Investigating the causes and downstream effects of factors leading to prescribing of antibiotics in outpatients for children under five years at Koidu and Portloko hospitals in Sierra Leone

Ibrahim Gassama, MMSc '24 (expected)

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Ibrahim is a pharmacist from Sierra Leone with seven years of experience. He has provided services as a pharmacist at national and district levels and tertiary, secondary, and primary care facilities, tending to patients, ensuring the quality of medicines, reviewing prescriptions, and completing monthly stock reports. His research experience has focused on strengthening HIV, TB, and malaria care. Though a licensed pharmacist with a background in clinical pharmacy, he is also interested in advocacy, research, and health systems strengthening.

Anahi Strader interview 2023

Student Perspectives

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This picture shows the administrative and outpatient departments of the Koidu Government Hospital in Kono District, Sierra Leone. This health facility is one of the two sites where I collected data, and this administrative building holds the hospital records that will be key in the quantitative component of his thesis.

Koidu Hospital's pediatric outpatient unit exemplifies healthcare ingenuity tailored to its surroundings. In a region where resources can be scarce, the staff at this hospital have found innovative ways to provide care to children. What struck me the most was their emphasis on community engagement and education on using medicines and patient follow-up to ensure patients’ full recovery. The waiting area with a mini playground immediately puts children at ease. This small touch goes a long way in creating a welcoming environment.

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Pictured above is the Gbense Market in Kono District. It is the largest market in the District. Many women in rural Sierra Leone primarily work as subsistence farmers or engage in small-scale trading. Through his my, I discovered that these women often face a conflict between taking care of their sick children and continuing their trading activities, which provide essential income for their families.

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Sierra Leone's healthcare system is highly fragile. The government has introduced a free healthcare initiative for pregnant and lactating women and children under five years old. However, this system faces numerous challenges, one of which is the frequent unavailability of essential antibiotics.

A woman on the left is interviewed by student Ibrahim Gassama, on the right. They are on the porch of a house

During the interviews, the caregivers expressed their struggles with this system, particularly the unexpected costs associated with services that should be free. They often find themselves having to purchase medicines from private pharmacies due to stockouts. As a result, they must divert funds meant for feeding their families to buy medicine for their sick children. It's also worth noting that caregivers commonly believe they should administer metamizole (a drug banned in the US) to children under five to manage fever without consulting a healthcare provider. Many caregivers also provide antibiotics and antimalarials along with metamizole. If the child's condition doesn't improve, only then do they seek care at a hospital.

Ibrahim with interviewees

Here I am standing with a family who I interviewed. 

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In this photo, I am assessing the availability of key medicines, especially antibiotics, at Koidu Hospital.

The accessibility of pharmaceuticals significantly impacts prescribing practices, contributing to potential shortcomings. In view of this, evaluating the availability of 20 essential medicines, identified by the World Health Organization as crucial and always needed, serves as a vital indicator for assessing overall availability.

Read more about the Master of Medical Sciences in Global Health Delivery program here.