History and Current Statistics of Shenge in Sierra Leone, West Africa Too many mothers and babies have died during birth in Shenge due to the distance from a hospital and health clinics. Most of these deaths are due to preventable causes. Without further improvements, the number of women and children who die will continue to rise.

Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth. In East and Southern Africa, 1 out of 4 children will die before the age of fifteen. An African woman has a 1 in 39 risk of dying from pregnancy-related causes, while the equivalent figure in developed countries is 1 in 4,900

The first 28 days of life are extremely fragile in Africa. Too many children die and far too many are less than one month old. In fact, Forty-six percent of all mortality for children under five years of age occurs during the first 28 days of life. Years of life lost from newborn (commonly referenced as “neonatal”) conditions now surpasses that from HIV and tuberculosis, or from malaria and neglected tropical diseases. To reduce under-5 mortality, neonatal death must be addressed, but access to quality, life-saving newborn care—which requires well-trained staff, quality surgical capacity, and developed health systems—is extremely limited.

Background information on Sierra Leone Shenge is a coastal town situated in Kargboro chiefdom, Moyamba district in southern Sierra Leone. The main economic activities are predominately fishing and farming, which are the main sources of income. Shenge is a hard-to-reach community with bad road networks, especially during the rainy season causing waterlogged landscape. Women in Kargboro chiefdom including the neighboring chiefdoms are one of the most vulnerable populations because of their poor socio-economic and educational status.

A country of over 7 million people, Sierra Leone has struggled to rebuild its health care infrastructure since the end of the civil war in 2002 and the complications aggravated by the outbreak of Ebola in 2014 that killed almost 4,000 people and the ongoing Covid-19 pandemic. The overall health infrastructure is inadequate to serve the population’s health needs, and the limited facilities that do exist are often understaffed and lacking proper equipment and supplies.

Sierra Leone has one of the highest maternal mortality and Infant Mortality ratios in the world. Poor access to maternal and child health services and the low rate of skilled birth attendance makes Sierra Leone one of the most unsafe places for women to deliver. One of the key strategies for averting maternal and infant mortality is ensuring that quality skilled birth attendance is available, accessible, and used throughout the country. The size of the competent health workforce including Community health practitioners, nurses, doctors, and midwives, required to provide universal health coverage for the basic package of care is inadequate and mal-distributed, making it very difficult for rural pregnant and lactating mothers including their babies to access quality RMNCAH services. Additionally, low male involvement and participation is also reported to result in poor access and utilization of services.

In the bid to reducing infant and maternal mortality the Government through the Ministry of Health and Sanitation (MOHS) has policy which stipulates that BeMNOC facilities in all community health centers situated in chiefdom headquarter towns should be upgraded to deliver quality essential maternal and child health services. Eighty percent (80%) of the community health centers are yet to meet BeMNOC compliance standards as stipulated in the Basic Health Essential Package Handbook.

The only Health facility located in Shenge Town does not have enough space to cater for all the services (treatment of patients, antenatal Clinic, Growth Monitoring, post-natal services, delivery, health education, Laboratory services, and immunization) to be provided by a referral Health facility. The existing health facility lack space for Antenatal clinic, delivery room, observation room, immunization, and growth monitoring sessions. The Shenge Health facility is currently serving a population of 115,319 and referral health center for 506 villages in Kargboro, Timdale, Kongbora and Bagruwa chiefdoms. Currently there is no existing functional means of communication in the district for reporting emergency obstetric cases like delayed difficult labor and reliable ambulance services to transport pregnant women in labor from remote villages to the referral district hospital. The District referral hospital is located about 100 kilometers from the nearest village in the three chiefdoms (Kargboro, Bagruwa, Timdale and Kongbora). Furthermore, the distance between Shenge health facility and the other villages in the three chiefdoms is far which make referral of emergency obstetric cases virtually impossible. The lack of maternity Hospital in Shenge, ambulance services and means for reporting referral cases has resorted to high rate of maternal death in the three chiefdoms. Last year alone, ten pregnant women lost their lives during labor due to Ante partum/postpartum bleeding as result of lack of reliable referral system.

The existing health clinic in Shenge Town does not have the space or means for Antenatal care to treat pregnant patients in need of care and is lacking delivery rooms, observation rooms, growth monitoring, health education, laboratory services, post-natal services, and immunization care. It currently serves as a referral health center under the Basic Emergency Obstetric Maternal and Newborn Care (BeMNOC) for villages in Kargboro, Timdale, Kongbora and Bagruwa chiefdoms. Currently there is no existing functional means of communication in the district for reporting emergency obstetric cases like delayed difficult labor and there are no reliable ambulance services to transport pregnant women in labor from remote villages to the referral district hospital. Furthermore, the distance between Shenge health facility and the other villages in the four chiefdoms is far which makes referral of emergency obstetric cases virtually impossible. The lack of maternity Hospital in Shenge, ambulance services, and means for reporting referral cases has resorted to a high rate of maternal death in the four chiefdoms.

Situated on the West Coast of Africa, Sierra Leone borders Guinea and Liberia and has an estimated population of 7,092,113 million people. Of these, an estimated 4,187,016 (59%) and 2,905,097 (40 %) reside in rural and urban areas respectively. The 2015 Population and Housing Census (PHC) results reflect the demographic profile of a young population where 40.9 % of the total population is under 15 years. The country has five administrative regions of: Northeast, Northwest, Southern, Eastern and Western. The four regions are further sub-divided into 16 districts and 149 chiefdoms. Districts are governed by a council consisting of a district chairman, administrators, and counselors while chiefdoms are governed by locally elected paramount chiefs. The main economic activity is predominately agriculture especially in the rural areas and others like mining and fishing along the coastal lines. Like many other sub-Saharan Africa countries, Sierra Leone has high out of pocket expenditure for health. Out of the total health expenditure of approximately $95 per capita, 13% is from donors, 16% from government, and the rest 71% from private out-of-pocket household contributions. In real terms government expenditure for health, Sierra Leone is at 12.3%, which falls short of the Abuja declaration of 15 %.

Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth. In East and Southern Africa, one in every four children will die before age 15. An African woman has a 1 in 39 risk of dying from pregnancy-related causes, while the equivalent figure in developed countries is 1 in 4,900. The first 28 days of life are extremely fragile and too many children die and far too many are less than one month old. In fact, Forty-six percent of all mortality for children under 5 years of age occurs during the first 28 days of life. Years of life lost from new-born (commonly referenced as “neonatal”) conditions now surpasses that from HIV and tuberculosis, or from malaria and neglected tropical diseases. To reduce under-five mortality, neonatal death must be addressed, but access to quality, life-saving new-born care which requires well-trained staff, quality surgical capacity, and developed health systems is extremely limited.

Most deaths are attributed to nutritional deficiencies, pneumonia, diarrheal diseases, anemia, malaria, tuberculosis, and HIV/AIDS. This situation is worsened by the Ebola and Covid-19 epidemic outbreaks which had a devastating impact on the health care systems. The government of Sierra Leone is committed to ending preventable maternal, new-born, child and adolescent deaths as well as improving their wellbeing through the NHSP and Recovery plan. The Reproductive, Maternal, New-born, Child, and Adolescent Health (RMNCAH) Strategy 2017 to 2021 is a further demonstration of the country’s commitment to the health of women, newborns, children, and adolescents.

Bottlenecks to access and utilization of RMNCAH services were both demand and supply side barriers identified as negatively impacting access and utilization of high impact interventions. Demand side barriers include socio-cultural practices, geographical limitation, and financial barriers. Supply side barriers were mainly health systems disparities which include inadequate (numbers and skilled) doctors and nurses, demotivated and mal-distributed human resources for health, unstable commodities for supplies, weak infrastructure, poor referral, low community involvement, and weak health information systems, as well as poor governance and coordination of the sector.

The construction, staffing and equipping of Emergency Obstetric Maternal and Newborn Care (BeMNOC) Centre (Maternity Hospital) in Shenge, training of health facility management Board, provision of Ambulance and mobile phones for reporting referral of emergency obstetric cases will contribute to reduce both maternal and infant morbidity and mortality in Moyamba district