Sierra Leone

Sierra Leone is located in western Africa, between Guinea and Liberia on the Atlantic Coast. Once a colony for the Portuguese and the British, it became an independent republic in 1961. Civil war between 1991 and 2002 killed around 50,000 people and displaced 2 million more. While it has taken steps to regain political and economic standing in the world community, quality of life remains low and almost 70 percent of Sierre Leoneans live in poverty.

The population is 6,144,600, growing at 2.3 percent annually. The birth rate is 45.41 per 1,000 and the death rate is 22.64 per 1,000. Thousands of refugees still live in neighboring countries, and continue to trickle back. Median age is 17.5 years. Life expectancy is 38.36 years for males and 42.87 years for females. Gross national income is $220, with 57 percent of the population living on less than $1 a [Page 1544]day. Fifty percent of the total population may be undernourished.

Communicable diseases flourish in Sierra Leone. A 2004 survey by the Ministry of Health found that in four districts, the most common causes of morbidity and mortality were malaria, diarrhea, pneumonia, intestinal worms, scabies, anemia, acute respiratory infections, sexually transmitted diseases, tuberculosis, yellow fever, measles, leprosy, polio, meningitis, and AIDS. Malaria alone is responsible for 35 percent of outpatient cases and kills about 312 per 100,000, with a much higher rate in young children. Much of the country's water and sewerage infrastructure was damaged or neglected during the war, exposing people to typhoid, hepatitis A, schistosomiasis and cholera. There was an outbreak of Lassa fever in 2007.

AIDS and tuberculosis are believed to have spread rapidly during the war, and the adult prevalence rate for HIV may be as high as 7 percent. Tuberculosis prevalence is 847 diagnosed cases per 100,000, with 58 deaths per 100,000.

Women and children receive free healthcare from the government, but it has done little to diminish Sierra Leone's staggeringly high rates of child and maternal mortality. Only 4 percent of women have access to contraception, and the total fertility rate of 6 children per woman reflects this. Less than 70 percent receive prenatal care, and 42 percent have trained support during childbirth. The maternal mortality rate is estimated at 2,000 deaths per 100,000 live births, easily among the highest in the planet.

Child mortality is also among the world's highest, with 282 out of 1,000 children dying before their fifth birthday. Immunization rates are about 60 percent. Despite the fact that 1,500 per 100,000 children die of malaria, only 2 percent of them sleep under insecticide-treated nets. In 2003, UNICEF stated that 46 percent of deaths in children under 5 are in part attributable to poor nutrition. There are more than 340,000 orphans under the age of 17 within the country.

A large percentage of medical facilities were damaged during the war, and now need rebuiling, resupply, and upgraded equipment; 80 percent of rural health centers were completely destroyed. Overall, 90 percent of primary health centers are open but barely functioning. Fifty percent of the health system is run by the government, with the remainder in the hands of non-governmental organizations, for-profit institutions, and faith-based groups. Healthcare absorbs 3.3 percent of the gross domestic product, and Sierra Leone works with international donors on major initiatives. All agree that rebuilding will take time.

...