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South Africa

In South Africa, a neonatal care initiative builds health and saves lives

© UNICEF South Africa/2011/Marinovich
Nkhesani Ndleve gave birth to twins - a boy and a girl - at Malamulele District Hospital in Limpopo province, South Africa. In her arms is her newborn daughter while her son is receiving more support in the high care unit.

By Greg Marinovich and Marisol Gutierrez

LIMPOPO, South Africa, 23 June 2011 – It’s a sad fact that 83 per cent of children in Limpopo province live in poverty. So you’d assume that Malamulele District Hospital probably performs poorly – especially since most of South Africa’s infant mortality rates are linked to district hospitals.

But you would be mistaken. This hospital, despite its humble status, is a beacon of hope in the province. It has seen a 30 per cent reduction in deaths since 2006 and its neonatal unit has reduced the number of exposed infants who test positive for HIV at six weeks of age. It was around 13 per cent in 2007. By 2010, it had dropped to around six per cent.

Life-saving care

This life-saving difference was spearheaded by the Limpopo Initiative for Neonatal Care (LINC), supported by the Limpopo Provincial Department of Health, UNICEF and Save the Children. Before the existence of LINC, newborn care was mostly seen as a routine task in post-natal wards. This meant that sick newborns often went unrecognised with the result that treatment was inadequate.

One of LINC’s priorities is to empower medical staff and management to improve newborn care services at community, district and regional levels. Combined with strong leadership and motivated staff, this initiative has led to mothers and babies receiving better care and lives being saved.

© UNICEF South Africa/2011/Marinovich
A mother at the Malamulele District Hospital prepares to breastfeed her baby. Skin-to-skin contact is encouraged as is breastfeeding so tha children develop healthy and strong.

LINC’s other priority is to train nurses who work in neonatal units, so they can offer excellent care to the most vulnerable babies, like those who are severely underweight. Malamulele District Hospital is a success story – but challenges remain.

Senior Clinical Manager Dr. Stanley Langa says that the hospital should have 40 doctors, yet there are only 10. Four of them are doing their community service year. To cope with the shortfall, Dr. Langa relies on private doctors from surrounding areas to help with shifts.

Protecting the most vulnerable

Dr. Benni Mathiba, 32, a senior medical officer, has responsibility for the most helpless and vulnerable of beings – the perilously underweight and prematurely born infants in the neonatal unit of Malamulele District hospital.

The tiny babies seem lost in their nappies as they struggle for life in the transparent incubators. Some of these newborns would fit in an adult’s hand. Below 2.5 kg is considered a low birth weight. To an observer, it seems unlikely they can survive, let alone thrive.

Yet sitting on a comfortable couch in the visitors’ room is five-year-old Angel Masiya. She was born prematurely to her 16-year-old mother at just 29 weeks and weighed just 700 grams.

© UNICEF South Africa/2011/Marinovich
Angel Masiya’s grandmother, Nothisa Macebele, recalls the joy she felt when she knew that her granddaughter would survive after being born premature. The Limpopo Initiative for Neonatal Care is reducing infant mortality rates in the South African province.

Angel should not have made it, but at Malamulele District Hospital, they have built a team that cares for babies like few other rural hospitals. One of the innovations the hospital introduced was the ‘Kangaroo Mother and Father Care’, where the importance of skin-to-skin contact for underweight infants was made a priority.

This is in order to boost the child’s immunity through exposure to parental benign bacteria and temperature regulation. Skin-to-skin contact also helps strengthen family bonds.

Children flourish

Whenever Dr. Mathiba goes shopping at the local supermarket, the parents of his former patients will come up and update him on the progress that ‘his’ children are making. Dr. Mathiba did his community service at Malamulele District Hospital and was recruited just as the provincial neonatal programme was initiated. Even though he had no ambitions to be a paediatrician, he soon realised that he loved it.

“My cell phone is full of images of ‘my kids’,” he says proudly. “I follow up on the kids as they grow, and especially form a relationship with the grandmother of the child as she is the most stable person in the family.”



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