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Decreasing Maternal Mortality Rate in Sierra Leone

How the Maternal Mortality Rate is Decreasing in Sierra LeoneThe capital of Sierra Leone, Freetown, is historically known for being a home for freed slaves during the transatlantic slave trade, giving Sierra Leone a prominent place in history. However, the small west African country boarding Guinea has faced many adversities. One is the significant increase in adolescent pregnancies and fertility being some of the highest in the world. Women in Sierra Leone have “a one in 17 lifetime chance of dying during pregnancy, delivery or its aftermath.” This article will discuss the main reasons for the decreasing maternal mortality rate in Sierra Leone.

Data Behind the Mortality Rate in Sierra Leone

For the government of Sierra Leone, keeping a consistent record of deaths was nearly nonexistent during the Ebola outbreak. According to an article by Financial Times, Dr. Sesay, who is “the government’s director of reproductive and child health,” conducts the government’s response to the maternal deaths. According to Dr. Sesay, procedures are set out to lower the maternal mortality rate in Sierra Leone. “We’ve put in place a maternal death surveillance and response team, and developed a technical guideline. When a death is reported, they go and confirm.”

Part of the surveillance is ensuring that reporting the deaths is imperative. This requires health workers within communities to report the deaths to major health facilities. Furthermore, this is vital to decreasing the maternal mortality rate in Sierra Leone as it ensures that all families are accounted for and not misrepresented in the sample population. However, the same health workers reporting the data are the same ones attempting to save these expectant mothers’ lives, which stretches on the ground workers.

Looking at the Numbers

Maternal mortality in Sierra Leone had reached 1,070 deaths between January to June of 2020. According to a report by the ministry of health and sanitation in Sierra Leone, from January to March of 2020, there was a total of 581 maternal deaths. And from April to June of 2020, the total was 489 maternal deaths.

Equally as important, the predominant reference of data for maternal deaths is CRVS (Civil Registration and Vital Statistics). The issue is that Sierra Leone doesn’t recognize this system of data reporting. When this occurs, other data systems are created, such as surveys and various studies, which leaves more room for inaccurate information. The organizations the World Health Organization, the United Nations International Children’s Emergency Fund, the United Nations Population Fund and the World Bank Group have collectively concluded that not all deaths can be recorded due to “systematic error.” Meaning the data presented won’t be accurate due to the actual number being lower or higher and this will impact how the maternal mortality rate is decreasing in Sierra Leone.

However, when using CRVS, “records will be systematically lower than the true number because there will always be deaths that go unreported. This is referred to as a systematic error.” Along with systematic error, there is the possibility of “random error,” meaning when a health worker records inaccurate information. This increases the inaccuracy of maternal deaths in Sierra Leone. Considering health workers are underpaid and overworked, random error is present when recording maternal deaths.

How to Improve Maternal Mortality Rate Efforts

There are multiple ways of decreasing the maternal mortality rate in Sierra Leone. However, today’s most beneficial way is by increasing and encouraging education for traditional birth attendants (TBAs). Undergoing childbirth for many women in Sierra Leone in the past meant being at home and having a TBA present. Usually, a TBA is an elderly woman from within the community and is often referred to as “auntie” or “mother.” Although this may sound beneficial and comfortable, such as having a midwife or doula, according to the government, TBAs were the primary reason for the country’s maternal deaths.

If patients were to have any complications during delivery, the TBA would inform the patient that emergency transportation would take too long to arrive and going to the nearest clinic would take too much time. In most cases, patients would bleed out as healthcare officials would arrive too late. The government attempted to resolve this issue by ratifying a law in 2010 forbidding TBAs to assist in deliveries outside of a clinical environment. If a TBA and anyone else taking part in the process, including the expectant mother, were caught defying this law they would face extreme retribution.

Established in 2001, the non-governmental organization IsraAID is working towards providing “emergency and long-term development settings in 50 plus countries.” The organization also has a medical care program that targets “reproductive health,” along with expanding educational opportunities. For the maternal mortality rate to decrease, the government of Sierra Leone has to establish effective maternal mortality reporting data and education for TBAs.

—Montana Moore
Photo: Flickr

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Psychosocial Recovery from Ebola in Sierra Leone

Psychosocial Recovery from Ebola in Sierra LeoneCommunity healing dialogues are proving effective in providing psychosocial recovery from Ebola in Sierra Leone by addressing the trauma and stigma that survivors face. These sessions give community members a forum to raise and address their concerns about problems in the community, promoting health, wellness and prosperity in both psychosocial, emotional and economic senses. The dialogues seek to erase the stigma and promote economic recovery via micro-enterprise groups.

Poverty and Public Health Challenges

Sierra Leone is a West African country with a population of 7.5 million. Life expectancy is approximately 52 years for women and 51 years for men. The top ten causes of death include malaria, neonatal disorders, diarrheal diseases, tuberculosis and HIV/AIDS. Sierra Leone has the highest maternal mortality rate in the world (women have a one in 17 chance of dying from pregnancy or childbirth), in addition to one of the highest mortality rates for children under five. The country lacks a centralized public health system, and most people cannot access health care due to extreme poverty.

Support and Strides Amid Ebola

Sierra Leone had the highest number of fatal Ebola cases in the 2014-2016 outbreak. The disease’s severity prompted the CDC and NGOs like Partners in Health to provide resources and support. The CDC mounted its largest ever response to an outbreak in an individual country, providing services that included:

  • Epidemiological/strategical support
  • Infection prevention and control
  • Case management
  • Health promotion
  • Laboratory/diagnostic support
  • Emergency management
  • Border health
  • Research support

Partners in Health also provided emergency Ebola care and stayed in Sierra Leone after the outbreak to help strengthen the country’s public health system, staff, supplies and infrastructure. It has provided prenatal care, community health services, tuberculosis treatment, mental health care, blood banking and emergency medical services. The organization also established ongoing support systems for Ebola survivors. Strengthening Sierra Leone’s health system is an important means of both alleviating poverty and helping the country heal from Ebola. However, much work remains to be done.

Returning to Communities Through Healing Dialogues

Ebola is a disease with severe physical manifestations, but its social and psychological aftereffects can also be devastating and can help ensure that those affected remain in poverty.

In the words of one lifelong resident of Sierra Leone, “The Ebola outbreak in West Africa had the same psychological effects on individuals as war.”

Often, Ebola survivors are grieving for the deaths of their loved ones. At the same time, they face stigma and discrimination when trying to return to their communities because people fear that they still carry Ebola.

To address these complex and multifaceted issues, USAID’s Advancing Partners & Communities project introduced community healing dialogues. These meetings, which are conducted by trained facilitators, give community members space to talk through and resolve their concerns. These sessions are having positive effects on psychosocial recovery from Ebola in Sierra Leone for both survivors and their communities. Some survivors have been able to rejoin their communities free of stigma. In addition, the sessions serve as a forum for the community-based resolution of economic problems. For example, the forum led to a micro-enterprise group helping pay for a young woman’s school fee.

Sierra Leone’s Ebola outbreak was devastating on medical, economic and psychosocial levels. Support from governmental and non-governmental organizations have helped the country face these issues. Community healing dialogues have been extremely beneficial in aiding psychosocial recovery from Ebola in Sierra Leone.

– Isabelle Breier
Photo: USAID

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A Brief History of Ebola in Sierra Leone

A Brief History of Ebola in Sierra Leone
The history of Ebola in Sierra Leone can be traced back to December of 2014. The illness started out slow and unsuspecting as it crept across the land until really solidifying its grasp in May and June.  From then on, the cases of Ebola continued to increase at an exponential rate.

The First Case and Subsequent Infection

The first case was that of an eighteen-month-old boy from a small village in Guinea. He was thought to have been infected by bats in the region. Soon after, other reports of Ebola-like symptoms became rapidly apparent. In March alone, there had been a reported 49 cases and 29 deaths.

One of the next infected was a house guest to the family of the index patient. She traveled home to Sierra Leone from Guinea unknowingly carrying the Ebola virus with her. She died shortly after her return due to the disease; however, her death was not investigated or reported until two other members of her family died.

The epidemic really began to flourish after the death of an infected traditional healer. The healer would treat Ebola patients across the border in Guinea but was a resident of Sierra Leone.

She eventually succumbed to the disease and a funeral service was held on her behalf; this is where the spread in Sierra Leone really increased. Thirteen women, all of whom attended the funeral, contracted the disease and eventually died as well.

A Death-Giving Funeral

Investigation processions commenced proceeding the funeral induced infections and it was found that 365 Ebola-related deaths started from that very funeral. It was also recognized that there were two strands of the virus present amongst the infected from the funeral.

In knowing the two variations of Ebola, researchers were able to retrospectively look for and trace the disease in blood samples. This made the containment of Ebola in Sierra Leone and respective infected regions much easier.

By the summer of 2014, the major town of Kailahun and its neighboring city Kenema were declared to be in a state of emergency. The World Health Organization (WHO) and other affiliated aid agencies provided and concentrated their response teams in the area.

The Ebola Epidemic

Unfortunately, the unsatisfactory public health infrastructure, the impoverished living conditions and the lack of preparedness aided the rapid spreading of the disease. By halfway through July, the aid teams from the World Health Organization buried over 50 bodies in the span of just 12 days in Kailahun alone.

Approximately two years after the first Ebola case was discovered, there were 28,600 cases and a resulting 11,325 deaths reported. The epidemic finally came to an exhausted end when Sierra Leone declared itself officially Ebola-free in March 2016.

Constant Vigilance

Unfortunately, the history of Ebola in Sierra Leone has continued in 2018 as the virus reared its ugly head again in May. The vigilance in regards to Ebola in Sierra Leone improved tremendously over the years since the first epidemic but it is still quite difficult to contain and extinguish.

Countless families and civilians still face the mental effects of the calamity from both the initial epidemic and the most recent devastation.

– Samantha Harward

Photo: Flickr

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Ebola Virus Returns

Ebola VirusIn January, officials in Sierra Leone confirmed a new death from the Ebola virus in the country, days after Liberia, Sierra Leone and Guinea declared themselves Ebola-free.

According to NewsWeek, the World Health Organization (WHO) said last Thursday that “it was the first time all three West African countries had held the Ebola-free status simultaneously…effectively bringing to an end the deadliest Ebola outbreak in history that has claimed lives of some 11,300 people.”

The Ebola virus disease is a severe, often fatal illness in humans. It is transmitted to individuals from human to human transmission, or from wild animals. There are currently no licensed Ebola vaccines and the average EVD case fatality rate is around 50 percent, according to the WHO.

The Ebola outbreak in West Africa has been the largest and most complex outbreak since the deadly disease was first discovered in the late 70’s.

Said the WHO, “The most severely affected countries, Guinea, Liberia and Sierra Leone, have very weak health systems, lack human and infrastructural resources, and have only recently emerged from long periods of conflict and instability.”

A test center in Sierra Leone announced that the tests on the patient who died a few days ago confirmed that his death was due to the deadly virus. To reduce further threats, Sierra Leone officials are currently investigating how the individual became infected and who may have been in contact with him.

The World Health Organization also emphasized that future flare-ups of the deadly virus are probable.

Bruce Aylward, the Ebola correspondent in the organization said that the “risk of re-introduction of infection is diminishing as the virus gradually clears from the survivor population, but we still anticipate more flare-ups and must be prepared for them.”

According to NewsWeek, recent investigations have found that the virus can remain in the male survivor’s semen for up to nine months. Hence, the WHO suggests Ebola survivors and their sexual partners abstain from sex or practice extremely safe sex.

“There is as yet no proven treatment available for EVD. However, a range of potential treatments including blood products, immune therapies and drug therapies are currently being evaluated,” said the WHO. Additionally, two potential vaccines re undergoing human safety testing.

The World Health Organization suggests that in order to prevent and control this deadly threat, community engagement is the key to successfully control the outbreaks. “Raising awareness of risk factors for Ebola infection and protective measures that individuals can take is an effective way to reduce human transmission.”

– Isabella Rolz

Sources: NewsWeek, World Health Organization
Photo: Bloomberg Business

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Sierra Leone Declared Ebola-Free

No More Ebola in Sierra LeoneAfter nearly a two-year battle with Ebola, the World Health Organization (WHO) has announced that Sierra Leone is finally free of Ebola.

The country recently celebrated the milestone after almost 4,000 people died since the outbreak.

The WHO noted that 42 days have passed since the last confirmed patient was discharged on September 25 of this year. Anders Nordstrom, the Sierra Leone representative for WHO, revealed the positive news.

“WHO commends the government and people of Sierra Leone for the significant achievement of ending this Ebola outbreak,” Nordstrom said.

While the country has reached the 42-day benchmark, it still has to undergo a 90-day surveillance period.

Indeed, reaching the 42-days is a good reason to rejoice. However, it does not mean that Ebola in Sierra Leone is completely eradicated. Neighboring Liberia reached the 42-day goal in May, only to experience new cases before it was declared Ebola-free again.

Still, Sierra Leone remains optimistic with the news WHO has brought forth.

“We have prevailed over an evil virus. We persevered and we have overcome. We must not let down our guard,” said Sierra Leone President Ernest Bai Koroma.

The country will continue to take preventative measures to disable potentially new cases. Bodies will still continue to be swabbed and “safe burials will continue for all suspicious cases.”

It seems as though the disease has been prevented from spreading further. However, the people who had contracted the disease have ongoing health issues.

Juliet Spencer is considered by many to be one of the lucky ones. She contracted Ebola while taking care of her husband but was able to beat the virus. While she is happy that she is alive, she is still prevented from accomplishing tasks due to lingering complications.

“I feel good today that I have survived to see this day, witnessing this ceremony,” Spencer said. “My only regret is that I do not have a good health to carry on my business. I am unable to walk, I have joint pains and ear and eye problems.”

The 90-day surveillance period will be sure to test the country. However, the WHO and the people of Sierra Leone are confident that the disease will soon be eradicated. Nordstrom adds that the country could set an example for other countries looking to expunge Ebola.

“We now have a unique opportunity to support Sierra Leone and build a strong and resilient health system ready to detect and respond to the next outbreak of the disease or any other health threat,” Nordstrom said.

– Alyson Atondo

Sources: CNN, ABCNews, The Atlantic
Photo: Wikimedia