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.

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. 

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 5^th 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.      

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.

 

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.

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

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.

 

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.