Child deaths in South Africa: Lessons from the child death review pilot

Mathews, Shanaaz; Martin, Lorna J.; Coetzee, David; Scott, Christiaan; Brijmohun, Yasheen

doi:10.7196/samj.2016.v106i9.11382

Cited by 15 publications

(13 citation statements)

References 14 publications

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“…[14,57] Nevertheless, it is important to familiarise ourselves with the definitions of neonaticide and infanticide before deciding if either crime encompasses D and X. Neonaticide is the unlawful killing of a new-born child during the first week of its life, and infanticide is the unlawful killing of a child during the first year of its life. [58] Abortion is the expulsion of the uterine contents, particularly the fetus. [20] Legally, neonaticide and infanticide necessitate the killing of a person.…”

Section: Infanticide and Neonaticidementioning

confidence: 99%

“…According to the common law, in order to attain personhood and its accompanying rights, the child must be born alive and exist independently of its mother. [58][59][60][61] During D and X, fetal demise transpires within the womb, if the fetus is alive. [14] Thus, D and X does not constitute infanticide or neonaticide; killing the fetus is not an essential element of D and X, as the procedure is often employed in cases of miscarriage.…”

Section: Infanticide and Neonaticidementioning

confidence: 99%

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Partial-birth abortion – is it legally and ethically justifiable? Lessons for South Africa

Jogee

2018

S Afr J BL

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REVIEW 'Partial-birth abortion' (PBA) is a US colloquialism for intact dilation and extraction (D and X), [1] coined by conservative pro-life advocates, who liken the procedure to infanticide. [2] Their reasoning is founded on the erroneous belief that D and X constitutes the partial delivery and subsequent murder of a full-term baby. [3 ,4] Conversely, D and X is a variant of dilation and evacuation (D and E), [5,6] possibly the safest procedure employed during late termination of pregnancy (LTOP), which refers to abortions that occur after 20 weeks' gestation. [7-15] The Centers for Disease Control and Prevention have stated that on average, 1.3% of abortions in the USA are LTOPs, of which D and Xs comprise fewer than 20%. [15] D and Xs are carried out between 20 and 24 weeks' gestation, [16] and typically comprise four steps: cervical dilation; breech conversion; breech extraction, excluding the fetal head; and cephalocentesis to induce vaginal delivery of the intact fetus. [14,17] The defining feature of D and X is cephalocentesis, which entails the removal of the intracranial contents by way of a suction device, consequently preventing cervical injury by reducing the diameter of the fetal skull prior to intact delivery. [9,10] Hence D and X may be more advantageous than D and E, [14] which involves fetal dismemberment that is known to increase the risk of maternal mortality and morbidity. [11,12] Nevertheless, D and X is federally proscribed except in lifethreatening circumstances, as per the US Partial-Birth Abortion Ban Act of 2003. [18] Failure to comply with the provisions of the Act will result in a fine, imprisonment of up to 2 years, or both a fine and imprisonment. [18] The legality of the Act was brought before the Supreme Court in Gonzales v Carhart [19] and scrutinised for its perceived ambiguity; the Act proscribes surgical feticidal abortion procedures comprising the substantial removal of the fetus via vaginal delivery. [19] D and E encompasses fetal dismemberment requiring substantial removal of the fetus through the vagina, a practice that is explicitly proscribed by the Act, and therefore D and E could be included under the ban, which could subsequently impose an undue burden on women by restricting their reproductive health choices. [19] The Supreme Court found the state to hold a bona fide interest in fetal protection, and held that the Act exclusively proscribes D and X; therefore, proscription is not unduly burdensome to women. [19] Currently, D and X is proscribed in 32 US states. [13] Currently, the US is the only country worldwide to legally proscribe and criminalise D and X. [14] South Africa (SA)'s Choice on Termination of Pregnancy Act No. 92 of 1996 (CTOPA) [20] is universally hailed as one of the most liberal pieces of legislation worldwide. [21] CTOPA makes provision for LTOP after 20 weeks' gestation once a physician, having consulted with another physician or registered midwife, concludes that: the patient's life is at risk; the fetus is suffering from acute malformation; or t...

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Section: Infanticide and Neonaticidementioning

confidence: 99%

Section: Infanticide and Neonaticidementioning

confidence: 99%

Partial-birth abortion – is it legally and ethically justifiable? Lessons for South Africa

Jogee

2018

S Afr J BL

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“…South Africa has not met the child mortality target for the Millennium Development Goals, in spite of having invested substantially in programmes and policies to achieve these targets. (1) The Sustainable Development Goal targets for child mortality rate and infant mortality by 2030 are <25 and <12 per 1000 live births, respectively. However, in 2016 these rates were 42 and 35 and their decline has slowed.…”

Section: Introductionmentioning

confidence: 99%

Strengthening the quality of paediatric primary care: A process evaluation of a complex health systems intervention in South Africa

Curran¹,

Murdoch²,

Cornick³

et al. 2019

Preprint

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BACKGROUND: Innovative strategies like WHO's Integrated Management of Childhood Illness (IMCI) have resulted in progress in addressing infant and child mortality. However, the needs of children continue to present a burden upon primary healthcare services. The capacity of services and quality of care offered require greater support to address these needs and extend integrated curative and preventive care, specifically, for the well child, the child with a long-term health condition and the child older than 5 years, not included in IMCI. In response to these needs, the PACK Child intervention was developed, based on a similar successful approach in adults, that expands the scope and reach of integrated management and training programmes for paediatric primary care. We report findings from the process evaluation of the integration of PACK Child intervention within the existing primary health care system. METHODS: A mixed methods process evaluation was completed in ten primary health care facilities in the Western Cape province in South Africa, where clinicians were trained to integrate PACK Child into routine practice. Qualitative data included transcribed interviews with managers, clinicians, caregivers and policymakers; audio-recordings and observational fieldnotes of training, consultations and clinic flow. Quantitative data were collected from training logs, questionnaires, and consultations. Qualitative data were analysed using linguistic ethnographic techniques, including conversation and thematic analysis. Quantitative data were analysed descriptively. RESULTS: Influence of PACK Child on clinical practice: Longer consultations, improved clinical knowledge and practice, better teamwork, strengthening of appropriate referrals and inclusion of psychosocial risk screening. Implementation fidelity of PACK Child was hindered by over-reliance on documentation and embedded checklist approach to consultations limited to acute episodic illnesses. PACK Child increased caregiver participation during consultations. CONCLUSIONS: The PACK Child intervention has strengthened primary care for children despite institutionalised care provided by a limited number of clinicians focusing on acute illness with little participation of the caregiver. With refinement of the programme, there is potential for PACK Child to strengthen paediatric care in low-resource settings. 3

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“…The understanding of how and why children die informs prevention efforts and guides interventions to save lives. Mortality reviews are recognized as important tools in understanding cause of death and prioritizing opportunities for intervention in high-resource countries [1, 2]. Yet, insufficient mortality reviews are conducted in areas where they would be most needed—that is, where the highest child mortality is currently happening [3].…”

mentioning

confidence: 99%

Overview and Development of the Child Health and Mortality Prevention Surveillance Determination of Cause of Death (DeCoDe) Process and DeCoDe Diagnosis Standards

Blau

Caneer

Philipsborn

et al. 2019

Clinical Infectious Diseases

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Mortality surveillance and cause of death data are instrumental in improving health, identifying diseases and conditions that cause a high burden of preventable deaths, and allocating resources to prevent these deaths. The Child Health and Mortality Prevention Surveillance (CHAMPS) network uses a standardized process to define, assign, and code causes of stillbirth and child death (<5 years of age) across the CHAMPS network. A Determination of Cause of Death (DeCoDe) panel composed of experts from a local CHAMPS site analyzes all available individual information, including laboratory, histopathology, abstracted clinical records, and verbal autopsy findings for each case and, if applicable, also for the mother. Using this information, the site panel ascertains the underlying cause (event that precipitated the fatal sequence of events) and other antecedent, immediate, and maternal causes of death in accordance with the International Classification of Diseases, Tenth Revision and the World Health Organization death certificate. Development and use of the CHAMPS diagnosis standards—a framework of required evidence to support cause of death determination—assures a homogenized procedure leading to a more consistent interpretation of complex data across the CHAMPS network. This and other standardizations ensures future comparability with other sources of mortality data produced externally to this project. Early lessons learned from implementation of DeCoDe in 5 CHAMPS sites in sub-Saharan Africa and Bangladesh have been incorporated into the DeCoDe process, and the implementation of DeCoDe has the potential to spur health systems improvements and local public health action.

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Child deaths in South Africa: Lessons from the child death review pilot

Cited by 15 publications

References 14 publications

Partial-birth abortion – is it legally and ethically justifiable? Lessons for South Africa

Partial-birth abortion – is it legally and ethically justifiable? Lessons for South Africa

Strengthening the quality of paediatric primary care: A process evaluation of a complex health systems intervention in South Africa

Overview and Development of the Child Health and Mortality Prevention Surveillance Determination of Cause of Death (DeCoDe) Process and DeCoDe Diagnosis Standards

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