The Child Health and Mortality Prevention Surveillance Sierra Leone (CHAMPS-SL) held its 9th inaugural Advisory Committee Meeting at the National Public Health Agency’s (NPHA) Emergency Operations Center (EOC) conference hall in Wilberforce Freetown on June 13, 2024. This year’s theme, “Exploring data-driven interventions to respond to unaddressed child mortality in Sierra Leone,” brought together approximately sixty participants selected across the Ministry of Health (MoH), international organizations working in health, and other local organizations to deliberate on the findings of CHAMPS on the immediate and underlying causes of deaths in children, with a specific focus on three: malaria, malnutrition, antimicrobial resistance (AMR), and human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS). The CHAMPS-SL Advisory Committee is a component of the project that comprises medical experts who looked at the findings and focused their energies on providing solutions through collaboration with relevant partners to reduce neonates, stillbirths, infants, and child mortality in the country.
Making his welcoming address, Dr. Mohamed Alex Vandi, Deputy Executive Director of NPHA, welcomed the participants to the CHAMPS-SL Advisory Committee meeting as he went on to recognize the efforts each person is making in the fight against diseases in the country with specific reference to CHAMPS-SL. He said that the venue of the meeting was so befitting that it suits their thirst for data, as the NPHA is a data drive. He said that as an institution, they believe in seeing, interpreting, and analyzing the data to provide sustainable solutions to the ever-challenging health issues the country is facing. He thanked CHAMPS-SL for complementing the efforts of the MoH in the surveillance of diseases and proffering real-time, reliable, and accurate data that presents reality on the ground and thus will aid in influencing policy reform.
CENTER FOR DISEASE CONTROL (CDC) COUNTRY DIRECTOR, DR. DAPHNE MOFFET
She started by acknowledging the data collected by the CHAMPS-SL project with specific reference to HIV/AIDS during their adult minimal invasive tissue sampling (Adult MITS). She said that there is preliminary work going on in relation to HIV/AIDS that has warranted increased funds to further investigate the disease in the country. She thanked every other partner for their collaboration for the betterment of healthcare outcomes within the country.
- SARTIE KANNEH, CHIEF MEDICAL OFFICER, MOH
He acknowledged the work of every partner working in the health sector, especially CHAMPS-SL, that has been consolidating the gains the MoH has in maternal mortality and many other areas. He added that they have made gains in child mortality, but with CHAMPS-SL, they will have to unravel a lot of things that will guide the MoH in implementing appropriate policies to make those gains very remarkable through strategic planning. He added that the challenge of coordination is paramount, though not easy, but for the achievement of objectives, there is every need for alignment and synergy among stakeholders to overcome the challenges of maternal and child mortality. “The dynamic nature of plans should not be fixed even when the data suggests otherwise, and thus, there should be some amount of flexibility to ensure a fruitful partnership,” he said. He implored all not to be focused on the figures but on how to rally around to utilize the limited resources to lower these numbers.
BRIGADIER-GENERAL PROF. FODAY SAHR, EXECUTIVE DIRECTOR, NPHA
He started off by thanking CHAMPS-SL for the involvement of the NPHA and committed to working with the project as it strategically aligned with the aims and aspirations of their institution. He said that the project for them is like an extension of their mandate to collect data, look at it, analyze it, and utilize it for the prevention and surveillance of diseases in the country. He encouraged all to continue on that path to change the narrative of disease surveillance in the country.
- AMARA JAMBAI, CO-DIRECTOR, CHAMPS-SL
As the chairman, he said that the project has always been his legacy, as he is one of the pioneers of the child health project. He said that the results combined will aid those who are very passionate about numbers and those who are passionate about shifting directions. He added that he was passionate about the initiation of a specific child health program designed to handle child health issues in the country. He explained that the CHAMPS-SL uses a scientific method called Minimal Invasive Tissue Sampling (MITS) to investigate the immediate and underlying causes of deaths in children and is now being used for adults. “The results are not to blame individuals but to influence the creation of policy briefs that will address the reality on the ground by highly placed political decision-makers,” he said. He said that the death of children has become very scary, and there is every need for every sector to rally around the National Child Health Program to thrive and succeed in saving the next generation of children in this country.
- IKE OGBUANU, CHAMPS-SL DIRECTOR
He started his presentation by stating the essence of the meeting, which was to pull together energies to salvage the lives of children in Sierra Leone. He further encouraged all to be frank in discussing the issues therein to bring out sustainable solutions. He said that his presentation was looking at four areas: malnutrition, malaria, AMR, and HIV/AIDS, as the Advisory Committee is a decision-making body and provides guidance on the findings to help curb some of these challenges. He presented a case in which the verbal autopsy revealed that there was no electricity, the alternative power supply, which is a solar panel, was not connected, and there was no water in the theater. We paid for everything at every stage, despite the implementation of free healthcare. According to Dr. Ike, he presented it to lay the basis and create a picture in the minds of the participants of the realities healthcare facilities face in the country. He admonished all that the limitation of the data is based on two districts and not the entire country, missing an unknown proportion of deaths, especially community deaths, but participants should be focused on the “so what” question in addressing these findings gathered by the project. He added that the project is blessed with the strength of pathology, social autopsy, clinical data abstraction, postmortem sampling, and lab testing; an expert panel of determination of cause of death (DeCoDe); a health demographic surveillance system (HDSS) to address the denominator issue of the targeted population for the study; and a data-to-action (D2A) to address some of the challenges the data is pointing to. He said that the project adopted the MITS procedure as it is more culturally acceptable by the community as opposed to a full autopsy. He explained to participants the activities of the project and the nested project that will be implemented in the near future. He gave a brief explanation of the ways of working on the project. He said that the collection of samples is being done within 24 hours of the death of a person.
In his presentation on malnutrition, out of 76 children (12 months to <60 months) and 45 infants (28 days to <12 months), 24 and 19 accounted for where malnutrition was the underlying cause, and 11 and 4 were in the causal chain, amounting to 46% and 51%, respectively. The findings showed that 50% of malnutrition occurred between the ages of 12 and 23 months, amounting to 110 out of the 353 cases. 46% accounted for children that were not breastfed out of 125 cases. He further presented on malaria. The malaria prevalence for infants and children is 21% and 57% of 664 cases, respectively. The underlying cause of malaria leading to anemia as a cause of death accounts for 75% out of 88 cases, and 51% of malaria cases have cerebral as the underlying cause of death, where anemia is the immediate cause of death. His presentation on AMR showed that the proportion of Klebsiella pneumonia isolates resistant to antibiotics out of 152 shows that ampicillin is 0% resistant and sensitive, gentamycin is 13% sensitive and 87% resistant, ciprofloxacin is 13% sensitive and 87% resistant, imipenem is 12% sensitive and 88% resistant, and meropenem is 7% resistant and 93% sensitive. He ended his presentation on HIV/AIDS. The presentation shows that the prevalence of the disease in infant and child death cases in Bo and Bomabali from 2019–2024 is 7% and 7.5%, respectively. The adult cases account for 21% positive and 79% negative out of 298 cases. Only 35% are aware of their status, while 65% are unaware out of 63 positive cases. Out of the 298 cases, 63 were positive cases, 22 were aware of their status, and 7 were on Rx. The positivity rate among the ages of 15–19 and 30-44 for HIV and TB is 30%, 21%, 42%, and 28%, respectively.
During the discussion, Dr. Alie H. Wurie, deputy CMO, said that there is every need for the stepping up of supervisory, health education, and training at healthcare facilities and communities. He said that health education at every level, but with specific reference to the community, will help to address many health-related issues such as malnutrition, exclusive breastfeeding and its importance, raising awareness about HIV/AIDS and its treatment, and intensive ANC to address child and maternal mortality outcomes. He further said that healthcare providers should use the protocols on integrated management of neonatal and childhood illness (IMNCI), the provision of child commodities, and the setting up of a child situation room to monitor who is dying and why, what the cause is, and what should be done. He concluded that it will serve as a feedback mechanism on the reality on the ground as an early response system.
Madam Aminata Shamit Koroma, Chief Nutritionist at the Directorate of Food and Nutrition, MoH, said that they are embarking on a mandatory policy for every organization, especially those working in health, to embark on the backyard gardening process to address the incidence of malnutrition in children and adults. She said that the overdependence on imported complementary foods is worrisome, as most of them are not suitable for children’s consumption. She said that they have started as a directorate to implement backyard gardening to reach their target of 50% countrywide. She also added that awareness-raising on the eating behavior of pregnant women should be done at all levels to boast micro- and macronutrients to prevent deficiency.
Dr. Sartie Kanneh, CMO, said that there is a need for every directorate, especially those having bearings with children, such as malaria, an expanded program on immunization, HIV, and nutrition, to work in consonance with the national child health program to be able to address all these challenges. He recommended the early dissemination of the finding, especially on AMR, to address the issue before escalating.
Dr. James Komeh, registrar of the of the pharmacy board of the of the MoH, said that the AMR is based on the high misuse of drugs in the country. He said that they have all the systems, but people deliberately refused to adhere to the terms of the system. He added that they have developed a template to record all importations of drugs to curb AMR, but there is still the challenge of people importing without using the specific channel. He added that they are now embarking on a spot check based on intelligence to address the challenge of AMR. He concluded that he was not surprised by the data, as ICARIA has done similar studies, and that there is a need for them to supervise at the prescription level at all levels and review their strategic plan.
Dr. Lakoh said that the institution of infection prevention and control at healthcare facilities is of the essence. He added that the need for synergy among MoH departments is very key in complementing each’s effort in achieving the overall aim of improving health care outcomes in the country. He said that the recent campaign on Penta 1 is a testimony to how powerful collaboration can be, as 98% of the children in the country received it. He said that the need for coaching and publishing of manuscripts is essential to sharing lessons learned and encouraging.
Dr. Daphne Moffet, CDC country director, said in her closing remarks that the data has created a lot of discussions at national and global levels, especially on HIV/AIDS. She thanked every participant for their participation in the discussions and encouraged them to continue with their hard work in transforming the health sector of the country.
The following were suggested to be added to the committee:
- Ministry of Energy
- District medical officers in all the districts
- M&Es
- Pedriatic association
- Nutrition
- CSOs
- SLMDA, Allied health professional
Copyright –Published in print in Expo Times Newspaper on Friday, June 21th , 2024 (ExpoTimes News – Expo Media Group (expomediasl.com)