ArticleCommunications medicine2026
Health-system barriers and missed opportunities in cardiovascular care in Sierra Leone: a scoping review.
Article in Communications medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCardiovascular disease (CVD) mortality is rising in Sierra Leone, but the health-system drivers of this trend are not well characterised. We mapped health-system barriers and facilitators for CVD care in Sierra Leone using a systems lens tied to universal health coverage (UHC).
methodsWe conducted a scoping review following PRISMA-ScR guidelines. We searched MEDLINE, Embase, Scopus, Global Health, and African Journals Online (1 Jan 2000 - 10 May 2025), Of 498 unique records, we included 40 sources reporting CVD-relevant data. Findings were mapped to WHO health-system building blocks, and synthesised narratively.
resultsOur findings show a health system shaped by path dependence: investments in infectious disease programmes have strengthened vertical delivery platforms with limited integration of non-communicable disease services. Facility readiness averaged 41% for HIV services versus 16.8% for cardiovascular care. An urban risk paradox was identified: urbanisation increased the odds of hypertension (OR 1.46) and diabetes (OR 1.84), while primary care infrastructure remained more oriented toward rural maternal health. Service delivery was undermined by diagnostic gaps; limited access to neuroimaging for stroke was associated with a threefold increase in mortality. High out-of-pocket costs narrowed effective coverage toward wealthier groups, and recurrent medicine stockouts reinforced distrust and disengagement from formal care. Scalable enablers included task-sharing, digital tools, pooled procurement, and community engagement.
conclusionStrengthening task-shared primary care, ring-fenced CVD budgets, pooling drug procurement, and improving digital infrastructure could accelerate UHC-effective coverage in Sierra Leone. Evidence on cost-effectiveness and socio-cultural determinants remains limited and should guide implementation research.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.