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A decrease in mortality in the MSF catchment area in Sierra Leone between 2006 and 2007 – why?

A decrease in mortality in the MSF catchment area in Sierra Leone between 2006 and 2007 – why?. Sibylle Gerstl 1 , Michel van Herp 2 , Cecile Bassi 3 , Samuel Baker 4 , Maureen Billiet 2 1 MSF, London, United Kingdom 2 MSF , Brussels, Belgium 3 MSF , Bo, Sierra Leone

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A decrease in mortality in the MSF catchment area in Sierra Leone between 2006 and 2007 – why?

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  1. A decrease in mortality in theMSF catchment area in Sierra Leone between 2006 and 2007 – why? Sibylle Gerstl1, Michel van Herp2, Cecile Bassi3,Samuel Baker4, Maureen Billiet2 1 MSF, London, United Kingdom 2 MSF, Brussels, Belgium 3 MSF, Bo, Sierra Leone 4 Ministry of Health and Sanitation, Freetown, Sierra Leone

  2. Overview • 2006 and 2007 • Retrospective mortality studies • In MSF catchment area in Sierra Leone • Substantially different results

  3. History • 2006Commitment to stay • High rates of mortality due to malaria • Mainly in children < 5 years of age • Now focus on malaria • Free diagnosis, treatment, prevention • In clinics and outreach program

  4. Study site - MSF catchment area Bo Pujehun • Population of152 000 persons • Living in 334 villages • Malaria perennial • No peakduring year

  5. Objective • To estimate retrospectively • Crude mortality rate (CMR) • Under 5 years mortality rate (U5MR) • Under 2 years mortality rate (U2MR) • To obtain an indication of malaria / fever as reported causesof death

  6. Survey Methodology (1) • Three-stage, cross-sectional survey • 2006: 30 clusters x 30 households • 2007: 40 clusters x 40 households • Standardized questionnaires

  7. Survey Methodology (2) 97 days 01/2006 12/2006 16.06.African Child Day 20.09. 201 days 12/2007 01/2007 09.04.Easter Monday / Rabbil awal 20.10. • Recall period

  8. Study Population 2006 2007 Sample population 5179 11358 Children < 5 years 1244 24% 2324 21%

  9. Deaths / 10 000 / day CMR 10 U5MR 7.3 U2MR 7 6 5 4 3.7 3 2.6 2 1.8 1.3 1 0.7 2007 2006

  10. Malaria /feveras reported causes of death [%]

  11. Malaria /feveras reported causes of death [%] *p=0.04

  12. Methodological limitations • Differences in training and supervision of 2006 and 2007 studies • Potential recall bias in the reported causes of death

  13. Summary • Mortality results 2007 lower than 2006 • Target population in a stable conditionof non-emergency • CMR + U5MR in line with levels considered normal for developing countries

  14. Discussion – MSF interventions (1) Internal MSF interventions for lower mortality rates in 2007 • Actions taken to reduce morbidity / mortality for malaria in the catchment area • Since 2005 • Free malaria diagnosis and treatmentin all MSF supported health structures • Gondama Referral Centre • 5 community health centres

  15. Discussion – MSF interventions (2) • Since 2007 • Introducing malaria diagnosis and treatment in low-level health structures • On-going support of primary health units (PHU) for malaria management • Today 27 PHUs • In 2006/2007 • 65 000 bednets distributed • Education-sensitisation programs

  16. Discussion – MSF interventions (3) • Since November 2007 • Network of community health volunteers on home management of uncomplicated malaria • Goal: 300 villages • Human resources • End of 2006: 322 • Today: 364 today (+13%)

  17. Discussion – Other reasons • Probable slight overestimation of mortality rates in 2006 • Population might not rememberAfrican Child Day • Potential external factors • Different rain patterns between2006 and 2007? • Harvest not comparable?

  18. Bear in mind… • Difficult to attribute changes in mortality rates to the impact of interventions • Individual programmes should not entirely judged on mortality data

  19. Recommendations • Establish a prospective mortality surveillance system • Repeat mortality survey end of 2008 • Assess CMR and U5MR trends We still have to work hard together to fight malaria!

  20. Acknowledgements • Ministry of Health and Sanitation for authorization and support of the study • Desk, the capital and field teams of MSF-Belgium for all their outstanding help and the warm welcome • All the families in the MSF catchment area in Bo and Pujehun district,Sierra Leone

  21. 2007: Slept under ITN • 49.1% slept under ITN (95%CI 43.3–55.4) • 66.9% of children < 5 years (95%CI 59.3–74.6) • 59.8% of women aged 15 to 49 years being > 3 months pregnant (95%CI 52.3–66.9)

  22. 2007: Education Status In Sub-Population of 15 years and older (n=6496) • 16.1% able to read and write(95%CI 13.5–18.8) • 26.5% male study population (95%CI 22.5–30.5) • 7.9% female study population (95%CI 6.0–9.8) (p < 0.0001)

  23. Malnutrition (1) Weight-for-height z-scores (NCHS reference curve) • Global acute malnutrition • 2006: 5.0 (95%CI 3.7–6.3) • 2007: 5.8 (95%CI 4.1–6.9) • Severe acute malnutrition • 2006: 0.9 (95%CI 0.3–1.4) • 2007: 0.4 (95%CI 0.2–1.1)

  24. Malnutrition (2) Height-for-age z-score • 2006: 55.6 (95%CI 50.8–60.4) • 2007: 30.8 (95%CI 27.4–34.1)

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