INFANT AND YOUNG CHILD FEEDING PRACTICES IN THE EAST END OF FREETOWN, SIERRA LEONE

Adequate dietary intake may be a major determinant of the health outcome of children. This study aims at describing the infant and young child feeding practices amongst a group of mothers, factors affecting such practices and the effect of the practice on the nutritional status of the children.Semi-closed ended questionnaire was used to address some of the Infant and Young Child Feeding (IYCF) indicators among the three hundred and forty-seven mothers.Almost all of the index children in this study were breastfed with a majority within 30 minutes of delivery. Breast milk was the first drink in 79.8% of cases, and Exclusive breastfeeding rate was 26.3%. Breastfeeding for less than six months tends to be more prevalent among the low socioeconomic group and those who had Antenatal Care in the private clinics. Complimentary feeds for the majority of the children consisted mainly of cereal based gruels. There was a positive correlation between the nutritional status and the first drink, educational level of mother and length of breastfeeding.Poor infant and young child feeding practices impinged negatively on the nutritional status of the children. Improved training of health care workers, female education, and empowerment are recommended.

Prevalence of Tobacco Use and Physical Activity among Adult Sierra Leonean Population

The current burden of non-communicable diseases (NCDs) and their risk factors such as tobacco use and physical inactivity remain largely unknown in Sierra Leone. Thus, this study was conducted to document the prevalence of tobacco use and physical activity among the adult Sierra Leonean population with a specific objective of determining the sex and age prevalence. A cross sectional population based survey utilising the multi-stage cluster sampling strategy was used. A total of 5,483 individuals aged 25-64 years of both sexes were recruited into the survey. The World Health Organisation (WHO) STEPwise approach to surveillance instrument was adapted and questionnaire was administered to one individual in selected household. The data was analysed and graphed using Epi-Info software version 3.4.3 and graph pad prism version 5.1 respectively. The analyses showed that 34% of the respondents use tobacco products with 26% engaged in smoking tobacco products and 8% were smokeless tobacco users at the time of this study. The average age of commencing tobacco smoking was 21 years; with 92% and 96% of the male and female daily smokers smoking at least six manufactured tobacco respectively. Seventy four percent (74%) and 69% of the non-smoking respondents were exposed to environmental tobacco smoke (ETS) at home and workplace respectively. The study further revealed that 15%, 23% and 87% of the total respondents reported no work-, transport- or recreational- related physical activity respectively; and were therefore classified as physically inactive. The lowest level of physical activity was reported in the recreation domain. Even those who reported moderate physical activity at work or from travel, their median metabolic equivalent (MET) was not sufficient to achieve a level of physical activity that is beneficial to their health. In conclusion, a significant proportion of the population is exposed either directly or indirectly to tobacco smoke, and a large proportion of the adult population is physically inactivity. Thus, NCD prevention policy addressing lifestyle changes such as no smoking should not be limited to work places but should be population based. Keywords: Non-communicable diseases, Physical activity, Risk factors, Sierra Leone, Tobacc

Analgesic Utilisation in People with Knee Osteoarthritis: A Population‐ Based Study Using Primary Care Data

PurposeOsteoarthritis (OA) is a chronic painful condition that often affects large joints such as the knee. Treatment guidelines recommend paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids. Antidepressants and Anti-epileptic drugs (AEDs) are commonly prescribed for chronic non-cancer pain conditions including OA, as an off-label use. This study describes analgesic utilisation in patients with knee OA at population-level using standard pharmaco-epidemiological methods.MethodThis was a cross-sectional study between 2000 and 2014 using data from the UK Clinical Practice Research Datalink (CPRD). The use of antidepressants, AEDs, opioids, NSAIDs and paracetamol was studied in adults with knee OA using the following measures: annual number of prescriptions, Defined Daily Doses (DDD), oral morphine equivalent dose (OMEQ) and days’ supply.ResultsIn total, there were 8,944,381 prescriptions prescribed for 117,637 patients with knee OA during the 15-year period. There was a steady increase in the prescribing of all drug classes, except for NSAIDs, over the study period. Opioids were the most prevalent class prescribed in every study year. Tramadol was the most commonly prescribed opioid, with the number of DDD increasing from 0.11 to 0.71 DDDs per 1000 registrants in 2000 and 2014, respectively. The largest increase in prescribing was for AEDs, where the number of prescriptions increased from 2 to 11 per 1000 CPRD registrants.ConclusionThere was an overall increase in the prescribing of analgesics apart from NSAIDs. Opioids were the most frequently prescribed class however, the greatest increase in prescribing between 2000 and 2014, was observed in AEDs

Ebola Holding Units at government hospitals in Sierra Leone: evidence for a flexible and effective model for safe isolation, early treatment initiation, hospital safety and health system functioning.

The 2014-2015 West African outbreak of Ebola Virus Disease (EVD) claimed the lives of more than 11,000 people and infected over 27,000 across seven countries. Traditional approaches to containing EVD proved inadequate and new approaches for controlling the outbreak were required. The Ministry of Health & Sanitation and King’s Sierra Leone Partnership developed a model for Ebola Holding Units (EHUs) at Government Hospitals in the capital city Freetown. The EHUs isolated screened or referred suspect patients, provided initial clinical care, undertook laboratory testing to confirm EVD status, referred onward positive cases to an Ebola Treatment Centre or negative cases to the general wards, and safely stored corpses pending collection by burial teams. Between 29th May 2014 and 19th January 2015, our five units had isolated approximately 37% (1159) of the 3097 confirmed cases within Western Urban and Rural district. Nosocomial transmission of EVD within the units appears lower than previously documented at other facilities and staff infection rates were also low. We found that EHUs are a flexible and effective model of rapid diagnosis, safe isolation and early initial treatment. We also demonstrated that it is possible for international partners and government facilities to collaborate closely during a humanitarian crisis

In silico transcriptional regulation and functional analysis of dengue shock syndrome associated SNPs in PLCE1 and MICB genes

YesSingle nucleotide polymorphisms (SNPs) in PLCE1 and MICB genes increase risk for the development of dengue shock syndrome (DSS). We used Bioinformatics tools to predict alterations at the transcriptional and posttranslational levels driven by PLCE1 and MICB SNPs associated with DSS. Functional and phenotypic analysis conducted to determine deleterious SNPs and impact of amino acid substitution on the structure and function of proteins identified rs2274223 (H1619R) as deleterious to protein coding as it induces structural change in the C2 domain of PLCε, with the mutant residue more positively charged than the wild-type residue (RMSD score, 1.75 Å).Moreover, rs2274223 condenses the chromatinrepressing PLCε expression in DSS. Briefly, this study presents the impact of a single nucleotide transition at SNPs associated with DSS on differential protein binding patterns with PLCE1 and MICB genes and on protein structure modification and their possible role in the pathogenesis of DSS

Implementation of Energy and Power Saving Scheme in The Avenues Mall

This paper presents the results on an energy audit and subsequent implementation of energy efficient operation and maintenance strategies between April 2008 and March 2009 in Phase 1 of the Avenues mall with total area of 170,000 m2. It has cooling production system with a capacity of 7200 RT and prior to energy audit, its peak power demand was close to 15 MW and annual energy consumption was 84000 MWh/y. Overall reductions of 9919 MWh/y in the annual energy consumption and 345 kW in peak power demand were achieved. The major contributors for the savings were time-of-day control for the air-handling units and lighting and optimization of chilled water flow. The project facilitated a benefit of 19838 KD/y to the Mabanee and company. More importantly, it achieved financial benefits to the Ministry of Electricity and Water of nearly 160,000 KD for reduction in power generation and transmission equipment cost and 372000 KD/y towards reduction in annual electricity subsidy in addition to an environmental benefit of reduction in CO2 emissions by 6940 t/y

An Innovative Approach Towards National Peak Load Management

An innovative approach was developed and implemented in eight governmental buildings to reduce their load during the peak demand hours in summer of 2007. The innovative approach implemented in these buildings included pre-closing treatment (PCT) between 13:00 and 14:00 h and time-of-day control (TDC) after 14:00 h for air conditioning (A/C) and lighting systems. PCT realized an overall reduction of 3.43 MW, a saving of 11.7% of the buildings peak power demand; while TDC realized a total savings of 8.67 MW at 15:00 h, a saving of 30.7% of the buildings peak power demand at that hour. The temperature build up inside the buildings due to PCT and TDC was within the acceptable range, which validated the technical viability of these measures. The implementation of the innovative approach in the eight governmental buildings with a total measured peak demand of 29.3 MW achieved a reduction of 8.89 MW. This power is now available to other users leading to financial savings of $13.5 million for the nation towards the cost of constructing new power plants and distribution network equipment. More importantly, this reduction in peak power demand of well over 30$232 million towards the cost of new power generation equipment and distribution network

Dalbavancin Sequential Therapy for Gram-Positive Bloodstream Infection: A Multicenter Observational Study

Introduction Long-acting lipoglycopeptides such as dalbavancin may have utility in patients with Gram-positive bloodstream infections (BSI), particularly in those with barriers to discharge or who require prolonged parenteral antibiotic courses. A retrospective cohort study was performed to provide further multicenter real-world evidence on dalbavancin use as a sequential therapy for Gram-positive BSI. Methods One hundred fifteen patients received dalbavancin with Gram-positive BSI, defined as any positive blood culture or diagnosed with infective endocarditis, from 13 centers geographically spread across the United States between July 2015 and July 2021. Results Patients had a mean (SD) age of 48.5 (17.5) years, the majority were male (54%), with many who injected drugs (40%). The most common infection sources (non-exclusive) were primary BSI (89%), skin and soft tissue infection (SSTI) (25%), infective endocarditis (19%), and bone and joint infection (17%). Staphylococcus aureus accounted for 72% of index cultures, coagulase-negative Staphylococcus accounted for 18%, and Streptococcus species in 16%. Dalbavancin started a median (Q1–Q3) of 10 (6–19) days after index culture collection. The most common regimen administered was dalbavancin 1500 mg as one dose for 50% of cases. The primary outcome of composite clinical failure occurred at 12.2%, with 90-day mortality at 7.0% and 90-day BSI recurrence at 3.5%. Conclusions Dalbavancin may serve as a useful tool in facilitating hospital discharge in patients with Gram-positive BSI. Randomized controlled trials are anticipated to validate dalbavancin as a surrogate to current treatment standards