Analytical summary - Maternal and newborn health
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In addition to its high child mortality rate, Sierra Leone has one of the highest maternal mortality rates in the world, with a maternal mortality ratio of 857 per 100 000 live births.
The Sierra Leone Health and Demographic Survey 2008 reported that 87% of pregnant women had attended antenatal care at least once, only 25% of births were institutional deliveries and 43% were supervised by skilled attendants.
This is a surprising result and can only be true if a significant number were attended at home by professionals. The health management information system cannot provide such data. However, approximately 73% of births occurred in rural areas and many of these institutional deliveries were attended by maternal and child health aides who lack the competencies to qualify as skilled attendants.
There was an increase in antenatal care visits immediately after the introduction of the Free Health Care Initiative in April 2010. However, there was a downward trend in antenatal care consultations in November and December 2010.
To reverse this downward trend, community sensitization needs to be strengthened and the quality of services provided at antenatal care needs to be improved. Approximately 25% of births were delivered in a health facility, with the majority of births taking place at home. The proportion of babies born in a health facility was generally low in most regions but was lowest (15.5%) in the Northern Region. The proportion of children born in health facilities increased with increased level of education and wealth quintile of the mother.Caesarean section is a life-saving emergency obstetric care intervention when complications occur during childbirth. According to the Sierra Leone health and demographic survey 2008, only 1.5% of births were delivered by caesarean section. Caesarean section rate was 3.5-fold higher in urban areas than in rural areas (see figure).
Health management information system data reveal that caesarean section was used for 0.63% of all deliveries in 2009 and 1.14% in 2010. Although this shows an 80% average monthly increase, this figure is still very low. It shows that women who needed caesarean section were not receiving the services, considering that the United Nations recommended proportion of deliveries conducted by caesarean section is between 5% and 15% of all deliveries in the population.
The Sierra Leone health and demographic survey 2008 reported a neonatal mortality rate of 36 per 1000 live births and a postneonatal mortality of 53 per 1000 live births. No estimates for perinatal mortality are available at present.
The 2008 survey also reported that 11% of newborn babies who were weighed at birth were classified as low-birth-weight babies. These are a mix of premature and small-for-dates babies. While it is widely known that keeping low-birth-weight babies dry and warm is an important intervention contributing to the prevention of up to 40% of neonatal deaths, kangaroo mother care is not promoted and is hardly practised in Sierra Leone.
At national level, the contraceptive prevalence rate was 7%. A higher use of modern contraceptives was reported among women living in urban areas. Total fertility rate was reported as five children per woman. The rate of exclusive breastfeeding for the first 6 months after delivery was only 8%. The HIV prevalence rate among pregnant women was also reported to be 4.4%. Furthermore, only 15.2% of pregnant women received any Fansidar during an antenatal care visit, while 9.7% received at least two doses.
According to the health management information system, the proportion of pregnant women who took two doses of intermittent presumptive therapy for prevention of malaria increased from 58% in 2009 to 99% in 2010. This requires further investigation.
A large proportion of the maternal and neonatal deaths occur during the first 48 hours after delivery. According to the Sierra Leone health and demographic survey 2008, 74% of women in the richest group received postnatal care within 2 days of delivery, compared with 47% of women in the poorest group. In 2010, the health management information system data indicate that about 55% of all mothers sought postnatal care at a health facility in the first 7 days after delivery and only 38% sought postnatal care 6 weeks after delivery.
The Ministry of Health and Sanitation has special programmes for maternal and newborn health, for example the Reproductive and Child Health Programme and the Expanded Programme on Immunization. The Ministry has a budget for these programmes and this budget benefits from support from development partners.
Routine data collection and reviews into maternal deaths are continuing.
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Performance report. Government of Sierra Leone, Ministry of Health and Sanitation, 2010
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Sierra Leone health and demographic survey, 2008: key findings (pdf 3.15Mb). Calverton, Maryland, Statistics Sierra Leone and ICF Macro, 2009
- ↑ Leigh B. Child survival and development mid-term review report for the programme 2008–2010. Sierra Leone, United Nations Children’s Fund, 2009
- ↑ Health management information system report. Government of Sierra Leone, Ministry of Health and Sanitation, 2010