Assessment of antimicrobial stewardship programmes and antibiotic use among children admitted to two hospitals in Sierra Leone: a cross-sectional study.

INTRODUCTION: Antimicrobial resistance (AMR) is a global public health concern and irrational use of antibiotics in hospitals is a key driver of AMR. Even though it is not preventable, antimicrobial stewardship (AMS) programmes will reduce or slow it down. Research evidence from Sierra Leone has demonstrated the high use of antibiotics in hospitals, but no study has assessed hospital AMS programmes and antibiotic use specifically among children. We conducted the first-ever study to assess the AMS programmes and antibiotics use in two tertiary hospitals in Sierra Leone. METHODS: This was a hospital-based cross-sectional survey using the World Health Organization (WHO) point prevalence survey (PPS) methodology. Data was collected from the medical records of eligible patients at the Ola During Children's Hospital (ODCH) and Makeni Regional Hospital (MRH) using the WHO PPS hospital questionnaire; and required data collection forms. The prescribed antibiotics were classified according to the WHO Access, Watch, and Reserve (AWaRe) classification. Ethics approval was obtained from the Sierra Leone Ethics and Scientific Review Committee. Statistical analysis was conducted using the SPSS version 22. RESULTS: Both ODCH and MRH did not have the required AMS infrastructure; policy and practice; and monitoring and feedback mechanisms to ensure rational antibiotic prescribing. Of the 150 patients included in the survey, 116 (77.3%) were admitted at ODCH and 34 (22.7%) to MRH, 77 (51.3%) were males and 73 (48.7%) were females. The mean age was 2 years (SD=3.5). The overall prevalence of antibiotic use was 84.7% (95% CI: 77.9% - 90.0%) and 77 (83.8%) of the children aged less than one year received an antibiotic. The proportion of males that received antibiotics was higher than that of females. Most (58, 47.2 %) of the patients received at least two antibiotics. The top five antibiotics prescribed were gentamycin (100, 27.4%), ceftriaxone (76, 20.3%), ampicillin (71, 19.5%), metronidazole (44, 12.1%), and cefotaxime (31, 8.5%). Community-acquired infections were the primary diagnoses for antibiotic prescription. CONCLUSION: The non-existence of AMS programmes might have contributed to the high use of antibiotics at ODCH and MRH. This has the potential to increase antibiotic selection pressure and in turn the AMR burden in the country. There is need to establish hospital AMS teams and train health workers on the rational use of antibiotics.

Factors impacting water quality and quantity in rapidly expanding urban areas based on the DPSIR model: experiences and challenges from Addis Ababa City, Ethiopia.

Due to the increasing pressures of global change, such as urbanization, climate change, population growth, and socioeconomic changes, cities around the world are facing significant water challenges, both in terms of supply and quality. This emphasizes the need for concerted effort to manage water supplies effectively for sustainable development. The driver, pressure, state, impact, and response (DPSIR) model was applied in this study to determine the underlying causes of Addis Ababa's water supply and quality issues. Field observations, key informant interviews, and previously published reports were used to identify these variables, impacts, and coping mechanisms. The model suggests that issues with urban water are caused by inadequate waste management, fast urbanization, climate change, sociodemographic shifts, economic challenges, changes in land use and land cover, and institutional pressures. As a result, aquatic ecosystems endure damage and there is also an increase in water-related diseases and unmet water demand. Some of the responses to these effects include using bottled water, digging boreholes, harvesting rainwater, planting trees, and soliciting funds. The study concludes by recommending an integrated approach to managing the risks of declining water quality and shortage. This study will advance the important empirical understanding of how urban water supply and quality are impacted by environmental stresses on a global scale. It will also positively impact the development of sustainable water management policies and practices.

The Ripple Effect of Climate Change: Assessing the Impacts on Water Quality and Hydrology in Addis Ababa City (Akaki Catchment).

This research aimed to evaluate the effects of climate change on the hydrology and water quality in the Akaki catchment, which provides water to Addis Ababa, Ethiopia. This was performed using the soil and water assessment tool (SWAT) model and an ensemble of four global climate models under two Shared Socioeconomic Pathways (SSP) emission scenarios from Coupled Model Intercomparison Project Phase 6 (CMIP6). The climate data were downscaled and bias-corrected using the CMhyd tool and calibrated and validated using the SWAT-CUP software package. Change points and patterns in annual rainfall and temperature were determined using the homogeneity test and Mann-Kendell trend test. Water quality data were obtained from Addis Ababa Water and Sewerage Authority (AAWSA), and more samples were taken and analyzed in accordance with APHA recommended procedures. The SWAT model output was then used to assess the impacts of climate change on hydrological components and water quality. Rainfall increased by 19.39 mm/year under SSP2-4.5 and 12.8 mm/year under SSP8.5. Maximum temperature increased by 0.03°C/yr for SSP2-4.5 and 0.04°C/yr for SSP5-8.5. Minimum temperature increased by 0.03°C/yr under SSP2-4.5 and 0.07°C/yr under SSP5-8.5. This warming will augment the evapotranspiration rate which in turn will have a negative impact on the freshwater availability. Streamflow will increase by 5% under SSP2-4.5 and 9.49% under SSP5-85 which may increase sporadic flooding events. Climate change is expected to contribute to the deterioration of water quality shown by 61%, 36%, 79%, 115%, and 70% increased ammonia, chlorophyll-a, nitrite, nitrate, and phosphorus loadings, respectively, from 2022. The increase in temperature results in increases in nutrient loading and a decrease in dissolved oxygen. Overall, this research demonstrated the vulnerability of the catchment to climate change. The findings of this research can offer vital knowledge to policymakers on possible strategies for the sustainable management of water.

Implications of land use/land cover dynamics on urban water quality: Case of Addis Ababa city, Ethiopia.

Water resources are often at the center of urban development but, as the city expands, the environmental pressure on its water resources increases. Therefore, in this study, we looked into how various land uses and changes in land cover affect the water quality in Addis Ababa, Ethiopia. Land use and land cover change maps were generated from 1991 to 2021 at intervals of five years. On the basis of the weighted arithmetic water quality index approach, the water quality for the same years was likewise divided into five classes. The relationship between land use/land cover dynamics and water quality was then evaluated using correlations, multiple linear regressions, and principal component analysis. According to the computed water quality index, the water quality decreased from 65.34 in 1991 to 246.76 in 2021. The built-up area showed an increase of over 338%, whereas the amount of water decreased by over 61%. While barren land exhibited a negative correlation with nitrates, ammonia loadings, total alkalinity, and total hardness of the water, agriculture and built-up areas positively correlated with water quality parameters such as nutrient loading, turbidity, total alkalinity, and total hardness. A principal component analysis revealed that built up areas and changes in vegetated areas have the biggest impact on water quality. These findings suggest that land use and land cover modifications are involved in the deterioration of water quality around the city. This study will offer information that might help reduce the dangers to aquatic life in urbanized environments.

Availability of medical abortion medicines in eight countries: a descriptive analysis of key findings and opportunities.

BACKGROUND: In recent years a growing number of manufacturers and medical abortion products have entered country markets and health systems, with varying degrees of quality and accessibility. An interplay of factors including pharmaceutical regulations, abortion laws, government policies and service delivery guidelines and provider's knowledge and practices influence the availability of medical abortion medicines. We assessed the availability of medical abortion in eight countries to increase understanding among policymakers of the need to improve availability and affordability of quality-assured medical abortion products at regional and national levels. METHODS: Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines in Bangladesh, Liberia, Malawi, Nepal, Nigeria, Rwanda, Sierra Leone and South Africa between September 2019 and January 2020. RESULTS: Registration of abortion medicines-misoprostol or a combination of mifepristone and misoprostol-was established in all countries assessed, except Rwanda. Mifepristone and misoprostol regimen for medical abortion was identified on the national essential medicines list/standard treatment guidelines for South Africa as well as in specific abortion care service and delivery guidelines for Bangladesh, Nepal, Nigeria, and Rwanda. In Liberia, Malawi, and Sierra Leone-countries with highly restrictive abortion laws and no abortion service delivery guidelines or training curricula-no government-supported training on medical abortion for public sector providers had occurred. Instead, training on medical abortion was either limited in scope to select private sector providers and pharmacists or prohibited. Community awareness activities on medical abortion have been limited in scope across the countries assessed and where abortion is broadly legal, most women do not know that it is an option. CONCLUSION: Understanding the factors that influence the availability of medical abortion medicines is important to support policymakers improve availability of these medicines. The landscape assessments documented that medical abortion commodities can be uniquely impacted by the laws, policies, values, and degree of restrictions placed on service delivery programs. Results of the assessments can guide actions to improve access.

Unsafe abortion is a leading cause of death and disability among women of reproductive age. Medical management of abortion with mifepristone and misoprostol pills, or just misoprostol, is a safe and effective way to end a pregnancy. Owing to an increase in the number of medical abortion products that have entered country health systems, we examined access to these medicines from supply to demand in selected countries. The overarching goal of the national landscape assessments was to produce evidence to support advocacy efforts and policymaking for improved access to quality medical abortion products that is appropriate to the needs of the country. This paper aims to describe key findings across eight country settings on the availability of medical abortion medicines and identify key opportunities to improve access to them across countries.

The rate and perioperative mortality of caesarean section in Sierra Leone.

INTRODUCTION: Sierra Leone has the world's highest maternal mortality, partly due to low access to caesarean section. Limited data are available to guide improvement. In this study, we aimed to analyse the rate and mortality of caesarean sections in the country. METHODS: We conducted a retrospective study of all caesarean sections and all reported in-facility maternal deaths in Sierra Leone in 2016. All facilities performing caesarean sections were visited. Data on in-facility maternal deaths were retrieved from the Maternal Death Surveillance and Response database. Caesarean section mortality was defined as in-facility perioperative mortality. RESULTS: In 2016, there were 7357 caesarean sections in Sierra Leone. This yields a population rate of 2.9% of all live births, a 35% increase from 2012, with district rates ranging from 0.4% to 5.2%. The most common indications for surgery were obstructed labour (42%), hypertensive disorders (25%) and haemorrhage (22%). Ninety-nine deaths occurred during or after caesarean section, and the in-facility perioperative caesarean section mortality rate was 1.5% (median 0.7%, IQR 0-2.2). Haemorrhage was the leading cause of death (73%), and of those who died during or after surgery, 80% had general anaesthesia, 75% received blood transfusion and 22% had a uterine rupture diagnosed. CONCLUSIONS: The caesarean section rate has increased rapidly in Sierra Leone, but the distribution remains uneven. Caesarean section mortality is high, but there is wide variation. More access to caesarean sections for maternal and neonatal complications is needed in underserved areas, and expansion should be coupled with efforts to limit late presentation, to offer assisted vaginal delivery when indicated and to ensure optimal perioperative care.

Primary HIV-1 subtype C infection in Ethiopia.

Between 1997 and 2001, 1624 Ethiopian factory workers were enrolled in prospective HIV-1 cohorts in Ethiopia, at Akaki and Wonji towns. HIV-1 seroprevalence at intake was 11.8% (Akaki) and 7.1% (Wonji). HIV-1 incidence was .75 per 100 person-years (Akaki) and .35 per 100 person-years (Wonji). During follow up, CD4 T-cell counts remained significantly lower and CD8 T-cell counts significantly higher in Ethiopian seroconverters compared with Dutch seroconverters. Viral loads were lower in Ethiopian seroconverters versus Dutch seroconverters in the first months after seroconversion, subsequently increasing to similar levels. All 20 Ethiopian seroconverters were infected with HIV-1 subtype C (15 with sub-cluster C' and 5 with sub-cluster C). Viral loads were higher in sub-cluster C'-infected Ethiopian seroconverters. One subject demonstrated a window period of at least 204 days, combined with a high preseroconversion viral load and no decline of CD4 T cells over a follow-up period of at least 3 years.