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Child death rate “alarmingly high” in Central African Republic

Central African Republic / 03.07.12

Two Médecins Sans Frontières interviewers meet a family near Boguila in northwest Central African Republic to gather information for a mortality survey. ©Sibylle Gerstl/MSF

Médecins Sans Frontières mortality survey shows children urgently need better access to healthcare.

An “alarmingly high” number of children under the age of five are dying in parts of Central African Republic, according to the findings of a new mortality survey conducted by the international medical humanitarian organisation Médecins Sans Frontières. A principal reason is the absence of easily accessible healthcare, with 60 percent of under-fives dying at home and 13 percent on the journey to hospital.

In April, a Médecins Sans Frontières team – made up of an epidemiologist, a logistician and 10 local interviewers – conducted the survey over two weeks, interviewing 30 heads of households in 30 randomly selected villages in the northwest prefecture of Ouham, in and around the town of Boguila, where Médecins Sans Frontières manages a hospital. The team collected data on the number of people who had died in those households since the start of the previous cotton season in June 2011, and asked interviewees how the deaths occurred and where they had taken place. The data collected gives Médecins Sans Frontières a clearer picture of the health status of the population in the catchment area, and will help the organisation determine its future medical activities.

Most alarming was the finding that almost half of all the reported deaths were of young children. Only 26 percent of those children died in a health facility, while the remaining 74 percent died at home or on the road to hospital.

“When a young child falls ill, the first thing parents try is treatment at home using traditional medicines and methods,” says Dr Jatinder Singh, Médecins Sans Frontières’ deputy medical coordinator in Central African Republic. “If those treatments fail, the children are usually in a bad state by the time they reach hospital. We also see sick children arrive late because of the long distances they have to travel.”

The findings reveal that mortality rates among the population as a whole, as well as mortality rates for under-fives, were alarmingly high for a stable, post-emergency context, although they were slightly below the emergency threshold. Poor access to treatment was identified as a major reason for the elevated death rate. Family members reported that the majority of people died of the three major illnesses prevalent in sub-Saharan Africa: malaria/fever, respiratory infections and diarrhoea. More than two-thirds of deaths occurred in the rainy season.

“The results show the mortality rate in the overall population is high, and almost 50 percent of the deaths during the survey period were children. This tells us that, on average, in this area, almost 200 out of every 1,000 children die before the age of five", says Till Kinkel, Médecins Sans Frontières’ health advisor for Central African Republic. “We have health posts around our hospital but, clearly, they are not enough. We will have to adapt our strategy and go into the communities, because this is where the children are dying.”

Other survey findings show:

  • Crude mortality rate was 0.84 deaths per 10,000 people per day (95% confidence interval: 0.68-1.01)
  • Under-five mortality rate was 1.77 deaths per 10,000 per day (95% confidence interval: 1.19-2.35)
  • 33% of all deaths in children under the age of five were reportedly related to fever and/or malaria
  • 50% of households have no bed nets to protect against malaria
  • 22% of children have been vaccinated for measles, with a vaccination card as proof
  • Fewer than 50% of pregnant women are taking antimalarial medicine

Once again Médecins Sans Frontières is confronted by a state of chronic medical emergency in Central African Republic. As highlighted in Médecins Sans Frontières’ recent report, Central African Republic: A State of Silent Crisis, the country needs more health providers to conduct larger operations covering more of the population.

Currently, Médecins Sans Frontières’ project in Boguila consists of a hospital providing secondary healthcare, an outpatient department and 10 health posts in the surrounding area. With half of all patients coming to health facilities suffering from malaria, Médecins Sans Frontières has implemented a comprehensive malaria strategy. This includes distributing insecticide-treated mosquito nets, providing preventive therapy for pregnant women and infants, and running information campaigns with the help of outreach workers. Rapid diagnostic tests help diagnose the disease, while those testing positive are provided with immediate treatment.

  

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