Posts in category: Blog

I think by now most of us know what diabetes is, symptoms, risk factors, complications etc. Most of us think of diabetes, we only associate it with sugar and foot amputations. The American Diabetes Association newest guidelines recommend that screening for diabetes should start as early as 35 years old, compared to 45 years old which was the recommended age in older guidelines. Why is that? This is because of the increased rate of obesity and diabetes globally, both occurring at a younger age. Screening at an earlier age can help identify individuals with abnormal glucose regulation, promote an early start with preventive care and may reduce risk of the multiple complications following the onset of diabetes. It is important that we all assess our risks of developing diabetes by using a diabetes risk calculator available online.

It makes me happy to see more people engaged in physical activity when I take a walk at the beach. We need to include exercise as a vital component in our lives, take it as seriously as our religion. Many international health organizations recommend that individuals must engage in at least 150 minutes of exercise per week, exercise that involves all major muscle groups to prevent diabetes. This recommendation is also vital for diabetic patients where they should not go for more than 2 days with no exercise. 

Exercise helps prevent complications of diabetes by controlling weight, lower blood pressure, lower harmful LDL cholesterol and triglycerides, raise healthy HDL cholesterol, strengthen muscles and bones, reduce anxiety, and improve your general well-being. Exercise also improves the action of insulin among diabetic patients. 

Obesity is a major cause of diabetes, heart disease, stroke, and cancer. Africa is facing a growing challenge of obesity and overweight and trends continue to rise. Obesity rates are higher north of the Sahara and in Southern Africa. In Western Africa, the great news is obesity rates are still not very high, but slightly higher than Eastern Africa and the interior. Our dietary habits such as consuming energy-dense foods, lack of physical activity associated with rising urbanization or changing modes of transport are significant drivers of obesity globally. Lack of strong policies in key sectors including health, agriculture, urban planning, and environment to support healthier lifestyles also contributes to growing rate of non-communicable diseases which we neglect in our society. 

In Sierra Leone, if you go to the local food market most of what is there is healthy and highly nutritious, the issue lies on how we use those foods to prepare our meals. Let us forget about going to the supermarket to buy expensive imported foods that are “considered healthy”. Focus on eating natural foods that have not been tampered with by humans! There are many foods at the store with labelled hidden sugars which we should be aware of. There are misleading food advertising labels like ‘sugar free’, light/fat free’ but still considered junk food! Always read your nutrition labels at the back! 

Diabetic patients I manage have this mindset that eating healthy can be expensive, it is quite the opposite. Here are some tips to help you eat healthily on a budget:

1. Shop smart, plan and make a list of healthy foods you can stick to in the supermarket or local market.
2. Use the fresh fruit and vegetables you already have at home first, before buying more.
3. Meal preparation means you can buy and cook in bulk, which will save you both time and money.
4. Only buy what you need.
5. A tip I give to myself is “Never go to the supermarket when you are hungry”.

Back to our main topic, here are the hidden side effects and sweet danger of sugar! Apart from weight gain and diabetes, excessive consumption of sugar causes bad skin (sagginess and wrinkles), depression, drains your energy, dementia, and Alzheimer’s disease, joint pain, fatty liver, heart disease. 

My key message today in commemoration of World Diabetes Day is to include regular physical activity as your lifestyle, as an obligation you owe to your mind and body, know what a healthy food/ meal consists of and make a change today, let us cherish and respect our body.

Hepatitis is an inflammation of the liver commonly caused by viral infection. There are five main  hepatitis viruses, referred to as types A, B, C, D and E. Every 30 seconds, someone dies from a  viral hepatitis related illness. The disease can affect anyone, but underserved communities are  disproportionately affected. Chronic hepatitis B and chronic hepatitis C are among the life threatening infectious diseases that cause serious liver damage, cancer, and premature death. 

Chronic hepatitis B and chronic hepatitis C are neglected, silent infectious diseases with a  burden that has surpassed malaria, human immunodeficiency virus (HIV) and tuberculosis (TB)  in Africa. Globally, 354 million people are living with the hepatitis B or C virus. According to African  Center for Disease Control and Prevention, the African region has the highest of hepatitis B,  where 82.3 million persons are living with chronic hepatitis B. Two of every three children infected  with hepatitis B globally are born in Africa and hepatitis B infection acquired at birth or in early  childhood is the most common cause of primary liver cancer in adulthood. In Sierra Leone,  according to a recent meta-analysis by Yendewa et al [1], 1 out of every 8 persons is infected with  hepatitis B, which means approximately 1 million Sierra Leoneans have chronic hepatitis B  infection.  

Millions of people living with hepatitis B face an added burden of stigma and discrimination.  Stigma is defined as a social process, experienced, or anticipated, and which is characterized by  exclusion, rejection, blame, or devaluation resulting from experience, perception, or reasonable  anticipation of an adverse social judgement about a person or a group [2]. Studies confirm key  underlying reasons for stigma included fear of infection, as well as negative assumptions and  stereotyping around the sources of infection, with hepatitis B transmission in adults often being  perceived as associated with the use of injectable drugs, sexual promiscuity, or homosexuality. 

Stigma resulting from hepatitis B infection has contributed to discrimination, a reduction in  quality of life, and difficulty accessing employment, education, and immigration. Studies have  been done to confirm the psychological responses to discrimination which include trauma,  suicide, mental health challenges, depression, economic instability, and social isolation. People  living with hepatitis B go through extreme poverty as they must pay out of pocket to manage their  life-long disease. Many young Sierra Leoneans who have ambitions to travel abroad to study or  seek greener pastures have been refused a visa after an unknown positive status was revealed to  them. Young aspiring individuals are stripped off great job opportunities in Sierra Leone, because  of their hepatitis B positive status. 

Lack of knowledge about the mode of transmission results in unnecessary stigma and  discrimination. So let us debunk some of the myths and misconceptions surrounding this silent  killer virus. Hepatitis B is not transmitted through casual contact, neither through sharing of food  nor kitchen utensils. Many reports have shown that even people living with hepatitis B have poor  understanding of the mode of transmission of the infection which can result to internalized  stigma. It is sad to witness a parent scared or have a sense of guilt to transmit the virus to their 

children. If we think about it, what can a poor man in a village, or an uneducated person know  about the disease if he can’t read? Thus, the importance of community outreach programs  should never be underestimated. Notwithstanding this, even educated people do not know much  about HBV infection and its mode of transmission. 

Household transmission of the virus, which is a form of horizontal transmission, can occur  through blood-to-blood contact from an open wound of an infected person or through sexual  contact. Therefore, it is very important to disinfect surfaces that have been contaminated by  blood and to keep wounds covered. Other than that, parents can hug, play, kiss their children and  eat together. Notwithstanding that, sharing of toothbrushes, nail clippers and razors can lead to  transmission of hepatitis B. It is however crucial for household members to be vaccinated.  Children can transmit the virus to each other through wounds or bites but not through tears,  sweat or urine. However, if a child has been immunized against the virus, this form of transmission  rarely occurs. 

In a first published study in Sierra Leone by Ghazzawi et al [3], on assessment of stigmatization  attitudes, 43.5% of the participants had concerns with sharing food or utensils with someone  with hepatitis B. Similarly, 44.1% stated that they would have concerns with having casual  contact or working with a person known to have hepatitis B. Overall, nearly half (49.3%) expressed  at least one stigmatizing attitude towards people with hepatitis B.  

A big misconception in Sierra Leone about the mode of transmission of hepatitis B is that people  believe it is transmitted through sweat, one big myth that needs to be demystified. According to  Ghazzawi et al [3], almost 68% of people believed hepatitis B is caused by a curse or evil spirit.  This underscores the need for educational interventions at all levels of society to dispel myths  and misconceptions by embarking on community awareness raising and sensitization.  Community education and mobilization campaigns related to hepatitis B vaccination are critical  to preventing CHB infection and reducing stigma and discrimination toward people living with  hepatitis B. 

Disclosure of positive hepatitis B status to sexual partners and family members remains a major  challenge for people living with hepatitis B. I have come across lived experiences of people living  with chronic hepatitis B whose partner and/or family member have abandoned them because of  their status. A handful of Sierra Leoneans are very hesitant to disclose their status to their  partners, especially when we know practicing a polygamous relationship is a way of life and a  culture in our society, keeping a positive status of the virus a secret and continuation of practicing  unprotected sex with partners can results in a chain reaction of transmission of the virus.  Remember that symptoms of hepatitis B infection appear after 9-21 weeks of exposure to the virus. 

According to Ghazzawi et al., assessment of health-seeking behaviors by the public, yielded  overwhelmingly positive results, where 80.4% were willing to take medication for treatment if they  tested positive for hepatitis B, while a similar proportion (78.8%) were willing to undergo regular  clinic follow up every 3 to 6 months for the management of hepatitis B. This study shows that  people are willing to seek healthcare if the environment is conducive to do so and having health  care professionals with adequate knowledge to offer the dire need for appropriate healthcare  services and psychosocial support. Studies in SL have demonstrated poor knowledge of hepatitis  B infection among healthcare professionals.

Although data does not exist in Sierra Leone to elucidate this, there are studies done in other  countries which reveal that healthcare professionals themselves contribute to stigma and  discrimination among people living with hepatitis B. hepatitis B-related stigma and  discrimination result in low uptake of hepatitis B education, screening, immunization, and sound  preventive practices among at-risk individuals, underscoring the importance of effective  hepatitis B education among healthcare professionals. 

Now that a hepatitis policy exists for the first time in Sierra Leone, we are eagerly waiting to see  government take swift actions towards providing dignified and equitable services to those living  with hepatitis B and to deliver effective prevention strategies and health promotion programs to  eliminate the virus by 2030! An ambitious target which all countries with high burden of the  disease have set as a target for elimination. 

Sadly, there are no anti-discrimination laws and policy in Sierra Leone to protect the rights of  Sierra Leoneans affected with hepatitis B. Eliminating the stigma surrounding hepatitis through  the introduction of policies and structural changes has been named as a key factor in hepatitis  elimination by the World health Organization. Policy makers and decision-makers have an  essential role in ensuring that anti-discrimination laws, public health policy, education and  health systems work together with civil society and the affected communities to tackle the crisis  of stigma and discrimination. To address these challenges, and as KnowHep Foundation is a  professional body that advocates for elimination of VH in Sierra Leone, in collaboration with the  World Hepatitis Alliance, we urge government to adopt the following policies:  

1. Provide accurate and accessible information regarding hepatitis B for those newly diagnosed  including transmission, health promotion information, rights and responsibilities, and long-term  health plan. 

2. Ensure all newly diagnosed individuals are linked to appropriate and supportive healthcare  services for ongoing monitoring and management. 

3. Ensure equitable and affordable access to prevention of mother-to-child transmission (PMTCT)  programmes for all women. 

4. Ensure that mental and emotional support is provided to people diagnosed with hepatitis B  and their families. 

5. Require that all healthcare professionals receive ongoing hepatitis education and are aware of  stigma and how to address it. 

6. Ensure testing for hepatitis B is conducted in the context of healthcare services, that the results  are confidential, that the testing is of direct benefit to the person being tested and is not required  as a condition of employment or education. 

7. Anti-discrimination laws and policies must be formulated, and correctly implemented, and  adequate recourse is given to enable people experiencing discrimination to pursue justice  through the legal system. 

8. Ensure there are legal protections in place for people with hepatitis B, including protection from  government sanctioned discrimination. 

9. Ensure that immigration and visa policies do not limit the freedoms of people living with  hepatitis B, because of their diagnosis.

10. People living with hepatitis B should have their voice heard. Sharing lived experiences will  reduce stigmatization. People living with hepatitis B must come forward to report any form of  discrimination against them and they have the power to drive political will. 

Despite the availability of hepatitis B medication and a vaccine, many people living with hepatitis  B in Sierra Leone are still unable to access or afford the treatment and preventative measures  they need. The poor people are left alone to tackle the epidemic. Policy makers must act now to  improve the lives Sierra Leoneans who are currently impacted by hepatitis B. We are NOT  WAITING, and we cannot leave people behind. The lives of people living with hepatitis B are  impacted by stigma and discrimination every day. Their human rights must be protected. With  concerted effort we can end stigma and discrimination and improve the lives of people affected  by hepatitis B in Sierra Leone. 

Below is a brief list of resources for people living with hepatitis B or individuals living with people living with  hepatitis B. 

1. Transmission of hepatitis B – how hepatitis B can be transmitted. 

2. Online Support Groups 

3. Factsheet – When Someone in the Family has Hepatitis B 

4. Know Your Rights – for anyone experiencing discrimination because of their hepatitis B status 

References 

1. Yendewa GA, Wang GM, James PB, Massaquoi SPE, Yendewa SA, Ghazzawi 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 May 22;109(1):105-114. doi: 10.4269/ajtmh.22-0711. PMID: 37217165; PMCID: PMC10323991. 

2. Martin N., Johnston V. A Time for Action: Tackling Stigma and Discrimination. Mental Health Commission  of Canada; Ottawa, ON, Canada: 2007. [Google Scholar] [Ref list] 

3. Ghazzawi M, Yendewa SA, James PB, Massaquoi SP, Babawo LS, Sahr F, Deen GF, Kabba M, Ocama P,  Lakoh S, Salata RA, Yendewa GA. Assessment of Knowledge, Stigmatizing Attitudes and Health-Seeking  Behaviors Regarding Hepatitis B Virus Infection in a Pharmacy and Community Setting in Sierra Leone: A  Cross-Sectional Study. Healthcare (Basel). 2023 Jan 6;11(2):177. doi: 10.3390/healthcare11020177. PMID:  36673546; PMCID: PMC9859485.

Why is sunlight so important to the human body?  

Let’s go to the cellular level, every cell in our body has a mitochondrion which is the machinery or  powerhouse in our body that produces energy. The mitochondria take the food that we eat and  transform it into energy. However just like every machine it can overheat, shut down and produces a  byproduct called oxidative stress which are oxygen radicals! When oxidative stress builds up too much, it can cause lots of problems that could lead to less optimal health causing inflammation, cancer,  dementia, diabetes, learning disabilities and even Covid-19 mortality. When oxidative stress builds up  in the mitochondria, there’s a cooling system which occurs day and night. There is a fascinating  chemical which is activated to be produced to reduce oxidative stress in the mitochondria, interesting  right? This chemical is called melatonin (see figure 1), produced in our brain both at night and during  the day, it is one of the strongest antioxidants, twice as potent as vitamin E.

Figure 1. The Importance of Melatonin Against Oxidative Stress 

According to a published paper in 2019, by Professor Scott Zimmerman, it was highlighted that  melatonin produced in the mitochondria to reduce oxidative stress, may play a role in the prevention  and/or treatment of Alzheimer’s and Parkinson’s disease (see figure 2). 

Figure 2. View of Melatonin and the Optics of the Human Body 

At night melatonin is produced in the brain, enters the blood stream, and then goes into every cell of  our body to mop off the oxidative stress produced by the mitochondria. We can say this is how the  body gets rid of oxidative stress at night and we are able to sleep. Any form of light at night, exposed  to our eyes can shut down melatonin production from the brain. During the day, there is a completely  different system that stimulates the production of melatonin to combat oxidative stress. At daytime, 

melatonin production in the mitochondria is stimulated by near infra-red radiation (NIR) from the sun.  This is a new scientific discovery which makes us rethink, as to how much sunlight we are getting, and  what happens if we don’t get enough?! It is important to understand that melatonin produced by our  brain at night (Hormone of Darkness) helps us sleep, and the melatonin produced at cellular level  inside the mitochondria, this is stimulated by sunlight (hormone of daylight) play different roles – which has nothing to do with sleep at all! Mind you the above effects do not occur with melatonin  supplements that you might be taking, melatonin supplements just go directly to your blood stream  and tell the body to sleep.  

How do humans interact with light?  

One way we can explain our interaction with light is through the circadian rhythm (CR). CR is a 24-hour  cycle that is part of the body’s internal clock, running in the background to carry out essential functions  and processes. The CR regulates our body temperature (figure 3), helps in production of melatonin,  and many other chemicals that are essential for our body functions. According to the CR, melatonin  production starts at 9 pm and that is the time you would want to avoid bright light exposures to  prevent shutdown of melatonin production. Consequently, is it very important that the CR is in sync, and it is well regulated. There is scientific evidence to prove that dysregulation of the CR, can cause  induced sleep-wake misalignment which in turn can cause unscheduled production of insulin and  other hormones, circadian misalignment due to sleep deprivation can induce production of  inflammatory markers and insulin resistance which is a main culprit in type 2 diabetes (Scheer et al.). Disruption of the CR can cause stress hormone production at a rate which can be associated with  anxiety and depression during the day.  

Figure 3. The Circadian Rhythm 

One way to allow the CR to align with what goes on outside your body and to help you sleep at night  is by avoiding screen time or bright lights during bedtime, as this could shut down the production of  melatonin and leads to insomnia. In other words, avoid using laptops, phones at the time you are  supposed to be sleeping. If you need to work at night with your laptop avoid screen time at least 2  hours before bed. In addition, if you are awake before bedtime, it is inevitable that you need some 

lighting but let it be low on the floor below your visual field and as dim as possible. Orange or red dim  light below your visual field could also be better if you need to have light in your room. 

Why should we be happy with West Africa’s sunny weather?  

If you have lived abroad in a country long enough during winter, you will learn to appreciate and long  for sunny weathers. You will appreciate sunlight even if it is freezing cold, you will feel rejuvenated to  see the sun shining bright while you are outside. The sun elevates your mood, for this reason people  experience seasonal affective disorder during the winter season, and women are more prone to be  depressed during winter than men according to studies. In a meta-analysis, it was proven that  exposure to bright light during the day between 15 minutes to an hour for 4 weeks improved mood,  hence reduced seasonal affective disorder (SAD) Figure 4. 

Figure 4. Mechanism of action of Light Therapy in patients with SAD 

To anchor the circadian rhythm or to set it right, NIR sunlight exposure should be done before 9am in  the morning ranging between 30 sec to 30 mins. Wearing sunglasses will limit kickstarting the CR  accordingly. The brighter the sunlight the shorter time you need to spend outdoor, if it is a cloudy day up to 30 mins exposure will be needed. NIR penetrates your clothes deep into the skin/body and can  be perceived as heat. Sunscreens can only block ultraviolet radiation but not NIR. When we say  sunlight exposure, sitting in your car driving somewhere does not count, it is about really getting  outside in the open; direct sunlight exposure I mean. Notwithstanding that, interestingly, you can still  be in the shade and get NIR exposure because leaves of trees reflect the latter. Sunlight exposure is  safest before 10 am and after 3pm. The more time spent under direct sunlight the more Vit D will be  produced by the skin through ultraviolet B (UVB) radiation (Figure 5). 

Figure5. The Solar Spectrum 

Environmental research published in 2018, demonstrates that spending time and living close to  natural green spaces reduces the risk of type2 diabetes, cardiovascular diseases (heart and blood  vessel diseases) and premature death. People living closer to nature have reduced blood pressure,  heart rate and stress. Exposure to light or sunlight improves subjective wellbeing, cognitive  performance, reduces depressive disorders and cancer. In fact, the World Health Organization  classifies CR disruptive work shift, as a probable carcinogen (cancer-causing agent). 

To cut matters short, go for a walk every morning, enjoy mother nature’s sunlight while you can, to  live a healthy and prolonged life! Rely on sunlight to naturally produce melatonin, get your CR on sync to help you sleep like a baby!

Ramadan is a sacred month eagerly anticipated by Muslims around the world. It brings immense joy and peace into our lives when observed, promoting overall well-being for both our minds and bodies. Research has shown numerous health benefits associated with fasting:

1. Improving verbal memory
2. Improves heart health by reducing blood pressure, resting heart rates and other heart-related measurements
3. Exercising when fasting enhances physical performance, more fat loss and maintenance of muscle mass
4. Fasting can help people that are obese to lose weight and people with diabetes (with strict supervision) to control their sugar level- helping to get off insulin therapy.

While fasting can be beneficial for individuals with diabetes, it is important to be aware of the associated risks and complications. It is crucial to approach the holy month with caution to avoid hypoglycemia (low blood sugar levels) or hyperglycemia (high blood sugar levels), dehydration, or diabetic ketoacidosis (liver breaks down fat for fuel). Prior to beginning fasting, it is essential to engage in advanced planning with your healthcare team.

Individuals with well-controlled type 2 diabetes who effectively manage their condition through a healthy lifestyle and medication regimen can fast by adjusting their medication and regularly monitoring their glucose levels with their healthcare team. However, those with diabetes who are fasting and taking high doses of medication, as well as engaging in physical activity, should exercise extreme caution to prevent hypoglycemia.

People who may be at high risk of complications when fast during Ramadan include the following:

• Type 1 diabetes
• Type 2 diabetes with poor blood sugar control or taking certain types of insulin
• Recent history of severe low blood sugar or diabetic ketoacidosis
• History of recurring low blood sugar or unawareness of low blood sugar
• Conditions such as severe kidney disease or blood vessel complications
• Diabetes and is pregnant

The expected values for normal fasting blood glucose concentration in a diabetic patient are 4-7 mmol/L (72mg/dL- 126mg/dL) and below 8.5 mmol/L (153mg/dL) at least 90 mins after eating. 

It is crucial to understand that individuals may react differently to varying levels of low blood sugar. Therefore, it is essential to closely monitor your glucose levels and educate your family members on recognizing signs of low blood sugar, which may include, irregular or fast heartbeat, fatigue, pale skin, shakiness, anxiety, wearing, hunger, irritability, tingling or numbness of the lips, tongue, or cheek

As low blood sugar progresses, symptoms can worsen and may include confusion, abnormal behavior, or both. These symptoms may manifest as the inability to complete routine tasks, visual disturbances like blurred vision, seizures, or loss of consciousness.

If you experience any of the aforementioned symptoms, immediate treatment is necessary. 

1. Eat or drink 15 to 20 grams of fast-acting carbohydrates. These are sugary foods or drinks without protein or fat that are easily converted to sugar in the body. Try glucose powder, fruit juice, regular (not diet) soda, honey, or sugary candy.
2. Recheck blood sugar levels 15 minutes after treatment. If blood sugar levels are still under 70 mg/dL (3.9 mmol/L), eat or drink another 15 to 20 grams of fast-acting carbohydrate, and recheck your blood sugar level again in 15 minutes. Repeat these steps until the blood sugar is above 70 mg/dL (3.9 mmol/L).

3. Have a snack or meal. Once your blood sugar is back in the standard range, eating a healthy snack or meal can help prevent another drop in blood sugar and replenish your body’s glycogen stores.

Additionally, to prevent hyperglycemia, it is important to be prepared to adjust medication doses, regulate food intake, and be willing to break your fast if needed.

What is best to eat during Iftar?

1. Eat few dates, they are high in fiber, calcium, iron – rich in potassium
2. Complex carbohydrates such as whole grains like lentils, quinoa, bulgar wheat, brown rice, millet, wheat etc
3. Protein-rich sources such as lean meat, skinless chicken, fish, eggs, legumes and low-fat dairy products.
4. Avoid deep fried foods and those with refined carbs like white bread, pastries, biscuits etc. Instead, break your fast with like salads and vegetable soups, then later citrus fruits after your main meal.
5. Reduce the intake of salt and salted food, such as dressing, sauces, salted nuts and crisps. Dehydration is a risk due to limited fluid intake during the day, and high salt foods can further increase this risk.
6. Drink plenty of water at Suhoor and Iftar. It is recommended that you drink at least 8 cups of water between Iftar and Suhoor so that your body may adjust fluid levels in time for the next day.

Avoid drinks that contain caffeine such as tea and coffee as these can make you lose more water by going to the toilet more. Avoid sugary drinks such as orange, apple, tropical fruit juice and fizzy drinks. Diet drinks and non-sweetened drinks are preferred options.

In conclusion, it is important to remember that while the Qur’an mandates fasting for Muslims during the month of Ramadan from dawn to dusk, it also emphasizes the importance of not harming one’s body. Individuals living with diabetes and other health conditions may be exempt from fasting due to the increased health risks involved.

I extend my warm wishes to all in advance for a blessed Ramadan and Eid al-Fitr.

We’ve been told that, eat 3 meals a day, with snacks in between, or 5 small meals a day to boost your metabolism, and that putting your body on starvation mode will slow down your metabolism and losing weight will backfire at you if you reduce your number of meals daily. In fact, intermittent fasting (IF) increases your metabolic rate, it is now the key to losing excess weight, having good health, mind, and body. This reminds me of the holy Quran, most of what is mentioned for us to be engaged in, is for our own good. The prophet Mohamed has always been fasting twice a week, and now evidence points out to the benefits of IF. During the holy month of Ramadan, our 14 hours fasting is literally a form of the modernized way of saying IF. 

What is intermittent fasting?

Our body is made to strive for a longer period without food, it is made to do the right thing just at the right time. IF can mean eating for 8 hours and fasting for the remaining 24-hour period or fasting for 20 hours and having 4 hours window period. It could also mean eating one meal a day every day or twice a week. Consistency is key when engaged in IF. I hear most people say, “I stop eating after 7pm till the next morning”, which is also a form of IF. Studies have shown that fasting for 16 hours kickstarts burning of stored fat, meaning it takes 16 hours for your body to consume calories that you have ingested before, for it to start burning excess fat stores, especially in the belly area. Try to avoid eating 3 hours before going to bed.

Strategies to losing belly fat through IF.

Before we dive into strategies to lose weight, let us first know the different types of fat, we have the subcutaneous fat, which is the fat underneath our skin and the visceral fat which is the fat wrapped around our organs. People have this false belief that abs exercise can help burn belly fat, it is through fasting that belly fat can be minimized. However, cardio exercise can help you lose belly fat, especially subcutaneous fat. 

The first thing you need to realize is that fat is excess sugar, excess hormones, or toxins. Hence, if you want to lose belly fast, you can adopt the above IF schedule but to be mindful of what you eat and how much you eat. When breaking your fast, the first step is to eat high fiber and clean protein foods, to keep your insulin levels low. Eat green leafy vegetables, foods with probiotics and healthy fats like avocados. Avoid inflammatory fats like canola oil, sunflower oil, corn oil, vegetable oil and soybean oil. In addition, avoiding all processed food, eating natural carbs is the best way to achieve healthy goals apart from losing weight. 

Practicing mindfulness can also help reduce belly fat indirectly because it reduces or prevents production of the stress hormone cortisol. Cortisol production spikes up in the morning after waking up, hence it is best to go for a walk within 2 hours after you wake up. Stressful jobs or situations can also increase your cortisol levels, which translates to increased belly fat if you do not exercise, sitting on a chair the whole day at the office. 

Intermittent fasting mistakes that make you gain weight.

1. Not varying your fast, i.e., not adopting different schedules of IF but just sticking to one. It is also important to take breaks during IF for like a week or two.
2. Not fasting long enough
3. Not eating the right foods and binge eating

Intermittent Fasting Benefits

1. IF helps to reduce insulin levels, increases levels of growth hormones which help in fat burning process. 

2. Helps in gene expression which is related to prevention of certain diseases that lead to inflammation or cancer.

3. IF also helps in cellular repair i.e., removing toxic wastes from cells.

4. Can help you lose weight and increase physical performance.

5. Lowers risk of type 2 diabetes mellitus (T2DM) and helps reduce insulin resistance in T2DM. Studies have shown that people with T2DM who fast under their doctor’s supervision, have better glucose control and were able to reverse the need for insulin therapy.

6. Lowers blood pressure, bad cholesterol, and inflammatory markers.

7. May help prevent Alzheimer’s disease as it improves verbal memory.

Is intermittent fasting safe?

IF is safe for most people but not for everyone. If you are pregnant and breastfeeding you should not do IF, or if you have kidney stones, gastroesophageal reflux, type 1 diabetes, or other medical problems. Speak to your doctor before starting IF.

If thou wouldst preserve a sound body, use fasting and walking; if a healthful soul, fasting and praying; walking exercises the body, praying exercises the soul, fasting cleanses both. ~Francis Quarles

26^th June 2024 marks the international day against drug abuse and illicit trafficking, a topic worth to have a spotlight on, as Sierra Leone is currently facing a pressing public health crisis as the prevalence of illicit drugs, notably Kush, continues to rise alongside an alarming increase in Hepatitis B incidence.This dual challenge poses significant threats to the health and well-being of the population, as well as the societal fabric of the country. Understanding the complexities of these interconnected issues is crucial in developing effective strategies to mitigate their impact and prevent further escalation of the crisis.

According to a study in sub-Saharan Africa, an estimated 95% of individuals with chronic HBV or HCV infection, or both, are unaware of their infection and so do not benefit from clinical care, treatment, and interventions that are designed to reduce onward transmission.

Risk Factors Contributing to The Prevalence of Hepatitis B Within Drug-Using Populations

Hepatitis B/C is like that unexpected guest who never leaves, and it is not the kind of guest you’d want crashing on your liver’s couch. Hepatitis B/C are viral infections that target the liver, causing issues ranging from mild illness to serious problems like liver cirrhosis, chronic liver disease including liver cancer. Drug users and Hepatitis B/C seem to go together and not in a good way. The prevalence of Hepatitis B/C among drug users is alarmingly high, making it a major concern in this community.

From city streets to remote corners of the world, Hepatitis B/C doesn’t discriminate – it’s making itself comfortable among drug users worldwide. Whether you’re in the bustling city or a quiet town, the risk is real for those who choose to play with fire.

Sharing needles isn’t just a red flag for hygiene; it’s practically rolling out a welcome mat for Hepatitis B/C. Injecting drugs puts you at a higher risk of spreading and contracting the virus, turning a needle into a risky business card. Unprotected sex and other high-risk behaviours increase the chances of transmission, making it easier for the virus to crash your liver’s party.

Effect of Substance Abuse on Hepatitis B/C Disease Severity

Illicit drug use mixed with alcohol and being infected with Hepatitis B/C is like throwing gasoline on a fire – it can intensify the severity of the disease and complicate treatment. Substance abuse can turn a manageable situation into a full-blown liver drama, making the battle against Hepatitis B/C an even tougher one.

Challenges in Hepatitis B/C Prevention and Treatment for Drug Users

Managing Hepatitis B/C among drug users is a challenging task for health care practitioners. From addressing substance abuse issues to ensuring proper medical care, there are hurdles at every turn. But with the right approach and support, tackling Hepatitis B/C in this population can lead to better health outcomes. In addition, barriers like stigma, lack of access to healthcare, and fear of judgment can make it challenging to protect this at-risk group.

Strategies for Hepatitis B Prevention in Drug Using Communities

1. Harm Reduction Approaches

It will be interesting to know how many drug users in Sierra Leone inject drugs, that we do not know. I think people inhale drugs more than injecting. When it comes to preventing Hepatitis B/C in drug using communities, harm reduction approaches play a crucial role. Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. Investigating harm reduction techniques that aligns with Sierra Leone’s perspective of illicit drug use could help in easy implementation.

2.     Community Outreach and Education Programs

Educating drug users about the risks of Hepatitis B/C and the importance of vaccination is essential in prevention efforts. Community outreach programs that engage with drug using populations can help raise awareness and promote positive health behaviours.

3.  Addressing Stigma and Access to Healthcare for Drug Users with Hepatitis B

Stigma surrounding drug use and Hepatitis B can create barriers to healthcare access and support for affected individuals. Addressing stigma through education and advocacy is key to ensuring that drug users with Hepatitis B receive the care they need.

4.     Improving Healthcare Access and Support Services

Improving access to healthcare services, including Hepatitis B testing, treatment, and counselling, is vital for drug users with the virus. Providing support services such as mental health care and addiction treatment can also enhance overall health outcomes.

5.     Public Health Implications and Policy Recommendations

The prevalence of Hepatitis B among drug users has significant public health implications, including the potential for outbreaks and increased healthcare costs. Addressing Hepatitis B within drug using communities is crucial for overall disease prevention efforts.

Policy recommendations for preventing and treating Hepatitis B among drug users should focus on increasing access to vaccination, improving healthcare infrastructure in underserved areas, and implementing evidence-based harm reduction strategies.

In conclusion, addressing Hepatitis B within drug users requires a multifaceted approach that combines harm reduction, education, stigma reduction, improved healthcare access, and supportive policies. By working together towards comprehensive solutions, we can make significant strides in preventing and treating Hepatitis B in this vulnerable community.

Dr. Manal Ghazzawi is a clinical pharmacist, CEO of CitiGlobe Pharmacies Ltd and KnowHep Foundation Sierra Leone. She has great passion for writing on health issues afflicted by Sierra Leoneans apart from her contribution in the fight against Hepatis B in Sierra Leone.

Diabetes mellitus (DM) is a global health catastrophe that affects how the body processes sugar due to either lack of the hormone insulin or issues that makes the body resistant to the action of insulin. Insulin is the hormone in our body that stores excess glucose to glycogen and helps the cells of our body absorb glucose for energy.

DM leads to devastating complications like stroke, heart issues, amputation, blindness etc, if left untreated or unattended to.

People with diabetes who lead a normal life have a full-time job to ensure their sugar level remains stable. But in as much as such affected persons try endlessly to prevent sugar levels from escalating, they must also work so hard to prevent sugar levels not to go too low to prevent complications like coma.

People in Africa face lots of difficulties in terms of accessibility to diabetes care. Marginalised communities are unaware of DM and its consequences, and they must pay out of pocket for their drugs and continuity of care.
In a country like Sierra Leone, most tertiary and secondary facilities are clustered in the city, leaving villagers accessing health care at community health centres which lack the necessary expertise to manage and prevent DM. Unfortunately, many Africans are diagnosed late after complications have already set in.

There are about 4 types of DM: Type 1, which is insulin dependent DM; Type 2, which is non-insulin dependent DM; Type 3, which is DM affecting women during pregnancy; and Type 4, which is DM due to drugs and other diseases affecting the pancreas.

Burden of DM in the Africa region

According to the International Diabetes Federation (IDF), the Africa region represents the highest proportion with undiagnosed DM, with 60% of its adults having it without knowing about their condition.

Below is a concise representation of types 1 & 2 diabetes in Africa and projections of prevalence of diagnosed and undiagnosed diabetes by 2030/2045, as well as projected government health expenditure by 2030/2045.

In summary, it is estimated in 2019 that 19 million people were living with diabetes in Sub-Saharan Africa (SSA) and this figure was expected to skyrocket to 47 million by 2045. Among those with undiagnosed DM, 12 million people have diabetes unknowing to them and 366,200 people in Africa die because of DM.

The 8th edition of the Diabetes Atlas report estimates that 77% of all diabetes related deaths worldwide occur in SSA, in people under 60 years of age (IDF atlas 2017).

This information is quite a bit alarming, but the good news is, diabetes is a preventable disease if we adopt healthy lifestyle behaviours.

A systematic analysis on prevalence and sub-regional distribution of undiagnosed diabetes mellitus among adults in African countries reveal that West Africa has the highest burden of undiagnosed DM. Nigeria represents the top five countries in Africa with high prevalence of DM.

In Sierra Leone, inadequate data makes it difficult to ascertain national prevalence of DM.It is inevitable that uncontrolled endemic and epidemic diseases affecting a nation can extremely place health expenditure burden on governments, especially with our fragile health system in Africa.

According to IDF 2019, government expenditure on health due to diabetes is US$10 billion and is projected to increase up to US$17 billion by 2045.

What could be the cause for the time-ticking-diabetes-bomb that awaits us?

DM is characterized as one of the leading non-communicable diseases (NCDs) in Africa. DM itself leads to increased risk of leading causes of communicable diseases like Human Immunodeficiency Virus (HIV), Tuberculosis (TB), viral hepatitis, pneumonia and Covid-19 infections (Davies K et al., 2020).

Food stuff like these increase the risk of diabetes. Image source unknown
Plausible reasons for the increasing prevalence of DM in Africa are due to common chronic communicable diseases on the continent, which cause inflammatory conditions, leading to organ dysfunction and damage. Even some drugs used to treat, for instance, HIV and TB, could also lead to DM (Davies K et al., 2020).

In addition, obesity appears to be a major issue among urban women aged 15–49 years, as demonstrated from the results of demographic and health survey from 24 African countries (Neupane S et.al, 2016). These women have high risk of developing gestational diabetes in the future, which in turn predisposes their poor babies to diabetes at adulthood or even childhood.

A study was conducted by me in 2017, to assess the risk of developing DM among adults in Freetown. A population size of 1013 was randomly selected, and the prevalence of participants to be at high risk of developing Type 2 DM (T2DM) was 17.8%. Though more rigorous and extensive research is needed to ascertain this, the study highlighted that age, gender, occupation, high waist circumference, hypertension and family history are associated risk factors that yielded statistical significance.

Body Mass Index (BMI) categorization by gender shows that more females (77%) had higher BMI compared to males (53%). Also, more females (19.2%) compared to males (8.1%) were found to have a high waist circumference (WC) which denotes central obesity. This study conforms to a systemic review and metanalysis conducted by Davies A et.al, in Nigeria, which demonstrated that there were 21 million and 12 million overweight and obese persons respectively, in the Nigerian population aged 15 years or more in 2020, and more females were over-weight and in the obese category compared to males.

Previous studies have established that West African Lineage is associated with greater BMI and total body fat. Many studies have shown distinct evidence to confirm that obesity is a major risk factor for T2DM.

Obesity is on the increase in Africa, due to adoption of westernized culture, urbanization, growth in economy, sedentary lifestyle, and introduction of processed foods (Searcey & Richtel 2017).

It is indeed poignant that improved standards of living is driving us to make poor health life choices. In Sierra Leone or in some regions in Africa, obesity is a sign of affluence, dignity, and respect (Janzon E et al., 2015).

Despite this fact, let us not forget that diabetes respects no socioeconomic status or boundaries in general. In a country like Sierra Leone, which probably other countries in the region can relate, people can hardly afford to buy fruits and vegetables. Healthy foods are not produced abundantly in our country, and the poor will continue to be deprived from eating healthy foods that could prevent the occurrence of diabetes. We are highly dependent on importation of most of our food items, even salt and sugar. It has reached a point where imported foods can be cheaper that home grown foods.

Poverty, which is our biggest killer, forces us to eat unhealthy foods to fill our stomach. Adoption of the Mediterranean diet, which mainly consists of fruits, vegetables, nuts, wholegrains and fish have been shown to prevent diabetes.

People with diabetes can prolong their health with the proper diet involving these kind of food stuffs. Image source unknown
Regular physical activity is undeniably relevant in the prevention and management of diabetes. The American Diabetes Association recommends 150 minutes of regular physical activity per week to prevent and manage DM.

Our road networks in Africa could be a turn off for citizens to be engaged in walking and jogging. That needs to be changed, citizens of African countries have every right to be able to exercise conveniently whenever and wherever they find themselves. People living in the rural setting walk miles to reach their farm or place of work, whereas in the urban setting we just rely on transportation. The latter provides such a convenience to people in the urban setting combined with the chair we sit in the whole day at work, highly encouraging us not to be active.

Among other factors that is causing high disease burden and undiagnosed cases in Africa are lack of motivation needed for health workers to provide service; shortage of health work force, brain drain, lack of organized structure for chronic disease care, fewer tertiary care hospitals, lack of awareness of prevalent diseases among the population and inappropriate health care information systems

Strategies to mitigate the epidemic in Africa

Without leadership, governance, financing, health workforce, health information systems, supply chains, and service delivery, we will continue to suffer from diabetes and many chronic diseases. Because diabetes is a lifelong disease and is associated with acute and chronic complications that could cause multiple organ damage, it requires several multi-faceted approaches to reduce the burden of the disease from a public health point of view.

Interventions to target obesity include nutrition labelling; marketing restrictions of unhealthy foods and beverages to kids; fruit and vegetable subsidies; physical activity policies and social marketing campaigns. WHO member states around the world, including South Africa, have committed to halt the rise of obesity and diabetes, reduce premature deaths from NCDs by 25% by 2025 and one-third by 2030. The latter target is in line with the Sustainable Development Goals.

How many countries in Africa are really committed to keep that ambitious promise? Many countries in Africa will be hesitant to execute laws that would prevent DM due to political reasons. In Sierra Leone, selling of alcohol occurs in the streets so freely that it can easily be accessed by kids. There are foreign companies that manufacture high percentage of alcohol beverages with no one to hold them accountable. Alcohol overuse and substance abuse is a rising pandemic that also needs to be addressed. Chronic alcohol use is an associated risk factor for the development of diabetes. Studies have shown a genetic predisposition to increased risk of DM among heavy alcohol users (Jang et al 2019).

As we know, diabetes was known as the disease of the rich. Though it is still affecting people living in developed countries, many strategies are being put in place to help protect their citizens. The political will is there. In Africa, some of our presidents themselves are obese, they are diabetic or are at high risk of developing T2DM. Politicians of African countries, including the health ministers themselves, will rather fly to the most sophisticated countries to seek medical care. They themselves do not trust their health system which they are supposed to fix, leaving their own citizens vulnerable and deprived of the basic health care they need.

With the exception of a few, the health system of Africa is highly fragile. In Sierra Leone, for example, we keep on putting the blame for our poor health system on the [1991-2200 civil war, Ebola and now Covid-19 pandemic.

If we do not finance our health system to achieve universal health coverage, life expectancy of Africans will remain low, with the potential of holding back economic growth.

Many people are pushed to extreme poverty when they must pay out of pocket for diseases other than TB, HIV.

A multipronged urgent control measure is needed to diagnose people at risk of developing diabetes to prevent subsequent complications of the disease that is affecting quality of life of people globally.

This is the time to take action towards strengthening our health system in Africa. We need to create a donor-independent health system, otherwise emerging and remerging infectious diseases will continue to claim our lives, further exposing our fragile health system. Sadly, this is a reality which we cannot ignore. Diversion of resources towards communicable diseases, away from non-communicable diseases, and provision of essential health services, further leads to more morbidity and mortality. Africa needs to wake up!

Hepatitis B is claiming lives of Sierra Leoneans, it is becoming a public health problem. Already it is a global health concern. Globally 350-400 million people are chronically infected with hepatitis B virus (defined as hepatitis B surface antigen positive for at least 6 months). Worldwide, more than 686,000 people die every year due to complications of hepatitis B, including cirrhosis and liver cancer. Though data does not exist to verify this, Sierra Leone has a higher prevalence of hepatitis B than C. Due to the paucity of research in Sierra Leone, we do not know the current prevalence of hepatitis B in the country. However few statistics exist for different population groups; for children affected with hepatitis B ranges between 1.3% – 1.6%, health care workers 8.7%, pregnant females 11.3% and blood donors at Connaught hospital 15.2%.

During my training as a clinical pharmacist, I came across many patients infected with the virus at the Joint Medical Unit within the military hospital. To make matters worse most of these patients are co- infected with HIV. Adding more burden to the disease, because they will have to deal with the side effects of their drugs, and debilitating symptoms of both diseases. Statistics in Sierra Leone has confirmed, that up to 22% of those infected with hepatitis B are also living with HIV/AIDs.

Hepatitis B is a viral infection that is transmitted through blood and body fluids such as vaginal fluids and semen. Hence, it is transmitted through sex, sharing of contaminated sharp object (needles, razors e.t.c), blood transfusion, and mother to child during birth. There is not much evidence to show whether it is transmitted by sweat or sharing of kitchen utensils or even by kissing. The hepatitis B virus can survive outside the body for at least 7 days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine. The incubation period of the hepatitis B virus is 75 days on average but can vary from 30 to 180 days. Due to the long incubation period, it is possible for an infected individual to be spreading the disease because he/she is asymptomatic. This is how the virus might be spreading at a faster rate, among many other factors. The virus may be detected within 30 to 60 days after infection and can persist and develop into chronic hepatitis B after 6 months.

People at risk of developing hepatitis B are:

• Infants born to infected mothers
• Sex partners of infected persons
• Persons with multiple sex partners
• Persons with a sexually transmitted disease (STD)
• Men who have sex with men
• Injection drug users
• Household contacts of infected persons
• Healthcare and public safety workers exposed to blood on the job
• Hemodialysis patients
• Residents and staff of facilities for developmentally disabled persons
• Travelers to regions with intermediate or high rates of Hepatitis B (HBsAg prevalence of ≥2%)

Signs and Symptoms:

• Fever
• Loss of appetite
• Muscle pain and joint pain
• Upper right abdominal pain
• Dark urine
• Clay colored stool

Complications of chronic active hepatitis include chronic liver disease, cirrhosis of the liver and liver cancer.

Hepatitis B infection continues to rise among Sierra Leoneans and will continue to rise if precautionary measures are not taken among already infected patients and uninfected individuals. Also, some health facilities misdiagnose the infection on clinical grounds for malaria and typhoid since these infections manifest mimicking symptoms like fever, malaise, joint pain, loss of appetite etc. This translates into infected patients  being treated wrongly with antimalarial agents, IV fluids and antibiotics leading to antimicrobial resistance, increased cost for patient, and reduced quality of life. Consistent misdiagnosis of this infection will lead to increased viral load, causing chronic infective hepatitis B with symptoms showing early or late signs of liver damage. The national hepatitis task force, has formulated a treatment guideline in the management of viral Hepatitis (VH). Until that guideline is released to all health care facilities in the country, it is important that most health care workers educate themselves about prevention and proper management of VH, instead of over prescribing antiviral drugs when it is not needed and when they are not authorized to do so. I cannot overemphasize the fact that not all those infected with the virus need an antiviral medication. I advise the public to seek the right health care advice, from specialists before accepting treatment not only for hepatitis but for any other disease.

For clinicians to decide whether to commence therapy or not, certain diagnostic criteria according to international guidelines must be met. Diagnostic tests such as liver function tests and identification of stage of the hepatitis B infection are available in Sierra Leone (but not easily accessible at all public hospitals nationwide). More sophisticated tests like viral load determination, which is a diagnostic criterion in the management of hepatitis B is provided by a private facility, which costs about $160. This is nerve wrecking for people who cannot afford it and might need more than 3 months of their salary to pay for that.  Thanks to Partners in Health at the Koidu Government hospital which is offering tremendous support in diagnosis and management for free.

Hepatitis B can only be managed but not curable. Those that are lucky with a strong immune system, can get infected and clear the virus completely and recover. Supportive treatment is only required for managing acute hepatitis B infection. Less than 4% of those infected become chronic, within this 4% some will become immune tolerant or have inactive chronic infection without evidence of active disease, hence asymptomatic and can be noninfectious. Those with chronic active infection can have symptoms of liver disease which is treated with antiviral medications to suppress viral load and disease progression. Patients infected with this virus should continue to eat a healthy balanced diet, avoid drinking alcohol and drugs that are toxic to the liver.

The best way to prevent hepatitis is to get vaccinated. The vaccine is not widely available and affordable, but can be accessible at some facilities, especially in Freetown. For those that cannot afford buying the vaccine, the best they could do, to stay out of trouble is sticking with one partner, use of condoms during sex, avoid sharing of sharp objects and blood transfusion from unscreened blood.

Introduction of the birth dose of hepatitis B vaccine for all babies have been introduced in many countries including Africa. China CDC in collaboration with the Ministry of Health and Sanitation (MOHS) is to implement that in Sierra Leone. However, the MOHS already provides HBV vaccine which is included in the pentavalent vaccine given at 6^th, 10^th and 14^th week of a baby’s life. Adoption of the birth dose is part of the global elimination strategy, to prevent mother-to-child transmission where a baby needs to be vaccinated within 12-24 hrs. This strategy is particularly important in prevention of new infections, because 90% of babies born from infected mothers will develop chronic hepatitis B which eventually could lead to liver cancer at their adult age.

The Ministry of Health and Sanitation (MOHS) needs to have a  Viral Hepatitis (VH) elimination action plan where its focus is on 4 main goals:

Goal 1: To prevent new viral hepatitis infections, through awareness raising, capacity building of HCWs, address data gaps through surveillance, preventive for vulnerable groups,

Goal 2: Reduce deaths and improve the health of people living with VH by swift identification of those infected with VH. Improved access to quality care and treatment among those infected with VH, those coinfected with HIV/AIDS and intravenous drug users,

Goal 3: Reduce VH health disparities by partnering with and educating priority populations and their communities about viral hepatitis and the benefits of available prevention, care, and treatment.

Goal 4: Coordinate, monitor, and report on implementation of VH activities by strengthening timely availability and use of data.

Government and private health facilities should be able to provide more sophisticated laboratory investigations, that will aid in the proper management of Hepatitis B in Sierra Leone. Moreover, all health professionals should be dedicated to educating the public by increasing awareness about the disease and its prevention.

This is not only government’s fight, but all of us, it takes the support and commitment of a broad mix of stakeholders i.e. the scientific community, community leaders, policy makers and the private sector. It is amazing how our national collective effort can create a massive impact towards elimination of VH by 2030.