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Section A: Delivery

4 Delivery Manala Makua, Naomi Massyn

This chapter covers several aspects of maternal health related to delivery, obstetric, intrapartum and postnatal care, and includes the following indicators:

✦ Delivery in 10 to 19 years in facility rate

✦ Maternal mortality in facility ratio

✦ Stillbirth in facility rate

✦ Early neonatal death in facility rate

✦ Mother postnatal visit within 6 days rate.

4.1 Delivery in 10 to 19 years in facility rate This indicator is included for the first time in the District Health Barometer in line with the 2017 National Indicator Data Set (NIDS).a It replaced the previous indicator of delivery in facility under 18 years rate. The purpose of the change was to align data collection with the international definition of teenagersb and further monitor the implementation of the Adolescent and Youth Policyc approved in 2017. The delivery in 10 to 19 years in facility rate indicator is defined as deliveries where the mother is 10 –19 years old and such delivery is conducted by a trained healthcare worker in a health facility. The numerator is the number of deliveries among women 10 to 19 years in public health facilities, while the denominator includes the total number of deliveries in public health facilities over the same time period. The data elements for the numerator are delivery 10 to 14 years in facility and delivery 15 to 19 years in facility. The subdivision of the age categories will provide data to enable the programme to develop specific interventions to reduce early teenage pregnancy.

As this indicator monitors the proportion of deliveries in facility by young women 10 to 19 years of age, it can be used as a proxy for the adolescent birth rate.d The adolescent birth rate is the annual number of live births to adolescent women per 1 000 adolescent women.

The South Africa Demographic and Health Survey (SADHS), 2016e indicates that most young women become sexually active by the age of 18. The proportion of women aged 15–19 who have begun childbearing rises rapidly with age, from 4% among women at age 15 to 28% among women at age 19. Due to this rapid rise, the change in this indicator will provide additional information on the rate of teenage pregnancy.

National and Provincial overview

Four provinces had a delivery in 10 to 19 years in facility rate below the national rate of 12.7% in 2017/18 (Figure 1). KwaZulu-Natal (KZN) had the highest delivery in 10 to 19 years in facility rate of 17.6% followed by Northern Cape (NC) at 17.1%. Gauteng (GP) and Free State (FS) reported the lowest rates at 8.1% and 10.5% respectively. KwaZulu-Natal (609) had the highest number of deliveries 10 to 14 years in facility followed by Limpopo (LP) (378) and Mpumalanga (MP) (363). Among the districts Tshwane (GP) (271) and Ehlanzeni (MP) (244) had the most deliveries 10 to 14 years in facility. KwaZulu-Natal (31 893) also had the highest number of deliveries 15 to 19 years in facility followed by Gauteng (17 315), Limpopo (15 860) and Eastern Cape (EC) (15 114). Among the districts Tshwane (GP) (8 043), eThekwini (KZN) (7 914), Cape Town (Western Cape (WC) (5 942) and Ehlanzeni (MP) (5 653) had the most deliveries 15 to 19 years in facility.

a National Department of Health. 2017 National Indicator Data Set. Pretoria: National Department of Health. April 2017.

b Mihalyi Csikszentmihalyi. Encyclopaedia Britannica. Available from: https://www.britannica.com/science/adolescence. [Accessed 14 November 2018].

c National Department of Health. National Adolescent and Youth Health Policy 2017. Pretoria: National Department of Health. 2017.

d United Nations. Indicators for monitoring the Millennium Development Goals. Available from: http://mdgs.un.org/unsd/mi/wiki/5-4-Adolescent-birth-rate.ashx. [Accessed 14 November 2018].

e National Department of Health. South Africa Demographic and Health Survey, 2016. Key Indicators Report. Pretoria: National Department of Health. 2016.

Delivery in 10 to 19 years in facility rate by province, 2017/18

Percentage [Source: DHIS]

KZN

NC

EC

LP

MP

WC

NW

FS

GP

5 10 15 20 25

8.1

12.9

17.1

15.4

10.9

13.5

10.7

17.6

10.5SA: 12.7

ProvincesECFSGPKZNLPMPNCNWWC

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Section A: Delivery

Figure 1: Delivery in 10 to 19 years in facility rate by province, 2017/18

District overview

Alfred Nzo (EC) had the highest delivery in 10 to 19 years in facility rate at 24.7% and Johannesburg (GP) the lowest rate at 4.7% (Figure 2). Five out of eight districts in Eastern Cape and nine out of the 11 districts in KwaZulu-Natal had a delivery in 10 to 19 years in facility rate above 16%. Four out of five districts in Gauteng had a delivery in 10 to 19 years in facility rate of less than 10%. While the teenage pregnancy rate is slightly lower than most African countries,e most teenagers in other African countries give birth within marriage which is not the case in South Africa.

Delivery in 10 to 19 years in facility rate by district, 2017/18


A Nzo: DC44Harry Gwala: DC43

Zululand: DC26uMkhanyakude: DC27

uMzinyathi: DC24iLembe: DC29

Pixley ka Seme: DC7O Tambo: DC15uThukela: DC23

Ugu: DC21Namakwa: DC6

J T Gaetsewe: DC45King Cetshwayo: DC28

Central Karoo: DC5Amathole: DC12

C Hani: DC13West Coast: DC1Joe Gqabi: DC14

Frances Baard: DC9Amajuba: DC25Tshwane: TSHVhembe: DC34

uMgungundlovu: DC22Ehlanzeni: DC32ZF Mgcawu: DC8

eThekwini: ETHG Sibande: DC30Waterberg: DC36

Overberg: DC3Eden: DC4

Sarah Baartman: DC10Mopani: DC33

Ruth Segomotsi Mompati: DC39Fezile Dabi: DC20

Sekhukhune: DC47Capricorn: DC35

Cape Winelands: DC2T Mofutsanyana: DC19

Bojanala Platinum: DC37Lejweleputswa: DC18

Ngaka Modiri Molema: DC38Sedibeng: DC42Cape Town: CPT

Dr K Kaunda: DC40Mangaung: MANNkangala: DC31

West Rand: DC48N Mandela Bay: NMA

Xhariep: DC16Buffalo City: BUF

City of Ekurhuleni: EKUJohannesburg: JHB

5 10 15 20 25

9.9

5.6 4.2

15.9

7.8

14.9

7.9

14.1

14.3

20.2

16.5

18.218.7

24.7

6.6

16.5

7.7

20.0

13.7

17.316.7

11.7

17.4

9.7

13.713.8

16.6

15.4

12.4

13.4

12.4

13.9

10.4

16.3

20.2

17.4

18.8

15.0

23.5

21.0

18.9

14.2

20.3

21.5

9.4

10.8

12.9

10.5

11.3

7.3

12.7

9.0

SA: 12.7


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Section A: Delivery

Figure 2: Delivery in 10 to 19 years in facility rate by district, 2017/18

CPT

NMA

BUF

ETH

EKUJHB

DC10

DC12

DC13

DC14

DC15

DC44

DC16

DC18DC19

DC20

MAN

DC42DC48

TSH

DC21

DC22

DC23

DC24

DC25 DC26 DC27

DC28

DC29

DC43

DC33

DC34

DC35

DC36

DC47

DC30

DC31

DC32

DC45

DC6DC7

DC8DC9

DC37

DC38

DC39DC40

DC1

DC2

DC3

DC4

DC5

LegendProvinceDistrict

DELFCU20 0.0 - 6.76.8 - 12.112.2 - 16.616.7 - 21.321.4 - 31.6

EKUJHB

DC42

DC48

TSH

Gauteng

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Section A: Delivery

Local municipality/sub-district overview

The 10 local municipalities/sub-districts (LM/SD) with highest and lowest delivery in 10 to 19 years in facility rates in 2017/18 are shown in Table 1 and Map 1.

Table 1: Local municipalities/sub-districts with 10 highest and 10 lowest deliveries in 10 to 19 years in facility rates, 2017/18

10 local municipalities/sub-districts with highest delivery in 10 to 19 years in facility rates (%)

10 local municipalities/sub-districts with lowest delivery in 10 to 19 years in facility rates (%)

Tshwane 3 SD (Tshwane – GP) 31.6 Johannesburg F SD (Johannesburg – GP) 2.9Mbizana (Alfred Nzo – EC) 27.3 Johannesburg B SD (Johannesburg – GP) 2.7Maphumulo (iLembe – KZN) 27.1 Johannesburg E SD (Johannesburg – GP) 2.5Ubuntu (Pixley Ka Seme – NC) 27.0 Johannesburg A SD (Johannesburg – GP) 2.4uMshwathi (uMgungundlovu – KZN) 26.1 Ditsobotla (Ngaka Modiri Molema – NW) 2.1Dr N Dlamini Zuma (Harry Gwala – KZN) 25.2 Ekurhuleni E1 SD (Ekurhuleni – GP) 2.0Port St Johns (OR Tambo – EC) 25.1 Dipaleseng (Gert Sibande – MP) 1.4Ubuhlebezwe (Harry Gwala – KZN) 24.5 Impendle (uMgungundlovu – KZN) 0.8Matatiele (Alfred Nzo – EC) 24.4 Ekurhuleni N2 SD (Ekurhuleni – GP) 0.4Abaqulusi (Zululand – KZN) 23.9 Mkhambathini (uMgungundlovu – KZN) 0.0

Source: DHIS.

Map 1: Delivery in 10 to 19 years in facility rate by local municipality/sub-district, 2017/18

Source: DHIS.

Tables 2 and 3 show the 10 LM/SDs with the highest number of deliveries 10 to 14 years and 15 to 19 years in facility in 2017/18.

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Section A: Delivery

Table 2: Local municipalities/sub-districts with the highest number of deliveries in 10 to 14 years in facility, 2017/18

Province District Local municipality/sub-district Number of delivery in 10 to 14 years in facility

Gauteng Tshwane Tshwane 3 218Mpumalanga Ehlanzeni Nkomazi 147KwaZulu-Natal uMgungundlovu Msunduzi 64Northern Cape John Taolo Gaetsewe Ga-Segonyana 55Eastern Cape Oliver Tambo King Sabata Dalindyebo 54Mpumalanga Ehlanzeni Bushbuckridge 53Gauteng Tshwane Tshwane 1 50KwaZulu-Natal Ugu Ray Nkonyeni 46Limpopo Mopani Greater Giyani 46Limpopo Vhembe Collins Chabane 44Western Cape Cape Town Tygerberg 43

Source: DHIS.

Table 3: Local municipalities/sub-districts with the highest number of deliveries in 15 to 19 years in facility, 2017/18

Province District Local municipality/sub-district Number of delivery in 15 to 19 years in facility

Gauteng Tshwane Tshwane 3 5 476Gauteng Johannesburg Johannesburg D 1 727KwaZulu-Natal King Cetshwayo City of uMhlathuze 1 721Western Cape Cape Town Tygerberg 1 702Gauteng Tshwane Tshwane 1 1 602Eastern Cape Oliver Tambo Ingquza Hill 1 540Mpumalanga Ehlanzeni Nkomazi 1 504Limpopo Vhembe Makhado 1 406KwaZulu-Natal Amajuba Newcastle 1 249KwaZulu-Natal uMkhanyakude uMhlabuyalingana 1 225

Source: DHIS.

Key findings ✦ In 2017/18 KwaZulu-Natal had the highest delivery in 10 to 19 years in facility rate of 17.6% followed by Northern

Cape at 17.1%. These rates were well above the national average of 12.7%. KwaZulu-Natal (609) had the highest number of deliveries 10 to 14 years in facility followed by Limpopo (378) and Mpumalanga (363). KwaZulu-Natal (31 893) also had the highest number of deliveries 15 to 19 years in facility followed by Gauteng (17 315), Limpopo (15 860) and Eastern Cape (15 114).

✦ Among the districts, Alfred Nzo (EC) had the highest delivery in 10 to 19 years in facility rate at 24.7% and Johannesburg (GP) the lowest rate at 4.7%. Tshwane (GP) (271) and Ehlanzeni (MP) (244) had the most deliveries 10 to 14 years in facility. Tshwane (GP) (8 043), eThekwini (KZN) (7 914), Cape Town (WC) (5 942) and Ehlanzeni (MP) (5 653) had the most deliveries 15 to 19 years in facility.

✦ Among the LM/SDs, the delivery in 10 to 19 years in facility rate varied between 31.6% in Tshwane 3 (Tshwane – GP) and zero per cent in Mkhambathini (uMgungundlovu – KZN).

✦ The LM/SD with the highest number of deliveries 10 to 14 years and 15 to 19 years was Tshwane 3 (Tshwane – GP).

Recommendations ✦ The data must be used to target interventions, including increasing access to sexual and reproductive health

services especially in the LM/SDs with high numbers of deliveries 10 to 14 years and 15 to 19 years.

4.2 Maternal mortality in facility ratio The 2017 NIDSa defines a maternal death as a death occurring during pregnancy, childbirth and the puerperium of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy and irrespective of the cause of death (obstetric and non-obstetric). The maternal mortality ratio (MMR) is a measure of maternal mortality and is defined as the number of maternal deaths per 100 000 live births. The numerator is the number of maternal deaths, while the denominator includes the number of live births and is expressed per 100 000 live births. This

Maternal mortality in facility ratio by province, 2017/18

per 100 000 live births [Source: DHIS]

FS

EC

MP

NW

LP

GP

KZN

NC

WC

50 100 150 200

132.9

55.1

128.3

109.2

108.5

65.9

117.5

101.9

120.0

SA: 105.7


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Section A: Delivery

ratio is a proxy for the population-based maternal mortality ratio, aimed at monitoring trends in health facilities between official surveys.

The MMR can be calculated from different sources in South Africa, namely, the District Health Information Software (DHIS) (maternal mortality in facility ratio (MMRiF) and the National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD). This indicator is also estimated from the SADHS.e For this chapter, the indicator source is the DHIS.

National and Provincial overview

The national MMRiF was 105.7 per 100 000 live births in 2017/18 and declined annually since 2013/14 when the ratio was 133.3 per 100 000 (Table 4).

However, if the country MMRiF continues to decline at this rate, the Sustainable Development Goals (SDG)f target of 70 per 100 000 live births will not be achieved.

All provinces showed a reduction in the MMRiF since 2013/14, with two provinces with a MMRiF below 100 per 100 000 live births in the past two years, namely Western Cape and Northern Cape and these provinces maintained the MMRiF below 100 per 100 000 live births in 2016/17 and 2017/18.

The ratio of 254.1 per 100 000 in Northern Cape in 2014/15 was due to poor data quality when 28 maternal deaths were reported in February 2015 at Harry Surtie Hospital in Upington (ZF Mgcawu). Free State had the highest MMRiF among the provinces in 2016/17 and 2017/18 at 148.4 and 132.9 per 100 000 live births respectively. Western Cape had the lowest MMRiF in 2017/18 at 55.1 per 100 000 live births (Figure 3).

Table 4: Maternal mortality in facility ratio by province, 2013/14 – 2017/18 (per 100 000 live births)

2013/14 2014/15 2015/16 2016/17 2017/18Eastern Cape 156.2 148.3 128.0 127.6 128.3Free State 143.4 217.8 122.1 148.4 132.9Gauteng 104.5 112.6 103.8 114.7 108.5KwaZulu-Natal 148.4 124.9 121.9 100.2 101.9Limpopo 152.0 165.2 139.4 125.9 109.2Mpumalanga 149.1 115.4 119.1 123.0 120.0Northern Cape 118.9 254.1 103.8 87.5 65.9North West 184.9 167.1 141.7 130.1 117.5Western Cape 68.6 54.4 66.9 57.7 55.1South Africa 133.3 132.5 115.6 111.5 105.7

Source: DHIS.

Figure 3: Maternal mortality in facility ratio by province, 2017/18

f Indicators and a Monitoring Framework. Launching a data revolution for the Sustainable Development Goals. Available from: http://indicators.report/targets/3-1/ [Assessed 11 December 2018].

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Section A: Delivery

Table 5 shows the total number of maternal deaths in facility by province in 2017/18. Although Free State had the highest MMRiF in 2017/18, the most maternal deaths in facility were in Gauteng (244) and KwaZulu-Natal (197). Eastern Cape and Limpopo also had more than 100 maternal deaths in the same period at 138 and 135 respectively.

Table 5: Number of maternal deaths in facility by province, 2017/18

Eastern Cape 138Free State 66Gauteng 244KwaZulu-Natal 197Limpopo 135Mpumalanga 98Northern Cape 15North West 71Western Cape 55South Africa 1 019

Source: DHIS.

District overview

Capricorn (LP) had the highest MMRiF of 218.3 per 100 000 live births in 2017/18 (Figure 4), however, the ratio declined from 258.2 per 100 000 live births in 2016/17. OR Tambo (EC) together with Fezile Dabi (FS) had the second and third highest MMRiF of 198.7 and 198.2 per 100 000 live births respectively. Namakwa (NC) and Xhariep (FS) had no maternal deaths in 2017/18 – this is the second year in a row for Xhariep. The three districts with the most maternal deaths in 2017/18 were in Gauteng, namely, Ekurhuleni (72) Johannesburg (68) and Tshwane (66).

Maternal mortality in facility ratio by district, 2017/18


Capricorn: DC35O Tambo: DC15

Fezile Dabi: DC20Nkangala: DC31

Dr K Kaunda: DC40uMgungundlovu: DC22

C Hani: DC13Sarah Baartman: DC10

Ngaka Modiri Molema: DC38uThukela: DC23

T Mofutsanyana: DC19King Cetshwayo: DC28

Amajuba: DC25Mangaung: MAN

N Mandela Bay: NMATshwane: TSH

West Rand: DC48Sedibeng: DC42

City of Ekurhuleni: EKUEhlanzeni: DC32Buffalo City: BUF

Harry Gwala: DC43Central Karoo: DC5

Ugu: DC21G Sibande: DC30

Lejweleputswa: DC18Frances Baard: DC9Johannesburg: JHB

Waterberg: DC36Mopani: DC33

Bojanala Platinum: DC37ZF Mgcawu: DC8

eThekwini: ETHuMkhanyakude: DC27

Vhembe: DC34Zululand: DC26

iLembe: DC29Eden: DC4

uMzinyathi: DC24A Nzo: DC44

Cape Town: CPTAmathole: DC12

Ruth Segomotsi Mompati: DC39Sekhukhune: DC47

Cape Winelands: DC2J T Gaetsewe: DC45Pixley ka Seme: DC7

Overberg: DC3West Coast: DC1Joe Gqabi: DC14

Namakwa: DC6Xhariep: DC16

50 100 150 200

0.0

128.6

140.2

95.2

198.2

44.5

96.8

58.3

27.1

71.2

23.4

99.7

148.0

20.3

128.3

63.1

143.5

218.3

91.1

78.4

55.6

198.7

54.0

92.5

107.6

93.7

116.0

123.4122.1

93.7

40.8

0.0

87.4

31.1

173.1

55.4

142.9

90.8

140.2

75.0

96.7

80.8

132.4

85.7

96.8

72.4

134.8

170.6

70.3

96.5

176.4

103.5

SA: 105.7


70

Section A: Delivery

Figure 4: Maternal mortality in facility ratio by district, 2017/18

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Section A: Delivery

Table 6 shows districts with an increase in the MMRiF between 2016/17 and 2017/18 as well as the increase in the number of maternal deaths in facility for the same period. Nkangala (MP) had the greatest increase in the number of maternal deaths in facility (22 maternal deaths). Although the MMRiF in Central Karoo (WC) increased from zero in 2016/17 to 96.8 per 100 000 live birth in 2017/18, the district had only one maternal death in 2017/18.

Table 6: Districts with an increase in maternal mortality in facility ratio and number of maternal deaths, 2016/17 – 2017/18

Maternal mortality in facility ratio

Number of maternal deaths

Increase in the number of maternal deaths between

2016/17 and 2017/182016/17 2017/18 2016/17 2017/18Eastern Cape Alfred Nzo 55.0 63.1 7 8 1

Chris Hani 114.3 148.0 10 17 7Sarah Baartman 49.2 143.5 3 9 6OR Tambo 187.4 198.7 43 59 16

Free State Fezile Dabi 113.8 198.2 6 15 9Thabo Mofutsanyana 111.3 140.2 13 20 7

Gauteng Johannesburg 88.0 93.7 49 68 19Sedibeng 91.4 116.0 7 18 11West Rand 108.8 122.1 14 20 6

KwaZulu-Natal Amajuba 124.7 132.4 9 12 3Harry Gwala 71.5 96.8 6 8 2iLembe 58.5 72.4 6 8 2uMkhanyakude 41.5 80.8 6 13 7uMzinyathi 26.1 70.3 3 8 5uThukela 104.2 140.2 11 17 6

Limpopo Vhembe 60.9 78.4 13 23 10Mpumalanga Nkangala 137.6 176.4 14 36 22Northern Cape Zwelentlanga Fatman Mgcawu 46.6 87.4 2 4 2North West Bojanala Platinum 70.2 90.8 6 20 14

Dr Kenneth Kaunda 150.2 173.1 16 23 7Western Cape Cape Town 57.8 58.3 25 38 13

Central Karoo 0.0 96.8 0 1 1

Source: DHIS.


Eighty-four LM/SDs reported no maternal deaths in facility in 2017/18 but the majority of these LM/SDs might not have hospitals. Table 7 and Map 2 shows the LM/SDs with an MMRiF above 200 per 100 000 live births in 2017/18. Swartland LM in West Coast (WC) had the highest ratio at 819.7 per 100 000 live births, but in number of maternal deaths in facility, only one maternal death. Nine LM/SDs in Eastern Cape had an MMRiF of more than 200 per 100 000 live births, four in North West (NW), three in KwaZulu-Natal and two each in Limpopo and Free State.

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Section A: Delivery

Table 7: Local municipalities/sub-districts with maternal mortality in facility ratio above 200 per 100 000 live births, 2017/18

Swartland (West Coast – WC) 819.7King Sabata Dalindyebo (OR Tambo – EC) 355.8Polokwane (Capricorn – LP) 352.6Dr Beyers Naude (Sarah Baartman – EC) 322.6Moqhaka (Fezile Dabi – FS) 315.8Dannhauser (Amajuba – KZN) 298.5Emalahleni (Chris Hani – EC) 282.6Enoch Mgijima (Chris Hani – EC) 272.4Metsimaholo (Fezile Dabi – FS) 268.0Ngqushwa (Amathole – EC) 266.7Kgetlengrivier (Bojanala Platinum – NW) 252.5Msukaligwa (Gert Sibande – LP) 250.1Blue Crane Route (Sarah Baartman – EC) 235.8Raymond Mhlaba (Amathole – EC) 220.6Nelson Mandela A (Nelson Mandela – EC) 215.8City of Matlosana (Dr Kenneth Kaunda – NW) 211.5Mahikeng (Ngaka Modiri Molema – NW) 210.6Maquassi Hills (Dr Kenneth Kaunda – NW) 206.6Greater Kokstad (Harry Gwala – KZN) 205.9Alfred Duma (uThukela – KZN) 205.3Kou-Kamma (Sarah Baartman – EC) 201.6

Source: DHIS.

Table 8 shows the LM/SDs with 20 and more maternal deaths in facility in 2017/18. Polokwane (Capricorn – LP) had the most maternal deaths in facility (57) followed by eThekwini (KZN) (50). All these LM/SDs have regional and or central hospitals that treat referrals from other LM/SDs and the number of maternal deaths does therefore not reflect the actual number of maternal deaths of the specific LM/SD.

Table 8: Local municipalities/sub-districts with 20 and more maternal deaths in facility, 2017/18

Polokwane (Capricorn – LP) 57eThekwini (eThekwini – KZN) 50King Sabata Dalindyebo (OR Tambo – EC) 47Johannesburg D (Johannesburg – GP) 39Tshwane 1 (Tshwane – GP) 35Msunduzi (Sarah Baartman – EC) 28Ekurhuleni S1 (Ekurhuleni – GP) 25Nelson Mandela A (Nelson Mandela – EC) 21Bloemfontein (Mangaung – FS) 21Ekurhuleni N1 (Ekurhuleni – GP) 21City of uMhlathuze (King Cetshwayo – EC) 20Emalahleni (Chris Hani – EC) 20

Source: DHIS.

CPT

NMA

BUF

ETH

EKUJHB

DC10

DC12

DC13

DC14

DC15

DC44

DC16

DC18DC19

DC20

MAN

DC42DC48

TSH

DC21

DC22

DC23

DC24

DC25 DC26 DC27

DC28

DC29

DC43

DC33

DC34

DC35

DC36

DC47

DC30

DC31

DC32

DC45

DC6DC7

DC8DC9

DC37

DC38

DC39DC40

DC1

DC2

DC3

DC4

DC5


MMRATIO 0 - 3839 - 112113 - 202203 - 356357 - 820

EKUJHB

DC42

DC48

TSH

Gauteng

73

Section A: Delivery

Map 2: Maternal mortality in facility ratio by local municipality/sub-district, 2017/18

Source: DHIS.

Key findings ✦ The national MMRiF was 105.7 per 100 000 live births in 2017/18 and has declined annually since 2013/14 when the

ratio was 133.3 per 100 000. However, if the country MMRiF continues to decline at this slow rate, the SDG target of 70 per 100 000 live births may not be reached. Free State had the highest MMRiF among the provinces in 2016/17 and 2017/18 at 148.4 and 132.9 per 100 000 live births respectively. Western Cape had the lowest MMRiF in 2017/18 at 55.1 per 100 000 live births.

✦ Capricorn (LP) had the highest MMRiF of 218.3 per 100 000 live births in 2017/18. Namakwa (NC) and Xhariep (FS) had no maternal deaths in 2017/18 — Xhariep for the second year in a row. The three districts with the most maternal deaths in 2017/18 were in Gauteng, namely, Ekurhuleni (72), Johannesburg (68) and Tshwane (66). Nkangala (MP) had the greatest increase in the number of maternal deaths in facility (22 maternal deaths) between 2016/17 and 2017/18 (from 14 to 26 deaths).

✦ Twenty-one local municipalities had an MMRiF above 200 per 100 000 live births in 2017/18. Polokwane (Capricorn – LP) had the most maternal deaths in facility (57) in 2017/18 followed by eThekwini (KZN) (50).

✦ This indicator counts maternal deaths occuring within public health facilities and reported by some private facilities and does not count deaths that occur in the community.

Recommendations ✦ Even though there has been a consistent decrease in the MMRiF, focused interventions are required in those districts

and LM/SDs with a high MMRiF, especially at hospitals that refer complicated cases to hospitals in other LM/SDs.

✦ Further efforts in developing a comprehensive maternal death reporting system will reduce the difference in ratios reported in DHIS and other sources such as NCCEMD and SADHS.

0.0

5.0

10.0

15.0

20.0

25.0

10.1 10.1 10.7 9.9 10.2

21.5 20.7 21.3 20.2 21.1

Early neonatal death in facility rate (per 1 000 live births

Stillbirth in facility rate (per 1 000 births )

2013/14 2014/15 2015/16 2016/17 2017/18

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Section A: Delivery

4.3 Stillbirth in facility rateImproving the counting of stillbirths and neonatal deaths is important in order to track progress towards reaching Sustainable Development Goal 3.2.f However, the validity of self-reported stillbirths and neonatal deaths in surveys is often affected by misclassification errors between the two birth outcomes.g Although stillborn deaths are now clearly distinguished from deaths in the first hours after birth, the two types of mortality are often very similar, with common aetiologies. The term perinatal mortality recognises the basic unity of stillbirth and early neonatal deaths.h

The International Classification of Diseases, 10th revision (ICD-10) refers to foetal deaths with a focus on the last two trimesters of pregnancy. A stillbirth is defined by a birth weight of 500g or more or a gestational age of 22 completed weeks or a crown-heel length of 25cm or more.

In South Africa, stillbirths, according to the Births and Deaths Registration Act 51 of 1992, is defined as the death of a foetus with an intrauterine existence of 26 or more weeks. As birth weight is known more often than gestational age, the 2017 NIDS uses a gestational age of 26 weeks or a weight of 500g or more.a

The stillbirth in facility rate indicator was covered in several District Health Barometer publications in the past but was dropped in the 2016/17 publication. Because stillbirths contribute significantly to neonatal deaths, it is again included in this edition.

The stillbirth in facility rate is defined as infants born still as a proportion of total infants born in health facilities. The numerator is stillbirths in facility and the denominator is total births in facility.

National overview

Both the stillbirth rate and the inpatient early neonatal death rate (ENDR) have plateaued over the past five years as illustrated in Figure 5 below. The national stillbirth in facility rate remained stable around 21 per 1 000 births between 2013/14 – 2017/18 and the early neonatal death in facility rate around 10 per 1 000 live births in the same period.

Figure 5: National stillbirth in facility rate and early neonatal death in facility rate, 2013/14 – 2017/18

Source: DHIS.

Provincial overview

The stillbirth in facility rate in three provinces (Western Cape, Gauteng and Eastern Cape) was below the national average of 21.1 per 1 000 births in 2017/18 (Figure 6 and Map 3). Free State had the highest stillbirth in facility rate of 26.2 per 1 000 births.

g Liu L, Kalter HD, Chu Y, Kazmi N, Koffi AK, Amouzou A, et al. (2016). Understanding Misclassification between Neonatal Deaths and Stillbirths: Empirical Evidence from Malawi. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168743. [Accessed 16 November 2018].

h Davenport R, Boulton J, Schwarz L. The relationship between stillbirth and early neonatal mortality: evidence from eighteenth century London. Available from: https://www.geog.cam.ac.uk/people/davenport/davenport9.pdf. [Accessed 16 November 2018].

Stillbirth in facility rate by province, 2017/18

per 1 000 births [Source: DHIS]

FS

KZN

NW

NC

MP

LP

EC

GP

WC

10 20 30

22.1

26.2

23.3

21.4

18.7

21.4

19.3

19.6

21.6

SA: 21.1


CPT

NMA

BUF

ETH

EKUJHB

DC10

DC12

DC13

DC14

DC15

DC44

DC16

DC18DC19

DC20

MAN

DC42DC48

TSH

DC21

DC22

DC23

DC24

DC25 DC26 DC27

DC28

DC29

DC43

DC33

DC34

DC35

DC36

DC47

DC30

DC31

DC32

DC45

DC6DC7

DC8DC9

DC37

DC38

DC39DC40

DC1

DC2

DC3

DC4

DC5


STBRTH_R12.1 - 16.116.2 - 19.419.5 - 22.622.7 - 26.626.7 - 33.5

EKUJHB

DC42

DC48

TSH

Gauteng

75

Section A: Delivery

Figure 6: Stillbirth in facility rate by province, 2017/18

District overview

All four districts in North West had a stillbirth in facility rate above 20 per 1 000 births in 2017/18 (Figure 7). Similarly, eight of the 11 districts in KwaZulu-Natal had rates above 20 per 1 000 births with the highest rate of 33.5 per 1 000 births reported in uThukela. Amathole (EC) had the lowest stillbirth rate of 12.1 per 1 000 births.

Map 3: Stillbirth in facility rate by district, 2017/18

Source: DHIS.

Stillbirth in facility rate by district, 2017/18

per 1 000 births [Source: DHIS]

uThukela: DC23Lejweleputswa: DC18

uMgungundlovu: DC22Fezile Dabi: DC20

Capricorn: DC35Nkangala: DC31

Frances Baard: DC9O Tambo: DC15

J T Gaetsewe: DC45eThekwini: ETH

Mangaung: MANKing Cetshwayo: DC28T Mofutsanyana: DC19

Bojanala Platinum: DC37Ruth Segomotsi Mompati: DC39

Buffalo City: BUFCentral Karoo: DC5

iLembe: DC29Sekhukhune: DC47

Ngaka Modiri Molema: DC38Amajuba: DC25Zululand: DC26

Ugu: DC21Dr K Kaunda: DC40

Tshwane: TSHEhlanzeni: DC32Waterberg: DC36Cape Town: CPT

Johannesburg: JHBC Hani: DC13

City of Ekurhuleni: EKUHarry Gwala: DC43

Mopani: DC33G Sibande: DC30

Sarah Baartman: DC10Vhembe: DC34Namakwa: DC6

Eden: DC4Sedibeng: DC42

Joe Gqabi: DC14Cape Winelands: DC2uMkhanyakude: DC27N Mandela Bay: NMA

ZF Mgcawu: DC8Pixley ka Seme: DC7

West Rand: DC48West Coast: DC1

A Nzo: DC44uMzinyathi: DC24

Xhariep: DC16Overberg: DC3

Amathole: DC12

10 20 30

23.123.2

21.5

20.5

27.5

25.125.2

28.1

14.1

21.0

19.3

22.2

24.8

13.7

20.9

30.7

24.3

21.0

16.1

33.5

20.1

14.9

27.4

18.7

21.9

18.1

16.1

22.5

20.0

17.4

12.4

18.5

20.1

26.6

19.4

19.9

20.4

14.9

16.6

12.1

19.8

16.5

15.1

26.0

18.4

14.5

22.6

26.0

25.2

17.7

15.015.0

SA: 21.1


76

Section A: Delivery

Figure 7: Stillbirth in facility rate by district, 2017/18

77

Section A: Delivery


Nine LM/SDs did not report data for stillbirth in facility in 2017/18 possibly because there are no hospitals in these LM/SDs. Table 9 shows the 10 LM/SDs with the highest and lowest stillbirth in facility rates of the facilities that reported on stillbirth in facility in 2017/18. Joe Morolong (John Taolo Gaetsewe – NC) had the highest rate at 66.7 per 1 000 births.

Table 9: Local municipalities/sub-districts with the highest and lowest stillbirth in facility rates, 2017/18

10 local municipalities/sub-districts with the highest stillbirth in facility rates (per 1 000 births)

10 local municipalities/sub-districts with the lowest stillbirth in facility rates (per 1 000 births)

Joe Morolong (John Taolo Gaetsewe – NC) 66.7 Blue Crane Route (Sarah Baartman – EC) 2.6Naledi (Mangaung – FS) 42.5 Mandeni (iLembe – KZN) 2.4King Sabata Dalindyebo (King Sabata Dalindyebo – EC) 40.6 Kou-Kamma (Sarah Baartman – EC) 2.3Moqhaka (Fezile Dabi – FS) 38.6 Rand West City (West Rand – GP) 1.9Alfred Duma (uThukela – KZN) 38.0 Mkhambathini (uMgungundlovu – KZN) 0.0Emalahleni (Chris Hani – EC) 35.4 Richmond (uMgungundlovu – KZN) 0.0Polokwane (Capricorn – LP) 35.3 Kamiesberg (Namakwa – NC) 0.0Tygerberg (Cape Town – WC) 33.6 Richtersveld (Namakwa – NC) 0.0Maquassi Hills (Dr Kenneth Kaunda – NW) 33.3 !Kheis (Zwelentlanga Fatman Mgcawu – NC) 0.0Matjhabeng (Lejweleputswa – FS) 32.9 Kgatelopele (Zwelentlanga Fatman Mgcawu – NC) 0.0

Source: DHIS.

Key findings ✦ The national stillbirth in facility rate remained stable around 21 per 1 000 births between 2013/14 – 2017/18.

✦ Free State had the highest stillbirth in facility rate of 26.2 per 1 000 births in 2017/18.

✦ All four districts in North West had a stillbirth in facility rate above 20 per 1 000 births in 2017/18. Similarly, eight of the 11 districts in KwaZulu-Natal had rates above 20 per 1 000 births with the highest rate of 33.5 per 1 000 births in uThukela.

✦ Joe Morolong (John Taolo Gaetsewe – NC) had the highest rate at 66.7 per 1 000 births in 2017/18.

Recommendations ✦ Strengthen the quality of antenatal care and early referrals for women with high-risk pregnancies.

✦ Monitoring of the stillbirth rates and addressing all other contributory factors as detailed in the Perinatal Problem Identification Programme (PPIP) will result in the introduction of better interventions.

Early neonatal death in facility rate by province, 2017/18


FS

EC

LP

MP

KZNGP

NC

NW

WC

5 10 15 20

10.2

7.2

12.0

11.0

7.9

10.4

11.8

10.0

10.3

SA: 10.2


78

Section A: Delivery

4.4 Early neonatal death in facility rateSeventy-three per cent of neonatal deaths occur in the first week of life and the day of one’s birth has been described as the most dangerous of one’s life. Very small babies account for 80% of these neonatal deaths with 35% due to conditions related to preterm birth, 24% due to intrapartum events, including asphyxia, and 20% due to neonatal infections.i

The early neonatal death in facility rate or inpatient death 0–7 days measures the number of deaths among live-born babies that occur within seven days of birth and is expressed per 1 000 live births. The numerator is the number of death in facility 0–7 days, while the denominator includes the number of live births in facility. It monitors trends in early neonatal deaths in health facilities and indications of health system results in terms of antenatal, delivery and early neonatal care.

The early neonatal death in facility rate provides an indication of the quality of antenatal, intrapartum and postnatal care and is a key indicator to address in order for South Africa to end preventable deaths among neonates and children under 5 years.

National overview

Figure 8 shows that the national early neonatal death in facility rate remained stable around 10 per 1 000 live births between 2013/14 and 2017/18 and was 10.2 per 1 000 live births in 2017/18.

Provincial overview

Three provinces (Western Cape (7.2), North West (7.9) and Northern Cape (10.0) scored below the national average of 10.2 per 1 000 live births.

Figure 8: Early neonatal death in facility rate by province, 2017/18

District overview

At district level, the early neonatal death in facility rate varied widely, from 3.9 per 1 000 live births in Overberg (WC) to 18.9 per 1 000 live births in Central Karoo (WC) in 2017/18 (Figure 9 and Map 4). However, there were 18 early neonatal deaths in Central Karoo and this was the fourth lowest number among the districts in 2017/18.

i McKerrow NH. Early neonatal death rate. In Maternal, Child and Women’s Health. District Health Barometer 2016. Durban: Health Systems Trust; March 2018. Available from: http://www.hst.org.za/publications/HST%20Publications/MCWH%20Publication%20Final%20web.pdf. [Accessed 14 November 2018].

Early neonatal death in facility rate by district, 2017/18


Central Karoo: DC5Lejweleputswa: DC18

Capricorn: DC35O Tambo: DC15

Buffalo City: BUFG Sibande: DC30

Harry Gwala: DC43iLembe: DC29

Frances Baard: DC9uThukela: DC23

Waterberg: DC36A Nzo: DC44

Fezile Dabi: DC20Amajuba: DC25

Joe Gqabi: DC14City of Ekurhuleni: EKU

Mangaung: MANZululand: DC26Namakwa: DC6

Nkangala: DC31Ugu: DC21

Tshwane: TSHuMzinyathi: DC24

J T Gaetsewe: DC45Mopani: DC33

Sedibeng: DC42N Mandela Bay: NMA

T Mofutsanyana: DC19King Cetshwayo: DC28uMgungundlovu: DC22

C Hani: DC13Dr K Kaunda: DC40

Sarah Baartman: DC10Johannesburg: JHB

eThekwini: ETHEhlanzeni: DC32

West Rand: DC48Bojanala Platinum: DC37

Sekhukhune: DC47Ruth Segomotsi Mompati: DC39

uMkhanyakude: DC27Eden: DC4

West Coast: DC1Amathole: DC12Vhembe: DC34

ZF Mgcawu: DC8Pixley ka Seme: DC7

Cape Town: CPTCape Winelands: DC2

Xhariep: DC16Ngaka Modiri Molema: DC38

Overberg: DC3

5 10 15 20

10.8

9.8

10.3

9.2

10.2

8.4 8.1

6.7

18.9

7.2

3.7

10.9

10.7

10.1

6.3

18.216.8

10.2

8.7

4.4

8.8 9.0

9.9

7.8

9.2

11.6

10.4

13.2

7.9

13.3

9.9

10.8

10.1

14.9

11.3

9.8

10.4

12.2

10.2

7.3 7.3

11.9

10.6

10.0

10.2

9.6

13.012.9

10.0

10.8

10.3

8.4

SA: 10.2


79

Section A: Delivery

Figure 9: Early neonatal death in facility rate by district, 2017/18

CPT

NMA

BUF

ETH

EKUJHB

DC10

DC12

DC13

DC14

DC15

DC44

DC16

DC18DC19

DC20

MAN

DC42DC48

TSH

DC21

DC22

DC23

DC24

DC25 DC26 DC27

DC28

DC29

DC43

DC33

DC34

DC35

DC36

DC47

DC30

DC31

DC32

DC45

DC6DC7

DC8DC9

DC37

DC38

DC39DC40

DC1

DC2

DC3

DC4

DC5


ENDR 0.0 - 3.43.6 - 8.18.5 - 13.413.6 - 20.322.2 - 34.9

EKUJHB

DC42

DC48

TSH

Gauteng

80

Section A: Delivery

Map 4: Early neonatal death in facility rate by local municipality/sub-district, 2017/18

Source: DHIS.

Table 10 shows the districts with 200 and more early neonatal deaths in 2017/18. The six districts with the highest number of early neonatal deaths were, with the exception of Capricorn, all metropolitan districts. The districts include all three districts in Mpumalanga and three of the five districts in Limpopo.

Table 10: Districts with 200 and more early neonatal deaths in 2017/18

Ekurhuleni (GP) 698Johannesburg (GP) 692Tshwane (GP) 533eThekwini (KZN) 532Capricorn (LP) 455Cape Town (WC) 453OR Tambo (EC) 413Ehlanzeni (MP) 363Mopani (LP) 251Gert Sibande (MP) 243Vhembe (LP) 223Sekhukhune (LP) 218Nkangala (MP) 202

Source: DHIS.

Figure 10 shows the annual trends for the early neonatal death in facility rate. In the Free State, Lejweleputswa had an increase in the rate from 16.8 to 18.2 per 1 000 live births between 2016/17 and 2017/18 and had the second highest rate among the districts in 2017/18. In KwaZulu-Natal, the rate increased in uThukela from 8.1 to 11.9 per 1 000 live births. Capricorn has the highest rate in Limpopo and had the third highest rate among the districts in 2017/18 at 16.8 per 1 000 live births. The rate in Central Karoo (WC) fluctuated on a year-to-year basis but the number of neonatal deaths in the district was low.

Annual trends: Early neonatal death in facility rate

per 1

000

live

birt

hs

0

5

10

15

20

25

EC FS

● ●

● ●

●

●

●● ● ●

GP

0

5

10

15

20

25

KZN

●

● ● ● ●●

●●

●

●

LP MP

0

5

10

15

20

25

2008

/09

2009

/10

2010

/11

2011

/12

2012

/13

2013

/14

2014

/15

2015

/16

2016

/17

2017

/18

NC

2008

/09

2009

/10

2010

/11

2011

/12

2012

/13

2013

/14

2014

/15

2015

/16

2016

/17

2017

/18

NW

2008

/09

2009

/10

2010

/11

2011

/12

2012

/13

2013

/14

2014

/15

2015

/16

2016

/17

2017

/18

●

●

●●

●●

●

●

●

●

WC

EC A NzoEC AmatholeEC Buffalo CityEC C HaniEC Joe GqabiEC N Mandela BayEC O TamboEC Sarah BaartmanFS Fezile DabiFS LejweleputswaFS MangaungFS T MofutsanyanaFS Xhariep

GP City of Ekurhuleni GP Johannesburg GP SedibengGP TshwaneGP West RandKZN AmajubaKZN eThekwiniKZN Harry GwalaKZN iLembeKZN King Cetshwayo KZN UguKZN uMgungundlovu KZN uMkhanyakude

KZN uMzinyathi KZN uThukelaKZN ZululandLP CapricornLP MopaniLP Sekhukhune LP VhembeLP Waterberg MP Ehlanzeni MP G Sibande MP Nkangala NC Frances Baard NC J T Gaetsewe

NC NamakwaNC Pixley ka SemeNC ZF MgcawuNW Bojanala PlatinumNW Dr K KaundaNW Ngaka Modiri MolemaNW Ruth Segomotsi MompatiWC Cape TownWC Cape WinelandsWC Central KarooWC EdenWC OverbergWC West Coast

●

●

●

81

Section A: Delivery

Figure 10: Annual trends: early neonatal death in facility rate by province and district, 2008/09 – 2017/18

Source: DHIS.

82

Section A: Delivery


Table 11 shows the LM/SDs with an early neonatal death in facility rate of more than 20 per 1 000 live births in 2017/18. The three LM/SDs with the highest early neonatal death rate were in Free State, namely Moqhaka (Fezile Dabi), Masilonyana (Lejweleputswa) and Naledi (Mangaung).

Table 11: Local municipalities/sub-districts with an early neonatal death in facility rate of more than 20 per 1 000 live births in 2017/18

Inpatient early neonatal death rate per 1 000 live births

Moqhaka (Fezile Dabi – FS) 34.9Masilonyana (Lejweleputswa – FS) 32.7Naledi (Mangaung – FS) 32.7King Sabata Dalindyebo (OR Tambo – EC) 30.7N Mandela A (Nelson Mandela – EC) 27.2Polokwane (Capricorn – LP) 26.4Kareeberg (Pixley Ka Seme – NC) 24.6Cape Agulhas (Overberg – WC) 23.6Inxuba Yethemba (Chris Hani – EC) 22.3Mahikeng (Ngaka Modiri Molema – NW) 22.2

Source: DHIS.

Key findings ✦ The national early neonatal death in facility rate remained stable around 10 per 1 000 live births between 2013/14

and 2017/18 and was 10.2 per 1 000 live births in 2017/18.

✦ At district level, the early neonatal death in facility rate ranged from 3.9 per 1 000 live births in Overberg (WC) to 18.9 per 1 000 live births in Central Karoo (WC) in 2017/18. However, the number of neonatal deaths in Central Karoo was 18 and it was the fourth lowest number in the country among the districts.

✦ The six districts with the highest number of early neonatal deaths in 2017/18 were, with the exception of Capricorn, all metropolitan districts. The districts with more than 200 early neonatal deaths include all three districts in Mpumalanga and three of the five districts in Limpopo.

✦ The three LM/SDs with the highest early neonatal death in facility rates in 2017/18 were in Free State, namely Moqhaka (Fezile Dabi), Masilonyana (Lejweleputswa) and Naledi (Mangaung).

Recommendations ✦ The districts with more than 200 early neonatal deaths should investigate the reasons for the early neonatal

deaths, including focussing on strengthening the quality of antenatal care. The same applies to the three local municipalities in Free State with the highest early neonatal death in facility rates among the LM/SDs.

4.5 Mother postnatal visit within 6 days ratePostnatal care takes place in the period directly after the delivery of the baby. The mother postnatal visit within 6 days rate provides insights into the access and utilisation of postnatal care. The purpose of the postnatal visit is to manage the normal psychological and physical changes that occur within those first few days after delivery, and to assist, counsel, and provide screening, care and treatment for any problems that threaten the health and wellbeing of the mother and baby.

The mother postnatal visit within 6 days rate measures the mothers who received postnatal care within 6 days after delivery as a proportion of deliveries in health facilities. The indicator is expressed as a percentage. The numerator is the number of mother postnatal visits within 6 days after delivery, and the denominator is the total number of deliveries in facility. The mother postnatal visit within 6 days rate indicator monitors access to and utilisation of postnatal care.

National and provincial overview

The national mother postnatal visit within 6 days rate increased annually since 2015/16 after a huge decline between 2014/15 and 2015/16 as illustrated by Figure 11 below.

73.0

74.3

68.6

70.570.9

65.0

66.0

67.0

68.0

69.0

70.0

71.0

72.0

73.0

74.0

75.0

2013/14 2014/15 2015/16 2016/17 2017/18

Perc

enta

ge

Mother postnatal visit within 6 days rate by province, 2017/18


WC

NC

EC

MP

FS

GP

NW

KZN

LP

50 100 150

70.8

62.0

63.3

64.0

75.4

58.0

85.8

63.4

76.8

SA: 70.9


83

Section A: Delivery

Figure 11: National mother postnatal visit within 6 days rate – 5 years trend, 2013/14 – 2017/18

Source: DHIS.

Three provinces (Limpopo, KwaZulu-Natal and North West) achieved above the national average of 70.9% in 2017/18 (Figure 12). Western Cape was the lowest performing province with a mother postnatal visit within 6 days rate of only 58.0% and had a 2.0 percentage point decline from the previous year’s performance of 60.0%. The rate in two other provinces also declined between 2016/17 and 2017/18 namely, Gauteng – from 85.9% in 2016/17 to 70.8% in 2017/18 and Free State from 71.4% to 64.0%. Limpopo was the only province with an increase in the rate in the same period – from 70.9% to 85.8%.

Figure 12: Mother postnatal visit within 6 days rate by province, 2017/18

District overview

The mother postnatal visit within 6 days rate in the districts in Eastern Cape showed huge variations. Seven districts in Eastern Cape performed below the national average of 70.9%. Buffalo City had the lowest mother postnatal visit within 6 days rate country-wide of 43.2% but Amathole performed the second best among the districts with a rate above 100% (108.7%) (Figure 13). Xhariep (FS) reported a rate of 167.2%. One reason for the more than 100% rate is that mothers deliver their babies in one district, but the postnatal visit is conducted in another district, e.g. Xhariep refers all complicated cases to Mangaung where the delivery takes place.

Mother postnatal visit within 6 days rate by district, 2017/18


Buffalo City: BUFEden: DC4

ZF Mgcawu: DC8Frances Baard: DC9

A Nzo: DC44West Rand: DC48

Sedibeng: DC42Cape Winelands: DC2

O Tambo: DC15Namakwa: DC6

Cape Town: CPTCentral Karoo: DC5

Mangaung: MANEhlanzeni: DC32

Lejweleputswa: DC18G Sibande: DC30

Ngaka Modiri Molema: DC38T Mofutsanyana: DC19

Zululand: DC26N Mandela Bay: NMA

Fezile Dabi: DC20Sarah Baartman: DC10

Joe Gqabi: DC14C Hani: DC13

Tshwane: TSHUgu: DC21

West Coast: DC1iLembe: DC29

uMzinyathi: DC24uThukela: DC23Nkangala: DC31

Johannesburg: JHBHarry Gwala: DC43

Capricorn: DC35Pixley ka Seme: DC7

Ruth Segomotsi Mompati: DC39Amajuba: DC25

uMkhanyakude: DC27City of Ekurhuleni: EKU

J T Gaetsewe: DC45Dr K Kaunda: DC40

Overberg: DC3Sekhukhune: DC47

eThekwini: ETHBojanala Platinum: DC37

uMgungundlovu: DC22Waterberg: DC36

King Cetshwayo: DC28Vhembe: DC34Mopani: DC33

Amathole: DC12Xhariep: DC16

50 100 150

55.3

78.4

71.5

69.4

55.6

54.5

78.5

57.3

72.4

53.6

67.5

66.0

57.1

66.4

64.2

167.2

66.0

59.3

61.2

69.2

108.7

63.6

55.9

58.3 57.3

82.0

73.9

54.8

53.0

70.7

43.2

79.8 79.9

72.3

97.8

84.9

80.0

93.8

71.4

59.5

63.4

80.4

82.2

71.9

70.8

90.8

69.9

70.8

64.8

74.0 76.2

71.0

SA: 70.9


84

Section A: Delivery

Figure 13: Mother postnatal visit within 6 days rate by district, 2017/18

CPT

NMA

BUF

ETH

EKUJHB

DC10

DC12

DC13

DC14

DC15

DC44

DC16

DC18DC19

DC20

MAN

DC42DC48

TSH

DC21

DC22

DC23

DC24

DC25 DC26 DC27

DC28

DC29

DC43

DC33

DC34

DC35

DC36

DC47

DC30

DC31

DC32

DC45

DC6DC7

DC8DC9

DC37

DC38

DC39DC40

DC1

DC2

DC3

DC4

DC5


PNMOTHU6 14.9 - 20.020.1 - 60.060.1 - 80.080.1 - 100.0100.1 - 6628.0

EKUJHB

DC42

DC48

TSH

Gauteng

85

Section A: Delivery


Map 5 shows that the Northern Cape had the most LMs with a poor mother postnatal visit within 6 days rate between 14.9% – 20.0%.

Map 5: Mother postnatal visit within 6 days rate by local municipality/sub-district, 2017/18

Source: DHIS.

Key findings ✦ The more than 100% performance reported by Xhariep (FS) and Amathole (EC) may be an indication of incorrect

denominators or cross district movement of women.

Recommendations ✦ The scores over 100% and below 50% of Amathole and Buffalo City should be investigated as it may relate to poor

data quality.

✦ This indicator is currently reported at the primary health care facilities and hospitals. Women who have had Caesarean Sections are likely to have postnatal visits while still in hospital and hospitals should ensure that these data are collected and captured.

✦ Primary health facilities should develop action plans to ensure that each woman who delivers, receives a postnatal examination and that data are recorded in the prescribed patient record.

86

Section A: Delivery

4 delivery - health systems trust health barometers/district+health... · mother postnatal visit...

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