Freetown, Sierra Leone
Freetown, Sierra Leone

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Fisher M.B.,University of North Carolina at Chapel Hill | Williams A.R.,University of North Carolina at Chapel Hill | Jalloh M.F.,FOCUS 1000 | Saquee G.,FOCUS 1000 | And 2 more authors.
PLoS ONE | Year: 2015

Packaged drinking water (PW) sold in bottles and plastic bags/sachets is widely consumed in low- and middle-income countries (LMICs), and many urban users in sub-Saharan Africa (SSA) rely on packaged sachet water (PSW) as their primary source of water for consumption. However, few rigorous studies have investigated PSW quality in SSA, and none have compared PSW to stored household water for consumption (HWC). A clearer understanding of PSW quality in the context of alternative sources is needed to inform policy and regulation. As elsewhere in SSA, PSW is widely consumed in Sierra Leone, but government oversight is nearly nonexistent. This study examined the microbiological and chemical quality of a representative sample of PSW products in Freetown, Sierra Leone at packaged water manufacturing facilities (PWMFs) and at points of sale (POSs). Samples of HWC were also analyzed for comparison. The study did not find evidence of serious chemical contamination among the parameters studied. However, 19% of 45 PSW products sampled at the PWMF contained detectable Escherichia coli (EC), although only two samples exceeded 10 CFU/100 mL. Concentrations of total coliforms (TC) in PSW (but not EC) increased along the supply chain. Samples of HWC from 60 households in Freetown were significantly more likely to contain EC and TC than PSW at the point of production (p<0.01), and had significantly higher concentrations of both bacterial indicators (p<0.01). These results highlight the need for additional PSW regulation and surveillance, while demonstrating the need to prioritize the safety of HWC. At present, PSW may be the least unsafe option for many households. Copyright © 2015 Fisher et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Li W.,Center for Global Health | Jalloh M.F.,Center for Global Health | Bunnell R.,Center for Global Health | Aki-Sawyerr Y.,Sierra Leone National Ebola Response Center | And 9 more authors.
Morbidity and Mortality Weekly Report | Year: 2016

What is already known about this topic? Public mistrust and fear based on misconceptions regarding health care system facilities and providers increased during the Ebola virus disease (Ebola) epidemic in Sierra Leone, and health care system usage rates declined sharply. Sierra Leone’s Ebola recovery and global health security strengthening efforts require willingness of citizens to seek care and place trust in that care. What is added by this report? A majority of participants in a knowledge, attitudes, and practices survey conducted after approximately 15 months of an Ebola epidemic in Sierra Leone expressed at least some confidence in the health care system’s ability to treat patients suspected to have Ebola, and >90% reported confidence that the health care system could also provide non-Ebola services, including immunizations, antenatal care, and maternity care. Respondents from areas with active Ebola transmission had higher confidence in the health care system, as did respondents with higher education levels. Respondents ranked Ebola and malaria as the most important health issues for Sierra Leone. What are the implications for public health practice? Understanding factors contributing to public confidence in the health care system can help develop education and health promotion campaigns. Public confidence in the health care system to deliver basic services provides a foundation on which to build a restored and improved post-Ebola health system in Sierra Leone. © 2016, Department of Health and Human Services. All rights reserved.

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