Up to half of child and maternal deaths in South Africa are due to health system shortcomings, new research suggests.
South Africa is one of only 12 countries in which mortality rates for children have increased since 1990 – when the Millennium Development Goals were laid down.
The main reason for this increase in the country’s child mortality rate is basic interventions that have been proven effective, are not being implemented effectively in the health care system. HIV/Aids and poverty are also contributing factors.
“Between a quarter and half of maternal, neonatal, and child deaths in national audits have an avoidable health system factor contributing to death,” reads a study on the topic published in the August 2009 edition of The Lancet – South Africa.
The researchers estimate 11,500 infants’ lives could be saved by effective implementation of basic neonatal care, and prevention of mother-to-child transmission efforts could save 37,200 a year.
2 million babies and mothers die each year
Worldwide some two million babies and mothers die at birth worldwide every year, and most of those deaths are preventable, international NGO Save the Children said.
"The double tragedy is that those deaths don't need to occur. You don't see those deaths occurring in rich countries," Save the Children policy director Dr Joy Lawn said.
She said the 904,000 babies who died each year due to complications at birth outnumbered both child deaths due to malaria and those caused by Aids, but received much less attention and investment.
"It's clear that it isn't just size that matters," she said. "There is a critical problem with societal recognition."
In addition to the deaths due to complications, there were an estimated 1.02 million stillbirths worldwide. Those were not even counted for the millennium development goal of reducing under-five child mortality by two thirds by 2015.
Developing world most at risk
Lawn said almost all deaths at birth occurred in low and middle-income countries, especially in South Asia and Africa. Those were also the regions where physicians were spread thinnest.
"Asia has some, but Africa has almost no skilled human resources," she said. The pattern was similar for midwives. She said some 60 million births worldwide occurred at home, rather than in a health facility. In addition to the babies, some 225,000 women died worldwide every year for lack of care at the time they gave birth.
Missed opportunity to save lives
Save the Children said in a statement released at the briefing that only one out of every five babies born in African hospitals was cared for by staff with the skills and simple bag-and-mask equipment to resuscitate them if they did not breathe at birth. "This is a crucial missed opportunity to save lives," the NGO said.
Over 600,000 lives could be saved if skilled care at birth was available for everyone, especially women and babies most in need. Strategies should look at ways of getting women closer to health facilities, and at incentives such as one tried in India of paying women to have their babies at facilities rather than at home.
Governments should also look at "task-shifting" -- allowing mid-level health workers to do procedures such as caesarians. - (Sapa/Wilma Stassen, Health24, October 2009)
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