Let’s talk about herbal medicine. The stuff that’s supposedly loaded with beneficial compounds yet stubbornly resists mass production. Normally, the medicine aisle is flooded with "natural" products that can't be scaled up—largely because plants are not factories. But in a notable twist, Kobe University’s bioengineers have cracked part of the code, using yeast to produce artepillin C, a plant-derived compound with enough health benefits to pique anyone’s interest. Findings from this new study were published recently in ACS Synthetic Biology. Artepillin C itself is a rare molecule. It’s antimicrobial, anti-inflammatory, antioxidant, and even has anticancer potential—like a wonder molecule in a wellness influencer’s dream come true. But there’s a catch: naturally, you get it from bees that gather it from a particular plant. That’s neither efficient nor scalable. Enter the lab of Kobe University’s bioengineering expert, Hasunuma Tomohisa. His team has developed a way to produce artepillin C using bioengineered yeast, essentially turning it into a fermentation marvel. But let's break down what that means. Producing plant compounds in a lab isn't like throwing ingredients in a blender. It’s high-stakes molecular engineering. To make this work, Hasunuma’s team needed to pinpoint the enzyme plants use to produce artepillin C. They got a helping hand from Kazufumi Yazaki at Kyoto University, who recently mapped this elusive enzyme. Once they had the code, Hasunuma’s team inserted it into the yeast Komagataella phaffii. Why this yeast? Well, unlike your garden-variety brewer’s yeast, K. phaffii doesn’t churn out alcohol that kills cells; instead, it quietly reproduces at high density—a much friendlier environment for chemical production. So, what did they find? The modified yeast churned out artepillin C at ten times the previously recorded levels. That’s huge. But here’s where it gets fascinating: artepillin C isn’t the easiest thing to harvest. It tends to accumulate inside the yeast cells instead of floating freely in the growth medium, complicating the extraction process. Hasunuma’s team had to strip out certain mutations from the yeast to allow for denser cell growth. By essentially beefing up the cells' resilience, they turned their yeast into mini artepillin C factories. And there’s more up their sleeves. The Kobe researchers have ideas for further boosting yields, such as tweaking the enzyme responsible for the final production step and even creating a molecular "transporter." Imagine this transporter as a kind of molecular bouncer—letting artepillin C leave the cell while keeping valuable precursor compounds locked inside, ready to crank out even more of the good stuff. Beyond artepillin C, this breakthrough holds promise for a range of plant-derived compounds. You see, the universe of herbal medicine isn’t limited to one “miracle” molecule—there are thousands of similar compounds hiding out in plants. Theoretically, Hasunuma’s engineered yeast could be adapted to produce any number of these, shifting us closer to a world where herbal medicine is scalable, reliable, and affordable. So, here’s where we are: Kobe University has taken a stubbornly natural process and bent it to the will of science, making herbal medicine one step closer to mainstream medicine. And as fascinating as that is for researchers, it’s even more exciting for anyone waiting for evidence-based medicine to deliver plant-based benefits without the folklore. Lorem ipsum dolor sit amet, consectetur adip elit. Donec posuere dolor massa, pellentesque aliquam nisl facilisis sed. Let’s talk about herbal medicine. The stuff that’s supposedly loaded with beneficial compounds yet stubbornly resists mass production. Normally, the medicine aisle is flooded with "natural" products that can't be scaled up—largely because plants are not factories. But in a notable twist, Kobe University’s bioengineers have cracked part of the code, using yeast to produce artepillin C, a plant-derived compound with enough health benefits to pique anyone’s interest. Findings from this new study were published recently in ACS Synthetic Biology. Artepillin C itself is a rare molecule. It’s antimicrobial, anti-inflammatory, antioxidant, and even has anticancer potential—like a wonder molecule in a wellness influencer’s dream come true. But there’s a catch: naturally, you get it from bees that gather it from a particular plant. That’s neither efficient nor scalable. Enter the lab of Kobe University’s bioengineering expert, Hasunuma Tomohisa. His team has developed a way to produce artepillin C using bioengineered yeast, essentially turning it into a fermentation marvel. But let's break down what that means. Producing plant compounds in a lab isn't like throwing ingredients in a blender. It’s high-stakes molecular engineering. To make this work, Hasunuma’s team needed to pinpoint the enzyme plants use to produce artepillin C. They got a helping hand from Kazufumi Yazaki at Kyoto University, who recently mapped this elusive enzyme. Once they had the code, Hasunuma’s team inserted it into the yeast Komagataella phaffii. Why this yeast? Well, unlike your garden-variety brewer’s yeast, K. phaffii doesn’t churn out alcohol that kills cells; instead, it quietly reproduces at high density—a much friendlier environment for chemical production. So, what did they find? The modified yeast churned out artepillin C at ten times the previously recorded levels. That’s huge. But here’s where it gets fascinating: artepillin C isn’t the easiest thing to harvest. It tends to accumulate inside the yeast cells instead of floating freely in the growth medium, complicating the extraction process. Hasunuma’s team had to strip out certain mutations from the yeast to allow for denser cell growth. By essentially beefing up the cells' resilience, they turned their yeast into mini artepillin C factories. And there’s more up their sleeves. The Kobe researchers have ideas for further boosting yields, such as tweaking the enzyme responsible for the final production step and even creating a molecular "transporter." Imagine this transporter as a kind of molecular bouncer—letting artepillin C leave the cell while keeping valuable precursor compounds locked inside, ready to crank out even more of the good stuff. Beyond artepillin C, this breakthrough holds promise for a range of plant-derived compounds. You see, the universe of herbal medicine isn’t limited to one “miracle” molecule—there are thousands of similar compounds hiding out in plants. Theoretically, Hasunuma’s engineered yeast could be adapted to produce any number of these, shifting us closer to a world where herbal medicine is scalable, reliable, and affordable. So, here’s where we are: Kobe University has taken a stubbornly natural process and bent it to the will of science, making herbal medicine one step closer to mainstream medicine. And as fascinating as that is for researchers, it’s even more exciting for anyone waiting for evidence-based medicine to deliver plant-based benefits without the folklore. Lorem ipsum dolor sit amet, consectetur adip elit. Donec posuere dolor massa, pellentesque aliquam nisl facilisis sed.
The 2024 NFL season continues with the Week 16 schedule as the Pittsburgh Steelers travel to M&T Bank Stadium to take on the Baltimore Ravens on Saturday. Here’s what you need to know about how to watch the Steelers at the Ravens, the NFL Week 16 TV schedule and more. Steelers-Ravens NFL predictions:Picks, odds for NFL Week 16 game The Pittsburgh Steelers and the Baltimore Ravens will play at 4:30 p.m. ET Saturday, Dec. 21, 2024. The Pittsburgh Steelers and the Baltimore Ravens will air on FOX at 4:30 p.m. ET Saturday, Dec. 21, 2024. The Pittsburgh Steelers and the Baltimore Ravens will stream on Fox Sports at 4:30 p.m. ET Saturday, Dec. 21, 2024. The app is available in the Apple App Store or on Google Play. Fans can also download NFL+ in the Apple App Store or on Google Play. Here is the NFL schedule for Week 16. All times are Eastern: Here is the NFL schedule for Week 15. All times are Eastern: Chris Sims is a digital content producer at Midwest Connect Gannett. Follow him on Twitter: @ChrisFSims. We occasionally recommend interesting products and services. If you make a purchase by clicking one of the links, we may earn an affiliate fee. USA TODAY Network newsrooms operate independently, and this doesn’t influence our coverage.
Advertisement BMC Infectious Diseasesvolume 24, Article number: 1453 (2024) Cite this article Metrics details Since the outbreak of the novel SARS-CoV-2 that caused COVID-19 in 2019, the government of Sierra Leone implemented immediate preventive measures to stop the disease from entering the country. On March 24, 2020, the country declared a state of emergency in response to the emerging global COVID-19 pandemic, even though no confirmed cases had been reported at that time. However, Sierra Leone recorded its first COVID-19 case later in March 2020. While there have been few scoping reviews to date, these primarily focuses on experiences from Western countries or expatriates. The main purpose of this scoping review is to document the various COVID-19 pandemic preparedness measures undertaken by the Sierra Leone health system, assess the impacts of the pandemic on health systems, and document the various responses of health systems implemented across different settings from a home-based perspective. We searched peer-reviewed papers and articles under review or submitted for publication in Sierra Leone and the COVID-19 pandemic found in the Web of Science, Scopus, Pubmed, Google Scholar, MedRxiv, and Research Square databases. In addition, we examined gray literature, including Sierra Leone government reports and academic unpublished works on Sierra Leone’s COVID-19 situation. Both quantitative and qualitative studies were analyzed, focusing on the Sierra Leone health system or on the essential health services provided by the Sierra Leone health system during the COVID-19 pandemic. Few (48.7%) studies were multi-country studies (i.e., involving different countries and Sierra Leone). The majority (83.7%) were original articles published either in peer-reviewed journals or were deposited in preprint repositories; 10.9% were editorials, commentaries, or news reports; 1 (2.7%) was a working paper; and 1 (2.7%) was personal correspondence. Sierra Leone’s health system was partially prepared for the COVID-19 pandemic, largely due to its previous experience in managing the Ebola virus disease outbreaks from 2013 to 2016. However, the pandemic had significant impact on other health services. Although the country’s response to the pandemic was swift, it fell below average in addressing the scale of the challenges posed by the crisis. Peer Review reports As of July 29, 2024, over 775 million people had been infected with the novel SARS-CoV-2 virus, the cause of the COVID-19 pandemic, resulting in 7 million deaths globally [1]. While COVID-19 reached Africa later than other regions, the continent has experienced varying prevalence rates and severities of the disease [2]. By April 7, 2024, Africa had recorded more than than 9.5 million confirmed COVID-19 cases, and approximately 175,000 deaths [1]. Similar to many other African countries, Sierra Leone significant challenges due to limited health infrastructures and a shortage of healthcare personnel. The country has a general lack of professional medical staff to manage a critical healthcare needs [3]. In major cities such as the capital Freetown, Bo, Kenema, Port Loko, and Makeni, referral hospitals are under-resourced and overcrowded due to staff shortages. In rural areas, the peripheral health units are difficult to access due to unreliable transportation and poor road networks, further complicating health delivery make them inaccessible and pose a serious challenge. Since the emergence of the SARS-CoV 2 in 2019 [4], the government of Sierra Leone (GoSL) implemented immediate preventive measures to stop the virus from entrying the country [5]. On January 30, 2020, the World Health Organization (WHO) declared COVID-19 a Public Health Emergency of International Concern (PHEIC). Shortly after, on February 20, 2020, the GoSL activated Level 2 of the National Public Health Emergency Operations Center (PHEOC) and the Incident Management Structure (IMS) to prevent the importation of the virus and reduce its impact [6, 7]. The IMS, led by the Chief Medical Officer, operates under six pillars: surveillance, including points of entry; case management, including psychosocial and infection, prevention and control; laboratories; risk communication, including social mobilization; and food assistance and nutrition [7]. As part of the level 2 measures, the government conducted two readiness assessments to evaluate national coordination, preparedness, and response capacity using the WHO’s standard COVID-19 checklist. Additionally, the two One Health Inter-Ministerial Committee (IMC) meetings were held to provide policy and strategic guidance [5]. On March 24, 2020, Sierra Leone declared a state of public health emergency, even though no confirmed cases had yet been reported in the country [8]. However, the first COVID-19 case was confirmed on March 31, 2020 [9]. The Ministry of Health reported that a swab from a 37-year-old Sierra Leonean male, who had traveled to France on 12 March 2020, and returned to Sierra Leone on March 16, 2020, tested positive for SARS-CoV-2 at the 34 Military Hospital [9]. Following the confirmation of the first case, the World Health Organization (WHO) Representative in Sierra Leone, Evans Liyosi told health personnel, “We (WHO) have now shifted from (COVID-19) pandemic preparedness to response. We must now focus on tracing the people whom the patient may have come in contact with to be able to isolate and provide them with medical care” [9]. In Sierra Leone, the capacity to manage and treat COVID-19 cases was limited. The country health system, already strained by the Ebola outbreak from 2013 to 2016, faced further challenges during the COVID-19 pandemic, which affected the general public’s access to essential health services [10, 11]. Although a few scoping reviews have been conducted to date [12, 13], these primarily focused on experiences from Western countries or expatriates. Therefore, it is important to review the available evidence on Sierra Leone’s health system preparedness, as well as the impacts of and responses to COVID-19, from local perspective. The primary aim of this scoping review is to explore the broad scope of the research questions, which focus on the COVID-19 pandemic preparedness measures undertaken by the Sierra Leone health systems, the impacts of the COVID-19 pandemic on health systems, and the various responses implemented across different settings. This scoping review followed Arksey and O’Malley’s methodological framework [14] and included the following steps: (a) research questions and relevant study identification, (b) study selection, (c) data extraction and charting, and (e) summarizing and reporting results. How well were the existing public health systems in Sierra Leone able to respond to the adverse impacts of the COVID-19 pandemic? What are the implications/consequences of the COVID-19 pandemic for public health systems in Sierra Leone? How do public health systems respond to providing and maintaining essential and nonessential healthcare services during the post-pandemic period in Sierra Leone? What is the current state of health financing for public health system operations in Sierra Leone? The scoping review used the population, concept, and context (PCC) framework [15] methodology, which is captured in (Table 1), to provide effective answers to these research questions. The literature search strategy was designed by JBK and the US. The team conducted searches for peer-reviewed papers, articles under review, and those submitted for publication related to Sierra Leone and the COVID-19 pandemic across several databases, including Web of Science, Scopus, PubMed, Google Scholar, MedRxiv, and Research Square databases. Additionally, gray literature was reviewed, such as Sierra Leone government reports and academic unpublished academic works addressing Sierra Leone’s COVID-19 situation. This scoping review included both quantitative and qualitative studies that broadly examined the Sierra Leone health system or the essential health services it provided, which were analyzed for content. The scoping review specifically focused onstudies that examined the impact of COVID-19 on maternal and child health services; the uptake of services provided for infectious diseases such as malaria, tuberculosis, and HIV; antiretroviral treatment; chronic care for diseases such as diabetes; and hypertension care and treatment. Only studies and documents produced or published from November 1, 2019, to d April 30, 2021, were included in the review. This study conducted fourteen interviews with senior personnel from the Ministry of Health. These key informant interviews (KIIs) were carried out to gather insights from Ministry of Health staff who were directly involved in providing healthcare services to patients or managing health services within government-owned healthcare facilities. Respondents for the 15–20 min semi-structured KIIs, targeting both senior-level and mid-level personnel, were selected through a stratified sampling process of healthcare facilities categorized by region, district, and facility level. Senior-level Ministry of Health respondents included district medical officers (1), medical superintendent (1), hospital in-charges (2), monitoring and evaluation officers (1), and human resource officers (1). Mid-level Ministry of Health respondentsincluded nurses (2), laboratory technicians (1), maternal child health aid (1), community health officers (2), and community health assistants (2). All respondents were eligible for interviews if they were at least 18 years old and willing to share their views on pandemic preparedness in Sierra Leone. The interviews, conducted in English, were tape-recorded using cellphones. Respondents were asked a range of questions about their duties during the COVID-19 pandemic and their assessment of healthcare acility preparedness during the COVID-19 pandemic. The recorded interviews were transcribed, and the datawas analyzed using thematic content analysis. This method was chosen to compare the contents of all the interviews and identify recurring themes. Initially, each transcript was reviewed multiple times to extract key phrases and themes. Codes were then developed to categorize these themes, followed by the coding theme used to identify the most common or recurring themes. The study included published, preprinted, or gray literatures written in English that explored the following four terms: ‘Sierra Leone’, ‘health system preparedness’, ‘the impact of’ and ‘responses to the COVID-19 pandemic’ were searched for during the conduct of this scoping review. Three research assistants (US, DMK, and FKK) conducted the search and screened studies based on their titles and abstracts, followed by the reviewing of the full texts to determine their inclusion in the Scoping Review Results section. Records were manually organized using Microsoft Excel, which included a reference list of published papers, government reports, preprints, and gray literatures relevant to the Scoping Review. JBK, US, and FKK served as arbiters to resolve any questions about study eligibility. Articles, reports, and gray literatures that dealt primarily with the clinical and biological aspects of COVID-19 without relevance to the health system were excluded. Additionally, editorials, letters to the editor, and scientific commentaries without primary data were not considered. US and DMK designed the MS Excel form for data charting, while JBK, US, and FKK were responsible for extracting data from the selected studies. The data extraction form captured details such as the publication year, name of publication country, article title, journal, study design, study setting, study population, date of access, Sierra Leone, health systems preparedness, health systems impact, health systems response, and URL. The extracted data were narratively described using thematic content analysis and subsequently organized into three main domains: health system preparedness, health system impacts, and health system responses. The scoping review was then reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines Extension for Scoping Review (PRISM-ScR) [16] format (Fig. 1). We retrieved 81 records from databases and conducted 14 key informant interviews (KIIs) with senior personnel working either directly in providing healthcare services to patients or in the management of health services in both private and public health organizations. Among the 81 records retrieved, 22 (27.2%) were on health system preparedness, 20 (24.7%) were commentaries, 15 (18.5%) were editorials, 15 (18.5%) dealt with the impact of COVID-19, and 9 (11.1%) dealt with the effects of COVID-19 (Fig. 1). After eliminating duplicate records, 70 (86.4%) of the retrieved records were screened for their titles and abstracts; 22 (31.4%) were only Sierra Leone articles whose titles included Sierra Leone; and 48 (68.6%) were multi-country studies (i.e., studies that involved more than one country). Few (n = 11, 13.6%) of the retrieved records were not screened for their titles and abstracts because they did not specifically report on pandemic preparedness, impact, or effects or mention Sierra Leone in their titles. Few 33 (47.1%) of the records screened for their titles and abstracts were specifically excluded from the final review because they covered expert opinions, editorials, or commentary on COVID-19 with no empirical evidence (n = 7, 21.2%); the articles were without primary data (n = 5, 15.2%); or they focused exclusively on other countries (n = 21, 63.6%). In total, only 37 (52.9%) records (Figs. 2 and 3, and 4) whose titles and abstracts were screened were reviewed (Sierra Leone-specific articles = 22, multi-country studies that include Sierra Leone = 15). PRISMA-ScR flow diagram Distribution of Sierra Leonean articles only Distribution of multicountry articles Distribution of articles by study design The scoping review focused on studies with the following key characteristics (Table 2). The publication dates for all the records reviewed ranged from March 31, 2020, to September 27, 2021, of which 14 (37.8%) were published in 2021 [3, 5, 17,18,19,20,21,22,23,24,25,26,27,28]. Eighteen (48.7%) studies [13, 27, 29,30,31,32,33,34,35,36,37,38,39,40,41,42,43] were multi-country (i.e., involved different countries and Sierra Leone). The majority of 31 (83.7%) were original articles [11, 13, 17,18,19, 23, 25, 26, 29,30,31,32, 34, 35, 39,40,41, 44,45,46,47,48,49,50,51,52,53,54,55,56] published either in peer-reviewed journals or were deposited in preprint repositories; 4 (10.9%) were editorial, commentary, or news reports [28, 43, 57, 58]; 1 (2.7%) was a working paper [59]; and 1 (2.7%) was a personal correspondence [42]. Among the studies that were eventually synthesized, 11 (29.7%) described health system preparedness for the COVID-19 pandemic [4, 12, 13, 19, 29, 30, 32, 34, 45, 50, 59], 9 (24.3%) reported how various public health systems responded to the COVID-19 pandemic [4, 31, 37, 52, 60,61,62,63,64], and 17 (46.0%) [18, 23, 26, 35, 36, 39, 40, 47, 48, 65,66,67,68,69,70,71,72] provided information on the impact or effect of the COVID-19 pandemic on health systems, society, and the general population. The KIIs were used to assess the state of the public health situation post-COVID-19 pandemic, to determine the level of public investment for the COVID-19 response, and to analyze the adequacy of resource investment in response to COVID-19 and the ability of Sierra Leone to build a resilient society to withstand a new COVID-19 strain or future pandemic. The majority (9, 64.3%) of the KII for this scoping review were performed with senior government officials (District Medical Officers, Medical Superintendents, Hospital Incharges, Hospital Monitoring and Evaluation personnel, Hospital Human Resource personnel), working at the Ministry of Health, and 5 (35.7%) were performed with staff working directly with patients in delivering healthcare services at various levels of health facilities (nurses, laboratory technicians, public health personnel, MCHAID, CHO and CHA). Many (85%) of the respondents of the KII reported that the COVID-19 pandemic had an adverse impact on the health systems of the country because of challenges related to the pandemic and disaster preparedness. The challenges faced by the health system during the COVID-19 pandemic involved a shortage of staff, poorly trained staff, and a shortage of logistic supplies. “We had staff that were not adequately trained and/or not properly prepared during the COVID-19 pandemic in spite of the knowledge and experience we all already had as a result of the Ebola virus disease outbreak in 2013–2016,” one district medical officer noted. According to the respondents, there was also a general challenge that was due to a lack of logistics, including the supply of constant electricity and water, especially for healthcare facilities located in larger cities. “For those (healthcare providers) with some form of training, the persistent lack of basic logistics, including constant electricity and water supply, was an enormous challenge,” one regional district medical officer noted. The COVID-19 pandemic has had widespread impacts on health systems in Sierra Leone. The lack of trained and experienced healthcare workers coupled with their shortage led to an increase in the incidence of diseases, including COVID-19, especially in remote regions. The increased number of COVID-19 cases, the lack of COVID-19 testing kits, and the refusal of COVID-19 testing by people led to the overburdening of hospital services. According to the respondents, health systems were able to respond to these catastrophic impacts caused by COVID-19 by delegating multitasking roles and shifting responsibility. “During the COVID-19 pandemic, we shifted many jobs and responsibilities and even changed the scope of some works to suit the operability of certain personnel,” a lab technician said. The financial constraints and daily uncertainties caused by the COVID-19 pandemic have been greatly handled by networking and collaborating with donor partners such as the WHO, UNICEF, and World Vision. The COVID-19 pandemic also made health officials in Sierra Leone to adapt to various demands of resources. The health system during the pandemic was also able to cope with staff exhaustion by recruiting short-term staff that work for a limited period. Some retired and experienced staff were recalled for duty and provided with part-time contracts to fill in the gaps caused by staff shortages. One sector that was directly impacted severely by the COVID-19 pandemic in Sierra Leone was the health sector [73]. In general, a significant portion of the public health system has been affected, especially during the pandemic period, due to a lack of knowledge of the transmission pattern of the virus in communities [19]. “We lost many of our colleagues during the early days of the pandemic, and that made many healthcare workers reluctant to show up for duties. However, as the pandemic continued and we started gaining knowledge about the pandemic, we became increasingly better at how to protect ourselves in the hospital”, a laboratory technician who worked in one of the regional public health labs noted. The pandemic also posed tremendous challenges to the utilization of healthcare facilities and the supply and management of medical equipment [23]. Tremendous disruptions in healthcare delivery were observed in regional healthcare facilities compared with those in cities. These disruptions not only were specifically due to the direct effects of the COVID-19 pandemic but also placed public health systems under undue stress and stretched others indirectly beyond their ability [23]. One CHO reported that “the pandemic made many staff to take jobs and perform services that they were not trained or qualified to do…and by so doing they became increasingly at risk for the infection”. Owing to the high incidence of COVID-19 cases, especially during the early period of the pandemic, many essential healthcare services were either delayed or suspended by the management of healthcare facilities [23]. These forms of disruption make many patients unable to perform regular medical visits or attend follow-ups [23]. The effects of the COVID-19 pandemic severely impacted the social, political, economic, and healthcare sectors of Sierra Leone. During the post-COVID-19 pandemic, many responses to the effects created by the pandemic focused on outbreak preparedness, social and behavioral changes, and translating previous disease outbreak experiences into actionable lessons to prevent similar future outbreaks [74]. Currently, as part of its response, the newly formed National Public Health Agency has recognized infectious diseases among the most important health problems. “One strategy we keep employing was robust surveillance to detect all new cases early as well as take proactive action. We are now strengthening our national and local public health laboratories with logistics and manpower”, a public health worker noted. Like in many developing countries, the laboratory capacity of Sierra Leone is weak and needs strengthening. However, despite the government’s best efforts, the country continues to suffer from the acute brain drain of its best and most qualified professionals, mainly because of low salaries and conditions of employment. The COVID-19 pandemic required robust and rapid fiscal resource mobilization to support national responses and management. The availability or unavailability of various health financing mechanisms along with national fiscal policies greatly affected the impact of the pandemic on the population. According to some KII respondents, the impact of the COVID-19 pandemic on health financing experienced two phases: initial and postpandemic. “We had a serious negative financial impact during the early period of the COVID-19 pandemic. As a public health system, we were unable to implement most of our public health activities because of the unavailability of funds from the central government and our donor partners. The limited funds that were available at the time were specifically meant for handling the COVID-19 pandemic; some funds were, however, reserved specifically for other serious health emergencies, such as surgeries and health complications. Most of the basic and some essential healthcare services had their deliveries strangulated”, a medical superintendent said. There has been an increase in public health funding since the end of the COVID-19 pandemic. A greater majority of the funding for Sierra Leone’s public health activities comes from international partners such as the WHO, UNICEF, and the Global Fund. With the global decline in COVID-19 cases, these international partners seem to have recovered from the initial and subsequent financial shocks caused by the pandemic and have succeeded in restabilizing themselves. “Currently, we are experiencing an expansion of health funds in our health finance space. This expansion is meant to provide a sustainable and resilient health finance system aimed at archiving Universal Health Coverage by 2030. This ongoing financial expansion is crucial because we will be better equipped for future health emergencies. Currently, the government has increased the annual budget for the health ministry to archive the UHC in Sierra Leone,” a DMO noted. Despite all the goodwill and intentions, Sierra Leone has yet to develop a health emergency basket that will be used to fund activities related to future outbreaks in the country. This extrabudgetary basket is crucial since it provides funds for swift initial outbreak response, ensures the rapid funneling of funds to their targeted beneficiaries, and mobilizes the various sectors into outbreak preparedness. Four studies [17, 19, 49, 59] reported low levels of preparedness by various sectors of the Sierra Leone public health system to address disease outbreaks, especially the COVID-19 pandemic, at the time these papers were written. Low levels of preparedness have been reported for the prevention, diagnosis, and management of disease outbreaks, including the COVID-19 pandemic. Five studies [17, 45, 49, 59, 61] reported insufficient resources both before and during the COVID-19 pandemic. One study [32] reported relatively lower COVID-19 incidence rates in Sierra Leone than in many parts of the world, as well as insignificant delays in reporting COVID-19 cases compared with Guinea and Liberia, which was attributed to lessons learned from the previous EVD outbreaks in 2013–2016. One study [3] reported that ‘In the absence of official guidance or resources to deal with the unfolding crisis, local responders resorted to mobilizing their resources and improvised approaches that were locally specific, acceptable, and supported’. One international African survey [30] that assessed the preparedness of African countries’ palliative care services to respond to the COVID-19 pandemic identified specific and systemic weaknesses that impeded the preparedness of African countries to respond to disease outbreaks and called for urgent measures to ensure staff and patient safety. One study [19] assessed the knowledge, attitudes, and practices of healthcare workers (HCWs) in Sierra Leone toward preparedness for the COVID-19 pandemic and reported mixed findings. The study reported that HCWs believe that their healthcare facilities are ill prepared to respond adequately to disease outbreaks, including the COVID-19 pandemic. Additionally, the authors reported that HCWs urged health authorities and policymakers in Sierra Leone to provide the necessary resources to enable HCWs to work in a safe environment. There was a concomitant decrease in the national hospitalization rate during the COVID-19 pandemic in Sierra Leone, despite the anticipated increase in the demand for healthcare services. S. Sevalie et al. [23] reported a decrease in hospital utilization in Sierra Leone during the COVID-19 pandemic compared with other countries and during the Ebola epidemic. One multi-country study [36] involving the Democratic Republic of Congo, Guinea, Sierra Leone, and Liberia reported no evidence of a difference in the level of activity during the pre-pandemic period (2018, 2019, and 2020) in Sierra Leone for any of the healthcare services that were available in 44 healthcare facilities in the Kambia district in northern Sierra Leone; there was an 18% reduction in outpatient department (OPD) visits during the pandemic period compared with 2019, with fewer respiratory and malaria OPD visits. This scoping review assessed the economic and financial investment and costs of the COVID-19 pandemic shock, how this shock was financed, and how current public investment financial arrangements can be improved upon. Insights into these queries were provided by 14 KIIs (9 KIIs conducted with senior health personnel and 5 KIIs conducted with junior health personnel) with personnel and various staff of the Ministry of Health. The overarching aim of these KIIs was to triangulate findings from the literature reviews with gray information obtained from these KIIs about the state of the Sierra Leone public health situation in the post-COVID-19 period since there is a paucity of published literature related to the performance of national public health during this period. “There were differences in how the government treated COVID-19 patients. The powerful and influential people who were infected with COVID-19 were usually well taken care of by the government. However, this was not the case for the poor and ordinary citizens…most times they were quarantined in institutions including schools or at the hostels of the University of Sierra Leone” a nurse noted. To the best of our knowledge, this review is among the most comprehensive and detailed analyses of Sierra Leone’s national health system’s preparedness, impact, effects, and response to the COVID-19 pandemic. It provides an in-depth assessment of the country’s capacity to build a resilient society to withstand future outbreaks of COVID-19 or other pandemics. Similar to other countries, Sierra Leone faced an unanticipated public health emergency with COVID-19 pandemic, which had significant economic, human, and social consequences due to nationwide lockdowns triggered by high infection rates [73, 75]. Before the pandemic, Sierra Leone’s healthcare system was already weak, as demonstrated during the Ebola outbreak from 2014–2015 [76]. This study identified several gaps and challenges in pandemic preparedness, including insufficient health-related resources and medical equipment, both before and during the COVID-19 pandemic. The country continues to struggle with a fragile healthcare system that requires significant investment and improvement. Issues such as poor healthcare infrastructure, overburdened, and poorly trained and unqualified healthcare staff remain pressing concerns [74]. Many healthcare services in Sierra Leone are substandard, particularly in rural areas and urban slums [77]. In terms of strategy, generally, the national health systems tends to prioritize curative over preventive medicine. The private health sector in Sierra Leone continues to grow unchecked, often exploiting users to rely on private services due to the low quality in public healthcare. This reliance increases out-of-pocket healthcare expenses for people in one of the world’s poorest countries. One major effect of the COVID-19 pandemic in Sierra Leone was a decline in hospitalization and healthcare service utilization rates. This study observed significant reduction in the number of patients who were hospitalized or accessing healthcare services. However, the COVID-19 pandemic was not the first outbreak to challenge Sierra Leone public health system. The country experienced four cholera outbreaks between 1990 and 2010 [78] and the EVD outbreak from 2013 to 2016 [10], both of which placed a heavy burden on the public health system. Past experiences with such emergencies have led experts to speculate that the impact of COVID-19 on Sierra Leone’s health system might not be catastropic as initially feared, given the country’s preparedness to mitigate the pandemic effect [74]. This study also found that healthcare funds were redirected toward the COVID-19 response, leaving numerous critical health issues unaddressed. The national health system must focus on the control and management of other communicable diseases such as tuberculosis, malaria, HIV/AIDS, which were neglected during the pandemic. Additionally, Sierra Leone faces emerging and remerging threats, along with increasing cases of noncommunicable diseases like hypertension, diabetes, and cancer. Mental health has also become a growing concern due to the recent substance abuse epidemic in the country [79]. Sierra Leone’s health system, like those across Africa, will continue to face challenges from emerging global and local events that could lead to new and more infectious disease outbreaks. Given its fragile health system, Sierra Leone is likely struggle with complexities such as case identification, establishing and maintaining strategic health communication system, and providing care for critically ill patients during emergencies. The priority now should be to build a resilient health system capable of addressing health challenges and responding effectively to future health shocks. The review’s integration of both quantitative and qualitative studies enhanced the volume of evidence and provided a multidimensional understading of COVID-19 effects in Sierra Leone. However, the findings should not be seen as an entire reflection of the views and perceptions of the Sierra Leonean health systems. As scoping reviews’ focus on mapping available evidence rather than appraising it quality [80], this study did not include a quality appraisal. Additionally, this review was limited to studies published in English, potentially excluding relevant research in other languages. Despite rigorous search strategies, some studies may have been missed due to database limitations. Most of the included studies focused on early stages of the COVID-19 pandemic, making the findings less generalizable to later pahses or the emergence of new variants. Furthermore, this review did not explore the private health sector’s role in responding to the pandemic or how it was affected, despite its signifcanct contribution to healthcare delivery. This omission highlights the private sector’s importance as a potential partner in public health interventions to prevent future pandemics. Sierra Leone’s health system was partially prepared for the COVID-19 pandemic, largely due to its prior experience managing the Ebola virus outbreak. However, the pandemic significantly impacted other healthcare services. While the country’s response was swift, it fell short of adequately addressing the magnitude of the crisis. This scoping review recommends that efforts to improve and strengthen the resilience of the public health system during the pandemics should prioritize international collaboration. Such engagement is critical for enhancing Sierra Leone’s capacity in areas such as testing, capacity building, and case investigation and management. Secondly, the government of Sierra Leone through the National Public Health Agency (NPHA), should work with international partners to establish an emergency response fund for the NPHA. This fund would significantly reduce the time required to obolize resources during an outbreak or pandemic, thereby improving preparedness and response measures. Third, the NPHA should regularly conduct rotational, refresher, and crash training on emergency preparedness and response at the district and national levels to achieve this, the NPHA should seek support — funding, logistics, and technical — from health development partners to organize these training programs. These sessions should include relevant public health responders from the “One Health” framework across the country. Fourth, the government of Sierra Leone should allocate financial resources to the NPHA to establish and strengthen isolation and treatment centers for effective case management. This is key to reducing disease morbidity and mortality during future public health emergencies. Fifth, the NPHA should heighten community sensitization efforts to encourage the use of healthcare services at the health centers during pandemics. This an be achieved through community engagement and the use of electronic and print media, which are vital for increasing case detection at outpatient departments in health centers. Lastly, for future pandemic management, the use of high-quality time-trend analysis is recommended. This approach would provide a more detailed understanding of the extent and nature of changes within the health system and its response to partners. This is a scoping review study that analyzed published papers that focused on pandemic preparedness and response. The publications that formed the basis of our analysis in this study are listed in the reference section of this manuscript. 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Indirect effects of Ebola Virus Disease Epidemics on Health Systems in the Democratic Republic of the Congo, Guinea, Sierra Leone and Liberia: a scoping review supplemented with Expert interviews. Int J Environ Res Public Health. 2022;19(20):13113. ArticlePubMedPubMed Central Google Scholar Download references Our sincere thanks go to all the health workers who provided technical assistance with this work and who were part of the Sierra Leone COVID-19 response. We received no funding or compensation whatsoever for this work. Department of Public Health, Njala University, Bo, Sierra Leone Jia Bainga Kangbai & Fatmata Kacida Kagbanda Mendewa Community Health Center, Bo, Sierra Leone Jia Bainga Kangbai Sierra Leone Field Epidemiology Training Program, National Public Health Agency, Freetown, Sierra Leone Umaru Sesay Extended Programme in Immunization, Ministry of Health and Sanitation, Freetown, Sierra Leone Desmond Maada Kangbai You can also search for this author in PubMedGoogle Scholar You can also search for this author in PubMedGoogle Scholar You can also search for this author in PubMedGoogle Scholar You can also search for this author in PubMedGoogle Scholar JBK and US conceived and designed this study and organized the conduct of this research. JBK, US, and FKK performed the literature searches and scooping. JBK, US, and DMK drafted the manuscript. JBK, US, and FKK critically reviewed and revised the manuscript. JBK and DMK obtained ethical clearance. All the authors have read and approved the manuscript and ensure that this is the case. Correspondence to Jia Bainga Kangbai or Umaru Sesay. Not applicable. The authors declare no competing interests. The Sierra Leone Ethics and Scientific Review Committee (Opinion date 13 December 2022) and the Institutional Review Board at Njala University, Sierra Leone (Opinion No. NU 17–582), provided ethical clearance and approved this study. The Sierra Leone Ethics and Scientific Review Committee granted us ethical clearance and waived the requirement to obtain individual informed consent from the KII respondents since the data they were providing were harmless. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. Reprints and permissions Kangbai, J.B., Sesay, U., Kangbai, D.M. et al. Public health system in post-pandemic Sierra Leone: a scoping review. BMC Infect Dis24, 1453 (2024). https://doi.org/10.1186/s12879-024-10360-w Download citation Received: Accepted: Published: DOI: https://doi.org/10.1186/s12879-024-10360-w Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article.
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