Maternal Trauma Exposure and Child Mental Health Service Contact in Post-Ebola Sierra Leone: A Sibling-Comparison Design Estimating Caregiver Bereavement Pathways

The 2014–2016 Ebola epidemic in Sierra Leone left thousands of children bereaved of a primary caregiver, yet the causal pathway from maternal death to child mental health service contact remains poorly identified because bereaved and non-bereaved children differ on many unobserved household characteristics. Because no observational data are available for this analysis, the paper characterises the operating characteristics of the proposed design under a declared variance structure: between-cluster standard deviation of 6.0, residual standard deviation of 4.5, and intraclass correlation of 0.64. Power was estimated across 2000 replications per design cell for cluster counts of 8, 16, 24 and 32 and effect sizes of 3, 5 and 8 percentage points. The analysis indicates that 54 clusters are required to detect a 5-percentage-point effect at 80% power. Sibling-comparison designs embedded within BACI estimators offer a defensible identification strategy for caregiver bereavement pathways in post-epidemic settings, and it specifies the design parameters and inferential boundaries that future fieldwork must satisfy.