A momentous year indeed
In early August, there was more reason to celebrate. Thousands of paediatricians from all over the world assembled in Johannesburg to participate in the first ever world congress of paediatrics to be held in Africa south of the Sahara. Important topics relevant to our children’s lives and health were discussed. It seemed child health issues in Africa had achieved their rightful importance.
The footballers and the paediatricians have departed. We have to once again face the reality that for the children of our country and on our continent, health care delivery and outcomes fall far short of the promises and the targets. We in South Africa have not achieved the gains and improvements in health care indicators of many other, less developed countries. Measured against our developmental status, provision and delivery of quality health care to mothers and children remains woefully inadequate. Appalling reports on the state of healthcare provision to mothers, babies and children in this country, worsened by recent healthworker strikes, just serve to confirm that as a nation, we can not lay claim to being a caring society. After all, caring for the most vulnerable members of society, the mothers and children, remains a political, professional and human imperative.
And yet, potentially the biggest reason for encouragement and hope for real progress in the field of South African child health had happened even before the beginning of this year. The government’s announcement of new policy guidelines in the field of maternal HIV infection and prevention of mother to child transmission gave cause for real hope that we would finally be able to make progress towards the achievement of one of the millennium development goals, that of reducing child mortality.
The new guidelines are therefore really Hot Topics. This issue of the Journal features two invited commentaries: Ramdhial and Coovadia provide the background and rationale for training of all categories of healthworkers in order to be able to help HIV-infected mothers obtain the best possible advice in the management of their pregnancies and newborn babies. Mother-to-infant transmission of HIV has always meant mother’s virus entering the baby, and not a feeding method! With the care package that is now available for pregnant HIV infected women, we should be able to control the virus in the pregnant woman; let us care for the mother and let breast milk care for the baby! That is the essential message of Goga and Jackson’s contribution.
This month, the Journal again carries a variety of interesting contributions from all over Africa. Mwachaka and Mbugua’s paper highlights factors influencing intended career choices among medical students in Kenya. Students choosing paediatrics seemed to rate role modelling by teachers and practitioners higher rather than expected financial rewards or status. Thandrayen and Saloojee’s survey of primary care settings in Johannesburg reveal a poor quality of primary health care being offered to children in the richest city of Africa. Even here, the modern buzz-word of “service delivery” is dependent on people actually doing the right thing. Kanji and others audited the follow-up rate of high risk babies in a very-low-birthweight auditory screening project and found a disappointingly low rate of follow-up, possibly related to very practical issues. Shay, Haidar and Kogi-Makau’s contribution draws attention to female circumcision in Ethiopia and shows up the importance of educational circumstances and unemployment rather than religion in perpetuating this habit. Finally, Kruger and Naman show that cranial ultrasound can be successfully used on neonates in resource-poor settings.
Child health care is about people and commitment. We know what should be done and what we should like to achieve. One lesson that we should learn from the success of the world cup is that after the planning, the targets and the rhetoric, real progress finally comes about by real people getting down to work towards the common goal.
Dankwart Friedrich Wittenberg, University of Pretoria
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Date published: 2010-10-04
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