Health knowledge and health practices in Makeni, Sierra Leone: A community-based household survey

Background: We characterize health knowledge and practices in urban and rural Makeni, Sierra Leone, drawing comparisons between areas served by community health workers (CHWs) with those that are not.We also inquire about causes of infant and maternal mortality and how they are understood in the local context. Our objective was to provide a baseline understanding of health knowledge and practices in Makeni during the implementation of a CHW program. Methods: We conducted 100 household interviews in Makeni City and rural villages in the surrounding area. We compared data between urban and rural areas to identify differences in health knowledge and practices. Results: Our sample size covered 855 individuals. Insecticide treated bednet ownership was lower in urban settings compared to rural populations (58% vs 94%; p<.001). With regards to maternal mortality, most respondents indicated 'no clinic' (lack of clinical care or skipped antenatal care visits) as the primary cause (n=35), followed by bleeding (n=17), 'lack of blood' (anemia) (n=11) and 'will of God' (n=11). Conclusions: This initial survey of health knowledge and practices in rural and urban Makeni, Sierra Leone, highlights some simple opportunities for community health promotion, health education programming and behavioral interventions. Findings will inform future iterations of a CHW training module for community health education.