Challenges in saving babies - avoidable factors, missed opportunities and substandard care in perinatal deaths in South Africa

Objective. To identify the most common avoidable factors, missed opportunities and substandard care in perinatal care in South Africa. Setting. Seventy-three state hospitals throughout South Africa representing metropolitan areas, cities and towns, and rural areas. Method. Users of the Perinatal Problem Identification Programme (PPIP) amalgamated their data to provide descriptive information on the causes of perinatal death and the avoidable factors, missed opportunities and substandard care in South Africa. Results. A total of 8 085 perinatal deaths among babies weighing 1000 g or more were reported from 232 718 births at the PPIP sentinel sites. Avoidable factors, missed opportunities and substandard care were reported to be patient-related (between 31.5% and 47.5% of deaths), due to administrative problems (between 10.1% and 31.1% of deaths), and due to health worker-related problems (between 28.4% and 36.0% of deaths) in the metropolitan and rural areas respectively. Figures for cities and towns lay between these ranges. Deaths due to intrapartum asphyxia and birth trauma were thought to be clearly preventable within the health system in 63.1%, 34.4% and 35.7% of cases in the metropolitan areas, cities and towns, and rural areas respectively. Deaths due to hypertension and antepartum haemorrhage were thought to be clearly preventable within the health system in 18.7%, 15.4% and 20.0% of cases in the metropolitan areas, cities and towns, and rural areas respectively Far fewer preventable deaths were recorded in the spontaneous preterm labour category. Conclusion. Concentration on the remediable priority problems identified (namely labour management, resuscitation of the asphyxiated neonate, and care of the premature neonate) makes the reduction of perinatal mortality in South Africa feasible, and inexpensive.