Posts in category: Publications

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 immunisation. Overall, 11181 mothers were analyzed (4846 from Sierra Leone, 2788 from Liberia, and 3547 from Guinea). Sierra Leone had the highest HBV childhood vaccination coverage (70.3%), followed by Liberia (64.6%) and Guinea (39.3%). Within countries, 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 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.

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 (b = 0.525, p <0.001), residence in Eastern Sierra Leone (b = 3.215, p < 0.001), and experiencing enacted stigma (b = 0.804, p < 0.001) were significantly associated with perceived stigma. Having a family member or friend with HIV (b = -0.499, p < 0.001), and HIV disclosure (b = -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.

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) (I 2 5 99%; P heterogeneity , 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.

By Dr Manal Ghazzawi

Hepatitis B virus (HBV) is a major global health challenge. Emerging evidence suggests that poor knowledge and stigma are impacting HBV control efforts in sub-Saharan Africa (SSA), but their role is not well understood. We conducted a cross-sectional study of adults aged ≥18 years in a community and pharmacy setting in Freetown, Sierra Leone. A structured questionnaire was used to assess knowledge, stigmatizing attitudes and health-seeking behaviors regarding HBV. Logistic regression was used to identify predictors of HBV knowledge and related stigma. A total of 306 adult participants were enrolled (50.7% male, 7.5% HBV positive and 11.7% vaccinated). Overall, 52.2% had good HBV knowledge and 49.3% expressed a stigmatizing attitude towards people with HBV. Notwithstanding, 72.2% stated they would receive the HBV vaccine if offered, 80.4% would take anti-HBV medication and 78.8% would be willing to attend clinic regularly. Good HBV knowledge was associated with HBV positive status (aOR 4.41; p = 0.029) and being vaccinated against HBV (aOR 3.30; p = 0.034). HBV-related stigma was associated with secondary or higher level of education (aOR 2.36; p < 0.001), good HBV knowledge (aOR 2.05; p = 0.006) and pharmacy setting (aOR 1.74, p = 0.037). These findings suggest that education and stigma reduction may benefit HBV elimination efforts in SSA.

https://www.researchgate.net/publication/366913501_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

Objective: To estimate the prevalence and burden of chronic HBV in Sierra Leone. Methods: We used electronic databases PubMed/MEDLINE, Embase, Scopus, ScienceDirect, Web of Science, Google Scholar and African Journals Online to systematically review articles reporting hepatitis B surface antigen (HBsAg) seroprevalence estimates in Serra Leone during 1997-2022. We estimated pooled HBV seroprevalence rates and assessed sources of heterogeneity Results: Of 406 publications screened, 22 studies of total sample size 107,186 were included in the meta-analysis. The crude pooled HBV seroprevalence was 13.0% (95% CI 10.0-16.0) (I 2 =99%, p-heterogeneity<0.01), translating into 1.06 million people (95% uncertainty interval 0.81-1.30) or 1 in 8 Sierra Leoneans living with chronic HBV in 2021. Sensitivity analysis yielded a pooled HBV seroprevalence of 12.0% (95% CI 10.0-14.0) (sample size 104,968) (I 2 =98%, p-heterogeneity<0.001). 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 in the Northern (19.0%, 95% CI 6.4-44.7) and Southern (19.7%, 95% CI 10.9-32.8) regions. HBV seroprevalence progressively declined from 17.9% during 1997-2014 to 10.7% during 2020-2022. Conclusions: These findings necessitate the urgent implementation of national HBV prevention and control programs in Sierra Leone.

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 13.8% 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.

By Dr Manal Ghazzawi

Hepatitis B (HBV) is a major public health threat in Sierra Leone. Pregnant women are disproportionately impacted, yet little is known about the epidemiology of HBV in this group. We conducted a cross-sectional study of pregnant women aged ≥16 years receiving antenatal care across 10 community health centers in Freetown from July to September 2021 to assess the prevalence and associated factors of HBsAg seropositivity. A logistic regression was used to identify the predictors of HBsAg seropositivity. In total, 394 pregnant women were screened. The mean age was 24.4 ± 4.9 years, 78.2% were married, and 47.2% were in the second trimester. Only 1% had received the HBV vaccine. The prevalence of HBsAg was 7.9%, while HIV was 5.8% and HIV/HBV co-infection was 0.3%. Regarding high-risk practices, 76.6% reported female genital circumcision, 41.9% ear piercing, 29.0% endorsed multiple sexual partners, and 23.6% reported sexually transmitted infections. In the logistic regression analysis, having a husband/partner with HBV (adjusted odds ratio (aOR): 6.54; 95% CI: [1.72–24.86]; p = 0.006) and residing in Central Freetown (aOR: 4.00; 95% CI: [1.46–11.00]; p = 0.007) were independently associated with HBsAg seropositivity. Our findings support the scaling up of HBV services to target pregnant women and their partners for screening and vaccination to help reduce mother-to-child transmission rates in Sierra Leone.
https://www.researchgate.net/publication/358557495_Factors_Associated_with_HBsAg_Seropositivity_among_Pregnant_Women_Receiving_Antenatal_Care_at_10_Community_Health_Centers_in_Freetown_Sierra_Leone_A_Cross-Sectional_Study

By Dr Manal Ghazzawi

Introduction: Diabetes Mellitus is a global health issue, though current prevalence data is lacking Sierra Leone has an increasing number of diagnosed and undiagnosed diabetes. Lack of education and self-care, poor adoption of healthy lifestyle may be the main factors leading to an increased risk of diabetic foot ulcers. 

Objectives: To identify patients with diabetes at risk of developing foot ulcers, diabetic neuropathy, peripheral artery disease and to investigate the association between independent risk factors involved in development of foot ulcers and other clinically related factors. 

Methods: Study was done at two sites, Connaught hospital and a clinic in Freetown. A standardized questionnaire was administered for risk assessment of diabetic ulcers. A total of 231 participants (Ages 45-75 years) were recruited via systematic random sampling. Descriptive statistics was used to analyze data using SPSS. 

Results: Majority of participants (64.5%) were diagnosed with diabetes within 1-5 years, 5.5% and 13.4% had eye and kidney disease respectively. Protective sensation evaluation revealed that 38.5% had loss of protective sensation and 19% had suspected peripheral arterial disease with absent pulse at the posterior tibial artery and dorsalis pedis. Age, occupation, years since diagnosis and type of diabetes was significantly associated with high risk of developing diabetic foot ulcers with a P value < 0.005. Risk Categorization of participants revealed 76% at low risk while those at moderate, high and highest risks were 20%, 17% and 3.5% respectively. Individuals with prior kidney disease, eye problems and previous history of amputation had greater loss of protective sensation, absent pulse, and tingling sensation at extremities. 

Conclusion: There’s great need for health care workers to become diabetes educators to offer proper services like diabetes foot examination to prevent diabetes ulcers which leads to amputation. Detecting diabetic patients at risk for diabetic foot ulcers will go a long way to prevent future amputations and other associated complications.

DOI URL: https://doi.org/10.53388/FTHC20210510002