Every year almost 23,000 South African babies die in their first month of life, yet one in five of these deaths could be avoided with better education, and relatively inexpensive and easily implemented changes in healthcare, says a new study by the Medical Research Council (MRC).

"The bad news is that, according to the report, 'one in five deaths could have been clearly avoided', and inequalities are also highlighted, with avoidable deaths being twice as common in rural areas," said Joy Lawn, Senior Policy and Research Advisor at Saving Newborn Lives, a programme run by Save the Children, an international non-governmental organisation for children's rights, in the foreword to the report.

"The good news is that these deaths are not complex or expensive to prevent - improving the quality of care during childbirth is a top priority that would also save mothers' lives and reduce long-term disabilities in children," Lawn commented.

The report, 'Saving Babies 2003-2005', was compiled the MRC, based on data voluntarily submitted by healthcare workers across the country to the Perinatal Problem Identification Programme, and covers about 20 percent of births in South Africa.

The data shows that each year, out of every 1,000 babies born alive, 21 will die within four weeks. This is better than the neonatal mortality rate of 41 babies per 1,000 in sub-Saharan Africa, but still nothing to be proud of. Infant mortality in South Africa is higher than other countries with a similar per capita income, such as Mauritius, where only 12 babies per 1,000 die.

Worldwide, approximately four million babies die within their first month of life. In Africa it is estimated that half a million babies do not survive the day of their birth, which often takes place at home and is not included in official statistics.

Missing the goal

Over the last two decades there has been almost no improvement in the chances of survival of a child born in Africa, but some individual countries have managed to cut the death toll among infants.

A 2006 World Health Organisation report, Opportunities for Africa's Newborns, found that six countries: Madagascar, Malawi, Tanzania, Uganda, Eritrea and Burkina Faso, had managed to reduce infant deaths - by 47 percent in Eritrea, and 20 percent in Tanzania and Malawi.

In South Africa there has been no evidence of a decline in either neonatal or perinatal (neonatal deaths plus stillbirths) mortality rates since 2000, although there is a dearth of fully representative national information.

The authors of the study said the number of newborn deaths would have to be cut if South Africa is to meet the Millennium Development Goal (MDG) of reducing the mortality rate of children under five by two-thirds (MDG Four). The MDGs are a set of development goals agreed in 2000 by 192 UN member states, to be achieved by 2015. Mortality among mothers is also to be reduced by three-quarters over the same time period (MDG Five).

"Achieving MDG Four and MDG Five necessitates significant improvements in the coverage and quality of care received by pregnant women and their infants, as well as ensuring that the health system is appropriately structured and functioning properly," the report said.

"The lack of progress towards achieving MDG Four in South Africa is disturbing ... Similar progress towards MDG Five is not on track and is being retarded by the HIV epidemic."

Something can and should be done

A "striking feature" in the data was the number of avoidable stillbirths. The most common perinatal cause of death (the period before and immediately after birth) was unexplained stillbirths, which accounted for just under 21 percent of all deaths among babies weighing more than 1kg at birth.

"Almost all women who gave birth to fresh stillbirths, identified as being caused by intrapartum asphyxia [a lack of oxygen during birth] and trauma, were admitted with live babies and probably failed by the health system. Similarly, examination of causes of neonatal deaths shows a significant contribution by intrapartum asphyxia and birth trauma," said the report.

The MRC's Prof Anthony Mbweu said educating mothers, communities and healthcare workers would be key to reducing the death toll: patient-associated factors, such as ignorance about monitoring foetal movement, were the biggest contributors to preventable infant deaths, followed by factors related to healthcare workers, such as failure to monitor a mother's progress during labour, and "administrative" issues, such as a lack of facilities and staff.

Mbweu pointed out that there were "really glaring disparities between provinces, with the Eastern Cape, Mpumulanga and Limpopo having child death rates that are much higher - twice as high in some cases - as the Western Cape and Gauteng [the two richest provinces]. Issues of socio-economics and education are key to child survival."

In response to 'Saving Babies 2003-2005', a national Department of Health official commented: "We welcome the report and have noted its contents, and that it involves 20 percent of babies delivered in the country. We will discuss it, as the Department of Health, to identify areas that require further attention."