Bailah Leigh - Academia.edu (original) (raw)

Papers by Bailah Leigh

Proceedings, 2020

Introduction: The West African Ebola outbreak of 2014–2016 necessitated clinical trials in commun... more Introduction: The West African Ebola outbreak of 2014–2016 necessitated clinical trials in communities with limited health data. The EBOVAC-Salone Ebola vaccine trial is ongoing in the largely rural Kambia District in northern Sierra Leone. To gain a baseline insight into our local noncommunicable disease (NCD) epidemiology, we examined screening blood pressure (BP) measurements in trial volunteers. Methods: BP involved taking multiple readings using an Omron M6 sphygmomanometer in rested individuals. We classified BP by the European 2018 ESC/ESH guidelines: optimal BP, normal or high-normal BP, or hypertension (systolic ≥ 140 mmHg ± diastolic ≥ 90 mmHg) with Grade 1, 2, or 3 (G1HT, G2HT, G3HT) severity levels. Results: Of 870 volunteers, 220 (25.3%) had optimal BP, 236 (27.13%) had normal BP, and 250 (28.7%) had high-normal BP. The remaining 164 (18.9%) were hypertensive. By gender, 16.5% (109/668) of males and 27.2% (55/202) of females were hypertensive. Among hypertensives, 62.2%...

International Journal of Gynecology & Obstetrics, 1997

Preliminary studies: A facility review and focus group discussions revealed poor capacity to mana... more Preliminary studies: A facility review and focus group discussions revealed poor capacity to manage obstetric complications. Inter¨entions: In response, a physician with obstetric skills was posted, and a second physician was trained. Courses in life-saving obstetric skills were held for nurses and midwives. An unused operating theater was made functional with simple modifications. A generator and blood bank were installed. Drugs and supplies were made available through a revolving fund. Subsequently, community interventions focused on improving utilization. Results: The number of women seeking treatment for major obstetric complications at the district hospital increased Ž. from 31 in 1990 to 98 in 1995, while the case fatality rate CFR among these women dropped from 32% to 5%. Cesarean sections increased from two in 1990 to 38 in 1995. In 1995, 444 abortion-related procedures were performed ᎏ almost all of them for unwanted pregnancy ᎏ compared with only 22 in 1990. Costs: The cost of material improvements and training was approximately US$39 000, of which 46% was from project funds, 41% from non-governmental organizations and 13% from government. Conclusions: Women with obstetric complications will seek hospital care if services are available. Government hospital services can be improved by building on existing resources. Obstetric CFR can be dramatically reduced. The need for safe abortion services, which are currently illegal in Sierra Leone, is demonstrated.

Hospital admissions and their clinical outcomes can reflect the disease burden in a population an... more Hospital admissions and their clinical outcomes can reflect the disease burden in a population and can be utilised as effective surveillance and impact monitoring tools. Inadequate documentation of admissions and their outcomes have contributed to the poor quality of paediatric care in many health care settings in sub-Saharan Africa. We have developed and piloted a simple tool for documentation of basic, standardised patient-level information on causes of admissions, diagnoses, treatments and outcomes in patients admitted to the paediatric ward of a district hospital in a rural community in Sierra Leone.From 1 August 2019 to 31 July 2021, we used this tool to document the admissions, treatments and clinical outcomes of 1,663 children admitted to this hospital. The majority of the children (1015, 62%) were aged between 12-59 months, were boys (942, 57%), were wasted (516, 31%), stunted (238 14%) or underweight (537, 32%). More than half of the children lived more than 1 km distance f...

IntroductionThe prevalence of type 2 diabetes mellitus (T2DM) and associated morbidity and mortal... more IntroductionThe prevalence of type 2 diabetes mellitus (T2DM) and associated morbidity and mortality are increasing in sub-Saharan Africa (SSA). To facilitate access to quality care and improve treatment outcomes, there is a need for innovative community care models and optimized use of non-physician healthcare workers bringing diagnosis and care closer to patients’ homes.AimWe aimed to describe with a scoping review different models of community-based care for non-pregnant adults with T2DM in SSA, and to synthesize the model outcomes in terms of engagement in care, blood sugar control, acceptability, and end-organ damage. We further aimed to critically appraise the different models of care and compare community-based to facility-based care if data were available.MethodsWe searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus, supplemented with backward and forward citation searches. We included cohort studies, randomized trials and c...

The Lancet Infectious Diseases

ObjectivesWe assessed the prevalence of immunoglobulin G (IgG) and immunoglobulin M (IgM) against... more ObjectivesWe assessed the prevalence of immunoglobulin G (IgG) and immunoglobulin M (IgM) against four endemic human coronaviruses (HCoVs) and two SARS-CoV-2 antigens, among vaccinated and unvaccinated staff at health care centres in Uganda, Sierra Leone, and the Democratic Republic of Congo (DRC).MethodsGovernment health facility staff who had patient contact in Goma (DRC), Kambia District (Sierra Leone), and Masaka District (Uganda) were enrolled. Questionnaires and blood samples were collected at three timepoints over four months. Blood samples were analysed with the Luminex MAGPIX®.ResultsAmong unvaccinated participants, the prevalence of IgG/IgM antibodies against SARS-CoV-2 RBD or N-protein at enrolment was 70% in Goma (138/196), 89% in Kambia (112/126) and 89% in Masaka (190/213). IgG responses against endemic HCoVs at baseline were not associated with SAR-CoV-2 sero-acquisition during follow-up. Among vaccinated participants, those who had evidence of SARS-CoV-2 IgG/IgM at b...

African Journal of Reproductive Health, Dec 1, 2012

In-depth studies on fertility in Namibia have been lacking so far. This examines the fertility tr... more In-depth studies on fertility in Namibia have been lacking so far. This examines the fertility trends in Namibia over the past 2 decades and examines fertility differentials across the various subgroups of Namibia population, and factors affecting such differentials using NDHS data. Estimates of the amount of variance in the total number of children ever born that could be explained by each of the independent variables were made using multiple regression analysis for the three data sources. Overall, results from descriptive analysis show that fertility levels in Namibia have been decreasing over the past two decades. The decrease could be associated with an increased trend in the prevalence of use of modern contraceptives which doubled since 1992. Age at first birth has remained constant but age at first marriage continues to increase. As a result, postponement of marriage increases the probability that women remain childless or that they have fewer children than desired. Replacement level is projected to be attained much faster than expected and the study recommend for further research that focuses on policy implications of family planning programmes once replacement level has been achieved to maintain it. (Afr J Reprod Health 2012; 16[4]: 50-57). Résumé Des études approfondies sur la fécondité en Namibie ont fait défaut jusqu'à présent. En se servant des données recueillies de l'ENDS, cette étude examine les tendances de la fécondité en Namibie au cours des deux dernières décennies et examine les différences concernant la fécondité auprès des divers sous-groupes de la population namibienne ainsi que les facteurs qui affectent ces écarts. Les estimations de la proportion de la variance dans le nombre total d'enfants nés vivants qui pourraient s'expliquer par chacune des variables indépendantes ont été effectuées à l'aide d'une analyse de régression multiple pour les trois sources de données. Dans l'ensemble, les résultats de l'analyse descriptive montrent que les niveaux de fécondité en Namibie ont baissé au cours des deux dernières décennies. Cette baisse pourrait être liée à une tendance accrue à la prévalence de l'usage des contraceptifs modernes qui a doublé depuis 1992. L'âge au premier accouchement est resté constant, mais l'âge au premier mariage continue d'augmenter. En conséquence, le report du mariage augmente la possibilité que les femmes restent sans enfants ou qu'elles aient moins d'enfants que le nombre désiré. Le niveau de remplacement devrait être atteint beaucoup plus rapidement que prévu et l'étude recommande encore de des recherches qui seront concentrées sur les implications politiques des programmes de planification familiale une fois que le niveau de remplacement aura été réalisé pour le maintenir (Afr

Abstract: Sierra Leone has one of the highest rates of female genital mutilation (FGM) in the wor... more Abstract: Sierra Leone has one of the highest rates of female genital mutilation (FGM) in the world, and yet little is known about the health consequences of the practice. Purpose: To explore whether and what kind of FGM-related health complications girls and women in Sierra Leone experience, and to elucidate their health care-seeking behaviors. Patients and methods: A feasibility study was conducted to test and refine questionnaires and methods used for this study. Thereafter, a cross-section of girls and women (n = 258) attend-ing antenatal care and Well Women Clinics in Bo Town, Bo District, in the southern region and in Makeni Town, Bombali District, in the northern region of Sierra Leone were randomly selected. Participants answered interview-administrated pretested structured questionnaires with open-ended-questions, administrated by trained female personnel. Results: All respondents had undergone FGM, most between 10 and 14 years of age. Complications were reported by 218 res...

Unusual cases of pneumonia detected in Wuhan City, China, in December 2019, were first reported t... more Unusual cases of pneumonia detected in Wuhan City, China, in December 2019, were first reported to the WHO Office in China on December 31, 20191. The causative agent was identified as a previously unknown type of coronavirus (2019-nCoV) which currently has no cure. The outbreak has not yet been declared as an international health emergency, but airports across the world are deploying screening measures to isolate passengers with symptoms related to the disease to contain the spread of the disease. The continent of Africa might be at risk, and there are several challenges facing Africa that may need to be addressed for adequacy in an anticipated African response.

Additional file 1: Appendix 1. Secondary objectives. Appendix 2. Sample size considerations and s... more Additional file 1: Appendix 1. Secondary objectives. Appendix 2. Sample size considerations and statistical analysis. Appendix 3. PREVAC study team. Appendix 4. Trial organization. Appendix 5. Assent and consent forms. Appendix 6. Participants in the PREVAC trial. Appendix 7. Enrollment of the participants in the PREVAC trial. Appendix 8. Baseline antibody data.

Trials, 2021

Reference 1. Badio, et al. Partnership for Research on Ebola VACcination (PREVAC): protocol of a ... more Reference 1. Badio, et al. Partnership for Research on Ebola VACcination (PREVAC): protocol of a randomized, double-blind, placebo-controlled phase 2 clinical trial evaluating three vaccine strategies against Ebola in healthy volunteers in four West African countries. Trials. 2021;22:86.

The Lancet Infectious Diseases, 2021

Safety and long-term immunogenicity of a two-dose Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine regimen i... more Safety and long-term immunogenicity of a two-dose Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine regimen in adults: a randomised, double-blind, controlled trial in Sierra Leone

Trials, 2021

Introduction The Ebola virus disease (EVD) outbreak in 2014–2016 in West Africa was the largest o... more Introduction The Ebola virus disease (EVD) outbreak in 2014–2016 in West Africa was the largest on record and provided an opportunity for large clinical trials and accelerated efforts to develop an effective and safe preventative vaccine. Multiple questions regarding the safety, immunogenicity, and efficacy of EVD vaccines remain unanswered. To address these gaps in the evidence base, the Partnership for Research on Ebola Vaccines (PREVAC) trial was designed. This paper describes the design, methods, and baseline results of the PREVAC trial and discusses challenges that led to different protocol amendments. Methods This is a randomized, double-blind, placebo-controlled phase 2 clinical trial of three vaccine strategies against the Ebola virus in healthy volunteers 1 year of age and above. The three vaccine strategies being studied are the rVSVΔG-ZEBOV-GP vaccine, with and without a booster dose at 56 days, and the Ad26.ZEBOV,MVA-FN-Filo vaccine regimen with Ad26.ZEBOV given as the f...

Revue d'Épidémiologie et de Santé Publique, 2017

meta-analyses. Despite the spontaneous adverse drugs reactions reporting may be influenced by the... more meta-analyses. Despite the spontaneous adverse drugs reactions reporting may be influenced by the knowledge of the treatment, the potential impact of study design was always ignored to estimate the true risk of these agents. We perform a systematic review and meta-analysis of randomized controlled-trials to determine whether the estimated risk of these adverse effects of antiangiogenic therapies differ between open-label trials and double-blind trials. Methods We searched Medline, Cochrane, ClinicalTrial databases, abstract in congress proceedings of the American Society of Clinical Oncology and the European Society of Medical Oncology for relevant clinical trials. We included all eligible phase II and III randomized clinical trials that randomly assigned patients with solid cancer to antiangiogenic group versus a control group. The adverse events of interest were bleedings, venous thrombotic events (VTE) and arterial thrombotic events (ATE). Interaction (Cochran's chisquared test) between open and double-blind designs was tested. Results A total of 166 trials (72 024 patients) were included. For bleeding events, the associated risk of bleeding on antiangiogenic treatment compared to no antiangiogenic treatment yielded an odds ratio (OR) equal to 3.18 (95% CI 2.65 to 3.81) with open trials compared to 1.89 (1.63 to 2.19) for doubleblind studies, i.e. a significant exaggeration of treatment effects of 68% (33 to 113) with open design (interaction test, P < 0.0001). Concerning VTE, an OR of 1.51 (1.26 to 1.81) for open trials was noted compared to a non-significant OR for double blind trials (OR 0.99, 0.83 to 1.17), with a significant enhancement of 53% (19 to 96) of treatment side effect with open trials (interaction test, P < 0.001). For ATE, the over-estimation was estimated to 65% (13 to 143) with open-label studies compared with double-blind trials (interaction test, P = 0.01). The same conclusions of over-estimation with open trials were done for antibodies drugs and tyrosine kinase inhibitors. Conclusion This meta-analysis showed a significant interaction of study design for the safety outcomes and shows for the first time that even the adverse event risk may be influenced by the knowledge of the treatment. Metaanalyses assessing safety events should be restricted to randomized clinical trials at low risk of bias for outcomes.

International Journal of Infectious Diseases, 2016

Background: Severe clinical cases exclusively associated with Plasmodium vivax are increasingly b... more Background: Severe clinical cases exclusively associated with Plasmodium vivax are increasingly being reported worldwide with complications like renal failure, jaundice, acute respiratory distress syndrome, cerebral malaria, seizures, anemia, thrombocytopenia, pulmonary edema, splenic rupture and death. Recently vivax severity has been on the rise in India where P.vivax contributes in equal ratio with P.falciparum to the disease. Two main transporters studied with regard to chloroquine resistance (CQR) are chloroquine resistance transporter (pvcrt-o) and the multidrug resistance transporter (pvmdr1) orthologous to the pfcrt and pfmdr1 genes respectively. Even though these transporters are not established as molecular markers for CQR, they have a speculated role in CQR of P.vivax. Further, it has been demonstrated that the clinical severity in P.vivax could be associated with increased expression levels of pvcrt-o and pvmdr1 genes. We report here two cases of vivax malaria-a severe and non-severe case, diagnosed and confirmed by microscopy, rapid diagnostic tests and 18S rRNA PCR assay. Methods & Materials: Relative quantification was carried out to find the expression levels of five vir genes (vir 14-related, vir 12, vir 17-like, putative vir 14 and vir 10-related) and two P. vivax speculated drug resistance genes viz. P. vivax chloroquine resistance transporter (pvcrt-o) gene and P. vivax multidrug resistance transporter (pvmdr1) gene. These genes were selected on the basis of their in silico data and a previous understanding of their speculated role in the pathogenesis of P. vivax. Results: Expression pvcrt-o and pvmdr1 genes and five vir genes (vir 14-related, vir 12, vir 17-like, putative vir 14 and vir 10-related), were measured simultaneously in these two cases for comparison. It was found that the expression levels of pvcrt-o and pvmdr1 genes and vir genes (vir 14-related, vir 12, vir 17-like and vir 10-related), was much higher in the severe vivax isolate as compared to the uncomplicated case. Putative vir14 gene was not expressed in the test and control isolates. Conclusion: It brings to light how genes linked to the emerging CQR in P.vivax might impart virulence to vivax malaria making them excellent genetic markers for disease severity.

Emerging infectious diseases, 2022

We explored the association of Ebola virus antibody seropositivity and concentration with potenti... more We explored the association of Ebola virus antibody seropositivity and concentration with potential risk factors for infection. Among 1,282 adults and children from a community affected by the 2014-2016 Ebola outbreak in Sierra Leone, 8% were seropositive for virus antibodies but never experienced disease symptoms. Antibody concentration increased with age.

Journal of Tropical Pediatrics, 1986

Sierra Leone like other developing countries is characterized by a shortage and uneven distributi... more Sierra Leone like other developing countries is characterized by a shortage and uneven distribution of trained health personnel and health care facilities. One consequence is that non-physician health workers such as maternal and child health (MCH) aides are burdened with considerable responsibility for medical interventions requiring skill and training for favorable outcomes under difficult conditions. The partogram a graphic record of the process of labor has become a necessary part of the management of the patient in labor. The purpose of this study was to assess how effectively the MCH-aide can use the partogram. 30 aides working in various villages in the Southern Province of Sierra Leone identified by random selection were trained in the use of partograms to monitor primagravid labor. Their performance in the effective use of the partogram was compared with that of midwives chosen by random selection from all government hospitals and similarly trained. The partogram used was the one modified by Philpott. Training stressed the graphic representation of cervical dilatation. Of 74 patients referred by the MCH aides over a 12-month period following their training 35 were primigravidae; 20% of those whose labors were monitored on the partogram were delivered by cesarean section while 55% of those where no partogram was used required a Cesarean section. The difference was statistically significant. Though aides promptly instituted patients transfer these could not benefit from timely intervention because of infrastructural difficulties such as transportation and problems of resources such as non-availability of blood for transfusion. It appears that the graphic recording of the progress of labor helps in the early detection of abnormalities.

BMJ Global Health, 2021

IntroductionInfectious disease misinformation is widespread and poses challenges to disease contr... more IntroductionInfectious disease misinformation is widespread and poses challenges to disease control. There is limited evidence on how to effectively counter health misinformation in a community setting, particularly in low-income regions, and unsettled scientific debate about whether misinformation should be directly discussed and debunked, or implicitly countered by providing scientifically correct information.MethodsThe Contagious Misinformation Trial developed and tested interventions designed to counter highly prevalent infectious disease misinformation in Sierra Leone, namely the beliefs that (1) mosquitoes cause typhoid and (2) typhoid co-occurs with malaria. The information intervention for group A (n=246) explicitly discussed misinformation and explained why it was incorrect and then provided the scientifically correct information. The intervention for group B (n=245) only focused on providing correct information, without directly discussing related misinformation. Both inte...

Proceedings, 2020

Introduction: The West African Ebola outbreak of 2014–2016 necessitated clinical trials in commun... more Introduction: The West African Ebola outbreak of 2014–2016 necessitated clinical trials in communities with limited health data. The EBOVAC-Salone Ebola vaccine trial is ongoing in the largely rural Kambia District in northern Sierra Leone. To gain a baseline insight into our local noncommunicable disease (NCD) epidemiology, we examined screening blood pressure (BP) measurements in trial volunteers. Methods: BP involved taking multiple readings using an Omron M6 sphygmomanometer in rested individuals. We classified BP by the European 2018 ESC/ESH guidelines: optimal BP, normal or high-normal BP, or hypertension (systolic ≥ 140 mmHg ± diastolic ≥ 90 mmHg) with Grade 1, 2, or 3 (G1HT, G2HT, G3HT) severity levels. Results: Of 870 volunteers, 220 (25.3%) had optimal BP, 236 (27.13%) had normal BP, and 250 (28.7%) had high-normal BP. The remaining 164 (18.9%) were hypertensive. By gender, 16.5% (109/668) of males and 27.2% (55/202) of females were hypertensive. Among hypertensives, 62.2%...

International Journal of Gynecology & Obstetrics, 1997

Preliminary studies: A facility review and focus group discussions revealed poor capacity to mana... more Preliminary studies: A facility review and focus group discussions revealed poor capacity to manage obstetric complications. Inter¨entions: In response, a physician with obstetric skills was posted, and a second physician was trained. Courses in life-saving obstetric skills were held for nurses and midwives. An unused operating theater was made functional with simple modifications. A generator and blood bank were installed. Drugs and supplies were made available through a revolving fund. Subsequently, community interventions focused on improving utilization. Results: The number of women seeking treatment for major obstetric complications at the district hospital increased Ž. from 31 in 1990 to 98 in 1995, while the case fatality rate CFR among these women dropped from 32% to 5%. Cesarean sections increased from two in 1990 to 38 in 1995. In 1995, 444 abortion-related procedures were performed ᎏ almost all of them for unwanted pregnancy ᎏ compared with only 22 in 1990. Costs: The cost of material improvements and training was approximately US$39 000, of which 46% was from project funds, 41% from non-governmental organizations and 13% from government. Conclusions: Women with obstetric complications will seek hospital care if services are available. Government hospital services can be improved by building on existing resources. Obstetric CFR can be dramatically reduced. The need for safe abortion services, which are currently illegal in Sierra Leone, is demonstrated.

Hospital admissions and their clinical outcomes can reflect the disease burden in a population an... more Hospital admissions and their clinical outcomes can reflect the disease burden in a population and can be utilised as effective surveillance and impact monitoring tools. Inadequate documentation of admissions and their outcomes have contributed to the poor quality of paediatric care in many health care settings in sub-Saharan Africa. We have developed and piloted a simple tool for documentation of basic, standardised patient-level information on causes of admissions, diagnoses, treatments and outcomes in patients admitted to the paediatric ward of a district hospital in a rural community in Sierra Leone.From 1 August 2019 to 31 July 2021, we used this tool to document the admissions, treatments and clinical outcomes of 1,663 children admitted to this hospital. The majority of the children (1015, 62%) were aged between 12-59 months, were boys (942, 57%), were wasted (516, 31%), stunted (238 14%) or underweight (537, 32%). More than half of the children lived more than 1 km distance f...

IntroductionThe prevalence of type 2 diabetes mellitus (T2DM) and associated morbidity and mortal... more IntroductionThe prevalence of type 2 diabetes mellitus (T2DM) and associated morbidity and mortality are increasing in sub-Saharan Africa (SSA). To facilitate access to quality care and improve treatment outcomes, there is a need for innovative community care models and optimized use of non-physician healthcare workers bringing diagnosis and care closer to patients’ homes.AimWe aimed to describe with a scoping review different models of community-based care for non-pregnant adults with T2DM in SSA, and to synthesize the model outcomes in terms of engagement in care, blood sugar control, acceptability, and end-organ damage. We further aimed to critically appraise the different models of care and compare community-based to facility-based care if data were available.MethodsWe searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus, supplemented with backward and forward citation searches. We included cohort studies, randomized trials and c...

The Lancet Infectious Diseases

ObjectivesWe assessed the prevalence of immunoglobulin G (IgG) and immunoglobulin M (IgM) against... more ObjectivesWe assessed the prevalence of immunoglobulin G (IgG) and immunoglobulin M (IgM) against four endemic human coronaviruses (HCoVs) and two SARS-CoV-2 antigens, among vaccinated and unvaccinated staff at health care centres in Uganda, Sierra Leone, and the Democratic Republic of Congo (DRC).MethodsGovernment health facility staff who had patient contact in Goma (DRC), Kambia District (Sierra Leone), and Masaka District (Uganda) were enrolled. Questionnaires and blood samples were collected at three timepoints over four months. Blood samples were analysed with the Luminex MAGPIX®.ResultsAmong unvaccinated participants, the prevalence of IgG/IgM antibodies against SARS-CoV-2 RBD or N-protein at enrolment was 70% in Goma (138/196), 89% in Kambia (112/126) and 89% in Masaka (190/213). IgG responses against endemic HCoVs at baseline were not associated with SAR-CoV-2 sero-acquisition during follow-up. Among vaccinated participants, those who had evidence of SARS-CoV-2 IgG/IgM at b...

African Journal of Reproductive Health, Dec 1, 2012

In-depth studies on fertility in Namibia have been lacking so far. This examines the fertility tr... more In-depth studies on fertility in Namibia have been lacking so far. This examines the fertility trends in Namibia over the past 2 decades and examines fertility differentials across the various subgroups of Namibia population, and factors affecting such differentials using NDHS data. Estimates of the amount of variance in the total number of children ever born that could be explained by each of the independent variables were made using multiple regression analysis for the three data sources. Overall, results from descriptive analysis show that fertility levels in Namibia have been decreasing over the past two decades. The decrease could be associated with an increased trend in the prevalence of use of modern contraceptives which doubled since 1992. Age at first birth has remained constant but age at first marriage continues to increase. As a result, postponement of marriage increases the probability that women remain childless or that they have fewer children than desired. Replacement level is projected to be attained much faster than expected and the study recommend for further research that focuses on policy implications of family planning programmes once replacement level has been achieved to maintain it. (Afr J Reprod Health 2012; 16[4]: 50-57). Résumé Des études approfondies sur la fécondité en Namibie ont fait défaut jusqu'à présent. En se servant des données recueillies de l'ENDS, cette étude examine les tendances de la fécondité en Namibie au cours des deux dernières décennies et examine les différences concernant la fécondité auprès des divers sous-groupes de la population namibienne ainsi que les facteurs qui affectent ces écarts. Les estimations de la proportion de la variance dans le nombre total d'enfants nés vivants qui pourraient s'expliquer par chacune des variables indépendantes ont été effectuées à l'aide d'une analyse de régression multiple pour les trois sources de données. Dans l'ensemble, les résultats de l'analyse descriptive montrent que les niveaux de fécondité en Namibie ont baissé au cours des deux dernières décennies. Cette baisse pourrait être liée à une tendance accrue à la prévalence de l'usage des contraceptifs modernes qui a doublé depuis 1992. L'âge au premier accouchement est resté constant, mais l'âge au premier mariage continue d'augmenter. En conséquence, le report du mariage augmente la possibilité que les femmes restent sans enfants ou qu'elles aient moins d'enfants que le nombre désiré. Le niveau de remplacement devrait être atteint beaucoup plus rapidement que prévu et l'étude recommande encore de des recherches qui seront concentrées sur les implications politiques des programmes de planification familiale une fois que le niveau de remplacement aura été réalisé pour le maintenir (Afr

Abstract: Sierra Leone has one of the highest rates of female genital mutilation (FGM) in the wor... more Abstract: Sierra Leone has one of the highest rates of female genital mutilation (FGM) in the world, and yet little is known about the health consequences of the practice. Purpose: To explore whether and what kind of FGM-related health complications girls and women in Sierra Leone experience, and to elucidate their health care-seeking behaviors. Patients and methods: A feasibility study was conducted to test and refine questionnaires and methods used for this study. Thereafter, a cross-section of girls and women (n = 258) attend-ing antenatal care and Well Women Clinics in Bo Town, Bo District, in the southern region and in Makeni Town, Bombali District, in the northern region of Sierra Leone were randomly selected. Participants answered interview-administrated pretested structured questionnaires with open-ended-questions, administrated by trained female personnel. Results: All respondents had undergone FGM, most between 10 and 14 years of age. Complications were reported by 218 res...

Unusual cases of pneumonia detected in Wuhan City, China, in December 2019, were first reported t... more Unusual cases of pneumonia detected in Wuhan City, China, in December 2019, were first reported to the WHO Office in China on December 31, 20191. The causative agent was identified as a previously unknown type of coronavirus (2019-nCoV) which currently has no cure. The outbreak has not yet been declared as an international health emergency, but airports across the world are deploying screening measures to isolate passengers with symptoms related to the disease to contain the spread of the disease. The continent of Africa might be at risk, and there are several challenges facing Africa that may need to be addressed for adequacy in an anticipated African response.

Additional file 1: Appendix 1. Secondary objectives. Appendix 2. Sample size considerations and s... more Additional file 1: Appendix 1. Secondary objectives. Appendix 2. Sample size considerations and statistical analysis. Appendix 3. PREVAC study team. Appendix 4. Trial organization. Appendix 5. Assent and consent forms. Appendix 6. Participants in the PREVAC trial. Appendix 7. Enrollment of the participants in the PREVAC trial. Appendix 8. Baseline antibody data.

Trials, 2021

Reference 1. Badio, et al. Partnership for Research on Ebola VACcination (PREVAC): protocol of a ... more Reference 1. Badio, et al. Partnership for Research on Ebola VACcination (PREVAC): protocol of a randomized, double-blind, placebo-controlled phase 2 clinical trial evaluating three vaccine strategies against Ebola in healthy volunteers in four West African countries. Trials. 2021;22:86.

The Lancet Infectious Diseases, 2021

Safety and long-term immunogenicity of a two-dose Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine regimen i... more Safety and long-term immunogenicity of a two-dose Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine regimen in adults: a randomised, double-blind, controlled trial in Sierra Leone

Trials, 2021

Introduction The Ebola virus disease (EVD) outbreak in 2014–2016 in West Africa was the largest o... more Introduction The Ebola virus disease (EVD) outbreak in 2014–2016 in West Africa was the largest on record and provided an opportunity for large clinical trials and accelerated efforts to develop an effective and safe preventative vaccine. Multiple questions regarding the safety, immunogenicity, and efficacy of EVD vaccines remain unanswered. To address these gaps in the evidence base, the Partnership for Research on Ebola Vaccines (PREVAC) trial was designed. This paper describes the design, methods, and baseline results of the PREVAC trial and discusses challenges that led to different protocol amendments. Methods This is a randomized, double-blind, placebo-controlled phase 2 clinical trial of three vaccine strategies against the Ebola virus in healthy volunteers 1 year of age and above. The three vaccine strategies being studied are the rVSVΔG-ZEBOV-GP vaccine, with and without a booster dose at 56 days, and the Ad26.ZEBOV,MVA-FN-Filo vaccine regimen with Ad26.ZEBOV given as the f...

Revue d'Épidémiologie et de Santé Publique, 2017

meta-analyses. Despite the spontaneous adverse drugs reactions reporting may be influenced by the... more meta-analyses. Despite the spontaneous adverse drugs reactions reporting may be influenced by the knowledge of the treatment, the potential impact of study design was always ignored to estimate the true risk of these agents. We perform a systematic review and meta-analysis of randomized controlled-trials to determine whether the estimated risk of these adverse effects of antiangiogenic therapies differ between open-label trials and double-blind trials. Methods We searched Medline, Cochrane, ClinicalTrial databases, abstract in congress proceedings of the American Society of Clinical Oncology and the European Society of Medical Oncology for relevant clinical trials. We included all eligible phase II and III randomized clinical trials that randomly assigned patients with solid cancer to antiangiogenic group versus a control group. The adverse events of interest were bleedings, venous thrombotic events (VTE) and arterial thrombotic events (ATE). Interaction (Cochran's chisquared test) between open and double-blind designs was tested. Results A total of 166 trials (72 024 patients) were included. For bleeding events, the associated risk of bleeding on antiangiogenic treatment compared to no antiangiogenic treatment yielded an odds ratio (OR) equal to 3.18 (95% CI 2.65 to 3.81) with open trials compared to 1.89 (1.63 to 2.19) for doubleblind studies, i.e. a significant exaggeration of treatment effects of 68% (33 to 113) with open design (interaction test, P < 0.0001). Concerning VTE, an OR of 1.51 (1.26 to 1.81) for open trials was noted compared to a non-significant OR for double blind trials (OR 0.99, 0.83 to 1.17), with a significant enhancement of 53% (19 to 96) of treatment side effect with open trials (interaction test, P < 0.001). For ATE, the over-estimation was estimated to 65% (13 to 143) with open-label studies compared with double-blind trials (interaction test, P = 0.01). The same conclusions of over-estimation with open trials were done for antibodies drugs and tyrosine kinase inhibitors. Conclusion This meta-analysis showed a significant interaction of study design for the safety outcomes and shows for the first time that even the adverse event risk may be influenced by the knowledge of the treatment. Metaanalyses assessing safety events should be restricted to randomized clinical trials at low risk of bias for outcomes.

International Journal of Infectious Diseases, 2016

Background: Severe clinical cases exclusively associated with Plasmodium vivax are increasingly b... more Background: Severe clinical cases exclusively associated with Plasmodium vivax are increasingly being reported worldwide with complications like renal failure, jaundice, acute respiratory distress syndrome, cerebral malaria, seizures, anemia, thrombocytopenia, pulmonary edema, splenic rupture and death. Recently vivax severity has been on the rise in India where P.vivax contributes in equal ratio with P.falciparum to the disease. Two main transporters studied with regard to chloroquine resistance (CQR) are chloroquine resistance transporter (pvcrt-o) and the multidrug resistance transporter (pvmdr1) orthologous to the pfcrt and pfmdr1 genes respectively. Even though these transporters are not established as molecular markers for CQR, they have a speculated role in CQR of P.vivax. Further, it has been demonstrated that the clinical severity in P.vivax could be associated with increased expression levels of pvcrt-o and pvmdr1 genes. We report here two cases of vivax malaria-a severe and non-severe case, diagnosed and confirmed by microscopy, rapid diagnostic tests and 18S rRNA PCR assay. Methods & Materials: Relative quantification was carried out to find the expression levels of five vir genes (vir 14-related, vir 12, vir 17-like, putative vir 14 and vir 10-related) and two P. vivax speculated drug resistance genes viz. P. vivax chloroquine resistance transporter (pvcrt-o) gene and P. vivax multidrug resistance transporter (pvmdr1) gene. These genes were selected on the basis of their in silico data and a previous understanding of their speculated role in the pathogenesis of P. vivax. Results: Expression pvcrt-o and pvmdr1 genes and five vir genes (vir 14-related, vir 12, vir 17-like, putative vir 14 and vir 10-related), were measured simultaneously in these two cases for comparison. It was found that the expression levels of pvcrt-o and pvmdr1 genes and vir genes (vir 14-related, vir 12, vir 17-like and vir 10-related), was much higher in the severe vivax isolate as compared to the uncomplicated case. Putative vir14 gene was not expressed in the test and control isolates. Conclusion: It brings to light how genes linked to the emerging CQR in P.vivax might impart virulence to vivax malaria making them excellent genetic markers for disease severity.

Emerging infectious diseases, 2022

We explored the association of Ebola virus antibody seropositivity and concentration with potenti... more We explored the association of Ebola virus antibody seropositivity and concentration with potential risk factors for infection. Among 1,282 adults and children from a community affected by the 2014-2016 Ebola outbreak in Sierra Leone, 8% were seropositive for virus antibodies but never experienced disease symptoms. Antibody concentration increased with age.

Journal of Tropical Pediatrics, 1986

Sierra Leone like other developing countries is characterized by a shortage and uneven distributi... more Sierra Leone like other developing countries is characterized by a shortage and uneven distribution of trained health personnel and health care facilities. One consequence is that non-physician health workers such as maternal and child health (MCH) aides are burdened with considerable responsibility for medical interventions requiring skill and training for favorable outcomes under difficult conditions. The partogram a graphic record of the process of labor has become a necessary part of the management of the patient in labor. The purpose of this study was to assess how effectively the MCH-aide can use the partogram. 30 aides working in various villages in the Southern Province of Sierra Leone identified by random selection were trained in the use of partograms to monitor primagravid labor. Their performance in the effective use of the partogram was compared with that of midwives chosen by random selection from all government hospitals and similarly trained. The partogram used was the one modified by Philpott. Training stressed the graphic representation of cervical dilatation. Of 74 patients referred by the MCH aides over a 12-month period following their training 35 were primigravidae; 20% of those whose labors were monitored on the partogram were delivered by cesarean section while 55% of those where no partogram was used required a Cesarean section. The difference was statistically significant. Though aides promptly instituted patients transfer these could not benefit from timely intervention because of infrastructural difficulties such as transportation and problems of resources such as non-availability of blood for transfusion. It appears that the graphic recording of the progress of labor helps in the early detection of abnormalities.

BMJ Global Health, 2021

IntroductionInfectious disease misinformation is widespread and poses challenges to disease contr... more IntroductionInfectious disease misinformation is widespread and poses challenges to disease control. There is limited evidence on how to effectively counter health misinformation in a community setting, particularly in low-income regions, and unsettled scientific debate about whether misinformation should be directly discussed and debunked, or implicitly countered by providing scientifically correct information.MethodsThe Contagious Misinformation Trial developed and tested interventions designed to counter highly prevalent infectious disease misinformation in Sierra Leone, namely the beliefs that (1) mosquitoes cause typhoid and (2) typhoid co-occurs with malaria. The information intervention for group A (n=246) explicitly discussed misinformation and explained why it was incorrect and then provided the scientifically correct information. The intervention for group B (n=245) only focused on providing correct information, without directly discussing related misinformation. Both inte...