Southern Africa: Rising child deaths illustrate region's health crisis
Now, Bolton and his colleagues see one child die every day.
"In the past, death was an uncommon event in children, especially after the newborn period," said Bolton. "Now we've seen a complete reversal of the gains we made in the 1960s, '70s and '80s."
In the early 1960s, nearly one in five children worldwide died before they were five years old. Globally, the rate of child mortality has declined, a result of improved health care, sanitation, and nutrition. In 2002, fewer than one in 12 children worldwide passed away before age five.
But while child mortality rates continue to decline in some countries in sub-Saharan Africa, death rates are on the rise in many others, according to a report released in October by the United Nations Children's Fund (UNICEF). Revealing an abrupt reversal in development in the last decade, the latest figures on childhood deaths are a new illustration of the escalating public health crisis.
According to the UNICEF report, 'Progress for Children: A Child Survival Report Card', childhood deaths in much of sub-Saharan Africa rose dramatically between 1990 and 2002, the latest year for which comprehensive data is available.
In Botswana, a middle-income country, child mortality nearly doubled during the period to 110 deaths per 1,000 children. In South Africa, a nation of 45 million that boasts some of the continent's most sophisticated infrastructure, 65 of every 1,000 children died before the age of five in 2002, up from 60 deaths per 1,000 children in 1990.
By comparison, only eight of every 1,000 children born in the United States died by age five in 2002.
"HIV/AIDS is unmistakably the main contributor to the reversal in childhood deaths in southern Africa," said John Clarke, spokesperson for the World Health Organization in South Africa, adding that rising childhood mortality is part of "the biggest public health challenge that the world has ever faced".
AIDS is indeed a major factor in the rising mortality rates at Coronation Hospital, just a few miles northeast of Johannesburg's Soweto township. Sometimes as many as 80 percent of the patients have a late-stage development of the disease, Bolton said.
Infants and children crowd the 220-bed hospital, suffering from pneumonia, dehydrating gastroenteritis, and tuberculosis -- secondary diseases that tax the children's weakened immune systems.
Many of these children also bear the signs of severe malnutrition, including the bloated stomachs of kwashiorkor or the dry and creased skin of marasmus. "We are seeing malnutrition now that I last saw in the 1960s," Bolton said.
Poverty -- a product of South Africa's 41 percent unemployment rate -- also plays a major role in the deterioration of children's health. Throughout sub-Saharan Africa, the urban and rural poor lack access to basic health services, nutritious food, and safe water and sanitation.
UNICEF said relatively inexpensive preventative tools -- including vaccines, micronutrient supplements and mosquito nets -- can save an estimated 11 million preventable deaths a year worldwide.
"These figures are important because interventions can help," said Sarah Crowe, a UNICEF official in South Africa. She added that governments must increase investment in health measures targeted at saving children. "If children are put at the top of priorities, then we can stop the erosion," said Crowe.
Calvin Maseko, donor liaison officer at the Pretoria-based non-governmental organisation African Medical and Research Foundation, agrees that many governments lack a commitment to child health.
"There aren't enough donations for child services as one would expect, given the high mortality rate, high orphan rate, and the increased vulnerability of children," he said. "If governments had this commitment, it would make it easier in terms of the flow of funds."
South African President Thabo Mbeki's response to the worsening health crisis has long been a source of controversy, with critics charging that his government has dragged its feet over the introduction of AIDS prevention and treatment programmes on the required scale.
But others contend that South Africa, like many African nations, simply lacks the financial capacity to adequately respond to what amounts to a global health crisis.
At Coronation Hospital, Bolton also said South Africa's ongoing "brain drain", the loss of skilled healthcare staff to other countries, was another factor crippling the nation's capacity to deal with the emergency.
"We need help from the rest of the world," said Bolton, who is also the chairman of the South African Medical Association's Public Sector Committee. "We're short of nurses. We're short of doctors."
Bolton said that in one shift recently, the hospital did not have a trained nurse to staff its newborn intensive care unit.
In one of Coronation's wards, Bolton examined a boy with the severely wrinkled skin of marasmus, which often accompanies late-stage HIV/AIDS. After talking briefly to his mother, he moved on.
"That child will be dead in two days," he said. "Even I cry regularly on my rounds when faced with the futility of this epidemic."
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