Gillings program works to fight maternal mortality, hunger in Sierra Leone

From over 4,500 miles away, researchers at the Gillings School of Global Public Health are working with community members in Sierra Leone to increase safety for pregnant women and fight malnutrition. 

The Humanitarian Health Initiative (HHI), an initiative within Gillings, is working with the Rural Health Care Initiative (RHCI), a non-governmental organization located in Tikonko Chiefdom, a part of Sierra Leone's Southern Province. 

The RHCI was founded by Alice Karpeh, a Sierra Leone native, in 2011. The group’s goal is to help lower maternal mortality rates, or the rates of women dying during pregnancy, delivery or soon after delivery.

A woman in Sierra Leone is 100 times more likely to die due to pregnancy or childbirth than a woman in the United States, said Carol Nelson, program coordinator for RHCI's Sierra Leone programs.

The HHI and RHCI began collaborating in early 2021, after the RHCI reached out to Sheila Leatherman, a professor of global health policy and Gillings global advisor who would go on to spearhead UNC's team. 

The collaboration came about as part of the RHCI's interest in evaluating its Sierra Leone program, said Doreen Alumaya, who led the nutrition evaluation program. At the time of her involvement, Alumaya was a graduate student at Gillings. 

“It was a really collaborative community-oriented and community-driven project,” she said. “Just what global health needs right now, programs where we are centering the communities and we are letting the communities lead.” 

The Gillings program conducted interviews with community members in Tikonko to learn more about how RHCI could better serve them, Leslie Lytle, faculty advisor for HHI, said in an email statement. Her work as a researcher focuses on interventions to promote community health. 

“Our goal was to help in essentially monitoring and evaluating the health programs,” Alumaya said. “Specifically, we worked on their maternal health programs.” 

The project in Sierra Leone was already underway when UNC joined, and the collaboration with the University gave RHCI the extra tools, funding and staff needed to evaluate its programs, Maggie Pilacinski, a board member and communications coordinator for the initiative, said.  

There are four key program areas: rural health system redevelopment, creating birth waiting homes, children’s health programs and sustainable food and agriculture

“(Rural) health system development includes a lot of different things, including medical donations that we send, trainings, health care workers, a transportation system, motorbike outreach clinics and then support to two more rural clinics,” Nelson said. 

Sierra Leone is still recovering from a civil war that ended in 2002 and the Ebola outbreak from 2014-2016, which devastated the country’s health care system, she said.  

Birth waiting homes are areas where pregnant women can stay at the end of their pregnancy. 

“The homes allowed them to rest and be well-nourished before the birth of their babies and also meant that they would be near the community health clinic when it was time to deliver their babies,” Lytle said in an email. 

Access to health care while giving birth helped reduce maternal mortality in the community. So far, the homes have served over 900 women, and she said 99 percent of them have had a healthy delivery.

RHCI has two maternal waiting homes. The first opened in 2018 and has 24 beds available; the second home opened in 2021 and has 11 beds available.

The food security program grows food for the birth waiting homes and has demonstration farms, where local community members educate local farmers on improved farming practices, Nelson said.  

RHCI has 16 full-time employees and more than 60 part-time staff from Tikonko Chiefdom as of May 2022. 

As part of the project, Alumaya designed a community healthcare worker network, a network of women in communities who are taught how to assess malnutrition. These women teach other mothers in the community about basic infant and young child feeding practices and nutrition. They also act as liaisons between RHCI and the members of the Tikonko Chiefdom.  

“Based on the evaluation results provided to the RHCI board, they moved to expand clinic days for malnourished children, providing additional treatment and follow-up care,” Lytle said in a statement. “In addition, training for rural community health care workers was enhanced and improved nutritional education and nutrition care protocol for the on-site nutritionist was instituted.” 

The collaboration is strong and the two are looking for other opportunities to work together to improve the health of mothers and children in Sierra Leone, she said. 

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