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Background Within Sub-Saharan Africa, some countries still report unacceptably high rates of maternal and perinatal morbidity and mortality, despite improvements in the utilisation of maternity care services. Postnatal care (PNC) is one of the recommended packages in the continuum of maternity care aimed at reducing maternal and neonatal mortality. This study aimed to determine the prevalence and factors associated with PNC utilisation in Sierra Leone. Methods We used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 7326 women aged 15 to 49 years. We conducted multivariable logistic regression to determine the factors associated with PNC utilisation, using SPSS version 25. Results Out of 7326 women, 6625 (90.4, 95% CI: 89.9–91.2) had at least one PNC contact for their newborn, 6646 (90.7, 95% CI: 90.2–91.5) had a postnatal check after childbirth and 6274 (85.6, 95% CI: 85.0–86.6) had PNC for both their babies and themselves. Delivery by caesarean section (aOR 8.01, 95% CI: 3.37–19.07), having a visit by a health field worker (aOR 1.80, 95% CI: 1.46–2.20), having had eight or more ANC contacts (aOR 1.37, 95% CI: 1.08–1.73), having tertiary education (aOR 2.71, 95% CI: 1.32–5.56) and having no big problems seeking permission to access healthcare (aOR 1.51, 95% CI: 1.19–1.90) were associated with higher odds of PNC utilisation. On the other hand, being resident in the Northern (aOR 0.48, 95% CI: 0.29–0.78) and Northwestern regions (aOR 0.54, 95% CI: 0.36–0.80), belonging to a female headed household (aOR 0.69, 95% CI: 0.56–0.85) and being a working woman (aOR 0.66, 95% CI: 0.52–0.84) were associated with lower odds of utilizing PNC. Conclusion Factors associated with utilisation of PNC services operate at individual, household, community and health system/policy levels. Some of them can be ameliorated by targeted government interventions to improve utilisation of PNC services.

Background: Undernutrition accounts for at least 50% of the annual global under-five mortality burden. Although disparities in the childhood stunting between urban and rural areas in Sierra Leone have been documented, information on factors associated with these differences is lacking. We aimed to determine rural-urban correlates of stunting among children under the age of 5 in Sierra Leone. Methods: We analyzed data from 2019 Sierra Leone demographic and health survey (SLDHS) focusing on under-five children. We conducted multivariable logistic regression to examine rural-urban factors associated with childhood stunting. Results: Prevalence of stunting was 31.6% (95% CI 29.8-33.2) in rural areas and 24.0% (95% CI 21.6-26.1) in urban areas. Within the rural areas, children of stunted mothers (aOR = 2.37; 95% CI 1.07-5.24, P < .05), younger mothers aged 15 to 19 years (aOR = 2.08; 95% CI 1.17-3.69, P < .05), uneducated mothers (aOR = 1.87; 95% CI 1.28-2.71, P < .01), as well as older children (24-59 months) (aOR = 1.83; 95% CI 1.48-2.27, P < .001), and boys (aOR = 1.37; 95% CI 1.12-1.66, P < .01) were more likely to be stunted compared to those of non-stunted, older, post-primary education mothers and those who were less than 24 months and girls respectively. While urban children whose fathers had lower education (aOR = 1.94; 95% CI 1.10-3.42, P < .05), whose mothers were more parous (para 2-4) (aOR = 1.74; 95% CI 1.03-2.95, P < .05), and boys (aOR = 1.48; 95% CI 1.06-2.08, P < .05) were more likely to be stunted compared to their counterparts with fathers that had tertiary education, mothers of low parity and girls, respectively. Conclusions: Stunting is more prevalent in the rural areas compared to the urban areas. Sex of the child was the only significant factor in both rural and urban areas. Our study findings suggest that programs designed to reduce stunting should aim for integrated yet context specific interventions in rural and urban areas.

Background: Access to sexual and reproductive health information enables young women to make appropriate decisions. We examined the association between exposure to family panning messages on different mass media and the use of modern contraceptives among young women in Sierra Leone.Methods: This was a secondary analysis of the 2019 Sierra Leone Demographic and Health Survey data of young women aged 15-24 years. Multistage stratified sampling was used to select study participants in the survey. We used multivariable logistic regression to determine the association between exposure to family panning messages on different types mass media channels and utilization of modern contraceptives. All our analyses were done using SPSS version 25.Results: Out of 6055 young women, 1506 (24.9%, 95% CI 24.0-26.2) were utilizing a modern contraceptive method with the prevalence higher among urban women (26.5%) compared to rural women (23.1%). Less than half (45.6%) had been exposed to family planning messages on mass media (radio 28.6%, television 10.6%, mobile phones 4.2% and newspapers or magazines 2.2%). Young women who had exposure to family planning messages on radio (AOR: 1.26, 95% CI 1.06-1.50) and mobile phones (AOR: 1.84, 95% CI 1.25-2.69) had higher odds of using modern contraceptives compared to their counterparts without the same exposure. Furthermore, having access to internet (AOR:

Background: A double burden of malnutrition is rising globally but particularly in sub-Saharan Africa. Recently in Sierra Leone, the incidence of overweight, obesity, and overnutrition among women have sharply increased. This study aimed to determine the prevalence of different malnutrition categories (underweight, overweight, obesity, and overnutrition) and associated factors among women of reproductive age in Sierra Leone using Demographic Health Survey of 2019. Methods: We conducted data analysis of 7,514 women aged 15 to 49 years. Data was collected using validated questionnaires. Participants were selected using a multistage stratified sampling approach. A multivariable regression analysis was used to determine factors associated with different malnutrition categories. Results: The prevalence of underweight was, 6.7%(95%CI:4.5%-8.9%); overweight, 19.7%(95%CI:17.7%-21.7%); obesity, 7.4% (95% CI:5.2%-9.6%); and overnutrition, 27.1%(95%CI:25.2%-29.0%). Underweight was more likely in 25-34 years (AOR=1.670, 95%CI:1.254-2.224;p<0.001) than 15-24 years; unlikely among single women (AOR=0.594,95%CI:0.467-0.755;p<0.001) than married. Unlikely in the north (AOR=0.734,95%CI:0.559-0.963;p=0.026) compared to east, and unlikely among those who did not listen to radios (AOR=0.673;95%CI:0.549-0.826;p<0.001) compared to those who did. Overweight was unlikely among 25-34 years (AOR=0.609,95%CI:0.514-0.722;p<0.001) and 35-49 years (AOR=0.480,95%CI:0.403-0.571;p<0.001) than 15-24 years; likely among single women (AOR=1.470,95%CI:1.249-1.730;p<0.001) compared to married; unlikely among working-class (AOR=0.840,95%CI:0.720-0.980;p=0.026) compared to not working-class; most likely in the north (AOR=1.325,95%CI:1.096-1.602;p=0.004), and unlikely in the south (AOR=0.755,95%CI:0.631-0.903;p=0.002) compared to east; unlikely among middle-wealth-index (AOR=0.656,95%CI:0.535-0.804;p<0.001), richer-wealth-index (AOR=0.400,95%CI:0.309-0.517;p<0.001), and richest-wealth-index (AOR=0.317,95%CI:0.234-0.431;p<0.001) compared to poorest-wealth-index respectively, and likely among women who did not listen to radios (AOR=1.149; 95%CI:1.002-1.317;p=0.047) compared to those who did. Determinants of obesity and overnutrition were the same with overweight, except they were unlikely in female-headed-households (AOR=0.717,95%CI:0.578-0.889;p<0.001). Conclusion: The prevalence of different types of malnutrition among women 15-49 years in Sierra Leone were high; affirming a double burden of malnutrition. It was likely to be underweight among 25-34 years. The predictors of overweight, obesity, and overnutrition were single women, from the north and not listening to radios. There is an urgent need for policies on healthy lifestyles and the dangers of malnutrition.

Background The double burden of Malnutrition globally, particularly in sub-Saharan Africa, is on the rise. In Sierra Leone, the incidence of overweight, obesity (OWOB), and overnutrition among women have recently sharply increased, in addition to undernutrition which has been prevalent for decades. This study aimed to determine the prevalence of the different Malnutrition categories (underweight, overweight, obesity, and overnutrition) with Malnutrition among women of reproductive age (15–49 years) in Sierra Leone and associated factors using secondary data analysis of the Demographic Health Survey of 2019 (SLDHS-2019). Methods We conducted a secondary data analysis of the Sierra Leone Demographic Health Survey (2019-SLDHS) of 7,514 women aged 15 to 49. We excluded pregnant, post-natal, lactating, and post-menopausal women. Data was collected using a validated questionnaire, and participants were selected through a multistage stratified sampling approach. A multivariable logistic regression analysis was performed to determine factors associated with the different Malnutrition categories among 15–49-year-old women in Sierra Leone. Results Among 15–49-year-old women in Sierra Leone, the prevalence of the different categories of Malnutrition was as follows: underweight, 6.7%(95%CI:4.5%-8.9%); overweight, 19.7%(95%CI:17.7%-21.7%); obesity, 7.4%(95% CI:5.2%-9.6%); and overnutrition, 27.1%(95%CI:25.2%-29.0%). The independent predictors of not being underweight included: age group of 25–34 years (AOR = 1.670, 95%CI:1.254–2.224;p < 0.001) unmarried (AOR = 0.594,95%CI:0.467–0.755;p < 0.001) women from the North (AOR = 0.734,95%CI:0.559–0.963;p = 0.026), and not listening to a radio (AOR = 0.673;95%CI:0.549–0.826;p < 0.001). The 25–34 years (AOR = 0.609,95%CI:0.514–0.722;p < 0.001) and 35–49 years (AOR = 0.480,95%CI:0.403–0.571;p < 0.001) age groups, unmarried women (AOR = 1.470,95%CI:1.249–1.730;p < 0.001), working-class (AOR = 0.840,95%CI:0.720–0.980;p = 0.026) coming from the North (AOR = 1.325,95%CI:1.096–1.602;p = 0.004) and South (AOR = 0.755,95%CI:0.631–0.903;p = 0.002), middle wealth index (AOR = 0.656,95%CI:0.535–0.804;p < 0.001), richer wealth index (AOR = 0.400,95%CI:0.309–0.517; p < 0.001), richest wealth index (AOR = 0.317,95%CI:0.234–0.431;p < 0.001), and not listening to a radio (AOR = 1.149; 95%CI:1.002–1.317;p = 0.047) were the independent predictors of overweight. The independent predictors of overweight among Sierra Leone women 15–49 years are the same as those of obesity or overnutrition, in addition to female-headed households (AOR = 0.717,95%CI:0.578–0.889;p < 0 .001). Conclusion The prevalence of all the Malnutrition categories among women of reproductive age in Sierra Leone was high, affirming the double burden of Malnutrition in this group. It was more likely to be underweight among the 15–24-year age group compared to the 25–34 and 35–49-year age groups. The independent predictors of overweight, obesity, and overnutrition were age groups of 25–34 and 35–49, unmarried/single women, working class, women from the North and South, female headed households, middle to richest wealth index, and do not listen to a radio. There is an urgent need for policymakers in Sierra Leone to design comprehensive educational campaigns for women in the reproductive age group on healthy lifestyles and the dangers of being underweight or over-nutrition.

Background The quality of contraceptive counseling information received by prospective clients of family planning services can greatly influence both the uptake and continued use of contraceptives. Therefore, an understanding of the level and determinants of quality contraception information among young women in Sierra Leon could inform family programs, with the aim of reducing the high unmet need in the country. Methods We analyzed secondary data from the 2019 Sierra Leone Demographic Health Survey (SLDHS). Participants were young women aged 15–24 years, who were using a family planning method (n = 1,506). Good quality family planning counselling was defined a composite variable that included; a woman being told about side effects, how to deal with side effects, and the availability of other family planning methods/options. Logistic regression was performed using SPSS software version 25. Results Out of 1,506 young women, 955 (63.4%, 95% CI: 60.5–65.3) received good quality family planning counselling services. Of the 36.6% that received inadequate counselling, 17.1% received no counselling at all. Good quality family planning counselling services was positively associated with receiving family planning services from government health facilities (aOR: 2.50, 95% CI: 1.83–3.41), having no major challenges with distance to access healthcare (aOR: 1.45, 95% CI: 1.10–1.90), having visited a health facility (AOR: 1.93, 95% CI: 1.45–2.58), and having been visited by a health field worker within the last 12 months (aOR: 1.67, 95% CI: 1.24–2.26) while residing in the southern region ( aOR: 0.39, 95% CI: 0.22–0.69) and belonging to the richest wealth quintile (aOR: 0.49, 95% CI: 0.24–0.98) were associated with less odds of receiving good quality family planning counselling services. Conclusion About 37% of the young women in Sierra Leone do not receive good quality family planning counselling services of which 17.1% received none. Based on the study’s findings, it is important to emphasize the need to ensure that all young women have access to proper counselling services especially for those receiving these services from private health units, from the southern region and richest wealth quintile. Ensuring easier access through increasing affordable and friendly access points and strengthening field health workers’ capacity in providing family planning services could also help improve access to good quality family planning services.