SAHR 2007 - Health Systems Trust

Health and Related Indicators 15
Health Status – Child Health
Table 27: Perinatal mortality rates estimated from unadjusted cause of death data, 2003-2005
EC FS GP KZN LP MP NC NW WC SA
2003 17.9 53.2 38.7 30.8 13.6 31.4 32.6 40.8 19.3 29.4
2004 20.6 61.1 38.0 30.3 17.1 32.4 36.7 44.5 21.1 31.1
2005 21.9 67.4 40.7 37.1 20.0 40.2 32.8 50.1 19.8 34.8
Source:
Calculated from StatsSA Causes of death 2005 – all deaths with
underlying cause of death in ICD-10 category ‘P’ (not adjusted
for under-reporting – data completeness is estimated to be
between 85-89% overall for all deaths), according to recorded
province of death.
Denominator – DHIS population estimates for number of children
under 1 multiplied by a factor of 1.04 to estimate the number
of live births for each year, plus the number of stillbirths in the
StatsSA Causes of death database to give estimated total births.
Figure 19: Perinatal mortality rates by difference sources, 2005-06
70
60
Per 1 000 births
50
40
30
20
10
0
EC FS GP KZN LP
MP
NC
NW
WC
SA
Stats SA 2005
DHIS 2006
2006 PPIP ≥1000g
2006 PPIP ≥500g
Sources: StatsSA value calculated from StatsSA Causes of death 2005
– all deaths with underlying cause of death in ICD-10 category
‘P’ (not adjusted for under-reporting – data completeness is estimated
to be between 85-89% overall for all deaths), according
to recorded province of death.
Denominator – DHIS population estimates for number of children
under 1 multiplied by a factor of 1.04 to estimate the number
of live births for each year, plus the number of stillbirths in the
StatsSA Causes of death database to give estimated total births.
DHIS.
Saving Babies 2003-2005.
between October 2003 and March 2006. This represents
about 20% of annual births. The change in the number of
sites used does complicate comparisons over time. In the
PPIP dataset the perinatal mortality for infants ≥500g was
37.5/1 000 births (and 27.9/1 000 for infants with a birth
weight of 1 000g or more); an analysis of the database
indicates that neither the perinatal mortality rate nor the
neonatal death rate has changed since the national database
started in 2000. Although South Africa has a “slightly
higher” neonatal mortality rate and stillbirth rate than is
seen in comparable middle income countries, the report
does note a “much higher” intrapartum stillbirth rate. Almost
two-thirds of such deaths were attributed to unexplained
intrauterine death, spontaneous preterm birth and intrapartum
asphyxia / birth trauma. Of concern, 1 in 5 perinatal
deaths were considered to be avoidable. The most common
administrative-related modifiable factor was “inadequate
facilities / equipment in neonatal unit / nursery”. Among the
recommendations provided in the report is the suggestion
that staffing norms be determined for neonatal units and
nurseries. Suggested norms are also provided. The low HIV
testing rate, less than 50% in those areas recording the data,
is of concern, as the perinatal mortality is twice as high in
HIV infected women compared with those not infected. A
useful analysis of DHIS data compared to the findings from
the PPIP in the report indicates that data coverage in DHIS is
excellent and that stillbirth and perinatal mortality data from
DHIS provide a reasonably accurate picture of the situation
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