Overcoming the challenges of iris scanning to identify minors (1-4 years) in the real-world setting.

OBJECTIVE: Biometric identification techniques for pediatric use are limited. This investigation studied iris scanning in minors aged 1-4 in two exploratory studies in Belgium (n = 197) and Sierra Leone (n = 230), and in a subsequent clinical study in Sierra Leone (n = 635). Images of participants' irises were captured using a camera, while a survey assessed the ease of use with children. RESULTS: The image capture success rate per individual was high; 86.0% of the participants had ≥ 2 successful captures. Iris scan quality and surface were similar in all age groups and in the matching population database. When including feasibility in the analysis of minors aged 3-4, sensitivity and specificity were non-inferior compared to using the biometric of a guardian. However, the quality of iris scanning in minors aged 1-4 was worse than the iris scanning reference quality in adults. A mean total usability score of 1.55 ± 0.27 was calculated; a usability threshold of 1.45 is required for routine use. Overall, this technique is feasible in minors aged 3-4, replacing the use of guardian biometrics. Additional work is ongoing to improve this technique further, striving for uniformity from the age of 1.

Can Sierra Leone maintain the equitable delivery of their Free Health Care Initiative? The case for more contextualised interventions: results of a cross-sectional survey.

BACKGROUND: In 2010, the Ministry of Health and Sanitation in Sierra Leone launched their Free Health Care Initiative (FHCI) for pregnant and lactating mothers and children under-5. Despite an increase in the update of services, the inequitable distribution of health services and health facilities remain important factors underlying the poor performance of health systems to deliver effective services. This study identifies current gaps in service delivery across two rural locations served by the same District Health Management Team (DHMT). METHODS: We employed a cross-sectional household survey using a two-stage probability sampling method to obtain a sample of the population across two rural locations in Bonthe District: the riverine and the mainland. Overall, a total of 393 households across 121 villages were surveyed in the riverine and 397 households across 130 villages were sampled on the mainland. Maternal health, child health and sanitation indicators in Bonthe District were compared using Pearson Chi-Squared test with Yates' Continuity Correction across the two areas. RESULTS: Women across the two regions self-reported significantly different uptake of family planning services. Children on the mainland had significantly greater rates of health facility based deliveries; being born in the presence of a skilled birth attendant; completed immunisation schedules; and higher rates of being brought to the health centre within 24 h of developing a fever or a suspected acute respiratory infection. Households on the mainland also reported significantly greater use of treated water and unrestricted access to a latrine. CONCLUSIONS: If the government of Sierra Leone is going to deliver on their promise to free health care for pregnant women and their children, and do so in a way that reduces inequalities, greater attention must be paid to the existing service delivery gaps within each District. This is particularly relevant to health policy post-Ebola, as it highlights the need for more contextualised service delivery to ensure equitable access for women and children.