Over 40 000 deaths could be prevented by better health services
The deaths of up to 40 200 South African babies and children could be prevented every single year if gaps in the healthcare system, including poor patient care and lack of interventions to address HIV/AIDS, were addressed.
This is according to a report, ‘Every death counts’, that was presented to Health Minister Manto Tshabalala-Msimang today (Tuesday 11 March) at the conference ‘Priorities in Perinatal Care’.
Every year at least 20 000 babies are stillborn, another 22 000 die within the first month of their lives and 1 600 mothers die from complications of pregnancy and childbirth.
Some 75 000 children die before their fifth birthday, according to the report.
‘The report makes for hard reading,’ says Dr Mark Patrick, a paediatrician at Grey’s Hospital in Pietermaritzburg and one of the report’s authors.
‘We are talking about a lot of deaths. Under five mortality appears to be increasing. Maternal mortality appears to be increasing. HIV infection amongst pregnant women appears to be increasing,’ says Patrick.
‘The fact that 260 mothers, babies and children die every day in South Africa should make people stop and think and ask why this is happening.’
A very high percentage of maternal deaths, stillbirths and child deaths are caused by inadequate care on the part of healthcare providers, described as ‘modifiable factors’.
‘Modifiable factors’ were identified in over half the cases of women who died in childbirth at clinics as well as over half the child deaths.
Over two-thirds of stillbirths had ‘avoidable factors’, including the failure of healthworkers to attend to some of the pregnant women’s high blood pressure.
Proper monitoring during labour could save most of the 7 300 babies dying each year either during childbirth or shortly afterwards, according to the report.
Little babies under the age four months of age are falling through a gap between maternal and child care programmes, with only about a quarter of these babies going to the clinic for a check-up.
Another serious gap is in HIV testing, with only around two-thirds of pregnant women being tested for HIV.
‘Coverage of key HIV interventions drops at the time of childbirth and postnatal care, when it is most crucial,’ notes the report.
During pregnancy and early childbirth is the only time that interventions with antiretroviral medicine can be made to prevent mothers with HIV from passing the virus on to their babies.
In addition, HIV positive mothers need to choose to either exclusively breastfeed their newborn babies or give them formula milk to prevent them from getting HIV.
‘Support to sustain (these) feeding choices is especially crucial,’ notes the report.
Gaps were also identified in healthcare workers’ skills, including the ability to resuscitate newborns and provide emergency care, identify and treat children at risk for malnutrition and give proper counselling to HIV positive mothers on feeding options.
The report is a synthesis of three reports, called ‘Saving Mothers’, ‘Saving Babies’ and ‘Saving Children’ and was compiled by a number of the country’s top health researchers including Professors Debbie Bradshaw and Mickey Chopra.
‘While the numbers are hard, the fact that we have identified the gaps offers a serious opportunity for all role players to get stuck in and make a difference to save the lives of mothers, babies and children,’ says Patrick.
Last month, the Health Minister appointed three committees to look into maternal mortality, perinatal mortality and infant mortality.
‘Every maternal, perinatal and under five death will be recorded by these committees. They are going to record cause of death, the contributing factors and classify that death incident accordingly. They will thereafter make recommendations of the measures that need to be taken to address preventable causes and factors,’ said Tshabalala-Msimang.
‘We expect these recommendations to include identification of improvements in the delivery of health services and protocols or guidelines to better manage cases within the health system. In cases where contributing factors are outside of the health system, we will have to engage with responsible sectors to ensure that such challenges are addressed.’
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