Intro to Public Health - Blog 12

Any given public health problem has a multitude of determinants and cases of determinants. There is never one direct, simple cause. A determinant is something that causes the problem at hand. There are different cases of determinants that include biological, social and cultural, clinical, environmental, economic, and political. The problem that I have been researching, maternal mortality in Sierra Leone, has an extremely long list of determinants in all different classes.

Biological:

Biological factors probably affect the mortality rate in Sierra Leone the least. One example is the prevalence of malnutrition and malaria throughout the country. Both of these illnesses can lead to complications in a pregnancy, such as anemia. When a pregnant woman has anemia it is more likely that she will need a blood transfusion, something that is hard to come by in this poor country.

Social and Cultural:

In Sierra Leone, women are essentially powerless when it comes to their sexual and reproductive health. They are not capable of making their own decisions about things such as how many children they have, how far apart they have children, and/or when to go to a health clinic. Related to this, the majority of women do not use contraceptives, often because their partner doesn’t want to. Also, women are often married and begin having children very young, increasing their risk of death during pregnancy significantly. Women are also subjected to female genital mutilation, a traditional practice in Sierra Leone. Furthermore, women rarely have access to education about sexual and reproductive health.

Clinical:

The clinical factors (ones having to do with medical or health care) probably contribute the most to the high mortality rate. One of the biggest issues is access to care. Many women have to travel miles in before they reach a facility. But even once they make it to the facility there is no guarantee that the facility will be adequate. Most facilities lack the necessary drugs or medical equipment. Also, not many facilities are open 24 hours. If a women were to go into labor at night she would most likely have to wait until morning when it would already be too late. Most importantly, there are not nearly enough trained professionals staffed in health clinics across the country. Women often rely on traditional birth assistants, women of the town who are not properly trained, to deliver their babies. There are also too few emergency obstetric care facilities. Pregnant women are dying from easily treatable diseases but a majority of them have no access to a facility that could help them.

Environmental:

One of the environmental factors that contribute to this problem is the uneven distribution of the facilities. Some areas of the country have a lot more facilities in their region than another one. This is also true of the urban and rural areas. The people of the rural areas often have much farther to travel than do the people living in urban areas. Also, the terrain and roads are not always conducive to traveling and can cause obstacles.

Economic:

Sierra Leone is a very poor country and often the cost of accessing care stops a woman from going to see any doctors at all. Families can be in debt for years after the birth of just one child. Even just getting transportation to a facility can cost a lot and most families just can’t afford it and opt to give birth at home, significantly raising their risk of death. Also, it is common for a man to have many wives. While this may increase his power and status in the community, a polygamous household is often very poor.

Political:

In order to take steps to fixing this problem, the Sierra Leonean national government needs to give its unwavering support. The country is in need of policies that actually need to put into practice, rather than be ignored. Currently, there is a decentralized health system, in which not every facility is equal in training, medical supplies, etc. Little to no communication occurs between the health facilities scattered throughout the country. Sierra Leone is also a war-torn and corrupt country that is still reeling from its brutal civil war that ended in 2002.