BackgroundThe number of maternal deaths in sub-Saharan Africa continues to be overwhelmingly high. In West Africa, Sierra Leone leads the list, with the highest maternal mortality ratio. In 2010, financial barriers were removed as an incentive for more women to use available antenatal, delivery and postnatal services. Few published studies have examined the quality of free antenatal services and access to emergency obstetric care in Sierra Leone.MethodsA cross-sectional survey was conducted in 2014 in all 97 peripheral health facilities and three hospitals in Bombali District, Northern Region. One hundred antenatal care providers were interviewed, 276 observations were made and 486 pregnant women were interviewed. We assessed the adequacy of antenatal and delivery services provided using national standards. The distance was calculated between each facility providing delivery services and the nearest comprehensive emergency obstetric care (CEOC) facility, and the proportion of facilities in a chiefdom within 15 km of each CEOC facility was also calculated. A thematic map was developed to show inequities.ResultsThe quality of services was poor. Based on national standards, only 27% of women were examined, 2% were screened on their first antenatal visit and 47% received interventions as recommended. Although 94% of facilities provided delivery services, a minority had delivery rooms (40%), delivery kits (42%) or portable water (46%). Skilled attendants supervised 35% of deliveries, and in only 35% of these were processes adequately documented. None of the five basic emergency obstetric care facilities were fully compliant with national standards, and the central and northernmost parts of the district had the least access to comprehensive emergency obstetric care.ConclusionThe health sector needs to monitor the quality of antenatal interventions in addition to measuring coverage. The quality of delivery services is compromised by poor infrastructure, inadequate skilled staff, stock-outs of consumables, non-functional basic emergency obstetric care facilities, and geographic inequities in access to CEOC facilities. These findings suggest that the health sector needs to urgently investigate continuing inequities adversely influencing the uptake of these services, and explore more sustainable funding mechanisms. Without this, the country is unlikely to achieve its goal of reducing maternal deaths.

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This work focused on three landslide events that have attracted significant public concern due to the associated calamities they recorded in 1945, 2017 and 2019, i.e. the Charlotte, Regent and Madina landslides, respectively. Their geology, tectonics (structural discontinuities) and geomorphology, i.e. their GTG characteristics were studied to establish links between them and the landslide events.Field surveys were conducted, particularly on the Charlotte landslide, where the identification of geological structures was impeded to an extent by its obliteration by vegetation and sediment accumulations on relatively planar sections of the landslide area. Remote sensing and GIS techniques (earth imagery and drone images) enhanced the mapping and determination of landslides’ geometric and geomorphic parameters. Laboratory analyses of rock and soil samples provided the landslides’ petrological characterisation and were used to determine the particle-size distribution in the slide-prone soil.The study indicated a change in the gabbroic rock composition, variable geomorphological characteristics, and nature/pattern and density of the discontinuities. These factors, to a large extent, determined the nature and magnitude of the rainfall-triggered landslides. Charlotte lithology slightly differed from the other two landslides and recorded higher Silica (Si) and Aluminum (Al) and lower iron (Fe) from X-Ray Fluorescence (XRF) than rocks of Regent and Madina landslides. The study also revealed only a tenuous correlation between rock composition and weathering depth. The slope angles at the landslides’ prominent scarps (depletion zone) are steep (> 45 degrees) with altitudes of approximately 270 m, 200 m and 470 m above sea level for Charlotte, Regent and Madina, respectively. Unlike the Charlotte landslide, both Regent and Madina landslides are active, but geometrically, their area, length and run-out distances have relatively high variance with a coefficient of variance equals to 1. Information derived from this work can help understand the spatial variation in landslide characteristics and develop a susceptibility map.

The increased demand for basic emergency obstetric and neonatal care (BEmONC) services in Sierra Leone since the launch of the nationwide free maternity care initiative in 2010 has strained the capacity of the system to provide high‐quality care. In 2014, members of our research team visited all 97 functioning primary health‐care facilities in Bombali district in the Northern Province of Sierra Leone to evaluate gaps in access to BEmONC. Although most facilities had the equipment necessary for maternal and neonatal care, these were often not in satisfactory condition. Most of the facilities did not stock all of the essential medicines for BEmONC, and less than 10 percent of the facilities had sufficient stocks of unexpired and properly stored medications. Stronger supply chains will be necessary to improve health system performance in Sierra Leone, reduce maternal mortality, increase neonatal survival, and achieve targets associated with the Sustainable Development Goals (SDGs).

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