Conectar
by Monalisa M. J. Faulkner, Fatima Jalloh, Foray Mohamed Foray, Sahr L. Gborie, Mohamed B. Jalloh
BackgroundSickle cell disease is a major cause of childhood mortality in sub-Saharan Africa, yet country-specific burden estimates for high-prevalence settings in West Africa remain limited.
ObjectiveTo describe Global Burden of Disease (GBD) 2023 modeled estimates of sickle cell disorders burden in Sierra Leone from 1990 through 2023, including temporal trends, age and sex patterns, and demographic contributors to mortality change.
MethodsWe analyzed GBD 2023 modeled estimates for sickle cell disorders in Sierra Leone, including prevalence, deaths, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) as absolute counts and age-standardized rates. Temporal trends in age-standardized rates were assessed using log-linear regression. The Kitagawa-Das Gupta decomposition partitioned the change in estimated deaths into population growth, age-structure change, and age-specific mortality-rate changes.
ResultsEstimated prevalent cases increased from 48,689 (95% UI, 42,588−56,140) in 1990–90,498 (78,126−105,815) in 2023. Estimated deaths increased from 408 (288−579) to 635 (438−862), while the estimated age-standardized mortality rate declined from 10.2 to 7.9 per 100,000 (APC, −0.46%; 95% CI, −0.64 to −0.29). Decomposition attributed 159.6% of the net increase in deaths to population growth, −7.8% to age-structure change, and −51.8% to lower modeled age-specific rates. In 2023, an estimated 49.5% of deaths occurred before age 20. Point estimates suggested possible higher male mortality, but uncertainty intervals were wide and compatible with no clear sex difference.
ConclusionsGBD estimates suggest that Sierra Leone’s absolute burden of sickle cell disorders increased substantially between 1990 and 2023, while modeled rates declined. These modeled estimates highlight a growing absolute burden and persistent early-life mortality, supporting the need for improved surveillance, newborn screening, infection prophylaxis, hydroxyurea access, and longitudinal care systems.
To examine the association between behavioural risk factors and their physiological sequelae among adults aged 40 and above in Bo District, Sierra Leone.
Cross-sectional study.
Household survey in Bo District, Sierra Leone.
The study included 1978 randomly sampled adults aged 40 and above (44.4% male and 55.6% female). The majority of participants were aged 40–49 years (34.5%). Data were collected using a household survey based on the validated WHO STEPs questionnaire.
Multivariable logistic regression analysis was performed to determine associations between behavioural risk factors (diet, physical activity and salt intake) and the presence of hypertension, diabetes and/or obesity, adjusting for sociodemographic variables.
The primary outcomes were the presence of hypertension, diabetes or overweight/obesity. Hypertension was defined as systolic blood pressure of ≥140 mm Hg and/or diastolic blood pressure of ≥90 (measured); diabetes as fasting glucose of ≥7.0 mmol/L, random plasma glucose level of ≥11.1 mmol/L or the use of antidiabetic medications (self-reported) and overweight/obesity as having a body mass index of ≥25 kg/m² (measured).
At least one physiological risk factor for cardiovascular diseases, that is, hypertension, obesity or diabetes, was present in 43.5% of participants. Hypertension was associated with urban living (OR=1.46, 95% CI (1.41 to 1.51)), older age (OR for 80+=3.98, 95% CI (3.70 to 4.28)), insufficient fruit and vegetable intake (OR=1.52, 95% CI (1.46 to 1.60)) and low physical activity (OR=1.35, 95% CI (1.27 to 1.43)). Diabetes was associated with urban residence (OR=1.84, 95% CI (1.66 to 2.05)), older age (OR for 70–79=3.82, 95% CI (3.28 to 4.45)), low fruit and vegetable consumption (OR=1.61, 95% CI (1.36 to 1.90)), high salt intake (OR=1.34, 95% CI (1.21 to 1.49)) and low physical activity (OR=1.47, 95% CI (1.26 to 1.71)). Obesity was associated with urban living (OR=1.66, 95% CI (1.59 to 1.72)), high salt intake from two or more sources (OR=1.21, 95% CI (1.17 to 1.25)) and low physical activity (OR=1.30, 95% CI (1.22 to 1.39)). Male sex (OR=0.37, 95% CI (0.36 to 0.38)) and older age (OR for 80+=0.39, 95% CI (0.35 to 0.43)) were protective factors.
In Bo District, nearly half of adults over 40 face hypertension, diabetes or obesity, especially urban dwellers, older age groups and those eating too few fruits and vegetables, consuming excess salt and getting little exercise. Public health efforts should focus on urban-targeted nutrition education, salt-reduction strategies, community exercise programmes and routine blood pressure and glucose screening, working with local leaders to ensure sustainable lifestyle changes and early disease detection.
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