Assessing the nutritional status and micronutrient gaps in Sierra Leone: a systematic rapid review of women, children, and adolescents

Sierra Leone continues to experience a substantial burden of malnutrition across all age groups. In response, the government has implemented several nutrition strategies, including the 2017–2021 RMNCAH&N Strategy and routine vitamin A supplementation, among others. While national surveys and programme evaluations have provided valuable insights, evidence on micronutrient status and dietary intake among women, children, and adolescents remains fragmented, limited, and in some cases outdated. This systematic rapid review aimed to synthesise existing data, map nutritional outcomes, identify priority evidence gaps, and provide insights to guide nutrition policy and the design of future national surveys and research. A systematic rapid review of 39 peer-reviewed quantitative studies published between 2001 and 2024 was conducted in PubMed. The review followed PRISMA-ScR guidelines and the methodological frameworks of Arksey & O’Malley and Levac et al. Child wasting ranged from 4.8% in a 2010 northern Sierra Leone survey to 9.3% nationally in the 2013 DHS, with higher estimates reported in studies focused on already malnourished populations. Stunting remained high at 37.9% in 2013 and 29.1% in 2019, with rural estimates exceeding 41%, highlighting regional disparities. Anaemia prevalence exceeded 60% among children under five, reaching 76.3% in some settings. Micronutrient evidence largely focused on haemoglobin, ferritin, vitamin A, and iodine, while zinc, riboflavin, and vitamin D were rarely assessed. Vitamin A deficiency was 17.4% among children in the 2013 Micronutrient Survey, and supplementation coverage reached 86.9% in 2019. Adolescent data were scarce, though available findings indicated poor birth outcomes among pregnant adolescents. Among women, overweight and obesity ranged from 27% to 30%. Exclusive breastfeeding was approximately 49% in 2017, approaching but not meeting 2025 and 2030 global targets, and dietary diversity remained low. Malnutrition remains pervasive in Sierra Leone, characterised by persistent undernutrition, widespread anaemia, and suboptimal feeding practices alongside overweight and obesity among women. Routine surveys (DHS and MICS) capture anthropometry and anaemia but lack comprehensive data on micronutrient biomarkers and dietary intake. Updated, nationally representative, age-disaggregated food consumption and micronutrient assessments are urgently needed to guide effective nutrition policies and programs.