Overview: Child Survival
South Africa’s progress in healthcare The new democratic South Africa has made substantial progress in transforming its health sector. Primary healthcare has vastly expanded to more than 4,000 clinics across the country and government health services are free for children under the age of five and for pregnant and breastfeeding women. Remarkable progress has been made in rolling out antiretroviral (ARV) treatment. The country has the largest number of people enrolled on ARVs in the world – close to one million people in 2009. A national food fortification programme has also reduced the number of birth defects by more than a third. The government spends about 11 per cent of its total budget on health – more than any other country in Southern Africa. New legislation has been passed to make the health system more equitable and accessible to all South Africans. Preventable deaths Despite this, child and maternal survival has stagnated over the past 10 years. More than 200 children under the age of five die every day of mainly preventable causes. HIV/AIDS-related diseases are a major cause of death in young children, followed by pneumonia and acute diarrhoea. South Africa has also recently identified problems in the levels of coverage of routine childhood vaccinations. Malnutrition is a major contributing factor to child death. One in four children is stunted and many are deficient in vitamins and minerals essential to preventing disease and disability. Given these current trends it is unlikely that South Africa will meet the 2015 Millennium Development Goal of reducing child mortality. Babies and mothers Of great concern are the high death rates of newborn babies and mothers. Almost 40 per cent of all under-five deaths occur in the first 28 days of life – the neonatal period. Around 20,000 babies are stillborn every year; many die during labour. The maternal mortality rate was last recorded at 400 per 100,000 in 2005. These deaths happen in a context where a high proportion of women attend antenatal care and deliver babies in hospitals and maternity clinics with skilled attendants. It is clear that the quality of maternity and neonatal health services is inadequate and that many lives are needlessly lost. HIV and AIDS: a major threat to children and women South Africa has the highest global burden of HIV and AIDS – 16 per cent of the world’s population with the disease lives here. HIV prevalence in pregnant women attending antenatal care is very high and around 300,000 children are born to HIV-infected mothers each year. Close to half of all orphans in the country have lost their parents to HIV/AIDS-related diseases. Prevention of mother-to-child transmission (PMTCT) of HIV is now almost universally available in the public health sector. Eighty-three per cent of pregnant HIV-positive women received ARV medication to reduce the risk of transmitting HIV to their babies in 2009. Of the children living with HIV and AIDS who were eligible for ARV treatment, 81 per cent received it in 2009 (Country Progress Report on the Declaration of Commitment on HIV/AIDS, 2010 Report, South Africa).
What UNICEF is doing The Department of Health has launched a maternal, neonatal and child health and nutrition strategic plan for 2008–2013. The UNICEF Child Survival and Development Programme works within this framework to reduce the suffering of children and child deaths. UNICEF estimates that close to 50,000 babies and young children could be saved every year through higher coverage of a few known high-impact healthcare interventions. The challenge is to ensure that these interventions reach the children and women who need them most. Child, neonatal and maternal health UNICEF supports a community-based maternal, neonatal and child health and nutrition programme in 18 priority districts across the country. The government has identified these as the most deprived in basic services, with the highest poverty and child and maternal death rates. The programme will use community health workers as the main delivery strategy to improve family healthcare practices, increase health-seeking behaviour and help families and communities to manage mild cases of childhood illnesses. Prevention of mother-to-child transmission of HIV Pregnant women with HIV need to be treated and monitored close to home for greatest impact. UNICEF is therefore helping the Department of Health to bring prevention of mother-to-child transmission services to community-based health clinics. This is part of the national acceleration plan for preventing mother-to-child transmission, which aims for 95 per cent coverage in the 18 high-risk districts by 2011. Professional nurses working in local clinics will be trained to screen HIV-positive pregnant women for ARV eligibility and start them on treatment. Outreach teams from experienced treatment centres will supervise and monitor the work of the nurses to make sure that quality care is provided. Paediatric HIV care and treatment HIV-positive babies and children also need access to treatment and care at their doorstep. Putting children on life-saving ARV therapy means accurately diagnosing HIV. This is now possible by using a special method for HIV testing that involves collecting blood onto filter paper (Dried Blood Spot). This way, those who have HIV can be indentified before they become sick or die. The aim is to test babies at their six-week immunisation visit, a strategy that promises to reach a large number of infants. UNICEF is supporting the scale-up of early infant HIV diagnosis by building laboratory capacity at national and provincial hospitals and integrating early infant diagnosis into immunisation programmes. Nurses will be trained to collect blood samples using the Dried Blood Spot method. With the roll-out of early infant diagnosis, children with HIV will be diagnosed early and will be able to access life-saving treatment and care. The Department of Health, with UNICEF’s technical support, is piloting the down referral of children’s HIV services to community-based clinics in KwaZulu-Natal, North West and Limpopo provinces. Nutrition UNICEF’s approach to child nutrition in South Africa puts emphasis on improving infant and young child feeding practices. Poor feeding practices, such as breastfeeding for less than six months, can lead to disease and malnutrition, which greatly increases children’s risk of death. UNICEF supports the Baby-Friendly Hospital Initiative in South Africa, an international certification programme for health facilities that promote breastfeeding. UNICEF also helps build national capacity to monitor regulations on the marketing of infant formula. Micronutrient deficiencies are addressed through mass supplementation campaigns. A community programme is being established to help families improve infant and young child feeding practices and manage mild cases of child malnutrition. Severe cases of malnutrition are handled by health facilities where UNICEF provides training and support to monitoring outcomes. What UNICEF plans to achieve Two-thirds of child deaths can be prevented through the full implementation of high-impact public health services. Effective interventions, however, are not enough unless they reach the children and mothers who really need them. In 2010 and 2011, UNICEF will continue to work with the Department of Health and other partners to identify and scale-up high-impact health and nutrition services to:
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Did you know? Vitamin A is vital for good health and development in young children, yet too few children receive Vitamin A supplementation in South Africa. Child Survival Statistics Under-five mortality (2009): 62/1,000 live births Maternal mortality (2008): 410/100,000 live births Stunting in children (2008): 27% HIV prevalence in pregnant women (2009): 29% Children living with HIV (2009): 330,000 Women attending antenatal care (2008): 92% Skilled attendant deliveries (2010): 91% UNICEF child survival strategies
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