Child, maternal, and adult mortality in Sierra Leone: nationally representative mortality survey 2018–20

Abstract

Background Sierra Leone's child and maternal mortality rates are among the highest in the world. However, little is known about the causes of premature mortality in the country. To rectify this, the Ministry of Health and Sanitation of Sierra Leone launched the Sierra Leone Sample Registration System (SL-SRS) of births and deaths. Here, we report cause-specific mortality from the first SL-SRS round, representing deaths from 2018 to 2020. Methods The Countrywide Mortality Surveillance for Action platform established the SL-SRS, which involved conducting electronic verbal autopsies in 678 randomly selected villages and urban blocks throughout the country. 61 surveyors, in teams of four or five, enrolled people and ascertained deaths of individuals younger than 70 years in 2019-20, capturing verbal autopsies on deaths from 2018 to 2020. Centrally, two trained physicians independently assigned causes of death according to the International Classification of Diseases (tenth edition). SL-SRS death proportions were applied to 5-year mortality averages from the UN World Population Prospects (2019) to derive causespecific death totals and risks of death nationally and in four Sierra Leone regions, with comparisons made with the Western region where Freetown, the capital, is located. We compared SL-SRS results with the cause-specific mortality estimates for Sierra Leone in the 2019 WHO Global Health Estimates. Findings Between Sept 1, 2019, and Dec 15, 2020, we enrolled 343 000 people and ascertained 8374 deaths of individuals younger than 70 years. Malaria was the leading cause of death in children and adults, nationally and in each region, representing 22% of deaths under age 70 years in 2020. Other infectious diseases accounted for an additional 16% of deaths. Overall maternal mortality ratio was 510 deaths per 100 000 livebirths (95% CI 483-538), and neonatal mortality rate was 31•1 deaths per 1000 livebirths (95% CI 30•4-31•8), both among the highest rates in the world. Haemorrhage was the major cause of maternal mortality and birth asphyxia or trauma was the major cause of neonatal mortality. Excess deaths were not detected in the months of 2020 corresponding to the peak of the COVID-19 pandemic. Half of the deaths occurred in rural areas and at home. If the Northern, Eastern, and Southern regions of Sierra Leone had the lower death rates observed in the Western region, about 20 000 deaths (just over a quarter of national total deaths in people younger than 70 years) would have been avoided. WHO model-based data vastly underestimated malaria deaths and some specific causes of injury deaths, and substantially overestimated maternal mortality. Interpretation Over 60% of individuals in Sierra Leone die prematurely, before age 70 years, most from preventable or treatable causes. Nationally representative mortality surveys such as the SL-SRS are of high value in providing reliable cause-of-death information to set public health priorities and target interventions in low-income countries.

Status of the latest 2016 World Health Organization recommended frequency of antenatal care contacts in Sierra Leone: a nationally representative survey

“…Sierra Leone has some of the worst maternal and child health indicators in the world including the third highest maternal mortality ratio (MMR) [1,19,20]. Maternal deaths account for 9% of all deaths among women of reproductive age with women having a maternal mortality lifetime risk of 3•4% [21]. Despite improvements in utilization of some maternal child health (MCH) services such as skilled birth attendance (SBA) (94% in urban areas and 84% in rural areas) [22], ANC coverage of four or more ANC contacts sluggishly increased from 76% in 2013 to 79% in 2019 while early initiation in the first trimester declined from 45% in 2013 to 44% in 2019 [2].…”

Countrywide Mortality Surveillance for Action in Mozambique: Results from a National Sample-Based Vital Statistics System for Mortality and Cause of Death

“…18 A COMSA project is also being implemented in Sierra Leone covering 678 randomly selected geographic census enumeration areas and a total population of 340,000. 19 We present in this paper the main results achieved by the COMSA project 4 years after its launch. We describe the demographic structure of the sample population, all-cause mortality rates, and cause-specific fractions by age groups.…”

Antibiotic prescribing practices for acute respiratory illness in children less than 24 months of age in Kenema, Sierra Leone: Is it time to move beyond algorithm driven decision making?

“…( 22) , ( 24) , (25) Sierra Leone, situated in West Africa, has a 2020 estimated population of roughly 7. 29) , (30) According to the Sierra Leone 2019 Demographic and Health Survey (DHS), there has been a gradual reduction in the under-ve mortality rate. For example, mortality dropped from 140 deaths per 1,000 live births in 2008 to 122 deaths per 1,000 live births in 2019; and infant mortality (dying within the rst year of life) decreased from 89 deaths per 1,000 live births in 2008 to 75 deaths per 1,000 live births in 2019.…”