Lessons Learnt - The 'Big Five' in South Africa

Haaritha Boltman, Lecturer (Midwifery),
July 20, 2011

I feel that this study leaves me with a sense of being on safari to catch a glimpse of the 'Big Five' - as a health professional from South Africa I recognize that it is only but interesting to note the first world trends in pre-eclampsia, but it does not provide any sustainable short or long term treatment modalities, where it is so urgently required.

Hypertension during pregnancy has been attributed to one of the top five causes of maternal deaths in South Africa (Blaauw and Penn-Kekana, 2010). The South African Health Review, 2010, admits that despite an increase in antenatal care coverage and skilled birth attendance, maternal mortality is still on the rise (Blaauw and Penn-Kekana, 2010). While other interventions like low dose asprin and multi-vitamin supplementation do play a role, in this study elective delivery before the due date was one of the primary causes attributed to the trend in the decrease of pre- eclampsia. I am not convinced that elective caesarean sections is the ideal, as this method of delivery may contribute to other causes of morbidity and mortality, not to mention increased costs of surgical delivery, especially in the African setting.

The abovementioned article makes some valuable contributions to the understanding of international trends in pre-eclampsia. However, once again it raises the issue of what we interpret as 'international'. My concern about these trends being acknowledged as international is that the study takes place across borders but it does not necessarily apply to the global context.

The study lacks inclusion of developing nations, and thus does not take in consideration the countries urgently seeking solutions, in their urgency to reach Millenium Development Goals and reduce maternal mortality (MDGs 4 and 5). I would urge that cognizance be taken of the location of the countries used in the study.


Blaauw, D & Penn-Kekana, M. 2010. In: Fonn, S., Padarath, A. South African Health Review. Durban: Health Systems Trust. Available online: http://www.hst.org.za/publications/876

Conflict of Interest:

None declared

Conflict of Interest

None declared