Despite the advancements in healthcare, South Africa continues to grapple with high child mortality rates. Preventable and treatable diseases like pneumonia, diarrhoea and other respiratory infections are the leading causes of death among children under five.  

The latest estimates by Statistics South Africa (StatsSA) show a rise in children’s deaths. 

Professor Shanaaz Mathews, research director at the Department of Paediatrics and Child Health at the University of Cape Town tells Health-e News that the death of children under five years old has increased to 40 per 1000 live births in 2022. In 2020 it was 28 per 1000 live births. 

“The reasons for rising childhood mortality after COVID-19 lockdowns are unclear as there have been long delays in the release of causes of death data,” she says.  

In 2020 during the most stringent lockdown restrictions, there was a downward trend in child mortality. 

“The numbers of registered deaths suggest that the winter increases in respiratory syncytial virus (RSV) and other pneumonias, as well as seasonal outbreaks of diarrhoea, were absent,” says Mathews. She adds that the lockdown restrictions on socialising and travelling may have protected young children from infectious diseases. 

Primary causes of child mortality 

According to the Department of Health, the primary causes of death in South Africa are neonatal factors (such as birth defects, lack of oxygen during and after birth, infections), pneumonia, diarrhoea, and moderate and severe acute malnutrition.

Mathews adds that malnutrition is often an underlying cause of death in young children.

“There were widespread concerns that COVID-19 disrupted childhood immunisation programmes as resources were redirected towards the pandemic response. This was reflected in a fall in immunisation rates among infants. The immunisation coverage at one year dropped from 83.5% to 79.5% in 2020,” she says.

“Lower respiratory tract infections, predominantly pneumonia, remain a major cause of disability and death in children under five years,” she says. These infections are largely vaccine-preventable. 

Mathews points out that immunisation rates have remained below their pre-COVID-19 levels in Limpopo, Mpumalanga, Gauteng, Northern and Western Cape.

Another common cause of death in children is poison, an issue that’s been widely reported in recent months.

In November the health department reported that 22 children died of food poisoning. President Cyril Ramaphosa announced that all deaths of children under 12 years and below will be made notifiable, this will allow the Department of Health to access cause of death information immediately after death is certified.

Challenges in reducing child deaths

Despite ongoing policies and initiatives aimed at improving child health, the public health system remains strained due to limited resources and inadequate infrastructure.

Mathews says that poverty and its associated impact on children is a huge barrier to reducing child mortality rates. Poor children bear the greatest burden of disease due to undernutrition and poorer living conditions. 

“Health facilities are least accessible to the poor. More than a quarter of children in the poorest of households travel far to access health care compared to 7% of children in the richest quintile,” she says.

Government interventions

National health spokesperson Foster Mohale says the department is putting in place evidence-based interventions that focus on the prevention, early detection, treatment, and referral of children with common childhood illnesses, including diarrhoea, pneumonia, HIV, TB, and acute malnutrition.

“There is ongoing capacity building for clinicians to prevent and manage childhood illnesses, utilising both face-to-face and online training methodologies. The department has taken key actions to improve monitoring and evaluation through routine programmes,”  Mohale says. 

“It also follows the implementation standard inpatient paediatric register to improve data quality and the use of data for identifying and responding to deficiencies.”

The Child Gauge 2024 report warns of worsening trends in the country, calling for urgent action to protect young lives. Addressing child mortality in South Africa requires sustained investments in healthcare, enhanced public awareness, and targeted interventions to tackle poverty and inequality. – Health-e News