The Gambia uses the Primary Health Care model with no trauma response system. Trauma patients are transferred through multiple levels of health care facilities before definitive care hospitals. This study was conducted to identify predictors of injury factors associated with transfer. In this study, we examined characteristics of transferred patients compared to those directly admitted in definitive care hospitals. The study was conducted in two major trauma hospitals in The Gambia. 251 road traffic injury (RTI) patients were either transferred (84%) from lower-level health centers or directly admitted (16%) to one of the study hospitals. Transferred patients were more likely to have been pedestrian/bicyclists (aOR = 1.81; 95% CI = 0.86 – 3.80). Administration of antibiotics was significantly associated with direct admit than transferred patients (aOR = 6.84; 95% CI = 2.38 – 19.68). Transferred patients were more likely to receive intravenous fluid compared to direct admits (aOR = 0.03; 95% CI = 0.01 – 0.08). The study results have implications for policies and planning in the healthcare setting in The Gambia and other LMICs with similar settings. Based on the findings of this study, it is essential that hospital management teams adapt to increasing reliance of RTI patients on lower-level healthcare facilities. The study results suggest increased burden on lower-level health care facilities. Efforts and resources should focus more on supporting lower-level facilities.

Occupational lead (Pb) exposure continues to be an important public health problem globally, yet data is lacking on the associated risks and resources available for the prevention of Pb related diseases in low middle income countries (LMICs) like The Gambia. In this study, we used a case-control design to compare blood lead levels (BLLs) between the exposed (auto repair workers) and unexposed (healthcare workers) populations in The Greater Banjul Area. The data was analyzed using Chi square test of independence to determine the characteristic factors associated with BLL. Multivariate logistic regression was used to test the relationship between BLLs for auto repair and healthcare workers and their experiences. The results of this study indicated 82.1% of cases had higher BLLs compared to 52.9% of controls. Also, the proportion of workers with elevated BLLs was higher for certain factors including more than 80% of those with greater than 10 of years job experience, more than 70% of those who worked greater than 5 days a week, worked more than 8 hours per day, did not use personal protective equipment (PPE), were illiterate or had no formal education, and smoked or ate at work. The study results have implications for policies and practice in the auto repair industry and related workplaces in The Gambia and other LMICs with similar settings. Based on the findings of this study, it is essential to initiate discussions to establish national occupational health policies in The Gambia aimed at protecting workers and the general population.

Background: Reproductive health is a critical component of overall health and development. Unmet contraceptive needs are one of the regularly cited measures of the efficacy of family planning (FP) initiatives. This study set out to determine the magnitude and associated factors of unmet need for FP among women of reproductive-aged (15-49 years) in the provincial areas of The Gambia. Methods: The study used a community-based cross-sectional analytical design. A multistage sampling strategy, comprising simple random and cluster sampling, was utilized to obtain a sample of 643 childbearing women (15-49 years) from rural Gambia's sampled clusters. Data collection was conducted using pre-tested structured interview questionnaires. The association was examined using chi-square/fisher's exact test with a significance level of p<0.05. Binary logistic regression analysis was performed to examine the effect of sociodemographic and cultural determinants on unmet FP need, with corresponding computed adjusted odds ratios (aOR). IBM SPSS version 24 was used for data entry and analysis. Results: The unmet need for FP among the study participants was 25.2%; unmet need for spacing and unmet need for limiting was 17.4% and 7.8%, respectively. The total demand for FP was 59.4%, while the satisfaction of demand for FP was 57.6%. The significant predictors of unmet need for FP were woman’s age at first pregnancy (aOR=0.899, p=0.033), LGA of origin (aOR=0.240, p=0.001) and frequency of using contraceptives (aOR=1.587, p=0.032). Conclusion: The present study demonstrated a high unmet need for FP among rural women in The Gambia, with the most often cited reason for non-use being fear of side effects. Hence, it is necessary to concentrate FP services for rural populations, stressing education regarding contraceptive side effects, service quality, and gender equality. Additionally, the study suggests that male participation and religious leaders' involvement in FP programs be strengthened and mainstreamed, as well as the establishment of a communication program that specifically promotes inter-spousal communication.

Background: Family planning (FP) methods have been found as an efficient approach of reducing fertility and are therefore widely supported in order to decrease population growth, particularly in poor nations. Promoting contraception availability among women (15 – 49) age has also been shown to be an efficient public health strategy for improving maternal and newborn health outcomes. This paper aimed at exploring the pooled prevalence of contraceptive uptake and its contextual determinants among women of childbearing age in The Gambia. Methods: The Gambia Demographic and Health Survey (GDHS) in both 2013 and 2019-20 was used for this study. Data were obtained from a pooled 22,098 women aged 15-49 (10,233 for 2013 and 11,865 for 2019-20) through a stratified two-stage cluster sampling approach. Percentages and chi-square tests were used and variables with p-value <0.05 were included into the model. A multivariable logistic regression model was used to assess the predictors of contraceptive usage at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs). All the study data were analyzed using Stata version 15. Results: The weighted pooled prevalence of modern contraceptive utilization in The Gambia was 10.1%. Younger age, compared with women aged 25-29; 30-34; 35-39; 40-44; primary education (aOR=1.25, 95% CI=1.05-1.49); secondary education (aOR=1.57, 95% CI= 1.32-1.85); Higher education (aOR=1.90, 95% CI=1.34-12.69); living in urban areas (aOR=1.49, 95% CI= 1.25-1.79); parity 2-4 (aOR=1.21, 95% CI= 1.01-1.47); told about FP at health facility (aOR=2.97, 95% CI= 2.61-3.38), and no desire for many children (aOR=1.96, 95% CI= 1.62-2.37) were more like to use modern contraceptives among Gambian women. Conclusion: The programme certainly needs to consider improvements in the quality of care being offered to acceptors. Government agencies should target these programs and campaigns on regional FP demands and provide suitable culturally sensitive and regionally adaptive services to the communities' contexts. The programme should intensify its efforts in rural and urban settings to improve accessibility to and availability of FP services.