Socio-Economic and other variables affecting maternal mortality in Sierra Leone

Abstract

This study identifies socioeconomic and health care variables affecting maternal mortality in 12 villages in Gbendembu Ngowahun Chiefdom in Sierra Leone. Data were obtained from Bombali district in the Northern Province. The villages include about 245,000 people. Analysis is based on interviews, participant observation, and health records from primary health care (PHC) centers and peripheral health units (PHUs). Interviews were conducted among 400 households and among 31 traditional birth attendants (TBAs) and PHC staff during November 1989 to February 1990. Findings indicate that high parity was related to early marriage. Over 40% of women were married by the age of 15 years. About 85% of women aged 45-49 years had 6 or more children. 55.1% had 9 or more children. Localized areas within the Chiefdom had even higher fertility. Fertility was somewhat lower among women living beyond a 3-mile radius of the PHUs. Most of the women had never had any formal primary education, particularly older women. More people were Christians than Muslims. About 80-90% of the population was composed of very poor subsistence farmers. During the rainy season people went hungry. Few could afford health care. About 69.5% of deliveries in the prior 24 months occurred at home, 21.5% were performed at a health center, and about 9% occurred in the hospital. The health units were located in Gbendembu and Kalangba. One aide per unit was assigned to maternal and child health services. The program aim--to reduce maternal mortality by 30% by the year 2000--is unattainable. Many factors are constraints to quality health care. Facilities were inadequate, prices were high, and nurses were unfriendly. Over 70% of deliveries within 3 miles of PHUs and over 90% of outside deliveries were performed by TBAs. Over 60% of TBAs were untrained and did not use sterile supplies.