FREETOWN, 3 March 2008 (IRIN) - Sierra Leone has the highest child and maternal mortality rates in the world because of underinvestment in health programs, malnutrition, and harmful cultural practices, UN children's agency (UNICEF) Executive Director Ann Veneman told journalists in the Sierra Leone capital.

"Child mortality in this country is the worst in the world at 270 deaths per 100,000 children born," Veneman said on 29 February, the last day of her three day visit to the West African nation.

"If you're a child born in Sierra Leone you have a more than one in four chance of not living to see your fifth birthday," she noted.

Sierra Leone also has the worst record for prenatal care, with one in eight women dying during pregnancy or childbirth, compared to a one in 76 average in the rest of the developing world and one in 8,000 in the developed world.

"It shows by comparison the difficulties women face in this country," Veneman said.

The causes of child and maternal mortality are well known by aid experts. Regular immunisations, vitamin A supplements, re-hydration for children suffering from severe diarrhoea and the use of bednets by women and children to protect them from malarial mosquitoes have all been proven to be simple and effective ways of keeping women and children alive.

"The challenge now [in Sierra Leone] is to scale these programs up," Veneman said, stressing the need to address food security and nutrition. "It's both a question of how to rebuild agriculture in this country… but also to ensure people have proper nutrition and buy the right foods to eat," she said.

Many of Sierra Leone's cultural practices are detrimental to child survival, according to UNICEF. Early and underage marriage, female genital mutilation/cutting, and child labour are frequently practiced.

"All these practices contribute to the health and well being of women and children and the health of the nation," Veneman pointed out.

The most harmful cultural practice of all is the lack of breastfeeding in Sierra Leone, Veneman said, pointing to practices of giving babies water instead of milk as soon as they are born and feeding children with rice water not breast milk.

"In this country only 10 percent of women breast feed exclusively for the first six months," she said.

With world-beating levels of child and maternal deaths, Veneman said that as Sierra Leone is a post-conflict country, aid agencies should be providing both development and humanitarian assistance.

"In post-conflict situations in particular there is the question of where do you draw the line between a humanitarian crisis and development issues," she said.

"UNICEF tends to look at post-conflict countries as a continuum where you need a blend of the two – special cases that involve humanitarian and development."

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