Healthcare Management Public Health Case Study

Healthcare Management Public Health

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Introduction: Healthcare Management Public Health

Mortality rates of infants and teenage mothers in Sierra Leone are found to be the highest following world records. There are higher incidences of prenatal deaths observed in Sierra Leone. Little knowledge is obtained regarding the cause of "premature mortality” in the country d Sierra Leone. The United Nations has estimated the birth life expectancy in the country in 2019 (Carshon-Marsh et al. 2022). The calculated “life expectancy at birth” is about 54 years which has marked the lowest among all countries across the world.

The mortality rate of teenage mothers and the prenatal in Sierra Leone is discussed in the essay. Death cause is recognized with several issues related to their health. The background and even the history of teenage pregnancy and prenatal death are Everly discussed in this topic. There is also evaluate the reasons for their death rate and various causes of the increasing rate of their death. Healthcare authority plays a vital role and responsibility in reducing the death rate of infants and even reducing the teenage pregnancy of young girls in Sierra Leone. Many people are engaged with different fields of society to overcome several issues related to these problems. Public health management helps those people who are suffering from these issues. Sierra Leone's education sector plan for 2022-2026 Exposed the concept of early-age pregnancy of young girls in the community area and even the prenatal deaths of the infants. It also helps the management of the government service of its own.

1. The Purpose

The main recognised issue is the “high rates of prenatal and teenage pregnancy deaths in the population of Sierra Leone”. The country Sierra Leone has the highest premature mortality rate in the world (Sierraleone.unfpa.org, 2023). It is important to implement the UN SDG of “Good health and well-being” for ensuring healthy lives and promote well-being at every age.

2. Summary of the Facts

Background

The maternal mortality rate in “Sierra Leone” is the world’s highest problem where approx. 1360 mothers die every approx. number of 100000 births of infants. The mortality rates of neonates and even infants and children aged under five years are also involved in this matter. It is the highest global rate of approx. 82-111 deaths happening per 1000 births of infants in the community of "Sierra Leone". In the year 2020, In "Sierra Leone" the child mortality rate was approx. 107.8 in 1000 newborn babies. The maternal death of this community is very high as per the research. It is a vital risk for the young aged mother as well as for the newborn babies of this community respectively (Pan et al. 2020). After recording the death rates of the community, the government of this community responded through cross-ministry collaboration and also with the multi-agency community to develop the current situation of the community regarding the death ratio of infants and the teenage pregnancy rate of young age girls. They mainly focus on the death ratio of infants and also help to reduce the rate of death cases in a certain time. It also helps the community and the government.

After recording the mortality death rates, the Government of Sierra Leone responded in 2013, by collaborating with "cross-ministry collaborations” and "multi-agency" and developed certain National strategies for the decrease in pregnancy teenage. After experiencing 10 years of brutal and deadly civil war, they finally got relief in "2001", (Panet al.2020)during the period of war there was barely any function of the health systems; also, they were under use by the people who were unable to provide the charges that are required for the treatment. Moreover, after the introduction of a free health care policy for pregnant and lactating women, in the year 2010, there was an increase observed in the use of health services. After the practice started the presence of a skilled delivery birth attendant caused less death and the life-saving rate increased from "42% to 60%" in the last 5 years from "2008 to 2013" (Legardy-Williamset al.2020). In previous days, the people were believed to have a weak heart rate and, thus suffered from stroke and diseases of heart, causing prenatal death. Certain other problems like "amniotic fluid embolism", severe bleeding, etc mostly caused prenatal deaths. Every country has certain goals for sustainable development and growth, which relate to the "Good health and well-being" goals for better living for women and decreasing the mortality rate. The background and the history of prenatal death and teenage pregnancy have been discussed in detail, where the reasons are discussed for which the death rate has increased in the past few days and how evolution in society and technologies have changed the current situation. Health care management plays a role and even the responsibility for noticing the direction of health care sectors and their facilities. People who are engaged in this field work influence the treatment process and the direction of the organization's procedure and even the policies. Public health management helps to put sources to optimal use of the services

After the introduction of free health care services for infants and teenage girls who became pregnant at a young age in their life span. There is also a saving rate which has increased from "42% to 60%" in five years from "2008 to 2013" (Legardy-Williams et al. 2020). In previous years people were suffering from various health-related issues in their community, but at that time many people were involved in the healthcare service of the community so they were very helpful to the authority. In the world, every country has its own rules and regulations of government. In that case, the community of “Sierra Leone” have to follow the basic rules and regulations of the government, so that the people of their community must be satisfied with the vital cause. Healthcare management plays a great role and responsibility for every healthcare sector. People who are involved in this matter have to work fluently in the field and also direct the organization as much as possible. The management of public healthcare sectors helps the community to reduce the mortality rate of infants in the community. The people of this community have to be very educated in each sector of their lives. This sustainable development goal includes the commitment to ending the AIDS epidemics, malaria, TB, and other communicable diseases (Turienzoet5 al.2023). It also focuses on achieving universal coverage of health and provides access and benefits to safe and effective vaccines and certain medicines for all. This relates to the present situation of the death cases in Sierra Leone.

During the early period, women were unaware of contraceptive use, and they never had choices about their "sexual behaviour" The observation was made that, the teenagers who became pregnant during those times were abundant and were related more to stigma, rather than physical maturity. This in turn led to a lack of family support, a lack of proper medications, and delayed delivery care or labour pain. The men behaved immaturely and domestic violence was done to the pregnant teenage girls, as they became physically weak and could not contribute to society (Unicef, 2017). Marriage was previously believed to be "a social prostitution", (Bash-Taqiet al.2020)where the women were forced to become pregnant several times and, they had a myth if there was no birth of a male child, then they were forced to do abortions. Several abortions or miscarriages led to the women being physically weak. This caused their reproductive system to conceive after a certain number of abortions or miscarriages. The mentality of the women in the society was pathetic and hypocritical during the days, which led to pre-natal deaths and more teenage infant deaths in the society, mainly in Sierra Leone. The historical situation had to change in a certain period, which needed evolution for the society to develop.

Various reasons for the evolution of the community are increased death rates in society. Society has to take the risk of the management assignment which includes the involvement and technologies of the community. Children below the age of 18 years are forced to marry in this community so they are affected by teenage pregnancy at an early age. Young girls mostly take certain medications in their lives and therefore many health problems are increased in their bodies at a certain time (Wessells et al. 2022). The death rates of the community should be reduced over time and for that reason, infants and teenage girls are very helpful in the community basis. The death rates are decreased in the current scenario by up to 20% and for that reason, the society of the community has to be very effective certainly. Teenage pregnancy was mainly discussed about the women who are forced to marry at an early age of life span, so they are affected by several health issues which are injurious to their health and also, they have to consult with qualified doctors as early as possible in time. At a certain period, the age regulation has to matter in the current situation of the community. The application must be followed to overcome the related issues of the community and for the infants and the teenage girls of the community and also they have to overcome serious problems.

Current situation of health management public health

In Sierra Leone the basic healthcare service is inadequate in each sector, they are such as shortage of medical professionals in the healthcare sectors. Teenage pregnancy remains the public health care service because of the associated prenatal and maternal mortality and morbidity rate (Bash-Taqi et al, 2020). To notice the political and economic effects of teenage pregnancy, there is even a need for the current epidemiological proof of its associated factors, which is especially from the resource setting. The ratio of teenage pregnancy was 22.1%, among this 17.8% had ever childbirth ratio and also 4.2% was pregnancy. After the adjustment, the odds of teenage pregnancy among married girls were almost about fifteen times more than those of people who are not married. The odd teenage pregnancy among young girls who certainly belong to poor households has a higher ratio than the richest households, so young girls in poor households are suffering from teenage pregnancy in Sierra Leone (Bussink-Voorend et al, 2020). Multistage sampling was used to signify the study on teenage girls in a certain community. Teenage pregnancy was mainly defined as people who had ever had a child terminated a pregnancy or were pregnant current period.

Figure 1: Current situation of health management public health

Key consideration

Teenage girls are suffering from teenage pregnancy rates in certain communities. The girls who belong to poor housing are the main sufferers of the issue of teenage pregnancy. In those days poor girls got married at a young age so they became pregnant at a young age (Massaquoi et al, 2021). In this case, they are also suffering from various health diseases at a young age. Their health condition became worse during the early age of the pregnancy. The young girls who become pregnant have a previous child also. In Sierra Leone the teenage pregnancy rate is very high, to reduce the teenage pregnancy rate the government of this area is to be concerned about this matter as early as possible. Thus, the young girls are taking relief from this matter. Besides this matter, the other issue in Sierra Leone is prenatal deaths. The infants are involved in this matter. Perinatal mortality is the death of a live newborn baby, who is dead before the age of a total of seven complete days. Infants are the sufferer in this matter (Moravej et al, 2022). While young girls become pregnant at an early age so their newborn babies cannot mature in their birth period, for this reason, they cannot exist in their life for a long period. In that case, the infants are the sufferer for their community purposes.

In Sierra Leone, teenage pregnancy ranges from 28.3% approx. and the adolescent fertility rate stands at the number of 102 per 1000. In this area, 857 maternal deaths per one lakh live births of infants. It is an estimated 40% occurs among teenage girls. These variables are involved in the prenatal deaths of infants; the infants are the main sufferers of this issue of prenatal deaths (Nuwabaine et al, 2023). The young girls are involved in the teenage pregnancy ratio and for them, the infants also suffer from the vital issue in Sierra Leone. The poor housing girls have no correct information about sexual and reproductive rights and healthcare assignment so they are suffering from this matter. The community and even their families are creating mental and physical pressure on the young girls to pregnant. They are forced to marry at a young age which can be the cause and consequence of this matter (Timbo et al, 2023). They also lack education in this matter, so they are dependent on their elder family members and also the community. Teenage pregnancy is also known as adolescent pregnancy. This rate of pregnancy can increase the risk of health problems and also affect the child.

Almost 16 million girls aged 15 to 19 years and almost 2.5 million girls under the age of 16 are the sufferers of teenage pregnancy matter. The complication during the pregnancy period and the birth procedure are produced for the young age of the girls (van Duinen et al, 2020). Girls who are between the ages of 10 to 15 face the risk of eclampsia, systemic infection in their body, and even puerperal endometritis. They have to maintain their health issues and also must avoid pregnancy in their teenage. In this case, they must overcome the process of early pregnancy (Ymcdn.com, (2017),). Early pregnancy is the fact that includes young girls and also newborn babies of their own.

Every year a huge number of young girls are affected by the situation at an early age. Adolescent mothers who are aged between 10 to 19 years face a high risk of several diseases such as eclampsia and its systemic infections. The women should maintain their health problems on each side and also, and they have to avoid the forced to become pregnant at an early age (Nice.org.uk, (2017). The community and the government of Sierra Leon must be concerned about this matter so that the young girl gets relief from this matter... People who are engaged in this field work influence the treatment process and the direction of the organization's procedure and even the policies. Intensive care must be taken for the newborn babies of teenage girls and also it is very important to overcome this situation as early as possible. Thus, the community will develop their current status in this situation and clarify the conduct of the issue with the help of the government.

Teenage pregnancies and prenatal deaths in Sierra Leone

Teenage pregnancy is a crucial problem that is affecting girls in Sierra Leone. Almost 28% of adolescents who are aged between 15 to 19 have started childbearing. 22% of them had a live birth and "6% among them are pregnant with their first child”. As stated by Nuwabaine et al. (2023) the rate of teenage pregnancy was 22.1% among 758 girls among 3,427. Among them 17.8% of girls almost 608 women among 3427 had childbirth, 4.2% of teenagers were pregnant and 1.2% had terminated their pregnancy (Turienzo et al. 2023). The rate of pregnancy in married girls was just more than 15 times that of those girls who were unmarried. The way of prevalence teenage pregnancy is very high in Sierra Leone. To reduce the rate of teenage pregnancy “the government of Sierra Leone” will target teenagers who are from rural households. The rate of maternal mortality and child mortality rate is very high in Sierra Leone in the world. According to Carshon-Marsh et al. (2022) however, to rectify the "rate of premature mortality" the "Ministry of Health and Sanitation of Sierra Leone" launched SL-SRS ("Sample Registration System".)

The rate of maternal mortality in "Sierra Leone is the highest in the World". About 1,360 mothers are dying among every 100, 00 birthed child. The rate of mortality of infants, neonates and children who are under five years old shows the highest mortality rate "globally, 34, 82 and 111 deaths per 1,000 live births".Maternal deaths in Sierra Leone account for 36% of all deaths from women aged between 15 to 49 years. The main causes of "maternal mortality in Sierra Leone" are hypertension (22%), obstetric haemorrhage (46%), sepsis (11%) and obstructed labour (21%) (Menzel 2019.). Sierra Leone supposedly broke the record for the rate of maternal death. This "World Bank line graph" shows the maternal mortality death rate in Sierra Leone. This line is decreasing gradually at a higher rate after the 1990s war.

Figure 2: Maternal mortality rate of Sierra Leone

This graph shows that 1,360 maternal deaths are occurring among 100,000 live births. Around 3,100 women have died due to maternal deaths last year. The country Sierra Leone has the 7^th ‘highest teenage pregnancy rate in the world”, where 38% of women aged 20 to 24 years old had their first ever baby before 18 years old. This issue of teenage pregnancy is very huge globally, there is a woman 15 to 19 years old who gave birth to a child and they count among 11%. This teenage pregnancy is very risky and 40 to 46% of the mothers are dying in the time of childbirth because the children are born before 20 years of their mother. Aside from terrible medical issues, it is economically and socially also devastating for adolescents. The leading cause of neonatal deaths are asphyxia (27%), prematurity (30%), pneumonia (7%), sepsis (23%), other "Acute respiratory infections" (12%), and congenital (7%) (Carshon-Marsh et al.2023). The death review of maternal mortality in Sierra Leone and the surveillance Report of 2017 show that 79% of "maternal deaths occurred" in a healthy facilitated area.

Figure 3: Rate of early adolescents in Sierra Leone

Adolescence is a distinctive period of transition from childhood to adulthood that is characterized by physiological, physical and social changes. It is important for a teenager to good adulthood. Sierra Leone has ranked among the world's worst maternal indicators of childhood worldwide. In Sierra Leone about “16% of women have sexual intercourse" before they have turned 15. 13.9% of women in this country have the highest unmet need for planning a family at 27.8%. This country has the highest rate of teenage pregnancy in the world. The range of teenage pregnancy from 28.3% to 34% (Bash-Taqi et al. 2022) the rate of adolescent fertility is 102 by 1000. The report shows that “857 maternal deaths occur per 100, 00 live births in Sierra Leone”. Which is an estimate among teenagers of 40%.

Sierra Leone is one of the highest-rated maternal mortality globally. There are almost "717 deaths occur per 1000000 live births". This has the greatest burden effect on adolescent girls. More than women aged between 20 to 24 years old in Sierra Leone have given birth before the age of 18 years, which is almost more than 10% of the girls that are aged between 16 years (Bussink-Voorend et al.2020). The risk remains lifetime of maternal death is in 17 years old women, some evidence suggests that the risk is higher for adolescents who are pregnant, and including them, infants who are born to adolescent mother also have a higher chance of risk of sickness which leads to death, more than two third of this maternal case death caused by hypertension, haemorrhage.

Figure 4: Mortality rate of under five in Sierra Leone

The under-five mortality rate of Sierra Leone among 9771 mothers who are aged between 15 to 49 years old shows the child status. The mortality rate of under 5 per the life of 1000 births report shows 105% in 2021.

Figure 5: Mortality rate of “infant per 1,000 live births” in Sierra Leone

The "Rate of mortality in an infant" (per 1,000 live births) in Sierra Leone is 78.3%. according to the World Bank, it has been found out the rate of mortality, in infants. The current news shows that the current rate of infant mortality in Sierra Leone is 70.123% deaths per 1,000 lives of birth, the rate of infant mortality was 75.253% among 1,000 live births in 2022 which also declined from 2021.

Options

The earlier estimated data has revealed that the ratio of maternal mortality in Sierra Leone was approximately "1400 per 100,000 live births” in 2015. The data has been found to show a fall in the number of teenage maternal deaths in the country in comparison to 1990 (Timbo et al. 2023). 1990 had revealed the highest death ratio of teenage mothers with an estimated value of nearly “2600 per 100,000 live births”. However, in Sierra Leone, the death ratio of early mothers has been observed to be the highest in comparison to other African countries and also the world. There has been observed very high mortality of infants in 1960 with the calculated number being “220 per 1000 live births” (Nuwabaine et al. 2023). However, in 2020 and 2021 the mortality ratio of infants decreased to "81 per 1000 live births” and “78 per 1000 live births” respectively. The data collected earlier has thereby revealed that over the years there has been a vivid decrease in the mortality rate of teenage mothers and prenatal deaths (Turienzo et al. 2023). Prenatal deaths have been observed to decrease in the country due to low occurrences of early deaths of young mothers.

Figure 6: Rate of infant mortality in Sierra Leone from 2011 to 2021

The above figure has revealed that in 2011 the rate of mortality among infants was “104.2 per 1,000 live births” in Sierra Leone. The graphical representation has highlighted a gradual decrease in the death rate of infants from 2011 to 2021 (O'Neill, 2023). In 2021, the calculated mortality rate in Sierra Leone among infants is about “78.3 per 1,000 live births”. The data thereby reveals improvement in the health and well-being of young teenage mothers of Sierra Leone. The country has thereby taken steps to improve the healthcare facilities and mode of accessibility in hospitals and at home (Pih.org, 2022). There was observed poor caregiving services in the country which was one of the primary causes of a high prevalence of mortality among prenatal and teenage mothers. The increasing cases of deaths of prenatal have been found to increase due to higher incidences of maternal deaths.

The country is required to implement the sustainable development goal of “Good health and well-being” adopted by the United Nations. The adoption of the goal by the government of Sierra Leone is known to improve the health and well-being of people both males and females of all ages. Effective implementation of the guidelines of SDG formulated by the UN has ensured an increase in the rate of life expectancy of teenage mothers and prenatal in future (Unicef.org, 2023). The future health facilities and accessibility are enhanced with the inclusion of the sustainable development goal of “Good health and well-being” for the citizens of Sierra Leone.

Conclusion

The above information has been evaluated in the community and the mortality rates of the infants and the teenage pregnancy rate of the young girl in the community. The certain concept is to overcome the serious issues related to their health problems. Good health and well-being are also very helpful for the health-related issues of the affected women of the community. The observation must follow the years from 1960 to 2011. In previous years the ratio of live births increased over a certain time. The community basis of the locality has to be involved at a certain time of the year. The guidance of sustainability has to develop their achievement and goals which are adopted by the United Nations. There is also a need to involve the government in the matter of mortality rates of infants and teenage young girls who are forced to marry in their community, so the women must avoid marriage and become pregnant at an early age. The goals have been developed with the help of the government of “Sierra Leone”. The people of the community have to be involved in this matter and they must become decrease ratio of the mortality rate of infants in the specific community. The community has to discuss overall issues with the government of the country so they are very helpful in this matter.

References

Journals

Bash-Taqi, R., Watson, K., Akwara, E., Adebayo, E. and Chandra-Mouli, V., (2020). From commitment to implementation: lessons learned from the first National Strategy for the Reduction of Teenage Pregnancy in Sierra Leone. [Online]Sexual and Reproductive Health Matters,28(1), p.1818376.

Bussink-Voorend, D., Bussink, A.P., Falama, A.M. and Stekelenburg, J., (2020). Health indicators of pregnant women in Tonkolili district, rural Sierra Leone. [Online] International Journal of Environmental Research and Public Health,17(11), p.3918.

Carshon-Marsh, R., Aimone, A., Ansumana, R., Swaray, I.B., Assalif, A., Musa, A., Meh, C., Smart, F., Fu, S.H., Newcombe, L. and Kamadod, R., (2022). Child, maternal, and adult mortality in Sierra Leone: nationally representative mortality survey 2018–20.[Online] The Lancet Global Health,10(1), pp.e114-e123.

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Massaquoi, H., Atuhaire, C., Chinkonono, G.S., Christensen, B.N., Bradby, H. and Cumber, S.N., (2021). Exploring health-seeking behaviour among adolescent mothers during the Ebola epidemic in the rural district of Freetown, Sierra Leone. [Online]

Menzel, A., (2019). 'Without Education, You Can Never Become President': Teenage Pregnancy and Pseudo-empowerment in Post-Ebola Sierra Leone,[Online]. Journal of Intervention and Statebuilding, 13(4), pp.440-458.

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Timbo, A., Fallah, J., Bourne, P.A., and Muchee, T., (2023). The Perceptions of Healthcare Workers on Factors Influencing Infant Mortality in the Western Area Rural District, Sierra Leone. [Online]

Turienzo, C.F., November, L., Kamara, M., Kamara, P., Goodhart, V., Ridout, A., Sam, B., Thomas, S., Williams, P.T., Sandall, J. and Shennan, A.H., (2023). Innovations to reduce maternal mortality and improve the health and well-being of adolescent girls and their babies in Sierra Leone. [Online] The Lancet Child & Adolescent Health,7(3), pp.151-153.

van Duinen, A.J., Westendorp, J., Kamara, M.M., Forna, F., Hagander, L., Rijken, M.J., Leather, A.J., Wibe, A. and Bolkan, H.A., (2020). Perinatal outcomes of cesarean deliveries in Sierra Leone: a prospective multicenter observational study. [Online] International Journal of Gynecology & Obstetrics,150(2), pp.213-221.