Improving Child Survival in Sierra Leone: The Work of ISGlobal’s Maternal, Child and Reproductive Health Initiative

With a life expectancy at birth of 55 years and a per capita GDP of €446, Sierra Leone ranks 182^nd (out of 189 countries) in the United Nations Human Development Index and its inhabitants have a very low standard of living. It is a country with some of the world’s worst maternal and child health indicators: 1,120 maternal deaths per 100,000 live births and an under-five mortality rate of 109 deaths per 1,000 live births—i.e. 27,580 deaths among children aged 1-59 months in 2019.

With a life expectancy at birth of 55 years and a per capita GDP of €446, Sierra Leone ranks 182nd (out of 189 countries) in the Human Development Index. It is a country with some of the world’s worst maternal and child health indicators.

ISGlobal’s Maternal, Child and Reproductive Health Initiative is working on various projects and activities in Sierra Leone, a country where we had never previously operated.

ICARIA: An Innovative Strategy to Reduce Child Mortality

Our work in Sierra Leone began in late 2019 after we were awarded the ICARIA project, which is co-funded by the Bill & Melinda Gates Foundation and the ”la Caixa” Foundation. ICARIA is a large-scale clinical trial with 20,560 participants. Its purpose is to determine how administering the antibiotic azithromycin through the Expanded Programme on Immunisation affects all-cause child mortality at 18 months of age.

ICARIA is a large-scale clinical trial with 20,560 participants. Its purpose is to determine how administering the antibiotic azithromycin through the Expanded Programme on Immunisation affects all-cause child mortality at 18 months of age

A few months later, the COVID-19 pandemic broke out, threatening the viability of the ICARIA project as it had so many other activities. Despite the challenges, the project forged ahead and preparations were made to start a clinical trial in three districts of northern Sierra Leone.

Recruitment of study subjects started in March 2021; approximately one third of the total participants have been recruited to date. Around the same time, we opened a project office in Makeni, the capital of Bombali district in the Northern Province. This office has allowed us to consolidate other research, training and knowledge-transfer activities in the field of maternal and child health in Sierra Leone.

As part of the preparations for the ICARIA project, we trained all staff involved in Sierra Leone.

MULTIPLY: Increasing Child Survival by Preventing Malaria

In May 2021, another research project, known as MULTIPLY, was launched in Sierra Leone with funding from the European and Developing Countries Clinical Trials Partnership (EDCTP). This project aims to enhance protection against malaria by increasing Intermittent Preventive Treatment in infants (IPTi) with sulfadoxine-pyrimethamine to a total of seven doses over the first two years of life. The doses are administered in tandem with routine vaccinations in districts of Sierra Leone, Togo and Mozambique.

MULTIPLY project aims to enhance protection against malaria by increasing Intermittent Preventive Treatment in infants (IPTi) with sulfadoxine-pyrimethamine. The doses are administered in tandem with routine vaccinations.

Of particular significance is the implementation of this project in Sierra Leone, as it is the only country where IPTi is a public health policy for preventing childhood malaria.

Within the framework of the ICARIA and MULTIPLY projects, several training activities have been organised—on the topics of best clinical practices, data management, household surveys, etc.—and three team members have started their doctoral studies.

IPERVAC: A Study of Perceptions of COVID-19 Vaccines

More recently, IPERVAC, a qualitative study with a socio-anthropological approach funded by the Glòria Soler Foundation, was launched in Sierra Leone. The aim of the project is to gain an understanding of perceptions of COVID-19 vaccines among health care personnel and the general population, as well as to ascertain the impact of these perceptions on health-seeking behaviours. This understudied aspect has taken on particular relevance in the context of current efforts to vaccinate the adult population, especially in countries like Sierra Leone, where COVID-19 vaccines are administered via the routine vaccination programme.

IPERVAC project is a qualitative study with a socio-anthropological approach with the aim o gaining an understanding of perceptions of COVID-19 vaccines among health care personnel and the general population in Sierra Leone

Finally, in collaboration with the International Health Service of Barcelona’s Hospital Clínic, the Paediatric Unit of Infectious and Imported Diseases at Hospital Sant Joan de Déu and the College of Medicine and Health Sciences at the University of Sierra Leone, the groundwork is being laid for a collaboration agreement that would strengthen the capacities of health professionals from Hospital Clínic, Hospital Sant Joan de Déu and district hospitals in Sierra Leone.

A Positive Experience Overall

Despite the difficulties inherent to the context of our work—which have been exacerbated by the pandemic—these two years in Sierra Leone have been, on the whole, very positive. A strategic relationship has been established with the Ministry of Health and the College of Medicine and Health Sciences at the University of Sierra Leone—organisations that collaborate on all of our projects and activities—as well as with the London School of Hygiene and Tropical Medicine (LSHTM) and the Child Health and Mortality Prevention Surveillance (CHAMPS) network.

Despite the difficulties inherent to the context of our work—which have been exacerbated by the pandemic—these two years in Sierra Leone have been, on the whole, very positive

We work with a local team of more than 120 people: supervisors, health personnel, data managers, field staff, etc. In the beginning, and ultimately for an entire year, we were only able to collaborate with this team remotely. The local team accounts for more than 90% of the total project staff—a clear commitment to strengthening and consolidating the existing capacities in Sierra Leone. This is also a good opportunity to recognise the dedication and commitment of the colleagues working on these projects in both Sierra Leone and Barcelona.

From left to right, Kwabena Owusu (ICARIA project technical coordinator), Augustin Fombah (MULTIPLY project technical coordinator), prof. Mohamen Samai (Advisor to the Sierra Leone Ministry of Health and Sanitation), dr. Austin Demby (Minister of Health and Sanitation of Sierra Leone), Anna Lucas and Clara Menéndez, coordinator and director, respectively, of ISGlobal's Maternal, Reproductive and Child Health Initiative.

Sierra Leone embodies the set of circumstances that justify ISGlobal’s presence as well as our model of scientific activity focused on knowledge transfer and collaboration with multiple partners and contributors. Furthermore, working in one of sub-Saharan Africa’s most precarious health systems has forced us to optimise existing resources—such as the routine vaccination programme—while also making it possible to transfer the tools and approaches developed to similar resource-poor settings.

An estimated 2.5 million children under five years of age die in sub-Saharan Africa each year, most of them from preventable infectious diseases. If we are to help increase child survival, we need new approaches to the treatment and prevention of these diseases.

If we are to help increase child survival, we need new approaches to the treatment and prevention of these diseases

These approaches have to be adapted to local contexts—and not the other way around—so that they will be acceptable to the target populations and can feasibly be implemented by the health authorities. Nevertheless, global efforts to increase vaccination coverage and combat malaria have stalled in recent years. This situation has been exacerbated by the COVID-19 pandemic, making it more urgent than ever to develop new tools and propose approaches that complement those currently in use to achieve the international targets set for child health and malaria. Our activities in Sierra Leone are fully aligned with this approach.