Child Survival and Development

Introduction

UNICEF works hard to make a difference to the lives of women and children by contributing to key health interventions.

UNICEF worked hard to make a difference to the lives of women and children by contributing to key health interventions. A highlight in 2008 was our support of the country’s first ever national vitamin A campaign, which reached more than three million children between the ages of one and four years. This meant that vitamin A coverage was increased from the low rate of 24% to 70% of children in this age group.

Globally, it is estimated that the provision of twice yearly vitamin A supplements to children can contribute to the reduction of child mortality by 23%. It was the first time that the Department of Health had conducted an intervention of this scale, in all provinces, with the primary aim of increasing vitamin A coverage rates.

Safeguarding Children’s Health
Support from UNICEF also led to the first ever National Strategic Plan (2008–2011) on Maternal, Neonatal, Child and Women’s Health and Nutrition. Over the next five years, this plan will guide government in its efforts to scale up key health and nutrition programmes in a country where one in five children is chronically malnourished and many more are deficient in vitamins and minerals vital to their health.

This picture of under-nutrition is made more complex by the high rate of HIV in South Africa: AIDS is the leading cause of death among children under the age of five and malnutrition is the major underlying cause of 60% of all child deaths – particularly in those children who are HIV infected.

South Africa has the highest HIV and AIDS burden in the world, with 5.4 million people infected with HIV . More than 257,000 of those infected are children. Yet HIV infection in children can be prevented with proven interventions, and it is interventions that prevent mothers passing the HI virus on to their babies that UNICEF, through the Department of Health, is prioritising.

With HIV prevalence in antenatal clinics ranging from 39% in KwaZulu-Natal to 15% in the Western Cape, this is a key intervention. In the absence of services to prevent mother-to-child transmission of the virus, 68,000 South African children would be infected annually, and at least 34,000 would die before their second birthday.

South Africa has set the ambitious target of reducing mother-to-child transmission of HIV to below 5%, and UNICEF has provided support to developing plans to achieve this target. The national strategic plans for HIV and AIDS and for improving paediatric HIV treatment include phasing in a dual prophylaxis and antiretroviral treatment in the prevention of mother-to-child transmission programme, and introducing tests for early identification of HIV infection in infants.

A principal focus is making sure that pregnant women and children have access to HIV care and treatment. At present 61% of HIV infected pregnant women and less than half of HIV infected children needing antiretroviral treatment have access to it. One of the obstacles is the long distance to treatment centres, and the plan which UNICEF is supporting places antiretroviral services closer to communities.

UNICEF’s partnerships with government, other UN agencies, academic and research institutions and civil society led to ZAR14 billion being allocated to the National Strategic Plan on HIV and AIDS and ZAR 280 million going to preventing mother-to-child HIV transmission.

Paediatric HIV and AIDS interventions, as well as PMTCT, continued to be driven through the UNICEF office as part of the UN joint-support team’s efforts on AIDS.

Innovation in Infant Testing
Paediatric HIV and AIDS interventions, as well as PMT CT, continued to be driven through the UNICEF office as part of the UN joint-support team’s efforts on AIDS. During the year the quality improvement programme on PMTCT in the Ngaka Bodiri Malema district of North West province resulted in 100% of pregnant women choosing to go for counselling and HIV testing.

Discussions between UNICEF and the Department of Health are under way for the creation of the first ever HIV population based study which will measure HIV prevalence among children under the age of two. It will contribute to forecasting future paediatric HIV treatment needs, and will have far reaching global implications for conducting similar research.

Renewed Vigour for Infant Feeding Regulation
Safe infant feeding is an area which needs urgent assistance. In June 2008 the National Infant and Young Child Feeding Policy was promulgated, but accompanying regulations on the marketing of infant foods have yet to be passed. UNICEF will continue to advocate and provide technical support towards the promulgation of these regulations.

Research for Children
In a separate project, UNICEF supported the documenting of the experiences of young HIV infected mothers enrolled in the multi-country Kesho Bora study. This was the first time in the current programme cycle that real life experiences of women living with HIV and the daily challenges they face have been captured in a documentary.

UNICEF continues to support the South African component of this study, which determines the impact of highly active antiretroviral therapy on transmission of the HI virus from mother to child. Clinical results are expected to be released in the first quarter of 2009. The South African study site is the KwaDabeka Community Health Centre in KwaZulu-Natal where HIV infection among pregnant women ranges between 42% and 47% – the highest rates in South Africa.

Together with the Department of Health, UNICEF supported a study into the safety of infant formula. This followed an outbreak of microbiological contamination in infant formula in 18 hospitals across six provinces and contributed to an increase in infant deaths. The study found poor hygiene practices to be the cause and this finding has led to a plan to develop new standards for hospital feeding of newborns.

Raising Standards of Care
In South Africa over 90% of pregnant women have at least one antenatal care visit and deliver in the hands of skilled health professionals. Despite this, almost half of maternal and neonatal deaths occur around the time of delivery, during the short stay in the maternity and neonatal care units.

This highlights the need for programmes which improve the quality of care in the health system. Expert consultations were convened to improve the quality of services for maternal, neonatal and child health, and work began in the last quarter of 2008 to revise the hospital accreditation system.

The focus will be on ensuring that women and children are followed up within the continuum of care, and to ensure that antiretroviral treatment is made widely available to women and children at the primary health care level.

Resources

Stories from the field