Prevalence and Determinants of Psychosocial Stress Among Public Health Students in Sierra Leone

Background: Psychosocial stress is a significant and measurable public health concern in West African universities. Kowama Campus of the School of Public Health (SPH), Njala University, Bo, Sierra Leone, presents a unique institutional context marked by financial barriers, infrastructure challenges, and emerging digital health risks. No prior quantitative baseline existed for this campus. Objective: To determine the prevalence, severity, and key determinants of psychosocial stress among School of public health students at Kowama Campus, with specific focus on unauthorized monetary demands, university fee burden, social media usage, academic workload, and other institutional indicators. Methods: A cross-sectional analytical study using stratified random sampling recruited 239 eligible students (from n=248 target) across Prelim, HND, and BSc academic levels. Data were collected via a structured self-administered questionnaire combining the Perceived Stress Scale (PSS-10), General Health Questionnaire (GHQ-12), and Institutional Stressor Inventory (ISI-15). Analysis included descriptive statistics, chi-square tests, Spearman rank correlations, and binary logistic regression. professional data visualizations were produced. Results: The overall prevalence of moderate-to-high psychosocial stress (PSS-10 >= 14) was 74.1% (n=177/239). Mean PSS-10 score was 22.8 (SD=5.7). GHQ-12 revealed probable psychiatric morbidity in 38.7% of students. The ten leading stress indicators ranked by MSCS were: (1) Heavy academic workload (3.97; aOR=3.21; p<0.001); (2) University fee burden (3.63; aOR=2.61; p<0.001); (3) Erratic lecture scheduling (3.28); (4) Inadequate lecturer support (3.15); (5) Fear of academic failure (3.08); (6) Interpersonal conflicts (2.89); (7) Poor accommodation (2.74); (8) Transport/campus access (2.57); (9) Social media distraction/FOMO (2.41; aOR=2.44 for >4hrs/day usage). Social media usage showed a clear dose-response relationship with both PSS-10 and GHQ-12 scores. Conclusion: Psychosocial stress burden at Kowama Campus SPH is critically high and multifactorial. University fee burden and social media overuse represent two underappreciated but empirically significant contributors.