I’ve been thinking about what I wrote yesterday about the drop in percentage of population who are over 15 compared to the under 15s. Liberia has a very high under 5s mortality rate and it is probably that that skews the chart so heavily. In the UK, our under 5s mortality rate (expressed as the number of children under 5 dying per 1000 live births) is very similar to our infant mortality rate (number of under 1s dying per 1000 live births). ie. if you survive till your first birthday in the UK, the likelihood is that you will survive till your 5th. Not so in countries like Liberia and Cameroon. Take a look at the table below (2017 data from UNICEF). All forms of childhood mortality are expressed as the number dying per 1000 live births:
UNDER 5 MORTALITY
Many children die between the ages of 1 and 5 in low income (eg. Liberia) and lower middle income (eg. Cameroon) countries (World Bank classification according to GNI (more on this tomorrow I think)). Actually, according to UNICEF statistics (https://www.unicef.org/liberia/children.html), Liberia has done rather well recently in reducing under-five child deaths, from 241 to 78 per 1,000 live births between 1990 and 2011. This is great but still means there’s a long way to go before the UN’s sustainable development goal (SDG) of 25 per 1,000 by 2030 is achieved (https://www.un.org/sustainabledevelopment/health/).
The SDG neonatal mortality goal which is what NICHE International is all about is “at least as low as 12 per 1,000 live births” worldwide. Take a look at my table above again. We have some work to do.
I’ve been reading a couple of books relevant to the history of Liberia. The map in a previous post shows you where it is in West Africa, bordered by Sierra Leone to the West (where we stopped on the plane on the way here) and Cote d’Ivoire to the East. Liberia is Africa’s oldest republic and was set up at the beginning of the 19th century as a homeland for freed American slaves. There were 2 violent, devastating civil wars in the late 1990s up until 2003 and reading about them is harrowing stuff. 8% of the population was killed. As we were driving today I couldn’t help looking at people on the roadside and wondering what part they may have played in those wars. There were so many different factions, most of which recruited children as young as 7 as child soldiers. Many will have died of course but what does that kind of trauma do to the survivors who will now be in their 20s?
43% of Liberia’s population is under the age of 15. I wonder if the big drop down to the 15-44 year olds in the graph below partly reflects the effect of those wars.
After a whole day in the plane (there are no direct flights to Liberia from the UK) and another day in the car (gathering up instructors for our course, dropping off an obstetrician from Northern Ireland who is at a hospital a couple of hours north of here for a week to run the examinations for a group of midwives who have been taught extended skills), we are now ensconced in a house within the compound of CH Rennie hospital in Kakata.
Due to start the course the day after tomorrow so will be spending tomorrow setting up the room, ensuring the programme is correct and going through the content with Kola and Agnes, neonatal nurse practitioner and midwifery practitioner respectively who are going to be our co-instructors.
I’m struggling to upload pictures. It’s been a bit rainy and heavy today so the photos won’t really do the country justice anyway. It’s very green and lush against the red laterite soil that runs in a band across sub-Saharan Africa. Here’s one I found on the internet which is pretty true to form except I’m not sure that I’ve seen any motorbike helmets yet.
Alistair and Julia are off to Liberia at the crack of dawn tomorrow to facilitate 2 Newborn Care Courses in CH Rennie hospital alongside a local neonatal nurse practitioner and some midwifery interns. My understanding is that an intern is a trained midwife who is then given extended roles which would overlap with those of an obstetrician in well resourced countries like the UK. But we’ll find out more when we’re there and have met the local faculty.
This trip is in collaboration with the charity, Maternal and Child Health Advocacy International (www.mcai.org) who originally designed the Newborn Care Course and under whose umbrella we taught the course in Cameroon until 2016.
Newborn, Infant and Child Health Education (NICHE) International is a small charity with 6 trustees, 3 of whom are also Newborn Care Course instructors. Our mission is elsewhere on the website but basically we travel to low resource countries of the world to facilitate courses on care of the newborn infant in the first 28 days of life and train local instructors.
The charity was set up in autumn 2017. In 2018 we led a big group of 7 instructors to Cameroon in March and 2 of us are about to set out to Liberia to deliver our first NCC there.
Seb is our webmaster and says we must write blog posts while overseas to let the world know what the charity is up to. Please do leave a comment if you want to ask us any questions!
Julia and Alistair