Reduction in perinatal mortality in developing countries: experiences from Zululand.

Abstract

The principles governing the reduction of perinatal mortality are: 1) provision of good prenatal care; 2) safe delivery at term; and 3) the maintenance of infant nutrition and the prevention of infection. The author speaks of her experiences in a rural area of the Zulu country of South Africa. Cultural attitudes and beliefs are very different in rural Africa than they are in developed countries. Zulu mothers have a sense of fatalism--the baby is not ill it just dies. When the author began her work in 1945 the small hospital in the Nqutu district of Zululand was largely ignored. The people are poor; the roads bad. The author learned to build confidence. She tried to reach the remotest parts of the district. 11 centers were established throughout the 700 square miles served. The visiting team consisted of a doctor a nurse and a dispenser-driver. Prenatal exams were done in these clinics. They became places where mothers at particular risk could be selected. High-risk factors made hospital delivery essential. A number of the clinics were tended by a resident nurse. She had a single labor ward and a lying-in ward for delivery of low-risk cases. Training was begun for midwives in diagnosis pelvic assessment and decision-making. Also learned was application of the vacuum extractor resuscitation of the newborn setting up scalp vein infusions and taking blood for bilirubin estimation. Recognition of low-weight babies is an important part of midwife work. After initial training midwives returned for refresher courses. Breastfeeding must be taught even to Zulu mothers. This is done in the hospital.