Inpatient case fatality rates improvements in children under 5: Diarrhoeal disease, pneumonia and severe acute malnutrition

Data on the number of admissions and deaths in children aged under 5 years from diarrhoea, pneumonia and severe acute malnutrition are routinely collected through the District Health Information System. These data, and the associated case fatality rates, are available for all public sector hospitals in South Africa (SA), and can be compared over time, as well as across different settings. This article presents these data for the period 2011/12 - 2016/17. It reflects on the remarkable improvements in these case fatality rates, and the likely reasons for their declines across all provinces. The article concludes by identifying the actions that need to be taken to ensure that SA achieves the Sustainable Development Goal aim of ending preventable child deaths by 2030

Innovations in the clinical care of mothers and children in South Africa: The contribution of district clinical specialist teams

The contribution of the District Clinical Specialist Teams (DCSTs) to improving maternal and child health outcomes in South Africa, through strengthening the four pillars of clinical governance, is reflected in innovative work presented at a ‘Promising Practices’ symposium and at various conferences. Of the 24 identified DCST innovations, 21% reflected the clinical effectiveness pillar, 17% clinical risk management, 41% staff development, and 21% user-related considerations. In order to ensure scale-up, the submitted best practices/ innovations were reviewed using the World Health Organization quality standards and ExpandNet parameters for likely scalability. Here we describe one case study from each pillar, illustrating the contribution of the innovations to improved patient outcomes. The development and scale-up of innovations needs to be institutionalised and must include effective support and action from the relevant health managers

Reducing neonatal deaths in South Africa: Progress and challenges

Although current levels of the neonatal mortality rate (NMR) are within reach of the Sustainable Development Goal (SDG) target of 12 per 1 000 live births, the absolute number of deaths is unacceptably high for a lower-middle-income country such as South Africa (SA). Neonatal mortality over the last decade has declined very slowly, and is not commensurate with the level of government investment in healthcare. The recent neonatal mortality rate of 21 per 1 000 live births reported by the SA Demographic Health Survey is of major concern. This paper reviews recent efforts to reduce the neonatal mortality rate, including support for the implementation of neonatal policies and plans, and strengthening programmes to deliver low-cost, high-impact interventions. We review recent estimates of the NMR and causes of neonatal deaths, and discuss how the mortality from preventable causes of death could be reduced. If SA is to meet the SDG target, special attention should be given to the availability of high-impact interventions, providing an adequate number of appropriately trained healthcare providers and a more active role played by ward-based community health workers and district clinical specialist teams

Inpatient case fatality rates improvements in children under 5: Diarrhoeal disease, pneumonia and severe acute malnutrition

Data on the number of admissions and deaths in children aged under 5 years from diarrhoea, pneumonia and severe acute malnutrition are routinely collected through the District Health Information System. These data, and the associated case fatality rates, are available for all public sector hospitals in South Africa (SA), and can be compared over time, as well as across different settings. This article presents these data for the period 2011/12 - 2016/17. It reflects on the remarkable improvements in these case fatality rates, and the likely reasons for their declines across all provinces. The article concludes by identifying the actions that need to be taken to ensure that SA achieves the Sustainable Development Goal aim of ending preventable child deaths by 2030

Innovations in the clinical care of mothers and children in South Africa: The contribution of district clinical specialist teams

The contribution of the District Clinical Specialist Teams (DCSTs) to improving maternal and child health outcomes in South Africa, through strengthening the four pillars of clinical governance, is reflected in innovative work presented at a ‘Promising Practices’ symposium and at various conferences. Of the 24 identified DCST innovations, 21% reflected the clinical effectiveness pillar, 17% clinical risk management, 41% staff development, and 21% user-related considerations. In order to ensure scale-up, the submitted best practices/ innovations were reviewed using the World Health Organization quality standards and ExpandNet parameters for likely scalability. Here we describe one case study from each pillar, illustrating the contribution of the innovations to improved patient outcomes. The development and scale-up of innovations needs to be institutionalised and must include effective support and action from the relevant health managers

Innovations in the clinical care of mothers and children in South Africa : the contribution of district clinical specialist teams

The contribution of the District Clinical Specialist Teams (DCSTs) to improving maternal and child health outcomes in South Africa, through strengthening the four pillars of clinical governance, is reflected in innovative work presented at a ‘Promising Practices’ symposium and at various conferences. Of the 24 identified DCST innovations, 21% reflected the clinical effectiveness pillar, 17% clinical risk management, 41% staff development, and 21% user-related considerations. In order to ensure scale-up, the submitted best practices/ innovations were reviewed using the World Health Organization quality standards and ExpandNet parameters for likely scalability. Here we describe one case study from each pillar, illustrating the contribution of the innovations to improved patient outcomes. The development and scale-up of innovations needs to be institutionalised and must include effective support and action from the relevant health managers.http://www.samj.org.zaam2019Paediatrics and Child Healt

Global prevalence of autism and other pervasive developmental disorders

We provide a systematic review of epidemiological surveys of autistic disorder and pervasive developmental disorders (PDDs) worldwide. A secondary aim was to consider the possible impact of geographic, cultural/ethnic, and socioeconomic factors on prevalence estimates and on clinical presentation of PDD. Based on the evidence reviewed, the median of prevalence estimates of autism spectrum disorders was 62/10 000. While existing estimates are variable, the evidence reviewed does not support differences in PDD prevalence by geographic region nor of a strong impact of ethnic/cultural or socioeconomic factors. However, power to detect such effects is seriously limited in existing data sets, particularly in low-income countries. While it is clear that prevalence estimates have increased over time and these vary in different neighboring and distant regions, these findings most likely represent broadening of the diagnostic concets, diagnostic switching from other developmental disabilities to PDD, service availability, and awareness of autistic spectrum disorders in both the lay and professional public. The lack of evidence from the majority of the world's population suggests a critical need for further research and capacity building in low- and middle-income countries

Implementation of strategies to improve programme effectiveness lead to an improvement in maternal and child health outcomes in South Africa

Over the last few years, the South African (SA) National Department of Health has led the design, implementation and monitoring of key strategies to improve maternal, newborn, and child health outcomes. The strategies have resulted in the reduction of maternal, under-5 and infant mortality rates in SA. Here, we examine the strategies using a framework to understand the determinants and actions that influence the quality of care, coverage and resultant programme effectiveness in saving the lives of mothers and children. Three case studies from the field, namely, the Essential Steps In Managing Obstetric Emergencies, undernutrition in young children and breastfeeding are illustrated through applying the framework and demonstrating how improved quality of care and coverage achieved better health outcomes for pregnant women and children under 5 years of age. These case studies highlight different aspects of the framework, including improving healthcare workers’ skills, ensuring implementation of standard protocols and strengthening management accountability within facilities and across the districts. We also highlight how these aspects collectively improved the overall programme impact. The paper concludes that the framework would be strengthened through addition of critical cross-cutting aspects related to targeting and sustainability of actions

Breastfeeding advice for reality: Women's perspectives on primary care support in South Africa

Breastfeeding education and support are critical health worker skills. Confusion surrounding infant feeding advice linked to the HIV epidemic has reduced the confidence of health workers to support breastfeeding. High antiretroviral therapy coverage of breastfeeding women living with HIV, and an Infant Feeding policy supportive of breastfeeding, now provides an opportunity to improve breastfeeding practices. Challenges remain in restoring health worker confidence to support breastfeeding. This qualitative study presents findings from focus group discussions with mothers of young infants, exploring their experiences of health worker breastfeeding counselling and support. Analysis followed the thematic framework approach. Six researchers reviewed the transcripts, coded them independently, then jointly reviewed the codes, and agreed on a working analytical framework. Although mothers received antenatal breastfeeding messages, these appeared to focus rigidly on the importance of exclusivity. Mothers described receiving some practical support with initiation of breastfeeding after delivery, but support and advice for post-natal breastfeeding challenges were often incorrect or absent. The support also ignored the context in which women make infant feeding decisions, including returning to work and pressures from family members

Post-neonatal Mortality, Morbidity, and Developmental Outcome after Ultrasound-Dated Preterm Birth in Rural Malawi: A Community-Based Cohort Study

Using data collected as a follow-up to a randomized trial, Melissa Gladstone and colleagues show that during the first two years of life, infants born preterm in southern Malawi are disadvantaged in terms of mortality, growth, and development