0932 Achieving Millennium Development Goals (MDGs) by 2015

Securing almost exclusive South African coverage in a single issue of the Lancet is no mean feat and the spirit in which the authors presented the data and the editors responded bears testimony to the quality of the authorship, the reasonableness of the proposals for change, and the current and future potential for results in light of recent changes in government personnel and policies. This summary addresses only the article concerned with responding to the estimated annual loss of 2500 mothers, 20000 foetuses, 21900 neonates and 52000 children before their 5th birthday – up to 50% from preventable causes. Of concern is that South Africa is one of only 12 countries that have gone backwards since targets (MDGs) were set in 1990. Public sector doctors are most likely aware of national initiatives that have focused on preventable causes of maternal, perinatal and childhood deaths – this because the responsible factors (such as inadequate health systems, access to care, policies, trained personnel, patient knowledge and support) almost exclusively affect public sector patients. These initiatives have enabled the authors of the Lancet paper to estimate the number of lives that could be saved by 2015 (and thereby reach MDGs) provided that the country responds appropriately. With the majority of maternal and under-5 deaths the consequence of HIV/AIDS (almost half of maternal deaths and ~60% of child deaths after 28 days), clearly the priority is to address this issue through effective implementation of existing policies (potentially saving >37000 lives). Additionally, intrapartum asphyxia remains an important avoidable cause of death, indicating that obstetric monitoring and management of the second stage of labour need attention (potentially saving >1000 neonates per annum), while adding improved management of pre-eclampsia and antenatal steroids to the ‘package’ could bring the number saved to >4000. Postnatal care (possibly slightly longer hospital stays) plus kangaroo care have the potential to save another 4000 lives. Incremental cost of achieving the MDGs by 2015 is not exorbitant, the estimated annual cost being around R1.75bn.

Read more:
Lancet 2009; Online August 25
Saving children 2005: MRC Unit for Maternal and Infant Health CareStartegies, 2007
Saving babies 2006-7; National Dept of Health, South Africa, 2009