Healthcare seeking for diarrhoea, malaria and pneumonia among children in four poor rural districts in Sierra Leone in the context of free health care: results of a cross-sectional survey

BACKGROUND: To plan for a community case management (CCM) program after the implementation of the Free Health Care Initiative (FHCI), we assessed health care seeking for children with diarrhoea, malaria and pneumonia in 4 poor rural districts in Sierra Leone. METHODS: In July 2010 we undertook a cross-sectional household cluster survey and qualitative research. Caregivers of children under five years of age were interviewed about healthcare seeking. We evaluated the association of various factors with not seeking health care by obtaining adjusted odds ratios and 95% confidence limits using a multivariable logistic regression model. Focus groups and in-depth interviews of young mothers, fathers and older caregivers in 12 villages explored household recognition and response to child morbidity. RESULTS: The response rate was 93% (n=5951). Over 85% of children were brought for care for all conditions. However, 10.8% of those with diarrhoea, 36.5% of those with presumed pneumonia and 41.0% of those with fever did not receive recommended treatment. In the multivariable models, use of traditional treatments was significantly associated with not seeking outside care for all three conditions. Qualitative data showed that traditional treatments were used due to preferences for locally available treatments and barriers to facility care that remain even after FHCI. CONCLUSION: We found high healthcare seeking rates soon after the FHCI; however, many children do not receive recommended treatment, and some are given traditional treatment instead of seeking outside care. Facility care needs to be improved and the CCM program should target those few children still not accessing care

Household Possession and Use of Insecticide-Treated Mosquito Nets in Sierra Leone 6 Months after a National Mass-Distribution Campaign

BACKGROUND: In November 2010, Sierra Leone distributed over three million long-lasting insecticide-treated nets (LLINs) with the objective of providing protection from malaria to individuals in all households in the country. METHODS: We conducted a nationally representative survey six months after the mass distribution campaign to evaluate its impact on household insecticide-treated net (ITN) ownership and use. We examined factors associated with household ITN possession and use with logistic regression models. RESULTS: The survey included 4,620 households with equal representation in each of the 14 districts. Six months after the campaign, 87.6% of households own at least one ITN, which represents an increase of 137% over the most recent estimate of 37% in 2008. Thirty-six percent of households possess at least one ITN per two household members; rural households were more likely than urban households to have ≥ 1:2 ITN to household members, but there was no difference by socio-economic status or household head education. Among individuals in households possessing ≥ 1 ITN, 76.5% slept under an ITN the night preceding the survey. Individuals in households where the household head had heard malaria messaging, had correct knowledge of malaria transmission, and where at least one ITN was hanging, were more likely to have slept under an ITN. CONCLUSIONS: The mass distribution campaign was effective at achieving high coverage levels across the population, notably so among rural households where the malaria burden is higher. These important gains in equitable access to malaria prevention will need to be maintained to produce long-term reductions in the malaria burden

Individual use of ITNs (LLIN and ITN) by socio-demographic and malaria knowledge characteristics (n = 25,076), Sierra Leone, 2011.

<p>Taylor Series Linearization approach used for standard error estimation and accompanying Rao-Scott <i>X²</i> test statistics.</p><p>CI: Confidence interval.</p

Among all household members, percent who slept under an ITN the night before the survey, by five-year age category and gender, Sierra Leone, 2011.

<p>Among all household members, percent who slept under an ITN the night before the survey, by five-year age category and gender, Sierra Leone, 2011.</p

Percent of households with at least one LLIN/ITN for every two household members, by district, Sierra Leone, 2011.

<p>Percent of households with at least one LLIN/ITN for every two household members, by district, Sierra Leone, 2011.</p

Household possession of ITNs (LLIN and ITN) by socio-demographic and malaria knowledge characteristics (n = 4,610), Sierra Leone, 2011.

<p>Taylor Series Linearization approach used for standard error estimation and accompanying Rao-Scott <i>X²</i> test statistics.</p><p>CI: Confidence interval.</p

Logistic regression model assessing the associations between socio-demographic and knowledge characteristics with ITN use, among those in households with ≥1 ITN (n = 22,344), Sierra Leone, 2011.

<p>Model also controls for district; standard errors estimated with the Taylor Series Linearization method.</p><p>AOR: Adjusted odds ratio.</p><p>CI: Confidence interval.</p>*<p>p<0.10; **P<0.05; ***P<0.001.</p

Logistic regression models assessing the associations between socio-demographic and knowledge characteristics and household possession of ITNs (LLIN and ITN) (n = 4,610), Sierra Leone, 2011.

<p>Model also controls for district; standard errors estimated with the Taylor Series Linearization method.</p><p>AOR: Adjusted odds ratio.</p><p>CI: Confidence interval.</p>*<p>p<0.10; **P<0.05; ***P<0.001.</p