Each year in South Africa:
- At least 2,500 mothers die due to complications of pregnancy and childbirth
- 20,000 babies are stillborn and another 22,000 die before they reach one month of age
- In total, at least 75,000 children die before their fifth birthday
This toll of over 260 deaths every day is due to 5 major health challenges: (1) HIV & AIDS (2) Pregnancy and childbirth complications (3) Newborn illness (4) Childhood illness and (5) Malnutrition.
1) HIV & AIDS
HIV & AIDS cause 57% of annual under-five deaths (nearly 43,000 under-five deaths every year).
The HIV prevalence among pregnant women seems to be levelling at about 30%, but this still means that each year there are 300,000 pregnant women with HIV who need services. Also only 68% of pregnant women are currently tested for HIV. Only 61% of pregnant women who are HIV positive and only 47% of babies exposed to HIV are receiving Anti-Retroviral Treatment (ARTs).
Use of ARTs needs to be urgently increased to 100% as Botswana has done to reduce PMTCT. Also prevention needs to be promoted (condom use by women in the 15-24 age group is only about 53%).
2) Pregnancy and Childbirth complications
Pregnancy and childbirth complications cause around 25% of annual under-five deaths and 50% of maternal deaths (nearly 19,000 under-five and 1,250 maternal deaths every year): Birth and the first day of life is the time of greatest risk for mother and baby. Approximately half of all maternal deaths take place within one day of childbirth. Around 40% of stillbirths occur during labour and between one third and one half of all newborn deaths are on the first day of life – many due to asphyxia resulting from poor quality of care during childbirth.
Among the poorest 40% of the population only 68% of births are accompanied by a skilled health person and in general only 27% of pregnant women receive an antenatal visit before the twentieth week and only 68% have four antenatal visits. Health service coverage needs to target the poorest and this will require recruiting and training more health service personnel and ensuring that the necessary drugs are available for all, especially the poorest. All mothers should receive a postnatal visit within 3 days of giving birth and counselling to increase exclusive breastfeeding is urgent (only 7% of mothers exclusively breastfeed for the first six months)
3) Newborn Illness
Newborn illness causes around 10% of annual under-five deaths (about 7,500 deaths every year): Small and preterm babies have a much greater risk of dying, many from lack of simple care such as warmth, feeding, hygiene, and early treatment of infection. Fifteen percent of babies in South Africa are low birth weight, weighing less than 2,500 grams. Infections, particularly sepsis, pneumonia, and meningitis, are also a major cause of newborn deaths. Health service coverage needs to target the poorest and this will require recruiting and training more health service personnel and ensuring that community case management, particularly of pneumonia and sepsis is rolled out in poorer districts.
4) Childhood illness
Childhood illness: Although South Africa has made good progress here – only 76% of under-five children suffering pneumonia receive treatment; only 74% receive a full course of immunizations; only 37% receive oral rehydration treatment (ORT) for diarrhoea; and only 29% of under-five children have full vitamin A coverage. So there is room for improvement especially for the poorest who have least access.
5) Malnutrition: Food security and dietary quality remain a challenge for many South Africans and have a profound impact on pregnant women and children. According to Child PIP, one third of children who died were severely malnourished, and over 60% were underweight for their age, particularly those who were HIV- infected. Preventing HIV in these children should prevent the malnutrition.
Exclusive breastfeeding is very low 7% and needs to be steadily increased. Pregnant women need additional nutritional supplements, as 15% of babies are low birth weight. HIV positive women and children need special diets to complement ARTs.
Equity Issues
In South Africa as in many southern African countries, there is a serious issue of in equity, with the poorest 40% of the population, having only half the rate of access to basic health services, compared to the richest 20% of the population. So again investment must be directed to the poorest 40% and in ensuring that all direct and indirect barriers to access are removed or at least reduced substantially. (Countdown to 2015)
Equally the differences in under-five mortality rates related to geography, education of mother and birth spacing are very striking.
Eastern Cape has an under-five mortality rate of 80.5 per 1,000 live births against a rate of just 39 in Western Cape. Children born to mothers unable access education have an under-five mortality rate of 83.8 against a rate of 29.3 for children of mothers who have completed higher education. Children born less than two years after their sibling have a 100.8 under-five mortality rate as against a rate of 51.8 for children born two to three years after their sibling. (DHS Survey 1998)
The key role of girls’ education and adequate family planning advice on safe motherhood can make a critical contribution to reducing under-five mortality rates.
