Malaria in a rural area of Sierra Leone. I. Initial results

Malaria surveys to collect base-line data for an intervention study was carried out in a rural, high rainfall area of West Africa. Methods for the different components of the study are described. A mortality survey, using verbal autopsy questionnaires, established an infant mortality rate of 74/1000 live births/year, a child mortality rate of 25/1000/year and a mortality rate for children under five years of 36/1000/year. The most common causes of death were malaria and malnutrition. The results of two clinical surveys showed that the prevalence of illness in nought to seven-year-olds increased from 30% at the pre-rains survey to 58% at the post-rains survey. The most significant increases were a three-fold increase in the prevalence of upper respiratory infections, whilst skin and eye infections and fever rates doubled. A knowledge, attitudes and practice survey of 210 heads of households or women of child-bearing age revealed that 76% had never had any formal education. Eighty-nine per cent recognized that there was a malaria problem in the area, but only 30% knew that mosquitoes were involved in its transmission, and only half of the respondents were aware that malaria was preventable.