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The South African child death review pilot: A multiagency approach to strengthen healthcare and protection for children

Shanaaz Mathews, Lorna J Martin, David Coetzee, Chris Scott, Threnesan Naidoo, Yasheen Brijmohun, Karisha Quarrie

Abstract


Background. Child mortality trends in South Africa (SA) show a decrease, but remain high and appear to have plateaued. To attain the new sustainable development goals, we need a better understanding of causes of death and the associated factors.

Objectives. To describe the SA child death review (CDR) pilot, the pattern of child deaths reviewed and the factors associated with these deaths.

Methods. CDR teams were established at two pilot sites, Salt River mortuary (Western Cape Province) and Phoenix mortuary (KwaZulu-Natal Province). All child deaths were reviewed by a multidisciplinary team at the pilot sites for the period 1 January 2014 - 31 December 2014.

Results. The CDR pilot reviewed 711 cases. Over half (53.3%) were natural deaths, as opposed to 42.6% non-natural deaths. Most infant deaths (83.9%) were due to natural causes, while 91.7% of deaths in the 15 - 17-year-old age group were due to injuries. The leading cause of deaths reviewed (30.8%) was respiratory tract infection (RTI), mainly among infants (51.6%). Homicide was the second most common cause of death and affected children of all ages, with the highest burden (52.8%) in the 15 - 17-year age group. Child abuse and neglect accounted for 11.3% of deaths. RTI was shown to be more likely after the neonatal period (odds ratio (OR) 2.92; p<0.000) and in preterm infants (OR 1.98; p=0.005).

Conclusions. CDR teams have been effective in improving identification of the causes of out-of-hospital deaths, as well as by identifying remediable factors critical to reducing child deaths further.


Authors' affiliations

Shanaaz Mathews, Children’s Institute, Faculty of Health Sciences, University of Cape Town, South Africa

Lorna J Martin, Division of Forensic Medicine and Toxicology, Faculty of Health Sciences, University of Cape Town, South Africa

David Coetzee, Health Impact Assessment, Western Cape Department of Health, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Chris Scott, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa

Threnesan Naidoo, Forensic Pathology Services, KwaZulu-Natal Department of Health, Durban, South Africa; Department of Forensic Medicine, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

Yasheen Brijmohun, Forensic Pathology Services, KwaZulu-Natal Department of Health, Durban, South Africa; Department of Forensic Medicine, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

Karisha Quarrie, Forensic Pathology Services, KwaZulu-Natal Department of Health, Durban, South Africa

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Keywords

Child mortality; Child deaths; Respiratory tract infection; Fatal child abuse; Child death review; Health system strengthening

Cite this article

South African Medical Journal 2016;106(9):895-899. DOI:10.7196/SAMJ.2016.v106i9.11234

Article History

Date submitted: 2016-06-27
Date published: 2016-08-04

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