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
Received 22 August 2013; revised 16 September 2013; accepted 23 September 2013
Copyright © 2013 Tamramat I. Runsewe-Abiodun, Sahr F. Bondi. This is an open access article distributed under the Creative Com-
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
p
repared and agreed on the fina l c ontent of the manuscript.
#Corres
p
ondin
g
author.
The association between teenage pregnancy and social
disadvantage is global [4-7] and the continuing appre-

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.
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