Following reports of infant deaths at the Nelson Mandela Academic Hospital in Mthatha, the Eastern Cape Department of Health on Monday sent a team of senior clinicians to establish the facts. Their preliminary report shows that 54 premature babies died at the hospital in January this year, 31 in February and 46 in March.
This is the equivalent of 45 deaths per 1 000 births. The World Health Organisation target is ten deaths per 1 000 births and the national figure in South Africa is 36. The death rate at Nelson Mandela is therefore unacceptably high. The preliminary report shows that 23 of the January deaths were due to a lack of oxygen.
The investigating team discovered on Monday that the compressor that supplies oxygen to the entire hospital has been malfunctioning since March last year. In January, it stopped working altogether. However, the hospital made adequate alternative arrangements, using oxygen cylinders. So the deaths were not due to the problems with the hospital’s oxygen supply.
The department will however be taking disciplinary action against the clinical engineer at the hospital, the person responsible for ensuring that the oxygen supply functions properly. The investigating team has also noted poor clinical record-keeping at the hospital. Nurses do not record when patients arrive and do no record the treatment given. This will also be remedied.
But there are a number of factors that contribute to the high death rate that are beyond the control of either the hospital or the department. Twenty-one mothers of the January babies were HIV positive. HIV positive mothers contribute to the problem by presenting late at ante-natal clinics, too late for an effective course of antiretroviral. Young mothers in particular often try to hide their pregnancies from their parents, and are unwilling to go to clinics.
Another factor is the massive distances between the district hospitals, where the babies are born and Nelson Mandela. When they are born in Matatiele or Mbizana they are already in a critical condition. By the time they get to Mthatha, it is often too late to save them.
Having more doctors at district hospital level would go some way to solving the problem and the department has already launched a programme to revitalise primary healthcare. This will see a redistribution of doctors from centres such as Nelson Mandela, which has some 300 medical officers in addition to specialists, to district level. One of the advantages is that district hospitals will be in a better position to perform caesarean sections, which give a better chance of life to many babies.
The department is also focussing, in the Transkei in particular, on raising awareness of antenatal care, and the need for women to present themselves at clinics early. So I say again, the deaths at Nelson Mandela are unacceptably high. But they must be seen as a symptom of the massive challenges the department is facing in ensuring the good health of the people of our province.
Issued by: Department of Health, Eastern Cape Provincial Government
25 May 2010
Source: Department of Health, Eastern Cape Provincial Government (http://www.ecprov.gov.za/)
