How children die Living with AIDS # 348
An audit of deaths of children under the age of five in the South African health care system shows that many of these deaths can be avoided.
KHOPOTSO: A nationwide survey called the Child Health-Care Identification Programme, CHIP, studied about 54 000 children admitted to public hospitals. It also analysed the deaths of just over 4 200 children in these institutions as well as those who are dead on arrival. Factors contributing to children who died include poverty, malnutrition and HIV. Dr Mphele Mulaudzi is a paediatrician at Kalafong Hospital, on the border of Atteridgeville township, in Pretoria west.
Dr MPHELE MULAUDZI: We can really see that (the) majority of the children who die are under one year old’¦ A lot of the children that die are actually malnourished with 29% of them under-weight and 36% with severe malnutrition’¦ This actually, really, is the social ill that is carried through and becomes the burden in the health circumstance. We have also been able to assess HIV for the children to be able to say that in the children who die, 30% of them are actually infected. When they are less than 18 months, have actually had a PCR test done. So, that has been confirmed.
KHOPOTSO: But that may be the tip of the ice-berg. Mulaudzi fears that many more children die without having been tested for HIV. She goes on to list the major direct causes of death among children.
Dr MPHELE MULAUDZI: The lower respiratory tract infection, the sepsis, diarrhoea, PCP and TB. As years progressed, the TB has actually increased. And the lower respiratory tract infection, if one adds the PCP with it, then that becomes quite a huge problem for the children.
KHOPOTSO: A lot of the deaths occur in the homes and hospital wards. Mulaudzi says a number of factors can be attributed to children dying. She calls them modifiable or avoidable factors.
Dr MPHELE MULAUDZI: The process of emergency care for children ‘ that’s where the other problems are’¦ A lot of the problems involve the clinical personnel and also the care giver’¦ We have a lot of delay in seeking care; and the care giver not recognising the severity of the illness. We also have the clinical personnel not prescribing appropriate treatment. And we have problems which are of the managers and administrators ‘ where there is lack of hospital beds and lack of senior doctors and professional nurses looking after the child.
KHOPOTSO: Thirty hospitals participated in the research, which involved facilities in rural, urban and peri-urban South Africa, since 2001. The CHIP report highlights five key areas of importance, which include HIV/AIDS and nutrition for children.
Dr MPHELE MULAUDZI: It will be able to say something about the children who die’¦ What have they received as far as our PMTCT programme (is concerned) because it asks specific questions about whether the child has received prophylaxis ‘ the Nevirapine or not’¦ It also asks specific questions about children whom when they died actually qualified for ARVs, but did not have the opportunity to get that. It can also inform about children who die about the nutrition programme, as you can see almost 60% of the children who die are malnourished.
KHOPOTSO: The information collected in CHIP will be used to better equip health professionals and facilities to improve the treatment and care given to children.
Dr MPHELE MULAUDZI: Our aim is not only to count the number of deaths or what caused the deaths. Our aim is to improve the care of the children’¦ It may be used as a sentinel site to improve knowledge on childhood mortality on where and why and how and when children die, especially when it is not possible to have this review tool being done in all facilities’¦
KHOPOTSO: Levels of child mortality in South Africa are soaring. About 75 000 children die before they reach the age of five in South Africa every year. That puts the country among only 12 countries in the world where the proportion of children dying has increased since 1990. This is difficult to comprehend, considering that South Africa has a relatively higher income as well as better resources to prevent these deaths from occurring. Dr Ngashi Ngogo is with the United Nations’ Children’s Fund.
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 clear targets.