The Select Committee on Social Services was briefed by the Department of Health on child mortality in South Africa. Dr Pakishe Aaron Motsoaledi, Minister of Health, said that the main causes of death in South African children under the age of 5 were HIV infection; new born conditions such as prematurity, asphyxia, and infection, pneumonia and diarrhoea; and tuberculosis.
Recent statistics showed some positive trends. According to United Nations estimates, South Africa’s under-5 mortality had declined between 2000 and 2011 from 74 per to 47 per 1000 live births. The decline was attributed to better services being delivered to communities. In 2012, only 2.7 percent of HIV positive mothers transmitted the virus to their babies, a significant decrease from previous years.However, the number of child deaths in South Africa remained high, and most of these deaths were preventable. The African Union’s Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMM) was making good progress in gathering empirical evidence and scientific findings on infant mortality.
The six areas the Department had identified as priorities were: the promotion of early and exclusive breastfeeding, including ensuring that breastfeeding was made as safe as possible for HIV-exposed infants; the resuscitation of new borns; care for small or ill new borns according to standardised protocols; the provision of initiatives for Prevention of Mother to Child Transmission (PMTCT); Kangaroo Mother Care (KMC); and Post-natal visits within six days of childbirth. The importance of natural breastfeeding over formulas, and especially over mixing natural breast milk and formulas during the first six months of life, was stressed.
Members stressed the importance of public health campaigns and asked if there were campaigns for breastfeeding and healthy foods. They were concerned about the sometimes negative attitudes of staff members at clinics and hospitals. A particular public hospital was praised, as was the Department’s push for family planning.
The Chairperson welcomed all present, including Dr Pakishe Aaron Motsoaledi, Minister of Health, Ms Malebona Precious Matsoso, Director-General of the Department of Health and the Committee Members.
Child Mortality in South Africa: Department of Health briefing
Ms Matsoso thanked the Committee for the warm welcome and introduced the team she arrived with.
The Minister thanked the Committee for the opportunity to speak on child mortality in South Africa. He said it was important for the country and important globally to discuss child mortality. He began by defining a few terms. Neonatal mortality rate (NNMR) referred to the number of deaths during the first 28 days of life per 1,000 births. Infant mortality rate (IMR) referred to the number of deaths during the first year of life per 1,000 live births. Under-five mortality rates referred to the number of deaths during the first five years of life per 1,000 live births.
The majority of child deaths result from HIV infection and new born conditions such as prematurity, asphyxia, and infection, pneumonia, diarrhoea, and tuberculosis. Malnutrition was an important contributor in many deaths. These causes of death were mostly related to socio-economic conditions.
According to United Nations estimates, South Africa’s under-5 mortality had declined between 2000 and 2011 from 74 per to 47 per 1000 live births. Reducing maternal and neonatal mortality and morbidity and improving women’s health had been a key public health goal in South Africa, and a key indicator of the Millennium Development Goals (MDGs). However, the number of child deaths in South Africa had remained high, and most of these deaths were preventable. Child mortality rates were falling due to the strengthening of services to communities. Neonatal mortality rates were static, and interventions to improve new born care were being implemented. The more child mortality rates fell, the more time the government and health community could focus on ensuring optimal nutrition and development of children.
Key priorities for the Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA) included:
• Advancing contraception and family planning;
• Encourage early booking and improve the quality of antenatal care;
• Prevention of mother-to-child transmission of HIV;
• Providing obstetric ambulances;
• Maternity waiting homes for better care of expecting mothers;
• Improving new born care and treatment of sick children, including Kangaroo Mother Care;
• Expanded programmes on immunisation at pre-schools (ECD) and schools;
• Encourage exclusive breast-feeding during pregnancy; and
• Training, with a particular focus on essential steps in the management of obstetric emergencies and skilled birth attendants including additional midwives.
South Africa had identified six priority areas in addressing infant mortality, namely:
• Promotion of early and exclusive breastfeeding, including ensuring that breastfeeding was made as safe as possible for HIV-exposed infants;
• Resuscitation of new borns;
• Care for small or ill new borns according to standardised protocols;
• Provision of initiatives for Prevention of Mother to Child Transmission (PMTCT);
• Kangaroo Mother Care (KMC); and
• Post-natal visits within six days of childbirth.
In order to address perinatal mortality, South Africa must improve access to appropriate healthcare, improve the quality of care, ensure the availability of adequate resources, and improve data collection and review, in order to better audit and monitor efforts.
Child mortality had been going down in South Africa and at the end of 2012 international organisations had received praise for decreasing the number of HIV/AIDS deaths. In 2012, only 2.7 percent of HIV positive mothers transmitted the virus to their babies, a significant decrease from previous years. This was particularly important as any child that was born HIV positive was 15 times more likely to die within his or her first six months of life than an HIV negative child.
The African Union had come up with a campaign in 2010 called the Campaign on Accelerated Reduction of Maternal and Child Mortality in Africa (CARMMA). One of its main goals had been to get empirical evidence and scientific findings in order to inform solutions. A conference was held on CARMMA, which was attended by Heads of State, not Ministers of Health. After the conference, South Africa created three ministerial committees to work on decreasing child mortality. Accurate statistics were essential to identify trends and develop appropriate strategies.
Diarrhoea had been one of the biggest, if not the biggest, causes of death for babies. However, since 2008 when vaccines for pneumonia and diarrhoea were widely introduced to South Africa, deaths by these conditions had decreased in number. People should remain vigilant against tuberculosis (TB). It was especially difficult to diagnose TB in children because one of the main symptoms was spitting up, which was usually expected in children. The Department was working to increase life expectancy and reduce maternal and child mortality while combatting HIV/AIDS and TB and increasing effectiveness of the health care. The Minister was required to report the Department’s progress to the Cabinet Committee every quarter.
It was important to reach children while they were at school and of to hire more women’s and children’s health specialists for every district. Currently, the Department did not have the resources or enough qualified applicants to hire people for all of the positions envisioned, but it had filled 46 percent of the positions. This could help to free up hospitals for more urgent medical care and form the core of South Africa’s healthcare system. Breast milk banks, which were structured similar to blood banks, helped to nourish babies in need. The European Union had helped South Africa secure 30 vehicles for the NHI Pilot Project. These vehicles, with fully equipped health facilities, visited schools to provide healthcare.
The Chairperson thanked the Minister of Health for his briefing. She noted that there were a few pregnant women in the room that surely learned from the presentation.
Ms B Mncube (ANC; Gauteng) asked if there was an information campaign for breastfeeding. She asked how broad a breastfeeding campaign ought to be. She suggested a campaign on healthy foods, since malnutrition had contributed to so many child deaths. Even poor people could access nutritious foods if they were educated on healthy options.
Mr S Plaatjie (COPE; North West) asked the Director-General and the Minister of Health to clarify what results had been seen since the signing of the Tshwane Declaration on support of breastfeeding.
A Member noted the importance of public health campaigns. She also said that she was impressed by a public hospital in her area and that the role of fathers in prevented child mortality ought to be further discussed.
A Member raised concerns about the attitudes of staff members at clinics and hospitals, especially rural ones, which were sometimes problematic. She noted that it was impossible to legislate against such behaviour. She also praised the Department’s push for more family planning and asked how spacing out children could improve the health of the mother and of the children.
A Member suggested more educational campaigning to address the shortage of nurses. She said that she had learned a lot from the Minister’s presentation. She argued that any increase in maternity homes ought to begin in the more rural, poor areas and asked how the Department decided to distribute obstetric ambulances in the districts.
The Minister and his team assured the Members that campaigning was important to them, but admitted that with communications campaigns there was always more work to do. Campaigning would be especially important for the workplace to create more breastfeeding-friendly environments.
Ms Matsoso said that Save the Children had recently published a report which stated that if women exclusively breastfed, hundreds of thousands of lives would be saved globally. She suggested that the Members access the report for more information.
The Minister said that since the Millennium Development Goals (MDGs) were declared, countries were required to report their progress to the United Nations. In order to give the UN accurate reports, South Africa relied on a special team, headed by a statistician. Reliable statistics were important especially for this Committee and for others such as Home Affairs, Higher Education, and Social Development. Statistics had also been increasingly important to the African Union.
It was hard to study the relationship between teenage pregnancies, particularly the child mortality rate of children born to teenaged mothers, but he said that efforts were being made.
He was pleased to hear praise of a public hospital.
Fathers had also been an important consideration in decreasing child mortality, but a mother’s bond with a child could be particularly powerful, especially with Kangaroo Mother Care and breastfeeding.
Staff members demonstrating proper attitudes in clinics and hospitals was an area in need of improvement in the healthcare system.
Family planning was of great importance. Fifty years ago, women started menstruating at the age of 17 or 18, but more recently menstruation often started at the age of 9, due to food-induced precocious puberty. The parents who condemned family planning must consider these important facts.
In October, November, and December, over 77,000 children at quintile 1 and 2 schools starting at grade 1, received health care through the vehicles in the NHI Pilot Program.
Ms Matsoso responded that workplaces must be more breastfeeding-friendly. She said that her office had a special place designated for mothers to express milk and that this helped promote breastfeeding.
The Minister recalled when it was decided South African mothers would be allowed a 4-month maternity leave. He credited its approval to the fact that the issue was framed as a child rights issue, not a labour issue. Many different groups, including UNICEF, led this campaign.
The Chairperson thanked the Department of Health for being at the meeting. She also recognised Thabile Ketye, who was newly appointed as Content Advisor for the Committee.
The meeting was adjourned.
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