ADVOCACY BRIEF: ADDRESSING CHILD MORTALITY
BACKGROUND
Child mortality refers to the death of infants and children under the age of five. South Africa has
decreased the under-five mortality rate from 61 deaths per 1000 live births in 1990, to 45 in 2013
(UNICEF, 2013). Despite this reduction; diarrhoea, malnutrition and inconsistent immunisation
continue to be issues of concern for the survival of children.
In South Africa, diarrhoea and malnutrition are the leading cause of death amongst children under five
years of age (Massyn et al, 2013). Malnutrition has an impact on the growth, well-being, school
attendance and performance of children in the short term and in the longer term may also lead to
nutrition-related chronic diseases of lifestyle (Iversen et al, 2011).
A review of the literature on child mortality reveals that there are a number of caregiver behaviours
that may contribute towards a lack of adequate diarrhoea prevention and the late accessing of
treatment (Gumede, 2014). Caregiver behaviour also impacts on aspects of children’s nutrition and
on the uptake of immunisation. It is therefore recommended that non-governmental organisations as
well as the national, provincial and district offices of the Department of Health prioritise changing
caregiver behaviour that may impact negatively on child mortality.
CURRENT POLICY AND PRIORITIES
The National Department of Health (NDoH) monitors the under-five mortality rate; the infant
mortality rate; immunisation coverage under one year of age; life expectancy at birth for males and
females; and both diarrhoea and pneumonia incidence under five years of age.
Responses from the NDoH include the Maternal, Newborn, Child and Women’s Health and Nutrition
Strategic Plan, 2012-2016, the Campaign for the Accelerated Reduction in Maternal and Child
Mortality in Africa (CARMMA) and a re-engineering of the primary health care system to address some
of the issues related to child mortality. Priority interventions that have been introduced to reduce
child mortality include the following:
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Promotion of supplements and food fortification for pregnant mothers;
Promotion of exclusive breastfeeding;
Prevention of HIV infection through effective PMTCT;
Resuscitation of newborns and care for small/ill newborns;
Post-natal visit within six days, which includes newborn care and helping mothers to breastfeed;
Better nutrition for infants and young children through food fortification and the provision of
supplements;
Increased growth monitoring and promotion;
Nutrition rehabilitation in communities;
Nutrition management during illness;
Hospital based management of severe malnutrition.
Regular deworming;
Immunisations – with new vaccines against some forms of diarrhoea and pneumonia;
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BARRIERS TO UPTAKE OF SERVICES
Despite the DoH interventions, there are a number of barriers that prevent caregivers from accessing
services or practicing behaviours that may prevent child mortality (Durden, 2014). These include the
following:
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Lack of access to safe water and to hygienic sanitation facilities;
Lack of information regarding recognising and treating diarrhoea at home;
Traditional health practices are used which may exacerbate diarrhoea or other health problems
(particularly by older caregivers);
Lack of knowledge about the efficacy and different types of immunisation for children;
Lack of money to access clinics to continue with immunisation programme or other care;
Caregivers receive conflicting information from clinic staff regarding duration of breastfeeding;
Perception that exclusive breastfeeding is unnatural; as herbs, water and soft foods are often
introduced early in many communities;
Breast-feeding is stopped or supplemented because of mothers going back to school or work;
Lack of understanding about what growth monitoring is;
Lack of adequate information on food fortification and the use of supplements;
Lack of money prevents caregivers from being able to travel to buy healthy or fortified foods;
Small plots, full-time employment or other issues prevent caregivers from growing food gardens;
Concern that post-natal care and immunisation will result in a diagnosis of HIV for the infant;
Perception amongst older caregivers and grandmothers about a lack of respect from clinic staff;
Religious beliefs and traditional practices determine how caregivers approach child-rearing, and
some of these may conflict with medical information.
RECOMMENDATIONS
To increase uptake of services and further prevent child mortality, it is recommended that the
following steps be taken:
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National, Provincial and District DoH must ensure that primary health care staff are uniformly
trained to better communicate with caregivers about the drivers of child mortality and its
prevention so that they are able to understand the benefits of changing related behaviours.
National DoH and partner communications organisations must promote better nutrition and
address other drivers of child mortality through increased communication campaigns on radio
and television.
National, Provincial and District DoH must ensure the delivery of reliable heath services and
address issues related to transport and access to clinics, so that desired behaviour change of
caregivers is supported.
Any community mobilisation campaigns must be developed at the local level to take into account
the lived realities of the populations they are targeting so that they are realistic.
REFERENCES
Durden, E. (2014) Drivers of Child Mortality: Insights from community members in the Ugu and
Uthungulu districts. RMCH / South African Red Cross Society.
Gumede, M. (2014) Drivers of Child Mortality: A literature review. RMCH / South African Red Cross
Society.
Iversen, P.O., du Plessis, L., Marais, D., Morseth, M., Høisæther, E.A. and Herselman, M. (2011)
‘Nutritional health of young children in South Africa over the first 16 years of democracy’. South
African Journal of Child Health. 5(3):72-77.
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Massyn, N., Day, C., Dombo, M., Barron, P., English, R. and Padarath, A. (eds). (2013) District Health
Barometer 2012/2013. Durban: Health Systems Trust.
UNICEF (2013) ‘2013 Statistical Snapshot: Child Mortality’. In Committing to Child Survival: A Promise
Renewed, Progress Report, UNICEF.
CONTACT INFORMATION
For more information, contact SARCS KwaZulu-Natal, 201 Kenneth Kaunda Road, Durban North
South Africa (website: www.redcross.org.za) or the RMCH Programme, GRM International | Futures
Group Europe, 2nd Floor, Turnberry House, 100 Bunhill Row, London, EC1Y 8ND, United Kingdom
(Website: www.rmchsa.org; www.futuresgroup.com)
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