Neonatal mortality in South Africa: How are we doing and can we do better?

Lloyd, Lizel G; Witt, T W de

doi:10.7196/samj.7200

Cited by 29 publications

(33 citation statements)

References 2 publications

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“…Risk of death was threefold higher for gestational age between 34 and 36 weeks, but if also SGA mortality was 20-fold higher [ 18 ]. In a recent South African report of neonates requiring intensive care in Pretoria, 68% were LBW, with 8% weighing below 1000 g, 24% between 1000 and 1499 g, and 24% between 1500 and 2000 g [ 19 ]. In an audit of HIV-exposed preterm infants at a tertiary neonatal unit in Cape Town between 2010 and 2011, 3.3% had a birth weight below 1000 g and were significantly more HIV exposed than those with a higher birth weight.…”

Section: Discussionmentioning

confidence: 99%

The last and first frontier – emerging challenges for HIV treatment and prevention in the first week of life with emphasis on premature and low birth weight infants

Cotton

Holgate

Nelson

et al. 2015

Journal of the International AIDS Society

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IntroductionThere is new emphasis on identifying and treating HIV in the first days of life and also an appreciation that low birth weight (LBW) and preterm delivery (PTD) frequently accompany HIV-related pregnancy. Even in the absence of HIV, PTD and LBW contribute substantially to neonatal and infant mortality. HIV-exposed and -infected infants with these characteristics have received little attention thus far. As HIV programs expand to meet the 90-90-90 target for ending the HIV pandemic, attention should focus on newborn infants, including those delivered preterm or of LBW.DiscussionIn high prevalence settings, infant diagnosis of HIV is usually undertaken after the neonatal period. However, as in utero infection may be diagnosed at birth, earlier initiation of therapy may limit viral replication and prevent early damage. Globally, there is growing awareness that preterm and LBW infants constitute a substantial proportion of births each year. Preterm infants are at high risk for vertical transmission. Feeding difficulties, apnoea of prematurity and vulnerability to sepsis occur commonly. Feeding intolerance, a frequent occurrence, may compromise oral administration of medications. Although there is growing experience with post-exposure prophylaxis for HIV-exposed term newborn infants, there is less experience with preterm and LBW infants. For treatment, there are even fewer options for preterm infants. Only zidovudine has adequate dosing recommendations for treating term and preterm infants and has an intravenous formulation, essential if feeding intolerance occurs. Nevirapine dosing for prevention, but not treatment, is well established for both term and preterm infants.HIV diagnosis at birth is likely to be extremely stressful for new parents, more so if caring for preterm or LBW infants. Programs need to adapt to support the medical and emotional needs of young infants and their parents, where interventions may be lifesaving.ConclusionsNew focus is required for the newborn baby, including those born preterm, with LBW or small for gestational age to consolidate gains already made in early diagnosis and treatment of young children.

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Section: Discussionmentioning

confidence: 99%

The last and first frontier – emerging challenges for HIV treatment and prevention in the first week of life with emphasis on premature and low birth weight infants

Cotton

Holgate

Nelson

et al. 2015

Journal of the International AIDS Society

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“…The neonatal mortality rate (NMR) for the year 2013 (13.7/1 000 live births) was lower than the rate in South Africa (15/1 000 live births). [11] The NMR was similar to the NMR at Central and Eastern Tshwane district (13.6/1 000 live births) in 2011, [12] but it was higher than the rate in the West Rand region (8/1 000 live births).…”

Section: Discussionmentioning

confidence: 78%

Neonatal mortality at Leratong Hospital

Moundzika-Kibamba

Nakwa

2018

S Afr J CH

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Each year there are an estimated 3.6 million neonatal deaths globally. [1] These deaths occur mostly in low-income countries. However, neonatal mortality and morbidity is also a problem in high-income countries. [2] Almost 41% of the 9.7 million deaths in children under the age of 5 occur in sub-Saharan Africa. [3] South Africa has an unacceptably high infant mortality rate, with neonatal deaths accounting for 35-40% of all deaths of children younger than the age of 5 years. [4,5] South Africa is also one of the countries which have not reached the Millennium Development Goal's 2015 deadline to reduce child mortality by two-thirds. [4] Furthermore, deaths during the first 7 days of life account for 88% of South African neonatal deaths. [6] Poor survival rates in neonates admitted to Chris Hani Baragwanath Academic Hospital, Johannesburg, were linked to premature birth in association with very low birth weight, but was also related to limited resources, especially the lack of mechanical ventilation. [7] The present study was conducted at Leratong Hospital, a publicsector regional hospital in the West Rand region of Gauteng that renders secondary-level healthcare services. The institution is a site for the Perinatal Problem Identification Programme (PPIP), which is an audit tool for evaluating perinatal care that was designed and developed in South Africa. It is compulsory for all public health facilities to collect and report data to the National Department of Health using PPIP. In a meta-analysis of 7 before-after studies in lowand middle-income countries, perinatal mortality audit was shown to be associated with up to a 30% reduction in perinatal deaths. [8] Neonatal care rendered at Leratong Hospital includes: basic newborn care of healthy infants; special care to infants with moderate risk of serious complications related to immaturity, illness, requiring nasal cannulae and antibiotics; Kangaroo Mother Care (KMC) provided to stable premature infants waiting for weight gain; high care (HC) and intensive care unit (ICU) which provide continuous positive airway pressure (CPAP) or mechanical ventilator support to infants with severe illness. A neonatal intensive care unit (NICU) is run by a paediatrician and it has four beds and two ventilators. The unit lacked sufficient NICU equipment. The aims of the present study were to describe the causes of neonatal deaths and to identify health services factors associated with neonatal deaths at Leratong Hospital between 15 April 2013 and 15 July 2013. Methods This was a prospective review of the clinical records of all neonates admitted to the hospital during the study period (15 April 2013-15 July 2013). Variables were age, birth weight, gender, race, place of origin, reason for admission and cause of death. The primary causes of neonatal death were categorised using the Perinatal Problem Identification Programme (PPIP). Health factors examined were: access to high-care services, access to the NICU and the number of staff on duty, admission room care for all neonates fro...

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“…Provision of ANS will make the greatest difference in saving the number of newborn lives (12%) if coverage increases from the current estimated baseline of 20 -40%. [43) Provide a postnatal care package (including the supportive role of community health workers) in neonatal care The provision of postnatal care is essential for neonate survival. However, this has not been implemented at scale, owing to capacity constraints.…”

Section: Scale Up Evidence-based Medical Interventions To 80% Coveragementioning

confidence: 99%