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I know that child deaths occur globally and the leading cause could be communicable diseases and affects mainly lower income countries.

In the area where I live a child reaching their 5th birthday is quite good, taking into consideration that in every sub district is a primary health care facility and no reason for a mother not to seek medical care when the need arise.
The only area very far from medical care will be in the Karoo area which is far from PHC facilities and out of hospital emergency care, but a big sponsor has come up and a mobile unit will be distributed to that area in a month from now. It will be operated by a professional nurse and a staff nurse as the assistant with 8 hour access to a physician on standby. Acute and chronic medication will be distributed, family planning, pre-natal care and child immunisations will form part of services provided.

I think top causes of child mortality according to my knowledge and experience is pneumonia which lead to sepsis, diarrhea and communicable diseases like tuberculosis, etc. Children at risk of these diseases are mostly children from poor socio economic areas and immunocompromised children.

Efforts that come to mind will be the year 2030 goals (SDG's), which we also encountered in the 1st semester and I just want to allow myself to gain valuable and extensive knowledge regarding child mortality.

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In my career as a nurse i encountered child mortality in South Sudan, the country with the highest child mortality in the world, mainly due to lack of ante natal and post natal care and reproductive health services in general. Children mainly from the refugee communities, poverty stricken families were the victims. Malnutrition and HIV were the main contributing factors to child death. Diarrhea, Pneumonia, Malaria and HIV related Illnesses were the leading causes of child mortality. To mitigate against child mortality, the local authorities and the international community roll out programs like EPI, ante natal and post natal care, nutrition programs to all the under fives, and pregnant mothers.

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Riaan Nothnagel - Child mortality thoughts. 

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Riaan Nothnagel - Child mortality thoughts. 

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If I think back in the past six years of being in a new area I would say drownings is the cause of mortality.

In the area that I live and work there is a good chance that children will reach the age of five. In an urban setting there is access to health care and most of the people have access to a medical aid scheme.

I am not too familiar with the causes of child death in my local area, but if I just take the last month, I was called out to three different cases where two children died, one due to a drowning and the other due to choking. Both these deaths where preventable. Most of the children that come to our facility has dehydration or pneumonia.

I think most of the children at risk are the children in low income areas due to the lack of facilities and education among the community.

Before the start of this week I have not given much thought to what efforts are being made to reduce child deaths. I have decided to visit the local clinic in my area and to see what they are doing in terms of prevention programs, educating new parent and if they are running any special projects or programs. The clinic is literally less then a kilometre from where I stay.

I would like to find out more about the main causes of child mortality. I am keen to learn more about child emergency care in general.

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Pieter J v Vuuren - Child Mortality _ Global Context

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Pieter J v Vuuren - Child Mortality _ Global Context

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My knowledge regarding child deaths are purely based on my experiences in the prehospital setting and disconcertingly I have to admit that I have never given it much thought other than in this setting. Although I have been working in the international sector for the past 10+ years (with very limited exposure to child healthcare) I do recall many sad instances/stories whilst working in the prehospital setting in South Africa.

With regards to data-sets I would not be able to comment as I have never investigated the topic however do agree these are important and valuable questions to ask ourselves and anyone/everyone involved in any part of the treatment pathway should be aware of these answers/statistics.

I am aware (in brief) that there are many initiatives, strategies and programs actioned globally in the aim of reducing child mortality however cannot say that I am acutely aware of their aims.

Although there is a magnitude of influencing factors that contribute to the challenges in reducing child mortality, straight off the cuff I can already see how information/data-sets (something I did not consider in the past) will completely change my approach to child healthcare albeit it only be in the prehospital setting.

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Kyle Shiel - Child Mortality and my thoughts. 

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Kyle Shiel - Child Mortality and my thoughts. 

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This is such a fitting topic as it is sadly a regular callout situation in both the Urban and Rural areas. I was called out on Thursday to a child that was vomiting and weak at three years old. Upon arrival they child was very lethargic and sleepy as we would expect the patient to be. The history pointed to vomiting since Sunday which was then a 4 day history of vomiting and poor feeding.

This just shows how their death is preventable and yet it isn't. The scary thing of it all was the fact that an excellent mother and child hospital was less that 5km from the scene. This wouldn't have been an expensive taxi ride or provincial ambulance ride to the hospital for further care. But wait, there is more, 1km from the residence, there was a community click that would have been more than equipped to handle this case.

I often feel there is a socio-economic issue here as well as a lack of education but i also sometimes think its a lack of care and complacency. This being said colleagues of mine went to a 1 year old that burnt alive because mom left the baby in front of a heater and went to the shops. The surrounding area caught alight and burnt the child to death. I am mentioning this because thats 2 cases that I know of in literally one week. I am mentioning this because both cases are preventable, one survived and one wasn't so lucky.

These children were both under the age of 5 years old so it substantiates the statistics which are scary. 1 in 13 goodness me that is shocking but believable. What I know about child deaths is that it happens far far too often and it shouldn't, we should advocate for our younger populations.

In my immediate Urban area babies should reach the age of 5 years old but with that being said, we can be greatly surprised but I think the chances are high that they will see their 5th birthday. I don't know distinctly what the causes are of their deaths but from my experience I would take a guess and say, malnutrition, diarrhoea, sepsis due to infection, gastroenteritis and or dehydration, and maternal complications or maternal death. I would think together with their developing lungs I would think they are easily susceptible to pneumonia or some sort of lunch infections which if untreated I am sure would be detrimental.

I think children who are most at risk are the young developing child thats defenceless to their surroundings and environment especially in the rural or underprivileged communities or populations. Education I also think plays a vital role here too with lack of sanitation and running water. I think the WHO is constantly trying to advocate for children both locally and globally and have initiatives to try and improve child care. I know the different health organisations have improved both in-hospital and pre-hospital child care and responses to advocate for the younger population to ensure or attempt to ensure growth and survival.

I want to know what can we do to prevent or help with decreasing child mortality? How can we as a fraternity make a difference? That is why we are here so let's make it happen because its a group effort and not an individual effort.

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My knowledge regarding child deaths is limited to clinical encounter and futile resuscitations. I recently relocated to a small community in Eastern Cape and I am not familiar with child mortality statistics for the region. Based on my encounters with the local residents, I would guess that it is far higher than it ought to be. My perception is that extremely poor socio-economic conditions flows to a massive drug abuse problem, complicated with alcohol abuse. This results in foetal development issues and contributes to the  neglected of new-borns and children. I suspect that new-borns as a group with their limited reserves would be most at risk for mortality.

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Child deaths they occur in peri-urban areas, informal settlements, rural areas. With most of the cases that I've seen this occurs with young mothers, especially teens.
i think of SIDS it in my experience i see it more prevalent to boy children as opposed to girls. Causes of death it could be pre-term complication, asphyxia, infections. and other unknown causes. Local efforts are related to educating young mothers, and consistent attendance of child inoculations regimes according to their age groups.  Understand the purpose of documenting all infant deaths with SAPS .

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Child deaths - unpleasant and roller emotions. What i know is that children do compensate well, and sudden severe deterioration is unexpected. "bell curve".
Current location is West Africa = malaria, typhoid, sepsis and pneumonia that causes most deaths in children. Very poor country with limited resources and poor health care facilities...
Africa is Africa and its leaders.
Donations are made but unknown whether these are implemented into health care as it should.

Believe to gain much from this course...
Good luck to all.

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I have not taken much note of child deaths.
I know that in the area I work I have attended many deaths of children under 5. I would say that on a shift cycle of 2 days and 2 nights I would attend +- 3-4 deaths of children in that cycle. most were younger than 12 months. The parents would indicate that the child was sick. I would say that majority of the deaths were due to pneumonia or another childhood illness.
I know that the council embarked on an immunization drive and educated the parents on symptoms and the need to report to the nearest clinic to get early treatment. Globally the WHO and UN have started programs to decrease childhood deaths.

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To be quite honest, the only proper knowledge I have regarding child mortality, is the child resuses and deaths I encounter at work.. I do not actually really know any statistics or top causes etc, but I am eager to learn and grow, and that is why I am excited about this course, as I will get to know more about these things and improve my knowledge and understanding.

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Ditlou T: Child Emergency CareChild deaths: I know that most child deaths are caused by socio-economic factors which are also influenced by the class of the country or region. In the area, I previously stayed which was rural - most of the recorded deaths were due to sanitation issues like latrines toilets, or cholera from drinking river water. Also noted that poor nutrition due to poverty had a huge impact on their health leading to avoidable deaths. I think the leading cause of child mortality will be malnutrition leading to poor immune systems – multiple diseases. Poor immunizations and sanitation contribute as well to child mortality. Children at risk:-	Poorly immunized-	Impaired immune systems secondary to chronic conditions. -	Poor sanitation-	Malnutrition Efforts to reduce child mortality locally and globally:-	Feeding schemes-	Improved access to basic needs like clean water, sanitation, and healthcare services. What I want to know about child mortality – how accurate is the data since in the local or rural areas there is poor data collection due to resource constraints. 

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Ditlou T: Child Emergency CareChild deaths: I know that most child deaths are caused by socio-economic factors which are also influenced by the class of the country or region. In the area, I previously stayed which was rural - most of the recorded deaths were due to sanitation issues like latrines toilets, or cholera from drinking river water. Also noted that poor nutrition due to poverty had a huge impact on their health leading to avoidable deaths. I think the leading cause of child mortality will be malnutrition leading to poor immune systems – multiple diseases. Poor immunizations and sanitation contribute as well to child mortality. Children at risk:-	Poorly immunized-	Impaired immune systems secondary to chronic conditions. -	Poor sanitation-	Malnutrition Efforts to reduce child mortality locally and globally:-	Feeding schemes-	Improved access to basic needs like clean water, sanitation, and healthcare services. What I want to know about child mortality – how accurate is the data since in the local or rural areas there is poor data collection due to resource constraints. 

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Child mortality rates, like most other health concerns, will be influenced by the country as well as the area you are born in. Children in lower-income countries with poor health infrastructure and policies will have lesser change of reaching the age of 5
I live and work in an urban area where most people have access to adequate healthcare in the form of local clinics, a few district and academic hospitals as well as a number of private hospitals. Child mortality is therefore not as prominent in our area as I am sure it is in many remote areas of the country. We have however experienced a few under 5 deaths in the past year – more than we’ve had in previous years, relating to diarrheal disease, fatal drownings and burns.
Leading causes of death in SA in the under-5 population is diarrhoea, pneumonia and HIV infection, according to Bamford, et al in the SAMJ, 2018. The WHO lists the main causes in Africa as preterm birth complications, pneumonia, birth asphyxia, diarrhoea and malaria.
Children are the at highest risk of dying in the neonatal period, the first 28 days of life. Safe childbirth, antenatal programs and care and effective neonatal care are essential to prevent these deaths. Effective prevention programs, immunizations, parental support and training can assist in reducing the global child mortality rate

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Well I have had many bad experiences when it comes to child mortalities and equally so, did I have opportunities to save some of these lives. Most instances that I had been through, the parents were at fault and negligent when it came to looking after children and they ended up demising because of that. The informal settlements were notorious for such incidents and no matter how much talking was done with them, a few months down the line, we would go back again for same.

I was fortunate to have saved a few children and this particular two, both were at advanced stages of dehydration to an extent that no veins could be found and I had to do Intraosseous on them which saved their lives. Doctors at the then JHB Gen were very happy that these drips were put up and it saved the children's lives.

In the area where I live, it is rather scary because most of the children that are born, are born to mothers who abuse drugs and this will have an effect on their unborn children which will in turn reduce their lifespan

From the top of my head I can think of a few causes of child death based on the experience I have had, namely: diarrhoea, pneumonia, diseases especially when the children are not immunised, trauma.

WHO has required from each country to record the child mortality rates and the causes thereof so that this can be used to come up with preventative measure into child deaths which has seen a significant drop over the years to date

Hoping to gain more skills from this lecture so that we can use that in health education

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What I know about child deaths in my clinical experience is that sometimes things aren’t as clear cut as we’d like them to be. For example there was a time when I would be called out on multiple declarations to clinics such as Zandspruit or other clinics in the Tembisa region. Sadly the infants were victims of force feeding and this led to death by aspiration. Other child deaths have been due lack of education, traditional medicine and even battery acid and organophosphate enemas. All of which one has to call out SAPS for. Sadly there is a massive disparity in education levels and even just taking the constipated child to the clinic could have saved it’s life instead performing a home remedy which resulted in a fatality and absolute tragedy for the family and relatives. I know that these deaths could certainly have been prevented with the correct education in place.

In the area I live, I would be very surprised if a child didn’t reach their fifth birthday.

Yes having worked at multiple clinics set up specifically for maternity I do know that the causes of death amongst South African children are diarrhoea, malaria (still a killer! Less so in JHB but i have definitely seen my fair share of it!), pneumonia and malnutrition. I’ve had my heart broken and emptied my wallet for many families who can’t afford formula or food, I remember clearly the first time I bought food for a mother and child as an ALS, she had nothing to give the baby and couldn’t produce her own milk so she was feeding the baby water and sugar. I had to gently explain to her that that was why her baby was sick and that she needed formula. I believe the clinic did end up supplying her with formula which is a positive outcome but just reflecting back on this it was quite eye opening to see the abject poverty that I was going to continue to deal with from that point onwards.

The children most at risk are those who live below the bread line.

With regards to specific efforts, I know there are programmes in place, I also know they don’t always work, or people that need access, can’t always gain access. I believe there is a big drive to get mothers breastfeeding after seeing some posters in the clinics. However I can’t name any of these initiatives.

Well, I would like to know how I, as an individual can make a meaningful impact and assist in reducing child mortality. That would be first prize for me.

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Child deaths remain a taboo in most conversational circles resulting in the subject not being awarded the attention due to these cases, the true depth span and gravity of the crisis we actually face remains gravely underestimated therefore poorly resourced.In the area I live, rural Kwa Zulu Natal, many children will not reach their fifth birthday, with a majority of these deaths taking place before the child’s second or third birthday.I am led to believe that the top causes of child mortality within my area closely mimic what I understand are the global cases being, malnutrition, dehydration, malaria and accidental or traumatic deaths including drowning.Children who are born to families and situations where poverty is prevalent face an incrementally higher risk of mortality.Without doing any research, relying on general knowledge and exposure to the efforts through work over the years, expanded vaccination programs for preventable diseases, rehydration stations at clinics as well as community education drives vis rehydration and a concerted effort a few years back termed MAGPI or medics against paediatric injuries conducting home safety classes as well as raising donations of car booster seats for public transport.I have a limited understanding of the pathophysiology of undifferentiated shock in the Paediatric setting and care thereof I would like to better understand the ways in which we as care providers are able to address this type of picture.

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Child deaths remain a taboo in most conversational circles resulting in the subject not being awarded the attention due to these cases, the true depth span and gravity of the crisis we actually face remains gravely underestimated therefore poorly resourced.In the area I live, rural Kwa Zulu Natal, many children will not reach their fifth birthday, with a majority of these deaths taking place before the child’s second or third birthday.I am led to believe that the top causes of child mortality within my area closely mimic what I understand are the global cases being, malnutrition, dehydration, malaria and accidental or traumatic deaths including drowning.Children who are born to families and situations where poverty is prevalent face an incrementally higher risk of mortality.Without doing any research, relying on general knowledge and exposure to the efforts through work over the years, expanded vaccination programs for preventable diseases, rehydration stations at clinics as well as community education drives vis rehydration and a concerted effort a few years back termed MAGPI or medics against paediatric injuries conducting home safety classes as well as raising donations of car booster seats for public transport.I have a limited understanding of the pathophysiology of undifferentiated shock in the Paediatric setting and care thereof I would like to better understand the ways in which we as care providers are able to address this type of picture.

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According to UNICEF 5.0 million children under the age of 5 years died as reported in 2020 globally. This means that 13, 800 children were dying every day under the age of 5 in 2020 due to key factors which will be discussed. However the risk of dying for those from the age group of 5 – 24 is lower than the children under 5 years of age.  It is stated that the likelihood of children and youth of dying among 5 – 24 years was 18 deaths per 1,000 in 2020.

Somali children 1 in 8 die before turning five years.

Globally the top cause of death in child mortality is infectious diseases which include pneumonia, diarrhea, malaria, pre-term birth complications, birth asphyxia, trauma and congenital anomalies.

The under five years, children are the ones at risk.

Various efforts are being made to reduce child deaths locally and globally through the following areas: Immediate and exclusive breastfeeding; Skilled attendants for antenatal, birth, and postnatal care; Access to nutrition and micronutrients; Family knowledge of danger signs in a child's health; Improved access to water, sanitation, hygiene; And Immunization.

I would be interested to know the role of EC for LMICs in child mortality, in-line with SDGs.

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Childhood mortality is a great concern and health services attempt to reduce the rate. In my area I have declared a few children. The most common age  was between 1 to 3 months of age . On history I could not determine the real cause of death .  Many cases we are  called for  is due severe dehydration   due to  vomiting and diarrhea.
We also see premature births happening and these babies more prone to die at home with complications developing such as apnea spells and parent do not recognize problem in time or do not seek help in time . With our socio-economic climate , more people are in severe poverty and malnutrition , and this going impact on the weakest and the most vulnerable.

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As much as the mortality rate has fallen gradually from 73.1 deaths per 1,000 live births in 2001 to 32.2 deaths per 1,000 live births; the South African child mortality rate (under 5yrs age) is unacceptably high.

Mabaso et al identifies Limpopo, Kwazulu-Natal, Eastern Cape and the Free State as the provinces with the highest number of mortalities. The causes of child mortality include diarrheal disease, HIV and AIDS, malnutrition,  meningitis & lower respiratory tract infections (pneumonia). The majority of these diseases are preventable and treatable. Contributing factors include poor communication, access to healthcare, lack of adherence to immunization programs and nutrition. From this, it is evident that the poorest and under-privileged are most affected and likely to die before the age of 5.

The UN's Millennium Development Goals (MDG) was a way of addressing newborn and child mortality. The main objective was to reduce child deaths by at least two thirds by year 2015. Further to this, South Africa developed the Sustainable Development Goal (SDG) targets to reduce under-5 mortality rates.

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I know now that 1 in 13 children will reach their 5th birthday depending on which part of the world they are born in.

I can only guess with an increase in teenage drugs, alcohol and gangsterism locally (usually in a broken home i.e. no parents or guardians present) will result in an increase in teenage pregnancies. An increased natality to immature parents with no or minimal formal education furthermore increases mortality in paediatrics. We often see unbooked pregnancies, lack of immunizations, "TIK babies" and other negligence causing premature births, RDS in newborns, poor lung development and long-term respiratory issues.

The top causes of child mortality will probably be the pneumonia, gastro and sepsis medical topics mentioned in the course overview.

Unfortunately we are fighting a losing battle being reactive rather that proactive and preventative, there are designated teams of varying professions that have a particular focus on child health and well-being .

I am hoping to learn a lot about Child Health for Emergency Care.

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Child Mortality in the Global Context - MGRJAS001.

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Child Mortality in the Global Context - MGRJAS001.

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My thoughts on child deaths are as follows: Child death is a premature death of a child in the age bracket of birth to exactly 5 years. Literature has it that 1 in 27 children die before the age of 5 years, according to the World bank data of year 2020.

In the area I live the chances are high that a child will reach the age of 5 years, however the country in general experiences children deaths based on a number of factors, health, social and economic.

The top causes of child mortality are HIV/AIDS, New born disorders and complications, Pneumonia, Diarrhea, Malaria, trauma/motor vehicle crashes, religious - anti immunization and social-economic factors.

The infants (under 1 year) are the most at risk of dying.

Efforts are been done locally and globally to reduce child deaths, by rolling out immunization programs, designing auto mobiles that takes children safety needs into consideration, involving parents and guardians and encourage them to get the children vaccinated, and the children nutritional supplements programs operated by the government in partnership, with non governmental organizations advocating for children welfare, care and children rights, and availability of free emergency care to children of 5 years and below.

In general child mortality is decreasing in the current years, as compared to yester years, for example in the 1990s the children death was on an average of 74 death in every 1000 lives, and as of 2020 the number dropped to between 26 to 36 death per 1000 live births, according to Nazik Armenakyan, 2020  (World bank data).

In this module I want to learn more of ways to further prevent children death, nutritional support and implement the acquired skills and knowledge for the betterment of my community and country at large.

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I have limited knowledge about child mortality, I do know that the mortality rate significantly decreased since 1990 from 1 in 11 children dying before reaching the age of 5, to 1 in 27 in 2020. Sub-Saharan Africa and South Asia account for 80% of the deaths under 5 years of age.

According to WHO - Infectious diseases (pneumonia, diarrhoea, and malaria), pre-term birth complications, birth asphyxia, trauma and congenital abnormalities are the main causes of child mortality, which children with malnutrition is more at risk.

Working for the Western Cape Department of Health and Wellness I am aware of some of the child health program which include Prevent, promote, and manage childhood illnesses and rehabilitative services, Maternal health, HIV/AIDS and mental health programs, Immunisation, nutrition and feeding services, screening and testing for HIV, TB and development, growth monitoring, infant and young child feeding support and follow up care.  This includes the first 1000-days (conception until the child’s second birthday program.  www.westerncape.gov.za/first-1000-days).

I have witnessed that poverty and low socio-economics status plays a major role in child death.

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Child death rates in South Africa decreased from 60.3% in 2009 to 32.2% in 2020 according to Knoema South African Health. Personally my knowledge with regards to child deaths are limited accept for the minimal incidents I have been involved in..

In the area where I live, the changes that a baby born will reach their 5th birthday are very good due to very active community health cares in my area as well as the Primary Health services.

I would suspect that the top causes for child mortality are: pneumonia, diarhea, cot deaths, asperation during birth and premature deliveries.

I would like to learn about preventative measures to put in place to prevent child deaths as well as identifying critically ill babies before they get critical.

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I know now that 1 in 13 children will reach their 5th birthday depending on which part of the world they are born in.

I can only guess with an increase in teenage drugs, alcohol and gangsterism locally (usually in a broken home i.e. no parents or guardians present) will result in an increase in teenage pregnancies. An increased natality to immature parents with no or minimal formal education furthermore increases mortality in paediatrics. We often see unbooked pregnancies, lack of immunizations, "TIK babies" and other negligence causing premature births, RDS in newborns, poor lung development and long-term respiratory issues.

The top causes of child mortality will probably be the pneumonia, gastro and sepsis medical topics mentioned in the course overview.

Unfortunately we are fighting a losing battle being reactive rather that proactive and preventative, there are designated teams of varying professions that have a particular focus on child health and well-being .

I am hoping to learn a lot about Child Health for Emergency Care.

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My knowledge of child death is that we have an increased number of child death especially in the rural areas where equipment is scarce and staff shortage prevails.

In 2017, the Statistics South Africa published a death rate of 5.5% between 2013 and 2017. There is no data available for the Eastern Cape province with regards to child deaths. Most of the leading causes of death are HIV & TB, pneumonia and malnutrition as well as low birth weight. Most children that are at risk are those less than 1 year old and mostly neonates.

Nationally, I know that the constitution of South Africa has adopted a free medical treatment and nutrition for all children under the age of 5 years old. The course contents seems like it will cover all of what I would like to know about child death.

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My knowledge of child death rates and causes is quite limited, and I am sure that I will learn a lot about this topic during the first week.

According to the Statistics South Africa website, Gauteng has the second lowest under-5 death rate in South Africa at 34 deaths per 1000 births. The information I found seems to be at least ten years old though because they used the 200-census data to compile their report.

The top causes of child mortality that I could find were tuberculosis, premature and low birth weight, malnutrition, diarrhoea, HIV, and some other causes was trauma and fires

The children that are most at risk of dying according to the WHO, are new borns in the first 28 dayss of life and account for half of the recorded deaths. Safe childbirth and effective neonatal care can assist in lowering the mortality rate of new-borns during this period.

Immunization also plays a major role in reducing child deaths.

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In a simplified explanation of my current knowledge regarding child deaths, I know that the mortality of children younger than five years old is significant. This owing to many factors such as a lack of parental awareness in understanding the importance of vaccinations as well as recognising the severity of illnesses when they occur, lack of infrastructure, and access to imperative care.

The likelihood of survival to the age of five in the area where I live is high, purely due to it being an urban area with relative access to healthcare. This is where the awareness and education of the parent are pivotal. In some cases, there is an element of poor education leading to the parent having a higher threshold of when to seek help for their child, and although living in an urban area with access to healthcare, by the time they seek the necessary emergency care, the child is already severely ill.

Child and infant mortality is currently classified as a component of the quadruple burden of disease that South Africa is facing. The deaths are mainly a result of pre-term/birth complications, diarrhoea, and pneumonia.

Malnutrition and a state of being immunocompromised place these children at a higher risk of demise. Late recognition of severity, as well as lack of access to adequate healthcare, are also major contributing factors. This occurrence is most often seen in rural, low-income countries with very little socioeconomic support.

I am aware that UNICEF and the World Health Organisation are advocates for and have prioritised child healthcare and system changes according to data collection, globally.

The implementation of changes and improvement of systems would only be as good as the directives and delegates who drive them.

“Be the change you wish to see in the world” – Mahatma Gandhi

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I think that I have been oblivious to the causes of childhood deaths and am sure that this week will enlighten me.  However, reflecting on the work I have been involved in over the years, several causes came to light.  I also assume that the topics in this course will also cover the most common causes.

In my current working environment, we do a fair number of neonatal and paediatric transfers for upgrade in care.  Pneumonia and cardiac abnormalities are the most common complaints that we deal with, and many of the patients that we transport are in grave condition.  In my opinion, the transfer of many of these children is often left too late and we are not doing them any favours with regards to morbidity or mortality, and the first link in the paediatric chain of survival is being neglected.

Being in Johannesburg, I think that the children stand a better chance of reaching their 5th birthday than those in low-income rural areas when it comes to causes by both disease and injuries, purely based on the health infrastructure, education, and resources available.  This thought came to mind after considering some of the transfers as previously mentioned from the rural areas where patients are taken to clinics or hospitals or referred late due to various factors.

The under 5 mortality rate has been on a steady decline as per the UNICEF Data both in South Africa and Globally, which is a positive indicator that there is a concerted effort in decreasing mortality and working towards the WHO Sustainable Development Goal of establishing good health and well being by 2030.  There is a long way to go though, and the current strained global economies may hinder this decline in the near future unless we put in a major effort.  The South African Government has written into the constitution that healthcare will be free to all children under the age of 5 and has made many resources available to try and achieve this.  The government can only do so much though and children’s parents and guardians as well as healthcare workers also need to bring their part.