Countries of the World/COUNTRYS.BIN/dp/0314/03147.txt

Text File | 1991-06-25 | 18KB | 322 lines

$Unique_ID{COW03147}
$Pretitle{380}
$Title{Sierra Leone
Chapter 6B.   Health}
$Subtitle{}
$Author{Irving Kaplan}
$Affiliation{HQ, Department of the Army}
$Subject{health
development
number
water
diseases
medical
percent
community
sierra
hospitals}
$Date{1976}
$Log{}
Country:     Sierra Leone
Book:        Sierra Leone, A Country Study
Author:      Irving Kaplan
Affiliation: HQ, Department of the Army
Date:        1976

Chapter 6B.   Health

     In the mid-1970s Sierra Leone's health infrastructure was characterized
by a lack of medical facilities; too few doctors, nurses, and other medical
personnel; and insufficient supplies of medicine. The prevalence of a number
of serious diseases, coupled with widespread malnutrition, made for a life
expectancy that was, according to United Nations projections for 1970 to 1975,
forty-two years for men and forty-five for women. The mortality rate for
infants under one year was estimated by the United Nations to be 183 per 1,000
(see ch. 3).

     The 1975-79 development plan deals with two of the most serious problems:
the acute shortage of medical personnel and the geographical imbalance of
services. One-third of the facilities are in the Western Area where only
one-eighth of the population lives, and even there they are concentrated in
Freetown. In the provinces most villages do not have even a resident trained
midwife.

Prevalent Diseases

     Parasitic and infectious diseases, including influenza and pneumonia,
accounted for almost half of all registered and certified deaths in the
Western Area during the 1969-71 period. The 1975-79 development plan suggests
that these diseases are responsible for a substantially higher proportion of
deaths in the provinces and that the national average is about 60 percent.
Malaria, measles, tuberculosis, anemia, and various illnesses caused by
dietary deficiencies were also prevalent. Complications during pregnancy and
childbirth accounted for 27.8 percent of all deaths of women in the Western
Area between fifteen and forty-four years old.

     Health authorities consider malaria the most serious contributor to
chronic ill health. It is believed to be endemic in about 80 percent of the
population. Almost all children suffer from malarial attacks until they
acquire a state of partial immunity. Although by itself seldom fatal, malaria
weakens its victims and makes them susceptible to other diseases. During the
1969-71 period malaria was thought to be the major contributing factor in 9.4
percent of all the deaths occurring in the Western Area.

     Crowded living conditions, inadequate diet, and physical weakness because
of other illnesses contribute to the high incidence of tuberculosis. A World
Health Organization (WHO) team discovered in the 1958-59 period that 16
percent of children under ten were infected with tuberculosis-one of the
highest rates in Africa. More recent estimates of the number of adults
affected by tuberculosis varied considerably, but their number was considered
to be substantial and on the increase.

     Schistosomiasis (formerly referred to as bilharzia) presents a major
health hazard in Eastern, Southern, and part of Northern provinces, especially
in the vicinity of streams and swamps. In schistosomiasis the
disease-producing organisms penetrate the skin of the foot when a person
enters a contaminated body of water. The organisms reproduce in the liver, and
some of them are returned to the soil and water through the victim's urine.
One stage in their development is carried out in snails living in the swamps
and rivers (the popular name of the disease is snail fever). Thereafter the
organisms live in stagnant water until they find another human host. Like
malaria, schistosomiasis causes general debility and lassitude and is
disabling rather than fatal. It is extremely difficult to eliminate because
the eradication of snails is a very costly process.

     Two intestinal diseases, gastroenteritis and helminthiasis, are very
common because of frequently contaminated water supplies and widespread lack
of proper sanitation. Cases of blindness resulting from onchocerciasis are
frequent in villages near rivers, which are the breeding grounds for the
Simulium fly (black fly), the main carrier of the parasite. In this illness
tiny worms move through the body just under the skin causing blindness when
they reach and affect the eye. Occasionally the infestation drives the human
host to insanity. A survey conducted during February and March of 1973 along
the Rokel River indicated that onchocerciasis might be more widespread than
had previously been assumed.

     Leprosy is quite prevalent, but the precise number of cases is not known.
(A random survey carried out by the British Leprosy Relief Association in the
late 1960s suggested that there were about 80,000 cases.) Measles is
widespread and has a very high mortality rate. Venereal disease, 70 to 80
percent of it gonorrhea, is fairly common. In the 1969-71 period tetanus
accounted for over 25 percent of all the deaths of infants under one year in
the Western Area and often caused deaths of mothers after childbirth.

     Large-scale immunization programs have proved successful in fighting
smallpox. In 1974 no new cases had been reported since 1969. Two other
diseases that have been brought under control are sleeping sickness and yaws,
but active surveillance continues. A sudden outbreak of cholera in 1970
demonstrated the need for continued vigilance, but in 1974 no new cases had
been reported for the previous two years.

     Malnutrition in association with measles, malaria, pneumonia, and
intestinal infections contributes substantially to the high rate of infant
mortality. Nutritional deficiency causes kwashiorkor and marasmus in children
and anemia in pregnant women and children. Anemia ranks fourth as a recognized
cause of death.

     Various skin lesions attributable to nutritional deficiencies are common
and are slow to heal because of the climate. Goiter is endemic in the
northeastern highlands, where the iodine content of the water is very low.

Medical Services

     The Ministry of Health is responsible for the administration of all
government hospitals, health center, and dispensaries. The ministry comprises
an administrative branch under a permanent secretary and a medical branch
under a chief medical officer, who is adviser to the minister of health. A
considerable part of Sierra Leone's medical care is also provided by
missionary societies and mining companies.

     Various units in the Ministry of Health deal with such specific areas as
leprosy, health education, and nutrition. The mobile Endemic Diseases Control
Unit, headed by a senior medical officer, has been successfully controlling
sleeping sickness, cholera, and smallpox. Short-term consultants from WHO and
the United States Agency for International Development (AID) assist this unit.

     In the mid-1970s most hospitals lacked modern equipment, were old and
overcrowded, and often operated at two to three times their capacity. Twenty
government hospitals existed at independence in 1961. Eighteen were general
hospitals, and two were specialized: the Kissy Mental Hospital and the Lakka
Chest and Infectious Diseases Hospital. Another hospital was being built in
Kailahun in 1974. In the mid-1970s there existed eight mission hospitals,
three of which were specialized, and three hospitals run by mining companies.
In addition health centers, dispensaries, treatment centers, and mobile units
provided health care. Some of these were built by local self-help teams, such
as a small hospital facility at Port Loko in 1975. Their total number had been
raised in the first decade after independence, but several chiefdoms remained
without a health facility in 1972. The total number of beds at the end of 1972
(excluding those in mining hospitals) was 2,155. This provided a countrywide
ratio of 0.8 bed per 1,000 people, a ratio that, according to the 1975-79
development plan, was to be rais