Counties Of Liberia Research Articles

Exploring How Small Business Grow to Levels of Competitiveness and Sustainability: The Case of Liberia

Abstract Small businesses are regarded as the backbone of economies worldwide. Despite the government’s numerous sustainability efforts in the public sector, small businesses are acknowledged to contribute significantly to the expansion and prosperity of any economy. This is also true across Africa. Many Liberians rely on the viability and success of small businesses as their primary source of survival. Unfortunately, the results and trends for economic growth are not meeting expectations. This study explores how small businesses can achieve competitiveness and sustainability. A qualitative phenomenological method was used following a descriptive research approach. Five business owners representing two counties in Liberia were selected using purposive sampling. An in-depth individual interview was conducted and discussed. Data were analyzed and coded using thematic descriptive analysis with four identified themes. The findings reveal that small business owners have similar lived experiences with positive and negative aspects. It highlights the need for effective strategies to compete and maintain small businesses, including driving success, market research, and customer relationships. However, it emphasizes that knowledge and skills are essential.

A Serological Multiplexed Immunoassay (MIA) Detects Antibody Reactivity to SARS-CoV-2 and Other Viral Pathogens in Liberia and Is Configurable as a Multiplexed Inhibition Test (MINT).

The SARS-CoV-2 pandemic ignited global efforts to rapidly develop testing, therapeutics, and vaccines. However, the rewards of these efforts were slow to reach many low- to middle-income countries (LMIC) across the African continent and globally. Therefore, two bead-based multiplexed serological assays were developed to determine SARS-CoV-2 exposure across four counties in Liberia. This study was conducted during the summer of 2021 on 189 samples collected throughout Grand Bassa, Bong, Margibi, and Montserrado counties. Our multiplexed immunoassay (MIA) detected elevated exposure to SARS-CoV-2 and multiple variant antigens. Additionally, we detected evidence of exposure to Dengue virus serotype 2, Chikungunya virus, and the seasonal coronavirus NL63. Our multiplexed inhibition test (MINT) was developed from the MIA to observe antibody-mediated inhibition of SARS-CoV-2 spike protein binding to its cognate cellular receptor ACE-2. We detected inhibitory antibodies in the tested Liberian samples, which were collectively consistent with a convalescent serological profile. These complementary assays serve to supplement existing serological testing needs and may enhance the technical capacity of scientifically underrepresented regions globally.

COVID-19 vaccine hesitancy among adults in Liberia, April-May 2021.

Vaccination is one of the most cost-effective public health interventions used to prevent diseases in susceptible populations. Despite the established efficacy of vaccines, there are many reasons people are hesitant about vaccination, and these reasons could be complex. This rapid survey estimated the prevalence of COVID-19 vaccine hesitancy and potentially contributing factors in Montserrado and Nimba counties in Liberia. A cross-sectional study was conducted among adults living in Liberia. The relationship between vaccine non-acceptance and sociodemographic characteristics was examined using chi-square statistics. The variables with a p-value less than 0.2 at the bivariate analysis were modelled in a binary logistic regression at a 5% level of significance. The adjusted odds ratio and 95% confidence interval are reported. There were 877 participants in the study. Majority were 25-34 years of age (30.4%, 272/877), females (54.05%, 474/877), and Christians (85.2%, 747/877). Most of the participants were aware of the COVID-19 vaccine (75%, 656/877), single (41.4%, 363/877), self-employed (37.51%, 329/877), and live-in rural communities (56.1%, 492/877). Vaccine hesitancy was (29.1%, 255/877; 95% CI:26.2-32.2). Vaccine hesitancy was greater among adults living in urban areas (41%) compared to persons living in rural communities (59%) (aOR; 1.5, 95% CI: 1.1-2.1) and respondents aged 45-54 years (aOR:0.5; 95% CI: 0.2-0.9; p = 0.043) were 50% less likely to be hesitant to COVID-19 vaccination compared to those more than 55 years. The most common source of information was the media (53%, 492/877) and the main reason for being hesitant was a need for more information about the vaccine and its safety (84%, 215/255). The majority of study participants were aware of the COVID-19 vaccines and their most common source of information was the media (television, radio). Vaccine hesitancy was moderate. This could pose a challenge to efforts to control the spread of the COVID-19 pandemic. Therefore, the health authorities should provide more health education on the importance of vaccines and their safety to the populace.

Anaemia and Dietary Diversity among Pregnant Women in Margibi and Grand Cape Mount Counties, Liberia.

Background: Globally, anaemia remains a severe public health concern among women of reproductive ages, including pregnant women in developing countries such as Liberia. Poor dietary diversity is a major contributor to micronutrient deficiencies. However, there is limited documentation of anaemia prevalence and dietary diversity among pregnant women in Liberia. Objective: The present study assessed the prevalence of anaemia and dietary diversity among pregnant women in the Margibi and Grand Cape Mount Counties in Liberia. Methods: The study design was cross-sectional. Systematic sampling was used to recruit 139 pregnant women between 15-49 years from antenatal clinics in Margibi and Grand Cape Mount counties. Dietary intake obtained from a 24-hour recall was used to assess dietary diversity following the FAO dietary diversity determination protocol for women in their reproductive ages. Anaemia was determined from blood obtained from finger pricks using a Hemocue. Results: Nearly all the pregnant women (98.1%) consumed grains. Conversely, only a few women (23.7%) consumed vitamin A-rich fruits and vegetables. Anaemia was discovered in 54% of the pregnant women. The mean haemoglobin level was 10.44 ± 1.46 g/dl. The mean Minimum Dietary Diversity among women of reproductive age (MDD-W) was 3.57±1.01. There was no significant association between anaemia and dietary diversity among 12 pregnant women. Poor dietary diversity was observed in 83.5% of the pregnant women,85.1% in Margibi and 80.8% in Grand Cape Mount, respectively. Conclusion: This study confirms evidence of anaemia and poor dietary diversity among pregnant women. It highlights evidence for the need to encourage and improve diversity in dietary intake. This can be achieved through awareness, education and knowledge of dietary diversity during pregnancy

Fungal Pathogens Affecting the Quality of Rice (<i>Oryza sativa L.</i>) Seed in Selected Agro-ecological Zones of Liberia

The study aimed to investigate the presence and characterization of fungal pathogens in rice grains collected from four major rice producing counties in Liberia. Samples were collected from rice farmers in Bong, Lofa, Montserrado, and Nimba Counties during the dry season and taken to a laboratory in Kenya for isolation and characterization of fungal colonies. The results showed that Aspergillus spp and Penicillium spp were the most abundant fungal isolates found in the rice grains. The most abundant fungal isolate was Aspergillus niger, followed by A. flavus and Penicillium spp. The study showed that the extensive presence of these fungi in rice grains is favored by warm and humid subtropical climates similar to Liberia, which can encourage conditions for fungal contamination. Other fungi found were Fusarium spp and Pyricularia oryzae. The findings of this study highlight the importance of controlling fungal contamination in stored rice grains to ensure food safety and security.

Evaluation of acute flaccid paralysis surveillance performance before and during the 2014-2015 Ebola virus disease outbreak in Guinea and Liberia.

the number of wild poliomyelitis cases, worldwide, dropped from 350,000 cases in 1988 to 33 in 2018. Acute flaccid paralysis (AFP) surveillance is a key strategy toward achieving global polio eradication. The 2014 Ebola virus disease (EVD) epidemic in West Africa infected over 28,000 people and had devastating effects on health systems in Guinea, Liberia, and Sierra Leone. We sought to assess the effects of the 2014 Ebola outbreak on AFP surveillance in Guinea and Liberia. a retrospective cross-sectional analysis was performed for Guinea and Liberia to evaluate EVD´s impact on World Health Organization (WHO) AFP surveillance performance indicators during 2012-2015. both Guinea and Liberia met the WHO target non-polio AFP incidence rate nationally, and generally sub-nationally, prior to the EVD outbreak; rates decreased substantially during the outbreak in seven of eight regions in Guinea and 11 of 15 counties in Liberia. Throughout the study period, both Guinea and Liberia attained appropriate overall targets nationally for "notification" and "stool adequacy" indicators, but each country experienced periods of poor regional/county-specific indicator performance. these findings mirrored the negative effect of the Ebola outbreak on polio elimination activities in both countries and highlights the need to reinforce this surveillance system during times of crisis.

Geospatial clustering and correlates of deaths during the Ebola outbreak in Liberia: a Bayesian geoadditive semiparametric analysis of nationally representative cross-sectional survey data

ObjectiveTo investigate the extent of geospatial clustering of reported deaths during the Ebola outbreak in Liberia and the covariates associated with the observed clustering.DesignCross-sectional study.ParticipantsMale and female respondents from the...

COVID-19-related knowledge, attitudes and practices: a mixed-mode cross-sectional survey in Liberia

ObjectivesTo examine the knowledge, attitudes and practices (KAP) of COVID-19 of rural and urban residents in Liberia to inform the development of local social and behaviour change communication strategies.DesignCross-sectional, mixed-mode...

Knowledge, attitudes and practices (KAP) regarding Lassa fever disease among adults in endemic and non-endemic Counties of Liberia, 2018: A Cross-sectional study

Background: Lassa fever (LF) causes significant morbidity and mortality worldwide with estimated 3-5 million individuals being infected yearly. In West Africa, the disease is endemic in Nigeria, Sierra Leone, Guinea and Liberia. Liberia recorded its first outbreak in 1972. We determined knowledge, attitudes, and practices (KAP) toward LF disease, to identify practices related to LF transmission, determine differences in KAP and to identify factors associated with LF among adult populations in endemic and non-endemic counties of Liberia. Methods: We conducted a cross-sectional study among 858 respondents in all 15 counties in Liberia. A combination of probability sampling techniques were used to obtain the desired sample size. We used electronic semi-structured questionnaires for data collection. We summarized data using counts, proportions, 95%CI and Chi-square. Results: Of the 858 respondents from all 15 counties in Liberia, only 24(3%) had good knowledge generally about LF management (<i>P-value=0.02</i>), 250(29%) had a positive attitude towards LF (<i>P-value=0.6</i>), and 217(25%) carried out good LF-related practices (<i>P-value=0.1</i>). A higher level of education was associated with good knowledge and positive attitudes in endemic and non-endemic counties. (<i>P-value=0.01</i>). Conclusions: KAP of LF was low in both endemic and non-endemic counties. There was no difference seen in attitudes and practices among endemic and non-endemic counties. We recommended that Ministry of Health and National Public Health Institute of Liberia increase awareness of LF in Liberia and work with the Ministry of Education to introduce modules on LF in all schools.

Stochastic meta-frontier function analysis of the regional efficiency and technology gap ratios (TGRs) of small-scale cassava producers in Liberia

To enrich agriculture reform and reap its benefits, policy makers need to localise policy issues within and across their domestic zones. Using a stochastic meta-frontier function, this study analysed the production efficiency of the cassava subsector of cassava growers from Bomi and Nimba counties in Liberia. The paper contributes to the domestication of agriculture policy issues within a country. The study found different scales of production returns for cassava growers in Bomi and Nimba counties. Farmer age, gender, household size and access to credit were key determinants of the technical gap ratio of the cassava subsector. The study recommends that relevant stakeholders (in a multistakeholder partnership) design a holistic approach of innovative finance (including microfinance, agriculture insurance and a grouped loan scheme) and social enterprise development that will encourage more women and young people to grow cassava efficiently for the higher productivity of the cassava subsector

Maternity waiting homes in Liberia: Results of a countrywide multi-sector scale-up.

ObjectiveDescriptions of maternity waiting homes (MWHs) as an intervention to increase facility delivery for women living in remote geographic areas dates back to the 1950s, yet there is limited information on the scale-up and sustainability of MWHs. The objective of this study was to describe the evolutionary scale-up of MWHs as a component of health system strengthening efforts and document the successes, challenges, and barriers to sustainability in Liberia.MethodsData were collected from a national sample of 119 MWHs in Liberia established between 2010–2018. The study used a mixed method design that included focus group discussions, individual interviews, logbook reviews, and geographic information systems. Qualitative data were grouped into themes using Glaser’s constant comparative method. Quantitative data were analyzed using negative binomial regression to measure the differences in the counts of monthly stays at facilities with different funding sources and presence of advisory committee. Additionally, each MWH was geo-located for purposes of geo-visualization.ResultsIn the years since the original construction of five MWHs, an additional 114 MWHs were constructed in 14 of the 15 counties in Liberia. Monthly stays at facilities funded by community were 2·5 times those funded by NGOs (IRR, 2·46, 95% CI 1·33–4·54). Attributes of sustainability included strong local leadership/active community engagement and community ownership and governance.ConclusionSuccess factors for scale-up and sustainability included strong government support through development of public policy, local and county leadership, early and sustained engagement with communities, and self-governance. A multi-pronged approach with strong community engagement is key to the scale-up and sustainability of MWHs as an intervention to increase facility delivery for women living the farthest from a healthcare facility.

Neglected tropical disease as a 'biographical disruption': Listening to the narratives of affected persons to develop integrated people centred care in Liberia.

BackgroundIntegrated disease management, disability and inclusion (DMDI) for NTDs is increasingly prioritised. There is limited evidence on the effectiveness of integrated DMDI from the perspective of affected individuals and how this varies by differing axes of inequality such as age, gender, and disability. We used narrative methods to consider how individuals’ unique positions of power and privilege shaped their illness experience, to elucidate what practical and feasible steps could support integrated DMDI in Liberia and beyond.MethodsWe purposively selected 27 participants affected by the clinical manifestations of lymphatic filariasis, leprosy, Buruli Ulcer, and onchocerciasis from three counties in Liberia to take part in illness narrative interviews. Participants were selected to ensure maximum variation in age, gender and clinical manifestation. Narrative analysis was grounded within feminist intersectional theory.FindingsFor all participants, chronic illness, morbidity and disability associated with NTDs represented a key moment of ‘biographical disruption’ triggering the commencement of a restitution narrative. Complex health seeking pathways, aetiologies and medical syncretism meant that adoption of the ‘sick role’ was initially acceptable, but when the reality of permanency of condition was identified, a transition to periods of chaos and significant psycho-social difficulty occurred. An intersectional lens emphasises how biographical disruption is mediated by intersecting social processes. Gender, generation, and disability were all dominant axes of social inequity shaping experience.SignificanceThis is one of the first studies to use narrative approaches to interrogate experience of chronic disabling conditions within LMICs and is the only study to apply such an analysis to NTDs. The emotive power of narrative should be utilised to influence the value base of policy makers to ensure that DMDI strategies respond holistically to the needs of the most marginalised, thus contributing to more equitable people-centred care.

English

After two civil wars Liberia’s warring sides signed a peace agreement in 2003 providing for, among other things, the creation of a truth and reconciliation commission (TRC) to help it on the path to reconciliation. After public hearings in all fifteen counties in Liberia and extensive input from Liberians out of the country, Liberia’s TRC concluded its proceedings in 2009 with recommendations for improvement of the rule of law by prosecution of war crimes and human rights abuses and lustration of many smaller offenders, including the current president of Liberia. This paper reviews the efforts of the Liberian TRC to improve the rule of law against the backdrop of the bigger question of whether TRCS assist states in making that transition or make it more difficult. Field research from 2011 in Liberia as well as various surveys of Liberian opinion as indexes relating to corruption and rule of law are utilized along with the TRC report and recommendations. This paper concludes that although Liberia has made some improvements in the rule of law since 2003, the TRC has not been instrumental in bringing about an improvement, partially due to a lack of political will in Liberia but also due to its failure to bring about a change in the conflict between the Americo-Liberian elites in Liberia and the indigenous population that led to the civil war and to the lack of accountability caused by the failure to follow the recommendations of the TRC. Key words: Truth and reconciliation commissions, rule of law, civil wars, Liberia, transitional justice.

Health-Care Access during the Ebola Virus Epidemic in Liberia.

The Ebola virus disease (EVD) epidemic, which began in West Africa in December 2013, claimed more than 11,000 lives, with more than 4,800 of these deaths occurring in Liberia. The epidemic had an additional effect of paralyzing the health-care systems in affected countries, which led to even greater mortality and morbidity. Little is known about the impact that the epidemic had on the provision of basic health care. During the period from March to May 2015, we undertook a nationwide, community-based survey to learn more about health-care access during the EVD epidemic in Liberia. A cluster sampling strategy was used to administer a structured in-person survey to heads of households located within the catchment areas surrounding all 21 government hospitals in Liberia. A total of 543 heads of household from all 15 counties in Liberia participated in the study; more than half (67%) of urban respondents and 46% of rural respondents stated that it was very difficult or impossible to access health care during the epidemic. In urban areas, only 20-30% of patients seeking care during the epidemic received care, and in rural areas, only 70-80% of those seeking care were able to access it. Patients requiring prenatal and obstetric care and emergency services had the most difficulty accessing care. The results of this survey support the observation that basic health care was extremely difficult to access during the EVD epidemic in Liberia. Our results underscore the critical need to support essential health-care services during humanitarian crises to minimize preventable morbidity and mortality.

Community Engagement in Liberia: Routine Immunization Post-Ebola

A national integrated polio, measles, and deworming campaign was implemented across Liberia May 8–14, 2015. The community engagement and social mobilization component of the campaign was based on structures that had been invested in during the Ebola response. This article provides an overview of the community engagement and social mobilization activities that were conducted and reports the key findings of a rapid qualitative assessment conducted immediately after the campaign that focused on community perceptions of routine immunization in the post-Ebola context. Focus group discussions and interviews were conducted across four counties in Liberia (Montserrado, Nimba, Bong, and Margibi). Thematic analysis identified the barriers preventing and drivers leading to the utilization of routine immunization. Community members also made recommendations and forwarded community-based solutions to encourage engagement with future health interventions, including uptake in vaccination campaigns. These should be incorporated in the development and implementation of future interventions and programs.

Intensive Group Learning and On-Site Services to Improve Sexual and Reproductive Health Among Young Adults in Liberia: A Randomized Evaluation of HealthyActions.

Young Liberians, particularly undereducated young adults, face substantial sexual and reproductive health (SRH) challenges, with low uptake of contraceptive methods, high rates of unintended pregnancy, and low levels of knowledge about HIV status. The purpose of this study was to assess the impact of a 6-day intensive group learning intervention combined with on-site SRH services (called HealthyActions) among out-of-school young adults, implemented through an existing alternative education program, on uptake of contraception and HIV testing and counseling (HTC). The intervention was implemented among young women and men ages 15-35 who were enrolled in alternative basic education learning sites in 5 counties of Liberia. We conducted a randomized evaluation to assess program impact. Baseline data were collected in January-March 2014, and endline data in June-July 2014. Key outcomes of condom use, contraceptive use, and HTC were estimated with difference-in-difference models using fixed effects. All analyses were conducted in Stata 13. We assessed outcomes for 1,157 learners at baseline and 1,052 learners at endline, across 29 treatment and 26 control sites. After adjusting for potential confounders, learners in the HealthyActions intervention group were 12% less likely to report never using a condom with a regular partner over the last month compared with the control group (P = .02). Female learners who received HealthyActions were 13% more likely to use any form of modern contraception compared with learners in control sites (P<.001), with the greatest increase in the use of contraceptive implants. Learners in HealthyActions sites were 45% more likely to have received HTC (P<.001). Providing intensive group learning in a supportive environment coupled with on-site health services improved SRH outcomes among participating learners. The focus of HealthyActions on participatory learning for low-literacy populations presents an adaptable solution for health programming across Liberia and the region.

New Records and Updated Checklist of Phlebotomine Sand Flies (Diptera: Psychodidae) From Liberia.

Phlebotomine sand flies from three counties in Liberia were collected from January 2011 to July 2013. In total, 3,118 sand flies were collected: 18 species were identified, 13 of which represented new records for Liberia. An updated taxonomic checklist is provided with a brief note on sand fly biology, and the disease vector potential for species is discussed.

Ebola virus disease outbreak; the role of field epidemiology training programme in the fight against the epidemic, Liberia, 2014.

The African Field Epidemiology Network (AFENET) is a public health network established in 2005 as a non-profit networking alliance of Field Epidemiology and Laboratory Training Programs (FELTPs) and Field Epidemiology Training Programs (FETPs) in Africa. AFENET is dedicated to supporting Ministries of Health in Africa build strong, effective and sustainable programs and capacity to improve public health systems by partnering with global public health experts. The Network's goal is to strengthen field epidemiology and public health laboratory capacity to contribute effectively to addressing epidemics and other major public health problems in Africa. The goal for the establishment of FETP and FELTP was and still is to produce highly competent multi-disciplinary public health professionals who would assume influential posts in the public health structures and tackle emerging and re-emerging communicable and non-communicable diseases. AFENET currently networks 12 FELTPs and FETPs in sub-Saharan Africa with operations in 20 countries. During the Ebola Virus Disease (EVD) outbreak in West Africa, African Union Support for the Ebola Outbreak in West Africa (ASEOWA) supported FETP graduates from Uganda, Zimbabwe, Ethiopia and Tanzania for the investigation and control of the EVD outbreak in Liberia. The graduates were posted in different counties in Liberia where they lead teams of other experts conduct EVD outbreak investigations, Infection Control and Prevention trainings among health workers and communities, Strengthening integrated disease surveillance, developing Standard Operating Procedures for infection control and case notification in the Liberian setting as well as building capacity of local surveillance officers’ conduct outbreak investigation and contact tracing. The team was also responsible for EVD data management at the different Counties in Liberia. The FETP graduates have been instrumental in the earlier successes registered in various counties in Liberia in the control of the Ebola virus disease. Such efforts should be sustained by supporting local authorities develop strong health systems that are able to respond to epidemic of such magnitude in the near future.

Services for mothers and newborns during the ebola outbreak in liberia: the need for improvement in emergencies.

Background: The magnitude of the Ebola outbreak in West Africa is unprecedented. Liberia, Guinea, and Sierra Leone are in the bottom ten countries in the Human Development Index, but all had made gains in child survival prior to the outbreak. With closure of healthcare facilities and the loss of health workers secondary to the outbreak, the region risks reversing survival gains achieved in maternal and newborn health. Methods: Anonymized service utilization data were downloaded from the Liberia District Health Information Software (DHIS) 2 for selected maternal health services at PHC facilities in Margibi and Bong Counties from March 2014, when the first case of Ebola was reported in Liberia, through December 2014. Absolute numbers are provided instead of percentage measures because of the lack of a population-based denominator. Results: Overall, the data show a decrease in absolute utilization from the start of the outbreak, followed by a slow recovery after October or November. In Bong County, totals were less than 14% of the peak numbers during the outbreak for number of antenatal visits and pregnant women receiving intermittent preventive treatment for malaria in pregnancy (IPTp). For total deliveries, utilization was less than 33% of the highest month. In Margibi County, during what now appears to be the height of the outbreak, numbers dropped to less than 9% of peak utilization for antenatal care visits and 4% for IPTp. Total health facility deliveries dropped to less than 9% of peak utilization. Conclusion: It is clear that Bong and Margibi Counties in Liberia experienced a large drop in utilization of maternal health care services during what now appears to be the peak of the Ebola outbreak. As the health of women and their babies is being promoted in the post-2015 sustainable development agenda, it is critical that the issue of maternal and newborn survival in humanitarian emergency settings, like the Ebola outbreak, is prioritized.

Examining gender based violence and abuse among Liberian school students in four counties: An exploratory study

The purpose of this article is to uncover the extent of sexual gender based violence (GBV) experienced by a convenience sample of students from select counties in Liberia and to understand the disclosure experiences of those victims willing to come forward. Girls (n=758) and boys (n=1,100) were asked about their sexual GBV experiences including their disclosure experiences, if applicable. Results indicated that sexual violation (i.e., peeping or inappropriate touching) was found among both girls and boys. Sexual coercion (i.e., forced sex) was more prevalent than transactional sex (i.e., trading sex for grades or money). Both sexual coercion and transactional sex were reported by more girls than boys, yet the rates for the most severe form of sexual violence (i.e., sexual coercion) were high for both girls (30%) and boys (22%). When students were asked if they told anyone, 38% reported that they did disclose their experiences. This study contributes to a small but growing body of research to document the prevalence and types of sexual violence against children in Liberia. Consistent with other studies, the evidence shows that sexual violence against boys and girls is occurring at alarming rates.