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Maternal Mortality in Sierra Leone

Maternal Mortality in Sierra Leone

Maternal mortality may not be a constant fear of yours if you think about pregnancy. However, this threat has not been eliminated in many parts of the world. Simply because developed countries have significantly decreased this issue with medical advances, many women in various regions must contend with this terrible plight. Maternal mortality in Sierra Leone, specifically, is still considered to be of high risk and something women should consider prior to pregnancy.

The Most Dangerous Place to Become a Mother

The most dangerous place in the world to become a mother, in fact, is Sierra Leone. This country has one of the highest maternal mortality rates globally. Around every one in 17 pregnancies end in the death of the mother- an overly alarming statistic. An endeavor that is supposed to be filled with joy and excitement is now clouded with fear as mothers worry about their health instead of being able to focus on their babies. This worry is not one experienced globally: Sierra Leone women are 300 to 400 times more likely to die with each pregnancy in comparison to women in Sweden, Finland, and other high-income countries.

Factors That Contribute to Higher Rates of Maternal Mortality in Sierra Leone

Postpartum hemorrhaging has accounted for 32% of deaths along with bleeding, hypertension, abortions, obstructed labor, and infections. Hemorrhaging is problematic because a blood transfusion is required immediately to resolve the issue. However, when a woman gives birth at a local clinic, it can take hours to transport her to a hospital for the procedure. Unfortunately, many women bleed to death while waiting. However, most of these conditions can be treated with the correct healthcare, but due to extreme poverty, an overwhelming percentage of families do not have access to the necessary care.  This has resulted in unnecessary deaths.

Another significant factor that contributes to higher maternal mortality rates is that women in low-income countries tend to have more children. As a result, this increases their risk of complications. On average, women in Sierra Leone have five children, which, is considerably high when looking at countries like the United States whose average is 1.73 children. More children typically mean earlier pregnancies. In a 2016 report, researchers found 20% of deaths were girls ages 15 to 19 years old; a grim statistic especially when considering a 15-year-old is three times more likely to die during childbirth than a 22-year-old.

The Good News

Although the facts appear troubling, all hope is not lost. The United Nations has recognized maternal mortality as a serious issue. Thus, it has begun to combat the risk of death during pregnancy and the six weeks that follow.

The UN agency called the United Nations Fund for Population Activities (UNFPA) has started supporting midwifery through three government-run schools that graduate 150 students each year to tackle the high mortality rates. This alone will not improve the situation, as the majority of women in Sierra Leone already have midwives. It should result in better outcomes as these midwives will be better trained and even more common.

The UNFPA also focuses on family planning which reduces mortality by 25 to 30%. This UN organization provides 90% of the country’s forms of contraception through an annual $3 million budget. They estimated that from 2015 to 2017 this service prevented 4,500 maternal deaths and 570,000 unplanned pregnancies.

Maternal mortality in Sierra Leone may be among the highest rates in the world, but the country is taking imperative steps to diminish the risks, steps that have been working thus far. By 2023, UNFPA hopes that they can reduce adolescent births to 75 per 1,000. This, in turn, will massively decrease maternal mortality.

– Victoria Mangelli
Photo: Flickr

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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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10 Facts About Sanitation in Sierra Leone

Sanitation in Sierra LeoneSierra Leone is a country on the west coast of Africa with a population of more than 7.5 million people and is perhaps most widely known for its turbulent diamond trade. The country’s heart resides in its lively capital, Freetown and it attracts many visitors with its beautiful beaches and vibrant rainforests. Despite its rich natural resources, the country struggles when it comes to providing adequate sanitation services for its citizens. Here are 10 facts about sanitation in Sierra Leone.

10 Facts About Sanitation in Sierra Leone

  1. A decade-long civil war severely impacted the country’s infrastructure. Ensuring access to safe water and sanitation services has been a top priority during Sierra Leone’s post-conflict governance reform. However, there is still much work to be done to restore services that halted during the war in the 1990s.
  2. Waste management is a major challenge. The Minister of the State, Office of the Vice President, Mohamed Alie Bah said in 2017 that the increasing amounts of solid waste need to be addressed, as the problem will only worsen with expected population growth. The Ministry of Health and Sanitation in Sierra Leone is troubleshooting the most effective and sustainable ways to address the problem with the hopes of improving overall health and wellness in their communities.
  3. Nearly 3 million people lack access to clean water. As a result, millions drink from freestanding water such as ponds and unprotected wells, which increases the likeliness of exposure to infections and parasites. According to a 2017 report, risks associated with poor water, sanitation and health facilities are the second largest cause of death and disability. The Water Project is an example of one nonprofit working to improve clean water access in Sierra Leone. To date, the group has built wells that have benefited 7,000 Sierra Leoneans to date.
  4. Diarrheal disease is a leading cause of child death. Drinking unclean water that contains bacteria or parasites can lead to an infection in the intestinal tract. Diarrheal disease usually results in malnutrition and dehydration, which can become fatal. In Sierra Leone, more than 1,400 children die from diarrheal diseases each year.
  5. Sierra Leone is trying to improve water quality and availability. Officials in Sierra Leone are aware of the importance of providing adequate drinking water and are currently taking steps to conceptualize, budget and fundraise for systems that would hopefully improve the country’s water supply. Due to a lack of funding, it appears that the project will be a collaborative effort between several sectors and organizations. An anticipated $164 million annual investment is needed to create and maintain rural and urban water supply facilities. Even with donations from organizations such as the World Bank and UNICEF, the monetary goal is expected to be missed by a large margin, around $130 million.
  6. Sierra Leone has one of the world’s highest maternal mortality rates. While a majority of maternal deaths are caused by severe bleeding, 11 percent of the deaths are caused by sepsis. Most maternal deaths are treatable and preventable, and this statistic is another indicator of the changes that still need to be made. Over recent years, the Ministry of Health and Sanitation in Sierra Leone has partnered with the World Health Organization to implement several health initiatives, including the Emergency Obstetric and Newborn Care training program, which aims to ensure health care professionals have the knowledge needed to manage child-birth related complications.
  7. Hand-washing facilities are often lacking. According to a report published by the Government of Sierra Leone in 2017, 27 percent of people in urban areas have access to hand-washing facilities with soap and water, and only 15 percent of people in rural communities have the same access.
  8. Household toilet facilities are often inadequate. Nationally, only 16 percent of households have an improved toilet facility, which is defined as “a non-shared facility constructed to prevent contact with human waste.” These facilities reduce the spread of diseases such as cholera and typhoid. Conversely, 18 percent of households nationwide do not have access to any toilet facilities, and instead, must defecate outdoors.
  9. Poor menstruation hygiene management affects girls’ education in Sierra Leone. Girls in Sierra Leone can face several challenges while menstruating, especially while attending school. The quality of restroom facilities can vary at schools, but oftentimes there are not bathrooms with running water or separate facilities for girls. This leads to girls having difficulty disposing of pads and managing their periods, which can leave them feeling embarrassed or distracted during classes. Others miss school altogether during their periods.
  10. Training is being offered to prepare Sierra Leone for future disasters or outbreaks. The CDC offers water, sanitation and hygiene (WASH) training to help at-risk countries strengthen their infrastructure and workforce to ensure they are prepared to prevent, detect and respond to infectious disease threats. There are several facets to the training, such as Outbreak Investigation Training, which trains public health staff to detect and respond to waterborne diseases, and training to teach students how to test water samples for contamination.

Improving sanitation in Sierra Leone has been a priority for the nations’ leaders for decades. While finances continue to be a challenge, improvements have been made thanks to the efforts of organizations within the country, such as the Ministry of Health and Sanitation, as well as organizations outside of the country, such as the World Health Organization.

– Lindsey Shinkle
Photo: Flickr

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Key Improvements in Maternal Health in Sierra Leone

Improvements in Maternal Health in Sierra Leone
The life expectancy of women in Sierra Leone is just 61 years old. The country leads in the world in maternal mortality ratio, ranking in 1,360 deaths per 100,000 live births — nearly 500 more than the next nation and three times higher than the average for sub-Saharan Africa. Lack of clean water and well equipped sanitary equipment has unsurprisingly come with generally high maternal health risks. Maternal health in Sierra Leone is improving (albeit with further necessary upgrades) despite its numerous impediments.

Sierra Leone’s Economic and Political State

In 2010, the government in Sierra Leone announced an ambitious program — the Free Health Care Initiative — to provide free care in public facilities for pregnant and lactating women and young children. Still, mothers felt care to be inadequate as little transportation assistance, sociocultural barriers and poor quality still remain difficult years later.

In addition, a devastating 2014 outbreak of Ebola further stunted improvements in health conditions in the nation. In fact, according to a 2015 paper, the reduced number of health personal after the epidemic may have forced maternal mortality to increase by 74 percent in Sierra Leone. But workers are on the ground making progress — individuals from as close as neighboring communities, to as far as a dozen time zones away in Asia, are dedicated to creating improvements in maternal health in Sierra Leone.

Impact of Aid Organizations

A UNICEF partner, Sierra Leone Social Aid Volunteers, built modern toilets, a laundromat, incinerator, placenta pit, water well and water supply system in the nation. And that’s not all — UNICEF and other humanitarian aid organizations have offered aid to over 150 facilities across Sierra Leone.

Fatmata Conteh, midwife at the Konta Line Community Health Center, stated that as a result of these efforts, people in Sierra Leone “can easily clean the health facility and wash all our equipment here. Mothers have access to convenient toilets and water in the bathroom to have a bath after delivery.”

The health center where Conteh is employed provides service to over 7,000 individuals across nearly 30 cities in which nearly one half of patients are under the age of five. In December 2015, UNICEF, funded by the European Union, oversaw 16 separate construction and rehabilitation projects started across the country. All theses projects aimed to improve basic health infrastructure, including maternal facilities.

In November 2017, the World Health Organization (WHO) launched a new five-year strategy for Reproductive, Maternal, Newborn, Child and Adolescent Health in Sierra Leone. The strategy highlights several focus areas, including emergency obstetric and neonatal care, management of newborn and childhood illnesses and prevention of teenage pregnancy. This strategy will hope to launch off the recent progress of late — the females’ increased attendance (at least four checkups) during pregnancy and malaria treatment.

“WHO is proud to have supported the country in developing this strategy together with our partners, but we are also aware that this is just the beginning,” said Alexander Chimbaru, Officer-in-Charge of WHO Sierra Leone.

External Influencers

China has also been an influential partner in the region through its support of aid programs in Sierra Leone. In early June, a group of Chinese health workers touched down in Freetown and joined other medical technicians at the Jui China Sierra Leone Friendship hospital. The hospital provides medical care to children, pregnant and mothers free of charge.

To accompany such dutiful care, the first lady of Sierra Leone, Fatima Bio, officially launched the China-Sierra Leone Maternal and Child Health Care Innovation Project. At a launch event, Bio highlighted the importance of a strong education system and health network, as well as the negative effects of teenage pregnancy.

Closer to home, individuals make substantial sacrifices to assist mothers in giving healthy births. Health Poverty Action has featured Mary Turoy, a successful Maternal Health Promoter in the Kamalo village in the Northern Bombali District of the country. To mitigate the difficulties women face in just traveling to medical centers, Turoy and others in her community offer housing, pregnancy information and much-needed advice.

Maternal Health in Sierra Leone

One of the Sustainable Development Goal health targets is to decrease from 216 maternal deaths per 100,000 in 2015, to less than 70 maternal deaths. The United Nations (U.N.) holds that maternal deaths can be largely prevented if programs bolster the level of care during delivery. And improvements around the globe are, in fact, being made — infectious diseases and adolescent childbearing are down worldwide.

However, conditions remain the most concerning in sub-Saharan Africa. Improvements in maternal health in Sierra Leone are happening, but change is still necessary. Healthcare and maternal conditions in this coastal, west African nation are still an area of concern that could do with continued care today and in the future.

– Isabel Bysiewicz
Photo: Flickr