Montserrado County Research Articles

Addressing data quality issues to assess clinical and epidemiological risk factors for COVID-19 among documented cases in Liberia: a single-centre, retrospective, observational study

IntroductionIdentification of risk factors for severe COVID-19 can help to inform case management in resource-constrained settings. We aimed to rigorously but retroactively address data issues to identify risk factors for...

The Impact of Covid-19 in Liberia: A Case Study of Monrovia (January 2020-December 2023)

 Background: In 130 years, there have been five pandemics related to coronavirus (Maital, 2020). An epidemic of mysterious pneumonia was characterized by dry cough, fever, and body fatigue in late December 2019(Wu et al., 2020). The situation posed additional risks and challenges to the populace, increasing physical illness (Kmetty, 2020). The spread of COVID-19 across Africa created a considerable impact ranging from economic cybertage, starvation, and educational setbacks (Webmaster, 2020). The COVID-19 pandemic occurred in Liberia five years after ebola and during the Resilient and Responsive Health Systems (RRHS) designed to support Liberia's national health workforce to improve health outcomes (Marsh et al., 2021).  Methodology: The research used a descriptive case study design to explain concepts, policies, and tools related to identified problems. Since the impact of COVID-19 reflects not only on survival but also on relatives, the research considered the population of Monrovia. Monrovia's current metro area population in 2023 is 1,678,000(Macrotrends, 2023). The study considered Liberia the main case, with Monrovia and Montserrado County as specific Sub-cases. The purposive sampling technique was used to ensure the representation of various socio-economic groups, including urban and rural areas and different regions within Monrovia. The research used a 95% CI and Slovins's formula to derive a sample size of 400. Questionnaires were used to collect field data. The data herein includes documentary analysis, interviews/surveys, and observations. The data was analyzed using SPSS and narratives of qualitative findings.  Findings: This data suggests that a large portion of the population has been affected by job loss or reduced employment opportunities due to the pandemic. Overall, the data reflects the widespread impact of the COVID-19 pandemic on the employment status of individuals in Liberia.  Recommendations: The study proposes improvements to Liberia's public health sector, including better risk-benefit policies, salary increments, and training/deployment of healthcare professionals.

How Depression and Anxiety Impact Adherence to COVID-19 Prevention Practices in Urban Liberia.

Understanding the relationship between mental health and COVID-19 prevention practices is crucial but challenging considering COVID-19's impact on mental well-being. Liberia, a West African country, had well-documented rates of depression and anxiety prior to COVID-19. Liberia responded aggressively to COVID-19 while case counts remained low; thus, it is an ideal setting to study the relationship of mental health and COVID-19 prevention practices. A validated cross-sectional survey was administered to 250 randomly selected residents of Montserrado county, Liberia in June 2021, asking about their mental health and adherence to COVID-19 prevention practices. The survey included the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9 to assess for anxiety and depression, respectively. Responses were analyzed using Spearman correlation and regression. Scores indicative of depression were present in 43% (95% confidence interval [CI]: 37-49) of participants; scores indicative of anxiety were present in 41% (95% CI: 34-47). Self-reported adherence to COVID-19 prevention practices was middling and varied greatly by behavior. Higher scores for depression and anxiety were significantly associated with lower adherence to COVID-19 prevention practices. Results indicate that while the spread of COVID-19 has certainly affected mental health, it is likely that pre-existing mental health conditions affected the spread of COVID-19 through lower adherence to prevention practices. Policymakers should consider investing in mental health services as an important step in managing future epidemics, and the needs of people with poor mental health when designing epidemic responses, particularly in low-income countries where the burdens of adherence are likely to be greater.

Understanding the Effects of Trauma Exposure, Life Stress, Intimate Partner Violence, and Depression on Sexually Transmitted Infection Risk in Post-Conflict Liberia.

In sub-Saharan Africa, sexually transmitted infections (STIs) are a public health concern. The impact of STIs are exacerbated in post-conflict low- and middle-income countries, such as Liberia, where exposure to traumatic events is prevalent and access to mental health services are limited. Following a syndemics framework, this study used regression analyses to explore the independent, additive, and multiplicative effects of four psychosocial conditions (exposure to war-related traumatic events, intimate partner violence [IPV], stressful life events, and depressive symptoms) on self-reported STIs. Data were collected from 379 youth aged 18-30 years (n = 170 women; n = 179 men) in Montserrado County, Liberia. Results revealed that psychosocial variables correlated with each other and STI risk. In multivariable analysis, stressful life events, depressive symptoms, and IPV were statistically significant predictors of STI risk. We found support for an additive effect between the number of psychosocial conditions reported and STI risk, as well as a multiplicative effect (interaction) between IPV and depressive symptoms on STI risk. Our results suggest a synergy between experiencing psychosocial conditions and STI risk and point to the potential benefit of multi-level sexual health approaches that simultaneously address mental health and IPV among youth in Liberia.

THE ROLE OF SOCIAL WORK IN PROMOTING COMMUNITY ENGAGEMENT IN DECENTRALIZED GOVERNANCE SYSTEMS IN LIBERIA

The research draws on empowerment theory demonstrating the role of social work in transforming structural challenges through leadership development, critical consciousnessbuilding and accountable institutions. . The study uses qualitative method and used interview as the data collection technique. The study used Semi-structured key informant interviews with 7 participants inclusive of 4 social workers, 1 county planning officer and 2 community leaders in Montserrado County, Liberia. Analysis of the findings of the study was done by utilizing thematic analysis. The findings reveal that social workers can assist marginalized groups demand accountability from decentralized units and facilitate the gathering of evidence by acting as intermediaries thereby enhancing oversight, responsiveness and social accountability towards good governance.

Findings from a national evaluation of social work field education programs in Liberia, West Africa

Program evaluation is an integral component of social work field education and continuous social work programmatic improvement. To conduct an inaugural national survey of social work field education programs in Liberia, West Africa, Made in Africa Evaluation (MAE) was used to design and implement a national evaluation of social work field education programs. The evaluation was led by and implemented with Liberian social work faculty and staff. Thirty-six field supervisors completed a quantitative survey. Results were used to assist programs identify strengths and areas for improvement. The MAE approach guided analysis and discussion of evaluation results. Findings revealed an emerging credentialed and experienced pool of field supervisors with high exposure and endorsement of human rights concepts, which was a strength. Field agencies were clustered in the city center of Montserrado County, the county seat for Monrovia-Liberia’s capital. Field agencies’ missions and services aligned with health, education, and gender equality sustainable development goals. Field agency supervisors provided few opportunities for students to practice macro based developmental social work activities such as advocacy and community work, an area identified as needing improvement. Challenges included Liberian social work faculty’s lack of experience in conducting evaluation research, insufficient access to scholarly databases to obtain research articles, and expensive data management platforms. Collaboration was recommended as a strategy to build evaluation capacity. How to reference using ASWNet style: Tuggle, F., Banks, S. and Gbessage, S. (2023). Findings from a national evaluation of social work field education programs in Liberia, West Africa. African Journal of Social Work, 13(6), 273-284. https://dx.doi.org/10.4314/ajsw.v13i6.1 Visit journal website: https://ajsw.africasocialwork.net

Prevalence and determinants of post-acute sequelae of COVID-19 in Liberia.

Evidence from resource-rich settings indicates that many people continue to have persistent symptoms following acute SARS-CoV-2 infection, called post-acute sequelae of COVID-19 (PASC). Only a few studies have described PASC in sub-Saharan Africa (SSA). We aimed to describe PASC in Liberia. We randomly sampled all people who were reported from the most populous county to the Liberian Ministry of Health (MOH) as having a laboratory-confirmed SARS-CoV-2 infection from June to August 2021. We interviewed individuals by phone 3 to 6 months later. Those with persistence of at least one symptom were considered to have PASC. From among 2848 people reported to the MOH from Montserrado County during the period of interest, we randomly selected 650; of these, 548 (84.3%) were reached and 505 (92.2%) of those who were contacted were interviewed. The median age was 38 years (interquartile range (IQR), 30-49), and 43.6% were female. During acute infection, 40.2% were asymptomatic, 53.9% had mild/moderate disease and 6.9% had severe/critical disease. Among the 59.8% (n = 302) who were initially symptomatic, 50.2% (n = 152) reported at least one persistent symptom; the most common persistent symptoms were fatigue (21.2%), headache (16.2%) and cough (12.6%); 40.1% reported that PASC significantly affected their daily activities. Being hospitalized with moderate disease [adjusted prevalence ratio (aPR), 2.00 (95% CI, 1.59 to 2.80] or severe/critical disease [aPR, 2.11 (95% CI, 1.59 to 2.80)] was associated with PASC, compared with those not hospitalized. Females were more likely than males to report persistent fatigue [aPR, 1.67 (95% CI, 1.08 to 2.57)]. Our findings suggest that persistent symptoms may have affected a large proportion of people with initially symptomatic COVID-19 in west Africa and highlight the need to create awareness among infected people and health care professionals.

Assessment of ventilation in low-resource healthcare settings: Montserrado County, Liberia—2022−2023

Background: Mitigating the risk of nosocomial respiratory disease transmission in the healthcare facilities of low- and middle−income countries (LMICs) poses unique challenges because mechanical ventilation and mixed−mode strategies are often unavailable. Carbon dioxide (CO2) can serve as a proxy for ventilation and, hence, airborne infectious disease transmission risk in naturally ventilated spaces. We assessed the adequacy of ventilation in Liberian hospitals. Methods: We sampled 3 hospitals, both urban and rural, in Montserrado County, Liberia. Moreover, 3 CO2 meters were concurrently utilized to measure CO2 levels at a 1-meter height in every patient-care room in each facility. We recorded temperature, humidity, room dimensions, and number of people in the rooms. From these variables, we calculated absolute ventilation using the ASHRAE equation to determine areas with the highest risk of nosocomial respiratory disease transmission. We also recorded qualitative observations about the sampled spaces. Results: From August 2022 to February 2023, 39 rooms in 3 healthcare facilities were sampled. Initial quantitative findings show that only 8 rooms (21%) met the WHO-recommended ventilation rate of 60 L per second per person. The average ventilation rate per person in the adequately ventilated settings was 86 L per second per patient, compared to 19 liters per second per patient in inadequately ventilated rooms. Additionally, 467 ppm mean CO2 was noted in well-ventilated rooms compared to 895 ppm mean CO2 in inadequately ventilated rooms.Initial qualitative observations showed that facilities with lower CO2 readings tended to be older constructions that likely had been constructed with airborne disease such as tuberculosis in mind. Willingness to open windows was limited by lack of window screens for malaria prevention, and there was a pervasive fallacy that air conditioning was a source of ventilation. Correspondingly, of the 31 inadequately ventilated rooms, 22 (71%) had operating air conditioning units compared with 4 (50%) of the 8 adequately ventilated rooms. Overall, of the 13 rooms without air conditioning, 7 (54%) were more frequently characterized by open windows compared to only 5 of 26 (28%) of rooms that did have air conditioners. Conclusions: Being prepared for the next respiratory disease outbreak and creating more resilient healthcare systems in LMICs requires a frameshift of prevention strategies. Measuring CO2 provides a simple strategy for identifying areas at highest risk for nosocomial respiratory disease transmission, which can be prioritized for low-cost environmental interventions, such as provision of window screens, as part of routine infection prevention and control efforts.Disclosure: None

Demographic Factors Associated with Presenting for Eye Evaluation in the Partnership for Research on Vaccines and Infectious Diseases in Liberia III Natural History Study of Ebola Virus Disease.

Survivors of Ebola virus disease (EVD) are at risk for ocular complications after infection. We sought to identify demographic factors associated with the likelihood to present for eye examination among Ebola survivors enrolled in a longitudinal natural history study of EVD. The Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL) III Ebola natural history study is a 5-year study that seeks to identify long-term sequelae of EVD, including ocular sequelae. All survivors enrolled in the PREVAIL parent study from June 2015 to March 2016 were asked to return for comprehensive eye examination through June 2016. Logistic regression was conducted using self-reported survivor status, age, gender, and distance from the hospital as covariates. A total of 1448 subjects enrolled in the parent PREVAIL III longitudinal cohort during the defined window, of which 1375 (95.0%) followed up for baseline eye examination. Ebola survivors (635/661, 96.1%) and adult close contacts (727/767, 94.8%) demonstrated a comparable likelihood for presenting for eye examination (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.36-1.28). In an adjusted model, age over 50 (OR 10.2, 95% CI 1.35-77.3) and living outside Montserrado County (OR 0.18, 95% CI 0.10-0.33) were associated with the likelihood of presenting for a baseline comprehensive eye examination. Most EVD survivors and their close contacts who enrolled during the study window presented for eye examinations. Older participants and those who lived closer to clinical facilities were most likely to present. Focused strategies accounting for these factors may assist with organizations planning survivor care in the setting of EVD.

Evaluation of groundwater vulnerability using GIS-based DRASTIC model in Greater Monrovia, Montserrado County, Liberia

To ensure that groundwater resources are effectively protected and to improve the quality of life, it is vital to take into consideration all polluting activities that could pose a potential risk to the resource. Groundwater potential research conducted only covers 5% of Montserrado County excluding Greater Monrovia in Liberia. Although this little percentage of groundwater potential research is well known, studies on the vulnerability of the aquifer to pollution are non-existent. Therefore, this study aims at assessing groundwater vulnerability in Greater Monrovia, Montserrado County, Liberia, which will help in optimizing water well drilling activities and protecting the resource. A groundwater vulnerability map for the study area using the Geographic Information System (GIS) based DRASTIC Model was developed and the results suggest that 73% of the study area is very sensitive to pollution, whereas 15% and 11% are moderately and weakly sensitive to pollution, respectively. The key pollution areas identified within the study area were communities of intensive anthropogenic activities and associated geological contamination. The effectiveness of the GIS-based DRASTIC Model in groundwater vulnerability assessment was validated and nearly 60% of the wells contained fluoride concentrations that exceeded the Liberia Water Quality Standard (LWQS) permissible limit. The findings suggest that even though the water table is relatively shallow, future projects in the high and moderate sensitivity zones should be handled carefully. Planners, groundwater managers, and decision-makers may utilize the maps created by this study as a general point of reference for vulnerability when making attempts to safeguard this delicate resource.

Knowledge, attitude, and practice towards hepatitis B virus among healthcare workers: a cross-sectional, hospital-based study in Montserrado County, Liberia.

Prevention is critical in safeguarding against the spread of hepatitis B virus (HBV) infection. The knowledge, attitudes, and practices of healthcare workers (HCWs) regarding the disease play an important role in its prevention or spread, yet in this regard, data in Liberia remains scarce. Hence, determining the Knowledge, Attitude, and Practices (KAP) level of HCWs toward HBV infection becomes necessary. A descriptive cross-sectional hospital-based study was conducted among 251 HCWs at two major health facilities in Monrovia. KAP regarding HBV was assessed using a standardized structured questionnaire. Results were analyzed using descriptive statistics for demographic characteristics, percentages for categorical variables, and mean ± standard deviation for continuous variables. Kruskal Wallis test, p < 0.05, was used to derive statistical inferences. Complete data from 248 respondents showed a mean age of 36.3 ± 8.9 years with most respondents were within 30-39 age range (45.82%). While poor knowledge was observed in responses to all categories of questions, correct response rates to questions range from 41.93 - 99.19% for transmission of HBV, to 98.79 - 100% for preventive measures of HBV. About 77.8% and 90.32% of study respondents strongly agreed that hepatitis B is a major public health threat and that following infection control guidelines will protect them from being infected with HBV at work respectively. More than half of the participants (60.08%) had a history of needle-stick injury (NSI), and washing the injury site with water and soap, sterilizing the wound, and checking whether the patient has a blood-borne disease was done by 48.79%, 53.62% and 27.01% of the respondents respectively. Findings from this study show that there is an inadequate level of KAP regarding HBV infection among the HCWs. It therefore is expedient to conduct regular awareness campaigns for HCWs on preventive measures against HBV infection in hospitals, in addition to workshops and in-service trainings on infection prevention and control (IPC) best practices.

Groundwater potential assessment using remote sensing and GIS-based multi criteria analysis – the case of Montserrado County, Liberia

Liberia is marked by poor and insufficient hydrogeological data due to limited studies coupled with years of civil instability. Although Montserrado County has abundant water resources, lack of adequate knowledge of the available water resources has led to unsustainable groundwater utilization as well as investment losses from drilling unsuccessful boreholes. This research therefore aims at blending remote sensing with GIS-based multicriteria analysis to delineate suitable groundwater potential zones. Remote sensing and conventional data were used to construct a groundwater potential zone (GWPZ) map by integrating lineament and drainage densities, geology, slope and elevation, soil, annual rainfall, land use land cover, and the normalized difference vegetation index (NDVI) maps of the study area. The Analytic Hierarchy Process (AHP) was used in assigning weights to each thematic map, according to its influence on groundwater accumulation, for their integration. The results reveal that slope, lineament density, drainage density, geology, and land use land cover are parameters with the most influence (about 68%) on groundwater recharge within the area. The result also shows that about 10 %, 25 %, 30 %, 25 %, and 10 % of Montserrado County has very high, high, moderate, low zone, and very low groundwater potential zones, respectively. The study, therefore, provides very useful information that may guide the development and management of the groundwater resources within the study area.

Factors influencing household’s charcoal consumption in Montserrado County, Liberia

Factors influencing household’s charcoal consumption in Montserrado County, Liberia

The influence of first wave of COVID-19 outbreak on routine healthcare services, Liberia, August 2020: a mixed study approach

BackgroundThe COVID-19 pandemic left countries to rapidly implement diverse and stringent public health measures without recourse to mitigate its effect on the sustenance of routine healthcare services. This study described routine health service disruption and restoration strategies at 6 months into the epidemic in Liberia.MethodsLiberia, with 15 counties, has 839 health facilities, with one-third in Montserrado County. A cross-sectional study using a mixed approach - quantitative and qualitative research with concurrent triangulation was conducted using a structured guide for group discussions among key health workers at 42 secondary and most patronized health facilities in 14 counties and 7 Montserrado districts. Additionally, routine health data between January and June 2019 and 2020 were extracted from the source documents to the electronic checklist. We performed a descriptive analysis of quantitative data and plotted the line graph of the relative percentage change. Transcribed audio recording notes were synthesized using ATLAS ti for content analysis to identify the themes and subthemes in line with the study objectives and excerpts presented in the results.ResultsLiberia declared COVID-19 outbreak on March 16, 2020. From conducted interviews at 41 health facilities, 80% reported disruption in routine health services. From January to June 2020, scheduled routine immunization outreaches conducted decreased by 47%. Using a relative percentage change, outpatient attendance decreased by 32% in May, inpatient admission by 30% in April, malaria diagnosis and treatment by 40% in April, and routine antenatal obstetric care by 28% in April. The fear of contacting COVID-19 infection, redeployment of healthcare workers to COVID-19 response, restriction of movement due to lockdown, inadequate or lack of PPE for healthcare workers, lack of drugs and vaccine supplies for clients, and partial closure of routine healthcare services were common perceived reasons for disruptions. Massive community health education and strict compliance with COVID-19 nonpharmacological measures were some of the health facility recovery strategies.ConclusionsThe COVID-19 outbreak in Liberia caused a disruption in routine healthcare services, and strategies to redirect the restoration of routine healthcare services were implemented. During epidemics or global health emergencies, countries should sustain routine health services and plan for them.

COVID-19 reinfection in Liberia: Implication for improving disease surveillance.

COVID-19 remains a serious disruption to human health, social, and economic existence. Reinfection with the virus intensifies fears and raises more questions among countries, with few documented reports. This study investigated cases of COVID-19 reinfection using patients' laboratory test results between March 2020 and July 2021 in Liberia. Data obtained from Liberia's Ministry of Health COVID-19 surveillance was analyzed in Excel 365 and ArcGIS Pro 2.8.2. Results showed that with a median interval of 200 days (Range: 99-415), 13 out of 5,459 cases were identified and characterized as reinfection in three counties during the country's third wave of the outbreak. Eighty-six percent of the COVID-19 reinfection cases occurred in Montserrado County within high clusters, which accounted for over 80% of the randomly distributed cases in Liberia. More cases of reinfection occurred among international travelers within populations with high community transmissions. This study suggests the need for continued public education and surveillance to encourage longer-term COVID-19 preventive practices even after recovery.

Preparing liberia for rabies control: Human-dog relationship and practices, and vaccination scenarios

To reach zero dog-related human rabies deaths by 2030, Liberia must prioritize rabies as a public health threat. Understanding dog demography parameters are imperative and sets the basis for planning cost-effective and sustainable mass dog vaccination programs nationwide. We conducted a cross-sectional household survey in eleven rural districts of Bong and one urban district of Montserrado County to gather baseline information on the canine population, human-mediated dog movements, people's relationships and practices towards dogs, and further information to estimate costs for a nationwide campaign. In total, 1282 respondents were interviewed (612 rural and 670 urban). About 34% of the rural and 37% of the urban households owned at least one dog. The canine: human ratios were 1:6.1 in the rural and1:5.6 in the urban area and did not differ notably among both counties. The estimated canine population for Liberia is 594,640. The majority of respondents (55%) reported poor waste disposal. Muslims were less likely to own a dog than Christians (39% vs 19% OR: 0.4 95% CI: 0.2–0.6) (p< 0.001). Six percent of respondents mentioned that a family member was exposed to a dog bite in the past year, and most victims were adult males. Four of the victims reportedly died after showing rabies compatible symptoms. Twenty-seven percent of dog-owning households in rural areas reported that at least one dog originated from urban areas, and 2% of urban households brought in dogs from another country. In addition, 43% of respondents consumed dog meat at least once. Fifty percent of the respondents claimed knowledge of rabies but only 5.7% and 1.9% mentioned rabies transmission through rabies-infected saliva and rabies-infected mucus on broken skin. Forty percent of the respondents did not know whether rabies was incurable in humans once clinical signs appear. Assuming 30 vaccinators could vaccinate 50 dogs per day for eighteen months (371 working days), the total cost for the vaccination of the national Liberian canine population is estimated at 1.6 million (USD) for one vaccination round.Our study reveals an overall poor disease knowledge and the potential for spread of rabies in the study areas. A nationwide rabies awareness is crucial to enhance rabies prevention and control through mass dog vaccination.

Lack of Proper Commercial and Domestic Waste Practices in Montserrado County 'Monrovia, Liberia'

Improper waste management practices are a global concern that is impacting the environment, health, and living conditions of households. The practices of corporations and households result in challenges that become evident due to inadequate waste management systems (David, Wenchaoa, Johna &amp; Mmerekib, 2019). The considerations of the people regarding solid waste management can be elevated through spreading awareness of waste management. The awareness levels of the people reflect the practices of waste management that prevail within society. The development of a sustainable infrastructure that includes machinery and systems to correct waste management practices is integral for society. The research focuses on evaluating the lack of proper commercial and domestic waste practices in Montserrado County, Monrovia, Liberia. The method used for this research quantitative method. A structured close-ended questionnaire has been used for conducting a survey analyzing the awareness and practices of the people of Montserrado County. Four hundred respondents' replies were analyzed to better understand people's waste management awareness and habits. The results reflect that people lack awareness of waste management and this reflects in their practices. The religion of the people is a depiction of their lifestyle and household standards.

Coordinated support for local action: Modeling strategies to facilitate behavior adoption in urban-poor communities of Liberia for sustained COVID-19 suppression

BackgroundLong-term suppression of SARS-CoV-2 transmission will involve strategies that recognize the heterogeneous capacity of communities to undertake public health recommendations. We highlight the epidemiological impact of barriers to adoption and the potential role of community-led coordination of support for cases and high-risk contacts in urban slums. MethodsA compartmental model representing transmission of SARS-CoV-2 in urban poor versus less socioeconomically vulnerable subpopulations was developed for Montserrado County, Liberia. Adoption of home-isolation behavior was assumed to be related to the proportion of each subpopulation residing in housing units with multiple rooms and with access to sanitation, water, and food. We evaluated the potential impact of increasing the maximum attainable proportion of adoption among urban poor following the scheduled lifting of the state of emergency. ResultsWithout intervention, the model estimated higher overall infection burden but fewer severe cases among urban poor versus the less socioeconomically vulnerable population. With self-isolation by mildly symptomatic individuals, median reductions in cumulative infections, severe cases, and maximum daily incidence were 7.6% (IQR: 2.2%−20.9%), 7.0% (2.0%−18.5%), and 9.9% (2.5%−31.4%), respectively, in the urban poor subpopulation and 16.8% (5.5%−29.3%), 15.0% (5.0%−26.4%), and 28.1% (9.3%−47.8%) in the less socioeconomically vulnerable population. An increase in the maximum attainable percentage of behavior adoption by the urban slum subpopulation was associated with median reductions of 19.2% (10.1%−34.0%), 21.1% (13.3%−34.2%), and 26.0% (11.5%−48.9%) relative to the status quo scenario. ConclusionsPost-lockdown recommendations that prioritize home-isolation by confirmed cases are limited by resource constraints. Investing in community-based initiatives that coordinate support for self-identified cases and their contacts could more effectively suppress COVID-19 in settings with socioeconomic vulnerabilities.

The Effect of Tax Rate on the Incentives to Grow Small Enterprises: The Case of Small Enterprises in Montserrado County, Republic of Liberia

Over the years several developing countries have prioritized providing powerful new resources including incentives to grow the economy and small businesses in their region, revitalize targeted areas of various cities and promote strong, balanced growth throughout the communities. However, the provision of incentives to grow small businesses and the economy at large is still in its infant stage in Liberia. Against this background, the objective of this study was to investigate the effect of the tax rate on the incentives to grow small enterprises in Montserrado County, Republic of Liberia. The specific objective of this study was to identify the effect of the tax rate on the incentives to grow small enterprises in Montserrado County and identify the factors that leads to the high tax rate on incentives to grow small enterprises.&#x0D; &#x0D; To carry out this study, the study used the casual mapping model and the Decision Explore software introduced by Ackermann et al. To identify these effects/factors. The study also used publish reports from the IMF (International Monetary Fund) on small enterprises in Liberia, specifically Montserrado County, Government official websites, including the Liberia Revenue Authority website (LRA), etc. These reports were cited and analysed using the casual mapping model, and coded using the Decision Explorer software. To identify the effects the of tax rate and the factors that lead to a high tax rate on incentives to grow small enterprises, the map central analysis was used for analysis purposes. Findings from the study revealed that there is a significant effect of the tax rate on the incentives to grow small enterprises in Montserrado County Republic of Liberia as a result of several factors. The study also concluded that tax is a tool for fiscal policy employed by the government to influence small Enterprises negatively or positively depending on the nature of enterprise activities in a country. The study recommended that the Government of Liberia adopt china&amp;rsquo;s incentives policy that has been successfully implemented in providing incentives to small enterprises for them to grow. Considering how China&amp;rsquo;s economy has grown tremendously over the years as a result of the incentives policy, the research conclude that if this practices is adopted and implemented in Liberia, this will boost the growth of small enterprises and the economy to a larger extent.

English

International Public Sector Accounting Standards (IPSAS) has become one of the popular tools implemented by governments to ensure greater transparency and accountability globally. This research assesses the impact of IPSAS adoption on transparency and accountability in the use of public funds in Liberia. A survey design using five-point Likert scale questionnaire was employed for collecting the data. Questionnaires were administered to accountants, auditors (private and state-owned), government departments and related public sector bodies within the Montserrado County of Liberia. The valid questionnaires were then analysed using descriptive statistics. The hypotheses were formulated and tested by means of analysis of variance (ANOVA) at a 5% significant level with the aid of Microsoft Excel 2013. The study finds that IPSAS adoption increases the level of transparency and accountability in the use of government funds. It further establishes that revenue leakage and inadequate disclosure of public expenditure impedes government commitment to ensure a transparent and accountable management of public funds in the country. Hence, the paper recommends that governments in developing counties should hasten in their transition to the accrual basis IPSAS. Key words: Accountability, international public sector accounting standards (IPSAS), public funds, transparency, Liberia.