Osborne Augustus, Bangura Camilla
Department of Biological Sciences, School of Basic Sciences, PMB, Njala University, Freetown, Sierra Leone.
Trop Med Health. 2024 Oct 2;52(1):66. doi: 10.1186/s41182-024-00633-0.
Sierra Leone has improved child health outcomes in recent decades. However, diarrhoeal diseases remain a public health concern, particularly among children under five. This study investigates the trends and inequalities in oral rehydration therapy and continued feeding for children under five with diarrhoea in Sierra Leone in 2008, 2013 and 2019.
The analysis utilised data from the Sierra Leone Demographic Health Survey rounds conducted in 2008, 2013, and 2019. The software utilised for the calculation of various measures of inequality, including simple difference, ratio, population-attributable risk, and population-attributable fraction, was the World Health Organization Health Equity Assessment Toolkit. An inequality assessment was conducted for six stratifiers: maternal age, maternal economic status, maternal level of education, place of residence, sex of the child, and sub-national region.
Our findings reveal that children under five with diarrhoea receiving oral rehydration therapy and continued feeding increased from 56.5% in 2008 to 59.7% in 2019 in Sierra Leone. Children of mothers aged 20-49 had more coverage over time than those with mothers aged 15-19. Children of mothers who are wealthy, more educated, and living in urban areas show a decrease in coverage with time compared to the poor, the lowly educated, and those residing in rural areas. Male children had higher coverage than female children. Regional inequality decreased slightly from 21.5 percentage points in 2008 to 21.2 percentage points in 2019.
The findings revealed a mixed picture of progress in oral rehydration therapy and continued feeding for children under five in Sierra Leone. While national coverage has increased, inequalities persist. Children of older mothers and those from disadvantaged backgrounds have experienced improvements, while children of younger, wealthier, and more educated mothers in urban areas have seen a decline in coverage. The gender and regional inequalities remain. Expanding community-based health programs, providing subsidised or free supplies, and strengthening health systems in underserved areas are key strategies to ensure equitable and effective healthcare for all children in Sierra Leone.
近几十年来，塞拉利昂儿童健康状况有所改善。然而，腹泻病仍是一个公共卫生问题，尤其是在五岁以下儿童中。本研究调查了2008年、2013年和2019年塞拉利昂五岁以下腹泻儿童口服补液疗法和继续喂养的趋势及不平等情况。
分析使用了2008年、2013年和2019年塞拉利昂人口与健康调查轮次的数据。用于计算各种不平等指标的软件，包括简单差异、比率、人群归因风险和人群归因分数，是世界卫生组织健康公平评估工具包。对六个分层因素进行了不平等评估：母亲年龄、母亲经济状况、母亲教育水平、居住地、孩子性别和次国家级地区。
我们的研究结果显示，塞拉利昂五岁以下腹泻儿童接受口服补液疗法和继续喂养的比例从2008年的56.5%上升到2019年的59.7%。20至49岁母亲的孩子随着时间推移的覆盖率高于15至19岁母亲的孩子。与贫困、受教育程度低和居住在农村地区的母亲的孩子相比，富裕、受教育程度高和居住在城市地区的母亲的孩子的覆盖率随时间下降。男童的覆盖率高于女童。地区不平等从2008年的21.5个百分点略有下降至2019年的21.2个百分点。
研究结果揭示了塞拉利昂五岁以下儿童口服补液疗法和继续喂养方面进展的复杂情况。虽然全国覆盖率有所提高，但不平等现象依然存在。年龄较大母亲的孩子以及来自弱势背景的孩子情况有所改善，而城市地区年轻、富裕和受教育程度高的母亲的孩子覆盖率却有所下降。性别和地区不平等仍然存在。扩大基于社区的卫生项目、提供补贴或免费用品以及加强服务不足地区的卫生系统是确保塞拉利昂所有儿童获得公平有效医疗保健的关键策略。
