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Diarrhoeal disease in early childhood: experiences from Sierra Leone
1St Andrew's Clinics for Children (STACC), Freetown, Sierra Leone.
Insights
Diarrhoeal disease deaths in children under five in Freetown decreased from 4% to 3% due to improved control programs and oral rehydration therapy. However, infant mortality from diarrhoea remains a concern, highlighting seasonal impacts and the need for better sanitation and literacy.
Area of Science:
- Public Health
- Pediatrics
- Infectious Diseases
Background:
- Diarrhoeal diseases remain a significant cause of under-five mortality globally, particularly in developing nations.
- In Sierra Leone, diarrhoeal conditions have historically contributed to high child mortality rates.
- Seasonal variations and nutritional status significantly influence the incidence and severity of childhood diarrhoea.
Purpose of the Study:
- To assess trends in diarrhoeal disease-associated mortality in children under five in Freetown, Sierra Leone.
- To identify factors contributing to the observed changes in mortality and morbidity.
- To evaluate the impact of public health interventions on diarrhoeal disease control.
Main Methods:
- Retrospective analysis of mortality data from the Freetown area.
- Assessment of the implementation and coverage of the National Diarrhoeal Diseases Control Programme.
- Evaluation of access to healthcare, oral rehydration therapy, safe water, sanitation, and immunization coverage.
Main Results:
- Under-five mortality due to diarrhoea decreased from 4% to 3% in Freetown, primarily in children aged 1-5 years.
- Infant mortality from diarrhoea has not significantly decreased; currently, 2% of infants and 1% of children under five die from diarrhoea.
- Oral rehydration therapy is utilized in 55% of acute diarrhoea cases; seasonal deterioration in nutrition correlates with increased severe diarrhoea and mortality during the rainy season.
- Rural areas show progress in healthcare access (60% within 4 miles) and measles immunization (60%), but safe water access is 22% and improved sanitation is 35%.
Conclusions:
- While overall under-five mortality from diarrhoea has declined in Freetown, infant mortality remains a critical issue.
- The National Diarrhoeal Diseases Control Programme and improved case management, including oral rehydration therapy, have contributed to reduced mortality.
- Sustainable control requires addressing seasonal nutritional impacts, improving water and sanitation infrastructure, and enhancing adult literacy, especially among women.
Abstract:
In the Freetown area of Sierra Leone, the proportion of children under five years of age dying from diarrhoea-associated conditions has decreased since the 1970s from 4% to 3%. This reduction relates to children between 12 months and 5 years; deaths associated with diarrhoeal disease in infancy do not appear to have decreased significantly. Currently, 2% of children die in infancy and a further 1% before their fifth birthday from diarrhoeal diseases. Thirty-one percent of short-term growth-faltering in children under five years of age is attributed to diarrhoeal disease. Reasons for improvement in mortality may include the implementation of a National Diarrhoeal Diseases Control Programme and improved case management; some 55% of cases of acute diarrhoea in Freetown now receive oral rehydration therapy. Morbidity and mortality are influenced by the seasons. This is likely to be related to the fact that the nutritional status of children shows a significant deterioration in the early rainy season. At this time incidence of severe diarrhoea warranting hospital admission and diarrhoea mortality rates in hospital and at a Rehydration Center increased significantly. On the other hand, the presentation of dehydrating diarrhoea is greatest in the driest months of the year. Progress in the rural areas of Sierra Leone may not have been so evident although 60% of the population now have access to primary health units within 4 miles and efforts to increase host resistance have included the measles immunization programme which currently protects 60% of under-fives nation-wide. Efforts to reduce the transmission of pathogens have meant increasing access to safe water to 22% and to improved sanitation to 35% in rural areas of Sierra Leone. The sustainable prevention and control of diarrhoeal diseases in developing countries depends also upon increasing levels of adult literacy especially of women.
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