Every death counts

KHOPOTSO: ‘€œEvery Death Counts’€ is a summary of a set of three different reports looking at what causes the deaths of newborns, children and mothers in South African hospitals and what the health system can do to avoid these deaths. The report shows some successes and failures, says Professor Mickey Chopra of the Medical Research Council. Addressing the media, Chopra said the good news is that there has been a decrease in the number of newborns that die in our hospitals.

 

Prof. MICKEY CHOPRA: The bad news is that in terms of infants and children dying we’€™re not making progress’€¦ Estimates from the 1990s, at least, show, at best, a flattening of the number of deaths and at worst, a worsening of the number of deaths. There are only 12 countries in the world where the proportion of children dying has increased in the 1990s and 2000s, and South Africa is unfortunately one of those 12 countries.

 

KHOPOTSO: The report shows alarming figures: 20 000 babies are still-born in South Africa every year. Another 22 000 die before one month of age. In total, 75 000 children die before they reach the age of five every year. And at least 1 600 mothers die from complications of pregnancy or child-birth. These translate to 260 deaths a day. Professor Bob Patterson is also from the Medical Research Council. He says there are five major causes for both child and maternal deaths.  

 

Prof. BOB PATTERSON: (They are) pregnancy and child-birth complications, new-born illness, childhood illness, HIV and AIDS and malnutrition.  

 

KHOPOTSO: Professor Chopra adds that some of the deaths are as a direct result of the quality of care in the health system.

 

Prof. MICKEY CHOPRA: There’€™s a lack of the use of health care facilities’€¦ people coming into health facilities presenting very late in their illness or not presenting at all and dying at home. That’€™s related to lack of transport. We also have problems with inadequate facilities, whether it’€™s sometimes doing a caesarean section when it’€™s required, the facilities don’€™t have a doctor to do it or whether it’€™s having equipment and skills as well. The other cause, which audits have found is a lack of caring attitude ‘€“ that health workers are not monitoring or doing the kinds of things that they should be doing.          

 

KHOPOTSO: Reports of poor quality of care in the public health system are rife. These include concerns raised recently about the high death rate of children at Frere Hospital in the Eastern Cape as well as inadequate equipment in children’€™s wards at the largest hospital in the southern hemisphere, Chris Hani Baragwanath. Dr S’€™thembiso Velaphi is a paediatrician there.      

 

Dr STHEMBISO VELAPHI: I think the problems are real and I don’€™t think they are only limited to the hospitals that have been in the media. It’€™s a bigger problem that affects quite a number of hospitals in the country… The problems are true in terms of the shortage of staff and in terms of the problem of equipment which do contribute to the number of deaths that we see.  

 

KHOPOTSO: South Africa is one of 12 countries in the world that are lagging behind in reducing child and maternal deaths. With a middle class economy like ours, this is of concern, says Dr Ngashi Ngogo, of the United Nations’€™ Children’€™s Fund (UNICEF)

 

Dr NGASHI NGOGO: First of all is that when you look at the countries that have made some progress, some of them do not even have the kind of infrastructure and resources that South Africa has like Malawi, Mozambique, Tanzania, and so on. I say what is critical to make progress’€¦ is to have (a) high-level government commitment that is actually translated into having a clear national strategy that has got clear targets where the implementers at provincial and district level can be actually held accountable to deliver on certain clear targets.            

 

KHOPOTSO: For a number of years now, South Africa has known the causes of maternal mortality in women receiving care from its public health facilities. It’€™s one of a few countries in the world to have what is known as the Confidential Enquiries Register into maternal deaths. Last month, the Minister of Health, Dr Manto Tshabalala-Msimang, appointed three committees to investigate maternal mortality, peri-natal and infant mortality.

 

Dr MANTO TSHABALALA-MSIMANG: This should be viewed as (a) national process where everyone should actively participate, including, indeed, the communities themselves. There is need to also apply our minds into how we can identify deaths that occur beyond the health institutions, hence the necessity for the participation and involvement of communities, and also to embrace all other facilities, including the work that’€™s done by the private sector and the NGOs in this quality improvement programme.    

 

KHOPOTSO: With the country’€™s less than flattering track record in the prevention of child and maternal mortality, perhaps it is opportune that Cape Town will host an international meeting in mid-April focussing on mechanisms to reduce maternal and child mortality.

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