Drivers of Severe Acute Malnutrition Among Children Under Five in Koidu, Sierra Leone
Severe acute malnutrition (SAM), defined as by a mid-upper arm circumference below 11.5 cm, weight-for-height Z-score, or the presence of bilateral pitting oedema, continues to claim the lives and futures of young children in Sierra Leone especially in resource-limited communities like Koidu, Kono District. This study aimed to identify barriers preventing the eradication of SAM among children under five in Koidu, where in 2021, one in every hundred children were severely malnourished and nearly four in every hundred suffered from some form of acute malnutrition.
We conducted a convergent mixed-methods study at Koidu Government Hospital. The quantitative component involved consecutive sampling of medical records from 300 children under five with SAM admitted to the pediatric ward between June 2024 and May 2025. We abstracted mid-upper arm circumference, height, weight, and clinical data at admission and discharge, with continuous variables summarized in mean and standard deviation, categorical variables in frequency and percentage, analyzed in Stata. The qualitative component comprised semi-structured in-depth interviews with purposefully sampled 14 caregivers and 10 healthcare providers, conducted in Krio and English between September 2025 and November 2025, audio- recorded, translated into English, transcribed, and analyzed using an inductive content analytic approach, with findings integrated through a joint display.
Learn more about this thesis project: Join us for the Class of 2026 MMSc-GHD Thesis Presentations May 11–13. Register for the Zoom. See the schedule of presentations.
Photos and reflections on the thesis project
Students submitted photos and reflections as part of their thesis research. All the people in the photos gave permission for their photos to be taken and shared.
Many Koidu residents are small scale informal vendors who depends on selling farm produce as a means of livelihood. Since their daily income depends on the little profit they earn by buying andselling farm produce or by cultivating and selling produce directly at the market for profit, they tend to sell their best agricultural produce and thereby not keeping enough quality food to offer their children in order to prevent malnutrition amongst the children under the age of five years.
The photo shows research team members sorting the charts which is an important early step in my quantitative study research, as it makes it easier to collect more organized accurate and reliable data.
This is the clinic where severely malnourished children can receive treatment.
People preparing grain to make benny mix to feed malnourished children.
These photos are from a feeding program. People are preparing a benny mix, which is a highly nutritious food to help malnourished children. On the right, people are preparing food, and on the left, mothers are feeding children.