Why children die: an under-5 health care survey in Mafikeng region.

OBJECTIVE

To describe causes of under-5 deaths occurring in the health care system in Mafikeng region and modifiable factors related to these deaths.

DESIGN

A prospective descriptive study.

SETTING

The four public sector hospitals in Mafikeng health region in North West province (Gelukspan, Zeerust-Lehurutshe, Thusong, and Mafikeng Provincial Hospital).

METHODS

This study of under-5 deaths used and piloted the Under-5 health care Problem Identification Programme.

STUDY PERIOD

1 November 2000-31 October 2001.

RESULTS

Two hundred and thirty-nine under-5 deaths occurred in the health system. The case fatality rate for the total of 4 226 under-5 admissions was 5.7%. Seventy-four per cent of the under-5 deaths occurred during the first year of life; 31% during the first 24 hours in hospital. The main causes of death were lower respiratory tract infections (31.4%), AIDS (21.3%) and sepsis (13.4%). When adding all causes of death and contributing conditions, 61.9% were AIDS- or HIV-related. Eighty-three per cent of cases had administrative modifiable factors, 67% had modifiable factors at primary care level, 47% during admission/emergency care in hospital, and 55% during routine care.

CONCLUSIONS

Priority problems identified in this study were case management of lower respiratory tract infections, failure to thrive, and insufficient documentation of patient care. As most under-5 deaths in this study were HIV/AIDS-related, it is an urgent necessity to expand effective programmes to prevent mother-to-child transmission and HIV infection in adults and to advocate comprehensive treatment programmes for HIV/AIDS.