SAHR 2007 - Health Systems Trust

Table 26: Immunisation indicators by province
Immunisation coverage of children 28 weeks
gestation
Perinatal
Mortality
Early neonatal
deaths
Birth ➜ end of
the 7th day
Neonatal
Mortality
Late neonatal
deaths
8th day ➜ end
of 27th day
Infant
Mortality
Under-5
Mortality
Post-neonatal
deaths
28th day ➜ end
of 365th day
Post-neonatal
Mortality
Child
deaths
1st year ➜ end
of 4th year
Child
Mortality
Perinatal mortality remains a highly controversial issue
in South Africa. Although these figures have not been
adjusted for under-reporting, the numbers of deaths noted
in the StatsSA Causes of death 2005 data can be gauged
from those with an underlying cause of death in the IC-10
code category “P”. This source showed a national total of
31 238 such deaths in 2002, 33 616 in 2003 and 38 404
in 2005. If the DHIS population estimates for the number of
children under 1 year are adjusted to estimate the number
of live births (multiplying by a factor of 1.04), plus stillbirths
from StatsSA Causes of death to give total births, then the
minimum perinatal mortality rates can be calculated (Table
27). These data should, however, be treated with caution as
data quality may not be uniform across provinces. The values
for EC and LP appear to be lower than expected, whereas
the FS value is unexpectedly high.
Mortality in children under 5 years has been the target of
the “Saving Children” reports. The report covering the period
September 2003 to August 2004 [Saving Children 2004]
showed that, of 19 695 admissions of children under 5 in 8
hospitals, 1 532 had died. This yielded a case fatality rate of
7.8%, ranging from 3.4 to 15% in the different sites. The main
causes of death were lower respiratory tract infections (33%),
gastroenteritis (15%) and septicaemia (12%), and in 60% a link
with HIV/AIDS was evident. Of those who died, 66% were in
their first year of life and 69% were underweight. Importantly,
from a quality of care perspective, administrative modifiable
factors were found to have been present in 31% of deaths.
Clinical personnel related modifiable factors were shown
in 26% of events at clinic level, 33% at hospital admission
and 37% during in-patient care. The second report [Saving
Children 2005] suggests that the infant mortality rate is
increasing and that this is closely linked to the HIV epidemic,
with four out of five deaths of children under 5 being associated
with HIV infection, compared to three out of five children
in the Saving Children 2004 report.
A new report on infant deaths [Saving Babies 2003-2005]
has recently been released, which again pointed to a
high level of modifiable factors. The Perinatal Problem
Identification Program (PPIP) now covers 164 sites and the
database contains details of 576 065 births recorded
Administrative modifiable factors include organisation of healthcare
and logistical factors. Clinical personnel related modifiable factors are
those associated with assessment, monitoring and case-management.
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