According to the WHO Global Health Observatory (GHO) data, Sierra Leone had a life expectancy at 52 years and 54 years for men and women, respectively, in 2016(WHO, 2020). The expectancy remains lower than the Sub-Saharan Africa average life expectancy of 57 years. The 2019 SLDHS brief highlights a gradual decline in the early childhood mortality rates in the last decade. The under-5 child mortality rate was 122 deaths per 1000 live births, the infant mortality rate at 75 deaths per 1000 live births, and neonatal mortality rate at 31 per 1000 live births(SLDHS, 2019). Despite the reduction in the early childhood mortality rates, the statistics are far from achieving the Sustainable Development Goal (SDG) of 12 deaths per 1000 live births for neonatal and infant mortality rates, and 25 deaths per 1000 live births for under-5 mortality rate. Focusing on increasing the children who receive essential vaccination (56% currently) and advocating for better infant and young child (IYCF) practices offer improvement opportunities( SLDHS, 2019). The leading causes of disease burden in this population include malnutrition, malaria, acute respiratory infections, and diarrheal illnesses.

Furthermore, data from the World Bank indicates a gradual decline in the maternal mortality ratio from 2000-2017. In 2017, the maternal mortality ratio in Sierra Leone was estimated at 1120 deaths per 100000 live births. The ratio is far from the SDG goal of fewer than 75 deaths per 100000 live births by 2030. Notably, the decline can be attributed to improved maternal care with an increased proportion of pregnant women giving birth in health facilities, receiving care from skilled labor, and rising antenatal clinic attendance (ANC).

Figure 2 showing trends in early childhood mortality (2019 SLDHS) Among the top 10 causes of death in Sierra Leone, approximately 60% are from infectious diseases with malaria, respiratory infections, diarrheal illnesses, tuberculosis, HIV/AIDS, and meningitis

being the commonest(CDC Global Health, n.d.). The country has experienced epidemics of deadly viruses locally in the last two decades. The Lassa virus in 2001, the Ebola virus epidemic in 2014, and outbreaks of the Zika virus have been reported (SLDHS, 2019). Non-communicable diseases contribute a less but significant proportion of the disease burden. However, the epidemiological transition with increased rural to urban migration, adoption of sedentary lifestyles, and improving socioeconomic statuses are likely to contribute to a larger proportion of the disease burden by 2050.

A cross-country comparison of Sierra Leone with other countries, high-income states such as the United States, reflects huge differences in most of the health indicators highlighted above. The Republic of Sierra Leone faces a considerable burden of communicable diseases, including epidemics such as Ebola. The country has also recorded among the world's highest maternal mortality ratios; it has weaker health systems- an insufficient health workforce and inadequate health financing(Robinson, 2019). Moreover, the country managed to attain political stability as late as 2002 after a decade of civil wars. Collectively environmental, political, and economic inferiority plays a significant role in the adverse health outcomes in Sierra Leone.

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Table showing the difference in Key Health Indicators between Sierra Leone and United States (CDC Global Health, n.d.)

Health Indicator

Sierra Leone

United States

Life expectancy (years)

54

78

Maternal mortality ratio (per 100000 live births)

1020

17

Under 5 mortality rate (per 1000 live births)

122

7

Neonatal mortality rate (per 1000 live births)

31

4

Top causes of disease and mortality

Communicable disease

Non-communicable diseases.