Sex-based disparities in whooping cough prevalence in Sierra Leone: Evaluating World Health Organization Health Equity Assessment Toolkit data

BACKGROUND: This study examines the trends and sex-based inequality in the prevalence of whooping cough in Sierra Leone, from 2000 to 2019. METHODS: We utilized national health records extracted from the WHO Health Equity Assessment Toolkit database to analysed age-standardized prevalence per 100 000 population and employed inequality measures: Difference (D), Population Attributable Fraction (PAF), Population Attributable Risk (PAR) and Ratio (R) to examine sex-based inequalities. RESULTS: The age-standardized prevalence of whooping cough in Sierra Leone declined from 81.0 cases per 100 000 in 2000 to 43.5 cases per 100 000 in 2019. Females exhibited higher prevalence rates compared with males across all study years. In 2019, the prevalence was 48.7 per 100 000 population (95% CI 37.4 to 62.0) among females and 38.4 per 100 000 (95%CI 29.5 to 49.0) among males. Inequality measures indicated a reduction in sex-based disparities over time, with the D decreasing from 19.0 in 2000 to 10.2 in 2019. The PAF remained stable at -11.7 throughout the study period, while the PAR decreased from -9.4 in 2000 to -5.1 in 2019. The R remained constant at 1.3 across all years. CONCLUSIONS: This study revealed a decline in whooping cough prevalence in Sierra Leone from 2000 to 2019. However, persistent sex-based disparities were observed consistent with global patterns likely attributable to biological differences. While addressing general gender inequalities in healthcare remains important, our findings do not specifically implicate local socio economic or cultural factors in these disparities for whooping cough in Sierra Leone.