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Poverty pushes up SA's child mortality
Ashley Keyser, IOL
2008-05-16
Poverty is the underlying cause of child deaths in South Africa, according to a recent study released by the Medical Research Council. But other sub-Saharan African countries, with less money and fewer resources, have managed to cut their child mortality rates. A recent study in The Lancet reported that deaths in children under age five have been dropping in Tanzania, where between 2000 and 2004 child mortality dropped by 24 percent. During this period, the Tanzanian government increased the annual amount spent on healthcare per citizen from 4.70 to 11.70 (about R36 to R89,60). The money was also evenly distributed across the country, rather than favouring richer districts.
South Africa recently faced criticism for falling behind on the Millennium Development Goals for reducing child mortality. The country must achieve a yearly rate of 15 percent reduction to meet the goal. But child mortality rates have actually increased since 1990, making South Africa one of 12 countries in which child mortality rates have grown. The study from the Medical Research Council, Every Death Counts, reported that about 75 000 children die in South Africa every year before they turn five. Of these, 22 000 die within their first month. The main cause of death is HIV and AIDS. Other leading factors are pregnancy and childbirth complications, newborn and childhood illness and malnutrition. Dr Joy Lawn, senior research adviser for Save the Children, has worked in Tanzania and in Malawi, another country that has reduced child mortality rates. Both countries, she said, have had a high-level commitment to addressing deaths, to being open and clear about statistics and facing that head on. If you want to address the problem, you have to say that the problem is here and we all need to work together on it.
Lawn criticised South Africa's statistics and its record-keeping of birth and death rates. Many maternal deaths from childbirth, a large factor in infant deaths, went unrecorded, she said. These deaths often occurred in the 15 percent of births that happened at home, which were riskier. We're reliant on surveys, and only every five years there's a population-based survey, she said. In particular the child mortality data is very out of date and depends on estimates. Many children are unregistered. If they die before getting a birth certificate and they don't receive a death certificate, then they're just invisible. The people we lose are the poorer ones, she said. Patric Solomons, from the child welfare group Molo Songololo, pointed out examples of Tanzania's attention to nutrition such as its Vitamin A supplements for children. In South Africa, he said, many children suffered from lack of proper nutrition. Many clinics were over-extended, lacked resources and were unable to give these children adequate treatment, he continued. There's been a neglect of duty by certain health institutions, he said. We have an urgent need to look at what is going wrong, and why aren't they getting it right. The Health Department has a number of strategies to reduce child mortality, spokesman Howard Kgoa said, including an Integrated Nutrition Programme. This works at community and health facility levels to improve the nutrition of children, and to prevent malnutrition. He said the Child and Youth Health Directorate was aware of Tanzania's successes. We are reviewing our strategies and will take note of lessons from Tanzania and other countries which have made good progress in reducing mortality.
Nadine Nannen, from the Medical Research Council, said: There's always something to learn from other countries. But she warned that comparisons with Tanzania needed to take HIV/AIDS into account. Countries like Tanzania do not have HIV rates anywhere near as aggressive as South Africa, she said. UNAIDS reported that in 2005 Tanzania had a prevalence rate of 6,5 percent, while South Africa was at 18,8 percent. Lawn conceded that South Africa has made progress in many directions, including prevention of mother-to-child transmission of HIV. What's important was that maternal care and neonatal care services reach poorer communities. South Africa may need to be braver and make sure care reaches more people, she said.
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