Claire Lewis

            Public health trends may be described as statistics telling us a story about the group of people they represent.  Kristen Westenskow teaches global public health classes at the University of Utah, and she has worked in sub-Saharan Africa, the Caribbean, Mexico, and in American Samoa with a focus on HIV/AIDS prevention education, maternal/child health, literacy education, and disaster preparedness.  She received her undergraduate degree in community health with a minor in international development from BYU, and completed a Master of Publice Health degree with a global emphasis at Columbia University. Months ago, I was able to hear Kristen speak at a dinner about health trends in Mali, Africa.  My family is highly involved in an organization called the “Ouelessebougou Alliance” in which we help to promote the health, education, and economic development in a small town called Ouelessebougou in Mali.  The things she spoke about I remember being so interesting, so I decided to contact her directly and ask her specifically what the five main public health trends are in Mali.

            The first key trend in Mali that she mentioned was school enrollment.  From 1993 to 2011, Mali has seen an 82% gross increase in primary school enrollment. Right now, about 77% of Mali’s children are enrolled in primary school.  Kristen stressed how important each year of school is for a child’s health and future economic prospects.  For example, if a girl drops out of school early or doesn’t go at all, she will probably be married earlier, experience unsafe childbearing, and as a result have less healthy children.  “The ramifications for increased primary school enrollment for Mali can’t be understated.”

            The second prominent health trend is the percent of population living below the national poverty line.  From 2001 to 2010 the percentage of the population living below the poverty line decreased from 55.6% to 43.6%.  Poverty and health are related.  A high percentage of the population in poverty means, among other things, that a high percentage of the population suffers from poor health conditions.  The gross national income per capita in Mali is $610/year…which is less than $2 a day.  Mali is such a poor country, so as a result, they are suffering from bad health conditions.

            Third is maternal mortality ratio (MMR).  This is the number of women dying from childbirth-related complications per 100,000 live births.  In the last twenty years, the MMR has gone down from 1,200 deaths (per 100,000) to only 540.  This number is still incredibly high compared to the US where our MMR is about 21, but it is still good progress for Mali.  These statistics mean that more Malian women are having skilled birth attendants, or they have the means to deliver their babies in facilities with emergency obstetric care.

            The fourth key trend is the child mortality rate.  This rate is defined as the number of deaths in children under 5 years old per 1,000 live births.  From 2003 to 2011, this rate slightly decreased from 203 to 176 (the US rate is 8).  This rate is still unacceptably high, but the decrease is significant and represents improvements in neonatal care, improved vaccination coverage for pneumococcal diseases, measles, and other vital childhood vaccines.  It is likely that more children are being exclusively breastfed and treated for diarrheal diseases with oral rehydration solution.  It is also likely that nutrition is improving slightly with breastfeeding and vitamin A drops.  It is possible that more children have been able to sleep under bug nets to prevent malaria and other insect-borne illnesses.

            Lastly, the fifth key health trend in Mali is life expectancy.  From 2003 to 2011, life expectancy in Mali has increased by three years!—from 48 years to 51.  A low life expectancy speaks of the quality of life in a country.  It often indicates the presence of widespread absolute poverty and infectious disease.  In Mali, the increase in life expectancy is likely due in party to the decrease in childhood deaths.

            Kristen described to me how each of these trends has been improving over the past decade or so.  It is amazing to me how a country can be struggling so much with health-related issues.  Right now, Mali is rated 182^nd out of 186 countries (at the bottom) in the human development index.  She described this as “a composite measure of life expectancy, literacy, and education, living standards, and quality of life particularly of children.”  Hopefully Mali can continue to improve its health conditions and become a better and better place to live.