Sierra Leone Journal of Biomedical Research

Beyond the Clinic: A One Health Qualitative Analysis of Antibiotic Use and Antimicrobial Resistance (AMR) in Sierra Leone

Memunatu Iye Suma — 2026-06-20

This study utilizes a One Health framework to explore AMR drivers across human, animal, and environmental domains in Freetown. Using a qualitative exploratory design, 25 semi-structured interviews were conducted, including 17 in-depth interviews with frontline human health, animal health, and environmental professionals, and 8 key informant interviews with One Health policymakers. Data were analyzed using Braun and Clarke’s thematic framework. Over 70% of hospital antibiotic prescriptions occur without diagnostic testing, driven by drug shortages and patient demand. In the animal sector, unregulated access to human medications for livestock is prevalent. Environmental pathways, specifically untreated hospital wastewater and pharmaceutical waste, remain unmonitored. Awareness is high in medical sectors but significantly lower among environmental professionals. AMR in Sierra Leone is a multisectoral crisis exacerbated by weak governance and lack of laboratory infrastructure. Effective containment requires translating One Health policy into actionable surveillance, waste management and diagnostic capacity.

Keywords: Antibiotics, Antimicrobial Resistance (AMR), Antibiotic Stewardship, Environmental Health, One Health, Global Health Policy, Hospital Wastewater, Qualitative Research, Sierra Leone.

Assessment of Malaria Treatment Interventions: A Critical Analysis of Government Initiatives and causes of treatment failure at Port Loko Government Hospital, Sierra Leone

Lawrence Sao Babawo — 2026-06-20

Background: Malaria disease continues to be a leading cause of morbidity and mortality, particularly among children under five years of age and pregnant women in Sierra Leone. Malaria treatment interventions are the many, various, and conventional methods used to manage and control the disease with little to no harm to human health.While great progress has been made, the challenge persists, necessitating ongoing efforts and solid partnerships among key players to address successes and challenges in malaria control comprehensively. This research is crucial to identify gaps in current strategies, inform policy decisions, and improve the overall effectiveness of malaria prevention and treatment efforts.

Aims: The study aims to critically evaluate the existing government interventions for malaria diagnosis, treatment and prevention, shedding light on the causes of treatment failure and the accessibility and efficiency of available resources.

Methods: The study utilizes a cross-sectional study design using purposive stratified random sampling of 300 (that is, 150 women of childbearing age and 150 Health Workers) respondents. A structured survey questionnaire was used to obtain data from the respondents. Secondary data were also sourced from documents like the District Health Information System (DHIS). Data were analyzed using Statistical Package for Social Sciences (SPSS), version 28 for which the analysis was stratified by respondent groups, i.e., Health Workers vs. women of childbearing age. Descriptive statistics were computed to summarize participant characteristics and findings were presented using frequency tables and bar plots to enhance data interpretation.

Results: From the analysis, 41.0% of respondents (62 Out of 150 women of childbearing age) said poverty and other socio-economic conditions are responsible for the increase prevalence and spread of malaria and also 40.0% (600) of the same respondents affirm the nearest drug store to be the first point of contact when they feel unwell as a result of poor socio-economic conditions. About 73.3% (110 out 150 health workers) of respondents mentioned malaria as the prevailing disease condition among women of childbearing age and other susceptible groups. 85.0% (128) of health workers’ respondents reveal that there is a stock out of malaria commodities every month and 78.0% (117) of respondents said most malaria diagnoses and treatments are mostly ineffective and inadequate. The study further shows that Bekeh Loko Chiefdom, Port Loko District is at high risk of ACT drug resistance with 93.0% (140) of the health workers respondents referred to non-adherence to prescribed and appropriate treatment as the leading cause of the ineffectiveness of malaria treatment interventions.

Conclusion: Inadequate, inappropriate, and ineffective malaria prevention, control, treatment services and facilities, such as; RDTs, Microscopic/Laboratory Tests, Malaria Case Management (Antesunate Lumefantrine, Rectal Artesunate, Injectable Artesunate), IPTp and IPTi ;the lack of positive malaria social behaviours coupled with poor socio-economic factors in most malaria-endemic regions like Bekeh Loko Chiefdom, Port Loko District of Sierra Leone might be a contributing factor to the increase prevalence of the disease in the study area. Active community engagement and education, strengthening healthcare infrastructure, quality improvement in diagnosis and treatment, targeted interventions for pregnant women and women’s livelihood empowerment, are urgently needed to control the high malaria prevalence in the study area and other endemic areas within the nation.

Keywords: Malaria, Treatment, Interventions, Port, Loko, Bekeh-Loko.

Assessing Knowledge and Self-Medication Practices Among Residents of Moriba Town Bo Southern Sierra Leone during the Covid-19 Pandemic

Andrew Moseray — 2026-06-20

Background: The COVID-19 pandemic exacerbated self-medication (SM) practices worldwide, especially in regions with limited healthcare access, like Moriba Town, Sierra Leone. This study aims to assess knowledge of SM and its causes during the pandemic among residents of Moriba Town.

Methods: A cross-sectional community-based survey was conducted in Moriba Town, Bo, Southern Sierra Leone. A sample of 246 adult participants was selected using a multistage systematic sampling technique. Data were collected using electronic questionnaires via Kobo-collect and analyzed using SPSS version 26. Descriptive statistics and chi-squared tests were employed to explore associations between socio-demographic factors and SM practices.

Results: From the results, 26.02% engaged in SM, with a higher prevalence among females (57.32%). The most common reasons for SM were healthcare facility charges (93.50%), emergency illness (1.63%), and delaying hospital services (0.41%), during the pandemic. Knowledge of SM was generally high, particularly among older age groups and individuals with a business or informal occupation. Amoxicillin (22.36%) and pain relievers (13.82%) were the most self-medicated drugs. Social networks, especially family members (47.17%), were the primary sources of SM information.

Conclusion: SM practices were widespread in Moriba Town during the COVID-19 pandemic, driven by economic barriers and limited healthcare access. Despite high knowledge of SM risks, gaps in public understanding of proper medication use were evident. Interventions focusing on healthcare affordability and public education on the safe and proper use of medications are necessary to mitigate inappropriate SM practices in similar settings.

Keywords: Self-medication, COVID-19 pandemic, Healthcare access, Moriba Town, Sierra Leone, Public health interventions.

The Awareness, Perceptions, and Prevention of Malaria Among Residents of Waterloo Community, Sierra Leone

Reuben Dauda — 2026-06-20

Malaria remains a major public health concern in Sierra Leone, particularly in endemic communities like Waterloo. Understanding local awareness, perceptions, and practices is essential for designing effective interventions. A cross-sectional survey was conducted among 250 residents of Waterloo community. The study assessed malaria symptom recognition, treatment perceptions, sources of information, and preventive behaviors using structured interviews. General awareness of malaria was high, with 99% of respondents having encountered malaria-related information. Fatigue (39%), fever (22%), vomiting (20%), and muscle pain (19%) were the most recognized symptoms. While 89% believed malaria is treatable, 10% were unsure and 2% denied treatment availability. Healthcare facilities (43%) and informal networks (42%) were the primary sources of information, whereas government programs (5%) and NGOs (0%) showed limited visibility. Only 24% had participated in malaria-related campaigns, and 130 respondents were unsure whether any initiative existed locally. Preventive knowledge was low: just 10% believed malaria is preventable, and misconceptions about transmission were common. Traditional medicine remained influential, with 60% expressing belief in its efficacy. Perceptions of malaria control efforts were mixed, and beliefs about symptom onset and seasonal severity varied. While Waterloo demonstrates high malaria awareness, persistent misconceptions, limited engagement, and low visibility of institutional efforts suggest the need for more inclusive, culturally sensitive, and community-driven approaches. Strengthening outreach, clarifying prevention strategies, and building trust through local engagement are essential to improving malaria outcomes in this and similar settings.

Keywords
Malaria awareness, Sierra Leone, Community health, Traditional medicine, Public health education, Prevention practices

Understanding Vision Impairment: A Comprehensive Study of Uncorrected Refractive Errors among Primary School Teachers and Pupils in Nongowa Chiefdom, Kenema District, Sierra Leone

Lawrence Sao Babawo — 2026-06-20

Introduction: Uncorrected Refractive Error (URE) is a major concern globally, particularly in developing nations like Sierra Leone, where limited access to eye care services pose challenges.

Aim: This study aims to investigate the prevalence of URE and associated knowledge, attitudes, and practices among primary school pupils and teachers.

Methods: Descriptive cross-sectional designs, incorporating both qualitative and quantitative methods were used. A structured survey questionnaire and visual acuity screening tools were used to assess uncorrected refractive errors among 692 randomly selected participants, and data analysis involved descriptive statistics and qualitative content analysis.

Results: A total of 374 pupils participated in this study, out of which 170 (45%) were boys and 204 (55%) were girls and a total of 318 teachers out of which 224 (70%) were males and 94 (30%) were females drawn from 145 public and 14 private schools, respectively. The prevalence of uncorrected refractive error to vision impairment was 66% with hypermetropia being the most prevalent while that of blindness was 0.13%. Girls contributed 29% of cases of uncorrected refractive error to vision impairment compared with 25% in boys and males and females 32% and 14% respectively. The age group most affected by uncorrected refractive error to vision impairment was 5-17 years at 54. Public schools contributed 91% of cases of uncorrected refractive error to vision impairment with private schools, accounting for 14%. Zones and type of school, with peri-urban characteristics contributed 24% of uncorrected refractive error to vision impairment cases while purely urban zones contributed 76%. Economic status and education influenced prevalence. Pupils exhibited varied knowledge, and teachers actively promoted eye health. Economic factors may have contributed to the observed differences in uncorrected refractive errors. Teachers played a vital role in promoting eye health education in primary schools.

Conclusion: The study highlighted the multifaceted nature of URE, involving demographic, economic, and educational factors. Addressing these complexities through targeted interventions is crucial for mitigating the burden of visual impairment in the region.

Keywords: Uncorrected Refractive Error, Visual Impairment, Sierra Leone, Primary School, Eye Health Education

Patterns Of Fungal Infections in Sputum of HIV Infected Patients with Lower Respiratory Tract Infections in Relation to CD4+ Lymphatic Counts in Central Medical Centre in Lagos, Nigeria

Colman Sunday Apagu — 2026-06-20

Fungal infections are serious Public Health Issues, particularly in People Living with HIV-AIDS. Human Immunodeficiency Virus (HIV) causes reduction of Clusters of (CD4) cells resulting to the disease syndrome. People Living with HIV (PLWH) are prone to respiratory infections, especially with mycoses and tuberculosis. Fungal infections cause respiratory tract diseases and other derangement, which include spread of necrosis, neurological disorder, depressed immune system leading to increased morbidity and mortality in PLWH. To detect the types of fungi in HIV positive patients with lower respiratory tract infections. To correlate the types of fungi with the CD4 count in the HIV positive patients. In a cross sectional study where 250 (200 PLWH and 50 HIV negative) participants attending clinic in Nigerian Institute of Medical Research Yaba, Lagos (NIMR). Expectorated sputum were collected in sterile cups and cultured in SDA, incubated at 25-27^o C. Identifications were done using Standard Laboratory Techniques. The CD4 count was done using The Standard Laboratory Techniques. Of the 200 PLWH, 163(81.5%) yielded fungi from their sputum, 19 of 50 (38.00%) HIV negative control had fungal infection (P=0.0001). The 163 isolated fungi from PLWA showed C. albicans (28.15%), A. niger (25.15%), A. fumigatus (13.50%), other Candida spp. (15.34%), A. flavus (7.36%), Penicillium spp. (8.60%), while Geotrichum spp., Mucor spp. and Cladosporum spp. had (0.61%) each. For HIV negative participants 2 types of fungi were isolated. Participants with CD4⁺ < 100/ul had (31.90%) of the fungi and those with CD4 cells > 400/ul had (12.27%) of the total fungal growth with P=0.0001.This study has shown that the isolated fungi C albicans, Aspergillus spp, Pennicillium spp. Geotrichum, Cladosporum sp, the presence of Candida albicans in females and the relatively low CD4 count are indications for laboratory Mycological investigations for proper patient management.

KEYWORDS: Fungi, HIV, infection, isolation and sputum.

The Burden of Past Hypertensive Disorders of Pregnancy in Females With CKD at Connaught Hospital, Freetown, Sierra Leone

Joshua Coker — 2026-06-20

Background: Hypertensive disorders of pregnancy (HDP) pose a significant long-term burden on maternal and fetal health globally and it is associated with an increased risk of developing chronic kidney disease (CKD) later in life. The objectives of this study include; The burden of past hypertensive disorders of pregnancy in females with CKD, to determine the relationship between hypertensive disorders of pregnancies and the development of CKD and to identify the risk factors for progression to CKD in patients with history of Hypertensive Disorders of Pregnancy (HDP).

Methods: This study was conducted at Connaught hospital. It is a cross-sectional study of females with CKD, using a structured and pretested questionnaire. Chronic kidney disease is defined as abnormalities of kidney structure or function, present for >3 months, with implications for health," and requires one of two criteria documented or inferred for >3 months: either GFR <60 ml/min/1.73 m2 or markers of kidney damage, including albuminuria.

Results: A total of 30 female patients with CKD were recorded during this study for analysis. Of this cohort, the majority of participants (83.3%) were aged 36-65years. Obstetric data showed that 54.2% were diagnosed with HDP in their second trimester. A vast majority (52.2%) experienced HDP during their second and third pregnancy. Grand multiparity was also commonly seen (26.1%). A high burden of past HDP (76.6%) in CKD females was noted. Preeclampsia was the most common type of HDP (56.5%). Notably, most patients (90.0%) presented with advanced CKD (Stages 4 & 5) at diagnosis.

Conclusion: There is a significant burden of past history of HDP in females with CKD and preeclampsia is the most common type of HDP. Patients presented with advanced CKD.

Key words: Hypertensive disorders of pregnancy (HDP), Chronic kidney disease (CKD), Preeclampsia, Renal outcomes

Osteogenesis Imperfecta in a Neonate: Case Report

Irene Eseohe Akhigbe — 2026-06-20

Osteogenesis imperfecta (OI) is a rare group of inherited connective tissue disorders characterized by increased bone fragility. Diagnosis of OI is mainly based on the clinical features of the disorder. We report, the case of a male neonate delivered via cesarean section at 38 weeks of gestation to a 20‑year‑old mother who has no family history suggestive of OI. He had clinical features of a type II OI and had a multidisciplinary approach to care. He was discharged for follow-up with pediatric and orthopedic specialists.

Keywords: Osteogenesis imperfect; Brittle bone disease and fragile bone disease; Term; Neonate