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14 June 2012

The causes of maternal and child deaths

The lack of proper sanitation, poor access to health services, malnutrition and HIV/Aids are all contributing factors to early childhood and maternal deaths.

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The lack of proper sanitation, poor access to health services, malnutrition and HIV/Aids are all contributing factors to early childhood deaths. Maternal deaths are also increasing, mainly due to HIV infection. This is according to studies done by the United Nations Children’s Fund (UNICEF).

More than seven million children died before their fifth birthday in 2010 - nearly all from preventable causes. One of the reasons for this is mothers not wanting to breast-feed their children. This is according to Dr Siobhan Crowley of the United Nations’ Children’s Fund (UNICEF).

“South Africa has the lowest rate of breast-feeding in the world. Breast-feeding is really important... but not only because it reduces mortality and morbidity... but if you look at children who have had that period of breast-feeding, their emotional behaviour and development outcomes are better in the long term. For instance, they are likely to stay longer in school and do well in school, be well-adjusting adults, therefore, contribute more in society. So, it is very important”, says Dr Crowley.

She adds that many other factors contribute to the mortality rate of children below the age of five.

“The rest of our newborns are diarrhoea and pneumonia as the big causes. Then, four percent is due to HIV. And, remember not all of these kids were tested for HIV. Then, there is also meningitis. If you look at the nutritional status of those neonates who died in the paediatric ward, 43% were okay, 39% were under-weight for their age and nine percent had severe malnutrition. So, this is very concerning, too”.

Better sanitation needed

Dr Crowley says a large number of the deaths due to diarrhoea and pneumonia can be avoided by making proper sanitation services widely available.

Jenny Holtzhausen from the Africa School Mission in a small rural town of White River, in Mpumalanga, says malnutrition is a huge problem in her community because many mothers find it difficult to sustain exclusive breast-feeding of their babies.

“There is also the challenge of moms going back to work while their infants are very young. They leave the children in the farms from 05:45 in the morning till 5pm. You get two unskilled labourers looking after 20 to 30, even 40 children, including tiny babies all day. So, malnutrition is a key challenge in the area”, Hotltzhausen says.

Holtzhausen adds that many child deaths could be prevented if health care providers did a little bit more than the obvious when treating children in facilities.

“Usually, a mother will come into the clinic and say her child has diarrhoea.

Better healthcare would prevent deaths

But when you do a correct assessment of the child, you discover the child also has pneumonia, yet she was worried about the diarrhoea or the other way around. So, we do a comprehensive assessment looking for signs like coughing, difficult breathing, dehydration, meningitis assessed and the normal ear infection”, she says.

Some of the deaths are caused by health facilities not providing quality care, or not having a certain product or medicine for child patients and even families bringing in children to health facilities when they are already very sick.

Coupled with child mortality, maternal mortality is also a huge concern. UNICEF’S Dr Crowley says HIV/Aids is a big threat, especially to women.

“In this country we have the highest burden of HIV in the world... 5.6 million of the people living with HIV...  women bearing the biggest brunt of HIV and many children as well infected. One in three women who come for antenatal care will have HIV - which is just phenomenal. In many parts of KZN, it is one in two”, she says.

Crowley says South Africa has the potential to save the lives of many women and children, if only health facilities could optimally apply the   Prevention from Mother to Child HIV Transmission programme and women sought medical help early enough for their HIV infection.

“Why does a woman die? If they look at those causes, it says 47% are non-pregnancy related causes. The bulk of those are HIV. If we look at how these deaths could be avoided, we see that in South Africa if we just did our PMTCT as our guidelines say, we could save at least 37 000 lives by 2015. And that is by doing what we are supposed to do.

If we can do better in our delivery care, you’ll see the impact in reducing maternal deaths, avoiding stillborns and preventing newborn death”.

(Health-e News, June 2012)

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