What is more terrible than the death of a child? Nothing. The Congolese are born in conditions of great precariousness and die en masse before the age of 5. We have tried to approach this reality through the concrete state of the Health Center of the Health District of Goma Tsé-Tsé near Brazzaville. No sooner are they born than we must already die. When the Congolese do not die at birth, they die en masse before age five from malaria, water-related diseases combined with chronic malnutrition.
According to the World Bank, the population of the Republic of Congo is young and poor. 47% of its 5 million inhabitants are under 18, and 35% of the population lived below the poverty line in 2016.
It is a barely renovated but empty building that stands out from the surrounding savannah. The grass is tall, and an abandoned ambulance stands in front of the health center. The district covers an area of 2271 inhabitants with three health professionals, a state registered nurse, an ATS (Technical Health Worker), and an assistant but no resident doctor.
According to Unicef, the leading causes of neonatal mortality are premature birth (44‰), asphyxia or respiratory distress (29%), and infections (27%). The significant causes of mortality before the age of five are malaria (54%), acute respiratory infections (18%), and diarrhea (17%). The living environment of the Congolese, made up of insalubrity, shortage of drinking water, and electricity, is undoubtedly the primary cause. The health center has no electricity or generator.
The visit to the center is instructive: the delivery bed is spartan, there is a makeshift pharmacy, but the state of conservation of the products raises questions. The center is empty or instead seems to have been emptied in anticipation of our visit. There is only one bed, itself in a sorry state. The ATS who guides us confesses that the sick sleep on the floor on mats for lack of beds. Although malaria causes up to 54% of childhood deaths, we do not see any mosquito net in the health center. Yet, we are in an area where this disease is endemic.
Congolese women give birth young. Sex education is non-existent, and family planning is in its infancy. Abortion remains prohibited and taboo although practiced semi-clandestinely in questionable sanitary conditions. According to MICS Congo 2014-2015, young girls aged 15 to 19 are more affected than their elders by maternal mortality. Between 2007 and 2013, the latter represented 39% of all deaths of young girls in this age group.
Thus, two adolescent girls out of 5 who died during the seven years preceding the MICS survey lost their lives from maternal causes against one older woman in 5. According to this study, teenage mothers are the women most at risk of dying in childbirth.
Yet if we are to believe the official statistics, the mortality of children under 5 fell slightly between 2011 and 2015, from 68 ‰ to 52 ‰, but not enough to reach the MDG target (39 ‰). In this land of falsification, as with the hidden debt statistics scandal, it is prudent not to take the official figures at face value. Child deaths in rural areas are poorly or not at all reported. There is a growing proportion of children under five who have no civil status and no legal existence. Finally, the bureaucracy tends to want to look good on the regime; a high rate of infant mortality is terrible publicity to be avoided.
Again according to the MICS Congo 2014-2015 study, out of 1,000 children who are born: 52 die before reaching the age of 5, including 36 before their first birthday (21 between 0 and 28 days, and 15 between 1 and 12 months), and 17 between 12 and 59 months. According to UNICEF, food insecurity persists, with more than 26% of children under 5 suffering from chronic malnutrition. Malnutrition remains a major underlying cause of death, as stunting affects more than one in five children.
With a birth rate of 35 ‰ against an infant mortality rate of 56.40 ‰ in 2016, it is no exaggeration to speak of missing generations of Congolese.
Three health professionals share a chair and a desk for a Health area of 2271 inhabitants. The Congolese are born in shameful disrepair. There is no certainty, which is why we are proposing a cooperative of women from Goma Tsé Tsé to improve childbirth conditions.
Everyone’s mobilization must take the place of discouragement and apathy. Giving life is the greatest of gifts; it is unacceptable that the Congolese continue to do so in precariousness.
Congo republic 22 September 2021
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