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.

The findings of the Lancet paper, one in a series of six about the health status of Africa’s largest economy, assume even more significance in the context of new child mortality figures released by Unicef. Unicef found that globally, mortality for children under 5 years of age continued to decrease in 2008, to 65 deaths per 1,000 live births last year compared with a rate of 90 deaths for 1,000 births in 1990.

South Africa, however, was one of only 12 countries in the world where child mortality increased about 20 percent over that period to 67 deaths for 1,000 births. Unicef said the increase is linked to HIV transmission, noting that South Africa has the highest number of HIV-positive women in the world.

HIV looms large in the fight to reduce child mortality in South Africa. According to the Lancet article, life expectancy in the country would be in line with those of similarly developed countries were it not for the devastating impact of the virus.

The key is to optimize procedures that are already in place and make screening and HIV treatment for mother and child more systematic. Less than 70 percent of pregnant women are tested for HIV, while only 60 percent of infected women and 45 percent of their babies receive nevirapine, an antiretroviral drug that dramatically reduces the rate of mother to child transmission of HIV, according to the Lancet paper. Things may be looking up, though. Aaron Motsoaledi, South Africa's new health minister, attended the recent launch of the Lancet series and has made prevention of mother-to-child HIV transmission a priority of his health agenda, Lawn said. His attitude toward the disease and the state of the country’s health system stands in sharp contrast to those of former President Thabo Mbeki, who rejected the existence of a link between HIV and AIDS and the former health minister, who advocated a diet of fruits and vegetables to fight the disease.

“It really feels like this is a moment for change,” Lawn said.

What’s more, Motsoaledi has not shied away from the failings of the country’s health system. At the launch of Child Health Week earlier this month, he said he was fully aware of the challenges faced by young mothers, including long lines, medicine shortages and many others.

“A lot of these deaths can be prevented,” he said. “My call to all South Africans, in particular health care workers and mothers, is to stop these deaths!”