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Analytical summary - Child and adolescent health

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Sierra Leone is ranked as having the highest under-five mortality rate in the world, with almost one out of every three children dying before the age of 5 years.[1]

A notable characteristic of under-five mortality in Sierra Leone is that urban–rural differences are very small; in the Sierra Leone health and demographic survey 2008[2] the figures were 167 and 168 deaths per 1000 live births, respectively.

Urban–rural differences in infant mortality are also very small. However, differences by wealth quintile are large, with the poorest quintile having a child mortality rate 150% higher than the best-off quintile.[2]

Adolescents aged 10–19 years constitute about 20% of the population and many of them reach adulthood with little knowledge about reproductive health. The majority of young people aged between 10 and 25 years have no correct knowledge about sexually transmitted infections, including HIV/AIDS, and risky sexual behaviour is common among them.

Health services do not adequately address the needs of adolescents. To address this situation, the Ministry of Health and Sanitation, with the support of partners, has developed a Reproductive and Child Health Policy (2008–2015). A Reproductive and Child Health Strategic Plan for 2008–2010 has also been developed. Through the Compact Agreement and the Joint Programme of Work and Funding, the stage is set for coordinating the inputs of the Government of Sierra Leone and its partners in mobilizing sufficient resources to ensure full implementation of the strategy.[3][4]

Since 2008, a major component of the renewed efforts to improve nutritional status of children and prevent malnutrition has been the adoption of community-based management of acute malnutrition. This approach promotes the treatment as outpatients in community-based health facilities of severely malnourished children in a stable medical condition and with appetite.

The implementation of this package has resulted in an increased coverage of therapeutic care for malnourished children from three traditional therapeutic feeding centres to nine stabilization centres that are well integrated into the community-based management of acute malnutrition. Major efforts continue to ensure that there is at least one stabilization centre in every district hospital.[5]

Prevention of malnutrition is also supported through prevention of micronutrient deficiencies by:

  • mass routine vitamin A supplementation of children 6–59 months;
  • deworming children 12–59 months;
  • routine supplementation of pregnant women with iron folate and postpartum supplementation of mothers with vitamin A;
  • promoting exclusive breastfeeding in the first 6 months of life.

These programme changes and the recent commitment of the Government to provide free health care to all children aged under 5 years offer a good opportunity to advocate for, and achieve, a gradual increase in direct procurement of supplies and supply chain management by the Reproductive and Child Health Programme.[6]

The nutritional status of children is an important contributing factor to their good health. The 2010 SMART survey shows 18.7% prevalence of underweight among children surveyed.[7] This is considerably lower than the 22.2% in the Sierra Leone health and demographic survey 2008.[2] This improvement is especially due to a reduction in the percentage of children with acute malnutrition (low weight for height) and to a lesser extent chronic malnutrition (low height for age). Health management information system data show that the percentage of underweight children detected at health facilities fell from 29.4% in 2009 to 17.7% in 2010.[7][8]

Immunization coverage for children from 2005 to 2010 shows that the proportions for the various vaccines have considerably increased since the Sierra Leone health and demographic survey 2008. The figures from the Ministry’s Child Health and the Expanded Programme on Immunization programme database for 2008 are far in excess of those from the Sierra Leone health and demographic survey 2008.[2][9]

Trend of immunization coverage (%) for key antigens, 2005–2010[9]
It should also be noted that figures for 2010 show more than 100% coverage of certain antigens, especially for Bacille Calmette Guerin (BCG) and tetanus toxoid for pregnant women (see table).[9] However, this is clearly related to the fact that the denominator used to derive the coverage is based on the population from the 2004 national census.


  1. WHO Country Cooperation Strategy 2008–2013 Sierra Leone (pdf 943.71kb). Brazzaville, WHO Regional Office for Africa, 2009
  2. 2.0 2.1 2.2 2.3 Sierra Leone health and demographic survey 2008: key findings (pdf 3.15Mb). Calverton, Maryland, Statistics Sierra Leone and ICF Macro, 2009
  3. National Health Sector Strategic Plan 2010–2015 Joint Programme of Work and Funding (JPWF) 2012–2014 (pdf 2.79Mb). Government of Sierra Leone, Ministry of Health and Sanitation, 2012
  4. Health Compact (pdf 510.02kb). Government of Sierra Leone, 2011
  5. Leigh B. Child survival and development mid-term review report for the programme 2008–2010. Sierra Leone, United Nations Children’s Fund, 2009
  6. Free health care services for pregnant and lactating women and young children in Sierra Leone. Government of Sierra Leone, Ministry of Health and Sanitation, 2009
  7. 7.0 7.1 Tolla A, Report on the nutritional situation in Sierra Leone: nutrition survey using SMART methods. United Nations Children’s Fund/Government of Sierra Leone, Ministry of Health and Sanitation, 2010
  8. Sierra Leone National Food and Nutrition Policy. Government of Sierra Leone, Ministry of Health and Sanitation 2009 (Word 156kb)
  9. 9.0 9.1 9.2 Child health and the Expanded Programme on Immunization programme database. Government of Sierra Leone, Ministry of Health and Sanitation, 2010