Liberia 2011 Liberia - The DHS Program - Quality .

FOREWORDMalaria is the leading cause of attendance at outpatient departments and also is the number onecause of inpatient deaths in Liberia. Hospital records suggest that at least 33 percent of all inpatient deaths and 41 percent of deaths among children under age 5 are attributable to malaria(NMCP, 2009). This health problem was exacerbated by 15 years of civil conflict that resulted in largepopulation displacements as well as damage to health systems. Although curable and preventable, malariaremains a major public health problem in Liberia, taking its greatest toll on young children and pregnantwomen. In an effort to reduce the malaria burden in Liberia, the Ministry of Health and Social Welfare(MOHSW), through the National Malaria Control Program (NMCP), introduced a policy and strategic planfor malaria control and prevention. The NMCP is currently implementing its third plan, the LiberiaNational Malaria Strategic Plan for 2010- 2015. This plan is in line with the Abuja Declaration, signed bythe government of Liberia in April 2000. The overarching goal of the Liberia National Malaria StrategicPlan for 2010- 2015 is to reach the Millennium Development Goal 6, to have halted by 2015 and begun toreverse the incidence of malaria and other major diseases.Since 2005, with funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria(GFATM) and the U.S. President’s Malaria Initiative (PMI) and other partners, the NMCP and her partnershave increased scaled-up malaria prevention interventions within the following areas: case management ofmalaria, management of malaria in pregnancy, integrated vector management, and advocacy and behaviorchange interventions. In addition, the plan also aims to strengthen the NMCP program by improvingprogram management, operational research, monitoring and evaluation, and overall health systemsstrengthening.The NMCP relies on the Liberia Malaria Indicator Survey (LMIS), now conducted every twoyears, to track the progress of malaria control interventions in the general population. The first LMIS wasconducted in 2005 and provided baseline data for all key malaria control and prevention indicators forLiberia. The 2009 LMIS updated data for the program, and the 2011 LMIS measures progress over the pastsix years.The results presented in this report clearly indicate that coverage of malaria control interventionsin Liberia is increasing gradually. However, use of interventions is still low, indicating that more needs tobe done, both by the MOHSW and partners in terms of bednet ownership and behavior changecommunication, if Liberia is to achieve the Millenium Development Goal 6 target of reducing malariamorbidity and mortality by 50 percent by the year 2015.The 2011 Liberia Malaria Indicator Survey will help the NMCP and other partners in the RBMinitiative to assess the current Malaria Control Policy and Strategic Plan. Moreoever, it will assist theprogram to better plan and implement future malaria control activities in Liberia. We want to urge ourpartners, both local and international, to double their efforts in rolling back malaria in Liberia.Mrs. Yah M. ZoliaDEPUTY MINISTER FOR PLANNING, RESEARCH AND DEVELOPMENTMINISTRY OF HEALTH AND SOCIAL WELFAREREPUBLIC OF LIBERIAForeword vii

ACKNOWLEDGMENTSThe 2011 Liberia Malaria Indicator Survey (2011 LMIS) presents the major findings of a survey of alarge, nationally representative sample of more than 4,000 households. This survey was conductedby the National Malaria Control Program (NMCP), with assistance from the Liberia Institute ofStatistics and Geo-Information Services (LISGIS), from late September 2011 through December 2011. The2011 LMIS is a follow-up to the 2005 and 2009 LMIS surveys and provides updated estimates of basicdemographic and malaria indicators.The primary objective of the 2011 LMIS is to provide current information for policymakers,planners, researchers, and programme managers. Topics include ownership, access, and use of mosquitobednets; coverage of the intermittent preventive malaria treatment program among pregnant women;prompt and effective malaria treatment practices among children under age 5; and malaria-relatedknowledge, attitudes, and practices in the general population. Additionally, the 2011 LMIS providespopulation-based prevalence estimates for anemia and malaria among children age 6-59 months.I would like to extend my heartfelt thanks and appreciation to all institutions and individuals thatmade the 2011 Liberia Malaria Indictor Survey (LMIS) achievable. NMCP extends its acknowledgmentand gratitude to the various agencies and individuals in the government, donor community, and publicsector for support that facilitated the successful implementation of the survey. Specific mention is due tothe overall coordinating body for the LMIS: the Technical and Coordinating Committee (TCC), made upof the Planning Department of the Ministry of Health and Social Welfare (MOHSW), LISGIS, the UnitedNations Children’s Fund (UNICEF), and the World Health Organization (WHO). Administrative andmoral support was provided by many individuals, including Dr. Walter Gwenigale, Minister of Health andSocial Welfare, RL; Mrs. Yah M. Zolia, Deputy Minister for Planning, Research and Human ResourceDevelopment, MOHSW; Dr. Bernice Dahn, Deputy Minister/Chief Medical Officer, MOHSW, RL; Mr. T.Edward Liberty, Director, LISGIS; Mr. Tolbert Nyenswah, Deputy Program Manager, NMCP/MOHSW;Dr. Noe Rakotondrajaona, Malaria Advisor, USAID/Liberia; Dr. Filiberto Hernandez, PMI/CDC; Dr.James Tanu Duworko, USAID; Mr. Kaa Williams, USAID; county health officers and countysuperintendents of the 15 counties in Liberia; and the Internal Affairs Ministry. Finally, Dr. Saye DahnBaawo of the Family Health Division of the MOHSW made valuable comments on the questionnaire. ICFInternational provided technical assistance and funding to the 2011 LMIS through the MEASURE DHSproject, a USAID-funded programme supporting the implementation of population and health surveys incountries worldwide. Financial support was provided by the President’s Malaria Initiative (PMI) throughthe United States Agency for International Development (USAID). Finally, we wish to thank all fieldpersonnel for commitment to high-quality work under difficult conditions and all LMIS respondents fortheir patience and cooperation.Again, I am highly grateful to all institutions and individuals who contributed to the successfulcompletion of the LMIS and the writing of this final report.Dr. Joel J. JonesPROGRAM MANAGERNATIONAL MALARIA CONTROL PROGRAMMINISTRY OF HEALTH AND SOCIAL WELFAREREPUBLIC OF LIBERIAAcknowledgments ix

LIBERIA GUINEALofaPopulation: 270114SIERRA LEONEGrand Cape MountPopulation: 129055GbarpoluPopulation: 83758NORTH WESTERNNORTH CENTRALBongPopulation: 328919BomiPopulation: 82036NimbaPopulation: 468088COTE D'IVOIRESOUTH CENTRALMontserradoPopulation: 1144806Grand BassaPopulation: 224839Grand GedehPopulation: 126146MONROVIAMargibiPopulation: 199689RivercressPopulation: 65862SOUTH EASTERN ASinoePopulation: 104932River GeePopulation: 67318SOUTHEASTERN BGrand KruPopulation: 5710602550100KilometresMarylandPopulation: 136404All population values are from the Liberia 2008 Population and Housing Censusx Map of Liberia

1INTRODUCTION1.1COUNTRY PROFILE: GEOGRAPHY, ECONOMY, AND HISTORY1.1.1Geography and EconomyLiberia is located on the west coast of Africa, with a land area of 110,080 sq km and a coastline of560 km along the Atlantic Ocean. It is bordered by Sierra Leone to the west, Guinea to thenorthwest, and Côte d’Ivoire to the northeast and the east (see map). The country is divided into 15counties that are further subdivided into 95 districts, chiefdoms, and clans, with a population ofapproximately 3.5 million people (LISGIS, 2008). Most of the country lies below 500 m in altitude; rainforest and swampy areas are common geographic features. The climate is suitable for malaria transmissionthroughout the year in almost all parts of the country. During the main rainy season—July throughSeptember—temperatures average 24.5 C and rise to 26.5 C in December and January when it ispredominantly dry. Rainfall in the coastal areas where the capital, Monrovia, lies, is over 5,000 mm a year;however, this decreases as one moves inland to as little as 2,000 mm. Average humidity is about 72percent (Ministry of Health, 2001).Driven by iron-ore and rubber exports and increased timber production, Liberia’s economy grewby an estimated 6.9 percent in 2011 (African Economic Outlook). Foreign direct investment in mineconstruction and palm-oil plantations as well as rubber and timber industries will contribute to growth inthe coming years. Coupled with iron-ore exports, which began in 2011, these resources are predicted toincrease the Liberian gross domestic product to 8.8 percent in the current year and stabilize growth at 7.2percent by 2013. Despite the economic growth of the country, more than four-fifths (84 percent) of thepopulation lives below the poverty line on less than US 1.25 per day (UNDP, 2011). Liberia’s HumanDevelopment Index (HDI), a composite score of the population’s general well-being as measured by theUnited Nations Development Program (UNDP), is 0.329. The 2011 HDI compiles indicators that measurelife expectancy, health, education, and standard of living to generate a composite score ranging from a lowof 0.0 to a high of 1.0

years, to track the progress of malaria control interventions in the general population. The first LMIS was conducted in 2005 and provided baseline data for all key malaria control and prevention indicators for Liberia. The 2009 LMIS updated data for the program, and