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Improving survival rates of newborn infants in South Africa
Robert Pattinson1, David Woods, David Greenfield
1Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa. rcpattin@kalafong.up.ac.za
Insights
Early neonatal deaths in South Africa are high, particularly in rural areas. Addressing modifiable factors like staffing, care quality, and healthcare access can significantly reduce infant mortality.
Area of Science:
- Neonatal mortality
- Public health
- Perinatal care
Background:
- Early neonatal mortality rates and causes in South Africa were previously unknown.
- Modifiable factors contributing to these deaths had not been documented.
- An audit was needed to inform strategies for reducing early neonatal deaths.
Purpose of the Study:
- To determine the number, rates, and causes of early neonatal deaths in South Africa.
- To identify modifiable factors associated with these deaths.
- To inform strategies for reducing the early neonatal mortality rate.
Main Methods:
- A four-year audit of live-born infants weighing 1000g or more across 102 South African sites.
- Data collection included infant deaths within the first week, causes of death, and associated modifiable factors.
- The Perinatal Problem Identification Programme (PPIP) was utilized.
Main Results:
- The early neonatal mortality rate for infants >= 1000g was high at 8.7/1000, with rural areas showing 10.42/1000.
- Intrapartum hypoxia and preterm delivery were identified as primary causes of death.
- Key modifiable factors included inadequate staffing/facilities, poor labor/neonatal care, and healthcare access barriers.
Conclusions:
- Effective, affordable interventions can decrease early neonatal deaths in South Africa.
- These strategies are potentially applicable to other under-resourced countries.
- Improving care quality and access is crucial for reducing infant mortality.
Background:
The number, rates and causes of early neonatal deaths in South Africa were not known. Neither had modifiable factors associated with these deaths been previously documented. An audit of live born infants who died in the first week of life in the public service could help in planning strategies to reduce the early neonatal mortality rate.
Methods:
The number of live born infants weighing 1000 g or more, the number of these infants who die in the first week of life, the primary and final causes of these deaths, and the modifiable factors associated with them were collected over four years from 102 sites in South Africa as part of the Perinatal Problem Identification Programme.
Results:
The rate of death in the first week of life for infants weighing 1000 g or more was unacceptably high (8.7/1000), especially in rural areas (10.42/1000). Intrapartum hypoxia and preterm delivery are the main causes of death. Common modifiable factors included inadequate staffing and facilities, poor care in labour, poor neonatal resuscitation and basic care, and difficulties for patients in accessing health care.
Conclusion:
Practical, affordable and effective steps can be taken to reduce the number of infants who die in the first week of life in South Africa. These could also be implemented in other under resourced countries.
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