Umkhanyakude, in the far north of KZN, also has the worst rate of severely malnourished children, with 13 out of 1000 children weighing less than 60% of what they should.

Seven of the 10 districts with the worst malnutrition rates are in KZN, while there has been an increase in severe malnutrition in the Eastern Cape and Limpopo.

This is according to the District Health Barometer (DHB), which compares health outcomes in the country’€™s 52 health districts. It was released yesterday (23 Feb) by the Minister of Health.

‘€œDeprivation’€ is defined as a combination of indictors including unemployment rate, access to piped water and electricity, female-headed households with many children and low education levels, according to the Health Systems Trust, which produces the Barometer.

The Eastern Cape’€™s Alfred Nzo (Mbizana) and OR Tambo (Port St Johns) districts, which used to be bottom of the pile, are also among the most deprived areas in the country.

The chance of a patient dying in a district hospital is highest in Alfred Nzo, where nine percent of patients die.

Alfred Nzo’€™s immunisation rate of children under the age of a year is also worst in the country, and has almost halved in the past four years. Only 49% of the district’€™s children have been immunised while the national average is 87%.

But countrywide, the introduction of a rotavirus vaccine has significantly reduced severe gastroenteritis and hospitalisation of young children. The rate of children under five with diarrhoea has more than halved since 2008. However, Limpopo’€™s Vhembe and Mopani districts had the worst rates in the country, double the country average.

Meanwhile, there appear to be serious problems with maternal health services in the Free State, with a high rate of stillbirths and deaths of babies within a week of birth. This is usually an indication of poor maternal services.

An average of 31 babies per 1000 births are born dead in the Free State. There has also been a jump in perinatal mortality (stillbirths plus deaths of babies within seven days) in the province from 38 deaths per 1000 births to 43 per 1000 in two years.

In the worst district in the country, Fezile Dabi (Mafube), the perinatal death rate leapt from 39.6 to 48.5 deaths per 1000 in two years.

Gauteng has the best immunisation rate despite spending relatively the lowest on primary health care of all the provinces, with Ekuhruleni spending the least of all the districts (R739 per person, compared to a country average of R1 100). But Gauteng’€™s spending on hospitals was higher than average, indicating that people are probably seeking healthcare at hospitals rather than clinics.

It’€™s no surprise that the wealthiest two provinces, Gauteng and the Western Cape, have the best levels of clinic supervision. In Gauteng, 81% of clinics get monthly visits from supervisors, while the country’€™s best district is Eden (Western Cape) where all clinics get monthly visits.

In contrast, there is pathetic supervision in the Northern Cape ), with five of its districts having a supervision rate of less than 20 percent.

The province with the lowest HIV rate (Western Cape) had by far the best condom distribution rate, at 49 per man over 15 a year. But eThekwini and uMgungundlovu, with the worst HIV rates in country, were almost bottom dishing out a mere five condoms per man for the year.