The country is currently one of only 12 countries globally that has increasing rates of child deaths.   Yet it is estimated that over 40,200 child deaths as well as many maternal deaths and stillbirths could be avoided with simple, internationally recognised interventions.

At least 260 mothers, babies and children die each day.

Dr Joy Lawn of Save the Children says  that South Africa has the potential to significantly reduce the increasing deaths by making sure the policies such as the prevention of mother to child transmission programme, are implemented properly.

Much poorer and less resourced countries such as Malawi, Rwanda and Tanzania have made significant progress in reducing maternal, newborn and child deaths by firstly admitting there was a problem and using available expertise to formulate interventions that have made an impact on the death rate.

The Countdown 2008 report, released recently showed that South Africa was failing its mothers and children, with almost 2 000 mothers and 75 000 children under five losing their lives every year. HIV was highlighted as a major challenge in South Africa given HIV rates up to ten times higher than other African countries.

Health minister Dr Manto Tshabalala-Msimang has  questioned  the report’€™s findings and dismiss the experts’€™ findings as flawed.

In response, The Lancet journal said Tshabalala-Msimang’€™s attempts to divert attention to the fact that developed counties were recruiting Africa’€™s healthworkers, the very people who she said would have provided care for the mothers and children, was flawed as South Africa has twice the Countdown benchmark for such personnel.

‘€œWhat she failed to do was openly concede failures, address the concerns set out in the Countdown report, or look for ways to improve health care for women and children. There were few signs of commitment to take action, other than to mention a need to strengthen health systems. How is she proposing to do this? She could follow Tanzania’s example by committing about US$11 per head of population to health and to develop systems essential to the continuum of care.

‘€œSouth Africa, of all African countries, is in the best position to devote more funds to its health programmes. What is lacking is political will. What is needed is less defensiveness and more action. South Africa should be looking forward, not back,’€ the Lancet concluded.

Tshablala-Msimang also tried to state that mortality rates had improved since 1990, but a Lancet article examining the varying data points and estimates concluded that all indications are that under five mortality in South Africa has increased since 1990, the baseline year, and that maternal and neonatal mortality have at best remained the same or more likely have also increased over the past 18 years.

Worldwide, only a dozen countries have increasing child mortality, all with wars or major HIV crises. Some countries that had similar child mortality rates and similar gross national incomes to South Africa in 1990, such as Brazil, Mexico, and Egypt, are now on track to meet Millennium Development Goal (MDG) 4 for child survival, having halved their under five mortality rate in those 18 years.

Lawn points out that in South Africa, child deaths fall into two main groups ‘€“ HIV and neonatal (new borns). If South Africa makes a concerted effort to address these two issues, even within two to three years the deaths could be halved.

‘€œThe first priority is to increase the reach of our prevention of mother to child transmission of HIV programme to full coverage or at least 80 percent of women and babies needing it, then the country would rid itself of the majority of AIDS deaths in children within a short time period.

‘€œTo achieve this will take more than providing the right tablets at the right time. Infant feeding issues in the first days after birth must also be addressed as many mothers opt for breastfeeding or mixed feeding seeing massive transmission rates of HIV. If South Africa achieved both the antiretroviral coverage and the feeding support, including effective care in the postnatal period, you could halve the HIV-related child deaths within three years,’€ says Lawn.

The country could also halve neonatal deaths if it targeted poorer communities with simple interventions that address the main causes of the 20 000 newborn deaths a year in South Africa ‘€“ preterm birth, birth asphyxia and infections.

Most women in South Africa do give birth in a health facility, but the quality of care during labour and rapid reaction to problems, such as a baby who does not breath at birth, may be lacking, especially for the poorest families.

‘€œKangaroo care’€, is a very effective and low-cost  intervention that has saved many premature babies. South Africa has made rapid progress with this in many provinces and reaching every facility is feasible with concerted effort. In addition, newborn infections can be treated with antibiotics but families and facilities need to recognize danger signs and act quickly.

At  a community level, new research from Bangladesh has also shown that by introducing home care visits within two days of the birth of the child, neonatal mortality had been reduced by an astounding 77 percent.

Lay healthworkers are able to speak to the mother about infant feeding practices (which is especially crucial in South Africa), and recognizing infections that are deadly, but treatable if identified early on.

The healthworker can also meet key decisionmakers in the family who are often the ones determining the choices made regarding feeding and careseeking for illness.

South Africa’€™s current policy is that a postnatal visit should happen within seven days, but no data is available as to whether this happens or not, and there is no current provision for routine home visits.

In any case research shows that three quarters of maternal and baby deaths had occurred by day 7 after birth so the first few days are the priority.

In facilities, audit systems to track deaths of mothers, babies and children have been used widely in South Africa to improve the quality of care, but staff shortages, low morale and security issues have limited the capacity of staff to make changes and have encouraged many to seek work in the private sector or out of the country.

Lawn said that South Africa could look at its human resource policies so that the most life saving care reaches people in rural and hard to serve areas. ‘€œThere needs to be more delegation of tasks, problems need to be solved within the context of human resources,’€ she said, explaining that many tasks are doctors dependent but may not need a doctor. ‘€œ There is, for example, no reason why middle-grade staff cannot do blood tests, which will free up midwives to do the work that is lifesaving. In Mozambique, Malawi and Tanzania the majority of obstetric procedures, including caesarean sections are done by non-physicians including midwives.’€ says Lawn.

Lawn points out that, compared to the rest of Africa, South Africa has fantastic facilities, more skilled staff and no user fees. ‘€œTheoretically all the ingredients are in place but we need to consider this as the critical time to act and put these do-able measures in place fast.’€    – Health-e News Service.