Neonatal, infant and child health in South Africa: Reflecting on the past towards a better future

Abstract

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Although the neonatal mortality rate in South Africa (SA) has remained stagnant at 12 deaths per 1 000 live births, the infant and under-5 mortality rates have significantly declined since peaking in 2003. Policy changes that have influenced this decline include policies to prevent vertical HIV transmission, earlier treatment of children living with HIV, expanded immunisation policies, strengthening breastfeeding practices, and health policies to contain tobacco and sugar use. The Sustainable Development Goals (2016-2030) have shifted the focus from keeping children alive, as expressed in the Millennium Development Goals (1990-2015), to achieving optimal health through the 'Survive, thrive and transform' global agenda. This paper focuses on important remaining causes of childhood mortality and morbidity in SA, specifically respiratory illness, environmental pollution, tuberculosis, malnutrition and vaccine-preventable conditions. The monitoring of maternal and child health (MCH) outcomes is crucial, and has improved in SA through both the District Health Information and Civil Registration and Vital Statistics systems, although gaps remain. Intermittent surveys and research augment the routinely collected data. However, availability and use of local data to inform quality and effectiveness of care is critical, and this requires ownership at the collection point to facilitate local redress. Potential game changers to improve MCH outcomes include mobile health and community-based interventions. In SA, improved MCH remains a crucial factor for human capital development. There is a pressing need to focus beyond childhood mortality and to ensure that each child thrives.

Micronutrient and Nutritional Status of HIV-Exposed and HIV-Unexposed Malawian Infants in the First Year of Life: Assessment of Ferritin, Vitamin A, and D Status and Its Association with Growth

“…Our findings confirm the progress achieved in recent years in improving maternal and infant health among women with HIV and their children [ 38 , 39 , 40 , 41 , 42 ]. Such advances can be attributed to several interventions implemented in Africa during the last two decades, which include wider dissemination of HIV programs [ 38 ], increased coverage of maternal antiretroviral treatment [ 43 ], integration of HIV services and other health services [ 40 , 42 ], involvement of community health workers [ 44 ], and introduction of infant vaccination for rotavirus and pneumococcus [ 45 ].…”

Early Reflections on Mphatlalatsane, a Maternal and Neonatal Quality Improvement Initiative Implemented During COVID-19 in South Africa

“…9 In Italy, 23% of maternal and perinatal facilities were understaffed during the first 3 months of the COVID-19 outbreak. 10 Similar to international trends, the pre-COVID-19 MMR in South Africa (SA) decreased from 200/100,000 in 2012 to 134/100,000 in 2017, 11 albeit with provincial differences. Despite a substantial decline in the MMR, much work still needs to be done to achieve the Sustainable Development Goal for an MMR of less than 70/100,000 by 2030.…”

“…Despite a substantial decline in the MMR, much work still needs to be done to achieve the Sustainable Development Goal for an MMR of less than 70/100,000 by 2030. 12 The NMR in SA remained stagnant at 12/1,000 live births between 2012 and 2017, 11 well above the SA National Department of Health (NDOH) 2030 goal of 7/1,000. 13 No recent data were found on the stillbirth ratios, estimated at 20.2 per 1,000 live births in 2016.…”

Health and related indicators 2022

“…32 Under-5 mortality (U5MR) continues to be one of the most challenging public health issues in LMICs, mainly due to poor dwelling units, poor access to breastfeeding, and the circumstances of birth, more specifically multiple births as these children are more likely to die than singleton children 82 The leading causes of under-5 mortality are neonatal causes, diarrhoea, and pneumonia or lower respiratory tract infections, despite there being a high immunisation coverage rate and a decreasing occurrence of malnutrition. 83 COVID-19 has resulted in a setback in achieving reduced deaths from infections and maternal and child health conditions that would have been possible by the year 2035. COVID-19 disrupted childhood vaccination programmes due to lockdowns, and redirected spending towards emergencies, including the procurement of COVID-19 vaccines.…”