In recent times, Liberia has achieved a striking decline in under-five child deaths, from 241 to 78 per 1,000 live births between 1990 and 2011 [SOWC2013]. Despite this remarkable achievement, children in Liberia face insurmountable challenges to survive their first five years of life. The difficulties start from the time they are inside their mother’s womb. A large number of pregnant women die every day due to birth related complications.
A very high maternal mortality rate of 770 per 100,000 live births means that many children die with their mothers inside the womb, or are born without a mother to take care and nourish them. Only one out of three children is exclusively breastfed during the first six months of their life.
The problem of food insecurity in Liberia, translates in the case of the infant and children under five years into a widespread problem of malnutrition. This is both of the chronic type, which leads to stunted growth; and of the acute type, where a child is visibly thin and wasted. Since 2006, the situation of under-five child malnutrition in Liberia has markedly improved, but chronic malnutrition or stunting – a problem before onset of the civil war – remains among the highest in the world at 42%.
One of the planks of better child survival is attention to immunization against the six vaccine-preventable diseases: tuberculosis (BCG, given at birth), diphtheria, pertussis and tetanus (three doses of DPT or Penta 3 given at four week intervals from six weeks of age); measles (given after 9 months), and polio (three doses, previously given at the same time as DPT, but since wild polio virus reappeared in Liberia in 2009,now targeted separately and more frequently under WHO’s eradication campaign). Liberia faces an enormous challenge to achieve and sustain universal immunization coverage, which is a core indicator for the attainment of MDG 4. UNICEF together with other developmental partners support childhood immunization, providing vaccines and cold chain equipment (including solar-powered refrigerators), and training for immunization managers and vaccinators.
The diseases which take a heavy toll on early childhood, for which vaccines are not currently available, are malaria, diarrhoeal diseases (including cholera) and acute respiratory infections. These represent, along with malnutrition, the biggest killers of children. All of these illnesses, and malnutrition, have close interactions with a lack of safe water and improved sanitation.
The distribution of Insecticide Treated Nets (ITNs) to prevent malaria has helped to reduce the prevalence and incidence of Malaria in Liberia. From 2007 to 2010 approximately 4 million nets have been distributed to households with children under five years, pregnant women and lactating mothers (source: MOHSW Annual Report 2010). The use of bed-nets has risen considerably, and is now estimated at 63% up from 30% in 2007, with use by children under five put at 70%. Malaria prevalence in children has declined, from 66% in 2006 to 32% in 2010.
The pervasive practice of defecating in the open without use of a toilet, and the consequent contamination of soil and water sources, leads to a high level of diarrhoeal disease. The Demographic and Health Survey of 2007 found that 29% of children aged between six and 11 months had experienced diarrhoea in the two weeks before the survey. The most serious manifestation of diarrhoeal disease, where access to diagnosis and treatment is low, is cholera.
Having discovered that the use of bleach or chlorine to treat well-water was a common practice, Population Services International (PSI), the US Center for Disease Control (CDC), the Ministry of Health and UNICEF developed a product called Waterguardâ, for disinfecting water in the home without making it taste unpleasant.
A very small proportion of babies born to Liberian parents are currently registered at birth: only 4%. In more recent times, the government expanded birth registration services to all 15 counties which is beginning to improve this percentage. Birth registration, to which every child is entitled as a right under the CRC and under the African Union Charter on the Rights and Welfare of the Child (ACRWC), is a vitally important administrative process that helps establish legal identity and citizenship, and facilitates access to services and benefits throughout life. However there is some way to go before the value of registration is fully understood by Liberia’s citizens.
Despite these challenges, the future looks brighter for children compared to their older sisters and brother. Liberia has enjoyed over a decade of peace. The government and the people, with support from the UN and development partners, are committed to sustaining peace and improving the quality of life of their children and their families.