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Operational Research and Capacity Building to Tackle Antimicrobial Resistance in Sierra Leone

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (15 April 2022) | Viewed by 38442

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Special Issue Editors

Dr. Roger Teck

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Guest Editor

Global Health and Humanitarian Medicine, Manson Unit, Médecins Sans Frontières (MSF), London EC4A 1AB, UK
Interests: HIV testing; vertical infectious disease transmission; prenatal care

Dr. Alex G. Stewart

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Guest Editor

College of Life and Environmental Science, University of Exeter, Exeter EX4 4RJ, UK
Interests: interaction between health and environment; environmental iodine and the iodine deficiency disorders; pollution from a health perspective; public health and health protection
Special Issues, Collections and Topics in MDPI journals

Dr. Chakaya Muhwa Jeremiah

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Guest Editor

1. Department of medicine, psychiatry and dermatology, School of Medicine, Kenyatta University, Nairobi, Kenya
2. Department of clinical sciences, Liverpool School of Tropical Medicine, Liverpool, UK
Interests: respiratory diseases and infections; tuberculosis; operational research; global health
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to antimicrobial medicines. This makes standard treatments ineffective and allows infections to persist, spread, cause prolonged illness and death. In 2019, an estimated 1.27 million deaths were directly attributable to AMR and 4.95 million deaths were associated with AMR. The World Health Organization has declared AMR as one of the 10 global public health threats facing humanity.

During the 2015 World Health Assembly, countries committed to a Global Action Plan to tackle the main drivers of AMR such as: misuse and overuse of antimicrobials; lack of access to clean water, sanitation and hygiene for both humans and animals; poor infection prevention and control measures in health-care facilities and farms; poor access to quality, affordable medicines, vaccines and diagnostics; lack of awareness and knowledge; and lack of enforcement of legislation.

This special issue highlights research from the Structured Operational Research and Training Initiative (SORT IT) project aimed at building sustainable operational research capacity to generate and utilize evidence to tackle the emergence, spread and health impact of AMR. SORT IT aims to make the AMR response in countries “data rich, information rich and action rich”.

We welcome you to this special issue. The research studies within this issue cover the human, agricultural and environmental sectors and together constitute “local research for local solutions with local ownership” in Sierra Leone.

Dr. Roger Teck
Dr. Alex G. Stewart
Dr. Chakaya Muhwa Jeremiah
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

health system resilience
SORT IT
SDGS, Universal Health Coverage
One Health

Published Papers (14 papers)

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Editorial

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5 pages, 1049 KiB

Open AccessEditorial

The Structured Operational Research and Training Initiative for Strengthening Health Systems to Tackle Antimicrobial Resistance and Improve Public Health in Low-and-Middle Income Countries

by Rony Zachariah, Alex G. Stewart, Jeremiah M. Chakaya, Roger Teck, Mohammed Ahmed Khogali, Anthony D. Harries, Charlotte Seeley-Musgrave, Thomas Samba and John C. Reeder

Int. J. Environ. Res. Public Health 2022, 19(8), 4582; https://doi.org/10.3390/ijerph19084582 - 11 Apr 2022

Cited by 2 | Viewed by 1674

Abstract

If research is to have an impact and change health outcomes for the better, the findings of the research should be translated into recommendations and actions that can influence policy and/or practice [...] Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Tackle Antimicrobial Resistance in Sierra Leone)

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Research

Jump to: Editorial

18 pages, 3781 KiB

Open AccessArticle

Evaluation of Drinking Water Quality and Bacterial Antibiotic Sensitivity in Wells and Standpipes at Household Water Points in Freetown, Sierra Leone

by Dauda Kamara, Doris Bah, Momodu Sesay, Anna Maruta, Bockarie Pompey Sesay, Bobson Derrick Fofanah, Ibrahim Franklyn Kamara, Joseph Sam Kanu, Sulaiman Lakoh, Bailah Molleh, Jamie Guth, Karuna D. Sagili, Simon Tavernor and Ewan Wilkinson

Int. J. Environ. Res. Public Health 2022, 19(11), 6650; https://doi.org/10.3390/ijerph19116650 - 29 May 2022

Cited by 4 | Viewed by 3125

Abstract

Water quality surveillance can help to reduce waterborne diseases. Despite better access to safe drinking water in Sierra Leone, about a third of the population (3 million people) drink water from unimproved sources. In this cross-sectional study, we collected water samples from 15 standpipes and 5 wells and measured the physicochemical and bacteriological water quality, and the antimicrobial sensitivity of Escherichia coli (E. coli) in two communities in Freetown, Sierra Leone in the dry and wet seasons in 2021. All water sources were contaminated with E. coli, and all five wells and 25% of standpipes had at least an intermediate risk level of E. coli. There was no antimicrobial resistance detected in the E. coli tested. The nitrate level exceeded the WHO’s recommended standard (>10 parts per million) in 60% of the wells and in less than 20% of the standpipes. The proportion of samples from standpipes with high levels of total dissolved solids (>10 Nephelometric Turbidity Units) was much higher in the rainy season (73% vs. 7%). The level of water contamination is concerning. We suggest options to reduce E. coli contamination. Further research is required to identify where contamination of the water in standpipes is occurring. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Tackle Antimicrobial Resistance in Sierra Leone)

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11 pages, 1016 KiB

Open AccessArticle

Assessment of Infection Prevention and Control Measures at Points of Entry in Sierra Leone in 2021: A Cross-Sectional Study

by Kadijatu Nabie Kamara, James Sylvester Squire, Joseph Sam Kanu, Ronald Carshon-Marsh, Zikan Koroma, Aminata Tigiedankay Koroma, Anna Maruta, Christiana Kallon, Marcel Manzi, Bienvenu Salim Camara, Aelita Sargsyan, Alexandre Delamou, Jamie Ann Guth, Anthony Reid, Mohamed Ahmed Khogali and Mohamed Alex Vandi

Int. J. Environ. Res. Public Health 2022, 19(10), 5936; https://doi.org/10.3390/ijerph19105936 - 13 May 2022

Viewed by 1900

Abstract

Implementing and monitoring infection prevention and control (IPC) measures at immigration points of entry (PoEs) is key to preventing infections, reducing excessive use of antimicrobials, and tackling antimicrobial resistance (AMR). Sierra Leone has been implementing IPC measures at four PoEs (Queen Elizabeth II Quay port, Lungi International Airport, and the Jendema and Gbalamuya ground crossings) since the last Ebola outbreak in 2014–2015. We adapted the World Health Organization IPC Assessment Framework tool to assess these measures and identify any gaps in their components at each PoE through a cross-sectional study in May 2021. IPC measures were Inadequate (0–25%) at Queen Elizabeth II Quay port (21%; 11/53) and Jendema (25%; 13/53) and Basic (26–50%) at Lungi International Airport (40%; 21/53) and Gbalamuya (49%; 26/53). IPC components with the highest scores were: having a referral system (85%; 17/20), cleaning and sanitation (63%; 15/24), and having a screening station (59%; 19/32). The lowest scores (0% each) were reported for the availability of IPC guidelines and monitoring of IPC practices. This was the first study in Sierra Leone highlighting significant gaps in the implementation of IPC measures at PoEs. We call on the AMR multisectoral coordinating committee to enhance IPC measures at all PoEs. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Tackle Antimicrobial Resistance in Sierra Leone)

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14 pages, 1343 KiB

Open AccessArticle

Achieving Minimum Standards for Infection Prevention and Control in Sierra Leone: Urgent Need for a Quantum Leap in Progress in the COVID-19 Era!

by Bobson Derrick Fofanah, Arpine Abrahamyan, Anna Maruta, Christiana Kallon, Pruthu Thekkur, Ibrahim Franklyn Kamara, Charles Kuria Njuguna, James Sylvester Squire, Joseph Sam Kanu, Abdulai Jawo Bah, Sulaiman Lakoh, Dauda Kamara, Veerle Hermans and Rony Zachariah

Int. J. Environ. Res. Public Health 2022, 19(9), 5642; https://doi.org/10.3390/ijerph19095642 - 6 May 2022

Cited by 6 | Viewed by 3109

Abstract

Introduction: Good Infection prevention and control (IPC) is vital for tackling antimicrobial resistance and limiting health care-associated infections. We compared IPC performance before (2019) and during the COVID-19 (2021) era at the national IPC unit and all regional (4) and district hospitals (8) in Sierra Leone. Methods: Cross-sectional assessments using standardized World Health Organizations IPC checklists. IPC performance scores were graded as inadequate = 0–25%, basic = 25.1–50%, intermediate = 50.1–75%, and advanced = 75.1–100%. Results: Overall performance improved from ‘basic’ to ‘intermediate’ at the national IPC unit (41% in 2019 to 58% in 2021) and at regional hospitals (37% in 2019 to 54% in 2021) but remained ‘basic’ at district hospitals (37% in 2019 to 50% in 2021). Priority gaps at the national IPC unit included lack of: a dedicated IPC budget, monitoring the effectiveness of IPC trainings and health care-associated infection surveillance. Gaps at hospitals included no assessment of hospital staffing needs, inadequate infrastructure for IPC and lack of a well-defined monitoring plan with clear goals, targets and activities. Conclusion: Although there is encouraging progress in IPC performance, it is slower than desired in light of the COVID-19 pandemic. There is urgent need to mobilize political will, leadership and resources and make a quantum leap forward. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Tackle Antimicrobial Resistance in Sierra Leone)

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12 pages, 1465 KiB

Open AccessArticle

Bacterial Isolates and Antibiotic Resistance of Escherichia coli Isolated from Fresh Poultry Excreta Used for Vegetable Farming in Freetown, Sierra Leone

by Alie H. D. Mansaray, Dennis P. Y. Yankson, Raymonda A. B. Johnson, Francis L. Moses, Joseph Sam Kanu, Ibrahim Franklyn Kamara, Rony Zachariah, Ajay M. V. Kumar and Kalaiselvi Selvaraj

Int. J. Environ. Res. Public Health 2022, 19(9), 5405; https://doi.org/10.3390/ijerph19095405 - 29 Apr 2022

Cited by 5 | Viewed by 2784

Abstract

The transfer of antibiotic resistance from animals to humans is of concern in recent times. One potential source of such transfer is the untreated poultry excreta used as manure in farming. We aim to identify bacterial isolates and antibiotic susceptibility patterns of Escherichia coli in poultry excreta in Sierra Leone. This was a cross-sectional study of fresh poultry excreta samples collected from four commercial poultry sites in Freetown, Sierra Leone, from June–September 2021. Bacterial isolates were tested against eight antibiotics using established standards. Of 100 samples, 93 showed Escherichia coli (93%): of those, eight isolates also had Salmonella (8%). E. coli was 100% resistant to all three ‘Watch’ drugs (erythromycin, cefoxitin and streptomycin) and tetracycline. E. coli was least resistant to ampicillin (12%), followed by chloramphenicol (35%). The prevalence of multidrug resistance was 95.6%. Multiple antibiotic resistance index ranged from 0.5–0.7 (optimal < 0.2), indicating high prior exposure to antibiotics in these poultries. Such high levels of resistance in E. coli isolated from poultry excreta could pose a serious threat to humans. We recommend (i) routine surveillance to monitor antibiotic resistance in poultry excreta, (ii) using poultry excreta as manure only after treatment and (iii) restricting the use of antibiotics as prophylactics and growth promoters in poultry feeds. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Tackle Antimicrobial Resistance in Sierra Leone)

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12 pages, 349 KiB

Open AccessArticle

An Update on the Surveillance of Livestock Diseases and Antimicrobial Use in Sierra Leone in 2021—An Operational Research Study

by Fatmata Isatu Bangura (Turay), Amara Leno, Katrina Hann, Collins Timire, Divya Nair, Mohamed Alpha Bah, Sahr Raymond Gborie, Srinath Satyanarayana, Jeffrey Karl Edwards, Hayk Davtyan, Sorie Mohamed Kamara, Amadu Tejan Jalloh, David Sellu-Sallu, Joseph Sam Kanu, Raymonda Johnson and Noelina Nantima

Int. J. Environ. Res. Public Health 2022, 19(9), 5294; https://doi.org/10.3390/ijerph19095294 - 27 Apr 2022

Cited by 2 | Viewed by 2338

Abstract

In Sierra Leone, in 2020, a study by the Livestock and Veterinary Services Division (Ministry of Agriculture and Forestry) on the surveillance system of animal diseases and antimicrobial use found poor reporting. Of the expected weekly districts reports, <1% were received and only three of the 15 districts had submitted reports occasionally between 2016 and 2019. Following this, staff-capacity-building on reporting was undertaken. In 2021, we reassessed the improvement in reporting and used the reports to describe livestock diseases and antimicrobials utilized in their treatment. Between March and October 2021, 88% of expected weekly reports from all 15 districts were received. There were minor deficiencies in completeness and consistency in the terminology used for reporting animal disease and antimicrobials. Available reports showed that 25% of the livestock had an infectious disease, and a quarter of the sick animals had received an antimicrobial drug. Most animals received antimicrobials belonging to World Organization for Animal Health’s “veterinary critically important” category (77%) and World Health Organization’s “critically” (17%) and “highly important” (60%) categories for human health. These indicate a significant improvement in the animal health surveillance system and highlight the need for enhanced antimicrobial stewardship to prevent misuse of antimicrobials that are significant in animal and human health. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Tackle Antimicrobial Resistance in Sierra Leone)

12 pages, 335 KiB

Open AccessArticle

Infection Prevention and Control in Three Tertiary Healthcare Facilities in Freetown, Sierra Leone during the COVID-19 Pandemic: More Needs to Be Done!

by Ibrahim Franklyn Kamara, Sia Morenike Tengbe, Bobson Derrick Fofanah, James Edward Bunn, Charles Kuria Njuguna, Christiana Kallon and Ajay M. V. Kumar

Int. J. Environ. Res. Public Health 2022, 19(9), 5275; https://doi.org/10.3390/ijerph19095275 - 26 Apr 2022

Cited by 6 | Viewed by 2473

Abstract

Infection Prevention and Control (IPC) measures are critical to the reduction in healthcare-associated infections, especially during pandemics, such as that of COVID-19. We conducted a hospital-based cross-sectional study in August 2021 at Connaught Hospital, Princess Christian Maternity Hospital and Ola During Children’s Hospital located in Freetown, Sierra Leone. We used the World Health Organization’s Infection Prevention and Control Assessment Framework Tool to assess the level of IPC compliance at these healthcare facilities. The overall IPC compliance score at Connaught Hospital was 323.5 of 800 points, 313.5 of 800 at Ola During Children’s Hospital, 281 of 800 at Princess Christian Maternity Hospital, implying a ‘Basic’ IPC compliance grade. These facilities had an IPC program, IPC committees and dedicated IPC focal persons. However, there were several challenges, including access to safe and clean water and insufficient quantities of face masks, examination gloves and aprons. Furthermore, there was no dedicated budget or no healthcare-associated infection (HAI) surveillance, and monitoring/audit of IPC practices were weak. These findings are of concern during the COVID-19 era, and there is an urgent need for both financial and technical support to address the gaps and challenges identified. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Tackle Antimicrobial Resistance in Sierra Leone)

12 pages, 1133 KiB

Open AccessArticle

Culture Requests and Multi-Drug Resistance among Suspected Urinary Tract Infections in Two Tertiary Hospitals in Freetown, Sierra Leone (2017–21): A Cross-Sectional Study

by Julian S. O. Campbell, Saskia van Henten, Zikan Koroma, Ibrahim Franklyn Kamara, Gladys N. Kamara, Hemant Deepak Shewade and Anthony D. Harries

Int. J. Environ. Res. Public Health 2022, 19(8), 4865; https://doi.org/10.3390/ijerph19084865 - 16 Apr 2022

Cited by 1 | Viewed by 2549

Abstract

In sub-Saharan Africa, there is limited information about the use of microbiology laboratory services in patients with suspected urinary tract infections (UTIs). This cross-sectional study assessed the requests for urine culture in patients with suspected UTI in two tertiary (maternal and paediatric) hospitals—Freetown and Sierra Leone, during May 2017–May 2021—and determined antimicrobial resistance (AMR) patterns among bacterial isolates. One laboratory served the two hospitals, with its electronic database used to extract information. Overall, there were 980 patients, of whom 168 (17%) had cultures requested and performed. Of these, 75 (45%) were culture positive. During 2017–2019, there were 930 patients, of whom 156 (17%) had cultures performed. During 2020–2021, when services were disrupted by the COVID-19 pandemic, there were 50 patients, of whom 12 (24%) had cultures performed. The four commonest isolates were Escherichia coli (36), Klebsiella pneumoniae (10), Staphylococcus aureus (9), and Pseudomonas spp. (6). There were high levels of AMR, especially for trimethoprim-sulfamethoxazole (47%), nalidixic acid (44%), nitrofurantoin (32%) and cefotaxime (36%). Overall, 41 (55%) bacterial isolates showed multidrug resistance, especially E. coli (58%), Pseudomonas spp. (50%), and S. aureus (44%). These findings support the need for better utilization of clinical microbiology services to guide antibiotic stewardship and monitoring of trends in resistance patterns. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Tackle Antimicrobial Resistance in Sierra Leone)

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14 pages, 1547 KiB

Open AccessArticle

Pesticide Importation in Sierra Leone, 2010–2021: Implications for Food Production and Antimicrobial Resistance

by Raymonda A. B. Johnson, Katrina Hann, Amara Leno, Collins Timire, Alpha J. A. Bangura, Margaret I. Z. George, Hayk Davtyan, Srinath Satyanarayana, Divya Nair, Alie H. D. Mansaray, Fatmata I. Bangura, Joseph S. Kanu and Jeffrey K. Edwards

Int. J. Environ. Res. Public Health 2022, 19(8), 4792; https://doi.org/10.3390/ijerph19084792 - 15 Apr 2022

Cited by 1 | Viewed by 2181

Abstract

There are no previous studies reporting the type and quantity of pesticides for farming from Sierra Leone and the impact of Ebola or COVID-19 on importation. This study reviewed imported farming pesticides by the Sierra Leone, Ministry of Agriculture and Forestry (MAF), between 2010–2021. It was a descriptive study using routinely collected importation data. We found the MAF imported pesticides for farming only during 2010, 2014 and 2021, in response to growing food insecurity and associated with Ebola and COVID-19 outbreaks. Results showed insecticide importation increased from 6230 L in 2010 to 51,150 L in 2021, and importation of antimicrobial pesticides (including fungicides) increased from 150 kg in 2010 to 23,560 kg in 2021. The hazard class risk classification of imported pesticides decreased over time. Increasing amounts of imported fungicides could increase the risk of future fungal resistance among humans. We found that in responding to escalating food insecurity, the government dramatically increased the amount of pesticide importation to improve crop production. Further support is necessary to decrease the risk of worsening food shortages and the possible threat of emerging antimicrobial resistance. We recommend continued monitoring and surveillance, with further studies on the most appropriate response to these multiple challenges. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Tackle Antimicrobial Resistance in Sierra Leone)

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9 pages, 808 KiB

Open AccessArticle

Incidence of Surgical Site Infection and Use of Antibiotics among Patients Who Underwent Caesarean Section and Herniorrhaphy at a Regional Referral Hospital, Sierra Leone

by Ronald Carshon-Marsh, James Sylvester Squire, Kadijatu Nabbie Kamara, Aelita Sargsyan, Alexandre Delamou, Bienvenu Salim Camara, Marcel Manzi, Jamie Ann Guth, Mohamed Ahmed Khogali, Anthony Reid and Sartie Kenneh

Int. J. Environ. Res. Public Health 2022, 19(7), 4048; https://doi.org/10.3390/ijerph19074048 - 29 Mar 2022

Cited by 5 | Viewed by 2623

Abstract

Surgical site infections (SSIs) are common postoperative complications. Surgical antibiotic prophylaxis (SAP) can prevent the occurrence of SSIs if administered appropriately. We carried out a retrospective cohort study to determine the incidence of SSIs and assess whether SAP were administered according to WHO guidelines for Caesarean section (CS) and herniorrhaphy patients in Bo regional government hospital from November 2019 to October 2020. The analysis included 681 patients (599 CSs and 82 herniorrhaphies). Overall, the SSI rate was 6.7% among all patients, and 7.5% and 1.2% among CS patients and herniorrhaphy patients, respectively. SAP was administered preoperatively in 85% of CS and 70% of herniorrhaphy patients. Postoperative antibiotics were prescribed to 85% of CS and 100% of herniorrhaphy patients. Ampicillin, metronidazole, and amoxicillin were the most commonly used antibiotics. The relatively low rate of SSIs observed in this study is probably due to improved infection prevention and control (IPC) measures following the Ebola outbreak and the current COVID-19 pandemic. A good compliance rate with WHO guidelines for preoperative SAP was observed. However, there was a high use of postoperative antibiotics, which is not in line with WHO guidelines. Recommendations were made to ensure the appropriate administration of SAP and reduce unnecessary use of antibiotics. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Tackle Antimicrobial Resistance in Sierra Leone)

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14 pages, 973 KiB

Open AccessArticle

Antibiotic Use in Suspected and Confirmed COVID-19 Patients Admitted to Health Facilities in Sierra Leone in 2020–2021: Practice Does Not Follow Policy

by Ibrahim Franklyn Kamara, Ajay M. V. Kumar, Anna Maruta, Bobson Derrick Fofanah, Charles Kuria Njuguna, Steven Shongwe, Francis Moses, Sia Morenike Tengbe, Joseph Sam Kanu, Sulaiman Lakoh, Alie H. D. Mansaray, Kalaiselvi Selvaraj, Mohammed Khogali and Rony Zachariah

Int. J. Environ. Res. Public Health 2022, 19(7), 4005; https://doi.org/10.3390/ijerph19074005 - 28 Mar 2022

Cited by 19 | Viewed by 2571

Abstract

Inappropriate use of antibiotics during the COVID-19 pandemic has the potential to increase the burden of antimicrobial resistance. In this study, we report on the prevalence of antibiotic use and its associated factors among suspected and confirmed COVID-19 patients admitted to 35 health facilities in Sierra Leone from March 2020–March 2021. This was a cross-sectional study using routinely collected patient data. Of 700 confirmed COVID-19 patients, 47% received antibiotics. The majority (73%) of the antibiotics belonged to the ’WATCH’ group of antibiotics, which are highly toxic and prone to resistance. The most frequently prescribed antibiotics were azithromycin, ceftriaxone, amoxicillin, metronidazole, and amoxicillin-clavulanic acid. Antibiotic use was significantly higher in patients aged 25–34 years than in those with severe disease. Of 755 suspected COVID-19 patients, 61% received antibiotics, of which the majority (58%) belonged to the ‘WATCH’ category. The most frequently prescribed antibiotics were ceftriaxone, metronidazole, azithromycin, ciprofloxacin, and amoxycillin. The prevalence of antibiotic use among suspected and confirmed COVID-19 patients admitted to healthcare facilities in Sierra Leone was high and not in line with national and WHO case management guidelines. Training of health care providers, strengthening of antimicrobial stewardship programs, and microbiological laboratory capacity are urgently needed. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Tackle Antimicrobial Resistance in Sierra Leone)

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14 pages, 725 KiB

Open AccessArticle

How Well Are Hand Hygiene Practices and Promotion Implemented in Sierra Leone? A Cross-Sectional Study in 13 Public Hospitals

by Sulaiman Lakoh, Anna Maruta, Christiana Kallon, Gibrilla F. Deen, James B. W. Russell, Bobson Derrick Fofanah, Ibrahim Franklyn Kamara, Joseph Sam Kanu, Dauda Kamara, Bailah Molleh, Olukemi Adekanmbi, Simon Tavernor, Jamie Guth, Karuna D. Sagili and Ewan Wilkinson

Int. J. Environ. Res. Public Health 2022, 19(7), 3787; https://doi.org/10.3390/ijerph19073787 - 23 Mar 2022

Cited by 7 | Viewed by 2740

Abstract

Healthcare-associated infections (HAIs) result in millions of avoidable deaths or prolonged lengths of stay in hospitals and cause huge economic loss to health systems and communities. Primarily, HAIs spread through the hands of healthcare workers, so improving hand hygiene can reduce their spread. We evaluated hand hygiene practices and promotion across 13 public health hospitals (six secondary and seven tertiary hospitals) in the Western Area of Sierra Leone in a cross-sectional study using the WHO hand hygiene self-Assessment framework in May 2021. The mean score for all hospitals was 273 ± 46, indicating an intermediate level of hand hygiene. Nine hospitals achieved an intermediate level and four a basic level. More secondary hospitals 5 (83%) were at the intermediate level, compared to tertiary hospitals 4 (57%). Tertiary hospitals were poorly rated in the reminders in workplace and institutional safety climate domains but excelled in training and education. Lack of budgets to support hand hygiene implementation is a priority gap underlying this poor performance. These gaps hinder hand hygiene practice and promotion, contributing to the continued spread of HAIs. Enhancing the distribution of hand hygiene resources and encouraging an embedded culture of hand hygiene practice in hospitals will reduce HAIs. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Tackle Antimicrobial Resistance in Sierra Leone)

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12 pages, 834 KiB

Open AccessArticle

Inconsistent Country-Wide Reporting of Adverse Drug Reactions to Antimicrobials in Sierra Leone (2017–2021): A Wake-Up Call to Improve Reporting

by Fawzi Thomas, Onome T. Abiri, James P. Komeh, Thomas A. Conteh, Abdulai Jawo Bah, Joseph Sam Kanu, Robert Terry, Arpine Abrahamyan, Pruthu Thekkur and Rony Zachariah

Int. J. Environ. Res. Public Health 2022, 19(6), 3264; https://doi.org/10.3390/ijerph19063264 - 10 Mar 2022

Cited by 4 | Viewed by 3741

Abstract

Background: Monitoring of adverse drug reactions (ADRs) to antimicrobials is important, as they can cause life-threatening illness, permanent disabilities, and death. We assessed country-wide ADR reporting on antimicrobials and their outcomes. Methods: A cross-sectional study was conducted using individual case safety reports (ICSRs) entered into the national pharmacovigilance database (VigiFlow) during 2017–2021. Results: Of 566 ICSRs, inconsistent reporting was seen, with the highest reporting in 2017 and 2019 (mass drug campaigns for deworming), zero reporting in 2018 (reasons unknown), and only a handful in 2020 and 2021 (since COVID-19). Of 566 ICSRs, 90% were for antiparasitics (actively reported during mass campaigns), while the rest (passive reporting from health facilities) included 8% antibiotics, 7% antivirals, and 0.2% antifungals. In total, 90% of the reports took >30 days to be entered (median = 165; range 2–420 days), while 44% had <75% of all variables filled in (desired target = 100%). There were 10 serious ADRs, 18 drug withdrawals, and 60% of ADRs affected the gastrointestinal system. The patient outcomes (N-566) were: recovered (59.5%), recovering (35.5%), not recovered (1.4%), death (0.2%), and unknown (3.4%). There was no final ascertainment of ‘recovering’ outcomes. Conclusions: ADR reporting is inconsistent, with delays and incomplete data. This is a wake-up call for introducing active reporting and setting performance targets. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Tackle Antimicrobial Resistance in Sierra Leone)

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11 pages, 326 KiB

Open AccessArticle

Hand Hygiene Compliance at Two Tertiary Hospitals in Freetown, Sierra Leone, in 2021: A Cross-Sectional Study

by Gladys Nanilla Kamara, Stephen Sevalie, Bailah Molleh, Zikan Koroma, Christiana Kallon, Anna Maruta, Ibrahim Franklyn Kamara, Joseph Sam Kanu, Julian S. O. Campbell, Hemant Deepak Shewade, Saskia van Henten and Anthony D. Harries

Int. J. Environ. Res. Public Health 2022, 19(5), 2978; https://doi.org/10.3390/ijerph19052978 - 3 Mar 2022

Cited by 4 | Viewed by 3031

Abstract

Hand hygiene actions are essential to reduce healthcare-associated infections and the development of antimicrobial resistance. In this cross-sectional study at two tertiary hospitals, Freetown, Sierra Leone, we observed hand hygiene compliance (defined as using handwash with soap and water or alcohol-based hand rub (ABHR) amongst healthcare workers between June and August 2021. Using the WHO Hand Hygiene tool, observations were made in relation to the type of opportunity, different wards and types of healthcare worker. Overall, 10,461 opportunities for hand hygiene were observed, of which 5086 (49%) resulted in hand hygiene actions. ABHR was used more often than handwash (26% versus 23%, p < 0.001). Overall, compliance was significantly better: after being with a patient/doing a procedure than before (78% after body fluid exposure risk compared with 24% before touching a patient—p < 0.001); in Paediatric (61%) compared with Medical wards (46%)—p < 0.001; and amongst nurses (52%) compared with doctors (44%)—p < 0.001. Similar patterns of compliance were observed within each hospital. In summary, hand hygiene compliance was sub-optimal, especially before being with a patient or before clean/aseptic procedures. Improvement is needed through locally adapted training, hand hygiene reminders in wards and outpatient departments, uninterrupted provision of ABHR and innovative ways to change behaviour. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Tackle Antimicrobial Resistance in Sierra Leone)

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