The Perspectives of Healthcare Professionals on the Strategies, Challenges, and Community Responses to Health System Response and Interventions Towards Lassa Fever Infections and Mortality in Sierra Leone

Figures & data

Table 1 Socio-Demographic Characteristics of Study Participants

Participant	Age	Gender	Professional Background	Years of Experience	Region of Expertise	Place of Work
1	45	Female	Nurse	15	Kenema	Lassa Ward – Kenema Government hospital
2	55	Female	Nurse	21	Kenema	Matron – Kenema Government
3	48	Male	Medical Doctor	12	Kenema	District Medical Officer
4	75	Male	Medical Doctor	45	Segbwema - Kailahun	Medical Superintendent _ Nixson Hospital Segbwema
5	33	Male	Laboratory Technician	8	Kenema	Laboratory – Kenema Government hospital
6	29	Male	Laboratory Technician	7	Panguma – Kenema	Panguma Government Hospital
7	65	Male	Medical Doctor	35	Panguma – Kenema	Medical Superintendent – Panguma Government Hospital
8	45	Male	Surveillance Officer	10	Freetown	District of Health Response Emergency
9	55	Male	Monitoring and Evaluation officer	28	Freetown	District of Health Response Emergency
10	52	Male	Director	25	Freetown	District of Health Response Emergency

Table 2 Summary of Themes and Subthemes

Theme	Sub-Theme	Illustrative Quote
Knowledge of LF Programs and Interventions	Concern about Spread & Diagnostics	“Well, the first thing to consider is the concern among people about the spread of LF to other areas. It is important to critically examine whether it is a genuine spread or if it is due to improvements in diagnostics”.
	Roles & Responsibilities in LF Management	“We are responsible for covering the health component of LF, including diagnosis through MoHS surveillance activities, as well as its management. Given that LF is categorized as a Grade A security issue, managing cases is crucial to ensuring health security. ”
Role of the Health System and Partnership Collaboration in LF Programs	Institutional Collaboration & Structured Coordination	“We have a range of partners, including WHO, CDC, Tulane University, Harvard University, MSF, among others... each activity is in line with the MoH’s objectives”.
	Global Context and Imperative for Research	“Absolutely! When it comes to development, LF is not limited to Sierra Leone alone. There is still much work to be done in terms of development through research”.
	Evolution of Health Systems through Partnership	“Tulane University has played a significant role in the transformation of the health system in Sierra Leone. With the DHSE now in place, the partners are more actively involved in decision-making processes”.
Impact of Community Participation/Cultural Practices on LF Programs	Community Resistance and Strategies	“When you go to some communities, as I mentioned, there are pockets of resistance because we have some that would believe that if you have researchers or people that are entering into communities, they would introduce samples and the virus”.
	Traditional Beliefs and Behavioral Change	“Well, one thing I will say is that, to agree with a fool you listen to him/her first. Traditional people have their own beliefs and practices... when the ambulance comes, they are nowhere to be found”.
Exploring LF Mortality and Death Certification	Issues with Mortality Surveillance and Death Certification	“Yes, there is a possibility that people could be dying of LF without being reported to any medical facility or hospital because first of all those people do not report the deaths of their loved ones”.
	High Case Fatality Rates due to Late Referrals	“Case fatality is high because we do get cases now that would come of late but if they have cases that are referred early which is the primary thing when you talk about hemorrhagic fever, it will help a lot”.
Channel of Communication on LF Programs and Interventions	Communication Delays and Safety Concerns	“The difficulty at hand presents a significant risk to the successful execution of interventions for LF. RDTs can serve as a solution to overcome such challenges”.
	Training, Knowledge Gaps, and Consistent Updates	“What I am going to say is, one of the things we normally fail to get right is communication. Most of the time, I do engage the staff on key areas in the laboratory operations to update their skills”.
	Established Communication Protocols and Hierarchy	“So, as I mentioned, is part of the ministry of health... there are channels or lines of communications established by the ministry of health that have been followed”.
	Feedback Mechanisms and Referral Communication	“The only problem we have had with our referral hospital KGH is that they normally do not give us feedback... sometimes they get to send us feedback as well as a patient survive or died or whether they suffered further complications”.
Challenges in LF Program Implementation	Assessing Risk of Infections among Healthcare Workers	“According to the PGH key informant interview, a clinical staff member contracted LF from a patient in the hospital. The staff member had grown fond of a young child who was being treated for the virus”.
	Mobility and Risk Perception	“Mobility is currently one of the main challenges that we face in our unit... reluctance of most motorbike riders in Panguma town to transport suspected laboratory samples”.
	Comprehensive Challenges	“Currently, we face several challenges in our work... urgent need for improvement in these areas to enhance our ability to tackle this disease”.
	Effective Intervention Strategies and Resource Management	“To date, we have not implemented any specific interventions for LF, aside from the projects led by the Tulane University team based in Kenema. However, we did initiate a Lassa fever survivors’ project, but it was impacted by the COVID-19 outbreak”.
Sustainability in LF Management, Control, and Prevention	Government Responsibility and Prior Donor Dependence	“I believe government always has it at the back of its mind that the work we are doing is for our own people, not for the donors. As a hospital, we do not have funds or any mechanisms at the moment to continue with the Lassa intervention in case donors and partners stop providing financial and logistical support”.
	Sustainability through Local Leadership	“When we talk of sustainable approach, I think one of the ways we can to be sustainable as it is now is been led by the MOHS... it means it would be easy and more sustainable”.
	Government’s Inherent Responsibility	“That is their responsibility, the responsibility of the MoHS is taking care of the citizens of Sierra Leone... they support of the ministry is providing the human resource, infrastructure for diagnostics and all of these”.
Lessons Learnt and Ways to Improve LF Program Delivery	Financing and Resource Provision	“The best way of improving the effectiveness of all LF services in Sierra Leone is just through finance. Finance, human resources, and laboratory interventions most especially if reagents and the rapid diagnostic test could be supplied to us would serve as a very good strategy in moving to the positive path”.
	Emphasis on Research and Practical Solutions	“For me I will not just sit and say we need to develop this model. As for me I do not believe in getting policies all the time. All you do with the policies; you write them down. If we get to straight things right, disparities, diagnostics and vaccines will go forward”.
	Transparency, Accountability, and Communication	“In order for us involved in the fight against LF in Sierra Leone to work effectively, there is need for transparency, accountability and communication across the board. If transparency and accountability are improved on and maintained, I believe Lassa interventions will be more robust and effective”.
Recommendations for LF Interventions	Laboratory Equipment and Reagents	“Okay like in the first place we need to equip the laboratory, we need to be having most of the reagents, (because at times reagents can be outdated also lose their powers or potency) ”.
	Decentralization of Testing Facilities	“...then we also need to increase the testing power of Lassa to other regional districts not only in Kenema. Because for example if you have Lassa in Tonkolili, there’s no need to take the samples from there to Kenema so we also need to have it in regional districts to reduce the cost of petrol and risk of transporting samples; that is…”
	Staff Training and Manpower	“And number (3) we train more staff to have more manpower”.