June 25. II. Health Status in Sierra Leone

I want to be careful to use the word, “worst” or “poorest.” These words sound really bad. Surprisingly, it is hard to explain the health status in Sierra Leone without using these adjectives. According to UNICEF, child mortality rate (deaths of children under 5-year-old per 1,000 live births) is 182 in Sierra Leone, which is the highest in the world. Almost 20% of Sierra Leone children cannot see their 6^th birthday in their lives. Even Somalia has lower child mortality rate – 147/1,000 live births – than Sierra Leone. WHO estimates that under-five mortality rate in Sierra Leone is 267/1000 live births, more than one-fourth children die before 60 months.

Under-5 age child mortality rates (deaths per 1,000 live births)

The number one cause of deaths in Sierra Leone is malaria. Malaria burden were more than 500 per 1,000 populations in 2003, and it decreased to 330 per 1,000 in 2007. That means half of people suffered from malaria, and still, one-third of people are not free from malaria these days.

Maternal mortality ratio is 495/100,000 births (2004) in Sierra Leone, which is one of the highest maternal mortality rates in the world. The contraceptive prevalence rates are 5% and exclusive breastfeeding rate is 8%. However, HIV/AIDS prevalence is only 1.50% (CIA, 2012), even though it has becoming threat to Sierra Leone. The highest HIV/AIDS prevalence rate is 26.50% in Swaziland, and South Africa is 4^th ranked, 17.90%.

Marriage before age 15 is 27% and before age 18 is 62%. Teenage pregnancy is a serious health problem in Sierra Leone; 40% of maternal deaths are a result of teenage pregnancies, and 70% of teenage girls are married and most of them drop out of school. Total fertility rate, which is the number of children that a woman give birth to, is 5. Life expectancy is 49.4 years. Adult literacy rate is 25%. Net primary school attendance rate is 48%, and net secondary school attendance rate is 19%. About two-third of population live in rural areas, but more than half of the 23 secondary care institutions are in capital city, Freetown.

According to 2007 Human Development Report, Sierra Leone is the least developed country in the world; its Human Development Index ranks as 177 out of 177 countries. GDP per capita (PPP) is $700, which is 102^nd out of 108 countries, and Human Poverty Index (HPI) is 51.7.

I looked around in Freetown. People are going somewhere, taxies are always honking horns, and motorbike drivers are standing in a line and waiting for passengers. Christians in churches are enthusiastic in their praises of, and security men at hotels and apartments are standing guard for 24/7. On the surface, everything seems to be fine. Where is Ebola virus? Where are starving children? Where are single teenage mothers? Inconvenient truth is that there is nothing that I can do right away. I am here to plan. I am here to estimate the impact of childhood/maternal health intervention. So then, when do we implement those interventions? Time is passing by, but I am slow in progress.

Reference: 

http://www.who.int/countries/sle/en/

http://www.wvi.org/child-health-now/publication/uncounted-and-unreached