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01.12.2015 | Research article | Ausgabe 1/2016 Open Access

BMC Public Health 1/2016

Strategic planning for saving the lives of mothers, newborns and children and preventing stillbirths in KwaZulu-Natal province South Africa: modelling using the Lives Saved Tool (LiST)

Zeitschrift:
BMC Public Health > Ausgabe 1/2016
Autoren:
Shelley-Ann McGee, Lumbwe Chola, Aviva Tugendhaft, Victoria Mubaiwa, Neil Moran, Neil McKerrow, Leonard Kamugisha, Karen Hofman
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-015-2661-x) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

All authors are responsible for the study concept and design. NMc, NM and VM provided provincial level data and estimates and assisted in the interpretation of the results. SM performed the analysis and drafted the manuscript. LC, KH, LK, NMc and AT reviewed and provided critical review of the manuscript. All authors read and approved the final manuscript.

Abstract

Background

KwaZulu-Natal province in South Africa has the largest population of children under the age of five and experiences the highest number of child births per annum in the country. Its population has also been ravaged by the dual epidemics of HIV and TB and it has struggled to meet targets for maternal and child mortality. In South Africa’s federal system, provinces have decision-making power on the prioritization and allocation of resources within their jurisdiction. As part of strategic planning for 2015–2019, KwaZulu-Natal provincial authorities requested an assessment of current mortality levels in the province and identification and costing of priority interventions for saving additional maternal, newborn and child lives, as well as preventing stillbirths in the province.

Methods

The Lives Saved Tool (LiST) was used to determine the set of interventions, which could save the most additional maternal and child lives and prevent stillbirths from 2015–2019, and the costs of these. The impact of family planning was assessed using two scenarios by increasing baseline coverage of modern contraception by 0.5 percentage points or 1 percentage point per annum.

Results

A total of 7,043 additional child and 297 additional maternal lives could be saved, and 2,000 stillbirths could be prevented over five years. Seventeen interventions account for 75 % of additional lives saved. Increasing family planning contributes to a further reduction of up to 137 maternal and 3,168 child deaths. The set of priority interventions scaled up to achievable levels, with no increase in contraception would require an additional US$91 million over five years or US$1.72 per capita population per year. By increasing contraceptive prevalence by one percentage point per year, overall costs to scale up to achievable coverage package, decrease by US$24 million over five years.

Conclusion

Focused attention on a set of key interventions could have a significant impact on averting stillbirths and maternal and neonatal mortality in KwaZulu-Natal. Concerted effort to prioritize family planning will save more lives overall and has the potential to decrease costs in other areas of maternal and child care.
Zusatzmaterial
Additional file 1: Sheet 1. Interventions added to List. Additional interventions not included in the LiST Tool, with descriptions, effect sizes and affected fractions. Sheet 2. Adjusted Mortality. Deaths reported to Statistics South Africa, adjusted for under-reporting to estimate actual mortality rates for neonatal and under-five mortality. Sheet 3. Changes in contraceptive mix. Changes in the assumption of proportion of different contraceptive choices used by the population over time (2015 to 2019). (XLSX 15 kb)
12889_2015_2661_MOESM1_ESM.xlsx
Additional file 2: Sheet 4. Summary of impacts of scaling up LiST interventions to achievable levels from baseline by 2019 and a 0.5 percentage point per annum increase in contraceptive prevalence. Summary of lives saved, life years gained, costs over five years and cost to life years gained ratios for all interventions where contraceptive prevalence increases by 0.5 percentage points per annum. Sheet 5. Summary of impacts of scaling up LiST interventions to achievable levels from baseline by 2019 and a one percentage point per annum increase in contraceptive prevalence. Summary of lives saved, life years gained, costs over five years and cost to life years gained ratios for all interventions where contraceptive prevalence increases by one percentage point per annum. (XLSX 27 kb)
12889_2015_2661_MOESM2_ESM.xlsx
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