Mercy Hospital Research Laboratory

Bo, Sierra Leone

Mercy Hospital Research Laboratory

Bo, Sierra Leone

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McMahon S.A.,University of Heidelberg | Ho L.S.,International Rescue Committee | Brown H.,Durham University | Miller L.,International Rescue Committee | And 2 more authors.
Health Policy and Planning | Year: 2016

Although research on the epidemiology and ecology of Ebola has expanded since the 2014-15 outbreak in West Africa, less attention has been paid to the mental health implications and the psychosocial context of the disease for providers working in primary health facilities (rather than Ebola-specific treatment units). This study draws on 54 qualitative interviews with 35 providers working in eight peripheral health units of Sierra Leone's Bo and Kenema Districts. Data collection started near the height of the outbreak in December 2014 and lasted 1 month. Providers recounted changes in their professional, personal and social lives as they became de facto first responders in the outbreak. A theme articulated across interviews was Ebola's destruction of social connectedness and sense of trust within and across health facilities, communities and families. Providers described feeling lonely, ostracized, unloved, afraid, saddened and no longer respected. They also discussed restrictions on behaviors that enhance coping including attending burials and engaging in physical touch (hugging, handshaking, sitting near, or eating with colleagues, patients and family members). Providers described infection prevention measures as necessary but divisive because screening booths and protective equipment inhibited bonding or 'suffering with' patients. To mitigate psychiatric morbidities and maladaptive coping mechanisms-and to prevent the spread of Ebola-researchers and program planners must consider the psychosocial context of this disease and mechanisms to enhance psychological first aid to all health providers, including those in peripheral health settings. © The Author 2016.

Leski T.A.,U.S. Navy | Stockelman M.G.,U.S. Navy | Moses L.M.,Tulane University | Park M.,Thomas Jefferson High School | And 4 more authors.
Emerging Infectious Diseases | Year: 2015

Lassa virus (LASV) is endemic to parts of West Africa and causes highly fatal hemorrhagic fever. The multimammate rat (Mastomys natalensis) is the only known reservoir of LASV. Most human infections result from zoonotic transmission. The very diverse LASV genome has 4 major lineages associated with different geographic locations. We used reverse transcription PCR and resequencing microarrays to detect LASV in 41 of 214 samples from rodents captured at 8 locations in Sierra Leone. Phylogenetic analysis of partial sequences of nucleoprotein (NP), glycoprotein precursor (GPC), and polymerase (L) genes showed 5 separate clades within lineage IV of LASV in this country. The sequence diversity was higher than previously observed; mean diversity was 7.01% for nucleoprotein gene at the nucleotide level. These results may have major implications for designing diagnostic tests and therapeutic agents for LASV infections in Sierra Leone. © 2015, Emerging Infectious Diseases. All rights reserved.

PubMed | University of the Sierra, Royal Veterinary College, Medical Research Council Unit, Institute of Tropical Medicine and 4 more.
Type: Journal Article | Journal: EcoHealth | Year: 2016

Lassa fever is a zoonotic hemorrhagic illness predominant in areas across Nigeria, Sierra Leone, Guinea, Liberia, and southern Mali. The reservoir of Lassa virus is the multimammate mouse (Mastomys natalensis), a highly commensal species in West Africa. Primary transmission to humans occurs through direct or indirect contact with rodent body fluids such as urine, feces, saliva, or blood. Our research draws together qualitative and quantitative methods to provide a fuller and more nuanced perspective on these varied points of human-animal contact. In this article, we focus on the hunting, preparation, and consumption of rodents as possible routes of exposure in Bo, Sierra Leone. We found that the consumption of rodents, including the reservoir species, is widespread and does not neatly tally against generational or gender lines. Further, we found that the reasons for rodent consumption are multifactorial, including taste preferences, food security, and opportunistic behavior. We argue that on certain topics, such as rodent consumption, establishing trust with communities, and using qualitative research methods, is key to investigate sensitive issues and situate them in their wider context. To conclude, we recommend ways to refine sensitization campaigns to account for these socio-cultural contexts.

PubMed | George Mason University, United State Naval Research Laboratory and Mercy Hospital Research Laboratory
Type: | Journal: The Pan African medical journal | Year: 2016

Bypassing refers to a persons decision to seek care at a healthcare facility that is not the nearest one of its type to the persons home.This study examined inpatient care facility bypassing in urban Bo, Sierra Leone using data from 1,980 women with children 15 years of age and younger who were interviewed in 2010-2011. The locations of residential structures and hospitals were identified using a geographic information system (GIS), and the road distances from participating households to the nearest and preferred inpatient care facilities were measured.Nine inpatient care facilities serve Bo residents, but more than 70% of the participating women reported that the citys main public hospital (Bo Government Hospital), located in the city center, was their preferred inpatient care provider. Participants resided within a median distance of 0.9 km (Interquartile range (IQR): 0.6, 1.8) from their closest inpatient facility, but they would travel a median distance of 2.4 km (IQR: 1.0, 3.3) to reach their preferred providers. About 87% of the women would bypass their nearest inpatient care facility to access care at a preferred provider. Bypassing rates were similar for various demographic and socioeconomic groups, but higher for women living farther from the city center.Although Bo has a diverse healthcare marketplace, access to affordable advanced care options is limited. Most women in Bo would choose to bypass facilities nearer to their homes to seek the low-cost and comprehensive care offered by Bo Government Hospital.

PubMed | United Information Technology, George Mason University, Center for Bio Molecular Science and Engineering and Mercy Hospital Research Laboratory
Type: Journal Article | Journal: International journal of public health | Year: 2016

To examine the diversity of the health-care providers in urban Bo, Sierra Leone, identify the types of health-care facilities preferred by women for fevers, and analyze the road network distances from homes to preferred health-care providers.A population-based random sampling method was used to recruit 2419 women from Bo. A geographic information system was used to measure the road distance from each womans home to her preferred provider.Preferred health-care providers for acute febrile illnesses (commonly referred to as malaria in the study communities) were hospitals (62.3%), clinics (12.6%), and pharmacies (12.4%). Participants lived a median distance of 0.6km from the nearest provider, but on average each woman lived 2.2km one-way from her preferred provider. Women living farther from the city center had preferred providers significantly farther from home than women living downtown.The diverse health-care marketplace in Bo allows women to select clinical facilities from across the city. Most women prefer a malaria care provider farther from home than they could comfortably walk when ill.

de Souza D.K.,University of Ghana | Sesay S.,Ministry of Health and Sanitation | Moore M.G.,Ministry of Health and Social Welfare | Ansumana R.,Mercy Hospital Research Laboratory | And 9 more authors.
PLoS Neglected Tropical Diseases | Year: 2014

Background:In West Africa, the principal vectors of lymphatic filariasis (LF) are Anopheles species with Culex species playing only a minor role in transmission, if any. Being a predominantly rural disease, the question remains whether conflict-related migration of rural populations into urban areas would be sufficient for active transmission of the parasite.Methodology/Principal Findings:We examined LF transmission in urban areas in post-conflict Sierra Leone and Liberia that experienced significant rural-urban migration. Mosquitoes from Freetown and Monrovia, were analyzed for infection with Wuchereria bancrofti. We also undertook a transmission assessment survey (TAS) in Bo and Pujehun districts in Sierra Leone. The majority of the mosquitoes collected were Culex species, while Anopheles species were present in low numbers. The mosquitoes were analyzed in pools, with a maximum of 20 mosquitoes per pool. In both countries, a total of 1731 An. gambiae and 14342 Culex were analyzed for W. bancrofti, using the PCR. Two pools of Culex mosquitoes and 1 pool of An. gambiae were found infected from one community in Freetown. Pool screening analysis indicated a maximum likelihood of infection of 0.004 (95% CI of 0.00012-0.021) and 0.015 (95% CI of 0.0018-0.052) for the An. gambiae and Culex respectively. The results indicate that An. gambiae is present in low numbers, with a microfilaria prevalence breaking threshold value not sufficient to maintain transmission. The results of the TAS in Bo and Pujehun also indicated an antigen prevalence of 0.19% and 0.67% in children, respectively. This is well below the recommended 2% level for stopping MDA in Anopheles transmission areas, according to WHO guidelines.Conclusions:We found no evidence for active transmission of LF in cities, where internally displaced persons from rural areas lived for many years during the more than 10 years conflict in Sierra Leone and Liberia. © 2014 de Souza et al.

Jacobus H.,U.S. Navy | Jacobus H.,Nova Research Inc. | Lin B.,U.S. Navy | Jimmy D.H.,Mercy Hospital Research Laboratory | And 3 more authors.
Energy Conversion and Management | Year: 2011

Hybrid power systems have the capability to incorporate significant renewable energy penetration for a small autonomous system while still maintaining reliable grid stability. While there are many papers covering the optimization of component size and dispatch strategy, far fewer papers contain experimental performance data from hybrid systems. Mercy Hospital in Bo, Sierra Leone is converting their power system into a photovoltaic (PV)-diesel hybrid system, thus providing an opportunity to examine the change in system performance before, during, and after the conversion. Due to the seasonal availability of electric power in Sierra Leone, two datasets representing two distinct load profiles are analyzed: Wet Season and Dry Season. The difference in generation efficiency,cost per kW h, generator runtime, and fuel consumption are calculated between a diesel-only generation baseline and the recorded hybrid system performance. The results indicated that the hybrid system significantly reduces operation costs; approximately 37% less during Dry Season and 64% reduction in the Wet Season than a diesel-only generator serving the same load. © 2011 Elsevier Ltd.

Leski T.A.,Center for Bio Molecular Science and Engineering | Bangura U.,Mercy Hospital Research Laboratory | Bangura U.,Njala University | Jimmy D.H.,Mercy Hospital Research Laboratory | And 7 more authors.
International Journal of Antimicrobial Agents | Year: 2013

The tet(X) gene encodes a flavin-dependent monooxygenase that confers resistance to all clinically relevant tetracycline antibiotics including tigecycline. It has only previously been identified in environmental and non-human pathogenic bacteria. To investigate levels of multidrug resistance in Bo, Sierra Leone, a molecular epidemiological study was conducted using an antimicrobial resistance determinant microarray (ARDM), PCR and DNA sequencing. The study found that 21% of isolates from Mercy Hospital (Bo, Sierra Leone) were tet(X)-positive, all of which originated from urinary specimens. Use of molecular epidemiological surveillance tools has provided the first evidence of tet(X)-containing multidrug-resistant Gram-negative hospital isolates in a hospital in Sierra Leone. © 2013 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Leski T.A.,Center for Bio Molecular Science and Engineering | Bangura U.,Mercy Hospital Research Laboratory | Jimmy D.H.,Mercy Hospital Research Laboratory | Jimmy D.H.,Njala University | And 9 more authors.
Journal of Clinical Microbiology | Year: 2013

We describe the results of a molecular epidemiological survey of 15 carbapenemase-encoding genes from a recent collection of clinical isolates from Mercy Hospital in Bo, Sierra Leone. The most salient findings revealed that (i) 60% of the isolates harbored multiple carbapenemase genes; (ii) the bla DIM-1 gene, which has previously only been reported in The Netherlands, is also circulating in this environment; and (iii) bla OXA-51-like and blaOXA-58 genes, which were thought to reside exclusively in Acinetobacter species, can also be found in members of the Enterobacteriaceae. © 2013, American Society for Microbiology.

PubMed | Bowie State University, Mercy Hospital Research Laboratory and U.S. Navy
Type: | Journal: BMC infectious diseases | Year: 2016

The rising level of antimicrobial resistance among bacterial pathogens is one of the most significant public health problems globally. While the antibiotic resistance of clinically important bacteria is closely tracked in many developed countries, the types and levels of resistance and multidrug resistance (MDR) among pathogens currently circulating in most countries of sub-Saharan Africa are virtually unknown.From December 2013 to April 2014, we collected 93 urine specimens from all outpatients showing symptoms of urinary tract infection(UTI) and 189 fomite swabs from a small hospital in Bo, Sierra Leone. Culture on chromogenic agar combined with biochemical and DNA sequence-based assays was used to detect and identify the bacterial isolates. Their antimicrobial susceptibilities were determined using a panel of 11 antibiotics or antibiotic combinations.The 70 Enterobacteriaceae urine isolates were identified as Citrobacter freundii (n=22), Klebsiella pneumoniae (n=15), Enterobacter cloacae (n=15), Escherichia coli (n=13), Enterobacter sp./Leclercia sp. (n=4) and Escherichia hermannii (n=1). Antimicrobial susceptibility testing demonstrated that 85.7% of these isolates were MDR while 64.3% produced an extended-spectrum-lactamase (ESBL). The most notable observations included widespread resistance to sulphonamides (91.4%), chloramphenicol (72.9%), gentamycin (72.9%), ampicillin with sulbactam (51.4%) and ciprofloxacin (47.1%) with C. freundii exhibiting the highest and E. coli the lowest prevalence of multidrug resistance. The environmental cultures resulted in only five Enterobacteriaceae isolates out of 189 collected withlower overall antibiotic resistance.The surprisingly high proportion of C. freundii found in urine of patients with suspected UTI supports earlier findings of the growing role of this pathogen in UTIs in low-resource countries. The isolates of all analyzed species showed worryingly high levels of resistance to both first- and second-line antibiotics as well as ahigh frequency of MDR and ESBL phenotypes, which likely resulted from the lack of consistent antibiotic stewardship policies in Sierra Leone. Analysis of hospital environmental isolates however suggested that fomites in this naturally ventilated hospital were not a major reservoir for Enterobacteriaceae or antibiotic resistance determinants.

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