Infant Mortality and Chlorhexidine in Liberia When applied to the umbilical cord and stump, the antiseptic chlorhexidine has been shown to reduce neonatal deaths by preventing infection. Liberia, which has high rates of infant mortality, has included chlorhexidine in its national health policy. As health is closely linked to poverty, this is an important measure in improving both the health and prosperity of Liberians. Chlorhexidine and infant mortality in Liberia represent a global health success story.  

Liberia and Public Health: A Brief Background 

Liberia is a country in western Africa with a population of around five million and a per capita income of $710. The country faces a variety of public health crises. For instance, life expectancy in Liberia is 64 years for women and 62 years for men, and the infant mortality rate was 50 per 1,000 live births as of 2018. Neonatal disorders are the third most common cause of death, exceeded only by malaria and diarrheal diseases, which also commonly affect infants and young children.


Around the world, 21% of neonatal deaths are caused by severe bacterial infection. This amounts to over 500,000 neonatal deaths annually. Fortunately, simple and affordable interventions can greatly reduce the occurrence of neonatal infection. Chlorhexidine is a prime example. It is an affordable antiseptic that is easy to manufacture and use. Hospitals often use chlorhexidine as a preoperative skin disinfectant, as well as for sterilizing surgical instruments.

When chlorhexidine is applied to the umbilical cord stumps of newborns, it can prevent infection and the complications of infection. Studies demonstrate that using chlorhexidine on newborns can decrease the risk of severe infection by 68% and can decrease the risk of neonatal mortality by 23%. Chlorhexidine is now used in neonates in several countries around the world, including the Democratic Republic of the Congo, Malawi, Madagascar, Afghanistan, Pakistan, Nepal and Bangladesh.

Using Chlorhexidine in Liberia

In Liberia, the newborn mortality rate was 26 per 1,000 live births in 2013. Neonatal deaths accounted for 35% of deaths of children under the age of five, and severe infections were the cause of 28% of neonatal deaths. To address this problem, Liberia adopted a chlorhexidine policy in 2013 requiring the application of chlorhexidine. The Liberian Ministry of Health and Social Welfare stated, “Henceforth 7.1% chlorhexidine digluconate (4% free chlorhexidine) will be applied to the tip of the [umbilical] cord, the stump and around the base of the stump cord of all babies delivered in Liberia immediately after cutting the cord as with repeat application once daily until the cord separates.” The policy follows WHO guidelines for infants born in areas of high neonatal mortality. Chlorhexidine was also added to Liberia’s essential medicines list.

Liberia has benefitted from the support of the U.S. Agency for International Development (USAID) Maternal and Child Survival Program and NGO partners like Save the Children. These organizations have helped Liberian healthcare to implement chlorhexidine use, train health workers and ensure supply and intake. The policy reduced infant mortality in Liberia by 2.2% annually.

The Ministry of Health and various organizations have made important strides in reducing the rates of infant mortality in Liberia. Using chlorhexidine in Liberia is a powerful example of how simple interventions can effectively improve health, save lives and help to end poverty. 


– Isabelle Breier

Photo: Flickr

Causes of Poverty in LiberiaSeveral reasons are behind the causes of poverty in Liberia. The country has dealt with a 14-year civil war, and even after slightly recovering, it is still in a vulnerable state.

What are the causes of poverty in Liberia? The main reasons are corruption and government conflict. Corruption in the government is the major epidemic, infiltrating many of the other sectors of society. According to Transparency International, low public sector salaries and a lack of decent training create the incentive for corruption.

The country also fails to utilize its natural resources in a productive way. The country is rich with mineral wealth including iron ore, timber, diamonds, rubber and gold; however, natural resource management continues to deal with corruption and governance issues. If natural resource management can remain uncorrupted, the country can use these minerals as a way to bring in legitimate funding.

Another of the causes of poverty in Liberia is that during the wars, more than 200,000 people lost their lives. Many Liberian children were forced to fight in these wars, and have had few opportunities to adjust back to a normal civilian life. This then results in them turning to crime and a life of poverty.

An estimated 64 percent of Liberians live below the poverty line and 1.3 million live in extreme poverty, out of a population of 4.6 million, according to World Food Programme. The country depends on imports, which does not help with its agricultural markets already being integrated poorly. There is inadequate rural road infrastructures, limited smallholder participation in value chains and restrained institutional capacity of farmers’ organizations. Food security is also affecting 41 percent of the population, making chronic malnutrition high.

Liberia, however, is beginning to benefit from the work of some organizations like Mercycorps, which is bringing aid to those in poverty. It is providing water, food and teaching locals how to provide for themselves in a developing economy. It is also helping to fix Liberia’s market gaps as well as helping its economy recover. Additionally, there are organizations helping children find better lives after being soldiers.

Liberia is slowly on track to overcome poverty but ultimately needs more help. With financial assistance from other countries including the U.S and stopping the corruption, Liberia can emerge from poverty.

Chavez Spicer

Photo: Flickr

Common Diseases in LiberiaAs one of the poorest countries in the world, Liberia has struggled to develop adequate healthcare infrastructure to combat the spread of disease. Many diseases in Liberia can be traced to poor hygiene, sanitation and water quality, allowing diseases such as tuberculosis, malaria and cholera to affect the population.

Despite economic barriers, Liberia has made progress in certain areas, such as combatting the spread of HIV/AIDS through government programs and improved conditions.

Some of the most common diseases in Liberia include pneumonia, acute respiratory diseases and diarrheal diseases, all of which have high mortality rates. Many respiratory diseases can be linked to poor indoor air quality in rural areas where coal is often burned with poor ventilation.

Another health concern due to poor living conditions is the prevalence of cholera and parasitic disease outbreaks, which are connected to contaminated water and lack of proper sanitation. Over half of Liberian households do not use any toilet facility, and only 10 percent of households use an improved, unshared toilet facility.

Malaria is one of the most common illnesses throughout West Africa, and Liberia is no exception. Malaria accounts for 38 percent of all outpatient visits — the most out of any disease. After peaking in 2011, confirmed Malaria cases per 1000 have declined drastically to 220 cases per 1000 all thanks to preventative efforts and increased awareness.

In the spring of 2017, Liberia experienced a “mystery outbreak” along with several other West African countries. After extensive testing on autopsies, the outbreak was classified as meningitis, which caught scientists off guard due to the introduction of a meningitis vaccine throughout West Africa in 2010.

This outbreak, however, is presumed to be a meningitis C strain, which required different antibiotics to treat. In all, Liberia’s quick response and containment of the outbreak has demonstrated the country’s health improvements since the first cases of Ebola in 2014.

In the last decade, Liberia has made a concentrated effort at curbing the spread of diseases such as HIV. Recently, the Ministry of Health and Social Welfare and its partners have increased the number of HIV counseling and testing centers, and helped increase the number of sites providing prevention of mother-to-child transmission services from 29 in 2008 to 230 in 2011.

While the prevalence of the disease remains relatively high at 1.9 percent for adults ages 15-49, the Liberian government has put infrastructure in place to bring this number down in the near future.

While poverty and poor living conditions continue to facilitate the spread of diseases in Liberia, recent efforts have reduced the threat of Malaria and HIV. Continued improvements to water quality, living conditions and health care access are necessary for Liberia to solve future questions regarding disease.

Nicholas Dugan

Help People in LiberiaApproximately 64 percent of Liberians live below the poverty line. Liberia is ranked at 182 out of 187 in the human development index. This poverty is caused by lack of sufficient farming methods, little to no access to healthcare and lack of political power. Here are some solutions for how to help people in Liberia.

How to help people in Liberia starts with the food insecurity rate. Chronic malnutrition is high, 41 percent of Liberians are considered food-insecure. Farmers that can barely support their own families are common in Liberia, this has led to more than one-third of the population being malnourished. More effective measures of farming need to be put in place to help people in Liberia.

The country has plentiful rainfall and good soil, yet it is not being used effectively. The government of Liberia has granted large plots of land to multinational companies for rubber, timber and palm oil. This has reduced opportunities for farmers to produce large amounts of food at a rapid pace. Agricultural reform needs to be made in order to fix the measures of farming and the allocation of land.

More than 75 percent of the population has little to no access to referral care services. The health care system in Liberia is heavily dependent on aid from outside resources. USAID funded Rebuilding Basic Health Services (RBHS), and since 2008, RBHS has been working closely with the Liberian Ministry of Health and Social Welfare to rebuild the health system in Liberia.

Training organized groups and volunteers, investing in basic infrastructure, and supporting the prosperity of the health system are crucial. Interventions must be put in place to develop a line of communication with village chiefs, community health committee members and political representatives. A multi-faceted approach is necessary when addressing the health system in Liberia.

Poor conditions Liberia can be traced back to the military coup in 1980. An absence of political stability in any country causes conflict and poor conditions. In Liberia’s case, being unable to change economic conditions through political activism condemns the poor to stay poor. Lack of opportunity alone does not cause poverty, it is also a lack of political power to change the systems and practices that cause impoverishment.

How to help people in Liberia starts with knowledge and action, both being essential factors. Influencing public policy, financial contributions and working directly with the poor are all impactful. Even though Liberia has not had a prosperous history, there are many successful programs that are encouraging future growth for this West African country.

Lucy Voegeli

Photo: Flickr

peope10 Facts About Refugees in Liberia
Bordering the Atlantic Ocean, Liberia is a country located on the continent of Africa and has a population roughly of 4 million people. Liberia is home to thousands of refugees, many of whom originate from Cote d’Ivoire (also known as the Ivory Coast), a country just east of Liberia. Here are 10 facts about refugees in Liberia.

10 Facts About Refugees in Liberia

  1. There are currently over 40,000 persons of concern in Liberia. From this total, 38,000 refugees originate from Cote d’Ivoire. This means that Ivorian refugees in Liberia make up 95 percent of the total refugee population.
  2. Ivorian refugees often flee to Liberia due to civil conflict in their country of origin. Populations in the Ivory Coast are constantly clashing with a rebellion which began shortly after the turn of the 21st century. Since then, there has been a great deal of unrest in the Ivory Coast, forcing many people out of the country. Liberia became a destination for many of the Ivorian asylum-seekers.
  3. A large majority of Ivorian refugees in Liberia live in refugee camps established by the United Nations High Commissioner for Refugees (UNHCR).
  4. With the sudden surge of persons of concern, Liberia has requested $34 million in foreign aid. Liberia has only been granted 28 percent of the requested funds.
  5. It is suspected that the reason Liberia is receiving less funding for its refugees is due to the Middle East’s own refugee crisis. People seeking refuge from the Middle East are more likely to gain the attention of nonprofits and global organizations than the Ivorian refugees in Liberia.
  6. In 2016, an Ebola outbreak occurred in Liberia which resulted in thousands of deaths. According to the UNHCR, refugees in Liberia were impacted the most by the outbreak.
  7. Even though it has been over a decade since the war in Cote d’Ivoire, many of the refugees in Liberia feel they cannot return to their country of origin. Instead, many people fleeing from their home countries choose to settle in refugee camps in Liberia.
  8. In 2016, Ivorian authorities, alongside the UNHCR, called for all Ivorian refugees to return home to Cote d’Ivoire. Mariatou Kone, the Ivorian Minister of Solidarity, Social Cohesion and Compensation, stated that Ivorians have conducted two elections without any problems since the election, pleading for the country’s citizens to return home.
  9. Refugee camps in Liberia were never intended or designed to be long-term settlements. As a result, food rations, educational opportunities and medical care are becoming difficult to obtain for people seeking refuge in Liberia.
  10. The majority of people seeking refuge in Liberia are women and children. As a result, UNICEF is working closely in order to ensure proper medical care and child protection for these refugees. For example, in 2012 UNICEF helped more than 20,200 Ivorian and Liberian children through child-friendly education and healthcare programs.


The refugee crisis is putting a lot of financial pressure on Liberia. It is absolutely crucial that conditions improve for refugees in Liberia in the near future.

Morgan Leahy

Photo: Flickr

For more than  a decade, the water quality in Liberia has been a steady issue. In 2016, only 25 percent of the population had access to clean water. Currently, of the 4.5 million people populating the country, more than one million are unable to access safe drinking water.

According to World Bank, the water quality in Liberia has been an issue ever since the country’s second civil war ended in 2003. For nearly 14 years, numerous Liberian citizens have been in vital need of access to clean water, but have failed to receive the assistance necessary to remedy the situation.

Unfortunately, many individuals living in Liberia have suffered from prevalent health issues due to the unsafe water conditions. In addition, many citizens are being forced to pay extra expenses daily so that they can buy clean water rather than rely on contaminated wells. In an article by FrontPageAfrica (FPA), a concerned citizen complained about the crippling effect of financial expenditures that she has been forced to make in order to buy clean water to do her laundry.

Research by WaterAid, an international charity dedicated to the access of clean water, shows that fewer than 20 percent of Liberians have access to sanitary toilets and more than 500 Liberian children die each year from diarrhea caused by unsanitary conditions. Additionally, 3.5 million people within the country have inadequate access to proper sanitation.

Chuchu Kordor Selma, WaterAid’s team leader in Liberia, voiced her concern over this growing issue by inferring that the number one most important way to satisfactorily address the quality of water in Liberia is by sufficiently investing in the government sector. Furthermore, WaterAid has been steadily working throughout the last year to produce increased access to clean water and proper sanitary conditions within the country. Due to the organization’s unfailing persistence, more than 12,000 Liberians have been provided with safe water and more than 10,000 have been provided with improved sanitary conditions.

Lael Pierce

Photo: Flickr

Liberia, officially the Republic of Liberia, is a country on the West African coast that is home to roughly 4.5 million people. Due to a recent civil war and outbreak of the deadly Ebola virus, the country has become vulnerable to poverty and hunger. Here are 10 facts about hunger in Liberia.

10 Facts About Hunger in Liberia

  1. Poverty in Liberia is high, and approximately 83.3 percent of the population lives on less than $1.25 a day.
  2. High levels of poverty often lead to hunger. Around 16 percent of households in Liberia are food-insecure and two percent are severely food-insecure.
  3. Food makes up a large portion of Liberian families’ expenses, with one-fourth of Liberian families spending more than 65 percent of their income on food. Some people are forced to resort to emergency coping strategies, such as begging, in order to feed their family.
  4. Liberia is classified as a low-income, least developed and food-deficit country. It ranks as number 177 out of 188 countries in the 2015 Human Development Index.
  5. Liberia is in the process of recovering from a 14-year civil war that destroyed social services and infrastructure critical to combating poverty and hunger in Liberia.
  6. An Ebola virus outbreak in March 2014 also had a detrimental impact on Liberia’s economy. Economic growth fell from an estimated 5.9 percent to between 0.7 and 0.9 percent in 2014.
  7. Refugees living in Liberia are even more vulnerable to hunger. The country has hosted approximately 39,000 refugees since December 2015, primarily people from Cote d’Ivoire. Those who live in camps are especially at risk for hunger.
  8. Livestock farming in Liberia is unable to meet the population’s demand. As a result, 80 percent of the country relies on fish as a protein source. However, climate change has led to flooding and rising sea levels that threaten Liberians’ ability to fish.
  9. Insufficient access to education contributes to poverty and hunger in Liberia. Only 26.7 percent of children are enrolled in school.
  10. Girls in Liberia are especially likely to be taken out of school early, either to help with work at home or as a way to save money. The World Food Programme offers take-home rations to girls as an incentive for families to keep them in school.

While the people of Liberia continue to face obstacles as they rebuild their country’s economy, continued international support and investment in education and infrastructure could help stabilize the country and reduce hunger.

Alexi Worley

Photo: Flickr

Diagnostic Methods Build the Foundation of Outbreak ControlDisease outbreaks are frequently portrayed by the news and other media as two-step occurrences: disease strikes, then people die. What’s left untold are the in-between moments that are crucial to outbreak investigation and disease outbreak control. Disease testing, the essential step of the diagnostic process, is one of the most useful tools in stabilizing disease outbreaks and preventing them from worsening.

The case of Ebola in Liberia provides an example of how breakthrough disease-testing methods can save thousands of lives. Jude Senguku, one of the leading physicians who treated Ebola patients in Liberia, told BBC that misinformation, panic and misdiagnosis kept people from seeking help at the onset of symptoms.

People knew very little about the deadly disease and feared being sent to Ebola isolation units. Public health workers needed better diagnostic methods to screen people for Ebola in order to obtain medical evidence that would support or invalidate a diagnosis.

For Monrovia’s Redemption Hospital, the solution came in the form of GeneXpert, a machine that rapidly tests for Ebola and provides results within 90 minutes.

At the beginning of the Ebola outbreak in 2014, there were 50 licensed doctors for a population of 4.3 million. To provide each symptomatic person a one-on-one doctor visit was both unfeasible and impractical. During and after the outbreak, GeneXpert allowed health care workers, including volunteers with limited medical training, to accurately test patients for the presence of the Ebola virus and direct them to care in time to receive life-saving treatment.

Senguku says that since 2014, GeneXpert was “very critical” in reducing Ebola scares and restoring Monrovia’s confidence in their doctors.

The technology uses a process called DNA amplification, which tests a human specimen — cheek cells, saliva, etc. — for the disease’s specific DNA sequence. In contrast to other diagnostic methods, the technology can identify extremely low amounts of viral DNA as well as drug-resistant strains, which makes it incredibly sensitive and accurate. The machine, which is used for multiple tests, costs about $17,000. The test cartridge, which is used in every test per person, costs a mere $10.

One of the technology’s most valuable features is its usability. The health care worker administering the test does not need to be trained to identify a specific disease. Rather, they simply need to know how to operate the machine. Moreover, because of its low dependence on electricity, GeneXpert is an ideal diagnostic tool for regions with limited access to power.

The diagnostic process plays a critical role in outbreak control, stabilizing population health and providing a sense of security to an affected community. Events like the Ebola outbreak of 2014 serve as examples of how improved diagnostic methods are helping health care workers deliver faster and more efficient care under strenuous circumstances.

Jessica Levitan

Photo: Flickr

Liberian MidwivesAlthough Liberia has been Ebola-free for over a year, the devastation the disease wreaked on the Liberian healthcare system persists. Liberian midwives are increasing in number, but they face many challenges.

Liberia was the center of an Ebola outbreak in 2014 that claimed the lives of roughly 180 healthcare workers. In the midst of the epidemic, maternal death rates rose, and they have been slow to decline.

Hannah Gibson, a trainee in a program designated to teach advanced obstetrics to midwives, recounted the panic that struck the Liberian healthcare system when patients suffering from Ebola first began to surface.

Many Liberian midwives abandoned their positions, leaving hospitals understaffed. Gibson and a few of her coworkers eventually quarantined themselves in their hospital, working around the clock to provide medical care for the women in the maternity unit.

Even before the Ebola outbreak, the number of obstetrician-gynecologists in Liberia was low. According to Liberian minister of health Bernice Dahn, today there may be fewer than five.

During the outbreak, Gibson became one of the first Liberian midwives to be trained by British NGO Maternal and Childhealth Advocacy International (MCAI). The NGO proposed teaching surgical procedures such as caesarean sections to midwives in order to bridge the gap in prenatal care in Liberia. The training empowers midwives to operate, resulting in more positive outcomes in semi-complicated childbirths.

Unfortunately, specialized midwifery like this is not accessible to all expecting mothers. There are currently only 400 trained midwives in the Liberian healthcare system, a number too small to meet the needs of over four million people, and the majority of midwives reside in urbanized sectors.

In Liberia, 44 percent of women give birth with no medical attendant because they live in rural areas where care is too far away to obtain. One in every 138 live births results in a mother’s death due to preventable complications requiring basic medical care.

The World Health Organization (WHO) is working with the Liberian Ministry of Health and Social Welfare to enhance Liberia’s six midwifery schools. But merely training midwives will not end the midwife crisis completely. Because midwifery in Liberia is a low-income profession with few opportunities to advance, retaining Liberian midwives is also a problem. Medical professionals trained in Liberia often take their credentials and move to countries that offer better salaries.

Fortunately, through a new Bachelor of Science midwifery program, midwives will be able to further their careers within the Liberian healthcare system, attending to peoples’ needs in understaffed locations. The Danish Midwives Association is giving program instructors current and advanced training in order to ensure the enterprise’s success.

Amy Whitman

Photo: Flickr

During the 14-year civil war in Liberia, the health system became increasingly fragile, and a lack of roads and transportation made it difficult for pregnant women to receive necessary emergency care. This issue has created a strong need for strengthened midwifery in Liberia.

As a result, Liberia had one of the highest maternal mortality rates in the world according to a 2015 USAID article, but the country is now trying to change that through investment in midwifery programs.

Currently, 44 percent of Liberian women give birth without a skilled attendant, and nearly one out of 138 mothers die from preventable causes during childbirth. Such issues could be avoided with basic or strengthened midwifery in Liberia, according to the World Health Organization.

Bentoe Tehounge, a trained midwife in Liberia, told WHO, “We need midwives who can ensure a safe pregnancy even before a woman is pregnant. People who can provide advice on family planning, nutrition, physical activity and preventing mother-to-child transmission of HIV.”

There are six midwifery schools in the Liberia, half of which are in rural areas, and less than 200 midwives for over four million people. Most of these midwives work in urban areas. Strengthening these schools, especially the rural ones, will improve access to quality care for women around the country.

Retaining these midwives is one step towards Liberia’s investment in the profession. According to WHO, many health professionals were driven out of the country due to the civil war and the Ebola crisis, and now midwives lack “safe accommodation and transport, are overworked and paid poorly and have limited opportunities for career advancement.”

A new B.S. program addresses a portion of these concerns by providing further professional development. The program graduates 50 to 75 registered midwives per class, which is expected to staff more than 700 health facilities in the country. To develop better teaching methods, Liberia is working with the Danish Midwives Association to pair Liberian and Danish midwives in order to learn more advanced skills, like preventing and treating hemorrhages. It is hoped that this new alliance will result in strengthened midwifery in Liberia.

In the United States, this final element is comparable to the apprenticeships or clinicals that midwives do to obtain a license. Mary Anne Brown, a midwife serving the Great Falls and Helena areas of Montana, said that degree programs require that their students find and work directly with a midwife to gain clinical experience.

Past midwife training in Liberia tried to work within a culture of home birth in Liberia (USAID reported that 63 percent of Liberian women gave birth outside of a health facility) and with the knowledge of traditional midwives.

The goal was to shift the focus to encouraging birth preparedness, recognizing and referring complications and providing appropriate emergency care through what USAID called “home-based life-saving skills.” By utilizing storytelling, case histories, discussion, role-play and demonstrations, midwives, expectant parents and community leaders were able to educate themselves at community meetings.

One of the greatest achievements of the previous midwife training in Liberia was its ability to connect traditional midwives to both health facilities and certified midwives. Certified midwives perform their own visits to discuss problems the traditional midwives are having, replenish supplies and reinforce the training.

The current programs are a part of WHO’s efforts to provide clear guidelines, tools and an evidence base to lead to strengthened midwifery in Liberia and around the world in order to improve care for pregnant women and reduce both maternal and neonatal mortality rates.

Anastazia Vanisko

Photo: Public Domain Images