How can it be...?

Although syphilis screening and treatment are inexpensive and effective this disease remains a major cause of perinatal mortality in South Africa. In large areas many with syphilis prevalences close to 20% screening is not performed. Reasons given for this failure include costs a lack of transport to send blood tests to the laboratory and failure of the laboratories to return test results. These problems could be overcome through use of accurate inexpensive on-site syphilis tests. Although the partogram has been established as a simple effective method of detecting prolonged labor--and all that is required to put together a partogram is a pen paper and pinard stethoscope--intrapartum asphyxia remains a common cause of perinatal death. Although anemia--occurring in about 20% of pregnant South African women--is simple to both diagnose and treat in many areas only 5% of pregnant women are screened. Other problems include a failure to refer pregnant women with a history or signs of high-risk for maternal or perinatal deaths for assessment and unacceptably high rates of Cesarean and instrumental deliveries. Among the reasons suggested for this disregard of infant and maternal health are overwhelming staff workloads lack of effective training management reluctance to discipline physicians for gross errors or omissions and an emphasis on financial rather than patient care considerations. The health care system especially its managers must take responsibility for investigating these unnecessary maternal and perinatal deaths and implementing solutions.