SA child deaths increase

The South African under-five child mortality rate has risen dramatically in recent years, says a new report.

South Africa is one of the 10 countries that have made the least progress in cutting child deaths since 1990, according to an international study released this week.

In terms of child mortality South Africa is now ranked 61 out of the 68 high-priority countries researched in the Countdown to 2015: Maternal, Newborn & Child Survival report for The Lancet. The 68 countries account for 97% of all maternal, newborn and infant deaths worldwide.

The report tracks 22 health interventions that reduce the deaths of mothers, infants and children to assess progress towards the Millennium Development Goals.

Countries that signed the goals committed themselves to cutting mortality among children under five by two-thirds by 2015. The goals also commit governments to reduce maternal mortality by three-quarters by 2015.

Health Minister Manto ­Tshabalala-Msimang criticised the report, saying that inadequacies in data meant it was difficult to determine whether progress was being made. She was reported as saying: ‘I can say South Africa is improving and we are going to meet our goals.”

Tshabalala-Msimang said there was a need to look at social determinants of health such as poverty and that ‘the inequities between the north and south continue to undermine the wellbeing of our populations particularly women and children.”

The report says the South African under-five child mortality rate rose 15% between 1990 and 2006, from 60 to 69 per 100 000 live births. The millennium goals target is 20 deaths, meaning South Africa would need to cut child mortality by just under 14% a year to meet it.

However, South Africa is one of only eight countries on track to reach the target of 80% of women receiving treatment to prevent of mother-to-child transmission of HIV.

By 2006 HIV/Aids had become the biggest killer of children in South Africa, accounting for 57% of deaths. Neonatal mortality accounted for 35% of child deaths: of these 23% were from asphyxia, 39% because babies were pre-term and 19% were from ­infections.

The four worst-ranked countries for child mortality are all in Southern Africa, with Botswana seeing a 114% rise between 1990 and 2006, followed by Swaziland (49%), Zimbabwe (38%) and Lesotho (31%).

Overall only 16 of the 68 high-priority countries are on track to achieve the millennium goal, while 26 have made no progress and 26 insufficient progress. The report says lack of equity within countries, armed conflict, limited funding and the problems around HIV/Aids have all contributed to the failure to improve child health.

This week Tshabalala-Msimang announced the launch of Africa’s ‘Movement to Improve Maternal Health and Promote Child Survival and Development in Africa” at an African Union workshop in Johannesburg.

She said that it was ‘of great concern — that in some of our African countries maternal, newborn and child mortality have not decreased significantly or even increased in some member states of the African Union”.

Total child deaths have dropped in sub-Saharan Africa, but its proportion of global child deaths continues to rise. HIV and armed conflicts have been the drivers of rising child mortality in 12 African countries since 1990.

The report also criticises the lack of improvement of clinical care for women and children. Maternal mortality in South Africa is classified as high, with a South African woman having a one in 110 lifetime risk of dying during pregnancy or childbirth. In China, which has made most progress, a woman has a one in 1 300 chance of dying in these circumstances. But a woman in Niger has a one in seven chance of dying. About half of all women in the 68 priority countries go through childbirth without skilled care or access to emergency obstetrics.

‘Under-­nutrition”, which accounts for a third of child deaths and contributes to nearly 20% of maternal deaths globally each year was also highlighted.

South Africa was one of the 15 countries classified as making no progress in reducing the proportion of underweight children under the age of five.

In 2007 11% of South African government expenditure was on health, below the 15% agreed to by African heads of government.

The authors of the report say that official development assistance for maternal, newborn and child health from richer to poorer countries increased by 64% to almost $3,5-­billion between 2003 and 2006.

Yet this amount still represents just 3% of development aid and much of it was spent on vaccinations and malarial prevention. Yet childhood illnesses are not treated properly, especially pneumonia and diarrhoea, which together account for more than a third of deaths among children under five. In South Africa diarrhoea and pneumonia each account for 1% of deaths among children.