Doshendran Naidoo
Private Mother and Child Hospital, South Africa
Title: The changing face of under 5 morbidity and mortality in South Africa
Biography
Biography: Doshendran Naidoo
Abstract
South African under-5 mortality rate is still driven by poor neonatal outcomes (neonatal mortality rate 12.4 per 1000 live births, neonatal sepsis 8.5-10% prevalence), malnutrition (males <5 years 13.6%, females <5 years 9.6%), HIV disease (12000 new cases per year 0-14 years), Tuberculosis (TB notification rate 664/100000-1044/100 000 under 15 years), gastro-enteritis (prevalence 8.5%; <5 years) and pneumonia (prevalence: 21% seeking medical attention <5 years). Case fatality rates have declined over the last 7 years for both gastro- enteritis and ARI and Mother-To-Child transmission of HIV is declining. The number of HIV positive children on HAART <5 years old is increasing and the burden of HIV disease and HIV orphans overall is declining (210000 HIV orphans). There is a trend with declining mortality from traditional causes to those of rarer congenital anomalies and malignancies, together with a re-emergence of vaccine-preventable diseases. Measles and Diptheria are increasing in under 5 years old probably due to inadequate vaccine uptake (66-75% for measles/DPT). Tuberculosis and its contribution to U5MR in HIV infected and an uninfected individual has not declined in over 10 years. Neonatal sepsis is the second highest contributor to neonatal mortality but our neonatal mortality rate has not declined in over two decades. This may be related to poor antenatal care and/or lack of antibiotic stewardship in neonatal care. As South Africa gets a grip on the U5MR, epidemiological and neonatal outcomes are still poor and TB remains a significant contributor to adverse under 5 outcomes. As we tackle U5MR, our focus needs to be on health promotion, surveillance, stewardship and contact tracing, as we slowly move away from the traditional emerging economy health burdens for children under 5 years old.