Sierra Leonean Research Articles

Risk factors, clinical outcomes and predictors of stroke mortality in Sierra Leoneans: A retrospective hospital cohort study

BackgroundStroke data from Sierra Leone is limited, despite the increase in global burden of the disease. The aim of this study was to assess the risk factors, clinical outcomes and predictors of stroke mortality at a tertiary hospital in Freetown, Sierra Leone. MethodsThis retrospective cohort study was conducted on stroke patients admitted at the Connaught Teaching Hospital between 1st January to December 31, 2018. Clinical data related to stroke, with variables including patients’ demographics, stroke subtype, vascular risk factors, modified Rankin Scale (mRS), and outcomes were documented. In-hospital mortality, associated risk factors and predictors of stroke were determined. The study was approved by the Sierra Leone Ethics and Scientific Review Committee. It was registered under Research Registry https://www.researchregistry.com/browse-the-registry#home/with the unique identifying number researchregistry6009. ResultWe studied 178 (95 male and 83 female) patients. The mean age was 59.8 ± 14.0 years, median was 58.1years (ranging: 29–88 years). The commonest risk factors were hypertension (84.3%), tobacco smoking (35.9%) and alcohol (31.4%). Ischemic stroke confirmed by CT scan was 76.3%. In-hospital mortality was 34.8% and at discharge, mean modified Rankin Score (mRS) was 3.89 ± 1.62. The independent predictors for stroke mortality were: hypertension [AOR = 2.2; C.I 95%: (1.32–3.80), p = 0.001], previous stroke [AOR = 2.31; C.I 95%: (1.43–5.74), p = 0.001], GCS < 8 [AOR = 6.06; C.I 95%: (3.17–12.79), p < 0.001], clinical diagnosis in the absence of imaging [AOR = 3.11; C.I 95%: (2.1–9.87), p = 0.001], hemorrhagic stroke [AOR = 2.96; C.I 95%: (1.96–9.54), p < 0.001], and aspiration pneumonia [(AOR = 3.03; C.I 95%:(1.44–6.36), p = 0.001]. Women had poorer outcome than men. ConclusionThis study highlights a high stroke mortality in a resource limited hospital, with some stroke patients having difficulties in accessing Computer Tomogram (CT) scan services. It illustrates the need to establish a stroke care setting to improve the quality of stroke care.

English

This article addresses the question, how does Sierra Leone’s language regime, moderated through formal and informal education, contribute to post-war globalization dynamics? Since Sierra Leonean independence from Britain in 1961, Krio, a type of Creole, has gone from being the mother tongue of a small ethnic minority to the lingua franca, particularly in Freetown, the state capital. English has been Sierra Leone’s elite language since colonial times and remains the only official language of government. Yet many other languages are spoken in Sierra Leone in different communities and contexts. Drawing on interviews and political ethnographic work in Freetown and the districts, the study argues that language and identity shift connected to post-war globalization reflects tensions between upward socio-economic mobility and cultural survival. Key words: Sierra Leone, language, education, participation, identity, citizenship.

Deconstructing the local in peacebuilding practice: representations and realities of Fambul Tok in Sierra Leone

The ‘local’ has become central to peacebuilding, both in theory and in practice. While there is extensive conceptual literature analysing the ‘local’, there is much less that looks at how what is often considered local in peacebuilding programmes actually works in practice. The empirical peacebuilding literature that does exist has largely focussed on the international–local interface and those studies that have focussed solely on the ‘local’ largely rely on discussions with more elite civil society leaders. In contrast, this article empirically analyses ‘local–local’ dynamics. Using a Sierra Leonean peacebuilding project called Fambul Tok, this article both provides in-depth analysis on how the organisation externally projects itself as ‘local’ and contrasts this with how the organisation actually works in practice. Externally, Fambul Tok’s media materials equate ‘local’ with Sierra Leonean place and people, as well as notions of culture and tradition. However, by examining the dynamics between different Sierra Leoneans, including staff members and programme participants, a complex picture of the ‘local–local’ emerges. I argue that by engaging with comprehensive empirical research, we can understand how local peacebuilding is actually experienced and enacted and how the theoretical discussions of the ‘local’ and ‘local–local’ in peacebuilding converge with how peacebuilding works in practice.

The Promise and Pitfalls of Security Sector Interventions: Examining the Medium-Term Impact of Security Sector Reform in Sierra Leone

ABSTRACT Development practitioners and scholars have touted security sector reform (SSR) in Sierra Leone as a model for intervention. Twenty years after such reforms began, the West African country presents one with the opportunity to study the medium-term impact of SSR. This article argues that specialists should consider this SSR along five dimensions: security institution building, military reform and integration, internal security reform, professionalization, and disarmament, demobilization, and reintegration. This study further explores the impact these factors have had on security performance and legitimacy in the two decades since their implementation. Finally, this work concludes with an analysis of the current state of the security sector as well as a consideration of the lessons to be learned from the Sierra Leonean experience.

Antibodies from Sierra Leonean and Nigerian Lassa fever survivors cross-react with recombinant proteins representing Lassa viruses of divergent lineages

Lassa virus (LASV) is the causative agent of Lassa fever, an often-fatal hemorrhagic disease that is endemic in West Africa. Seven genetically distinct LASV lineages have been identified. As part of CEPI’s (Coalition for Epidemic Preparedness Innovations) Lassa vaccine development program, we assessed the potential of the human immune system to mount cross-reactive and cross-protective humoral immune responses to antigens from the most prevalent LASV lineages, which are lineages II and III in Nigeria and lineage IV in Sierra Leone. IgG and IgM present in the blood of Lassa fever survivors from Nigeria or Sierra Leone exhibited substantial cross-reactivity for binding to LASV nucleoprotein and two engineered (linked and prefusion) versions of the glycoproteins (GP) of lineages II–IV. There was less cross-reactivity for the Zinc protein. Serum or plasma from Nigerian Lassa fever survivors neutralized LASV pseudoviruses expressing lineage II GP better than they neutralized lineage III or IV GP expressing pseudoviruses. Sierra Leonean survivors did not exhibit a lineage bias. Neutralization titres determined using LASV pseudovirus assays showed significant correlation with titres determined by plaque reduction with infectious LASV. These studies provide guidance for comparison of humoral immunity to LASV of distinct lineages following natural infection or immunization.

Making neoliberal subjects: ‘idle’ youth, precarity, and development intervention in Sierra Leone

Since the end of the Sierra Leonean civil war, successive governments have designated youth as a priority area of policy intervention and proposed numerous programmes to deal with the so-called ‘idle’ youth problem in the country. This focus on youth as objects of policy concern partially owes to contemporary discourses about the relationships between youth and conflicts, and especially, the idea that the existence of a large youth population represents a threat to domestic and international security, and thus functions as part of a larger global governance mechanism that targets societies as part of a liberal interventionist and conflict containment strategy. This paper uses the Sierra Leonean example to stage a broader critique of these interventionist and conflict containment strategies and the ideological schemas that make them possible. It suggests that these programmes are circumscribed epistemically by evolutionist preconceptions that construct the targeted populations as objects of power to be reproduced as neoliberal cosmopolitan subjects as a way of transcending the purported threat they represent. However, that these policies are incapable of transforming the structures within which the so-called ‘idle’ youth problem is produced. Rather, they reproduce, in other guise, the very conditions of precarity that they aim to address.

Determinants of Employees Outstanding Performance in Public Corporations: Strategic Human Resource Management Perspectives of Organisational Development and Sustainability

Performance management is a strategic component of organisations operationswhich requires careful assessment of its constituents. Success of every institution is determined by its performance management system which ensures the provision of adequate tools that enhances outstanding performance. This study examined determinants of employee outstanding performance in corporate institutions with strategic human resource management perspectives of organisational development and sustainability. In this regard, the study critically reviewed pieces of literature published on issues relating to employee performance, which facilitated the discoveryof great concerns of exceptional performance. In order to addressgaps identified, the study employed descriptive quantitative and correlational methods which facilitated the gathering, classification and presentation of data that led to descriptive analysis, discussions and objective conclusion of the study. Nevertheless;obtaining first-hand information was enhanced through the distribution of 300 questionnaires to sample units. Data obtained from sample units was analysed, using Descriptive statistics and Persian correlation. Processed data shows the significance of training and employee development as key element towards improving performance in several facets of organisational operations. However, further facts discoveredestablished that, high employee engagement facilitate effective employer-employee relationship,which shows motivational values and employees worth that prompt institutions workforce todemonstrate commitment towards organisations success. In addition, financial reward was classified as the principal motivator and its judicious use,emphasised by respondents, could influence employees towards exceptional performance.Persian Correlation established significant relationships described thus: Institutions with efficient performance management systems ensures staff capacity building which increasesemployees’competency level.On the other hand, effective engagement and allocation of financial and no-financial rewards generate an outstanding workforce that leads to organisational development and competitive advantage. In consideration to the foregoing facts, this study is significant to human resource management specialists, training and development consultants and corporate institutions in Sierra Leonne.

Classifying childhood war trauma exposure: latent profile analyses of Sierra Leone's former child soldiers.

Former child soldiers are at elevated risk for mental health problems (e.g., traumatic stress, emotion dysregulation, and internalizing and externalizing problems). To examine which groups of former child soldiers are more likely to have difficulties with emotion regulation, interpersonal relationships, and mental health postconflict, we explored patterns of war trauma exposure and their effects on subsequent mental health problems among former child soldiers in Sierra Leone. Participants were 415 (23.86% female) Sierra Leonean former child soldiers participating in a 15-year, four-wave longitudinal study. At T1 (2002), 282 former child soldiers (aged 10-17) were recruited. T2 (2004) included 186 participants from T1 and an additional cohort of self-reintegrated former child soldiers (NT2=132). T3 (2008) and T4 (2016/2017) participants were youth enrolled in previous waves (NT3=315; NT4=364). Latent profile analysis (LPA) was used to classify participants based on the first-time reports of eight forms of war exposure (separation and loss of assets, parental loss, loss of loved ones, witnessing violence, victimization, perpetrating violence, noncombat activities, and deprivation). ANOVA examined whether patterns of war exposure were associated with sociodemographic characteristics and mental health outcomes between T1 and T4. LPA identified two profiles: higher exposure versus lower exposure, using cumulative scores of eight forms of war-related trauma exposure. The 'higher war exposure' group comprised 226 (54.5%) former child soldiers and the 'lower war exposure' group included 189 (45.5%). Significantly higher levels of violence-related and combat experiences characterized the group exposed to more traumatic events. The 'higher war exposure' group reported more PTSD symptoms at T2, more hyperarousal symptoms across all waves, and more difficulties in emotion regulation at T4. Former child soldiers exposed to higher levels of war-related traumatic events and loss should be prioritized for mental health services immediately postconflict and as they transition into adulthood.

Sierra Leonean doctors' perceptions and expectations of the role of pharmacists in hospitals: a national cross-sectional survey.

Background The effective implementation of pharmaceutical care requires pharmacists' collaboration with other healthcare providers, especially doctors. However, doctor's perceptions and expectations may not be in line with the tasks and responsibilities of pharmacists. Objectives We aim to explore doctors' expectations and perceptions of pharmacists while working together in a multi-disciplinary team in Sierra Leone. Setting Twelve public hospitals in Sierra Leone. Method A national cross-sectional survey was conducted between July and September 2018. Anonymous self-administered questionnaires were distributed to all doctors at randomly selected public hospitals. Data were analyzed in Excel and SPSS using descriptive and inferential statistics, and a p > 0.05 was taken as statistically significant. Main outcome measure Doctors' perceptions and expectations towards pharmacists role in patient care. Results A total of 119 out of 150 questionnaires were returned. Doctors hold a mixed perception of pharmacists. The majority of medical doctors believed that pharmacists are vital (n = 98; 82.4%) as they provide services that foster better patients outcomes (n = 78; 65.6%). However, about half (n = 58; 48.8%) expressed uncertainty or perceived pharmacists as incompetent in providing clinical pharmacy services. Our findings also showed a large proportion of doctors expect pharmacists to review medication order (n = 110; 92.4%) for appropriateness and monitoring patients' response to therapy and possible adverse drug effects (n = 112; 92.2%). M ore than three quarters (n = 104, 87.4%) were in favour of collaborating with pharmacists in the process of developing patients' treatment plans. Doctors (n = 116; 97.5%) were of the view that doctor-pharmacist collaborations can be improved by developing trust relationships through dialogue. No demographic characteristics were independently associated with doubt in pharmacist clinical competence. Conclusion Reservations regarding pharmacists' clinical competency still prevail amongst medical doctors. Conversely, they view pharmacists as crucial players in the healthcare delivery system in Sierra Leone. Doctors also have high expectations of pharmacists in terms of contributing to better patient outcomes and therefore wish to collaborate. Possible interventions to settle doctors' discontent regarding pharmacists may include fostering interprofessional training, practice, and constructive dialogue.

Do the determinants of food security differ in improved rice variety adoption? Evidence from Sierra Leone

AbstractThe Sierra Leonean government has implemented the improved rice varieties directed at enhancing more rice production to reduce food insecurity. This paper evaluates the food security effect of improved rice variety adoption using cross-sectional data collected in 2017 from a randomly selected sample of 624 rice farmers in Sierra Leone. The analysis uses the endogenous switching regression and propensity score matching (PSM) approach. The results revealed that the adoption of improved rice varieties has a significant positive effect on food security. That confirms the crucial role of improved rice variety adoption in increasing food production and food security. Therefore, the study recommended the intensification of policies that promote improved rice variety adoption, if more food production and food security are to be realized. Further, the government should continue the lead in rice variety promotion and dissemination and in enhancing an enabling environment for the effective adoption of farmers. Given the preponderant evidence of the different factors of food security, appropriate policies that seek to promote formal education, more income generation for farmers, and easy and credible access to farmland for landless farmers would enhance food security.

The Missing Women of Sande: A Necessary Exercise in Museum Decolonization

The Missing Women of Sande: A Necessary Exercise in Museum Decolonization

Improving inpatient provider-initiated HIV testing and counseling in Sierra Leone.

Only 47% of HIV-positive Sierra Leoneans knew their status in 2017, making expanded HIV testing a priority. National guidelines endorse provider-initiated HIV testing and counselling (PITC) to increase testing coverage, but PITC is rarely provided in Sierra Leone. In response, a Quality Improvement Collaborative (QIC) was implemented to improve PITC coverage amongst adult inpatients. Ten hospitals received the intervention between October 2017 and August 2018; there were no control facilites. Each hospital aimed to improve PITC coverage to ≥ 95% of eligible patients. Staff received training on PITC and QIC methods and a package of PITC best practices and tools. They then worked to identify additional contextually-appropriate interventions, conducted rapid tests of change, and tracked performance using shared indicators and time-series data. Supportive supervision bolstered QI skills, and quarterly meetings enabled diffusion of innovations while spurring friendly competition. Baseline PITC coverage was 4%. The hospital teams tested diverse interventions using QI methods, including staff training; data review meetings; enhanced workflow processes and supervision; and patient education and sensitization activities Nine hospitals reached and sustained the 95% target, and all saw rapid and durable improvement, which was sustained for a median of six months. Of the 5,238 patients tested for HIV, 311 (6%) were found to be HIV-positive and were referred for treatment. HIV rapid test kit stockouts occurred during the project period, limiting PITC services in some cases. The intervention led to swift and sustained improvement in inpatient PITC coverage and to the diagnosis of hundreds of people living with HIV. Sierra Leone's Ministry of Health and Sanitation plans to take the initiative to national scale, with close attention to the issue of test kit stockouts.

‘We have a role to play:’ American Sierra Leoneans communicating the impact of the Ebola virus locally and across the diaspora

ObjectiveThe aim of this study was to examine New Jersey Sierra Leoneans' experiences, perceptions, and knowledge about the Ebola outbreak to better understand how to serve diaspora communities during disease outbreaks and improve international community engagement efforts. Study designFive focus groups were conducted with a total of 34 members of a New Jersey Sierra Leonean community. A short demographic survey was also administered. MethodsFocus groups were audio-taped, transcribed, and then analyzed using QSR NVIVO. Demographic data were analyzed using SPSS. ResultsMajor themes emerged from the focus groups as related to the Ebola outbreak: (1) stigma and discrimination; (2) psycho-socio-economic impact; and (3) public health communication challenges. ConclusionsNovel findings reveal the impact of the Ebola virus on a West African diaspora community in the United States. These findings also advance existing literature. Diaspora communities are an underutilized resource in international disease education, management and prevention outreach research. It is vital that health professionals begin to find effective ways to fold them into relief efforts.

Sierra Leone

The COVID-19 pandemic is severely impacting the Sierra Leonean economy, threatening to wipe out the hard-won gains since the Ebola health crisis just five years ago. The sharp contraction in external demand, and disruptions to mining production and exports are straining the external and fiscal accounts. Proactive measures vital to contain the spread of the crisis are dampening economic activity. The already tight financing situation and fragile health sector, and vast development needs, limit the authorities’ ability to reallocate resources within and across sectors.

International law, the paradox of plenty and the making of resource-driven conflict

AbstractAccess to and distribution of natural resources have been since immemorable time at the root of violent conflict. Over the last few decades, international institutions, legal scholars and civil society started to pay attention to the dangerous liaison between resource commodities and wars. Current debates emphasize how, through sanctions, global regulatory initiatives, and legal accountability, the governance of natural resources in conflict and post-conflict countries has improved, although international law should play a greater role to support the transition to a durable peace. The aim of this article is to illuminate the biases and limitations of dominant accounts by exploring the influence of the resource curse thesis, and its hidden propositions, upon legal developments. Using the Sierra Leonean and Liberian Truth Commissions as a case study, it shows how legal practices and discourses have contributed to a narrow understanding of resource-driven wars as started by voracious rebel groups or caused by weak/authoritarian/corrupt governments. What is obscured by the current focus on greed and ineffective resource governance? What responsibilities and forms of violence are displaced? Engaging with these questions allows us to see the dynamics through which structural injustices and distributive concerns are marginalized in existing responses to these conflicts, how the status quo is perpetuated, and the more subtle ways in which external interventions in the political economy of the Global South take place.

World Music Without Profit

AbstractThis article explores political and aesthetic dimensions of the ‘bubu music’ made by Sierra Leonean émigré Janka Nabay while living in the United States from 2010 to 2017. It narrates Nabay's story while tracing granular flows of creative labour, collaboration, and negotiations of cultural and economic capital at some level of ethnographic detail. The central sections of the article excavate the complex and often non-linear labour that went into the production of his band's music, and gives readers a sense of the way Nabay himself intellectually framed this process. It ultimately argues that Nabay was a resilient but often-dehumanized subject who exemplified the cultural and economic cross-currents of ‘World Music 2.0’ in ways that set privileged Western values of artistic autonomy into vivid relief. As an economically precarious subject split between indigenous nationalism and Western forms of cultural capital, Nabay lived a life of profound contradictions, by turns dissenting and exuberant.

Identification of Common CD8+ T Cell Epitopes from Lassa Fever Survivors in Nigeria and Sierra Leone.

Early and robust T cell responses have been associated with survival from Lassa fever (LF), but the Lassa virus-specific memory responses have not been well characterized. Regions within the virus surface glycoprotein (GPC) and nucleoprotein (NP) are the main targets of the Lassa virus-specific T cell responses, but, to date, only a few T cell epitopes within these proteins have been identified. We identified GPC and NP regions containing T cell epitopes and HLA haplotypes from LF survivors and used predictive HLA-binding algorithms to identify putative epitopes, which were then experimentally tested using autologous survivor samples. We identified 12 CD8-positive (CD8+) T cell epitopes, including epitopes common to both Nigerian and Sierra Leonean survivors. These data should be useful for the identification of dominant Lassa virus-specific T cell responses in Lassa fever survivors and vaccinated individuals as well as for designing vaccines that elicit cell-mediated immunity.IMPORTANCE The high morbidity and mortality associated with clinical cases of Lassa fever, together with the lack of licensed vaccines and limited and partially effective interventions, make Lassa virus (LASV) an important health concern in its regions of endemicity in West Africa. Previous infection with LASV protects from disease after subsequent exposure, providing a framework for designing vaccines to elicit similar protective immunity. Multiple major lineages of LASV circulate in West Africa, and therefore, ideal vaccine candidates should elicit immunity to all lineages. We therefore sought to identify common T cell epitopes between Lassa fever survivors from Sierra Leone and Nigeria, where distinct lineages circulate. We identified three such epitopes derived from highly conserved regions within LASV proteins. In this process, we also identified nine other T cell epitopes. These data should help in the design of an effective pan-LASV vaccine.

Reporting in a health emergency: The roles of Sierra Leonean journalists during the 2014-2015 Ebola outbreak.

IntroductionIn public health emergencies, local media are important sources of information for the public. Not much is known about the professional and personal roles and experiences of Sierra Leonean journalists during the Ebola virus disease (EVD) outbreak between 2014–2015.Methods/Principal findingsThis qualitative study is based on semi-structured interviews with 13 Sierra Leonean journalists based in urban Freetown and rural Waterloo in February and March 2016. The majority of the journalists worked for radio stations. The mostly male journalists represented national, regional and local radio stations. Transcripts of the interviews were analysed using thematic analysis. The analysis was inspired by previously reported journalist roles and agenda-setting theory, which state that the media filter what is happening, making a few core issues more salient. Sierra Leonean journalists shifted from being sceptical monitors in the beginning of the outbreak, to collaborative instructors towards the end. While they adapted to different roles, journalists struggled with their own fears for the virus, which hampered their work. They indicated that the training they received about Ebola helped them overcome their fear. Being trained gave a sense of security that helped them carry out their jobs. By turning into instructors, journalists stepped away from their journalistic professional detachment–potentially exacerbated by their personal experiences.Conclusion/SignificanceThe first months of the outbreak were marked by passive agenda-setting roles of Sierra Leonean journalists. It took several months before the outbreak became a core issue in local media. In health emergencies, efforts should be made to partner with local media to use their platforms for local, trusted journalists and leaders to disseminate public health messages. Whereas this might hamper journalists’ credibility and can be challenging in areas with problematic press freedom, Sierra Leonean journalists experienced the outbreak as a driver of necessary change in their profession.

Ebola-Specific CD8+ and CD4+ T-Cell Responses in Sierra Leonean Ebola Virus Survivors With or Without Post-Ebola Sequelae.

Ebola virus (EBOV) disease has killed thousands of West and Central Africans over the past several decades. Many who survive the acute disease later experience post-Ebola syndrome, a constellation of symptoms whose causative pathogenesis is unclear. We investigated EBOV-specific CD8+ and CD4+ T-cell responses in 37 Sierra Leonean EBOV disease survivors with (n = 19) or without (n = 18) sequelae of arthralgia and ocular symptoms. Peripheral blood mononuclear cells were infected with recombinant vesicular stomatitis virus encoding EBOV antigens. We also studied the presence of EBOV-specific immunoglobulin G, antinuclear antibodies, anti-cyclic citrullinated peptide antibodies, rheumatoid factor, complement levels, and cytokine levels in these 2 groups. Survivors with sequelae had a significantly higher EBOV-specific CD8+ and CD4+ T-cell response. No differences in EBOV-specific immunoglobulin G, antinuclear antibody, or anti-cyclic citrullinated peptide antibody levels were found. Survivors with sequelae showed significantly higher rheumatoid factor levels. EBOV-specific CD8+ and CD4+ T-cell responses were significantly higher in Ebola survivors with post-Ebola syndrome. These findings suggest that pathogenesis may occur as an immune-mediated disease via virus-specific T-cell immune response or that persistent antigen exposure leads to increased and sustained T-cell responses.

Kerjasama UNICEF dan IRC dalam Penegakan Hak Anak di Sierra Leone

Sierra Leone was one of the countries with the largest use of child soldiers during the civil war between 1991-2002. Girl child soldiers made up to 30 percent of the total child soldiers involved in the Sierra Leone civil war. The Disarmament, Demobilization and Reintegration program (DDR) which was one of the UN mandate as a post-conflict peace consolidation could only reach 506 out of a total of 6,845 child soldiers who have been disarmed. This was because the requirement for the disarmament phase was to hand in their weapon, while many girls were not equipped with weapon by their armed forces commander considering that most of them acted as cooks, house workers, and bush wives. UNICEF and IRC as international organizations then carried out further DDR projects with more gender-responsive and community-based with gender mainstreaming and inclusive citizenship policies to enforce children rights of Sierra Leonean girl soldiers who previously had not included in DDR program. This paper will discuss the enforcement of children rights of Sierra Leonean girl soldiers in the furtjer DDR projects.