Chapter 12a. Eastern Cape

The Eastern Cape is the third most populous Province in South Africa, and the majority of its population is non-urban (64.4%) and female (53.9%) (Data from Census 96). The Province is divided into 5 Regions as shown in Table 12a.1.

The pattern of disease is shown in Table 12a.2.

The pattern of disease reflects the rural nature of the Province. There is considerable under-reporting in the Province, and caution must be exercised when interpreting this data. The avoidable factors, missed opportunities and substandard care are shown in Tables 12a.3-5.

Problems

1. The most significant problem has been the lack of reporting of cases. Some regions had very low reporting (Table 12a.1). Without adequate reporting, a true picture of the problems in the Province and in its regions is not possible.
2. Transport between health institutions was a significant problem in a third of cases.
3. Not following standard protocols or making the wrong diagnosis was a significant feature in 54% of maternal deaths.
4. Poor patient monitoring or lack of response to prolonged abnormal observations played a significant part in the deaths of 40% of women.

Solutions

1. Workshops on the Maternal Death Notification process and on how to complete the forms are required. The medical faculty of UNITRA needs to become involved in the process. District, Regional and a Provincial committee have been proposed to facilitate this process, and improve reporting and feedback of information to the health workers.
2. Negotiations with the ambulance section will need to take place to address the problem of poor or lack of transportation. A list of priority conditions will need to be established.
3. A skills and human resources audit will need to urgently conducted in all health institutions to establish the reason for the poor patient monitoring.
4. Standard protocols for managing emergency obstetric conditions will need to be introduced and implemented at each institution dealing with pregnant women.

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