The contribution of congenital disorders to child mortality in South Africa

Reduction in child mortality has been a priority issue in South Africa leading up to the Millennium Development Goals. However, the contribution of congenital disorders (CDs) to child mortality is yet to be recognised and acted upon.Rapid reductions in child mortality have resulted largely from comprehensive HIV and AIDS programmes and interventions such as the childhood Expanded Programme of Immunisation. However, the Rapid Mortality Surveillance System reports that since 2011, reductions in child mortality rates stopped abruptly. This indicates that health issues other than those currently being addressed may require long-term prioritisation. In 2013, congenital anomalies (excluding many CDs) overtook infection as the third leading cause of early neonatal deaths, which account for one-third of all under-five deaths.As South Africa transitions epidemiologically, the proportion of deaths caused by CDs is increasing, as mortality from communicable diseases drops, revealing the previously hidden disease burden of CDs. In South Africa, many CDs go undiagnosed or are misdiagnosed, resulting in the incorrect cause of death being reported. These inaccurate data result in an underestimation of the true disease burden of CDs in the country.As up to 70% of CDs can be prevented or ameliorated, it is essential that they be prioritised and that relevant, accessible services for prevention and care be implemented. A good legislative and regulatory framework exists in South Africa for the provision of services, but implementation has been poor and fragmented. Current services are available at a lower base than in 2001.This chapter argues for recognition of the role of CDs in child mortality and morbidity and the potential advantages of medical and genetic services for the prevention and care of CDs.