Inflammation and stories on maternal health

Heart Disease in Bolivia
Bolivia is the second poorest country in South America, performing poorly in education, life expectancy, economic strength and overall development. Most alarmingly, it lacks sufficient medical care due to a limited supply of adequate resources. Bolivia’s unique geography advances its tremendous healthcare challenges, causing children to be 10 times more likely to be born with congenital heart defects. These conditions are nearly impossible to treat without trained cardiologists and updated facilities, two things often inaccessible to most Bolivians. Thus, addressing heart disease in Bolivia is quite challenging as a result of these factors. However, Franz Freudenthal, inventor and cardiologist, is improving medical care with a simple technique that utilizes an indigenous hobby to heal holes in hearts.

What is PDA?

Patent Ductus Arteriosus (PDA) is a common congenital heart defect, particularly prevalent in certain parts of Bolivia. The defect is caused by an opening between two major blood vessels traveling away from the heart. The opening is crucial to a baby’s circulatory system before birth, but it should close almost immediately upon exiting the womb. PDA cases, however, present holes in the heart that remain open. Although the exact cause of congenital heart defects like PDA is typically unclear, decreased oxygen levels have a direct impact on fetal heart health. Because La Paz, Bolivia sits at 3,600 meters above sea level, where the atmosphere has lower oxygen levels than most parts of the world. Therefore, Bolivia’s altitude is the likely cause of irregular blood. Also, the mother’s inability to provide appropriate oxygen levels to her child can result in severe complications.

Breathlessness and failure to thrive are the most common symptoms in mild cases, but fatigue and failure to gain weight can also occur because harmed hearts must work three times harder to pump blood than healthy hearts. Children with severe cases of PDA are at a higher risk for pulmonary hypertension, arrhythmias, infective endocarditis, anticoagulation and congestive heart failure. However, each of these symptoms can be relieved by skilled women in the Andes Mountains’ high plains.

Ingenuity to Fight Heart Disease in Bolivia

Aymara women have been knitting clothes and blankets for centuries, but with help from Franz Freudenthal, they are now knitting heart-closure devices to mend PDA. The Nit Occlud is a hi-tech medical advancement modeled after an occluder, an industrially-produced device intended to block holes in babies’ hearts. Unlike a normal occluder, the Nit Occlud’s design cannot be mass-produced due to its intricate design. Therefore, Freudenthal had to search for an alternative production plan. The perfect method, he soon found, was the wonderful weaving skills of the Aymara women.

The Nit Occlud is composed of a super-elastic metal known as nitinol, a nickel-titanium alloy capable of memorizing its own shape. After a doctor inserts the device through the body’s natural channels, it travels through blood vessels, expands to its original shape, plugs the heart’s hole and permanently restores basic cardiac functionality.

Typical treatments for PDA include surgical procedures, cardiac catheterizations, or heart transplants, but these are not available Bolivia and are not welcomed by the Aymara people. Even though the Aymara people have recently adopted Catholicism, they still believe in the power of the Andes Mountains spirits and their effects on human souls. Keeping in mind that manipulating a heart – performing open-heart surgery or a transplant – is considered desecration according to the spirits, Freudenthal created a minimally invasive innovation to respect patient beliefs and to “make sure that no child is left behind.”

Making Impact

Although congenital heart defects remain the fourth leading cause of premature deaths in Bolivia, the rate has dropped 36% since 2007. Freudenthal’s Nit Occlud has saved more than 2,500 children in nearly 60 countries after experiencing immense success in Bolivia. The country is also succeeding in its fight against poverty. The number of Bolivians living on less than $3.20 a day is projected to decrease by 35% in the next 10 years. Additionally, more children are being vaccinated and more prenatal care opportunities are becoming available to mothers. With these advancements in healthcare and poverty reduction, the economy will soon flourish and rates of heart disease in Bolivia are sure to drop .

Natalie Clark
Photo: Flickr

healthcare in peruPeru carries a heavy history of periodic instability that has made the establishment of an accessible healthcare system perilous. The country suffers from an inequitable distribution of healthcare workers. It also struggles with the partition between private and governmentally-sponsored healthcare, the provisions of which skew inequitably toward the wealthy. Peru’s wealth gap shows the richest 20% in the nation controlling nearly half of its income and the poorest 20% earning less than 5%. This inequality is quite literally killing Peruvians. According to the 2007 National Census of Indigenous Peoples conducted by the Peruvian government, over 50% of census-interviewed communities did not have access to any form of health care facility.

Healthcare in Peru by the Numbers

  • The life expectancy in Peru is 74 years, landing the country at 126 out of 224 countries.
  • The probability of a child in Peru dying before the age of five is 1.4%, compared to 0.1% in the United States.
  • Peru spends 5.5% of its GDP on healthcare, compared to the U.S.’s 17.1%, ranking the country at 128 out of 224 countries.
  • In Peru, there are one and a half hospital beds available per 1,000 individuals. This is a number that is especially dire during the coronavirus pandemic.
  • Peru clocks in at just under one and one-quarter of a physician per every 1,000 Peruvians in need of medical care.

Structure of Healthcare in Peru

Due in part to fluctuating governmental structures and rulers, Peru currently operates with a decentralized health care system administered by five entities. Two of these entities provide 90% of the nation’s healthcare services publicly, while three provide 10% of the nation’s healthcare in the private sector. This distribution results in considerable overlap and little coordination, depleting the healthcare system of resources and providers. In fact, many healthcare providers in Peru work an assortment of jobs across different subsectors.

As healthcare is a necessary sector of the economy, Peru’s healthcare worker density is increasing, even as health worker outmigration also increases. But since these workers are not equitably distributed, coastal and urban areas monopolize the majority of these providers. Lima and tourist coasts boast the highest distribution of healthcare workers, while rural and remote areas such as Piura and Loreto are home to few health providers.

Impact of the Healthcare Structure on Women

The detrimental effects of inequitable healthcare distribution are most visible in the country’s astonishing maternal mortality rate. In Peru, 185 out of 100,000 mothers dying from pregnancy-related causes, one of the highest in the Americas. The burden of maternal mortality rests squarely upon the shoulders of poor, rural, and Indigenous women. They are dying from largely preventable causes in a massive breach of human rights. These women disproportionately face countless barriers to pregnancy wellness and birth healthcare, including a dearth of emergency obstetric and neonatal services, language barriers and a lack of information regarding maternal health. Peru has implemented policies in recent years to reduce the rate of maternal mortality, such as the increase of maternal waiting houses for rural pregnant women to reside in as they approach birth. Unfortunately, women and health professionals attest that these measures are inadequate and improperly implemented.

The only cause of premature death that precedes neonatal disorders as a result of inadequate neonatal obstetrics is lower respiratory infections. This type of infection is the most likely cause of premature death, and it has remained so since 2007. This illness, too, disproportionately impacts women and children. They are the most likely groups to die from household air pollution, a type of pollution caused by the burning of solid fuels for cooking and heating purposes. In Peru, 429 out of an estimated 1,110 yearly childhood deaths are caused by acute lower respiratory infections resulting from household air pollution. Combined, neonatal disorders and lower respiratory infections cause more death and disability than any other factor in Peru. These are shortening the lives of Peruvian women and children by almost 20%.

Moving Forward with Healthcare in Peru

The healthcare system in Peru is one that suffers many flaws. It is straining to support its people, especially in the midst of a worldwide pandemic. While the going is slow, the country is striving to reform its healthcare system. Peru is doing this by reforming its healthcare system in the direction of universal coverage – an achievable but certainly strenuous goal. Since vigorously implementing healthcare reform in the late 90s, Peru reports coverage of 80% of its population with some form of health services. While this number is far from ideal, it is evidence that the Peruvian government is not only cognizant of but concerned about its healthcare failures, and it is striving for a fuller coverage future.

 

– Annie Iezzi
Photo: NeedPix

Reproductive Healthcare in SenegalThe country of Senegal has made major strides over the past 10 years for access and care in women’s reproductive and maternal health. Here are some initiatives and four recent centers that have opened to provide women with reproductive healthcare in Senegal in both rural and urban settings.

Reproductive Healthcare Barriers for Senegalese Women

Senegal’s healthcare system is not free to the public. If one does not have the funds to pay for their needed care, they are refused treatment. With more than 50% of Senegal’s population in poverty, only 32.5% of births are performed with a healthcare professional, making the maternal death rate one in 61 women.

Senegalese women are averaged to have at least four children, which is often a result of early forced marriage and the patriarchal family structure. Young women are limited from attaining an education, inhibiting their ability to gain knowledge and power over their reproductive and maternal health.

Over 77% of Senegalese women who desire sexual contraception such as birth control, do not have access to that resource. This has led to unplanned pregnancies for women 20 years old and younger. Additionally, most young women do not receive sexual education in school or at home. This results in less than a third of women in Senegal having a comprehensive understanding of HIV/AIDs or how to protect themselves from such diseases. Government initiation and non-profit organizations are improving these statistics. More women in Senegal are receiving resources and education for their reproductive healthcare.

The Maputo Protocol

Before the 2000s, there was no access to national government or international organizations’ reproductive health for Senegalese women. In 2005 Senegal signed the agreement of the African Charter of Human Rights and Rights of Women, known as the Maputo Protocol, declaring Senegalese women’s reproductive health to be a “universal human right” that must be protected. Following the Maputo Protocol, the Senegalese healthcare system began providing contraception as well as pregnancy and STI testing for women over the age of 15.

4 Centers and Initiatives for Women’s Reproductive Healthcare in Senegal

  1. Keur Djiguene Yi Center: The Keur Djuguene Yi Center is the first public OBGYN clinic in Dakar, Senegal that provides complete reproductive and maternal care to women who cannot afford or have access to government-provided healthcare options. Opening its doors in 2017 with the help of Dr. Faye, the lead gynecologist on-site, more women than ever before in Senegal now have access to pre and post-natal exams, “education on contraception, HIV prevention, family planning and infant immunization,” free of cost. Dr. Faye has been consciously expanding on the center, adding another full-time gynecologist in 2019. She hopes to expand the center to operate at full capacity with an entire team of OBGYN professionals to help four times the number of patients the Keur Djiguene Yi Center services currently.

  1. VOICES mHealth Program: The World Health Organization partnered with the Voices project, created an initiative for reproductive and maternal awareness in Senegal. The VOICEmHealth Program uses voice messages to spread the word about openings of women’s healthcare centers as well as education on maternal care and child-feeding practices. The project works with Bajenu Gox, known as “community godmothers,” to extend the amount of knowledge and power for young women through home visits and information on their healthcare during and after their pregnancy to reach women who do not have access to a cellular device. Voices mHealth program is a highly effective project in its ability to have immediate, trusted contact with Senegalese women living in both rural and urban communities.

  1. Le Korsa: Le Korsa is a nonprofit organization that empowers communities and healthcare centers in Senegal to improve their provided healthcare with grants and educational resources. One of the organization’s most impactful recent projects was in 2017 when Le Korsa began the renovation of the Tambacounda Hospital’s Maternity and Pediatric Units. The project is expected to finish in 2021, providing more enhanced and comfortable care to the 47,000 annual visitors.

  1. Bajenu Gox Project — Action Et Developpement: The Action Et Developpement organization in Senegal has made major strides in having increased community inclusion and education on women’s healthcare with a global lense. Partnering with the Bajenu Gox of the Kaolack, Fatick, Saint Louis, Louga and Dakar regions in 2015, the Bajenu Gox project has brought new, needed knowledge to rural and urban Senegal. The Bajenu Gox in these locations are now trained on how to talk about the prevention of  STI’s and HIV/AIDs in their local communities. They are bringing a new wave of education to young women and forever changing the empowerment of women in Senegal through awareness of their rights.

With the remarkable breakthroughs in women’s reproductive healthcare in Senegal, women now have access to centers and initiatives. The foundation for a new perspective, action and approach towards the autonomy of a women’s health and reproductive system in Senegal is now able to grow and flourish.

– Nicolettea Daskaloudi

Photo: Flickr

Health Care in SwedenSweden has the highest income tax rate in the world. More than 57% is annually deducted from people’s incomes. However, Sweden placed seventh out of 156 countries in the World Happiness Report 2019, and its healthcare system is one of the best in the world.

In 1995, Sweden joined the European Union and its population recently reached over 10 million people. Healthcare is financed through taxes and most health fees are very low. Sweden operates on the principle that those who need medical care most urgently are treated first. Higher education is also free, not only to Swedes, but also to those who reside in the rest of the European Union, the European Economic Area, and Switzerland. Like healthcare, it is largely financed by tax revenue. Here are 10 facts about healthcare in Sweden.

 10 Facts About Healthcare in Sweden

  1. Sweden has a decentralized universal healthcare system for everyone. The Ministry of Health and Social Affairs dictates health policy and budgets, but the 21 regional councils finance health expenditures through tax funding; an additional 290 municipalities take care of individuals who are disabled or elderly. To service 10.23 million people, Sweden has 70 regionally-owned public hospitals, seven university hospitals, and six private hospitals.

  2. Most medical fees are capped and have a high-cost ceiling. According to the Swedish law, hospitalization fees are not allowed to surpass 100 kr (Swedish Krona), which is equivalent to $10.88, a day and, in most regions, the charge for ambulance or helicopter service is capped at 1,100 kr ($120). Prescription drugs have a fee cap and patients never pay more than 2,350 kr ($255) in a one-year period. In the course of one year, the maximum out-of-pocket cost is 1,150 kr ($125) for all medical consultations. If the person exceeds the cap, all other consultations will be free. Additionally, medical services are free for all people under the age of 18.

  3. The cost for medical consultations not only has a price cap, but is generally low. The average cost of a primary care visit is 150 kr-300 kr ($16-$33) and the cost of a specialist consultation, including mental health services, ranges from 200 kr-400 kr ($22-$42). The cost of hospitalization, including pharmaceuticals, does not exceed 100 kr ($11) per day and people under the age of 20 are exempt from all co-payments. Healthcare services, such as immunizations, cancer screenings, and maternity care, are also free and have no co-payments.

  4. All dental care for people under the age of 23 is free. When a person turns 23, they no longer qualify for free dental health care in Sweden and must pay out of pocket. However, the government pays them annual subsidies, or an allowance, of 600 kr ($65) to pay for dental expenses. In Sweden, the cost of a tooth extraction is 950 kr ($103) and the cleaning and root filling for a single root canal costs 3,150 kr ($342). If dental care costs total anywhere between 3,000 kr-15,000 kr ($326-$1,632), the patient is reimbursed 50% of the cost. If it exceeds 15,000 kr, 85% of the cost is reimbursed.

  5. To battle its large medical waiting lists, Sweden has implemented a 0-30-90-90 rule. The wait-time guarantee, or the 0-30-90-90 rule, ensures that there will be zero delays, meaning patients will receive immediate access to health care advice and a seven-day waiting period to see a general practitioner. The rule also guarantees that a patient will not wait more than 90 days to see a specialist and will receive surgical treatment, like cataract removal or hip-replacement surgery, a maximum of 90 days after diagnosis. Sweden’s government also committed 500 kr million ($55 million) to significantly decrease wait time for all cancer treatments. In 2016, Sweden developed a plan to further improve its health services by 2025 through the adoption of e-health.

  6. In 2010, Sweden made private healthcare insurance available. The use of private health insurance has been increasing due to the low number of hospitals, long waiting times to receive healthcare, and Sweden’s priority treatment of emergency cases first. In Sweden, one in 10 people do not rely on Sweden’s universal healthcare but instead purchase private health insurance. While the costs for private plans vary, one can expect to pay 4,000 kr ($435) annually for one person, on average.

  7. Sweden’s life expectancy is 82.40 years old. This surpasses the life expectancies in Germany, the UK, and the United States. Maternal healthcare in Sweden is particularly strong because both parents are entitled to a 480-day leave at 80% salary and their job is guaranteed when they come back. Sweden also has one of the lowest maternal and child mortality rates in the world. Four in 100,000 women die during childbirth and there are 2.6 deaths per 1,000 live births. There are 5.4 physicians per 1,000 people, which is twice as great as in the U.S and the U.K, and 100% of births are assisted by medical personnel.

  8. The leading causes of death are Ischemic heart disease, Alzheimer’s disease, stroke, lung cancer, chronic obstructive pulmonary disease and colorectal cancer. While the biggest risk factors that drive most deaths are tobacco, dietary risks, high blood pressure and high body-mass index, only 20.6% of the Swedish population is obese and 85% of Swedes do not smoke. The Healthcare Access and Quality Index (HAQ Index) also estimates that, in 2016, the rate of amenable mortality, or people with potentially preventable diseases, were saved at a rate of 95.5% in Sweden. The HAQ Index estimates how well healthcare in Sweden functions; the index shows that it is one of the best in the world.

  9. Sweden’s health expenditure represents a little over 11% of its GDP, most of which is funded by municipal and regional taxes. Additionally, in Sweden, all higher education is free, including medical schools. There are no tuition fees and a physician can expect to have an average monthly salary of 77,900 kr ($8,500).

  10. In Sweden, 1 in 5 people is 65 or older, but the birth rate and population size are still growing. Because Sweden has one of the best social welfare and healthcare systems in the world, people live longer and therefore 20% of the population does not generate income or pay taxes from their salary. This dynamic stagnates social welfare benefits and slows down the economy. Increasing immigration and a rise in births are the two solutions to ensure that the younger generations will receive the same benefits. Swedish-born women have an average of 1.7 children and foreign-born women have an average of 2.1 children. In 1990, Sweden broke the 2.1 children fertility rate but quickly dropped below 2.0 in 2010. Since 2010, Sweden has seen an increase of 100,000-150,000 immigrants and has seen 45,000 citizens emigrate.

In 2018, Sweden reached its record highest GDP (PPP) per capita of almost $50,000. Despite having the highest taxes in the world, the living conditions and healthcare in Sweden are some of the best. With time, its population will continue to grow and the healthcare system will continue to advance.

Anna Sharudenko
Photo: Flickr

Marie Stopes International Nigeria recently donated almost 1,500 units of the medication misoprostol to the Nigerian state Nasarawa. This donation will hopefully reduce maternal mortality in Nigeria, which, in Nasarawa, is higher than average. The donated misoprostol cost one million Nigerian Naira altogether, approximately $2,580.

What is Marie Stopes International?

Dr. Tim Black founded the current Marie Stopes International in 1976 when he purchased and revitalized the Marie Stopes Clinic in London, named after the late Dr. Marie Stopes. A year later, Dr. Black and his wife opened a clinic in Dublin, followed by another in New Delhi.

MSIN first came to Nigeria in 2009. These clinics provide ultrasounds, testing for pregnancy and sexually transmitted infections, counseling, and other related forms of reproductive healthcare. As of 2018, the Non-Governmental Organization has helped more than three million women in Nigeria alone, and Marie Stopes has opened clinics in 37 countries around the world. The NGO’s Nasarawa State Clinical and Training Officer Nathaniel Oyona praised Marie Stopes’s decision to “support the government by assisting pregnant women especially those that cannot afford to pay their bills.”

Why is Maternal Mortality in Nigeria So High?

A study from 1985 to 2001 at the University of Jos found that hemorrhage after delivery caused most maternal deaths, followed by sepsis and eclampsia. Furthermore, in 2015, Nigeria registered around 58,000 maternal deaths resulting in a maternal mortality ratio of more than 800 maternal deaths per 100,000 live births. By comparison, the WHO cited that the 46 most developed countries in the world had a maternal mortality ratio of 12 deaths per 100,000 live births in the same year.

As of 2017, childbirth causes the deaths of 7% of women in Nasarawa each year. Nasarawa’s shortage of medical staff, equipment and medicine means that many women do not trust the birth centers. Instead, many women choose to give birth at home without a doctor present. However, home births can pose problems if complications arise, such as a postpartum hemorrhage. Unfortunately, this situation leaves many pregnant women without proper access to much needed medical care.

How Does Misoprostol Help Maternal Mortality in Nigeria?

Misoprostol is an oral medication with multiple uses that can lower the chance of hemorrhage after childbirth. Various studies have found that misoprostol can reduce postpartum bleeding by 24% to 47%. Because misoprostol is taken orally, it is easy to distribute and administer. Heat exposure will also not negatively impact misoprostol’s effectiveness. Misoprostol’s versatility makes it useful for women who choose to have a home birth or lack access to birth centers.

MSIN specified that the 1,497 packs donated are earmarked for women without the means to afford postnatal care. The Commissioner for Health in Nasarawa confirmed the misoprostol will be distributed accordingly.

What Are the Next Steps to Fight Maternal Mortality in Nigeria?

Though the donation of misoprostol is a welcome short-term solution, long-term reform is needed to reduce maternal mortality in Nigeria. Since 2011, the government of Nasarawa has shifted to the Nigerian State Health Investment Project, in hopes of rebuilding trust with clinics and hospitals and giving better care to patients. The government has since granted multiple facilities in Nasarawa updated medical equipment and a better supply of necessary drugs. These reforms have caused a positive change in clientele and productivity.

As for Marie Stopes International, the NGO will continue to open clinics worldwide and train local people to provide reproductive healthcare. Through their social franchise networks, MSIN staff train Nigerian doctors and nurses to provide better reproductive healthcare and counseling in their facilities. Once local healthcare providers complete their program, MSIN gives them the medicine and other materials they may need for their practice. In Nigeria, 200 franchisees have completed the MSIN training program.

Though more work is necessary to combat maternal mortality in Nigeria, misoprostol has proven to be an accessible and effective tool to help prevent postpartum hemorrhage in women. This is one step in a larger plan to rebuild trust in the healthcare system and reduce maternal deaths in Nigeria.

– Jackie McMahon
Photo: Flickr

Maternal Health in NepalNepal is a landlocked country bordering India and China, with a population of approximately 30 million. With close to 80% of births occurring at home, maternal health in Nepal has become a focal point as mortality rates raised alarmingly.

4 Facts About Maternal Health in Nepal

  1. The maternal mortality rate saw a reduction of about 71% between the years 1990 and 2015. The decline is attributed to free delivery services and transport, access to safe delivery services, and medicines that prevent hemorrhaging.
  2. Midwives are one of the popular professional services for maternal health in Nepal. Fast intervention and postnatal suggestions from a skilled midwife allows for better care for both mother and child after birth. In Nepal, only about 27% of women receive care within 24 hours of giving birth. This makes way for hemorrhaging, heavy-lifting related injuries shortly after giving birth and complications for the baby during and directly after birth.
  3. To ensure that midwives are updated on the most current practices and procedures for successful pregnancy and birthing, midwifery education is imperative. Institutions have partnered with the United Nations Population Fund (UNFPA) to offer combined education for nursing and midwifery. Midwives do not have specific legislation for their work. They are not completely recognized under the law or regulated, creating issues with proper training and resources. Therefore, greater recognition and accessibility will allow midwives the resources, training and encouragement that they need for success.
  4. The National Medical College Teaching Hospital in Nepal published an extensive report of the challenges surrounding maternal health in Nepal. A specific challenge mentioned in this report includes the socio-economic influencers of maternal health. Due to poor nutritional health in women with lower economic status, issues like anemia that cause mortalities. Additionally, rural areas record about 280 birth complications per day.

As maternal health in Nepal becomes more of a focus in the healthcare system, certain policies and programs must be expanded. Midwifery education and access to services are the most important programs for successful maternal health in Nepal. Many experts and those in the field continue to push for individual programs that focus primarily on methods for successful midwives.

– Ashleigh Litcofsky
Photo: Pixnio

Life Expectancy in Timor-Leste
Timor-Leste, also known as East Timor, is a nation that occupies the eastern half of the island of Timor in Southeast Asia. With a population of 1.26 million people, Timor-Leste is one of the least populated countries in Asia. The Portuguese originally colonized the country in 1520. After declaring independence in 1975, Indonesia invaded the nation, which occupies the western half of the island. The Indonesian invasion brought violence, famine and disease to Timor-Leste, resulting in a large loss in population. After a majority of the Timorese population voted to become independent in 1999, Indonesia relinquished control and Timor-Leste moved under the supervision of the United Nations. The nation officially became independent in 2002, making it one of the newest nations in the world. These 10 facts about life expectancy in Timor-Leste outline the rapid improvement the country has made since Indonesian occupation and the issues it still needs to overcome.

10 Facts About Life Expectancy in Timor-Leste

  1. Life expectancy in Timor-Leste increased from 32.6 years in 1978 to 69.26 years in 2018, matching that of South Asia. The consistent improvement in life expectancy in the past decade is primarily due to the Ministry of Health’s public health interventions. Such interventions include the reconstruction of health facilities, expansion of community-based health programs and an increase in medical graduates in the workforce.
  2. Life expectancy in Timor-Leste increased despite a drop in GDP, which decreased from $6.67 billion in 2012 to $2.6 billion in 2018. However, Timor-Leste’s GDP rose by 2.8% from 2017 to 2018. Continued improvement in GDP and economic progress in the nation will only serve to increase life expectancy by providing more opportunities for employment, education and improved quality of life.
  3. Tuberculosis was the highest cause of death in 2014, causing 14.68% of deaths. In 2014, estimates determined that Timor-Leste had the highest prevalence of tuberculosis in Southeast Asia, and 46% of people with tuberculosis did not receive a diagnosis in 2017. Maluk Timor, an Australian and Timorese nonprofit committed to advancing primary health care, provides a service through which team members visit Timorese households to locate undiagnosed patients and raise awareness about the severity of tuberculosis in the community. The organization collaborates with the National TB Program and aims to eliminate suffering and deaths in Timor-Leste due to diseases that Australia, which is only one hour away, had already eliminated.
  4. Communicable diseases caused 60% of deaths in 2006 but decreased to causing 45.6% of deaths in 2016. While diseases such as tuberculosis and dengue fever remain a public health challenge, the incidence of malaria drastically declined from over 200,000 cases in 2006 to no cases in 2018 due to early diagnoses, quality surveillance, funding from The Global Fund to Fight AIDS, Tuberculosis and Malaria and support from the World Health Organization.
  5. The adult mortality rate decreased from 672.2 deaths per 1,000 people in 1977 to 168.9 deaths per 1,000 people in 2018. Additionally, the infant mortality rate decreased from 56.6 infant deaths per 1,000 live births in 2008 to 39.3 infant deaths per 1,000 live births in 2018. While public health interventions and disease prevention contributed to the decrease in the adult mortality rate, Timor-Leste needs to expand access to maternal health services in rural areas to continue to improve the infant mortality rate.
  6. Maternal mortality decreased from 796 deaths per 100,000 live births in 1998 to 142 deaths per 100,000 live births in 2017. The leading cause of the high maternal mortality rate is poor access to reproductive health services, as only 43% of women had access to prenatal care in 2006. While the Ministry of Health continues to expand access to maternal health care through mobile health clinics that reach over 400 rural villages, only 30% of Timorese women gave birth with a health attendant present in 2013. Even as access increases, challenges such as family planning services, immunization, treatment for pneumonia and vitamin A supplementation remain for mothers in rural communities.
  7. The violent crisis for independence in 1999 destroyed more than 80% of health facilities. Despite rehabilitation efforts to rebuild the health system, many facilities at the district level either have limited or no access to water. However, the number of physicians per 1,000 people improved from 0.1 in 2004 to 0.7 in 2017. The capacity of the health care system is also improving, as UNICEF supports the Ministry of Health in providing increased training for health care workers in maternal and newborn issues and in striving to improve evidence-based public health interventions.
  8. Timor-Leste has one of the highest malnutrition rates in the world. At least 50% of children suffered from malnutrition in 2013. Additionally, in 2018, 27% of the population experienced food deprivation. USAID activated both the Reinforce Basic Health Services Activity and Avansa Agrikultura Project from 2015-2020 to address the capacity of health workers to provide reproductive health care and the productivity of horticulture chains to stimulate economic growth in poor rural areas. Both projects aim to combat malnutrition by addressing prenatal health and encouraging a plant-based lifestyle that fuels the economy.
  9. Motherhood at young ages and education levels are key contributors to malnutrition, as 18% of women began bearing children by the age of 19 in 2017. Teenage girls are far more likely to experience malnourishment than older women in Timor-Leste, contributing to malnutrition in the child and therefore lowering life expectancy for both mother and child. As a result of malnutrition, 58% of children under 5 suffered from stunting in 2018. Additionally, findings determined that stunting levels depended on the wealth and education level of mothers. In fact, 63% of children whose mothers did not receive any formal education experienced stunting, while the number dropped to 53% in children whose mothers received a formal education.
  10. Education enrollment rates are increasing, as the net enrollment rate in secondary education increased from 40.5% in 2010 to 62.7% in 2018. Completion of secondary education links to higher life expectancy, especially in rural areas. Since 2010, Timor-Leste has increased spending on education. Additionally, local nonprofit Ba Futuru is working to train teachers to promote quality learning environments in high-need schools. After Ba Futuru worked with schools for nine months, students reported less physical punishment and an increase in innovative and engaging teaching methods in their classrooms. The organization serves over 10,000 students and provides scholarships for school supplies for hundreds of students. With more programs dedicated to increasing enrollment and the classroom environment, students are more likely to complete secondary education and increase both their quality of life and life expectancy.

These 10 facts about life expectancy in Timor-Leste indicate an optimistic trend. Although malnutrition, disease and adequate access to health care remain prevalent issues in Timor-Leste, the nation’s life expectancy has rapidly increased since Indonesian occupation and has steadily improved its education and health care systems since its founding in 2002. To continue to improve life expectancy, Timor-Leste should continue to focus its efforts on improving public health access and community awareness in poor rural areas, and particularly to emphasize maternal health services to reduce both maternal and infant mortality rates. Despite being one of the newest nations in the world, Timor-Leste shows promise and progress.

Melina Stavropoulos
Photo: Flickr

Maternal health in Nepal Nepal, a landlocked country bordering India and China, has a population of approximately 30 million. In 2015, close to 41 percent of births occurred at home in Nepal. Of those home births, just under half were carried out without a trained professional. Due to the alarming rate of maternal deaths seen in the early 2000s, maternal health in Nepal has been a focal point for many years. Even though complications during births at health centers still occur, the presence of trained professionals during birth remains the best way to avoid preventable deaths. Many organizations have partnered with the Nepalese government and are working hard to bring these numbers down even further every year.

4 Facts About Maternal Health in Nepal

  1. Nepal’s maternal mortality rate decreased about 71 percent between 1990 and 2015. The decline is attributed to free delivery services and transport in rural areas, access to safe delivery services and medicines that prevent hemorrhaging. In rural parts of Nepal, it has historically been much more difficult to receive proper healthcare. Through the combined efforts of various organizations and the Nepalese government, the number of facilities in remote areas has increased. Additionally, the incentive to travel to these facilities has risen. In 2005, the government began giving stipends to pay for transportation costs. Four years later, the government passed the Safe Motherhood Programme, which allowed free delivery services to pregnant women. In 2011, the government continued to promote safe pregnancies by adding another incentive of $5 for attending antenatal checkups. Through these efforts, the government has had an enormous impact on the development of maternal health in Nepal.
  2. Midwifery is one of the most important services for maternal health in Nepal. Fast intervention and postnatal suggestions from a skilled midwife allows for better postnatal care for both mother and child. In Nepal, only about 27 percent of women receive care within 24 hours of giving birth. This increases risk of hemorrhaging and heavy-lifting related injuries shortly after giving birth. It also increases risk of possible complications for the baby during and directly after birth.
  3. Midwifery education ensures that midwives are up to date on the most current practices and procedures for successful pregnancy and birthing. Institutions have partnered with the United Nations Fund for Population Activities (UNFPA) to offer combined education for nursing and midwifery. In 2011, Nepal and the UNFPA committed to training 10,000 birthing attendants. However, in a report about midwifery authored by the UNFPA, midwives do not have specific legislation for their work. Midwives are not completely recognized under the law nor are they regulated, which results in issues with proper training and resources. Therefore, greater recognition and accessibility will allow midwives the resources, training and encouragement that they need for success.
  4. Women of lower socioeconomic status have more complications surrounding maternal health. The National Medical College Teaching Hospital in Nepal published an extensive report of the challenges surrounding maternal health in Nepal. A specific challenge mentioned in this report includes the socioeconomic influencers of maternal health. Due to poor nutritional health in women of lower economic status, issues such as anemia can cause mortalities. Additionally, rural areas record about 280 birth complications per day. Although there has been significant work since then to expand access to cesarean sections and birthing centers in rural areas, there are still around 258 women dying per 100,000 live births.

As maternal health in Nepal becomes more of a focus in the healthcare system, there are certain policies and programs that must be expanded upon. Midwifery education and access to services are the most important programs for successful maternal health in Nepal. Many experts in the field continue to push for individual programs that focus primarily on methods for successful midwifery education and overall increased care for maternal health in Nepal.

– Ashleigh Litcofsky

Photo: Flickr

Maternity Crisis in Sierra Leone
There is a maternity crisis in Sierra Leone. The country has the highest maternal death rate in the world, with one in 17 women dying from pregnancy or birth complications. This number could be even higher, as Sierra Leone’s 2017 Maternal Death and Surveillance Report estimated that seven in 10 maternal deaths go unreported. Below are seven facts about the maternity crisis in Sierra Leone.

Top 7 Facts About the Maternity Crisis in Sierra Leone

  1. The Majority of Maternal Deaths are Preventable: The top causes of maternal death in Sierra Leone are bleeding, pregnancy-induced hypertension, infection and unsafe abortions, all of which are preventable through adequate medical treatment, according to the World Health Organization. Bleeding is a particularly difficult problem for under-served rural areas where mothers do not have access to health care facilities. Another issue facing mothers is infrastructure. People poorly maintain many roads between towns and clinics and these make for a difficult journey for sick and laboring women. Again, road maintenance is a simple problem that can help reduce maternal death in Sierra Leone.
  2. The Majority of Mothers are Under 20: One hundred and twenty-five out of 1,000 mothers in Sierra Leone are under age 20 according to a 2017 United Nations Population Fund (UNFPA) study. Maternity in Sierra Leone is particularly dangerous for adolescent mothers and 20 percent of maternal deaths in Sierra Leone were among teenagers. Beyond maternal death, pregnant teenagers in Sierra Leone lose out on life prospects – a 2015 law banned pregnant girls from attending school, and parents describe teenage pregnancy as the “ultimate shame” for a family.
  3. The 2014-2015 Ebola Crisis Halted Progress: Before 2014, Sierra Leone was making progress in reducing maternal death – from 2000 to 2015, maternal deaths dropped by 4.4 percent. However, the Ebola epidemic caused an immediate increase in maternal death through 2015. Sierra Leone planned to meet many Millennium Development Goals by 2015, but the May 2014 Ebola outbreak reversed progress, particularly in maternal health. Not only did Ebola put a strain on general health care in Sierra Leone, but it also dramatically reduced the number of health care workers in the country. A 2016 World Bank report estimated that maternal death could increase by 74 percent due to the extreme shortage of health care workers in the country.
  4. Programs for Maternity Care Still Need Funding: There is a dearth of doctors in Sierra Leone. For example, in the district of Bonthe, there are nine doctors for 220,000 patients and only 44 percent of births receive support from a nurse or midwife. Unfortunately, between the civil war from 1991 to 2001 and the 2014 to 2015 Ebola outbreak Sierra Leone, the burgeoning health care system in Sierra Leone lost momentum. The E.U., the U.N. and UNICEF have all devoted funds to maternity in Sierra Leone in addition to Partners in Health and other nonprofit organizations. Donations are critical to moving forward with maternal health.
  5. Sierra Leone’s Government has Committed Itself: President Julius Maada Bio announced in October 2019 that Sierra Leone increased its health budget from 8.9 percent to 11.5 percent of the country’s national budget to help combat dangerous maternity in Sierra Leone. On October 18, 2019, Sierra Leone opened a $1.6 billion maternity facility in Freetown to better serve the country’s largest city. Sierra Leone also launched a free health initiative in 2010 to help improve pre- and post-partum care. The government’s goal for maternity in Sierra Leone is to meet Millennium Development Goals by 2030, reducing the global maternal mortality ratio to less than 70 per 100,000 live births.
  6. Nonprofits are Deeply Involved: Multiple nonprofit organizations, including UNICEF, Partners in Health and the Borgen Project have covered issues with maternity in Sierra Leone. Partners in Health has been particularly successful, building a maternal waiting home and opening a health clinic in Kono in 2018. UNICEF provided safer water for mothers to help with illness and sanitation. These nonprofits prove that the crisis is not insurmountable.
  7. Celebrities are also Getting Involved: In October 2019, vlogbrothers, run by Hank and John Green, pledged $6.5 million to Partners in Health as part of his family’s initiative to bring awareness to maternity in Sierra Leone. John Green discussed how he traveled to Sierra Leone and saw first-hand the lack of hospital electricity, medical equipment and transport. He praised the efforts of the Partners in Health in developing a large-scale hospital system and making systematic changes and he asked anyone who can donate to do so. Currently, the vlogbrothers have a goal of $240,000 per month in donations – so far, they have approximately $194,000. The vlogbrothers are also providing updates on their donations and work with Partners in Health in Sierra Leone.

Motherhood should not be a gamble. Families around the world deserve to look forward to pregnancy and birth and not feel distressed. Multiple organizations are pushing for progress, but more is necessary. Support in any form, from awareness to donations, can only help the crisis of maternity in Sierra Leone.

Melanie Rasmussen
Photo: Flickr

Life Expectancy in Georgia 

Georgia, located between Western Asia and Eastern Europe, has made significant progress over the past several decades when it comes to the life expectancy of its nearly 4 million citizens. Since around the 1990s, the country has experienced many health reforms that helped to improve the general health of its population as well as lower maternal and infant mortality rates. However, despite these improvements, Georgia still faces multiple health-related challenges that pose a threat to the life expectancy of its citizens. Listed below are five facts about life expectancy in Georgia.

5 Facts About Life Expectancy in Georgia

  1. According to a survey carried out by the United Nations in 2012, the average lifespan for Georgian women stood at 79 years, while the average life span for men was lower, at around 70 years. The average lifespan in Georgia is expected to increase to 80.6 years for women and 74.1 years for men by 2035. 
  2. As of 2019, the life expectancy in Georgia at birth is approximately 73.66 years. This marks a percentage increase of approximately 20 percent over 69 years. Back in 1950, the U.N. estimated that the life expectancy in Georgia at birth was less than 60 years in total. 
  3. According to the World Health Organization (WHO), the probability of death for people between ages 15 and 60 stands at 238 for males and 83 for females. The probability of children dying before the age of 5 per 1,000 births was around 11 in 2017.
  4. Georgia developed the Maternal and Newborn Health Strategy, as well as a short term action plan in 2017 to provide direction and guidance in improving maternal and newborn health. According to UNICEF, the three-year initiative “envisages that by 2030, there will be no preventable deaths of mothers and newborns or stillbirths, every child will be a wanted child, and every unwanted pregnancy will be prevented through appropriate education and full access for all to high quality integrated services.”
  5. In 2010, the leading causes of premature death in Georgia were cardiovascular and circulatory diseases, including ischemic heart disease and cerebrovascular disease. It was reported that in 2010, the three most prominent risk factors for the disease burdened people in Georgia were related to diet, high blood pressure and tobacco smoking. It was also reported that the leading risk factors for children who were younger than 5 and people between ages 15 to 49 were suboptimal breastfeeding and the aforementioned dietary risks.

As a whole, life expectancy in Georgia has improved significantly compared to the mid 20th century. With that being said, there is no denying that there is still work that needs to be done in a number of areas including maternal health. Hopefully, with strong investments from the government, life expectancy in Georgia will continue its upward trajectory. 

Adam Abuelheiga
Photo: Flickr