Improvement of Maternal and Child Morbidity and Mortality Surveillance System of South Africa (MIMMS): part 1

In the last decade South Africa has made significant progress in the reduction of both child and maternal mortality rates. The maternal mortality ratio remains relatively high at 141 (2013) deaths per 100,000 live births. The under-five mortality rate of approximately 48%, from 65.9 deaths per 1,000 live births to 34.3/1,000 was recorded between 2006 and 2013. Similarly, infant mortality rate reductions were observed from 47.1/1,000 in 2006 to 23.6/1,000 in 2013. The neonatal mortality rate has been reduced from 13/1,000 in 2010 to 11/1,000 in 2013. Although progress in maternal and child morbidity and mortality has been made it is important to indicate at this stage that data used are based on varied sources and systems that sometimes yield conflicting data. Civil Registration and Vital Statistics (CRVS) systems remain the most important source of information to collect high quality data to monitor mortality rates in many countries due to the high coverage, accurate medical certification and high quality coding of deaths. South Africa has a well-established and vital statistics system. However, not all deaths are registered and the quality of the cause of death information is often inadequate. Evidence shows that childbirths and child mortality surveillance suffers from under-reporting e.g. childbirths and deaths particularly those that occur outside health facilities might not be reported and there is no system in place to track down such births and deaths. The under-reporting of births and deaths renders the South African system inadequate for monitoring maternal and child morbidity and mortality. The Improvement of Maternal and Child Morbidity and Mortality Surveillance (MIMMS) project (Gap analysis) was initiated to address challenges within the current maternal and child mortality surveillance system which often yields inaccurate data, making it difficult to develop appropriate evidenced-based policies and programmes. To identify bottlenecks and short circuits (the 'gaps') within the surveillance system that serve to compromise the efficiency and effectiveness of the system with a view to strengthening the existing surveillance and strategies for monitoring maternal and child morbidity and mortality.