South African health facilities are slowly improving their treatment of pregnant women and babies, but certain provinces and districts are holding back progress.
Mpumalanga is the only province where more mothers died in childbirth in 2012/13 than the previous year. Stillbirths have increased in Limpopo and the Northern Cape.
The worst district for stillbirths was the Western Cape’s Central Karoo district, where they have more than doubled in a year although the number of cases is still small.
These are some of the findings of the District Health Barometer 2012/13, which was launched in Pretoria.
“The stillbirth rate is a good indicator of care during the third trimester [of pregnancy] and intra-partum period [labour],” according to the Barometer.
Improving maternal and child health is one of Department of Health's main priorities, particularly as research has shown that around four out of 10 maternal deaths are ‘preventable’ if women are given proper care.
South Africa has reduced maternal deaths from 189. 5 per 100 000 births in 2009 to 132. 9 per 100 000 in 2012/13. But the country is still very far from meeting our international commitment to cut maternal mortality to 38 deaths per 100 000 births by 2015 as part of the Millennium Development Goals (MDGs)
Mpumalanga’s maternal mortality rate is 175. 8 per 100 000, while the Capricorn district in Limpopo reported a shocking maternal mortality of more than double the national average (292. 2 deaths per 100 000 deliveries). KwaZulu-Natal’s uMgungundlovu (Pietermaritzburg) and Uthungula were also poor performers.
At the other end of the spectrum, only about six women died per 100 000 births in Cape Town.
About half the women who die in childbirth succumb to AIDS-related infections, so identifying HIV infection is critical.
Nationally, about 27 percent of pregnant women are living with HIV, and KwaZulu-Natal continues to battle with huge HIV infection rates with an infection rate that is 10 percent higher than the national average. Ugu was the worst in the country, with 44 percent of pregnant women living with HIV.
The Department of Health has been campaigning for pregnant women to visit their clinics for check-ups as soon as they know they are pregnant so that any potential problems can be picked up early.
But the Western Cape is the only province where the majority of pregnant women have had at least one check-up halfway through their pregnancies.
Only about one-third of pregnant women in OR Tambo and Alfred Nzo in the Eastern Cape and Johannesburg had check-ups by 20 weeks, the lowest rates in the country.
South Africa is also committed to reducing the deaths of children under the age of five years to 20 deaths per 1 000 births (two percent) as part of the MDGs.
But in 2011, we were triple this target with almost six percent of all children born dying before their fifth birthday - mainly from AIDS-related illnesses, diarrhoea, pneumonia, malnutrition and within a week of being born.
Significant progress has been made to ensure that newborn babies are not infected with HIV from their mothers. The national mother-to-child HIV transmission rate is now around 2. 5 percent and in the Western Cape, the transmission rate is only two percent.
The country is also making slow but steady progress to reduce diarrhoea with dehydration in children under five, and there are now 12 cases per 1 000 kids. Only the Free State and Northern Cape reported more cases than the previous year.
Pneumonia rates are also coming down (66. 8 cases per 1 000 kids), but KwaZulu-Natal continues to battle with a caseload of 119 cases per 1 000. KwaZulu-Natal’s Ugu district, had 178 cases per 1 000. The fatality rate for pneumonia rose in the Northern Cape but dropped in all other provinces.
There was a slight increase in cases of severe malnutrition (4. 4 cases per 1 000 children under five), with half the districts reporting increases. The Northern Cape reported the worst rates but it has also made the greatest progress in preventing malnutrition-related deaths.
Read more Health-e coverage of Health Systems Trust’s 2013 District Health Barometer:
· District health dunces
· South Africa’s worst places to be a woman, mother
· Gauteng doubles HIV treatment numbers
· The Western Cape’s dirty little secrets
· KwaZulu-Natal charts gains in HIV despite massive burden
- Kerry Cullinan is the managing editor at Health-e News Service. This article is published here with the permission of Health-e News Service.