Avoidable death: Dying babies, children and mothers

2009-08-28 00:00

DESPITE the health of women and children being a priority for the democratically elected government, South Africa is one of only 12 countries in the world where the mortality rate for our children has got worse since 1990.

“Each year, an estimated 2 500 mothers die, 20 000 babies are stillborn, another 21 900 die before the age of one and an additional 52 600 die before their fifth birthday, most from preventable and treatable causes,” according to authors Mickey Chopra and colleagues.

HIV/Aids is the biggest killer of both mothers and children. Pregnant HIV-positive women are 10 times more likely to die in, or shortly after, childbirth than HIV-negative women. Infections, mostly HIV/Aids, cause 44% of maternal deaths.

Aside from addressing HIV/Aids, poor health care also contributes to maternal and child deaths.

The latest “Saving Mothers” report (2007 figures) claims that 38% of maternal deaths in the health-care system were “clearly avoidable”. Most were failures in care such as managing post-labour bleeding, hypertension and sepsis.

The deaths of 44% of babies who suffocate in the womb (intrapartum asphyxia) were “probably avoidable”, according to the latest “Saving Babies” report. The deaths of about 1 180 babies in district hospitals of birth trauma and intrapartum asphyxia were “clearly avoidable”, had the health-care provider acted differently.

District hospitals remain the most dangerous places to give birth, with twice as many babies’ deaths than at regional and tertiary hospitals, despite the fact that these hospitals deal with more complicated cases.

Using a special analysis tool called “Lives Saved Tool” (LiSF), the authors estimate that 11 500 newborns could be saved just by ensuring that a comprehensive, essential package of care was implemented properly in 95% of births. This package contains nothing fancy, covering simple things such as proper foetal heart monitoring, antenatal steroids for preterm babies and routine postnatal care.

One of the biggest life-savers would be the proper implementation of prevention of mother-to-child HIV transmission (PMTCT), which could save a massive 50 000 babies and children in 2015.

But the PMTCT programme has “suffered from a lack of leadership” and needs to be integrated into an overall care package for mothers and babies.

Implementing the package of care and HIV prevention would cost an estimated 24% of the health budget, or some R15,7 billion. To achieve this package, women would need to pay more visits to health facilities (an increase of 9,4 million visits),.so more staff would be needed.

This accounts for 61% of the cost, as the authors estimate that 189 more doctors, 2 445 professional nurses, 250 enroled nurses and 134 nurse assistants are needed.

The other major costs are more drugs (22%), laboratory tests (five percent) and overheads (12%).

— Health-e News.

• The paper on “Mothers, babies and children” is written by Mickey Chopra, Emmanuelle Daviaud, Robert Pattinson, Sharon Fonn and Joy Lawn. http://press.thelancet.com/saser2.pdf

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