MSF 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 (MSF). A principal reason is the absence of easily accessible healthcare, with 60 per cent of under-fives dying at home and 13 per cent on the journey to hospital.

In April, an MSF 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 north-west prefecture of Ouham, in and around the town of Boguila, where MSF 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 MSF 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 per cent of those children died in a health facility, while the remaining 74 per cent 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, MSF’s 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 per cent 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, MSF’s 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 MSF is confronted by a state of chronic medical emergency in Central African Republic.

As highlighted in MSF’s 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, MSF’s project in Boguila consists of a hospital providing specialist healthcare, an outpatient department and 10 health posts in the surrounding area. With half of all patients coming to health facilities suffering from malaria, MSF 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.