12 March 2008

South Africa: Experts Defy Minister Over Death Figures

Cape Town — Researchers have dug in their heels over Health Minister Manto Tshabalala-Msimang's demand that they excise data describing the underlying causes of death in a new report on infant, child and maternal mortality.

According to correspondence leaked to Business Day, which was confirmed by a source close to the project, Tshabalala-Msimang demanded that four pages be removed from the health department' s Every Death Counts report, released in Johannesburg yesterday.

The section shows SA is making no progress towards achieving the Millennium Development Goals of reducing child deaths by two-thirds and maternal deaths by three-quarters by 2015 and underscores the damage wrought by the HIV/AIDS epidemic: the disease is responsible for 35% of infant and child deaths.

The report's authors insisted their recommendations would be meaningless without the figures, and appear to have reached a compromise with the minister.

The section that irked the minister was published as a four-page addendum to the report.

Attempts to obtain comment from the health department were unsuccessful. A request for comment from the minister's spokesman, Sibane Mngadi, was referred to his colleague, Fidel Hadebe, who did not return a cellphone message.

Every Death Counts synthesises three previously published reports on infant, child and maternal deaths. Read together with the addendum it paints a grim picture of rising infant and maternal mortality rates as the HIV/AIDS epidemic has taken hold. About 5,4-million South Africans, or one in nine people, are living with HIV, according to government figures.

Just less a third of pregnant women using government ante-natal clinics are HIV-positive, meaning about 30000 women need treatment to reduce the risk of passing the virus on to their babies.

"SA is one of only 12 countries globally that has seen a reversal in infant mortality rates since the goals were set in 1990, and that is obviously due to HIV ," said one of the report's authors, Joy Lawn, a senior policy and research adviser for Save the Children.

SA stood in stark contrast to countries such as Egypt, Mexico and Brazil, which had similar mortality rates and gross national incomes to SA and were on track to meet the targets, the report said. Every year, 20000 babies are stillborn, 22000 die within four weeks of birth, and at least 75000 children under the age of five die.

At least 1600 mothers die due to complications of pregnancy and childbirth, says the report.

"We have almost 100000 deaths a year, and it doesn't feel (as if) it's getting the attention that's needed," Lawn said.

At least 40 000 of these lives could be saved each year if SA did a better job of implementing its polices and programmes for combating infant and maternal health, she said. The lack of essential equipment at government healthcare facilities also needed to be addressed, she said.

Many women battled to get access to specialised obstetric care, and often faced dangerously long delays for procedures such as a caesarean section, she said.

The report includes specific recommendations for healthcare policy makers, managers, service providers and training institutions, emphasising the need to implement the National Strategic AIDS Plan.

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