospital outcomes. This study advocates for the implementation of routine measures to monitor and improve rational drug use and the quality of clinical care in such hospitals.     

Promoting transparency and accountability with district league tables in Sierra Leone and Malawi

Objectives

This paper looks at the effects on transparency and accountability of introducing league tables in the health sector in Sierra Leone and Malawi.

Access to health care for induced abortions: analysis by means of a French national survey

BACKGROUND: With an incidence of 15 per thousand, abortion is a common reproductive event in France. This study describes conditions of access to health care for abortions based on women's reports, taking into account the woman's background and the influence of the first professional contacted. METHODS: A representative sample of 2,863 women, aged 18 to 44, was interviewed by telephone between September 2000 and January 2001. Of these women, 480 had an abortion in the last 10 years. MAIN RESULTS: The choice of first professional depended on women's background, as we found differences according to age, educational level or past induced abortion. This choice affected subsequent access conditions, in terms of time delay or complexity of patterns of care to access abortion services. Women who first contacted a private gynaecologist, which is the most frequent situation in France, had more direct and shorter patterns of care. Conversely, general practitioners were associated with longer and more indirect patterns of care, especially when women were less well educated. CONCLUSION: This study reveals the heterogeneous nature of patterns of access to an abortion in France. It also raises questions concerning the training of general practitioners, who seem to be less well prepared to take charge of a request for an abortion than other professionals. Efforts must be made to better inform women and these professionals about the process required for abortions.     

Perceptions and acceptability of an experimental Ebola vaccine among health care workers,frontline staff,and the general public during the 2014–2015 Ebola outbreak in Sierra Leone

Introduction

Experimental Ebola vaccines were introduced during the 2014–2015 Ebola outbreak in West Africa. Planning for the Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE) was underway in late 2014. We examined hypothetical acceptability and perceptions of experimental Ebola vaccines among health care workers (HCWs), frontline workers, and the general public to guide ethical communication of risks and benefits of any experimental Ebola vaccine.

Access to health care in nursing homes: a survey in one English Health Authority

The objective of the study was to establish the arrangements for provision of general practitioner (GP), nursing advice, chiropody, physiotherapy and speech and language services to nursing homes and to establish the charging policies for those services. To this end a telephone survey of the managers of the 51 nursing homes registered with one English health authority, Merton, Sutton and Wandsworth Health Authority, was undertaken. Forty-nine homes (96%) with 1541 residents responded. Twenty per cent of homes had no regular GP visits and half the homes had no planned medication reviews. One in five homes (27% of residents) had access to all health-care services. Eight homes (10% of residents) did not have access to therapy services or nursing advice. Thirty-three homes used private or both private and NHS chiropody services and 16 homes used the NHS service only. Seventeen homes used private or both private and NHS physiotherapy services with 10 homes receiving a regular private service. Twenty homes used the NHS service and 12 homes (15% of residents) had used no physiotherapy service. None used private speech and language services. Twenty-four of the 33 homes using private chiropody charged extra for this service compared with two of 10 homes using regular private physiotherapy. The findings suggest that there are inequalities in access to health care services in nursing homes. Moreover, there has been a deterioration in access to and levels of provision of NHS nursing and physiotherapy services since the national survey undertaken by the Office Population Censuses and Surveys (OPCS) in Great Britain in the mid-1980s. The new regulatory framework for older people must include systems for monitoring the provision of health services.     

Coverage survey and lessons learned from a pre-emptive cholera vaccination campaign in urban and rural communities affected by landslides and floods in Freetown Sierra Leone

BackgroundOn 14 August 2017, massive landslides and floods hit Freetown (Sierra Leone). More than 1,000 people lost their lives while approximately 6,000 people were displaced. The areas most affected included parts of the town with challenged access to basic water and sanitation facilities, with communal water sources likely contaminated by the disaster. To avert a possible cholera outbreak following this emergency, the Ministry of Health and Sanitation (MoHS), supported by the World Health Organization (WHO) and international partners, including Médecins Sans Frontières (MSF) and UNICEF, launched a two-dose pre-emptive vaccination campaign using Euvichol™, an oral cholera vaccine (OCV).MethodsWe conducted a stratified cluster survey to estimate vaccination coverage during the OCV campaign and also monitor adverse events. The study population – subsequently stratified by age group and residence area type (urban/rural) – included all individuals aged 1 year or older, living in one of the 25 communities targeted for vaccination.ResultsIn total 3,115 households were visited, 7,189 individuals interviewed; 2,822 (39%) people in rural and 4,367 (61%) in urban areas. The two-dose vaccination coverage was 56% (95% confidence interval (CI): 51.0–61.5), 44% (95%CI: 35.2–53.0) in rural and 57% (95%CI: 51.6–62.8) in urban areas. Vaccination coverage with at least one dose was 82% (95%CI: 77.3–85.5), 61% (95%CI: 52.0–70.2) in rural and 83% (95%CI: 78.5–87.1) in urban areas.ConclusionsThe Freetown OCV campaign exemplified a timely public health intervention to prevent a cholera outbreak, even if coverage was lower than expected. We hypothesised that vaccination coverage in Freetown was sufficient in providing at least short-term immunity to the population. However, long-term interventions to ensure access to safe water and sanitation are needed.     

A call to action: Preparing a disability-competent health care workforce

People with disabilities make up the largest minority population in the country, yet our health care workforce is unprepared to meet their needs. Two initiatives – and the Alliance for Disability in Health Care Education’s Disability Competencies and the Resources for Integrated Care Disability-Competent Care model-provide essential tools to build a health care workforce prepared to meet the health needs of people with disabilities. We note gaps in health education and continuing education curricula, document barriers to progress, and demonstrate how the two initiatives offer a clear roadmap to effect systemic change. Finally, we issue a call to action for health care education, practice, and research to ensure a health care workforce prepared to provide quality health care to people with disabilities.     

已婚育龄妇女生殖健康状况分析

目的:了解我区已婚育龄妇女生殖健康状况及变化趋势,探讨综合干预措施。方法:分析2003～2005年全区计划生育技术服务机构妇女病普查资料。结果:3年共查出患有各种疾病者分别为2787例、4077例、4900例,患病率分别为42·10%、48·20%、53·00%,呈逐年增长趋势。从疾病的顺位来看,2005年乳腺疾病的患病率超过附件疾病,位居第4位。阴道疾病和附件疾病的患病率逐年下降,子宫疾病患病率无显著变化,宫颈疾病和乳腺疾病的患病率逐年上升。社区居民阴道炎和乳腺疾病的患病率(7·98%、3·62%)显著低于企事业职工(9·80%、4·50%),P<0·05,但其宫颈癌前病变的患病率(6·30%)明显高于企事业职工(5·20%),P<0·05。结论:生殖道感染干预工程对已婚育龄妇女的生殖道感染有所控制,应继续实施。通过引进先进的检测仪器,宫颈癌前病变和乳腺疾病的检出率增加,政府应继续重视妇女病普查普治,加大投入,乳腺癌和宫颈癌的防治可作为今后的重点。     

Knowledge and attitudes about Ebola vaccine among the general population in Sierra Leone

BackgroundClinical trials of Ebola vaccine are ongoing. Before it becomes commercially available, understanding the Ebola vaccine-related knowledge and attitude of the general population is imperative to developing an effective vaccine coverage strategy.MethodsWe conducted a survey including 400 participants from general communities of the West Area Rural District, Sierra Leone. Knowledge and attitudes about Ebola vaccine were investigated, and the determinants of having knowledge and a positive attitude toward accepting vaccination were identified.ResultsOver half (55.8%) of the participants were aware of Ebola vaccine. About 60% of the participants were willing to be study subjects if the Ebola vaccine clinical trial were conducted in their communities. Most of the participants (72.5%) were willing to take Ebola vaccination if it was free of charge. Given that the vaccination was not free, the proportion willing to pay a fee to take the vaccination declined dramatically to 26.6%. Using a forward step-wise logistic model, monthly salary was identified as the single determinant (OR for every 100,000 Leones increase: 1.17, 95%CI: 1.04–1.31) for awareness of Ebola vaccine, which was identified as the determinant (OR: 1.88, 95%CI: 1.17–3.02) for free vaccination uptake willingness. The combination of monthly salary, monthly average income of family members and their interaction was found to be associated with charged vaccination uptake willingness.DiscussionMeasures are still needed to promote the Ebola vaccine awareness and knowledge updating. Free or low-priced vaccine could increase the vaccination acceptability of the general community population significantly.     

女大学生生殖健康、避孕及乳房保健知识认知调查

目的:了解女大学生生殖健康、避孕及乳房保健知识认知现状及相关知识需求,提高学校对该方面教育的重视程度。方法:采用整群抽样的方法,以自行设计问卷对930名民族大学女大学生进行匿名调查。结果:民族大学女大学生生殖健康知识欠缺,对避孕方法及流产危害知晓率低,乳房保健自查意识淡薄,但希望学习性卫生相关知识。总体上,汉族和城市生源学生对避孕方法、乳房保健自查知识掌握程度稍好。结论:女大学生应该了解更多生殖健康、避孕及乳房保健方面的知识,减少对自身身体及心理的伤害,相关知识的健康教育有待加强。     

Past horrors,present struggles: The role of stigma in the association between war experiences and psychosocial adjustment among former child soldiers in Sierra Leone

Upon returning to their communities, children formerly associated with armed forces and armed groups--commonly referred to as child soldiers--often confront significant community stigma. Much research on the reintegration and rehabilitation of child soldiers has focused on exposure to past war-related violence and mental health outcomes, yet no empirical work has yet examined the role that post-conflict stigma plays in shaping long-term psychosocial adjustment. Two waves of data are used in this paper from the first prospective study of male and female former child soldiers in Sierra Leone. We examined the role of stigma (manifest in discrimination as well as lower levels of community and family acceptance) in the relationship between war-related experiences and psychosocial adjustment (depression, anxiety, hostility and adaptive behaviors). Former child soldiers differ from one another with regard to their post-war experiences, and these differences profoundly shape their psychosocial adjustment over time. Consistent with social stress theory, we observed that post-conflict factors such as stigma can play an important role in shaping psychosocial adjustment in former child soldiers. We found that discrimination was inversely associated with family and community acceptance. Additionally, higher levels of family acceptance were associated with decreased hostility, while improvements in community acceptance were associated with adaptive attitudes and behaviors. We found that post-conflict experiences of discrimination largely explained the relationship between past involvement in wounding/killing others and subsequent increases in hostility. Stigma similarly mediated the relationship between surviving rape and depression. However, surviving rape continued to demonstrate independent effects on increases in anxiety, hostility and adaptive/prosocial behaviors after adjusting for other variables. These findings point to the complexity of psychosocial adjustment and community reintegration in these youth and have a number of programmatic and policy implications.