Bacterial Profile, Susceptibility Patterns, and Factors Associated with Culture-Positive Sputum Among HIV Patients Presenting with a Cough in Northern Uganda.

Aim: Sub-Saharan Africa bears the highest burden of HIV/AIDS infections and constitutes 72% and 69% of AIDS-related deaths and people living with HIV worldwide, respectively. Due to the relationship between pulmonary infections and HIV/AIDS, it is biologically plausible that the surge in morbidity and mortality among HIV/AIDS patients could be attributed to an increase in pulmonary infections among this cohort of patients. This study determined the bacterial profile, susceptibility patterns, and factors associated with culture-positive sputum among HIV patients presenting with cough at the Lira Infectious Disease Centre in Northern Uganda.

Challenges and solutions to providing surgery in Sierra Leone hospitals: a qualitative analysis of surgical provider perspectives.

Objective: This study aimed to use qualitative interviews with surgical providers to explore challenges and solutions to providing surgical and anaesthesia care in Sierra Leone's hospitals.

Design: Data were collected through anonymous, semistructured interviews. We used a qualitative framework approach to analyse interview data and determine themes relating to challenges that were reported.

What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure.

Objectives: To measure the financial burden associated with accessing surgical care in Sierra Leone.

Design: A cross-sectional survey conducted with patients at the time of discharge from tertiary-level care. This captured demographics, yearly household expenditure, direct medical, direct non-medical and indirect costs for surgical care, and summary household assets.

Improving nursing documentation for surgical patients in a referral hospital in Freetown, Sierra Leone: protocol for assessing feasibility of a pilot multifaceted quality improvement hybrid type project.

Background: There is an urgent need to improve quality of care to reduce avoidable mortality and morbidity from surgical diseases in low- and middle-income countries. Currently, there is a lack of knowledge about how evidence-based health system strengthening interventions can be implemented effectively to improve quality of care in these settings. To address this gap, we have developed a multifaceted quality improvement intervention to improve nursing documentation in a low-income country hospital setting.

Staff recognition and its importance for surgical service delivery: a qualitative study in Freetown, Sierra Leone.

We examined the views of providers and users of the surgical system in Freetown, Sierra Leone on processes of care, job and service satisfaction and barriers to achieving quality and accessible care, focusing particularly on the main public tertiary hospital in Freetown and two secondary and six primary sites from which patients are referred to it. We conducted interviews with health care providers (N = 66), service users (n = 24) and people with a surgical condition who had chosen not to use the public surgical system (N = 13), plus two focus groups with health providers in primary care (N = 10 and N = 10). The overall purpose of the study was to understand perceptions on processes of and barriers to care from a variety of perspectives, to recommend interventions to improve access and quality of care as part of a larger study.

Macroeconomic costs of the unmet burden of surgical disease in Sierra Leone: a retrospective economic analysis.

Objectives: The Lancet Commission on Global Surgery estimated that low/middle-income countries will lose an estimated cumulative loss of US$12.3 trillion from gross domestic product (GDP) due to the unmet burden of surgical disease. However, no country-specific data currently exist.

Medical Officers in Sierra Leone: Surgical Training Opportunities, Challenges and Aspirations.

Background: The critical shortage of human resources for healthcare falls most heavily on sub-Saharan nations such as Sierra Leone, where such workforce deficits have grave impacts on its burden of surgical disease. An important aspect in retention and development of the workforce is training. This study focuses on postgraduate surgical training (formal and short course) and perceptions of opportunities, challenges and aspirations, in a country where more than half of surgical procedures are performed by medical officers.

Evaluation of a rapid and sensitive RT-qPCR assay for the detection of Ebola Virus.

Background: The 2013-2016 Ebola virus disease (EVD) outbreak showed a lack of diagnostic point-of-care methods. Currently, EBOV diagnosis relies on quantitative reverse-transcription-PCR (RT- qPCR), highly specific and sensitive, but requiring skilled personnel and well-equipped laboratories. In field settings, these factors and others, such as samples' time of collection and transportation, determine a prolonged turnaround-time to final results.

Safety, productivity and predicted contribution of a surgical task-sharing programme in Sierra Leone.

Background: Surgical task-sharing may be central to expanding the provision of surgical care in low-resource settings. The aims of this paper were to describe the set-up of a new surgical task-sharing training programme for associate clinicians and junior doctors in Sierra Leone, assess its productivity and safety, and estimate its future role in contributing to surgical volume.

Methods: This prospective observational study from a consortium of 16 hospitals evaluated crude in-hospital mortality over 5 years and productivity of operations performed during and after completion of a 3-year surgical training programme.

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.

Cost-Effectiveness of Two Government District Hospitals in Sub-Saharan Africa.

Background: District hospitals in sub-Saharan Africa are in need of investment if countries are going to progress towards universal health coverage, and meet the sustainable development goals and the Lancet Commission on Global Surgery time-bound targets for 2030. Previous studies have suggested that government hospitals are likely to be highly cost-effective and therefore worthy of investment.

Methods: A retrospective analysis of the inpatient logbooks for two government district hospitals in two sub-Saharan African hospitals was performed.

Quantifying the risk of nosocomial infection within Ebola Holding Units: a retrospective cohort study of negative patients discharged from five Ebola Holding Units in Western Area, Sierra Leone.

Objectives: A central pillar in the response to the 2014 Ebola virus disease (EVD) epidemic in Sierra Leone was the role of Ebola Holding Units (EHUs). These units isolated patients meeting a suspect case definition, tested them for EVD, initiated appropriate early treatment and discharged negative patients to onward inpatient care or home. Positive patients were referred to Ebola Treatment Centres.

Backlog and burden of fractures in Sierra Leone and Nepal: Results from nationwide cluster randomized, population-based surveys.

Background: The burden of injury is increasing worldwide; planning for its impact on population health and health systems is urgently needed, particularly in low- and middle-income countries (LMICs). This study aimed to model the burden of fractures and project costs to eliminate avertable fracture-related disability-adjusted life-years (i.e.

Prioritizing Surgical Care on National Health Agendas: A Qualitative Case Study of Papua New Guinea, Uganda, and Sierra Leone.

Background: Little is known about the social and political factors that influence priority setting for different health services in low- and middle-income countries (LMICs), yet these factors are integral to understanding how national health agendas are established. We investigated factors that facilitate or prevent surgical care from being prioritized in LMICs.

Methods And Findings: We undertook country case studies in Papua New Guinea, Uganda, and Sierra Leone, using a qualitative process-tracing method.

Assessing unmet anaesthesia need in Sierra Leone: a secondary analysis of a cluster-randomized, cross-sectional, countrywide survey.

Objectives: To determine the unmet anaesthesia need in a low resource region.

Introduction: Surgery and anæsthesia services in low- and middle-income countries (LMICs) are under-equipped, under-staffed, and unable to meet current surgical need. There is little objective measure as to the true extent and nature of unmet need.

The Surgical Workforce and Surgical Provider Productivity in Sierra Leone: A Countrywide Inventory.

Background: Limited data exist on surgical providers and their scope of practice in low-income countries (LICs). The aim of this study was to assess the distribution and productivity of all surgical providers in an LIC, and to evaluate correlations between the surgical workforce availability, productivity, rates, and volume of surgery at the district and hospital levels.

Methods: Data on surgeries and surgical providers from 56 (93.

Surgery in the time of Ebola: how events impacted on a single surgical institution in Sierra Leone.

Introduction: The mortality and morbidity of Ebola extends far wider than those contracting the disease. Surgical activity in Sierra Leone has been severely disrupted by the epidemic.

Method: This is a retrospective study examining the effect of the 2014-2015 Ebola virus epidemic on surgical activity in a Sierra Leone's main teaching hospital.

The demographics of patients affected by surgical disease in district hospitals in two sub-Saharan African countries: a retrospective descriptive analysis.

Background: There is a growing awareness of the importance of surgical disease within global health. We hypothesised that surgical disease in low income countries predominantly affects young adults and may therefore have a significant economic impact.

Methods: We retrospectively reviewed all surgical admission data from two rural government district hospitals in two different sub-Saharan African countries over a 6-month period.

Assessment of Environmental Contamination and Environmental Decontamination Practices within an Ebola Holding Unit, Freetown, Sierra Leone.

Evidence to inform decontamination practices at Ebola holding units (EHUs) and treatment centres is lacking. We conducted an audit of decontamination procedures inside Connaught Hospital EHU in Freetown, Sierra Leone, by assessing environmental swab specimens for evidence of contamination with Ebola virus by RT-PCR. Swabs were collected following discharge of Ebola Virus Disease (EVD) patients before and after routine decontamination.

Self-reported Determinants of Access to Surgical Care in 3 Developing Countries.

Importance: Surgical care is recognized as a growing component of global public health.

Objective: To assess self-reported barriers to access of surgical care in Sierra Leone, Rwanda, and Nepal using the validated Surgeons OverSeas Assessment of Surgical Need tool.

Design, Setting, And Participants: Data for this cross-sectional, cluster-based population survey were collected from households in Rwanda (October 2011), Sierra Leone (January 2012), and Nepal (May and June 2014) using the Surgeons OverSeas Assessment of Surgical Need tool.

Generation of national political priority for surgery: a qualitative case study of three low-income and middle-income countries.

Background: Surgical conditions exert a major health burden in low-income and middle-income countries (LMICs), yet surgery remains a low priority on national health agendas. Little is known about the national factors that influence whether surgery is prioritised in LMICs. We investigated factors that could facilitate or prevent surgery from being a health priority in three LMICs.