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Child, Maternal, and Adult Mortality in Sierra Leone: Nationally Representative Mortality Survey 2018-2020

20 Pages Posted: 22 Jun 2021

See all articles by Ronald Carshon-Marsh

Ronald Carshon-Marsh

Government of Sierra Leone - Ministry of Health and Sanitation

Ashley Aimone

University of Toronto - Centre for Global Health Research

Rashid Ansumana

Njala University

Ibrahim Bob Swaray

Njala University

Anteneh Assalif

Njala University

Alimatu Musa

University of Toronto - Centre for Global Health Research

Catherine Meh

University of Toronto - Centre for Global Health Research

Francis Smart

Government of Sierra Leone - Ministry of Health and Sanitation

Sze Hang Fu

University of Toronto - Centre for Global Health Research

Leslie Newcombe

University of Toronto - Centre for Global Health Research

Nandita Saikia

International Institute for Applied Systems Analysis (IIASA)

Hellen Gelband

University of Toronto - Centre for Global Health Research

Amara Jambai

Government of Sierra Leone - Ministry of Health and Sanitation

Prabhat Jha

University of Toronto - St. Michael's Hospital; University of Toronto - Centre for Global Health Research

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Abstract

Background: Sierra Leone’s child and maternal mortality rates are among the highest in the world. Yet little is known about the causes of premature mortality in the country.

Methods: The Countrywide Mortality Surveillance for Action platform established the Sierra Leone Sample Registration System (SL-SRS), which involved conducting electronic verbal autopsies in 678 randomly selected villages and urban blocks throughout the country. 61 surveyors enrolled 343,000 households and ascertained 8347 deaths below age 70 in 2019-20, capturing deaths from 2018 to 2020; two trained physicians assigned causes of death (ICD-10). SL-SRS death proportions were applied to United Nations total mortality to derive cause-specific totals and risks of death nationally and in four regions, with comparisons made to Western region, where Freetown, the capital, is located.

Findings: Malaria was the leading cause of death in children and adults, nationally and in each region, representing 23% of deaths below age 70 years in 2020. Other infections accounted for an additional 14%. Maternal mortality (510 per 100,000 live births) and neonatal mortality (31 per 1000 live births), among the highest rates in the world, were dominated by avoidable causes. Excess deaths were not detected concordant with the COVID-19 pandemic. Half of the deaths occurred in rural areas and at home. Had the Northern, Eastern, and Southern regions of Sierra Leone had the same lower death rates as the Western region, about 20,000 deaths (just over a quarter of national totals <70 years) would have been avoided. World Health Organization model-based data vastly underestimated malaria deaths, as well as some specific causes of injury deaths, and substantially overestimated maternal mortality.

Interpretation: Over 60% of Sierra Leoneans die prematurely, before age 70, the majority from preventable or treatable causes. Nationally representative mortality surveys are of high value in providing reliable cause-of-death information to improve life expectancy in low-income countries.

Funding Information: Bill & Melinda Gates Foundation, CIHR, Queen Elizabeth Scholarship Program.

Declaration of Interests: We declare no competing interests.

Suggested Citation

Carshon-Marsh, Ronald and Aimone, Ashley and Ansumana, Rashid and Swaray, Ibrahim Bob and Assalif, Anteneh and Musa, Alimatu and Meh, Catherine and Smart, Francis and Fu, Sze Hang and Newcombe, Leslie and Saikia, Nandita and Gelband, Hellen and Jambai, Amara and Jha, Prabhat, Child, Maternal, and Adult Mortality in Sierra Leone: Nationally Representative Mortality Survey 2018-2020. Available at SSRN: https://ssrn.com/abstract=3871719 or http://dx.doi.org/10.2139/ssrn.3871719

Ronald Carshon-Marsh

Government of Sierra Leone - Ministry of Health and Sanitation ( email )

Freetown
Sierra Leone

Ashley Aimone

University of Toronto - Centre for Global Health Research ( email )

Toronto, Ontario M5B 1W8
Canada

Rashid Ansumana

Njala University

Ibrahim Bob Swaray

Njala University

Njala
Korie Chiefdom, Moyamba District
Freetown
Sierra Leone

Anteneh Assalif

Njala University

Njala
Korie Chiefdom, Moyamba District
Freetown
Sierra Leone

Alimatu Musa

University of Toronto - Centre for Global Health Research ( email )

Toronto, Ontario M5B 1W8
Canada

Catherine Meh

University of Toronto - Centre for Global Health Research

Toronto, M5B 1W8
Canada

Francis Smart

Government of Sierra Leone - Ministry of Health and Sanitation ( email )

Freetown
Sierra Leone

Sze Hang Fu

University of Toronto - Centre for Global Health Research

Toronto, M5B 1W8
Canada

Leslie Newcombe

University of Toronto - Centre for Global Health Research

Toronto, M5B 1W8
Canada

Nandita Saikia

International Institute for Applied Systems Analysis (IIASA) ( email )

Schlossplatz 1
Laxenburg, A-2361
Austria

Hellen Gelband

University of Toronto - Centre for Global Health Research ( email )

Toronto, Ontario M5B 1W8
Canada

Amara Jambai

Government of Sierra Leone - Ministry of Health and Sanitation ( email )

Freetown
Sierra Leone

Prabhat Jha (Contact Author)

University of Toronto - St. Michael's Hospital ( email )

Toronto
Canada

University of Toronto - Centre for Global Health Research ( email )

Toronto, Ontario M5B 1W8
Canada

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