Geographical Locations - Sierra Leone

• (Statistical) Number of Inhabitants per Doctor: 13,150
• CIA World Factbook : Sierra Leone

Organisations and Networks

UN and Multinational

• WHO
  - WHO Country Profile - Sierra Leone
  - WHO - Tobacco control: Country Profile: Sierra Leone
  - WHO - Environmental Burden of Disease: Country Profile – Sierra Leone
  - WHO – Malaria Country Profile – Sierra Leone
• WHO - Regional Office AFRO in Harare (Zimbabwe)

Government

• Ministry of Health and Sanitation

Non-Government

• CARE in Sierra Leone
  CARE International's programming in Sierra Leone is based on rehabilitation and empowerment of communities. Projects work to meet people’s basic needs in an area such as food security, and through this meetings are held to address community level conflict and unrest – the initial causes of the civil war are addressed before they can escalate.
• Marie Stopes International
  Marie Stopes International provides sexual and reproductive health information and services to 4.3 million people worldwide. This site outlines the organisation's activities in Sierra Leone.
• Médecins Sans Frontières (MSF) in Sierra Leone
  Médecins Sans Frontières is the world’s leading independent humanitarian organisation for medical aid. Annually, some 3,000 volunteer doctors, nurses and support staff work in trouble spots around the world helping those living on the edge of human tolerance.

Academic Institutions

National Policy and Related Documents

• Republic of Sierra Leone, Ministry of Health and Sanitation, National Health Policy
• Human Resources for Health Policy in Sierra Leone for the Ministry of Health and Sanitation

Reports, Guidelines, and Projects

• Access to healthcare in post-war Sierra Leone – Summary of a 2005 survey in four districts: Kambia, Tonkolili, Bombali, Bo
  "In 2002, Sierra Leone emerged from more than a decade of civil war. In recent years, the country has been mostly stable, with the exception of a few incidents at the border with Liberia. The civil war – in which half the population was displaced, 50,000 people were killed, 100,000 were mutilated and 250,000 women were raped – has ruined the country’s economy, infrastructure and social services. Despite the end of the hostilities, population’s health status has not improved. Sierra Leone’s maternal mortality rate is among the highest in the world1. Some 17% of children die before their first birthday and 25% die before they reach the age of five. Malaria is the number one killer. A new national malaria protocol based on artemisinin-based combination therapy (ACT) has been adopted but effective treatment has not yet been implemented. The country’s healthcare delivery system is in a poor state. Among the health sector’s many problems are insufficient financial resources for guaranteeing appropriate healthcare. Faced with the shortfall of subsidies from government and international sources, most public health structures apply a de facto system of cost recovery, requiring patients to pay for most services. At present the health authorities, together with donor agencies, international organisations and technical advisors, are discussing the formal reintroduction of a cost recovery system for drugs and services at all levels of primary healthcare." [Médecins Sans Frontières Holland and Médecins Sans Frontières Belgium, January 2006]
• Evidence basis for antimalarial policy change in Sierra Leone: five in vivo efficacy studies of chloroquine, sulphadoxine–pyrimethamine and amodiaquine
  Objectives: To provide nationally relevant information on the antimalarial efficacy of chloroquine (CQ), sulphadoxine–pyrimethamine (SP) and amodiaquine (AQ) in Sierra Leone, with a view to updating antimalarial policy in the country. Methods: Between October 2002 and May 2003, standard WHO methodology for in vivo efficacy assessment was used in five sites to study the therapeutic response of 6–59 months old uncomplicated Plasmodium falciparum malaria cases treated with CQ (n = 247), SP (n = 353) or AQ (n = 434). Follow-up was of 28 days, with polymerase chain reaction genotyping to distinguish late recrudescences from re-infections. Results: Overall 85.3% of patients reached an analysable endpoint. CQ failure proportions were very high, ranging from 39.5% (95% CI: 25.0–55.6) in Kabala to 78.8% (65.3–88.9) in Kailahun. Early failures under CQ were frequent. SP efficacy was also disappointing, with failure from 23.2% (13.9– 34.9) in Kabala to 46.1% (35.4–57.0) in Kailahun. AQ resistance was more moderate, ranging from 5.4% (1.8–12.1) in Makeni to 29.8% (20.3–40.8) in Kailahun, with almost no early failures. AQ also provided more rapid fever and parasite clearance. Conclusion: In a consensus meeting organized by the Ministry of Health and Sanitation, and based on these findings, artesunate (AS) + AQ and artemether–lumefantrine (Coartem^TM) were identified as the only options to rapidly replace CQ. The choice fell on AS + AQ because of expected high efficacy, lower cost in a blister presentation, and the absence of safety data on artemether–lumefantrine in pregnancy. Donor support is required to support this policy change. Throughout Africa, as SP resistance increases, these two regimens are probably the only options available while newer combinations are developed. Efficacy studies should focus on testing AQ and AS + AQ. [author summary] [Tropical Medicine and International Health, volume 10, no 2, pp 146–153, February 2005]
• Rapid vitamin A supplementation coverage surveys drive program improvement in Sierra Leone
  "It is estimated that in sub-Saharan Africa over 42% of children under five years of age are at risk of vitamin A deficiency (VAD) and that sustained VAD control can avert over 645,000 child deaths per year (1). VAD control is an essential component of achieving the Millennium Development Goal (MDG) of reducing underfive mortality by two-thirds by the year 2015 in sub-Saharan Africa in general, and in Sierra Leone in particular. UNICEF estimates that Sierra Leone has the highest under-five mortality in the world – 284 per 1,000 live births (2). It is estimated that 47% of children in Sierra Leone are at risk of VAD (3) and that sustained VAD control will avert over 37,000 child deaths over the next five years (4). The Ministry of Health and Sanitation (MoH&S) of the Government of Sierra Leone is committed to sustained elimination of VAD. Biannual vitamin A supplementation (VAS) is the cornerstone of the VAD control strategy. The Nutrition Forum of the Economic Community of West African States (5) has set an objective of minimum 80% VAS coverage twice per year for children 6–59 months, in conjunction with National Immunization Days (NIDs) for all countries in the region." [Sight and Life Newsletter 3/2005]

Educational Resources

• CDC - Travel Information : West Africa