Sierra Leone has made strides in improving child welfare over the past 20 years, showing the greatest improvement worldwide, says the NGO Save the Children. While child mortality among under-fives in the West African country has nearly been halved, it still affects one in 10 children, according to the group's latest global report, "Changing Lives in Our Lifetime".
After implementing the Free Health Care Initiative countrywide in 2010, Sierra Leone improved the quality of life for children under five, including providing better care for malaria, diarrhea and pneumonia - frequent child killers - says Ramatu Jalloh, the advocacy director for Save the Children in Freetown.
She says that President Julius Mada Bio's administration, elected in March 2018, is working to improve on these positives.
"The new government recognizes that even though much progress has been made, much more needs to be done to strengthen the health system," Jalloh told RFI.
"We realize that those hard to reach communities need action or intervention in a timely manner," she says. The government has boosted its community health worker policy and are training those in remote areas to recognize health issues and to react to them.
She says that one of the problems is that mothers do not realise there is a problem with their child to address it, adding that Sierra Leonean culture also comes into play.
"I know that the behaviors and traditional beliefs around certain illnesses likely impacts on the timely services we are able to deliver to the vulnerable children," says Jalloh.
"This is something we've been working on and I know the government has been working on this to strengthen and move forward," she adds.
According to the Save the Children statistics compiled on 176 countries regarding child welfare, Sierra Leone had a 246-point increase from the year 2000 to 2018 -- the most worldwide.
The country gained points in lowering child marriage, reducing under-five child deaths to 53 percent, and reducing child labor, children with stunted growth, teen births, and child homicide.
The international organization has been working with other non-governmental organisations within the country, including local NGOs, in order to improve nutrition for children. Scaling Up Nutrition is a civil society platform led by Save The Children UK but under the office of the Sierra Leonean vice presidency in order to coordinate government, civil society and others in dealing with nutrition.
After conducting research throughout the country, says Jalloh, "they found anemia was one of the big factors affecting mothers and children." The Secretariat used this information to promote diversifying foods for mothers and children as well as food security.
Pregnant students still banned by government
In Sierra Leone, student pregnancy is an ongoing issue, says Jalloh, even though it has decreased by 30 percent over the past 20 years, according to the report.
"It's one of those issues that people have various opinions about, but what I think has been made very clear, in regard to government intervention in this area, is that all children, regardless of their situation, regardless of where they are, should access education," says Jalloh.
Under the previous government administration, pregnant girls were banned from the classroom in 2015 after numbers rose during the Ebola outbreak due to rape and abuse.
However, the new Mada Bio administration has reinforced the stigma of preventing pregnant girls from getting an education.
Jalloh calls the issue with the government a "work in progress".
"One of the key things that we're advocating more and we know that government is in favor of now is comprehensive sexuality education," says Jalloh.
"We believe that if young people are given the right information, the correct information, they'll be better to make informed choices. And hopefully that will also reduce the rates of teen pregnancy," she adds.
Save the Children is working with traditional leaders who are the paramount chiefs, as well as religious leaders to explain the impact of teen pregnancy and child marriage not only on the girl, but on the community as a whole.
"The idea is to find a way in which to build champions from these groups, so that they're the ones who are leading the conversation at a community level, because they're the ones who are trusted, who the communities listen to," says Jalloh, adding that this project has had success in Pujehun, the most southern district in Sierra Leone.
How Sub-Saharan Africa fares, overall
Sub-Saharan African countries such as Burkina Faso, Ethiopia, Niger, Rwanda and Zambia have also improved significantly over the past 20 years.
South Sudan, Rwanda and Ethiopia have reduced the number of children giving birth.
But there have been some setbacks, as well. Reducing child marriage in sub-Saharan Africa has had uneven success, as countries including Tanzania, the Democratic Republic of Congo, Nigeria, Niger, Chad, Madagascar, Mali and Mozambique have seen a significant rise in child marriage over the past 20 years.
The bottom 20 countries, with the exception of Afghanistan, are all in Sub-Saharan Africa.
And while the countries with the highest under-five mortality are from fragile states, including Central African Republic, Chad, Mali, Somalia and Sierra Leone, Sierra Leone is poised to reach its target for child survival by 2050.