Childhood Nutrition and Service Delivery Indicators across and between two Epidemics (Ebola and COVID-19) in Sierra Leone: A Descriptive Study using Serial Cross-Sectional Surveys

IntroductionSierra Leone is one of the worst affected by hunger and food insecurity, but data to understand the impact of public health emergencies on nutrition indicators is limited. In this study, we sought to describe nutrition service delivery and nutritional health among children under age five before and during the Ebola epidemic, the inter-epidemic period, and during the COVID-19 pandemic (2021) in Sierra Leone. MethodsWe conducted a descriptive study using secondary data from five serial cross-sectional surveys conducted using representative sampling as part of programmatic monitoring and evaluation: 2010 (N=14027, before Ebola); 2014 (N=10,975, during Ebola); 2017 and 2019 (N=9059, N=4,870, respectively, inter-pandemic period); 2021 (N=10,165, during COVID-19). We described and compared the prevalence of each of the following indicator at each time-point: shunting, global acute malnutrition, breastfeeding and underweight. ResultsThe prevalence of stunting was 34.1% before the Ebola epidemic, 28.8% during the Ebola epidemic, 31.3% after the Ebola epidemic, 25.9% before the COVID-19 epidemic, and 26.2% during the COVID-19 epidemic. The prevalence of global acute malnutrition was: 6.9% before the Ebola epidemic, 4.7% during the Ebola epidemic, 5.1% after the Ebola epidemic, 5.0% before the COVID-19 epidemic, and 5.2% during the COVID-19 epidemic. Finally, the report showed that the proportion of breastfeeding for up to 23 months was 84.0% (before the Ebola epidemic), 86.0% (during the Ebola epidemic), 85.0% (after the Ebola epidemic), 61.8% (before the COVID-19 epidemic), and 53.1% (during the COVID-19 epidemic). ConclusionWe found a variable effect of the Ebola epidemic and COVID-19 on nutrition health and nutrition indicators. Findings highlight the importance of continuing to strengthen the implementation of nutrition programs during and after public health emergencies.