Citation

Mathews S, Martin LJ, Coetzee D, Scott C, Brijmohun Y. S. Afr. Med. J. 2016; 106(9): 851-852.

Copyright

(Copyright © 2016, South African Medical Association)

DOI

10.7196/SAMJ.2016.v106i9.11382

PMID

unavailable

Abstract

South Africa (SA) has not met the child mortality target for the Millennium Development Goals, despite having invested substantially in programmes and policies to achieve these targets. The scale-up of the prevention of mother-to-child transmission programmes reduced HIV transmission from mother to child, but this has not been sustained owing to limitations in community-based child health services. Child mortality has declined, but has now plateaued. Children continue to die from preventable and treatable causes of death. Current data sources are incomplete, and do not provide information on deaths occurring out of health facilities. The child death review (CDR) pilot explores the pattern of child deaths and informs prevention strategies to improve child survival in SA. In this editorial we draw on the conclusions of the CDR pilot, where multiagency teams were established to investigate non-natural and unexpected deaths referred to two mortuary sites in order to strengthen child health and protection response systems and to prevent child deaths.

Strategies to improve child survival have mainly focused on under-5 deaths, yet our CDR pilot has shown that deaths throughout childhood require attention. The following patterns of child mortality were identified: (i) infanticide in the neonatal period; (ii) acquired natural causes (in particular lower respiratory tract infection (LRTI)) during infancy; (iii) child abuse- and neglect-related deaths in children aged <5 years; (iv) road traffic deaths, in particular deaths of pedestrians, as children become older; and (v) homicide and suicide in the older age group (15 - 17 years). The CDR investigates each child death using a set of questions that include the medical factors together with the social contributors to each child's death, particularly in sudden unexpected and injury-related deaths. This process requires an understanding of the context or environment in which each death occurred, including factors at each level - individual (biological and psychological), family, social, cultural, health and social welfare system - that influence access to care and the care the child received....

Language: en