Twenty-Year Trends in Sex-Based Mortality Inequality in Infectious and Parasitic Diseases in Sierra Leone: A WHO HEAT-Based Analysis

Abstract Background: Infectious and parasitic diseases, including malaria, HIV/AIDS, and tuberculosis, are leading causes of mortality in low-income countries like Sierra Leone. Despite progress in reducing mortality, sex-based disparities persist. This study examines trends in sex-based inequalities in mortality from infectious and parasitic diseases in Sierra Leone from 2001 to 2021. Methods: Using the World Health Organization’s Global Health Estimates from the WHO equity standardized data set, 2024 update, we analyzed mortality rates (deaths per 100,000 population) for infectious and parasitic diseases by sex (male and female) in 2001, 2006, 2011, 2016, and 2021. The Health Equity Assessment Toolkit (HEAT, Version 6.1) was used to compute four inequality metrics: Difference, Ratio, Population Attributable Fraction, and Population Attributable Risk, following WHO methodology. Results: Mortality rates declined substantially from 2001 to 2021, with female mortality decreasing from 792.3 to 258.5 per 100,000 and male mortality from 862.6 to 289.0 per 100,000. The absolute difference narrowed from −70.4 to −30.6, with males consistently showing higher mortality. The relative ratio remained stable at 0.9. PAF and PAR were consistently 0 (95% CIs crossing zero), indicating no significant population-level burden attributable to sex inequality. Conclusion: Despite notable declines in overall mortality from infectious and parasitic diseases in Sierra Leone, sex-based inequalities persist, with males experiencing a disproportionately higher burden. These findings highlight the need for targeted, gender-sensitive public health interventions to address persistent disparities and promote health equity.