Landscape analysis of Sierra Leone
There is a lack of published evidence on the equity dimensions of AMR in Sierra Leone and further research into the social drivers of AMR within Sierra Leone is needed. A recent analysis in Sierra Leone noted that AMR “disproportionately affects women and children,” undermining progress in maternal health and child survival. Water and sanitation infrastructure is limited and women typically shoulder caregiving responsibilities. They are tending to sick family members and making health decisions for children, which increases their contact with healthcare settings and antibiotics.
A study on antibiotic use and consumption in Freetown found that female patients were less likely to receive antibiotics for inappropriate indications compared with male patients. Another study found that the proportion of boy who received antibiotics was higher than that of girls. Research with healthcare workers in Sierra Leone also found that non-recommended prescribing practices were common.
The Sierra Leone National Strategic Plan for Combating Antimicrobial Resistance (2018–2022) included community-level strategies. However it lacked targeted interventions for vulnerable and marginalised groups. It mentioned rural communities, those with poor access to healthcare, healthcare workers and those exposed to environmental contamination, and suggested strengthening infection prevention at community and health facility levels, awareness campaigns and improved waste management systems. But it did not include equity in AMR governance and monitoring explicitly. Furthermore it was mostly focused on clinical and laboratory data. It didn’t advocate for collecting demographic or contextual data (like sex, gender, job or socioeconomic status) that are needed for equity monitoring. Sierra Leone has plans to strengthen technical and laboratory skills, but no training on collection or analysis of equity data.
Communication and awareness campaigns target health professionals and the general public, but they are not tailored to specific vulnerable groups like people who live in rural areas or work in the informal sector. The lack of gender, equity, and social inclusion considerations in the AMR strategy creates a gap in implementation. This could make it harder for the plan to deal with differences in AMR exposure and outcomes at the population level.
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