The 31st Conference on Priorities in Perinatal Care in South Africa was held under the auspices of the Priorities in Perinatal Care Association and sponsored by Abbott Laboratories SA (Pty) Ltd.

Editors Note:

The articles included in these Proceedings were, mostly, received electronically and have been included as submitted by the presenter/author. Faxed articles have been retyped.

Some articles have been shortened.

Abstracts were included where articles were not submitted.

Articles have not been included for presentations, which were withdrawn and not presented at Priorities.

Late submissions received after the Proceedings had been compiled and passwords allocated are included at the end of the Proceedings.

INDEX

NEONATAL AND CHILD CAUSE OF DEATH IN SOUTH AFRICA: A SYSTEMATIC ANALYSIS OF

AVAILABLE CAUSE OF DEATH DATA FOR CHILDREN UNDER-FIVE. Kate Kerber1

PERINATAL DATA FROM THE PRIVATE SECTOR IN SOUTH AFRICA. Peter Cooper6

NINE YEARS OF REGIONAL PPIP: A (SORT OF) SUCCESS STORY. Charl Oettle9

SEVEN YEARS PPIP DATA REVIEW AT PELONOMI HOSPITAL: HAVE WE GOT PROOF OF IMPROVED

SERVICE DELIVERY? (abstract) Nkhobo MM14

IMPROVING PERINATAL MORTALITY IN THE MATIKWANA DISTRICT LEVEL HOSPITAL FOR OCT

2010 TO SEPT 2011 USING PPIP DATA. Y Shasha15

MATERNAL AND CHILD HEALTH TURN AROUND STRATEGY FROM DARKNESS TO LIGHT THE

FREE STATE STORY (abstract). SS Matela23

CHILDBIRTH TRENDS IN THE PRIVATE SECTOR OF SOUTH AFRICA (2010). B Hanrahan24

TRENDS IN MATERNAL MORTALITY IN SOUTH WEST TSHWANE OVER 12 YEARS. Lerato Khoele28

ACUTE COLLAPSE AS A CAUSE OF MATERNAL DEATH IN SA. MG Schoon29

DEATHS DUE TO ECTOPIC PREGNANCY AND MISCARRIAGE IN SOUTH AFRICA: FINDINGS AND

RECOMMENDATIONS FROM SAVING MOTHERS 2008-10. N Moran32

PERINATAL AND MATERNAL MORTALITY RATES AND CAUSES FROM A PRIVATE HOSPITAL

GROUP. Dr Trevor Frankish36

OVERVIEW OF THE SAVING MOTHERS REPORT 2008-2010 (abstract). RC Pattinson42

MATERNITY CARE FACILITIES IMPACT ON MATERNITY CENTRE, KALAFONG HOSPITAL

(abstract). S Baloyi43

PATHMNTI PROJECT IMPROVING MIDWIVES SAVING LIFE SKILLS. Dolly Nyasulu44

TEXT MESSAGES AS A LEARNING TOOL FOR MIDWIVES. Dave Woods59

THE EFFECTIVENESS OF PRIMARY LEVEL REFERRAL SYSTEMS FOR EMERGENCY MATERNITY CARE IN DEVELOPING COUNTRIES: A SYSTEMATIC REVIEW (abstract). Stephen Munjanja62

DEVELOPING A RED-FLAG TOOL TO IMPROVE QUALITY OF SUPERVISION BY THE MATERNITY

MANAGERS IN ZULULAND DISTRICT HOSPITALS. NC Mzolo63

COMBINING LEARNING, RESEARCH AND COMMUNITY ENGAGEMENT IN MATERNAL, NEWBORN AND

CHILD HEALTH PROJECTS OF MEDICAL STUDENTS. Anne-Marie Bergh72

THE ROLE OF A NEONATAL NURSING SPECIALIST IN THE PHC RE-ENGINEERING PROCESS

(abstract). V Booysen76

NEONATAL OUTREACH INITIATIVES: WHAT HAS MADE A DIFFERENCE? DH Greenfield77

CHILD PIP 2005 2009: QUALITY OF NEWBORN CARE. Tony Westwood82

PATTERN OF NEONATAL INTENSIVE CARE ADMISSIONS AT A SEMI RURAL HOSPITAL: NEONATAL

DATABASE REVIEW. N. Kapongo87

CAUSES AND RISK FACTORS FOR STILLBIRTHS IN A RURAL HOSPITAL IN KWAZULU-NATAL.

Michelle Godfrey97

THE MONICA AN24 WIRELESS FETAL-MATERNAL MONITORING DEVICE (abstract).

Odendaal HJ103

CLINICAL PALPATION FOR AMNIOTIC FLUID VOLUME IN SUSPECTED PROLONGED PREGNANCY.

EJ Buchmann104

MATERNAL MENTAL HEALTH CARE: REFINING THE COMPONENTS IN A SOUTH AFRICAN SETTING.

Bronwyn Evans108

CAESAREAN SECTION ROPIVACAINE WOUND INFILTRATION VERSUS PLACEBO: RISK OF CHRONIC

PELVIC PAIN AFTER FOUR-YEAR FOLLOW UP OF A RANDOMIZED TRIAL.

Bamigboye A Anthony115

EVALUATION OF THE USE OF THE POSTNATAL CARD IN MACH I SUB-DISTRICTS IN MPUMALANGA.

Elsie Etsane120

FACILITY-BASED MATERNAL MORTALITY 2008-2010 (abstract). Vivian Black125

SAFETY OF NEVIRAPINE IN HIV-INFECTED PREGNANT WOMEN INITIATING ANTIRETROVIRAL

THERAPY AT HIGHER CD4 CELL COUNTS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

Ebrahim Bera126

EXAMINING THE PMTCT CASCADE HOW WELL IS SOUTH AFRICA DOING? RESULTS OF THE SA

PMTCT EVALUATION, 2010. Debra Jackson133

PHASE III RANDOMIZED TRIAL OF THE SAFETY AND EFFICACY OF THREE NEONATAL

ANTIRETROVIRAL REGIMENS FOR PREVENTION OF INTRAPARTUM HIV-1 TRANSMISSION

(NICHD HPTN 040/ PACTG 1043). GB Theron138

THE EFFECT OF THE MACH PROJECT, DIFFERENT PMTCT PROGRAMS, AND IMPROVED MATERNAL

UPTAKE, ON PAEDIATRIC MORTALITY AND MORBIDITY AT WITBANK HOSPITAL, MPUMALANGA. Janse van Rensburg SC142

HOSPITALISATION IN THE FIRST SIX MONTHS OF LIFE IN A COHORT OF INFANTS FROM SOUTH

AFRICA: EFFECTS OF HIV EXPOSURE, NON BREASTFEEDING AND LOW BIRTH WEIGHT.

Tanya Doherty144

EARLY CESSATION OF BREASTFEEDING AMONGST WOMEN IN SOUTH AFRICA: AN AREA NEEDING

URGENT ATTENTION TO IMPROVE CHILD HEALTH. Tanya Doherty153

FAMILY NURTURE INTERVENTION IN THE NICU (FNI-NICU): AN INTERIM ANALYSIS OF EFFECTS ON

QUALITY OF MOTHER/INFANT INTERACTIONS AND NEUROBEHAVIORAL DEVELOPMENT OF

PREMATURELY BORN INFANTS. Michael M. Myers165

NEWBORN LEARNING AND MEMORY DURING SLEEP (abstract). William P Fifer171

BREASTFEEDING TRENDS IN THE PRIVATE SECTOR OF SOUTH AFRICA (2011). B Hanrahan172

A QUALITATIVE EXPLORATION OF TRADITIONAL AND CULTURAL BELIEFS INFLUENCING EXCLUSIVEBREASTFEEDING IN RURAL TRANSKEI. Chan Marais176

PREGNANCY OUTCOME OF WOMEN WITH ABRUPTIO PLACENTAE AT A RURAL REFERRAL HOSPITAL

IN KWAZULU-NATAL, SOUTH AFRICA. Moore K182

BREECH VAGINAL DELIVERIES AT CHRIS HANI BARAGWANATH HOSPITAL. B Uzabakiriho186

OBSTETRIC OUTCOMES OF GRAND MULTIPAROUS WOMEN IN SOWETO. Dr Shastra Bhoora190

FETAL HEART RATE PATTERNS AND SHORT TERM VARIABILITY AT 20 TO 24 WEEKS GESTATION

(abstract). Hofmeyr F193

PERINATAL ASPHYXIA AT A SEMI-RURAL REGIONAL NEONATAL UNIT: A 1 YEAR REVIEW.

N Kapongo194

MODIFYING AND TESTING AN AUDIT INSTRUMENT FOR PARTOGRAPH EVALUATION.

Sheila E Clow204

i

SESSION 1: PAPER 1

NEONATAL AND CHILD CAUSE OF DEATH IN SOUTH AFRICA: A SYSTEMATIC ANALYSIS OF AVAILABLE CAUSE OF DEATH DATA FOR CHILDREN UNDER-FIVE

Kate Kerber on behalf of the South African Child Health Epidemiology Reference Group (SANCHERG)

Efforts to improve child survival are dependent on reasonably accurate information about the causes of deaths in order to prioritize interventions and to assess trends in disease burden in relation to national and international goals. The objectives of this research are to: (1) develop ICD-compatible, programmatically-relevant cause of death categories for neonates and under-fives including case definitions and hierarchy of causal attribution; (2) estimate the causes of neonatal deaths in South Africa for the most recent year, by province using available data and existing methodology; and (3) Estimate the causes of deaths among children 1-59 months in South Africa for the most recent year, by province using available data and existing methodology.

According to the United Nations (UN) Inter-agency Group for Mortality Estimation, in 2010 58,000 South African children died before their fifth birthday and an estimated 31% of these deaths took place in the first month of life, or the neonatal period.1 South Africa is one of less than a dozen countries where under-five mortality has not improved since the MDG 4 baseline in 1990.2

National vital registration (VR) systems are the ideal source of mortality estimates and standardised cause of death profiles. The countries with high mortality and the least are also among the least likely to have adequate local data to plan effective and efficient use of healthcare resources. Only 9 of 78 South Asian and sub-Saharan African countries accounting for 95% of the worlds under-five deaths have complete VR systems.3 South Africa has a relatively rich set of VR and other data sources to identify levels and causes of mortality, but there are still major challenges. The World Health Organization (WHO) classifies a VR system as reasonably complete if more than 80% of adult deaths are captured; South Africas VR system has been estimated to capture up to 89% of all adult deaths, but it may underestimate deaths due to HIV/AIDS by as much as 90%.4 Indeed, the 2007 national VR data includes fewer than 1000 deaths in children under-five within co-morbid conditions resulting from HIV infections (that is, International Classification of Diseases and Related Health Problems, tenth revision (ICD-10) codes B20-B24). In addition to misclassification of HIV/AIDS, other significant issues have been raised in regards to national VR data and challenge its ability to be used as the sole source of cause of death information.5 The causal categories and proportions of causes of death vary greatly across all sources of data, resulting in sometimes inconsistent and incoherent policy messages.

The UN and the Child Health Epidemiology Reference Group (CHERG) have developed national estimates for causes of newborn and under-five death for 193 countries.6 This multi-cause proportionate mortality model for 2008 attributes 46% of under-five mortality in South Africa to HIV/AIDS with other major causes of death being neonatal causes, diarrhoea and pneumonia (Figure 1).6 Similar recent exercises in China7 and India8 as well as detailed reviews advancing the modelling methodology3,6,9,10 have demonstrated the importance of revisiting estimates of under-five deaths created at global level through a nationally owned process, especially where additional rich national da