Teenage pregnancy and implications on child survival amongst mothers attending a clinic in the East-End, Freetown, Sierra Leone

doi:10.4236/ojped.2013.34053

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Open Journal of Pediatrics, 2013, 3, 294-299 OJPed

http://dx.doi.org/10.4236/ojped.2013.34053 Published Online December 2013 (http://www.scirp.org/journal/ojped/)

Teenage pregnancy and implications on child survival

amongst mothers attending a clinic in the East-End,

Freetown, Sierra Leone*

Tamramat I. Runsewe-Abiodun#, Sahr F. Bondi

Ola during Children’s Hospital, Freetown, Sierra Leone

Email: #[email protected]

Received 22 August 2013; revised 16 September 2013; accepted 23 September 2013

mons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work

is properly cited.

ABSTRACT

Introduction: Every year it is estimated that about 14

million adolescent girls give birth globally with the

highest rat e (143 per 1000 girls aged 15 - 19 years) in

the sub-Saharan Africa. Babies born to adolescent

mothers are at greater risk and are far more likely to

die than those born to older women. This study

therefore sets out to describe the health care seeking

behaviors in a cohort of teenage mothers attending an

Under-Five Clinic in a densely populated section of

Freetown, Sierra Leone with a view of determining

the impact of their behavior on the survival of their

children. Methodology: This is a descriptively cross

sectional and prospective study that involved four

hundred and six mothers attending the Under-Five

Clinic in the Eastern end of Freetown using semi-

closed ended questionnaire which were interviewers

administered between 1st and 29th July 2011. Result:

The age of the study population ranged between 12

and 45 years, with a mean of 24.8 ± 6.3 years. Of the

four hundred and six, eighty nine (21%) were teen-

agers (less than 20 years) with a majority (60.6%) of

them being between 18 and 19 years old. Concern-

ing the 89 teenage mothers in the study population,

the majority (95.5%) did not possess the secondary

school education, 42.7% were petty traders and more

than a half of them (61.8%) were married. The

mothers were rated low in all the activities geared

towards child survival except immunization. In addi-

tion there was a delay in the initiation of complemen-

tary feeds which were also of poor quality. Fewer

percentages of the mothers who had antenatal care in

the hospitals delivered there. Conclusion: This study

has revealed that early marriage is still common in

Sierra Leone. Also the teenage mothers did not en-

gage fully in a majority of activities that have been

proven to contribute to the survival of babies in the

Tropics thereby making their children vulnerable to

malnutrition, measles and diarrhoeal diseases. It was

recommended that the country should use recognised

teenage programs aimed at urgently addressing a

reduction in teenage pregnancy especially by im-

proving the provision of education/vocational studies

for the girl child.

Keywords: Teenage Pregnancy; Under-Five Mortality;

Freetown

1. INTRODUCTION

The definition of a teenager is as varied as who is an

adolescent. Generally, teenage pregnancy is considered

as that occurring between thirteen and eighteen years of

age. Occasionally girls as young as ten who are sexually

active could become pregnant.

Every year it is estimated that about 14 million ado-

lescent girls give birth globally [1] with the highest rate

(143 per 1000 girls aged 15 - 19 years) in the sub-Saha-

ran Africa [2]. It is also believed that women in Africa

generally get married at earlier ages than elsewhere

leading to early pregnancies [3].

Teenage pregnancy is beginning to attract significant

interest among researchers, political and religiou s leaders,

social scientists and co mmentators as a result of its com-

plexity, health and social implications.

*Disclosure: the authors declare no special interest.

Authors’ contribution: TIR conceived the study and wrote the initial

draft. SF read through for intellectual content and clarity. Both authors

repared and agreed on the fina l c ontent of the manuscript.

#Corres

ondin

author.

The association between teenage pregnancy and social

disadvantage is global [4-7] and the continuing appre-

OPEN ACCESS

T. I. Runsewe-Abiodun, S. F. Bondi / Open Journal of Pediatrics 3 (2013) 294-299 295

hension about teenage pregnancy is based on the pro-

found impact that teenage pregnancy can have on the

health of the girls and their children. Africa faces some

of the most daunting pub lic health problems in the world

and to meet the Millennium Development Goals, African

countries therefore need to reduce teenage pregnancy

[8].

In Sierra Leone, the 2008 DHS Survey revealed that

16 percent of pregnant women between 15 and 49 years

were married befor e the age of 15 years and abou t a half

before 18 years. A majority of them are in the poorest

wealth quintile [9].

It is agreed that babies born to adolescent mothers are

at greater risk. A review found that adolescent pregnan-

cies are associated with premature delivery, still birth,

fetal distress, birth asphyxia, low birth weight and mis-

carriages. Also, babies born to teen mothers are also far

more likely to die than those born to older women [10].

This study therefore sets out to describe the health care

seeking behaviors in a cohort of teenage mothers attend-

ing an Under-Five Clinic in a densely populated region

of Freetown, Sierra Leone with a view to determining the

impact of their behavior on the survival of their children.

2. METHODOLOGY

This is a descriptive cross sectional prospective study

that involved a cohort of mothers (four hundred and six)

attending the under-five clinic in the Eastern end of

Freetown.

Freetown is the socio and economic nerve centre of

Sierra-Leone. It is the capital and largest city. The city of

Freetown is politically divided into three “ends”; eight

municipalities or wards. The East End of Freetown has

three wards: East I, East II, and East III; the Central

Freetown includes two wards: Central I and Central II

and the West End of Freetown co ntain the wards West I,

West II, and West III. The wards in the East End of

Freetown are the most densely populated and are inhab-

ited by the poorest in the city. The estimated population

of Freetown is 773,000 [9].

Mothers attending the clinic were consecutively re-

cruited into the study between 1st July and 29th July 2011.

Semi-closed ended questionnaire were interviewer ad-

ministered.

Permission for the study was obtained from the medi-

cal superintendent of the Ola during Children’s Hospital

to which the under-five clinic is affiliated and a written

informed consent also obtained from the prospective

study subjects.

Data included in the questionnaire were information

on the bio data, socio-economic status of mother, sexual-

ity issues and other maternal information that may affect

the health of the child e.g. family planning choices,

number of children, child health care seeking and prac-

tices, family planning, pattern of breastfeeding, atten-

dance at Antenatal clinic, growth monitoring for the in-

dex child, knowledg e abou t ORS etc. Th e index ch ild bio

data, immunization status, anthropometric parameter, and

24-hour dietary were recalled.

The nutritional status was determined based on the

Gomez classification [11].

Data entry, validation and analysis were done using

Epi-info 3.5.3 software. Frequency tables were generated

for all the categorical variables and association between

them was tested using the chi-square test. Means and

standard deviations and other descriptive measures were

determined for quantitative variables such as age, parity,

etc. Level of significance was set at p value < 0.05.

3. RESULT

 A total of 406 mothers attending the clinic were con-

secutively recruited into the study. The age of the

study population ranged between 12 and 45 years,

with a mean of 24.8 ± 6.3 years. Over 40.5% of the

study population had their first child as teenager. Age

of first sexual contact in the study population ranged

between 10 - 18 years. There was a significant posi-

tive correlation between the time of first sexual con-

tact and first child correlation coefficient was 0.99

and p value of 0.0000.

Socio-demographic characteristics of the teenage

moth e r s

 Of the four hundred and six, eighty nine (21%) were

teenagers (less than 20 years) with a majority (60.6%)

of them being between 18 and 19 years old. The age

range of the teenage mothers ranged between 12 and

19 years. The mean age of the teenage mothers was

17.5 ± 1.6 years. They reside mainly in the eastern

end of Freetown (85.4%). Over two-thirds of the

mothers (77.5%) were Moslems, 19.1%, Christians

and 3.3% were traditional believers.

 Concerning the 89 teenage mothers in the study popu-

lation, the majority (95.5%) did not possess the sec-

ondary school certificate; 44(49.4%) did not go be-

yond secondary education, 34(38.2%) had no formal

education and 8(9.0%) had primary education. Ma-

jority of them were petty traders (42.7%), the others

were students, artisans or unemployed. More than a

half of them (61.8%) were married. This was the first

pregnancy in a majority, 72(80.9%), of the teenage

mothers. Table 1 depicts the socio-demographic char-

acteristics of the teenage mothers in the study popu la-

tion.

Child survival activities among the teenage mothers

As shown in Table 2, slightly more than a half (65.9%)

of the teenage mothers take their children for growth

monitoring and about a quarter (25.3%) of them can cor-

rectly prepare ORS. This activity is significantly differ-

T. I. Runsewe-Abiodun, S. F. Bondi / Open Journal of Pediatrics 3 (2013) 294-299

296

Table 1. Socio-demographic characteristics of the teenage

mothers.

Variables

Age (years) Frequency Percent Cum percent

12 1 1.1% 1.1%

13 1 1.1% 2.2%

14 1 1.1% 3.4%

15 7 7.9% 11.2%

16 15 16.9% 28.1%

17 10 11.2% 39.3%

18 19 21.3% 60.7%

19 35 39.3% 100.0%

Religion Frequency Percent Cum percent

Islam 69 77.5% 77.5%

Christianity 17 19.1% 96.6%

Traditional 3 3.3% 98.9%

Education Frequency Percent Cum percent

Tertiary 1 1.1% 1.1%

Post secondary 2 2.2% 3.4%

Secondary 44 49.4% 52.8%

Primary 8 9.0% 61.8%

Non formal 34 38.2% 100.0%

Occupation Frequency Percent Cum percent

Junior civil servant 3 3.3% 4.5%

Artisan 8 9.0% 12.4%

Petty traders 38 42.7% 55.1%

Students 22 24.7% 79.8%

Unemployed 18 20.2% 100.0%

Marital status

Married 55 61.8% 61.8%

Single 33 37.1% 98.9%

Separated 1 1.1% 100.0%

ent when compared with that of older mothers (p value =

0.04)

All mothers breast fed their babies. Breast milk was

the first drink in 72(80.9%) of the babies, out of which

breast milk was offered in 26 within the first 30 minutes

of life. On ly 11 out of the 53 mothers (2 0.9%) whose ba-

Table 2. Child survival activities by the teenage mothers.

Child survival activities Yes No

Growth monitoring 58(65.9) 30(34.1)

Preparation of ORS 23(25.4) 53(59.6)

Exclusive breastfeeding 11(20.8%)* 42(79.2)

Appropriate complimentary feeds 25(47.2)* 28(52.8)

Immunization

Complete for BCG 86(96.6) 3(3.4)

Complete for pentavalent 76(85.4) 13(14.6)

OPV 62(69.7) 27(30.3)

Measles 40(44.9) 49(55.1)

Yellow fever 28(31.5) 61(68.5)

Use of any family planning method 13(14.7) 76(86.3)

Appropriate ANC 72(80.9) 17(19.1)

Knowledge of HIV status 68(76. 4) 21(23.6)

Outcome of HIV test 59(66.3) 30(33.7)

*Total number of respondents was 53; Figures in bracket are percentages of

total.

bies were older than 6 months breastfed exclusively.

Water and Oral Rehydration salt solution were the major

additives to breastfeeding in the first six months of life.

Complimentary feeds were commenced between 1 and

24 months. Mean age of commencement of complemen-

tary feed was 7.25 ± 3.81 months. A quarter of the teen-

age mothers started complimentary feeds earlier than 6

months, similar number at 6 months and the remaining

half after the age of 6 months. More than a half of the

babies were weaned on inappropriate diets; mainly rice-

pap (15/53), pap (3/53), rice (7/53) and tea and bread

(3/53). The rest were weaned on Benni-mix (9/53) were

weaned on a locally available complementary feed

“Bennimix” which is a combination of pigeon peas, ses-

ame, rice and sugar) and Nutrilac/Tinned cereal (16/53).

Almost all the babies (96.6%) of the teenage mothers

had Bacille Calmette Guerin vaccine (BCG), 85.4% had

Pentavalent, OPV was taken by 69.7%, 44.9% had mea-

sles vaccine, and 31.5% had yellow fever vaccine. For

those who were not ab le to complete their immunization ,

major reason was non-availability of the vaccines in the

clinic as at the time that the baby was due for the vaccine.

Table 2 shows the activities geared toward child su rvival

by the teenage mothers in the study popu lation

There was no statistically significant difference be-

tween the number of teenagers and the entire study

population in their access of family planning. Although

72.4% of the study population were not using any form

of FP, 85.2% were not using any FP method among the

T. I. Runsewe-Abiodun, S. F. Bondi / Open Journal of Pediatrics 3 (2013) 294-299 297

teenage mothers. This difference was not statistically

significant. Amongst those using any form of family

planning method, Depo-Provera is preferred in 10.2%

and condom in 0.5%. There was a significant association

(p = 0.04) between the ages when the respondents had

the first child and FP preference. Table 3 indicates the

family planning preference among the teenagers.

Of the 80.9% of the teen agers who had Anten atal Care

(ANC) in the Govt. hospital only 66.3% delivered in the

hospitals. Although only 19.1% did not have any form of

ANC, more of them (28%) delivered at home/TBAs.

The age range of babies of the teenage mothers was

between 1 and 60 months, mean 10.4 ± 9.3 months. Al-

though the percentage weight for age (%WFA) of the

babies of the teenage mothers was not statistically sig-

nificantly different from that of the matured mothers,

91% of their children were malnourished (Gomez classi-

fication). There was a positive correlation between the

ages of the mothers and the nutritional status of the ba-

bies (r = 0.73).

Mean episode of diarrhea/child/month among the teen-

age mothers was 1.9 ± 1.98/month. There was no statis-

tically significant difference between this and babies of

matured mothe rs. p val ue = 0.2.

Majority of the teenage mothers will take steps when

their babies are sick with fever or diarrhea e.g. take ba-

bies to Government hospital, give Oral Rehydration Salt

Solutions (ORS) and drugs when ill but 12.5% will do

nothing.

Only sixty-eight of the teenage mothers (76.4 %) know

their HIV status, the rest do not know. It was negative in

59(66.3%) and the rest were not sure.

4. DISCUSSION

This study has identified that one out of every five

mothers attending the clinic delivered babies before the

age of 20 and the majority of them being between 18 and

19 years. Almost two-thirds of the teenage mothers were

married. This is in line with reports from Demographic

Health Survey in the country [9]. This experience is

supported by earlier observations that women in Africa

Table 3. Family planning choice of the study population.

Family Planning Choice Frequency Percentage

Coil 1 1.1

Pills 1 1.1

Injection 9 10.2

None 75 85.2

Traditional 2 2.3

TOTAL 88 100.0

generally tend to marry earlier than elsewhere [3]. Hence,

it will appear that teenage pregnancy in our community

may not be largely accidental. However, the place of

socio-economic perception of teenage pregnancy cannot

be overlooked. It is possible that a majority of the parents

married off the girls for reasons of relief of economic

burden, social stigmatization, religious or cultural. This

study did not determine whether the pregnancies were

within or outside marriage.

In this study, 9 out of the 10 teenage mothers did not

go beyond secondary school and were mainly either

petty traders or unemployed. The inverse relationship

between education and teenage pregnancy has been

documented in other studies [12]. Female education has

been found to be closely related to a more favourable life

outcome for the child [13-15]. An educated female is

more likely to access health care, be financially empow-

ered to provide appropriate nutrient for her children, able

to exercise her reproductive rights and thereby prevent

unwanted pregnancy and properly space her family. The

huge number of children in this report that are malnour-

ished is therefore not unexpected. All the aforementioned

factors will come into play to ensure the impairment of

the nutritional status of the children of the teenage

mother. Malnutrition alone or in combination with other

disease conditions is associated with close to 54% of

under-five mortality in the sub-region [16].

Change in the weight of the child is one of the earliest

and most reliable means of determining the health of the

child. This opportunity will be lost in tho se children who

were not being taken to the clin ic for growth monitoring.

The resultant effect of this will be a delay in presentatio n

at the health facility when the child is ill. In the Ola dur-

ing Children’s Hospital to which the clinic is affiliated,

close to 90% of deaths in the Under-Five occur within 24

hours of admission into the hospital (unpublished data),

majority of them being brought in a moribund state.

Dehydration is known to be the commonest cause of

death from Diarrhoea. This can be prevented with ap-

propriate use of Oral Rehydration Solution (ORS). In this

study the babies were reported to have close to 2 epi-

sodes of diarrhea in a month. With the poor knowledge

of preparation of ORS by a majority of the mothers, it

can be expected that that these children may succumb to

the effect of diarrhea.

Similar to other findings breastfeeding is a common

practice amongst the teenage mothers in this study [17].

However, a majority of the babies of these teenage

mothers were not exclusively breast fed. This may be

arrogated to their low education and or ignorance about

the benefit of breastfeeding. Lack of exclusive breast-

feeding has also been observed to be a contributory fac-

tor to the development of malnutrition and the attendant

health risks [18-20]. Also, in this study the teenage

T. I. Runsewe-Abiodun, S. F. Bondi / Open Journal of Pediatrics 3 (2013) 294-299

298

mothers commenced complimentary feeds much earlier

and even at that the feed s were of poor quality. Although

breastfeeding for a long period has been associated with

better cognitive and language development in children

[21], a delay in adding complementary feeds as being

practiced by some of the teenage mothers have been as-

sociated with m a l nut r i t i on [22].

The nutritional status of some of these children must

have been evidently compromised by the recurring epi-

sodes of diarrhea and lack of exclusive breastfeeding.

This study has found a strong positive correlation be-

tween the nutritional status of the children and the ages

of the mothers. The implication is that with maturity in

the age of the mothers a more favorable outcome can be

expected in the child. Malnutrition is known to be a major

contributor (54%) to chil dhood deat hs in the tropics [16] .

A majority of the teenage mothers were not using any

form of family planning; hence, there is a tendency for

repeat pregnancy not adequately spaced with complica-

tions for the moth er and implication for the health of the

child.

5. CONCLUSION

This study has revealed that the teenage mothers that do

not engage in a majority of activities hav e been proved to

ensure the survival of their babies probably because of

their low education. Therefore, it can be expected that

their children will have a less favorable outcome with

malnutrition, measles and diarrhoeal diseases, which are

three of the major disease conditions associated with un-

der-five mortality in the sub-region.

6. RECOMMENDATIONS

1) Teen pregnancy prevention programs e.g. use of

mass media campaigns to promote safe sex.

2) A rise in school leaving age has been predicted to

cut number of teenage pregnancies. This can be advo-

cated in the country.

3) In as much as traditional and religious leaders

preach abstinence, it may be more realistic that more

effective birth control practice be advocated in teenagers

as they are sexually active.

4) This study has rev ealed that the average age of first

sexual contact is about 10 years in the country, hence

primary school students must be educated about sex and

sexuality and the consequences of pregn a ncy.

5) Bye laws and others to discourage child marriage.

Cooperation of religious and traditional leaders will be

needed in achieving this.

6) Support must be given to organizations aimed at

provision of holistic approa ch to management of teenage

pregnancy related issues; counselling, training, etc.

7. ACKNOWLEDGEMENTS

The Authors appreciate the assistance of Miss Martins and… in admin-

istering the questionnaires and the cooperation of the entire staff of Jen-

ner-Wright Clinic , Freetown.

REFERENCES

[1] UNFPA (2013) State of world population 2004.

www.unfpa.org/public/cache/offonce/home/publications/

pid/2104

[2] World Health Organization (2012) Adolescent pregnancy

fact sheet No. 364.

www.who.int/mediacentre/factsheets/fs364/en/

[3] Bayisenge, J. (2013) Early marriage as a barrier to girl’s

education: A developmental challenge in Africa.

www.ifuw.org/fuwa/docs/Early-marriage.pdf

[4] Holgate, H., Evans, R. and Yuen, F.K.O. (2006) Teenage

pregnancy and parenthood: Global perspectives, issues

and interventions. Routledge, New York.

[5] Harden, A., Brunton, G., Fletcher, A. and Oakley, A.

(2009) Teenage pregnancy and social disadvantage: Sys-

tematic review integrating controlled trials and qualitative

studies. Britis h Me d i c al Journal, 339, 1182-1185.

http://dx.doi.org/10.1136/bmj.b4254

[6] Cherry, A.L., Byers, L. and Dillon, M.E. (2009) A global

perspective on teen pregnancy. In: Ehiri, J., Ed., Maternal

and Child Health: Global Challenges, Programs, and

Policies, Springer, New York, 375-397.

http://dx.doi.org/10.1007/b106524_21

[7] Jiang, N., Kolbe, L.J., Seo, D. -C., Kay, N.S. and Brindis,

C.D. (2011) Health of adolescents and young adults:

Trends in achieving the 21 critical national health objec-

tives by 2010. Journal of Adolescent Health, 49, 124-132.

http://dx.doi.org/10.1016/j.jadohealth.2011.04.026

[8] (2013) The linkages between the MDGs and young wo-

men’s health.

http://www.youthcoalition.org/attachs/MH_MDG_factsh

eet_webversion.pdf

[9] Sierra Leone demographic and health survey report 2008.

www.meaasuredhs.com/pubs

[10] Reichman, N.E. and Pagnini, D.L. (1998) Maternal age

and birth outcomes: Data from New Jersey. Family Plan-

ning Perspectives, 30, 127.

http://dx.doi.org/10.2307/2991626

[11] Gomez, F. and Galvan, R.R. (2000) Mortality in 2nd and

3rd degree malnutrition. Bulletin of the World Health Or-

ganization, 78, 1275-1280.

[12] Gakidou, E., Cowling, K., Lozano, R. and Murray, C.J.L.

(2010) Increased educational attainment and its effect on

child mortality in 175 countries between 1970 and 2009:

A systematic analysis. Lancet, 376, 959-974.

http://dx.doi.org/10.1016/S0140-6736(10)61257-3

[13] Cleland, J.G. and van Ginneken, J.K. (1998) Maternal

education and child survival in developing countries: The

search for pathways of influence. Social Science and

Medicine, 29, 1357-1368.

[14] Hobcarft, J. (1993) Women’s education, child welfare

T. I. Runsewe-Abiodun, S. F. Bondi / Open Journal of Pediatrics 3 (2013) 294-299

299

OPEN ACCESS

and child survival: A review of evidence. Health Transi-

tion Review, 3, 159-175.

[15] UNICEF State of the World Children (2007) The link

between child survival and women’s empowerment.

www.unicef.org/media

[16] UNICEF (2012) Nutrition report.

[17] Batal, M., Boulghourjian, C., Abdallah, A. and Afifi, R.

(2006) Breast-feeding and feeding practices of infants in

a developing country: A national survey in Lebanon.

Public Health Nutrition, 9, 313-319.

http://dx.doi.org/10.1079/PHN2006860

[18] Lamberti, L.M., Walker, C.L.F., Noiman, A., Victora, C.

and Black, R.E. (2011) Breastfeeding and the risk for di-

arrhea morbidity and mortality. BMC Public Health, 11,

S15-S27. http://dx.doi.org/10.1186/1471-2458-11-S3-S15

[19] Imdad, A., Yakoob, M.Y. and Bhutta, Z.A. (2011) Effect

of breastfeeding promotion interventions on breastfeeding

rates, with special focus on developing countries. BMC

Public Health, 11, S24-S32.

http://dx.doi.org/10.1186/1471-2458-11-S3-S24

[20] Black, R.E., Allen, L.H., Bhutta, Z.A, Caulfield, L.E., de

Onis, M., Ezzati, M., et al. (2008) Maternal and child

undernutrition: Global and regional exposures and health

consequences. The Lancet, 371, 243-260.

http://dx.doi.org/10.1016/S0140-6736(07)61690-0

[21] Belfort, M.B., Rifas-Shiman, S.L., Kleinman, K.P., Guth-

rie, L.B., Bellinger, D.C., Taveras, E.M., Gillman, M.W.

and Oken, E. (2013) Infant feeding and childhood cogni-

tion at ages 3 and 7 years: Effects of breastfeeding dura-

tion and exclusivity. JAMA Pediatrics, 167, Epub ahead

of print.

[22] Agarwal, K.N. (2011) Weaning practices in other parts of

the world: Case study India. Nestle Nutrition Workshop

Series. Paediatric Programme, 68, 107-115.

http://dx.doi.org/10.1159/000325670