Original articles

Neonatal, infant and child health in South Africa: Reflecting on the past towards a better future

A Goga, U Feucht, H J Zar, A Vanker, C S Wiysonge, N McKerrow, C Y Wright, M Loveday, W Odendaal, V Ramokolo, T Ramraj, L Bamford, R J Green, Y Pillay, N Nannan

Abstract


Although the neonatal mortality rate in South Africa (SA) has remained stagnant at 12 deaths per 1 000 live births, the infant and under-5 mortality rates have significantly declined since peaking in 2003. Policy changes that have influenced this decline include policies to prevent vertical HIV transmission, earlier treatment of children living with HIV, expanded immunisation policies, strengthening breastfeeding practices, and health policies to contain tobacco and sugar use. The Sustainable Development Goals (2016 - 2030) have shifted the focus from keeping children alive, as expressed in the Millennium Development Goals (1990 - 2015), to achieving optimal health through the ‘Survive, thrive and transform’ global agenda. This paper focuses on important remaining causes of childhood mortality and morbidity in SA, specifically respiratory illness, environmental pollution, tuberculosis, malnutrition and vaccine-preventable conditions. The monitoring of maternal and child health (MCH) outcomes is crucial, and has improved in SA through both the District Health Information and Civil Registration and Vital Statistics systems, although gaps remain. Intermittent surveys and research augment the routinely collected data. However, availability and use of local data to inform quality and effectiveness of care is critical, and this requires ownership at the collection point to facilitate local redress. Potential game changers to improve MCH outcomes include mobile health and community-based interventions. In SA, improved MCH remains a crucial factor for human capital development. There is a pressing need to focus beyond childhood mortality and to ensure that each child thrives.


Authors' affiliations

A Goga, Health Systems Research Unit, South African Medical Research Council, Pretoria, South Africa; Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa; HIV Prevention Research Unit, South African Medical Research Council, Pretoria, South Africa

U Feucht, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa; Tshwane District Health Services, Gauteng Department of Health, Pretoria, South Africa; Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria, South Africa; Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa

H J Zar, Department of Paediatrics and Child Heath, Faculty of Health Sciences, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa; SAMRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa

A Vanker, Department of Paediatrics and Child Heath, Faculty of Health Sciences, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa; SAMRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa

C S Wiysonge, Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa

N McKerrow, Paediatrics and Child Health, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa; Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

C Y Wright, Environment and Health Research Unit, South African Medical Research Council, Pretoria, South Africa; Department of Geography, Geoinformatics and Meteorology, Faculty of Natural and Agricultural Sciences, University of Pretoria, South Africa

M Loveday, Health Systems Research Unit, South African Medical Research Council, Pretoria, South Africa;Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

W Odendaal, Health Systems Research Unit, South African Medical Research Council, Pretoria, South Africa;Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

V Ramokolo, Health Systems Research Unit, South African Medical Research Council, Pretoria, South Africa

T Ramraj, Health Systems Research Unit, South African Medical Research Council, Pretoria, South Africa

L Bamford, Child, Youth, and School Health Chief Directorate, National Department of Health, Pretoria, South Africa; School of Health Systems and Public Health, University of Pretoria, South Africa

R J Green, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa

Y Pillay, Strategic Health Programmes, National Department of Health, Pretoria, South Africa

N Nannan, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa

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Cite this article

South African Medical Journal 2019;109(11b):83-88. DOI:10.7196/SAMJ.2019.v109i11b.14301

Article History

Date submitted: 2019-12-05
Date published: 2019-12-05

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