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A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
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A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting

Published on: January 12, 2018

Sex-stratified mortality trends in preterm birth complications in Sierra Leone: progress, persistence, and equity

Alpha Umaru Bai-Sesay1,2,3, Rosetta Doreen Jones1,4,3, Alimamy Paul Simeon Baun1

  • 1Ministry of Health/National Public Health Agency, Freetown, Sierra Leone.

Global Health Action
|August 6, 2026
PubMed

Insights

Preterm birth complications significantly decreased in Sierra Leone over 20 years, yet male neonates consistently faced higher mortality. Sex-disaggregated data is crucial for equitable neonatal care planning and reducing male disadvantage.

Area of Science:

  • Neonatal Health
  • Global Health Equity
  • Demographic Analysis

Background:

  • Preterm birth complications are a major cause of neonatal deaths in Sierra Leone.
  • Limited evidence exists on long-term, sex-specific mortality disparities from preterm birth, hindering equitable care.
  • Recent health system improvements have not fully addressed these disparities.

Purpose of the Study:

  • To analyze two-decade trends in sex-stratified mortality related to preterm birth complications.
  • To utilize standardized equity indicators to assess disparities in neonatal mortality.
  • To inform equitable neonatal care planning through evidence-based insights.

Main Methods:

  • Retrospective longitudinal analysis of sex-disaggregated mortality data (2001-2021).
  • Utilized World Health Organization (WHO) Global Health Estimates (GHE) via the WHO Health Equity Assessment Toolkit (HEAT).
  • Assessed inequality using absolute difference (D), relative ratio (R), population attributable risk (PAR), and population attributable fraction (PAF).

Main Results:

  • Mortality from preterm birth complications declined for both males and females between 2001 and 2021.
  • Male neonates consistently experienced higher mortality rates (approx. 20-25% excess).
  • Absolute inequalities narrowed modestly, while relative inequalities remained stable; PAR and PAF were near zero.

Conclusions:

  • Despite overall declines in preterm birth mortality, a persistent male disadvantage exists in Sierra Leone.
  • Integrating sex-disaggregated equity monitoring into neonatal policies is essential.
  • Further research is needed to address excess male neonatal mortality and sustain survival gains.
Abstract

Keywords:
Neonatal mortalitySierra LeoneWHO HEAT metricshealth equityinequality monitoringneonatal policypreterm birth complicationssex‑based disparities

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