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The case of Sierra Leone Nadine de Lamotte - MSF OCB London Scientific day, 7 June 07 Use of mortality data in humanitarian response.

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Presentation on theme: "The case of Sierra Leone Nadine de Lamotte - MSF OCB London Scientific day, 7 June 07 Use of mortality data in humanitarian response."— Presentation transcript:

1 The case of Sierra Leone Nadine de Lamotte - MSF OCB London Scientific day, 7 June 07 Use of mortality data in humanitarian response

2 Introduction Two mortality surveys. Focus on 2 nd survey. Operational response to surveys with specific focus on malaria.

3 Map of Sierra Leone Liberia Guinea Atlantic ocean Freetown

4 Country background. War officially over in January Sierra Leone “famous”for its poor health indicators (OMS 2006): – MMR: 2,000/100,000 live births. – Under 5 mortality the highest in the world at 282/1000 live births. –Life expectancy at birth: 37 male / 40 women.

5 Local context: Bo. Second largest city in Sierra Leone. Population of the district: Hyper-endemic for malaria. National malaria protocol changed in 2004 to ASAQ after efficacy studies showed high failure to SP & CQ.

6 OCB operations in Bo. MSF in Bo since Actual target population: MSF hospital (530 admissions/month). 1 therapeutic feeding centre (150 admissions/month). 5 clinics ( consults/month). Malaria is key morbidity/mortality hence lobbying for country ACT implementation.

7 1 st mortality survey: April – June 2005 Part of 3-sample access to health care survey to document access barriers in different systems of payment: - Cost recovery in MOH area - Flat fee in MSF H area - Free care in OCB area

8 Results: death/10.000/day. Total deaths reported as being due to malaria /fever: 39%. In < 5 deaths: 62%.

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10 Operational response to survey => Need to do sensitisation of local population on malaria, “show” Paracheck and ACT in the villages, distribute bed nets. Jan - June 2006: mapping of villages, population data, recruitment & training of outreach teams. Outreach & bed net distribution started in June 06. Monitoring bed net use: around 80% of the bed nets were seen hanging.

11 2 nd mortality survey Sept 2006: Reassess mortality following 2005 survey: -Retrospective mortality in catchment area of the clinics. -Causes of death (verbal autopsy). -Health seeking behaviour in those that died.

12 Methods Study population: ( ) 4 chiefdoms Sth Bo. Sampling method: 3 level cluster; each cluster= 30 children/ families. Family questionnaire: composition, mortality (recall period 97 days), health seeking behaviour. Child questionnaire: anthropometric data. Analysis: EpiInfo, deaths / / day.

13 Results (1) 907 families included. Total n = 5179 (<2yrs=8.4%; <5yrs=76%) 89 deaths ( 5yrs=44) Mortality rate / people / day 95% confidence interval CMR <2 MR – 9.5 <5 MR – 4.9

14 Results (2) Malaria related mortality. < 2 yrs = 71% (n=23), but recall period covering peak season (39% in June 05). < 5yrs = 53% (n=7) (62% in June 05). All malaria deaths = 42% (n=37). Died at home (all) = 74%. Died at hospital (all) = 25%.

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16 Limitations Sampling error: sampling methodology, rainy season means remote villages inaccessible and more malaria (versus 2005 survey). Measurement error: definition of malaria as fever in survey (over-estimation?). Recall bias: long period of recollection, lack of maternal deaths (stigma?).

17 Operational response to 2 nd survey: 3 year pilot plan. => Bring ACT closer to population via PHUs: Identification / mapping of 5 PHUs per clinic, staff training on RDT & ACT use (March 07). Prospective mortality follow-up through weekly data collection at community level. Continue sensitisation of population on malaria and health seeking behaviour. Op research agenda: study ACT efficacy < 2, mortality surveys, baseline study…

18 Rendez-vous in 3 years…


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