Congenital disorders in South Africa: A review of Child Healthcare Problem Identification Programme (Child PIP) mortality data, 2005 - 2017.

Background: Congenital disorders (CDs) form a major challenge for those affected, and for the structuring of services around their health needs. In South Africa (SA) the size and nature of the problem are unknown because reporting of CDs has been unreliable.

Objectives: To ascertain the occurrence and spectrum of congenital disorders in children dying in SA hospitals participating in the Child Healthcare Problem Identification Programme (Child PIP).

Methods: Child PIP has been used for auditing in-hospital childhood deaths in children's wards in SA state hospitals since 2005. By 2017, over 60 000 audited deaths had been entered into the Child PIP database. We searched this database for CD occurrence and spectrum.

Results: The number of deaths where a CD diagnosis was given as the Main Cause of Death was 243, 0.4% of all-cause mortality. In 1 678 deaths, CDs were assigned as an Underlying Condition, a 2.8% occurrence. A diagnosis of CD was assigned 1 968 times, indicating an overall CD burden in the children who died of 3.2%, many children having more than one CD diagnosis. The spectrum of CDs was wide, with CDs of the heart being most prominent.

Conclusions: These new data paint a broad picture of the CD challenge that confronts the SA health system, a challenge that will increase in importance with the current decline in infectious diseases.