WORLD HEALTH ORGANIZATION
Global Task Force on Cholera Control
CHOLERA COUNTRY PROFILE: SIERRA LEONE
Last update: 7 September 2009
General Country Information:
The Republic of Sierra Leone is located in western
Africa, and borders Guinea and Liberia with a
coast along the Atlantic Ocean. Sierra Leone is
divided in three provinces and one area further
subdivided into 12 districts. Freetown, the capital,
is also the largest city.
Sierra Leone became a British colony in 1808 and
gained its independence in April 1961. In 1992, a
coup launched by military officers was the start of
a civil war fueled by the fight between international
mining companies over the control of Sierra
Leone’s diamonds. The conflict was to end only in
2002.
A high number of UN peacekeepers troops were deployed (13,000) and an estimated 50,000 people died in the conflict.
250,000 people were internally displaced (last IDP camp was closed in 2003).
Despite those long years of civil war, Sierra Leone is showing signs of a successful economical transition and foreign direct
investment keep growing. However unemployment rates are still high among ex-combatants and 70% of the population still
lives under the poverty line. In 2009 Sierra Leone is ranked 179 out of 179 countries in the UN Human Development Index
(HDI). Life expectancy is currently 40 years, the 8th worst in the world, and Sierra Leone has the highest maternal mortality
ratio and child mortality rates in the world. The healthcare system was largely destroyed in the war along with much of the
other vital infrastructure. Now the Sierra Leonese government is struggling to improve facilities - many of which were burnt
down or destroyed.
Sierra Leone reported outbreaks of Lassa Fever in 2004 and yellow fever in 2003.
Cholera Background History:
Sierra Leone first reported cholera cases in 1970 and 1971 when the current pandemic hit the African continent. The
number of cases were respectively 293 and 211 but the case fatality rates (CFR) remained high: 25% and 6%.
The next cases were reported in 1986 and 1987 with CFRs of 7% and 5%, followed by the years 1994 and 1995 with
CFRs of 6% and 4%.
In 1998, Sierra Leone notified 2096 cases and 57
deaths (CFR 2.7%). The outbreak started in July
and affected 3 districts: Freetown, Port Loko and
Kambia.
Sierra Leone notified cholera cases/deaths/CFR
1970-2008
12000
30
Cases
10000
The outbreaks often occur during the rainy season
(from May to October) related to heavy rains
which cause flooding and contamination of water
sources.
8000
20
6000
15
4000
10
2000
5
0
0
CFR%
CFR%
nb of cases/deaths
Between 2 and 29 of August 2004, an outbreak
affecting 513, with 42 deaths (CFR 8.2%)
occurred in the districts of Western Area, Port
Loko and Kambia.
25
Deaths
19
7
19 0
7
19 1
7
19 2
7
19 3
7
19 4
7
19 5
7
19 6
7
19 7
7
19 8
7
19 9
8
19 0
8
19 1
8
19 2
8
19 3
8
19 4
8
19 5
86
19
8
19 7
8
19 8
8
19 9
9
19 0
9
19 1
9
19 2
9
19 3
9
19 4
9
19 5
96
19
9
19 7
9
19 8
9
20 9
0
20 0
0
20 1
0
20 2
0
20 3
0
20 4
0
20 5
0
20 6
07
20
08
In 1999, Sierra Leone notified 863 cases with 5
deaths (CFR 0.6%) starting in September.
year
Cholera Outbreak in 2006:
The outbreak in Sierra Leone started on 20 August 2006 in Freetown (Western area). It quickly spread to the rural Western
area and four other districts (Kambia, Tonkolili, Port Loko and Kailahun). The peak of the outbreak was reached at the end
of September 2006 with a daily incidence of 367 cases (see epicurve). As of October 2006, the total number of cases
reported was 2'560 and 99 deaths with an overall case fatality rate of 3.8%.
2007 and 2008:
In 2007, Sierra Leone reported 2'219 including 84 deaths (CFR of 3.79%) affecting 11 out of 13 districts. (see Map)
In 2008, Sierra Leone reported 62 cases (incl. 1 death) giving a CFR of 1.6%.
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WORLD HEALTH ORGANIZATION
Global Task Force on Cholera Control
CHOLERA COUNTRY PROFILE: SIERRA LEONE
Last update: 7 September 2009
Weekly Trend of Reported Cholera Cases and Deaths in Sierra Leone 2006/2007
400
350
300
No. of Cases
250
200
150
100
50
K8
K6
K7
K9
W
K1
0
W
K1
1
W
K1
2
W
K1
3
W
K1
4
W
K
15
W
K1
6
W
K
17
W
K1
8
W
K1
9
W
K2
0
W
K2
1
W
K2
2
W
K2
3
W
K2
4
W
K2
5
W
K2
6
W
K
27
W
K2
8
W
K
29
W
K3
0
W
K3
1
W
K3
2
W
K3
3
W
K3
4
W
K3
5
W
K3
6
W
K3
7
W
K3
8
W
K3
9
W
K4
0
W
K4
1
W
K4
2
W
K
43
W
K4
4
W
K4
5
W
K4
6
W
K4
7
W
K4
8
W
K4
9
W
K5
0
W
K5
1
W
K5
2
W
W
W
W
K3
K5
K2
K4
W
W
W
W
W
K1
0
Epiedmiological Weeks
No. of Cases 2007
No. of Deaths 2007
No. of Cases 2006
No. of Deaths 2006
WHO Support Actions in 2006 and 2007:
•
•
•
Technical support by country office
D
October 2006: cholera control guidelines and training material (video) were shipped
In 2007, the MoH and Sanitation and WHO sent a mission of Surveillance Officers to the district and areas affected.
The measures taken to control the outbreak include improved coordination and response at district level, health
education, encouraging appropriate sanitation in the affected communities, case management using IV fluids and oral
rehydration salt and surveillance of the outbreak and data management.
Demographic and Socio-Economic Data:
Geography
Environment
Demographics
Economy
Total surface
Capital
Provinces
Official Language
Climate
Rainy season
Floods and droughts
Desertification
Natural resources
Population
Religions
Ethnic groups
Migrants
Industry
Farming
Health
Indicators
Communicable
Diseases
Risk Factors
for Cholera
Per capita total
expenditure on health
Life expectancy birth (yrs)
Child mortality (per 1000)
Sources for Document: WHO, UNHCR, UNICEF, UNDP
71,740 km² (coastline 402km)
Freetown (population in Freetown: 1,070,200)
3 (southern, northern and eastern), one area (western including Freetown)
English (97% of population speaks Krio)
Tropical
From May to December
Strong thunderstorms at beginning and end of rainy season
Deforestation rates have increased by 7.3% since 2002
diamonds, titanium ore, bauxite, iron ore, gold, chromites
6 440 053
60% Muslim, 30 % Christian, 10 % indigenous religion
18 (60% Mende and Temme), 10% Krio (in Freetown), Limba, Kono, Loko, Kissi,
Mandingo, Sherbro, Fula, Susu, Vai, Kuranko, Yalunka, etc…
38,500 Liberian refugees, all IDP camps had been closed early 2003
Diamond mining; small-scale manufacturing (beverages, textiles, cigarettes,
footwear); petroleum refining, small commercial ship repair
Rice, coffee, cocoa, palm kernels, palm oil, peanuts; poultry, cattle, sheep, pigs,
fish
8US$
Males: 39
Males: 286
Females: 42 (2006)
Females: 252 (2006)
Malaria, tuberculosis, pneumonia, diarrhoeal diseases, typhoid fever, HIV/AIDS, Lassa fever, yellow fever ,
schistosomiasis
HIV prevalence (2005): 1.36%
Population with access to improved water source
53% (2006)
Population with access to proper sanitation facilities
11% (2006)
Chronic Malnutrition
51% (2007)
The Cholera Task Force country profiles are not a formal publication of WHO and do not necessarily represent the decisions
or the stated policy of the Organization. The presentation of maps contained herein does not imply the expression of any
opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or areas or its authorities, or
concerning the delineation of its frontiers or boundaries.
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