{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T09:24:15Z","timestamp":1777973055257,"version":"3.51.4"},"reference-count":51,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,11,16]],"date-time":"2024-11-16T00:00:00Z","timestamp":1731715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Sierra Leone has the fourth-highest child mortality rate in Sub-Saharan Africa. This retrospective study aimed to estimate the nationwide prevalence of fever, acute respiratory infection (ARI), and diarrhea in children under 5 years in Sierra Leone, and to identify the risk factors associated with these diseases. We extracted patient information from the 2019 Sierra Leone Demographic and Health Survey data. Data were analyzed using multivariate logistic regression. In total, 8659, 8652, and 8650 children were included in the analyses of fever, ARI, and diarrhea, respectively. The analysis revealed that the nationwide prevalence rates of fever, ARI, and diarrhea were 16.8%, 14.2%, and 7.2%, respectively. Children aged 12\u201323 months were found to be the most susceptible. Compared to children consuming unimproved water, the highest prevalence rates of fever, ARI, and diarrhea were observed among children residing in households with tube wells or boreholes. The adjusted odds ratio for diarrhea prevalence among children drinking water from household tube wells or boreholes was 1.47 (95% confidence interval: 1.17\u20131.84, p &lt; 0.001). This study has several limitations, including recall bias due to parental reporting. We suspect that the diseases may be associated with potential water contamination in tube wells or boreholes. We recommend national-level periodic inspections of water quality and community-level education on water supply management.<\/jats:p>","DOI":"10.3390\/life14111493","type":"journal-article","created":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T05:36:45Z","timestamp":1731908205000},"page":"1493","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prevalence of Child Fever, Acute Respiratory Infection, and Diarrhea and Their Risk Factors in Sierra Leone"],"prefix":"10.3390","volume":"14","author":[{"given":"Hana","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang 37554, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Dongguk University College of Medicine, Gyeongju 38066, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,16]]},"reference":[{"key":"ref_1","unstructured":"Jones, A., Brikci, N., Williams, R., and Keen, S. (2024, August 13). Evaluation of the Free Health Care Initiative in Sierra Leone. OPML. Available online: https:\/\/www.opml.co.uk\/projects\/evaluation-free-health-care-initiative-sierra-leone."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"13008","DOI":"10.7189\/jogh.11.13008","article-title":"Prevalence of diarrhea, acute respiratory infections, and malaria over time (1995\u20132017): A regional analysis of 23 countries in West and Central Africa","volume":"11","author":"Bogler","year":"2021","journal-title":"J. Glob. Health"},{"key":"ref_3","unstructured":"World Bank (2024, October 05). Mortality Rate, Under 5 (per 1000 Live Births)\u2013Sub-Saharan Africa. Available online: https:\/\/liveprod.worldbank.org\/en\/indicator\/sh-dyn-mort?gender=total."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e114","DOI":"10.1016\/S2214-109X(21)00459-9","article-title":"Child, maternal, and adult mortality in Sierra Leone: Nationally representative mortality survey 2018\u201320","volume":"10","author":"Aimone","year":"2022","journal-title":"Lancet Glob. Health"},{"key":"ref_5","unstructured":"Appiah, J., and Sanny, N. (2024, August 08). AD346: Sierra Leoneans Say Health Care Hard to Access, Beset by Corruption\u2014Especially for the Poor. Afrobarometer. Available online: https:\/\/www.afrobarometer.org\/wp-content\/uploads\/2022\/02\/ab_r7_dispatchno346_sierraleone_health_sector_beset_by_corruption_especially_for_the_poor.pdf."},{"key":"ref_6","unstructured":"IOM Sierra Leone (2019). Sierra Leone: Diaspora Health Professionals Offer Free Medical Services in Rural Communities, International Organization for Migration. Available online: https:\/\/www.iom.int\/news\/sierra-leone-diaspora-health-professionals-offer-free-medical-services-rural-communities."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Chivardi, C., Zamudio Sosa, A., Cavalcanti, D.M., Ordo\u00f1ez, J.A., Diaz, J.F., Zuluaga, D., Almeida, C., Serv\u00e1n-Mori, E., Hessel, P., and Moncayo, A.L. (2023). Understanding the social determinants of child mortality in Latin America over the last two decades: A machine learning approach. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-47994-w"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/S0140-6736(10)61257-3","article-title":"Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: A systematic analysis","volume":"376","author":"Gakidou","year":"2010","journal-title":"Lancet"},{"key":"ref_9","unstructured":"World Bank (2024, September 30). Girls\u2019 Education. Available online: https:\/\/www.worldbank.org\/en\/topic\/girlseducation."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1007\/s13524-019-00812-3","article-title":"The causal effect of maternal education on child mortality: Evidence from a quasi-experiment in Malawi and Uganda","volume":"56","author":"Andriano","year":"2019","journal-title":"Demography"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Apanga, P.A., and Kumbeni, M.T. (2021). Factors associated with diarrhea and acute respiratory infection in children under-5 years old in Ghana: An analysis of a national cross-sectional survey. BMC Pediatr., 21.","DOI":"10.1186\/s12887-021-02546-x"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Rahman, A., and Hossain, M. (2022). Prevalence and determinants of fever, ARI, and diarrhea among children aged 6\u201359 months in Bangladesh. BMC Pediatr., 22.","DOI":"10.1186\/s12887-022-03166-9"},{"key":"ref_13","unstructured":"PMI (2024, October 15). U.S. President\u2019s Malaria Initiative Sierra Leone Malaria Operational Plan FY 2022. Available online: https:\/\/d1u4sg1s9ptc4z.cloudfront.net\/uploads\/2022\/01\/FY-2022-Sierra-Leone-MOP.pdf."},{"key":"ref_14","unstructured":"Worldometers (2024, October 13). Sierra Leone Population. Available online: https:\/\/www.worldometers.info\/world-population\/sierra-leone-population\/."},{"key":"ref_15","unstructured":"Miesen, F. (2024, October 09). Blood Diamonds Fueled Sierra Leone\u2019s Civil War. D+C. Available online: https:\/\/www.dandc.eu\/en\/article\/blood-diamonds-fuelled-sierra-leones-civil-war."},{"key":"ref_16","unstructured":"Macrotrends (2024, October 02). Sierra Leone Life Expectancy 1950\u20132022. Available online: https:\/\/www.macrotrends.net\/countries\/SLE\/sierra-leone\/life-expectancy."},{"key":"ref_17","unstructured":"Witter, S., Brikci, N., Harris, T., Williams, R., Keen, S., Mujica, A., Jones, A., Murray, A., Bale, B., and Leigh, B. (2024, September 03). The Sierra Leone Free Health Care Initiative (FHCI): Process and Effectiveness Review. Available online: https:\/\/eresearch.qmu.ac.uk\/bitstream\/handle\/20.500.12289\/4358\/eResearch%204358.pdf?sequence=1."},{"key":"ref_18","unstructured":"Lynch, M. (2024, September 10). Girls\u2019 Education in Sierra Leone: A New Era in Female Empowerment. The Edvocate (Blog). Available online: https:\/\/borgenproject.org\/girls-education-in-sierra-leone\/."},{"key":"ref_19","unstructured":"Smurra, A., Rasul, I., and Bandiera, O. (2024, September 20). Lessons from Sierra Leone\u2019s Ebola Pandemic on the Impact of School Closures on Girls, The Conversation, Available online: https:\/\/theconversation.com\/lessons-from-sierra-leones-ebola-pandemic-on-the-impact-of-school-closures-on-girls-137837."},{"key":"ref_20","unstructured":"Wodon, Y.K., and Wodon, Q. (2024, October 14). The Power of Investing in Girls in Sierra Leone. Brookings (Blog). Available online: https:\/\/www.brookings.edu\/articles\/the-power-of-investing-in-girls-in-sierra-leone\/."},{"key":"ref_21","first-page":"140","article-title":"An analytical framework for the study of child survival in developing countries","volume":"81","author":"Mosley","year":"2003","journal-title":"Bull. World Health Organ."},{"key":"ref_22","first-page":"140","article-title":"Frameworks for studying the determinants of child survival","volume":"81","author":"Hill","year":"2003","journal-title":"Bull. World Health Organ."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"279","DOI":"10.4054\/DemRes.2019.40.11","article-title":"The effects of household and community context on mortality among children under five in Sierra Leone: Evidence from the 2013 Demographic and Health Survey","volume":"40","author":"Houle","year":"2019","journal-title":"Demogr. Res."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Travassos, M.A., Beyene, B., Adam, Z., Campbell, J.D., Mulholland, N., Diarra, S.S., Kassa, T., Oot, L., Sequeira, J., and Reymann, M. (2016). Immunization coverage surveys and linked biomarker serosurveys in three regions in Ethiopia. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0149970"},{"key":"ref_25","unstructured":"Joint Monitoring Program (JMP) (2024, September 05). Joint Monitoring Program for Water Supply and Sanitation. Available online: https:\/\/data.unicef.org\/wp-content\/uploads\/2015\/12\/Progress-on-Sanitation-and-Drinking-Water_234.pdf."},{"key":"ref_26","unstructured":"Joint Monitoring Program (JMP) (2020). Integrating Water Quality Testing Into Household Surveys: Thematic Report on Drinking Water, UNICEF and WHO. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240014022."},{"key":"ref_27","unstructured":"Joint Monitoring Program (JMP) (2022). Progress on Drinking Water, Sanitation and Hygiene in Schools: 2000\u20132021 Data Update, UNICEF and WHO. Available online: https:\/\/washdata.org\/report\/jmp-2022-annual-report."},{"key":"ref_28","unstructured":"SLDHS (2024, August 30). Sierra Leone\u2014Demographic and Health Survey 2019. Available online: https:\/\/microdata.worldbank.org\/index.php\/catalog\/3826."},{"key":"ref_29","unstructured":"African Development Bank (2024, August 24). Sierra Leone: Freetown WASH and Aquatic Environment Revamping Project: Appraisal Report. Available online: https:\/\/www.afdb.org\/en\/documents\/document\/sierra-leone-project-freetown-wash-and-aquatic-environment-revamping-project-appraisal-report-106857."},{"key":"ref_30","unstructured":"UNICEF (2024, August 30). Sierra Leone Multiple Indicator Cluster Survey 2017, Survey Findings Report. Available online: https:\/\/www.unicef.org\/sierraleone\/media\/391\/file\/SLMICS-Report-2017.pdf."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"262","DOI":"10.11604\/pamj.2018.30.262.13676","article-title":"Consumer perceptions and purchasing of packaged water products in Sierra Leone","volume":"30","author":"Jalloh","year":"2018","journal-title":"Pan Afr. Med. J."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Kamara, D., Bah, D., Sesay, M., Maruta, A., Sesay, B.P., Fofanah, B.D., Kamara, I.F., Kanu, J.S., Lakoh, S., and Molleh, B. (2022). Evaluation of Drinking Water Quality and Bacterial Antibiotic Sensitivity in Wells and Standpipes at Household Water Points in Freetown, Sierra Leone. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19116650"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1080\/00045608.2013.756257","article-title":"Influence of latrine proximity and type on tubewell water quality and diarrheal disease in Bangladesh","volume":"103","author":"Escamilla","year":"2013","journal-title":"Ann. Assoc. Am. Geogr."},{"key":"ref_34","unstructured":"Healing Waters Media (2024, October 10). The Sierra Leone Water Crisis: What Can We do?, Healing Waters, Available online: https:\/\/healingwaters.org\/the-sierra-leone-water-crisis-what-can-we-do\/."},{"key":"ref_35","unstructured":"Harpis (2024, October 07). Pollution: Air and Water. Available online: https:\/\/www.harpis-sl.website\/index.php\/hazard-assessment\/man-made-hazards\/pollution-air-and-water."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2252","DOI":"10.3390\/ijerph9062252","article-title":"Prevalence of acute respiratory infections in women and children in Western Sierra Leone due to smoke from wood and charcoal stoves","volume":"9","author":"Taylor","year":"2012","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1080\/09614524.2021.1937561","article-title":"Economic and social feasibility pilot of ethanol fuel for clean cooking in upland Sierra Leone","volume":"33","author":"Armstrong","year":"2021","journal-title":"Dev. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"9320603","DOI":"10.1155\/2018\/9320603","article-title":"Children under five from houses of unclean fuel sources and poorly ventilated houses have higher odds of suffering from acute respiratory infection in Wolaita-Sodo, Southern Ethiopia: A case-control study","volume":"2018","author":"Admasie","year":"2018","journal-title":"J. Environ. Public Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1093\/ije\/dyg240","article-title":"Indoor air pollution from biomass combustion and acute respiratory illness in preschool age children in Zimbabwe","volume":"32","author":"Mishra","year":"2003","journal-title":"Int. J. Epidemiol."},{"key":"ref_40","unstructured":"Sword, R. (2024, October 08). Early Child Development | Stages & Characteristics. The Hub High Speed Training (Blog). Available online: https:\/\/www.highspeedtraining.co.uk\/hub\/child-development-in-early-years\/."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Wiens, K.E., Schaeffer, L.E., Sow, S.O., Ndoye, B., Cain, C.J., Baumann, M.M., Johnson, K.B., Lindstedt, P.A., Blacker, B.F., and Bhutta, Z.A. (2013). Spoiled breast milk and bad water; local understandings of diarrhea causes and prevention in rural Sierra Leone. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-1172"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1093\/cdn\/nzaa061_091","article-title":"Why are adolescent mothers more likely to have stunted and underweight children than adult mothers? A path analysis using data from 30,000 Bangladeshi mothers, 1996\u20132014","volume":"4","author":"Nguyen","year":"2020","journal-title":"Curr. Dev. Nutr."},{"key":"ref_43","first-page":"138","article-title":"Determinants of child size at birth and associated maternal factors in Gurage Zone","volume":"21","author":"Alemayehu","year":"2020","journal-title":"J. Reprod. Infertil."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.econedurev.2018.07.004","article-title":"Private schools and student learning achievements in Kenya","volume":"66","author":"Wamalwa","year":"2018","journal-title":"Econ. Educ. Rev."},{"key":"ref_45","unstructured":"EIN Presswire (2024, October 04). A Pioneering Model for Global Education Funding Launches in Sierra Leone: Helping Over 130,000 Students Improve Outcomes, EIN Presswire, Available online: https:\/\/www.counton2.com\/business\/press-releases\/ein-presswire\/588680735\/pioneering-model-for-global-education-funding-launches-in-sierra-leone-helping-over-130000-students-improve-outcomes\/."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Koroma, J.M., Wang, Y., Guo, X., Zhang, X., Kpanda Ngobeh, J.J., Gabir, A.M.E.A., Li, Z., Li, L., Wu, R., and Zhou, X. (2022). A cross-sectional survey on the malaria control and prevention knowledge, attitudes, and practices of caregivers of children under-5 in the Western Area of Sierra Leone. Trop. Med. Infect. Dis., 7.","DOI":"10.21203\/rs.3.rs-270948\/v2"},{"key":"ref_47","unstructured":"Redman, K. (2024, October 11). Nigeria, India Account for One Third of Global Child Deaths\u2013UNESCO, Allafrica, Available online: https:\/\/www.premiumtimesng.com\/news\/163115-nigeria-india-account-one-third-global-child-deaths-unesco.html?tztc=1."},{"key":"ref_48","unstructured":"Rossiter, J., and Abreh, M.K. (2024, October 10). Sierra Leone Has Made a Big Bet on Free Education for Poor Children\u2014So Long as They Can Pass the Exams, Center for Global Development Ideas to Action, Available online: https:\/\/www.cgdev.org\/blog\/sierra-leone-has-made-big-bet-free-education-poor-children-so-long-they-can-pass-exams."},{"key":"ref_49","unstructured":"UNEP-DHI Partnership, UNEP-DTU, and CTCN (2024, October 11). Climate Change Adaptation Technologies for Water: A Practitioner\u2019s Guide to Adaptation Technologies for Increased Water Sector Resilience, CTCN (UN Climate Technology Centre & Network), Available online: https:\/\/www.ctc-n.org\/resources\/climate-change-adaptation-technologies-water-practitioner-s-guide-adaptation-technologies."},{"key":"ref_50","first-page":"1","article-title":"Psychological and social consequences of divorce: Emphasis on children\u2019s well-being: A systematic review","volume":"4","author":"Sarmadi","year":"2023","journal-title":"J. Prev. Couns."},{"key":"ref_51","unstructured":"Family Means (2024, September 06). Effects of Divorce on Children. Available online: https:\/\/www.familymeans.org\/effects-of-divorce-on-children.html."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/11\/1493\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:33:34Z","timestamp":1760114014000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/11\/1493"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,16]]},"references-count":51,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["life14111493"],"URL":"https:\/\/doi.org\/10.3390\/life14111493","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,16]]}}}