Child mortality rises in South Africa

SOSHANGUVE, South Africa — A cloud of anxiety descended upon the Motheo pre-school in this large township north of Pretoria. Gone were the smiles from just a few minutes before as boys and girls lined up in front of health workers, uncertain of their fate.

It turned out the little ones’ fears were largely overblown. A couple of vitamin A pills and de-worming medicine, a visual checkup for possible malnutrition but no syringes. Some kids even tried to go for seconds.

The recent visit to the school was one of hundreds to be conducted around South Africa over a two-week period. The campaign is also supposed to include catch-up immunizations, but a recent measles outbreak disrupted initial plans, said Tshifhiwa Mashamba, nutrition coordinator for the Pretoria area.

“We’re running out of stock,” he said. “That’s why we’re not immunizing them now.”

The latest effort is a sign of the renewed vigor of local health authorities. Incompetence and denial on the part of former president Thabo Mbeki's administration allowed the AIDS epidemic to reach gigantic proportions here, but a new crop of leaders seems keen on both acknowledging South Africa’s health challenges and tackling them. Even though the campaign dubbed “Child Health Week” is highly visible, it is unlikely to put a major dent in child mortality rates, health experts say. South Africa’s immunization coverage is already better than that of many other African countries, and resources dedicated to improved neonatal care and preventing mother-to-child transmission of HIV/AIDS are bound to have a larger impact on saving children’s lives.

“In South Africa the immunization system has got a few loopholes that do need to be plugged because these measles epidemics are not acceptable for South Africa, and I’m sure that there is some value to be had for having more complex vaccination,” said Joy Lawn, a pediatrician with Save the Children's Saving Newborn Lives program. “But the real benefit is to prevent the HIV.”

Lawn is a co-author of a recent paper examining gaps in South Africa’s health care system for mothers and young children that was published in the British medical journal The Lancet. The paper’s authors argue that 11,500 infants’ lives could be saved by improving basic neonatal care. Similarly, better prevention of mother-to-child transmission of HIV could save 37,200 children’s lives per year by 2015. The incremental annual cost to achieve these results would be $220 million out of a total package of $1.5 billion, according to the paper.

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