Dissertations / Theses: 'Sierra Leone. Ministry of Health'

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Chege, Eunice Nyambura. "Geographic Variations in Antenatal Care Services in Sierra Leone." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5062.

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Despite antenatal care presenting opportunities to identify and monitor women at risk, use of recommended antenatal care services remains. Barriers preventing use of antenatal services vary between countries, and limited knowledge exists about the link between geographical settings and antenatal service use. The objective of this cross-sectional quantitative study was to explore geographical variations and investigate how social demographic characteristics affect use of antenatal care for women in Sierra Leone using the Andersen behavioral model. The data used were from the 2016 maternal death surveillance report of the whole counrty (N =706). Logistic regression analysis was used to determine the individual predictor effects on antenatal care, including geographical location, the age of women, marital status, parity, and institution of birth impact. Southern, Northern, and Eastern women had significantly lower odds of attending the recommended antenatal services compared to women in the Western region (OR = .517, p = .019; OR = .497, p = .021; OR = 0.014, p = .041, respectively). The odds of married women attending the recommended antenatal services was 7.3 times more than that of the single women (OR = 7.397). Also, significantly associated with less uptake of recommended antenatal visits was lower education level among women (OR = .517). This study will contribute to positive social change by highlighting inequities in antenatal care use among women, thus allowing for accurate targeting of health promotion programs and ultimately saving lives of mothers and children of Sierra Leone through more inclusive policies.

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Bertone, M. P. "Exploring the complex remuneration of health workers in Sierra Leone." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2017. http://researchonline.lshtm.ac.uk/3482692/.

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The financial remuneration of health workers (HWs) is a key concern to address human resources challenges in many low-income countries. Analyzing the entire set of payments available to HWs is critical to understand the incentives they face, their motivation and performance, and ultimately to devise effective health workforce reforms. In this thesis, I investigate these issues by exploring the complex remuneration of HWs in Sierra Leone, defined as all income sources, both formal (salary, allowances, performance bonus) and informal (per diems, top-ups, private practice, nonhealth activities and illegal incomes). The study adopts a mixed-method approach. At central level, 23 key informants were conducted along with a stakeholder mapping workshop and a documentary review. At district level, 18 key informants were interviewed. Quantitative data were collected through a cross-sectional survey of 266 public HWs at primary healthcare level in three districts. Additionally, HWs were given a logbook to daily record their activities and incomes. Quantitative data at individual level were complemented with 39 in-depth interviews with a sub-sample of the same HWs. The analysis carried out in this thesis, first, sets the background to the complex remuneration by describing the incentive environment available to HWs as it developed during the post-conflict period, through policy-making processes at macro (central) level. It then investigates how the political economy dynamics between District Health Teams and NGOs at meso (district) level contribute to re-shape the incentive package. Moving to the micro (HW) level, I estimate the absolute and relative contribution of each income and I find that, while earnings from salary represent the largest share, HWs’ income is fragmented and composed of a variety of payments. Further data analysis shows that the determinants of the incomes are not in line with policies defined at national level and are influenced by the district of posting. Furthermore, the HWs’ narratives reveal the relevance of the features of each of their incomes (e.g., amount, regularity, reliability, ease of access, etc.) and the income use strategies through which HWs ‘manage’. Finally, I investigate whether the complex remuneration affects what HWs do or if there are other factors which constrain and/or influence HWs’ activities and service delivery. Findings from this research have important implications for how we go about (re)thinking financial incentive strategies. HWs’ income comes from a variety of sources, which they use differently. This questions the assumption of the fungibility of payments and highlights the potential consequences of increasing one rather than another of HWs’ incomes. Moreover, it is shown that the alignment of policies and incentive packages at central level may not be sufficient as dynamics at district level play a key role in influencing both HWs’ incomes as well as the activities they perform, thus effectively modifying incentive package and service delivery. From a methodological perspective, this thesis contributes to developing data collection and analysis techniques on the complex remuneration of HWs, which are relevant for a potential cross-country research agenda.

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Kanu, Alhassan Fouard. "Health System Access to Maternal and Child Health Services in Sierra Leone." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7394.

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The robustness and responsiveness of a country's health system predict access to a range of health services, including maternal and child health (MCH) services. The purpose of this cross-sectional study was to examine the influence of 5 health system characteristics on access to MCH services in Sierra Leone. This study was guided by Bryce, Victora, Boerma, Peters, and Black's framework for evaluating the scaleup to millennium development goals for maternal and child survival. The study was a secondary analysis of the Sierra Leone 2017 Service Availability and Readiness Assessment dataset, which comprised 100% (1, 284) of the country's health facilities. Data analysis included bivariate and multivariate logistic regressions. In the bivariate analysis, all the independent variables showed statistically significant association with access to MCH services and achieved a p-value < .001. In the multivariate analysis; however, only 3 predictors explained 38% of the variance (Rï¿½ = .380, F (5, 1263) = 154.667, p <.001). The type of health provider significantly predicted access to MCH services (Î² =.549, p <.001), as did the availability of essential medicines (Î²= .255, p <.001) and the availability of basic equipment (Î²= .258, p <.001). According to the study findings, the availability of the right mix of health providers, essential medicines, and basic equipment significantly influenced access to MCH services, regardless of the level and type of health facility. The findings of this study might contribute to positive social change by helping the authorities of the Sierra Leone health sector to identify critical health system considerations for increased access to MCH services and improved maternal and child health outcomes.

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Samba, Sheku. "Obstetric Fistula| The Experiences of Patients and Medical Personnel in Sierra Leone." Thesis, Walden University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10636481.

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Women face great risks in pregnancy and childbirth, especially in developing countries where there are very few skilled birth attendants and negligible government investments in maternal health programs. As a result, obstetric fistula (OF), a potentially fatal but preventable and treatable condition, affects some 3 million women and girls globally. In Sierra Leone, the prevalence of OF is extremely high, but the absence of quality data to inform decision-making, both on prevalence and risk factors, is a barrier to creating an environment for OF prevention and care. The purpose of this phenomenological study was to explore and document the barriers to medical care, and the perceptions of patients and medical personnel concerning the complexities of OF. In-depth interviews were performed over a 2-month period with 12 patients and 8 medical personnel at the Aberdeen Women's Center in Freetown, Sierra Leone. Results showed that patients face multiple medical barriers including high costs, fear of hospital treatment, severely inadequate treatment, and severe physical sequelae including paralysis and foot dragging. Multiple emotional, social, and financial harms related to OF were also reported, including stigmatization, abandonment by family, embitterment, depression, and job loss. Most patients expressed a preference for traditional birth assistants over medical personnel. However, many also benefitted from the intervention of friends or other good Samaritans. The results and recommendations from this study should be helpful in informing the general public and policy-makers about OF as a major public health problem, and in the design and delivery of programs to eradicate or alleviate the problem of OF in Sierra Leone.

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Samura, Salifu Salito. "The Impact of Free Healthcare on Hospital Deliveries in Sierra Leone." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2334.

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Improving maternal health has been a challenge for developing nations with very high rates of maternal mortality. Sub-Saharan Africa, particularly Sierra Leone, has some of the highest maternal mortality rates in the world. In an attempt to improve on this, the Sierra Leonean government enacted free maternal healthcare services in 2010. The Sierra Leone Free Healthcare Initiative (SLFHCI) provides free healthcare for pregnant women, lactating mothers, and children under 5 years old. This research explored the impact of the free healthcare on hospital deliveries. The determinant of health model was used to evaluate the effectiveness of the SLFHCI program, and a quantitative study design was used to analyze 1,200 samples of secondary data. Five research questions aimed to determine how the pre and postimplementation periods of the SLFHCI program impacted the rate of antenatal services usage, hospital deliveries, low birth weight deliveries, very low birth weight deliveries, and preterm deliveries. Descriptive statistics, chi-square tests, and logistic regression were used to analyze data. The results indicated improvements in antenatal visits, hospital deliveries, low birth weight deliveries, and preterm deliveries after adjusting for covariates. The results suggest that the SLFCHI program is an effective strategy for preventing low birth weight and preterm deliveries and for improving antenatal visits and hospital deliveries. The knowledge gained from this research could provide a roadmap for improving overall maternal care in Sierra Leone and other affected countries. Strategies to improve the quality of the SLFHCI intervention are worthy of further investigation

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Fendt-Newlin, Meredith Leah. "Enhancing mental health practice in Sierra Leone : a social intervention development study." Thesis, University of York, 2018. http://etheses.whiterose.ac.uk/20671/.

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Inadequacy in mental health care in low and middle-income countries has been an important contributor to the rising global burden of disease. The evidence base is building for innovative solutions to reduce the mental health treatment gap. However, what has largely been missing is the development of interventions which incorporate the nature of the social environment that contributes to the risk, cause, and maintenance of mental health conditions. This thesis aimed to explore the potential for social interventions to reduce the mental health treatment gap (greater than 95%) and the burden on resource-poor services in Sierra Leone. This thesis presents a methodological framework for social intervention development in low-resource settings. First, a feasibility and acceptability study examined stakeholder perceptions (n=59) using rapid ethnographic methods. Second, the evidence base and feasibility findings were modelled and validated in focus groups with Sierra Leone stakeholders (n=9) and members of the United Kingdom the Diaspora community (n=5). Third, a pilot study assessed the impact of the adapted intervention on district level mental health nurses’ knowledge, skills, attitudes, and behaviour (n=20) using qualitative data and a training evaluation tool developed co-productively with stakeholders. The intervention model endured several iterations as the context in the country changed due to the Ebola outbreak. The pilot study showed post-training improvement of skills in communicating and building relationships with service users, identifying assets and linking to community resources. Barriers to embed the model into nurse practice were identified such as stigma, reluctance to change from district health managers and policy makers, and significant financial and time constraints. This study suggests that it is important to harness local understanding of mental health conditions, build capacity of the existing workforce and enhance community engagement with services for mental health social intervention strategies to be effective.

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Sesay, Mohamed Lamin. "Patient Characteristics and Treatment Outcomes Among Tuberculosis Patients in Sierra Leone." Thesis, Walden University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10269501.

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Despite decades of the implementation of the directly observed therapy short-course (DOTS), Sierra Leone is ranked among the 30 highest TB-burdened countries. Several factors account for unfavorable treatment outcomes, among which are patient characteristics. Previous studies have only focused on treatment compliance without any consideration for the factors that lead to noncompliance to treatment. The purpose of this study was to investigate patient characteristics that are associated with treatment noncompliance (treatment not completed) among TB patients undergoing the DOTS program in Sierra Leone. A retrospective longitudinal quantitative design was used to analyze secondary data from the completed records of 1,633 TB patients, using the Andersen’s behavioral model of health services utilization as a theoretical framework work. Descriptive statistics and bivariate and multivariate logistic regressions were used to analyze the data. The results show that there was no significant association between treatment completion and age, gender, and TB-case category. On the other hand, being HIV-positive decreases the odds of treatment completion. Also, the educational level, geographic location, and year of treatment were significantly associated with treatment completion. Overall, program performance improved as the number of dropouts decreased significantly between 2013 and 2015. The social change implication of this study was that it identified HIV-positive patients and rural communities as areas needing specific attention such as the assignment of case managers to ensure compliance thereby improve DOTS program performance, thereby reducing the incidence and transmission of TB.

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Davids, Saarah Fatoma Gadija. "The correlation between the serious diseases affecting child mortality in Sierra Leone." University of the Western Cape, 2011. http://hdl.handle.net/11394/5364.

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Magister Philosophiae - MPhil
Child mortality in Sierra Leone is the highest ranked in the world. Government officials and researchers have tried to understand how and why this has become such a big phenomenon in Sierra Leone. Researchers have come up with three main causes for child mortality in Sierra Leone: maternal factors, environmental factors and health factors. The majority of research has been carried out on maternal, as well as environmental factors. However, minimal research has been carried out on health factors in Sierra Leone. Therefore, the objective of this study is to see how maternal and environmental factors have an effect on health factors, which in turn causes child mortality. The data used was from the 2008 Sierra Leone Demographic and Household Survey (SLDHS). The child dataset was used as it contained the information required from both the mother and the child. Of the three categories that were used, the first was maternal factors, which included the mother’s age, the mother's occupation, the mother's education, the sex of the child, the birth number and religion. The second category was environmental factors, which included the source of water, type of toilet, place of residence, source of energy and the dwelling material used for the household. The final category was health factors, which included whether the child had a fever in the last 2 weeks, short rapid breaths, a cough or fever, a problem in the chest or runny nose and whether the child had Diarrhoea recently and still has Diarrhoea. The study showed that child mortality had four statistically significant factors associated with it: place of residence, birth number, religion and type of toilet facility. Furthermore, when it came to diseases affecting children, the SLDHS had not given much information, so we looked only at the effects it had on children. From our results, we concluded that ARI, Diarrhoea and Measles each had one variable that was statistically significant to it. As for Pneumonia, there were no variables associated with children contracting the disease.

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Tsawe, Mluleki. "Inequalities in the use of maternal and reproductive health services in Sierra Leone." University of the Western Cape, 2019. http://hdl.handle.net/11394/6660.

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Philosophiae Doctor - PhD
This thesis extends the literature on the trends and magnitude of health inequalities in the area of maternal and reproductive health services in Sierra Leone, and particular across sub-Saharan Africa. It attempted to provide a good understanding of, not only the determinants of maternal and reproductive healthcare use, but also factors that enable health inequalities to exist in Sierra Leone. This is an appropriate topic in population health studies as it aims to address important questions on the research agenda in the context of sub-Saharan Africa, particularly in a country with poor health outcomes such as Sierra Leone. A proper understanding of not only the coverage rates of population health outcomes but also the extent of health inequalities as well as the factors that contribute to these inequalities is crucial for any government. The thesis applied various techniques in the analysis of DHS data (from 2008 and 2013 rounds) in an attempt to answer the research questions.

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Fabricant, Stephen Joel. "Community financing in Sierra Leone : affordability and equity of primary health care costs." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1992. http://researchonline.lshtm.ac.uk/682247/.

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Critics of user charges for government primary health care have focussed on the deterrent effect these charges might have on the poor, but there is little convincing empirical evidence that supports or contradicts these claims. The main research aims were to assess the equity effects of user charges for curative PHC services on households in 2 rural districts of Sierra Leone, a country that has suffered severe economic hardship in the last decade. Secondary objectives were to assess the feasibility of using objective means-testing to identify patients for exemption, and to recoimiend a simple methodology for acquiring the same information for local, operational purposes. A survey of 1156 households was carried out in the dry post-harvest season, and covered a range of household economic factors in addition to the actions taken in response to all reported illness episodes. A followup survey was made the following rainy season to assess seasonal effects. Supplementary information was obtained through focus groups and case studies. The data were analyzed within the framework of a conceptual model which assumed that preferences, access, and ability to pay were the main factors (or groups of factors) that determined which of several medical and non-medical treatment options would be used. Multiple regression models were used to assess the effects of each group of factors. The main findings were that, while wealthier households used cheap market drugs and expensive medical treatment options more than the poor, there was little difference in use of medium-priced PHC treatment. Household wealth and income factors correlated weakly with amounts actually paid for treatment. The immediate availability of money in the household appeared to be the economic factor most affecting utilization, with wealthier households nearly as likely = to have the amounts needed for PHC treatment on hand as poorer ones. Distance was a much more important determinant of choice of treatment than was income or assets, as were certain preference factors. However, the poor spent a much higher proportion of household income on treatment than the wealthy, so a way of limiting total expenditures for the poor would be more important than limiting their deterrence. Several readily-ascertained household factors correlated well with household income, but means-testing was concluded to be an inefficient way to accomplish the objective of selectively limiting expenditures unless incorporated into a prepayment scheme.

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Yumkella, Fatu. "Assessing the priority of health problems : the case of schistosomiasis in Sierra Leone." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.536756.

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Davies, Marcella. "Women's Perceptions of Malaria in the Western Rural Areas of Sierra Leone." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5618.

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Malaria is one of the leading causes of death for children and women in Sierra Leone. The purpose of this qualitative study was to explore and understand the lived experiences of women from the rural areas of Sierra Leone regarding malaria. A purposive sample of Krio women from the western rural area, aged 21-55 years, spoke English, and had taken care of someone with malaria described their perceptions and lived experiences with the disease in face-to-face interviews. The research questions were based on the health belief model and focused on knowledge, beliefs, and perceptions about malaria prevention and treatment. Interpretative phenomenological analysis was used to identify themes through coding. The findings indicated that (a) lack of doctors, medicines, and medical supplies at government clinics discourages malaria victims from visiting those clinics; (b) the use of traditional herbs is prevalent because of their effectiveness, affordability, easy access, and lack of side effects; (c) women were not aware of recommended comprehensive malaria control measures, which include the continuous use of durable insecticide nets, residual spraying, case management, and artemisinin-based therapy. The results also show that (a) pregnant women should not take prescribed medications to prevent or treat malaria because they harm the fetus, and (b) traditional herbs may be taken with Western medicines to treat severe malaria. Recommendations include: that the government evaluate the efficiency and effectiveness of its current malaria programs in local clinics, and that future studies be undertaken to identify antimalarial properties in commonly accepted local herbs. Changes in policies and practices relating to the prevention and treatment of malaria will serve as building blocks for positive social change to reduce the malaria incidence rate in Sierra Leone.

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M'Cormack, Fredanna A. D. "Ecological Determinants of Anemia in Pregnant Women Living in Freetown: Urban Western Area, Sierra Leone." OpenSIUC, 2008. https://opensiuc.lib.siu.edu/dissertations/262.

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Introduction Anemia prevalence in pregnancy ranges from 51%-60% globally. Genetic disorders, infectious diseases, reproductive factors, nutritional deficiencies, and poverty can affect anemia status. Anemia can negatively impact economic progress, social and intellectual development, and maternal health. Estimates indicate that anemia is the direct cause of 3-7% of maternal deaths and an indirect cause of 20-40% of maternal deaths. Although several initiatives by the international community address the anemia problem, prevalence remains unacceptably high in Sierra Leone at 2,000 per 100,000 live births. This study explored ecological determinants of anemia status of pregnant women living in Freetown, Sierra Leone. Method This was a mixed-method, retrospective, unmatched case-control research study based on the Modified Ecological Model for Health Behavior and Health Promotion. One hundred and seventy one pregnant women, who visited one of five health facilities were interviewed for the study. Anemic participants' (Hgb<11.0g/dL) responses were compared to responses of non-anemic participants and the differences were assessed. Content analysis and descriptive statistics were used to assess qualitative knowledge items, whereas t-tests were conducted to determine if mean knowledge differences existed between those with anemia and those without. Chi-square was used to analyze forced choice attitude items: perceived threat to anemia and perceived benefits of anemia prevention and treatment. Chi-square was also used to analyze selected behaviors and perceived barriers to anemia prevention and treatment. Odds ratio determined the strength of the relationship between the dependent variable (anemia status) and selected exposure variables (modifying factors). Results Seventy-seven percent of participants were anemic (M: Hgb=9.63g/dL). Those with anemia were more likely to first see a health care provider after 12 weeks of pregnancy (p<.05). Participants who earned income in the top two quintiles were less likely to have anemia than those in the lower three quintiles (p=.007). Participants who had anemia were more likely to cite lack of finances as a barrier to seeking prenatal services (p=.007). Although differences existed between participants who had anemia and those who did not have anemia, they were generally not statistically significant for knowledge, behavior or modifying factors. Participants who had pica, however, were more likely to have anemia than those who did not (p=.005). There was misinformation among participants about the use of palm oil, Vimto and "blood tonic" as treatment options. In addition, participants cited family and friends as sources of this same information as well as correct suggestions and information about anemia prevention and treatment. Discussion Health providers need to be clearer about messages that they deliver to service users to reduce misinformation about anemia prevention and treatment. Community awareness about anemia, anemia causes, anemia prevention and anemia treatment needs to be raised. Information, particularly about anemia causes, need to be disseminated and programs to address those causes need to be developed and implemented. Program development and implementation should be a comprehensive effort that includes training traditional birth attendants and lay health workers. Efforts should incorporate health efforts from government agencies, the non-governmental sector, donor groups, and community and civil society groups to deliver culturally and regionally appropriate interventions.

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Bond, Nell G. "Understanding the Emergence of HIV-2 Group F, a Novel, Pathogenic HIV-2 Indigenous to Sierra Leone." Thesis, Tulane University, School of Public Health and Tropical Medicine, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3734417.

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Background: AIDS is caused by infection with pathogenic strains of HIV-1 or 2. HIV-2 is broken into 9 groups, A-I. Groups A and B are epidemic in West Africa while the remaining groups are individual cases and are not known to be pathogenic. HIV-2F is an exception being both pathogenic and found in 2 persons, suggesting transmissibility. HIV's origins have been widely studied, however, questions remain. The simian ancestry of HIV is well established yet exactly how SIV adapted to HIV in humans is still unknown. Several theories have been put forth to explain HIV emergence from SIV including the serial passage theory of HIV emergence. Here we conduct an HIV survey in northern Sierra Leone (SL) to assess the public health threat of HIV-2F and also model the serial passage theory of emergence both in vivo and in vitro to elucidate mechanisms of adaptation.

Materials and methods: For the human HIV study in northern SL, we enrolled persons presenting for a voluntarily HIV test following education and outreach activities and those referred for an HIV test. This is a targeted, higher risk population than the general population. Commercial HIV-1/2 rapid tests were used in the field. Proviral DNA was amplified with PCR methods and sequenced with Sanger methods. Parallel pigtailed (PTM) and rhesus macaque in vivo and in vitro models were used to test the serial passage theory of HIV emergence. Virus was detected with an HIV-2F specific qPCR and commercial SIV p27 Antigen ELISA. Illumina methods were used to deep sequence day 3 samples with peak virus loads. A SNP analysis was conducted to investigate virus variation over serial passage.

Results: To date we have found the prevalence of HIV in the targeted sample population to be 6.36%. HIV-2 rates in the targeted sample were 0.50%, HIV-1 was 4.81% and apparent co-infections were seen in 1.06% of those tested. Two HIV-1 samples have been sequenced and typed to CRF02_AG. Attempts to PCR amplify proviral DNA from HIV-2 antibody positives were negative, possibly due to low virus load. In vitro, over serial passage, peak virus load decreased to undetectable, the opposite of what was expected. In fact, the in vitro serial passage results exactly contradict what was observed in a parallel in vivo serial passage experiment. In vivo we saw an increase in PVL over serial passage in the PTMs and viral escape in passages 2 and 3. SNP analysis showed mutations over serial passage allowing the virus to adapt to a new host in vivo.

Conclusion: In this study we asked two main research questions. First, is HIV-2F a public health threat? This question remains unanswered due to our inability to sequence the HIV-2 samples collected in this study. However, the samples remain preserved for applying different techniques. We described HIV burden in a self-selected, at risk population in northern Sierra Leone providing the first HIV-2 data in 20 years. We also provided the first HIV-1 sequence data from Sierra Leoneans living in Sierra Leone, all previous data are from SL immigrants to Europe or the USA. The second question was, can the serial passage hypothesis of HIV emergence be modeled to elucidate the role of serial passage in HIV cross-species transmission, adaptation and diversity? We successfully showed that this can be done through the in vivo serial passage experiment in pigtailed macaques. Together the data from the field studies along with the in vivo and in vitro models presented in this thesis provide a better understanding of mechanisms of HIV emergence as well as much needed information about HIV distribution and genetic diversity in northern Sierra Leone.

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Cham, Alphajoh. "Mining and HIV/AIDS Transmission Among Marampa Mining Communities in Lunsar, Sierra Leone." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1642.

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Since the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) was first reported in Sierra Leone in 1987, its prevalence rate has stabilized at 1.5% in the nation's general population. However, concerns exist regarding the potential increase in high-risk populations, particularly among mineworkers and commercial sex workers. The potential spread of HIV/AIDS as a result of labor migration may threaten the mining sector, which has been identified as a critical driver of recent economic growth and development. A gap remains in the literature regarding the contextual factors in mining communities that lead to high rates of HIV/AIDS. Therefore, the purpose of this study was to quantitatively examine the association between labor migration and of sexual risk behaviors among mineworkers in the Marampa Mines in Lunsar, Sierra Leone. Grounded in the ecological model and using a cross-sectional design, 296 mineworkers from the Marampa mining communities were surveyed using a standardized survey questionnaire. Research questions were answered using simple linear and binary logistic regression analyses. Analyses of the results indicated a significant relationship between labor migration and condom self-efficacy, where migrants were predicted to have condom self-efficacy scores 7 times higher than nonmigrants. However, the results showed no statistically significant relationship between labor migration and engagement in multiple sexual partnerships and commercial sex among the mineworkers. These findings will provide important implications for positive social change in the development of multilevel HIV intervention programs to reduce sexual risk behaviors that transmit HIV, thereby improving the health and wellbeing of miners and that of their partners and families in the mining communities.

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Strober, Rashida. "The Impact of Structural Adjustment on Health, Education and Employment: A Case Study on Sierra Leone." Scholar Commons, 2005. http://scholarcommons.usf.edu/etd/7115.

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Since their inception in African countries, structural adjustment has tended to cause more harm than help. This thesis aims to answer the question, in what ways have structural adjustment policies impacted Africa in general and Sierra Leone in particular? This question is highly relevant when it is considered that Africa is one of the poorest regions in the world and has experiences much conflict and suffering. In addition, much is known about the impact of structural adjustment in many African countries. However, little has been written on the impact of structural adjustment in Sierra Leone, especially in terms of the impact of structural adjustment on conflict. The hypothesis of this thesis is that the impact of structural adjustment policies has tended to increase poverty. Poverty has led to frustration and conflict in Africa in general and Sierra Leone in particular. In order to substantiate this hypothesis I have elected to focus on the years between 1960 and the late 1980s. The finding contained within this thesis show that structural adjustment policies may have led to a reduction of social services that include health, education and unemployment.

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Rodriguez, Candice A. "Risk Factors for Poor Birth Outcomes in Moderately Malnourished Pregnant Women in Sierra Leone." DigitalCommons@CalPoly, 2020. https://digitalcommons.calpoly.edu/theses/2241.

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Background: Maternal malnutrition in developing countries is associated with adverse pregnancy and birth outcomes. Malnourished mothers are often faced with additional risk factors as a circumstance of poverty. Supplementary nutrition can improve the outcomes of both mother and infant. Identifying maternal nutritional and socioeconomic risk factors is critical for developing effective interventions. Objective: A secondary analysis to evaluate maternal risk factors associated with poor birth outcomes including pregnancy loss, low birth weight, stunting, and preterm delivery among moderately malnourished pregnant women in Sierra Leone. Maternal risk factors in the analysis are age, education, parity, BMI, MUAC, gestational weight gain, and recent exposure to malaria infection. Methods: Pregnant women were enrolled into a randomized controlled trial when presenting with a MUAC ≤ 23cm (N=1475). Demographic information was collected and women were randomly assigned two receive either a ready-to-use supplementary food (RUSF) or a corn-soy blended flour with an iron and folic acid supplement (CSB +IFA). Anthropometric measurements of height, weight, MUAC, and fundal height were measured every two weeks during pregnancy. Upon delivery the infant was measured for length, weight, MUAC, and head circumference and the mother was measured for MUAC. Infant outcomes of interest included stunting (length-for-age z-score Results: The mean age of enrolled pregnant women was 21.2 years with a mean BMI of 19.78 kg/m2. A total of 33.2% had never attended school. Controlling for weeks on treatment and BMI at enrollment, mothers receiving the RUSF treatment gained a mean 0.49 kg (p2 produced infants that were significantly smaller than women with a BMI ≥ 18.5 kg/cm2 . Similarly, infants born to women with a MUAC(p=0.004) and had a 0.26 cm smaller MUAC (p=0.008) compared to women with a MUAC ≤23. Additionally, for every one unit decrease in maternal MUAC, women has 1.2 greater odds of preterm delivery (p=0.022). Also, women with adequate weekly weight gain gave birth to infants with a 0.37 cm greater mean length (p=0.012), 7.0 g greater mean weight (p=0.030), and 0.08 cm greater mean MUAC (p=0.045) than women with inadequate weight gain. No association was found between recent exposure to malaria at enrollment and poor infant outcomes. Conclusion: In resource poor settings like Sierra Leone with high rates of maternal malnutrition and a high burden of stunting, LBW, and preterm delivery, use of RUSF improved maternal nutritional status but did not impact infant outcomes. The youngest adolescents had the most adverse infant outcomes. Education did not have the expected outcome, indicating other risk factors in this population may play a greater role in infant outcomes. Maternal risk factors of malnutrition such as BMI2and MUACpregnancy, women should be encouraged to gain adequate weight. Young primiparous adolescent are at the highest risk and interventions to postpone motherhood should be priority.

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Kamara, Joseph. "Essays on willingness and ability to pay for health insurance among informal sector workers in Sierra Leone." Thesis, City University London, 2015. http://openaccess.city.ac.uk/14564/.

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Access to health care is a serious problem in Sierra Leone, more so in rural areas where living standards are low and there is absence of health care facilities. Health insurance, it is argued, will play an important role in giving access to medical care and reducing the high out of pocket (OOP) health expenditure, thus preventing unnecessary deaths and increasing well-being. It is however difficult to know the exact value households place on health and health care as they are not generally exchanged in the market place. For this reason, nonmarket valuation is increasingly becoming an important tool for informing policy makers. The Contingent Valuation and Discrete Choice Experiment (DCE) are the most widely used methods. However, due to its increased popularity, the ability to calculate incremental benefit of each attribute used, and it proving to be more appealing, this work therefore used the DCE method to collect data. This study provides the following: first, a review of the application of DCE to health outcomes including health insurance for the period 1990 – 2013; second it estimates the willingness to pay (WTP) for health insurance; third, it estimates the impact of corruption on participation in health insurance; and finally, it looks at ability to pay (ATP) for health insurance among informal sector workers in Sierra Leone using a DCE method. The four essays/papers (Chapters 2 – 5) represent the main outcomes of this research. Eight informal sector activities were selected namely – petty trading, subsistence farming, commercial bike riding (“okada”), cattle rearing, fishing, tailoring, alluvial mining and quarrying. More precisely, the first empirical paper used a random effect logit model to estimate households’ WTP for health insurance for an improvement in coverage, choice of provider and a reduction in waiting time. The second empirical paper on the impact of corruption introduces two definitions of corruption – perceived and actual (free health care). The study used the mixed logit (MXL) model to estimate the impact of corruption on households’ participation in health insurance. The final empirical paper on the other hand looked at ability to pay for health insurance. This paper is built on the assumption that simply perceiving need for health insurance is insufficient for someone to participate in it. Participation in health insurance is backed by the financial ability of the household to pay for health insurance. This study used two approaches: a univariate probit (naive) model and a recursive bivariate probit method (RBPM). We use data from discrete choice experiment to estimate ability to pay for health insurance. Conditional on a set of covariates, the findings of the thesis suggest the following: first, that households are willing to pay for health insurance for an improvement in coverage, choice of provider (public and non-public) and a reduction in waiting time; second, that corruption generates substantial additional cost to households, hence the higher WTP to participate in schemes with evidence of corruption, more so, actual (free health care) corruption; and finally, that households do not have the financial capacity to pay for health insurance. Our result also shows that households that perceived NEED do not only have the ability to pay for it but are also not likely to participate in the scheme.

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Sankoh, Alhaji Ibrahim. "An assessment of pesticide use, contamination and impact on the environment and the health of people in Sierra Leone." Thesis, Lancaster University, 2016. http://eprints.lancs.ac.uk/82526/.

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One of the biggest challenges faced by Sierra Leonean farmers is pest control. Birds, insects, rodents, crustaceans and other organisms can drastically reduce yields. In order to prevent these organisms from destroying their crops, farmers use pesticides. However there are reports that these chemicals are being misused and are having negative impact on the environment and the health of the farmers. This research aimed to investigate pesticide use in rice fields and its potential effects on the environment and the health of rice farmers. The research also studied the fate of chlorpyrifos (the most widely used pesticide) in Sierra Leone soils when applied using local methods used by farmers in Sierra Leone. Five hundred farmers and one hundred health workers across the country were interviewed. Fifty focused group discussion were done. Field observations were also done. Two experimental plots (one on a boliland and one on a riverine ecosystem) on which rice cultivated were setup. Three concentrations of each of chlorpyrifos diethyl, chlorpyrifos dimethyl and a 1:1 mixture of chlorpyrifos diethyl and chlorpyrifos dimethyl were applied. Soils and rice samples from the plots were analysed for residual chlorpyrifos. Soils, rice and biota samples were from rice fields were also analysed for residual chlorpyrifos. It was found that the prevalence of pesticide use on rice farms is high and the chemicals are misused. Farmers are exposed to pesticides. Cases of pesticide related symptoms investigated in this research were found to be more prevalent among farmers that use pesticides than those not using pesticides. Chlorpyrifos is not persistent in Sierra Leone soils when recommended doses are applied. Levels of chlorpyrifos in rice samples are far below the UK and WHO recommended maximum limits when recommended doses are applied during cultivation. Soils from farms are highly contaminated. Rice and biota samples from the farms are contaminated and their consumption can expose humans to levels that could cause chronic effects.

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Beyer, Molly. "The Public Health Response to an Ebola Virus Epidemic: Effects on Agricultural Markets and Farmer Livelihoods in Koinadugu, Sierra Leone." Thesis, University of North Texas, 2019. https://digital.library.unt.edu/ark:/67531/metadc1538797/.

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During the 2013/16 Ebola virus disease outbreak in West Africa, numerous restrictions were placed on the movement and public gathering of local people, regardless of if the area had active Ebola cases or not. Specifically, the district of Koinadugu, Sierra Leone, preemptively enforced movement regulations before there were any cases within the district. This research demonstrates that ongoing regulations on movement and public gathering affected the livelihoods of those involved in agricultural markets in the short-term, while the outbreak was active, and in the long-term. The forthcoming thesis details the ways in which the Ebola outbreak international and national response affected locals involved in agricultural value chains in Koinadugu, Sierra Leone.

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Gallo, Josie Eve. "The role of film in maternal health communication in low-income countries : An analysis of ‘Di Kombra Di Krai (Cry of a Mother)’ – a maternal health drama in Sierra Leone." Thesis, Malmö universitet, Malmö högskola, Institutionen för konst, kultur och kommunikation (K3), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-39257.

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Maternal mortality rates in low-income countries remain high and almost two thirds of global maternal deaths are in sub-Saharan Africa (WHO, 2019). Communications interventions such as media and entertainment education initiatives could help improve maternal health outcomes. The aim of this research is to explore this area further; focusing on the case study of ‘Di Kombra Di Krai (Cry of a Mother)’, a maternal health drama produced in Sierra Leone in 2020. The research utilises interviews with key stakeholders in the production, and content analysis, to understand why film is an appropriate medium of communication for maternal health, the processes involved, and the benefits to the participants. This research aims to provide further information that will be beneficial for communication for development professionals and organisations on the role of film in maternal health communication in low-income countries.

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Colorado, Eileen Ellsworth. "A Mixed-Method Study of Aid Workers in Sierra Leone during the 2014-2015 Ebola Epidemic| Exploring Psychological Distress, Trauma, Resilience, and Coping." Thesis, The Chicago School of Professional Psychology, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10743390.

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Sierra Leone suffered the worst Ebola outbreak in history. This is a study of Sierra Leone aid workers during the 2014–2015 Ebola epidemic using the mixed-method concurrent nested model. Data collection consisted of 4 quantitative surveys (BSI, PDS-5, CD-RISC, and CSI), demographic information sheet, and qualitative semi-structured interviews. The findings show 53% met the criteria for psychological distress indicated by the BSI and 40% met the criteria for PTSD indicated by PDS-5. The highest score on CD-RICS resilience questionnaire indicated a belief that God can help them. The CSI revealed 15% of the participants used wishful thinking, social support, problem-solving, and cognitive restructuring coping strategies. Sociocultural factors showed significant impact on NAWs during the Ebola epidemic The qualitative themes that emerged in the responses of the participants included psychological distress, trauma, coping, resilience, economic factors, social structure shift, social factors, basic needs, community support, infrastructure, and changing cultural practices.

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Antwi-Boasiako, Kingsley. "Reporting Health Emergency Outbreaks: African Journalists on the Frontlines of Ebola Coverage." Ohio University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1490939539694056.

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Panda, Comfort Kenyeh. "Kono Members' Perceptions of Burial Practices and the Spread of Ebola Virus Disease." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6088.

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Sierra Leone was heavily affected by the West African Ebola virus disease (EVD) epidemic from 2013 to 2016. Ongoing EVD transmission during the epidemic was connected to several factors including unsafe traditional burial practices. This phenomenological qualitative study addressed Kono members' perceived knowledge, attitudes, and beliefs regarding how burial practices influenced EVD transmission. Rosenstock's health belief model provided the framework for the study. The participants purposefully selected from various religions and professions were interviewed individually and in focus group settings. Similar phrases and comments were identified from the interview responses resulted which resulted in the following 5 main themes: (a) Kono community leaders and public health workers were cognizant of important EVD issues, but there was a knowledge deficit among Konos about EVD and its mode of transmission; (b) although customary burial rituals were temporarily banned from 2014 to 2016, they were practiced among the Konos to promote culture-driven dignity and respect for the dead; (c) many Konos harbored grudges and mistrusted government officials and public health workers; (d) infrastructural deficits were a barrier to health care as private and public sectors lacked training and equipment to mitigate the 2013-2016 EVD outbreak; and (e) participants were willing to adopt safer burial practices if EVD outbreaks were to reemerge. These findings indicated that EVD transmission was connected to unsafe burial practices. Findings may be used to improve community engagement and public health outreach efforts to promote safer burial practices, especially during periods of infectious disease outbreaks.

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"Village-level distribution of mastomys natalensis and arenavirus in eastern sierra leone." Tulane University, 2011.

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Nwafor, Gloria Chidimma. "Protection of the right of healthcare of people infected with ebola virus disease (EVD) : a human rights-based approach." Diss., 2016. http://hdl.handle.net/11602/623.

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LLM
Department of Public Law
Human rights are those inalienable rights of an individual by virtue of being a human being. They are guaranteed by various domestic and international instruments. This research argues that despite the existence of these instruments and wide acceptances of international human rights standards that seek to protect the right to healthcare, the people infected with Ebola Virus Disease (EVD) are victims of a wide range of constraints to their right to healthcare as a result of the failure by the governments of the respective nations where the impacts of the EVD are mostly felt to discharge their obligations under those instruments. The rights of the people infected with EVD are often violated because of their presumed or known EVD status, causing them to suffer both the burden of the disease and the social burden of discrimination and stigmatisation which could deter the infected persons from accessing available treatment. This would invariably contribute to the spread of the disease. The research further exposes the dilemma posed by the EVD to the healthcare system, where healthcare providers are caught between the rock of selfpreservation from a highly virulent disease and the hard place of discharging their Hippocratic Oath which prescribes ethical guidelines for the discharge of the duties of the medical profession. The present research, which is novel in the field of medico-legal research, seeks to proffer answers to this conundrum.

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Voves, Petr. "Úloha Světové zdravotnické organizace v případu epidemie viru eboly na území západní Afriky v roce 2014." Master's thesis, 2017. http://www.nusl.cz/ntk/nusl-357454.

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VOVES, Petr. Úloha Světové zdravotnické organizace v případu epidemie viru eboly na území západní Afriky v roce 2014. Praha, 2017. 95 s. Diplomová práce (Mgr.) Univerzita Karlova, Fakulta sociálních věd, Institut politologických studií. Katedra mezinárodních vztahů. Vedoucí diplomové práce PhDr. Irah Kučerová, Ph.D. Abstract The M.A. thesis deals with the World Health Organization's response to the outbreak of the ebola virus disease in Guinea, Liberia and Sierra Leone in 2014. The spread of the disease is mapped from its very beginning at the end of December 2013 until the creation of UNMEER in September 2014, which was the first international medical mission ever created by UN Security Council. The purpose of this thesis is to evaluate the particular problems, which limit WHO's role in a timely and effective response to the public health threats of international concern (PHEIC) under the reformed International Health Regulations (IHR). The response of WHO representatives to the spread of the disease is evaluated taking into account the available material and competence capacities of the organization as well as its previous practice in this field. The specific misconduct of WHO representatives is explained in the context of longstanding WHO's problems, which are mainly linked to the vertical fragmentation...

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Dissertations / Theses on the topic 'Sierra Leone. Ministry of Health'

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