Sunday Times (Johannesburg) - December 12, 2004
Ilse Fredericks and Nashira Davids

This was revealed in the results of a survey at 12 rural hospitals, conducted by the Medical Research Council's Unit for Maternal and Infant Health Care Strategies and the Child Problem Identification Programme Group.

The survey (the first if its kind to be conducted in this country) revealed that:

*Such infections, which include pneumonia, bacterial and viral infections, killed 33% of the children studied; and

*Septicaemia, a bacterial infection in the bloodstream, killed 12% of the children.

The survey, which ran between September 2003 and August this year, found that 1532 of 19695 children younger than five, admitted to 12 rural hospitals in six provinces, died.

Dr Mark Patrick, one of the authors of the survey report, said it was not clear how many children were infected with superbugs (MRSA - Methicillin Resistant Staphylococcus aureus).

"Our survey did not address the issue of organism type and resistance, but sought rather to quantify and characterise in-hospital child mortality, and to start understanding the problems and difficulties pertaining to looking after sick children," said Patrick.

He said it was not easy to identify the organisms causing lower respiratory tract infections, particularly at district and regional hospitals - where the survey was conducted - as laboratory services were less "sophisticated than in academic hospitals".

Patrick said one of the biggest problems hospitals had to deal with was HIV. The survey found that HIV was a factor in 60% of the deaths

"The 'bug' that we have to deal with daily and right now, and that overwhelms patients and staff, is HIV. It exacerbates the emergence and prevalence of other superbugs," he said.

In a study released by the University of California San Francisco's medical school in March this year, Dr Shirley Jankelevich said children infected with HIV showed an "exceptional vulnerability" to bacterial infections.

"South Africa has a high prevalence of MRSA. It was found to be more common in HIV-infected children in South Africa," she said.

The other main causes of death listed in the survey were:

Acute gastroenteritis, 14.8%;

Septicaemia or possible serious bacterial infection, 12%;

HIV/Aids, 10.3%;

Chronic diarrhoea, 4.2%;

Bacterial meningitis, 4%; and

Severe malnutrition, 2.8% .

TB, hospital-acquired infections, heart disease and liver failure were also listed as major killers.

The survey found that 30% of children who died were suffering from severe malnutrition.

Other factors contributing to the deaths of children included:

*Administrative factors, including a lack of proper documentation of patient care;

*Problems relating to a child's care by the family. These included numerous cases where caregivers had not realised the severity of the illness until it was too late; and

*Clinical personnel-related problems which included deficiencies during admission or emergency care.

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