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Health Survey Sets Baseline for Positive Change in Rural Liberia


A frontline health worker with Tiyatien Health conducts a health survey with a family. Photo courtesy of Tiyatien Health.

In August 2012, humanitarian organization, Last Mile Health, in partnership with Direct Relief, began surveying households in Konobo District in rural Liberia to understand the regional incidence of pneumonia—the most common cause of death for children under the age of five worldwide.

The survey results identified community-specific barriers to health care, estimated the prevalence of children with pneumonia who did not receive treatment, and obtained a baseline of health indicators. This information allows Last Mile Health, and other healthcare providers in rural Liberia, to design interventions addressing the identified local needs as well as demonstrate impact as they target the most vulnerable communities in the district.

The survey consisted of 99 questions and was deployed by a small team of local, trained Frontline Health Workers (FHWs). Last Mile Health applied a two-stage cluster sampling method to 31 villages containing more than 1,800 households and a population of 17,300 people.

The results show that more than 28 percent of children under the age of five had experienced recent symptoms of pneumonia, but only 11 percent were taken to a health facility. Nearly half of women surveyed had had at least one child die before reaching the age of five.

These number are stunningly worse than results of the 2007 Liberia Demographic and Health Survey, reporting that nine percent of children in rural areas had recent symptoms of pneumonia and 58 percent of those were taken to a health care facility.

The survey collected invaluable data on not only pneumonia in children, but also broader health and wellness issues, including health system access and use, education, water and sanitation, and maternal and child health. Additionally, Last Mile Health was able to use GPS devices to create the first comprehensive map of rural villages and access. Last Mile Health is using the health data combined with the mapping data to train additional FHWs in the primary identification and referral of health issues like pneumonia in young children.

As a result of the survey and the above-expected prevalence of pneumonia and pneumonia-like illnesses, Last Mile Health has decided that in addition to providing targeted treatment for pneumonia, they will also increase their provision of care for common related illnesses, malaria and diarrhea, that contribute to the high occurrence and morbidity rate of pneumonia in children.

“Liberia is one of the highest malaria endemic countries…hence, the best strategy to successfully and effectively treat acute respiratory infections/pneumonia, especially in the community, is to empower Frontline Health Workers (FHWs) to screen and treat malaria, pneumonia, and diarrhea in an integrated manner,” said Frontline Health Worker Clinical Mentor, Alice Johnson. She added that they are now training FHWs in community-based “Integrated Management of Childhood Illness: Malaria, Pneumonia, Diarrhea and Malnutrition.”

The survey is a part of an ongoing commitment to strengthen access to maternal and child health by supporting community-based expansion of rural access to pneumonia treatment for children. After full analysis, Direct Relief and Last Mile Health will work together to begin a year-long program to increase the treatment of childhood pneumonia by 50 percent in the Konobo district of 30,000 people.

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