The impact of the COVID-19 pandemic on hospital utilisation in Sierra Leone

Sevalie, Stephen; Youkee, Daniel; Duinen, Alex J. van; Bailey, Emma; Bangura, Thaimu; Mangipudi, Sowmya; Mansaray, Esther; Odland, Maria Lisa; Parmar, Divya; Samura, Sorie; Delft, Diede van; Wurie, Haja; Davies, Justine; Bolkan, Håkon A.; Leather, Andrew J M

doi:10.1136/bmjgh-2021-005988

Cited by 45 publications

(38 citation statements)

References 29 publications

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“…COVID-19 now presents as yet another non-specific febrile illness within Sierra Leone’s disease ecosystem which, like Ebola before it, is negatively affecting health service delivery and utilisation [ 74 ]. Marburg has, for the first time in West Africa, been detected in humans in West Africa [ 60 ].…”

Section: Discussionmentioning

confidence: 99%

Beyond Lassa Fever: Systemic and structural barriers to disease detection and response in Sierra Leone

Rohan

2022

PLoS Negl Trop Dis

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Background Lassa fever (LF) often presents clinically as undifferentiated febrile illness. Lassa Fever cases in Sierra Leone have been falling since the 2014–2016 Ebola epidemic. Data from other LF endemic countries suggest that this is not a true reflection of local epidemiological decline, but rather a function of either health seeking behaviour or the health/referral system. In Sierra Leone, many other diseases present with a similar early clinical picture, including COVID-19 and Marburg Disease (which has recently emerged in neighbouring Guinea). This empirical study explores the implementation of health system processes associated with International Health Regulations (IHR) requirements for early detection and timely and effective responses to the spread of febrile disease, through the case study of LF in Sierra Leone. Methodology/Principal findings This study used a qualitative approach to analyse local policy and guidance documents, key informant interviews with policy and practice actors, and focus group discussions and in-depth interviews with health care workers (HCWs) and community health workers (CHWs) in Kenema District to examine the ways in which undifferentiated fever surveillance and response policies and processes were implemented in the post-Ebola period. Multiple challenges were identified, including: issues with the LF case definition, approaches to differential diagnosis, specimen transport and the provision of results, and ownership of laboratory data. These issues lead to delays in diagnosis, and potentially worse outcomes for individual patients, as well as affecting the system’s ability to respond to outbreak-prone disease. Conclusions/Significance Identification of ways to improve the system requires balancing vertical disease surveillance programmes against other population health needs. Therefore, health system challenges to early identification of LF specifically have implications for the effectiveness of the wider Integrated Disease Surveillance and Response (IDSR) system in Sierra Leone more generally. Sentinel surveillance or improved surveillance at maternity facilities would help improve viral haemorrhagic fever (VHF) surveillance, as well as knowledge of LF epidemiology. Strengthening surveillance for vertical disease programmes, if correctly targeted, could have downstream benefits for COVID-19 surveillance and response as well as the wider health system—and therefore patient outcomes more generally.

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Section: Discussionmentioning

confidence: 99%

Beyond Lassa Fever: Systemic and structural barriers to disease detection and response in Sierra Leone

Rohan

2022

PLoS Negl Trop Dis

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“…Sierra Leone’s long civil war and Ebola epidemic left the health system fragile and overwhelmed with inadequate skilled health personnel having low and irregular remuneration [ 16 ], increasing demand and stock-outs of crucial medical supplies and equipment leading to patients having to pay for services that are meant to be free [ 17 , 18 ]. Secondary and tertiary care in Sierra Leone is provided by 14 district and regional governmental hospitals and four tertiary referral hospitals which are all located in the Western Area Urban District [ 19 ]. The country’s nurse density is one of the world’s lowest having approximately 0.2 nurses and midwives per 1000 people [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and factors associated with utilisation of postnatal care in Sierra Leone: a 2019 national survey

Sserwanja¹,

Nuwabaine²,

Kamara

et al. 2022

BMC Public Health

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Background Within Sub-Saharan Africa, some countries still report unacceptably high rates of maternal and perinatal morbidity and mortality, despite improvements in the utilisation of maternity care services. Postnatal care (PNC) is one of the recommended packages in the continuum of maternity care aimed at reducing maternal and neonatal mortality. This study aimed to determine the prevalence and factors associated with PNC utilisation in Sierra Leone. Methods We used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 7326 women aged 15 to 49 years. We conducted multivariable logistic regression to determine the factors associated with PNC utilisation, using SPSS version 25. Results Out of 7326 women, 6625 (90.4, 95% CI: 89.9–91.2) had at least one PNC contact for their newborn, 6646 (90.7, 95% CI: 90.2–91.5) had a postnatal check after childbirth and 6274 (85.6, 95% CI: 85.0–86.6) had PNC for both their babies and themselves. Delivery by caesarean section (aOR 8.01, 95% CI: 3.37–19.07), having a visit by a health field worker (aOR 1.80, 95% CI: 1.46–2.20), having had eight or more ANC contacts (aOR 1.37, 95% CI: 1.08–1.73), having tertiary education (aOR 2.71, 95% CI: 1.32–5.56) and having no big problems seeking permission to access healthcare (aOR 1.51, 95% CI: 1.19–1.90) were associated with higher odds of PNC utilisation. On the other hand, being resident in the Northern (aOR 0.48, 95% CI: 0.29–0.78) and Northwestern regions (aOR 0.54, 95% CI: 0.36–0.80), belonging to a female headed household (aOR 0.69, 95% CI: 0.56–0.85) and being a working woman (aOR 0.66, 95% CI: 0.52–0.84) were associated with lower odds of utilizing PNC. Conclusion Factors associated with utilisation of PNC services operate at individual, household, community and health system/policy levels. Some of them can be ameliorated by targeted government interventions to improve utilisation of PNC services.

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“…The first confirmed cases of COVID-19 in Sierra Leone were reported in March 2020. Similar to other countries in the region, the Government of Sierra Leone implemented a series of population-wide lockdowns in early April through June 2020 as part of the initial virus control measures [ 21 , 22 ]. Although the incidence rate of COVID-19 has been reported as low (i.e., 80 cases per 100,000) [ 17 ], a recent population serosurvey estimated the national SARS-CoV-2 antibody prevalence at 2.6%, which is 43-fold higher than the number of confirmed COVID-19 cases to date [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Vaccine Hesitancy among Healthcare Workers and Trainees in Freetown, Sierra Leone: A Cross-Sectional Study

et al. 2022

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Despite having safe and efficacious vaccines against COVID-19, vaccine hesitancy is widespread. Although a trusted source of information, vaccine hesitancy has been reported among healthcare professionals, yet few studies have explored this phenomenon in sub-Saharan Africa. We conducted a cross-sectional survey of healthcare professionals in Sierra Leone from January to March 2022. Measures included sociodemographic/health-related information and COVID-19-related concerns. From the responses, we constructed a hesitancy (VAX) score, with higher scores implying negative attitudes or unwillingness to vaccinate. Multivariate linear regression was used to access factors associated with vaccine hesitancy. Overall, 592 participants submitted responses (67.2% female, mean age 29 years, 5.6% physicians/pharmacists, 44.3% medical students, 29.2% nurses, 20.9% nursing students). The mean VAX score was 43.27 ± 8.77, with 60.1% of respondents classified as vaccine hesitant (>50th percentile) and 11.5% as highly hesitant (>75th percentile). Worries about unforeseen future effects (76.3%), a preference for natural immunity (59.5%), and profiteering/mistrust of health authorities (53.1%) were the most common concerns. Being a medical student (β = 0.105, p = 0.011) and previously refusing a recommended vaccine (β = 0.177, p < 0.001) were predictors of COVID-19 vaccine hesitancy. Our findings call for addressing vaccine hesitancy among healthcare professionals as an essential component of strategies aimed at increasing COVID-19 vaccine uptake in this setting.

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The impact of the COVID-19 pandemic on hospital utilisation in Sierra Leone

Cited by 45 publications

References 29 publications

Beyond Lassa Fever: Systemic and structural barriers to disease detection and response in Sierra Leone

Beyond Lassa Fever: Systemic and structural barriers to disease detection and response in Sierra Leone

Prevalence and factors associated with utilisation of postnatal care in Sierra Leone: a 2019 national survey

COVID-19 Vaccine Hesitancy among Healthcare Workers and Trainees in Freetown, Sierra Leone: A Cross-Sectional Study

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