Box 27.4South Africa and the Perinatal Problem Identification Programme: Locally Owned Data for Decision Making

Care for pregnant women and newborns in South Africa ranges from unattended childbirth in rural mud huts to advanced obstetric and intensive neonatal care. National perinatal mortality is estimated at 40 per 1,000 live births, with regional and racial disparities. During the 1990s, growing awareness of the importance and preventability of newborn deaths resulted in the development of the Perinatal Problem Identification Programme. Under the program, basic data are entered into a computer program that calculates perinatal mortality, supporting the identification of avoidable factors to aid the prioritization of actions to address key problems. More than 44 sites across the country use the Perinatal Problem Identification Programme, covering almost 80,000 births annually, or approximately 10 percent of deliveries, with 3,045 perinatal deaths (2000). Avoidable factors were identified in 83 percent of deaths, with half of these being patient related, such as a delayed response to complications. A further 14 percent of avoidable factors were administrative and, in particular, were related to transportation and lack of staff members. About 25 percent of the avoidable factors involving health workers pertained to intrapartum care, especially poor monitoring (not using the partograph) and inadequate response to problems identified during labor. Half of the cesarean sections were delayed by an hour or more.

The program identified the following national priorities to reduce perinatal deaths:

  • reducing intrapartum asphyxia, especially in rural areas—for instance, using maternity waiting homes and addressing transport delays
  • improving intrapartum management by means of protocols (partograph and effective monitoring), competency-based training, and ongoing audit
  • implementing syphilis screening and treatment more effectively.

Source: Authors, based on data from Pattinson 2002.

From: Chapter 27, Newborn Survival

Cover of Disease Control Priorities in Developing Countries
Disease Control Priorities in Developing Countries. 2nd edition.
Jamison DT, Breman JG, Measham AR, et al., editors.
Copyright © 2006, The International Bank for Reconstruction and Development/The World Bank Group.

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