Malaria drives hospitalizations and deaths in Sierra Leone's youngest children
A prospective study following 20,560 infants up to 24 months across three districts in Sierra Leone found malaria, respiratory infections, and diarrhea were the leading causes of hospitalization and death. Despite free child health care, malaria chemoprevention, pneumococcal vaccination, and a newer malaria vaccine, the country still has one of the world's highest child mortality rates. The researchers say routine surveillance that groups all children under 5 can obscure causes in the first two years of life.
The study tracked 20,560 infants through 24 months at 14 health centers in three Sierra Leone districts. It documented 2,688 hospital admissions and 859 deaths. Malaria caused 54.3% of admissions, followed by lower respiratory infections, diarrhea, undernutrition, and sepsis. Among in-hospital deaths with records, malaria accounted for 50.6%.
For deaths outside hospitals, researchers used caregiver interviews to reconstruct causes; malaria again appeared most often, followed by respiratory infections and diarrhea. The authors caution this method may undercount malaria because symptoms overlap with other infections. They also found children receiving all age-appropriate routine EPI vaccines had lower mortality risks.
The findings may sharpen how Sierra Leone and similar settings interpret child mortality data, potentially directing attention to the first two years of life rather than a single under-5 group. Families and caregivers could benefit if this leads to better-targeted prevention and care, while health services may face pressure to strengthen malaria, respiratory, and diarrheal programs. The study's impact depends on whether such evidence informs routine monitoring and resource decisions.