Photo Above: Women and Children Attending Antenatal and Under-Five Clinic in a Health Centre, Bumpe Chiefdom, Sierra Leone
Resources
Climate change
The impact of climate change is being seen in Sierra Leone as well as other West African countries. In August, 2017, a mudslide in Freetown killed more than 1,100 people. Increased rates of urbanization, torrential rain, and deforestation were contributing factors (https://blogs.worldbank.org/sustainablecities/preventable-disaster-landslides-and-flooding-disaster-freetown-sierra-leone).
Climate change impact reports and adaptation efforts in Sierra Leone can be found here:
https://www.irishaid.ie/media/irishaid/allwebsitemedia/20newsandpublications/publicationpdfsenglish/Country-Climate-Action-Reports-Sierra-Leone-FINAL.pdf)
World Bank Report: https://climateknowledgeportal.worldbank.org/country/sierra-leone
https://www.unido.org/stories/fostering-climate-adaptation-through-entrepreneurship-sierra-leone
Monkeypox
I recall hearing rumours about an outbreak of human monkeypox when I lived and worked in Sierra Leone in the early 1980s. However, there were no official reports of the disease in Sierra Leone at that time. We were in the midst of rolling out immunization campaigns. Having witnessed the eradication of smallpox through vaccination programs, village elders were encouraging mothers to bring their children for essential vaccines. Our public health team was concerned that reports of monkeypox might derail the uptake of immunizations, but they didn’t. Measles, neonatal tetanus, tuberculosis, and polio took the lives of many children. Families continued to seek protective immunizations for these diseases. No official cases of human monkeypox were reported in Sierra Leone between 1970 and 2014. However, serological antibody studies undertaken in Sierra Leone in the late 1970s, indicated that there had been unreported cases of monkeypox. Heymann et al’s article from the British Medical Bulletin (1998), traces the early history of human monkeypox in Africa and makes for an interesting read.
Traditional Birth Attendants (TBAs)
Descriptions of TBAs' roles and practices, the effectiveness of TBA training programs, and government policies regarding TBAs' midwifery practices can be found in many documents, some dating back to the 1960s. These recent resources are also relevant.
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1691-7
https://pubmed.ncbi.nlm.nih.gov/29375881
https://pubmed.ncbi.nlm.nih.gov/34582455
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6591059/
https://amref.org/position-statements/amref-health-africas-position-on-the-role-and-services-of-traditional-birth-attendants/
See a discussion about the debate on banning TBAs from doing deliveries in Sierra Leone that was published in The Guardian: https://www.theguardian.com/global-development/poverty-matters/2012/jan/17/traditional-birth-attendants-sierra-leone
An update on how the roles of TBAs are changing in Sierra Leone is available here:
https://www.globalcitizen.org/en/content/innovating-to-help-mothers-and-babies-in-sierra-le/
The following chapter by Margaret MacDonald (York University, Toronto) provides an excellent review of policy shifts that have shaped and shifted the role of TBAs in many countries over the last few decades: https://link.springer.com/chapter/10.1007/978-3-030-84514-8_6
Health Systems Fragility and Strengthening
There are lessons to be learned about health systems fragility and strengthening from resource poor countries. The qualitative studies listed below shed light on system challenges in Sierra Leone in both urban settings (e.g. Connaught Hospital) and rural Chiefdoms during the Ebola outbreak:
https://www.sciencedirect.com/science/article/pii/S027795362100592X?dgcid=raven_sd_via_email
https://www.sciencedirect.com/science/article/pii/S0277953621005414#bbib42
https://www.sciencedirect.com/science/article/pii/S0277953621005414?dgcid=raven_sd_via_email
Health Human Resources
Although there are nursing shortages across the globe, the health human resource crisis is particularly acute in the African Region of WHO. As the WHO 2020 World Nursing Report (https://www.who.int/publications/i/item/9789240003279) describes, while nurses make up 66% and 56% of health professionals in the WHO African and Americas regions, respectively; the density of nurses per 10,000 population is enormously different in these two regions: 8.7 per 10,000 in the African region versus 83.4 per 10,000 in the Americas. Investing in education, jobs, and leadership for nurses is essential to meet targets set out in the Sustainable Development Goals for health, education, gender, and decent work and economic growth.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458571/
The impact of climate change is being seen in Sierra Leone as well as other West African countries. In August, 2017, a mudslide in Freetown killed more than 1,100 people. Increased rates of urbanization, torrential rain, and deforestation were contributing factors (https://blogs.worldbank.org/sustainablecities/preventable-disaster-landslides-and-flooding-disaster-freetown-sierra-leone).
Climate change impact reports and adaptation efforts in Sierra Leone can be found here:
https://www.irishaid.ie/media/irishaid/allwebsitemedia/20newsandpublications/publicationpdfsenglish/Country-Climate-Action-Reports-Sierra-Leone-FINAL.pdf)
World Bank Report: https://climateknowledgeportal.worldbank.org/country/sierra-leone
https://www.unido.org/stories/fostering-climate-adaptation-through-entrepreneurship-sierra-leone
Monkeypox
I recall hearing rumours about an outbreak of human monkeypox when I lived and worked in Sierra Leone in the early 1980s. However, there were no official reports of the disease in Sierra Leone at that time. We were in the midst of rolling out immunization campaigns. Having witnessed the eradication of smallpox through vaccination programs, village elders were encouraging mothers to bring their children for essential vaccines. Our public health team was concerned that reports of monkeypox might derail the uptake of immunizations, but they didn’t. Measles, neonatal tetanus, tuberculosis, and polio took the lives of many children. Families continued to seek protective immunizations for these diseases. No official cases of human monkeypox were reported in Sierra Leone between 1970 and 2014. However, serological antibody studies undertaken in Sierra Leone in the late 1970s, indicated that there had been unreported cases of monkeypox. Heymann et al’s article from the British Medical Bulletin (1998), traces the early history of human monkeypox in Africa and makes for an interesting read.
Traditional Birth Attendants (TBAs)
Descriptions of TBAs' roles and practices, the effectiveness of TBA training programs, and government policies regarding TBAs' midwifery practices can be found in many documents, some dating back to the 1960s. These recent resources are also relevant.
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1691-7
https://pubmed.ncbi.nlm.nih.gov/29375881
https://pubmed.ncbi.nlm.nih.gov/34582455
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6591059/
https://amref.org/position-statements/amref-health-africas-position-on-the-role-and-services-of-traditional-birth-attendants/
See a discussion about the debate on banning TBAs from doing deliveries in Sierra Leone that was published in The Guardian: https://www.theguardian.com/global-development/poverty-matters/2012/jan/17/traditional-birth-attendants-sierra-leone
An update on how the roles of TBAs are changing in Sierra Leone is available here:
https://www.globalcitizen.org/en/content/innovating-to-help-mothers-and-babies-in-sierra-le/
The following chapter by Margaret MacDonald (York University, Toronto) provides an excellent review of policy shifts that have shaped and shifted the role of TBAs in many countries over the last few decades: https://link.springer.com/chapter/10.1007/978-3-030-84514-8_6
Health Systems Fragility and Strengthening
There are lessons to be learned about health systems fragility and strengthening from resource poor countries. The qualitative studies listed below shed light on system challenges in Sierra Leone in both urban settings (e.g. Connaught Hospital) and rural Chiefdoms during the Ebola outbreak:
https://www.sciencedirect.com/science/article/pii/S027795362100592X?dgcid=raven_sd_via_email
https://www.sciencedirect.com/science/article/pii/S0277953621005414#bbib42
https://www.sciencedirect.com/science/article/pii/S0277953621005414?dgcid=raven_sd_via_email
Health Human Resources
Although there are nursing shortages across the globe, the health human resource crisis is particularly acute in the African Region of WHO. As the WHO 2020 World Nursing Report (https://www.who.int/publications/i/item/9789240003279) describes, while nurses make up 66% and 56% of health professionals in the WHO African and Americas regions, respectively; the density of nurses per 10,000 population is enormously different in these two regions: 8.7 per 10,000 in the African region versus 83.4 per 10,000 in the Americas. Investing in education, jobs, and leadership for nurses is essential to meet targets set out in the Sustainable Development Goals for health, education, gender, and decent work and economic growth.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458571/
