Over the past 10 years, researchers from the University of the Witwatersrand’s vaccines and infectious diseases analytics unit analysed small tissue samples of 1 586 children under five who died at public health facilities in Soweto.
The alarming results show that more than half of the infections led to deaths in newborns (up to one month of age) and about a third in infants between one and 12 months, were caused by just two types of bacteria, both of which are fast becoming resistant to antibiotics, write Linda Pretorius and Jacques Verryn for Bhekisisa.
The study found many babies die because of preventable infections – not new knowledge, but it’s the detail in the study’s data that’s so valuable, said Ziyaad Dangor, who heads up the South African leg of the nine-country Child Health and Mortality Prevention Surveillance (Champs) study.
The two types of bacteria responsible for the fatalities are Acinetobacter baumannii and Klebsiella pneumoniae.
Antibiotics can kill bacteria, but when they figure out how to sidestep the medicine, this no longer happens.
Child health – including preventing children from dying – was a big talking point at the 80th United Nations (UN) General Assembly in September.
And rightly so.
With only five years to go to the cut-off for meeting the UN’s sustainable development goals, a global report published in March shows that babies dying within the first month of life made up almost half of the roughly 4.8m deaths in children under five in 2023.
Although the number of children dying before their fifth birthday has halved in just more than 20 years, dropping from 77 to 37 per 1 000 live births between 2000 and 2023, progress has slowed down so much in the past decade that 65 countries won’t make the UN’s target of getting this rate down to below 25 in 1 000 by 2030.
South Africa is one of them.
In 2023 – the last year for which data are included in the report – the country’s under-five mortality rate sat at just under 35 per 1 000 births, almost 1.5 times higher than the ideal.
This means close to 112 children died in South Africa every day that year based on UN data. (The rate differs from what StatsSA says it was at that time: around 30 per 1 000 births.
However, the statistics agency also notes that the estimates they show “are based on the selected model life table and may differ from similar indices published elsewhere”.)
Many of the under-five deaths are in babies who die either before they’re a month old or before they’re one-year-old.
Although at the current rate of 13.4 newborn deaths per 1 000 births South Africa is close to the UN’s target of no more than 12 per 1 000, it’s the highest this number has been in almost 10 years.
The number of babies in a population who die young is like a mirror of how healthy a country is, because many of the things that lead to their deaths, like infections, not having access to medicine or healthcare, or not having clean water, good housing or nutritious food, also affect the health of the rest of the nation.
By this measure things could go awry if the government doesn’t think wisely about how best to spend its health budget, which will likely become even tighter than before as money has to be shifted elsewhere to plug holes left by international funding cuts.
This is why understanding the causes of child deaths is all the more important, said Dangor. “If you don’t know what you’re fighting against, it’s very difficult to treat.”
Here are four takeaways from the South African data so far.
1. On-time screening = fewer stillbirths
Of the 460 stillbirths investigated in the Champs study, nine out of 10 were because of mostly preventable issues during pregnancy, like the foetus not getting enough oxygen in the womb or an infection passed on from the mother to baby.
During pregnancy check-ups, health workers test pregnant women for conditions like high blood pressure, which can reduce oxygen supply to the growing baby, or common bacterial infections such as from Group B Streptococcus (often lying dormant in the genital tract).
Group B Streptococcus is a common type of bacteria, and although it’s usually harmless in healthy adults it can cause a serious group B strep disease in newborns, with symptoms such as fever, low body temperature and seizures.
Nurses also check for the germ that causes syphilis.
If detected early, these issues can easily be treated with medication and good health checks.
But the finding that so many stillbirths were due to preventable factors like these suggest numerous holes in the safety net of antenatal care, said Dangor.
It could be because the mother didn’t book for a pregnancy check-up, had a screening test only late during her pregnancy, or she may have tested negative for something like syphilis once and then wasn’t tested again later during her pregnancy as she should have been.
South Africa’s national guidelines follow the World Health Organisation’s recommendation of eight pregnancy check-ups, and can start within 14 weeks of conception.
Despite data from the 2023/24 District Health Barometer showing that close to 70% of pregnant women go to a clinic for at least one antenatal check-up, and usually before 20 weeks, many don’t go back for follow-ups because it’s difficult or costly to get to the health facility or they have to wait in a long queue.
2. Preventing early births = preventing untimely deaths
In newborns, issues linked to premature births were the underlying cause of more than half of them dying, and the immediate cause of death in about a third of this group.
3. Superbugs = bad for babies
More than half of the infections that led to deaths in newborns and about a third in infants were caused by Acinetobacter baumannii and Klebsiella pneumonia, both of which are becoming resistant to antibiotics.
“Before the Champs study, we knew that, for example, Klebsiella pneumoniae caused infections, but not to the extent that we saw. So, either it’s become much more common in causing a problem or it’s been under-recognised before.”
The same goes for A. baumannii, a stubborn germ common in hospitals which can, for instance, cause pneumonia, and for which there currently is only one type of antibiotic available – with difficulty – in the public sector, and which doesn’t work all that well in the first place.
4. Prevention = better than cure
Knowing where the problems are means solutions can be built around it. With few treatment options available for in-hospital infections, it’s best to limit exposure by fixing things in the health system before a woman has to give birth, said Dangor.
The data show that three things, like better health checks during pregnancy, preventing in-hospital infections, and helping new moms to know when to ask for medical advice, can go a long way to preventing early child deaths.
The findings don’t put a number on how many deaths would be prevented, but rather show where efforts could be best spent to keep children safe depending on their age group. And this, said Dangor, is a win, especially as international funding cuts to the HIV programme in South Africa, particularly, are putting pressure everywhere in the health system.
“Anything that’s going to cause reprioritisation of the available budget is going to put pressure on the health system throughout.”
And that can have a ripple effect on child health in South Africa – and the country’s development future.
See more from MedicalBrief archives:
‘Alarming’ rise of superbugs in newborn babies – Australian study
Antibiotic resistance risking SA’s newborns’ lives
New antibiotics vital to stem newborn deaths
Safer not to move new-born, despite klebsiella infection deaths