In Practice

Changing priorities in maternal and perinatal health in Gert Sibande District, South Africa

M Bac, R C Pattinson, A-M Bergh

Abstract


Gert Sibande District is a predominantly rural district in Mpumalanga Province, South Africa (SA), with a population of just over 1.1 million. It has a high prevalence of HIV infection and pregnancy-related hypertensive disease. In 2010 the district was one of the worst-performing health districts in SA, with a maternal mortality ratio of 328.0 per 100 000 births. Various programmes were introduced between 2010 and 2017 to address major causes of maternal and perinatal morbidity and mortality in the district. The focus has been on HIV-related morbidity, the direct obstetric causes of maternal and perinatal morbidity and mortality, and health systems strengthening. During the period 2010 - 2017, there was a steady decline in institutional maternal mortality with a drop of 71% in maternal deaths over a period of 6 years, from 328.0 per 100 000 births to 95.0. However, the ratio levelled off in 2016 and 2017, mainly as a result of a changing disease profile. The stillbirth rate showed a decline of 24.4% over a period of 8 years. With perseverance, rapid response and evidence-based strategies it was possible to more than halve the institutional maternal mortality ratio within 6 years. However, with the changing disease profile, conditions such as hypertensive disease in pregnancy should be prioritised and new strategies developed to further reduce maternal and perinatal mortality and morbidity.


Authors' affiliations

M Bac, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa

R C Pattinson, South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa

A-M Bergh, South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa

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Keywords

Healthcare interventions; Maternal mortality; Perinatal mortality; Mpumalanga Province; South Africa

Cite this article

South African Medical Journal 2019;109(11):838-840. DOI:10.7196/SAMJ.2019.v109i11.14098

Article History

Date submitted: 2019-10-31
Date published: 2019-10-31

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