In 2021, there were 104.7 deaths per 1,000 live births among children under the age of 5 in Sierra Leone (1). From the Child Health and Mortality Prevention Surveillance (CHAMPS) findings of 610 minimally invasive tissue sampling (MITS) cases reviewed from February 2019 to December 2022, the determination of cause of death (DeCoDe) expert panel determined that 72% of deaths were preventable. Of these, 1 in 3 deaths could have been prevented by improving clinical management of cases. A majority (87%) of the reviewed MITS cases were regional facility deaths, underpinning the importance of auditing the clinical management of cases in these facilities.

Understanding the circumstances and full range of factors that contribute to a child’s death or health outcome is crucial to preventing future deaths, poor health outcomes, or reoccurrence in other children. The maternal and perinatal death review and response system has been successfully scaled up to referral hospitals in Sierra Leone. However, child death audits/reviews are rarely conducted. Although CHAMPS conducts detailed autopsies and laboratory testing for enrolled cases, the results often take several months to provide feedback to the hospitals. Routine child death audits provide a more immediate opportunity for corrective action by the health workers who cared for the deceased child.

As part of the broader quality improvement efforts within the CHAMPS data-to-action strategies in Sierra Leone, child death audits were established at the Makeni Regional Hospital (MRH) and Bo Government Hospital (BGH), in collaboration with the Ministry of Health (national and district levels) as well as the hospital administration and health care providers in each establishment. As of April 2024, 94 child deaths had been reviewed at MRH while 22 deaths had been reviewed at BGH by May 2024. Findings from these reviews have been disseminated with nascent actions already ongoing to resolve some of the modifiable factors delineated.

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Translating findings from child mortality audits into life-saving interventions.