The DHS Program

December 15, 2009 
First-ever DHS household survey in Sierra Leone finds vast majority of women seek care in pregnancy

Freetown, Sierra Leone. Seven years after Sierra Leone’s devastating civil war, which tore apart the country’s health infrastructure, more than 4 in 5 pregnant women sought antenatal care, but only one-quarter of births took place at health facilities, according to the country’s first Demographic and Health Survey.

While the number of women seeking checkups during pregnancy was encouraging, the lack of skilled delivery assistance during childbirth likely remains a major contributing factor to the country’s high maternal mortality rate, which is estimated at 857 maternal deaths for every 100,000 live births, one of the highest rates in the world.

The 2008 Sierra Leone Demographic and Health Survey (SLDHS) found that the health of Sierra Leoneans is slowly improving following 11 years of war, but that the country still suffers high maternal and child mortality rates. The survey also looked at HIV/AIDS indicators, finding relatively low HIV prevalence but also dangerously low rates of AIDS awareness and education.

The survey found that 87% of women received antenatal care (ANC) from a doctor, nurse, midwife, or MCH aide, but just 42% of births were delivered by a skilled provider. Higher education levels increased the chances of delivering at a health facility, with nearly half of women with secondary or more education giving birth at a facility, compared to only 20% of women with no education.

The survey found that only 7% of Sierra Leonean women use a modern method of contraception, with married women in urban areas using family planning tools more than any other group. The low level of contraceptive use likely contributes to the country’s continued high fertility rates. Women have an average of 5.1 children, according to the survey, ranging from an average of 3.8 children among women in urban areas to 5.8 in rural areas.

The survey uncovered several indicators of malnutrition among children under age of five. It found that 36% of children in Sierra Leone are stunted, or too short for their age, a sign of chronic malnutrition among children under five. In addition, more than three-quarters of children have some form of anaemia, another serious sign of poor nutrition.

Roughly 1 in 7 children in Sierra Leone die before reaching age five, according to the survey. Currently, 89 children per 1,000 live births die before their first birthday and 140 children die before their fifth birthday. Data for 1994 to 1998 estimate that 120 children per 1,000 live births died before their first birthday, and 190 per 1,000 live births died before the age of five.

More than one-third of households own at least one insecticide-treated net (ITN). Households in the Southern Region reported the highest ownership of ITNs (45%). The use of nets is limited, however, with only 26% of children under five and 27% of pregnant women having slept under an ITN the night before the survey.

As in other African countries, the Sierra Leone National Malaria Strategy has adopted the policy of preventive treatment of pregnant women to reduce malaria infection. The treatment involves two doses of SP/Fansidar during antenatal care visits. However, only 17% of women received any SP/Fansidar during an ANC visit, and only 10% of women said they received the recommended treatment of two or more doses, at least one of which was during an ANC visit.

Overall, 1.5% of women and men age 15–49 in Sierra Leone are HIV-positive, according to the 2008 SLDHS. HIV prevalence is highest among women living in urban areas (2.7%). Prevalence also ranges from 0.8% in the Southern Region to 2.9% in the Western Region. While HIV prevalence is low, knowledge of HIV prevention also remains low. Only 43% of women and 62% of men know that using condoms can reduce the risk of getting HIV. In addition, only 33% of women and 46% of men know that HIV cannot be transmitted by mosquito bites.

About the survey: The 2008 Sierra Leone Demographic and Health Survey (SLDHS) was carried out by Statistics Sierra Leone (SSL), in collaboration with the Ministry of Health and Sanitation (MOHS). The Government of Sierra Leone provided financial assistance in terms of funding and in kind contributions. Additional funding for the survey was provided by the United States Agency for International Development (USAID), the United Nations Population Fund (UNFPA), the United Nations Development Program (UNDP), the United Nations Children’s Fund (UNICEF), the Department for International Development (DFID), and the World Bank. Logistical support was also received from the United Nations High Commissioner for Refugees (UNHCR), the World Food Programme (WFP), and the World Health Organisation (WHO).