Nearly 6,000 mothers in the Eastern Cape lost their babies to perinatal deaths in the space of five years.
Perinatal deaths encompass stillbirths and deaths within the first week of life.
The perinatal death statistics released by Stats SA last week, revealing that the province lost an average of three babies a day over five years, has shocked health professionals.
They attributed access to healthcare among the factors contributing to the alarming mortality rate.
According to Stats SA, 5,615 babies died between 2016 and 2020 in the Eastern Cape.
A total of 24,120 died nationally — 15,908 stillbirths and 8,210 early neonatal deaths.
The report shows a yearly increase in deaths from 2016 to 2020.
The Eastern Cape recorded the highest number of deaths in 2020, with 1,305 deaths, up 311 from 994 deaths in 2019.
This also coincides with Covid-19 lockdown restrictions, which health officials said affected antenatal visits.
In 2018, 1,081 babies died, while 1,109 and 1,126 deaths were recorded in 2017 and 2016, respectively.
Provincial health spokesperson Siyanda Manana said the department had various interventions.
“The department is working on establishing at least two high-care beds in each district hospital,” he said.
“For women who are close to delivering, the department is establishing waiting beds so that they are near the hospital.
“To address transport issues, there is a working agreement between health and private ambulances so that when the need arises they take calls, and there is availability of aero services to attend to critical emergencies.”
The report said perinatal mortality was an indicator of maternal care, health and nutrition and reflected the quality of obstetric and paediatric care.
“The death of a mother or baby in labour is terrible,” SA Medical Association president Prof Mfundiso Mabenge said.
“Staffing is very important. The ratio of nursing staff to patient when delivering is vital.
“And you must have tools to monitor the mother in labour — things like cardiotocography (CTG), [used for monitoring foetal heartbeats and uterine contractions].
“In some hospitals, there are no CTGs, babies are not monitored and important aspects, such as foetal distress, are missed.
“These things cause intrapartum deaths [death of a foetus during labour], which increases perinatal deaths.”
Mabenge, an obstetrician and gynaecologist on the SA National Committee for the Confidential Enquiries into Maternal Deaths, said the numbers were alarming.
Mabenge is academic head of obstetrics and gynaecology at the Nelson Mandela University medical school in Gqeberha.
Prof Salome Maswime, an obstetrician and gynaecologist who heads the global surgery division at the University of Cape Town and is a member of the United Nations Core Stillbirths Estimates Group, expressed shock at the numbers.
Maswime said access to healthcare facilities played a role in perinatal deaths.
“Where the woman lives and her access to healthcare, such as if a woman requires a C-section and how long she has to wait [for this].
“Sometimes, ambulances are not efficient in rural areas. That plays a role for a woman who might be having a pregnancy complication but is unable to get to hospital on time,” she said.
Denosa provincial secretary Veli Sinqana said nursing staff and skills shortages contributed to the deaths.
“At times, because of staff shortages, nurses end up being more responsible for patients, which overburdens their workload.”
Manana said 70% of the main causes of perinatal deaths were patient-related, with 30% being related to health systems.
He said patient-related factors included inappropriate response to poor foetal movements, booking into hospital late, delays in seeking medical attention, not initiating antenatal care, failing to return on prescribed dates, infrequent visits to antenatal clinics and alcohol abuse.
Manana said community health workers used pregnancy screening tools.
“Our clinicians are trained on essential steps in managing obstetric emergencies and management of sick, small neonates to be able to manage all the complications for both pregnant women and their neonates.
“Referring hospitals conduct outreaches to district hospitals, which in turn come for training in special procedures.
“The Covid-19 period affected the mortality rate due to lockdown restrictions affecting antenatal visits.”
Health-associated factors include lack of transport, no dedicated high-risk clinics at referral hospitals and medical-personnel-related factors.
Manana said the most affected hospitals were Nelson Mandela Academic Hospital, OR Tambo district, Dora Nginza Hospital in Nelson Mandela Bay and Frere Hospital in Buffalo City because they had tertiary and regional hospitals to which complicated cases were referred.
Mabenge said: “Postpartum we need to monitor the baby — staffing comes in there again. Hypothermia still kills a lot of these babies.
“You find that there are no incubators ... Postpartum these babies have to be warm and have to be monitored.
“For instance, babies of diabetic mothers must be fed early and we have to manage whatever diseases are there.
“We need adequately trained nurses, doctors, anaesthetists, porters and cleaners, and equipment.
“Most of the time you are in theatre and you find scissors are not working or something is missing,” Mabenge said.
Provincial SA Human Rights Commission manager Dr Eileen Carter said: “We are deeply concerned about the alarming number of perinatal deaths in the Eastern Cape.
“The right to life and dignity of every child is enshrined in our constitution and international human rights law.
“We urge the relevant authorities to investigate the root causes of these deaths and implement effective measures to prevent such tragedies in the future.”
Daily Dispatch
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