Abstract Though mental and substance use disorders are a leading cause of disability worldwide, mental health systems are vastly under-resourced in most low- and middle-income countries and the majority of people with serious mental health needs receives no formal treatment. Despite international calls for the integration of mental health into routine care, availability of outpatient mental health services and integration of mental health into the broader healthcare system remain weak in many countries. Efforts to strengthen mental healthcare systems must be informed by the local context, with attention to key health system components. The current study is a qualitative analysis of stakeholder perspectives on mental health system strengthening in one low-income country, Sierra Leone. It utilizes locally grounded knowledge from frontline healthcare providers to identify constraints and opportunities for strengthening mental health care within each component of the health system. In-depth semi-structured interviews were conducted with 43 participants including doctors, nurses, community health workers, mental health advocates, mental health specialists, and traditional healers recruited from the Bo, Moyamba and Western Area Urban Districts. Interview transcripts were content-coded in NVivo using both a priori and emergent codes and aggregated into broader themes, utilizing the World Health Organization Health Systems Framework. Participants described an extremely limited system of mental health care, with constraints and obstacles within each health system component. Participants identified potential strategies to help overcome these constraints. Findings reinforce the importance of factors outside of the healthcare system that shape the implementation of mental health initiatives, including pervasive stigma towards mental illness, local conceptualizations of mental illness and an emphasis on traditional treatment approaches. Implications for mental health initiatives in Sierra Leone and other low-income countries include a need for investment in primary care clinics to support integrated mental health services and the importance of engaging communities to promote the utilization of mental health services.

A year after COVID-19 was declared a pandemic much of the Africa continent started experiencing spikes in the number of COVID-19 cases and related deaths in what was referred to as the third wave of the pandemic. These spikes came right behind the heels of a second wave of the pandemic that barely went unnoticed in Africa. As of July 2021, Morocco, South Africa, Tunisia, Egypt, Nigeria, Libya, Kenya, Algeria, Zambia and Ethiopia accounted for approximately 86% of the reported increase in COVID-19; these countries were aptly described as being at the forefront of the continent’s third wave of the COVID-19 pandemic. Unlike those countries in Asia and Latin America that experienced what may generally being described as autochthonous COVID-19 third wave, Africa’s third wave COVID-19 cases are widely believed to have been triggered by imported cases. Africa like the rest of the world relaxed its COVID-19 restrictions almost at the same time; hence the continent’s spikes of COVID-19 cases and related deaths during the third wave of the pandemic have raised some questions.

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Vesicovaginal fistula is a hole that develops between a woman's vagina and her urinary bladder, usually as a result of prolonged obstructed labour, resulting in continuous or intermittent urine leakage down their legs. The purpose of the study was to have a general overview of the burden of Vesico-vaginal fistula in 50 patients case-notes with urinary and/or stool leakage at the Aberdeen Women's Centre, Freetown city within the period under review. The specific objectives of this study were to investigate; the prevalence/burden of VVF, the risk factors contributing to it, the age distribution, the mode of delivery and the physical and psychosocial impacts of this condition on affected women. The results reveal an overall prevalence/burden of VVF to be 90% with prolonged obstructed labour with difficult vaginal delivery being the main associated cause (80%). Another reported associated cause was shown to be cesarean section (6%). It also shown that patients with ages 15-19 accounted for the highest number of fistula patients (28%) followed by ages 20-24 (20%). Ages 10-14 accounted for only 4%. In all, the age range 15-34 accounted for 82% as these are part of the sexually active reproductive age. Furthermore, the study reveals that a total of 30 patients (60%) were recorded for both stigmatization and depression which was highly responsible for the mental ill health of the patients. The high incidence of VVF is shown to be associated with low socio-economic status of women compounded with cultural and religious beliefs and practices as depicted in the conceptual framework for the risk management systems of fistulas. To reduce both the incidence and social impact of the consequences of VVF, it is recommended that women's status be improved through education, employment and teaching of income-generating skills to augment their resources in addition to creating community awareness at all levels as this involves reaching different target groups that make up the community such as leaders at national, regional and local levels including politicians, health professionals,