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. 2013 Oct 23;27(16):2637-48.
doi: 10.1097/01.aids.0000432987.53271.40.

South African child deaths 1990-2011: have HIV services reversed the trend enough to meet Millennium Development Goal 4?

Kate J Kerber  1 , Joy E Lawn, Leigh F Johnson, Mary Mahy, Rob E Dorrington, Heston Phillips, Debbie Bradshaw, Nadine Nannan, William Msemburi, Mikkel Z Oestergaard, Neff P Walker, David Sanders, Debra Jackson
Affiliations
Free PMC article

South African child deaths 1990-2011: have HIV services reversed the trend enough to meet Millennium Development Goal 4?

Kate J Kerber et al. AIDS. .
Free PMC article

Abstract

Objective: To analyse trends in under-five mortality rate in South Africa (1990-2011), particularly the contribution of AIDS deaths.

Methods: Three nationally used models for estimating AIDS deaths in children were systematically reviewed. The model outputs were compared with under-five mortality rate estimates for South Africa from two global estimation models. All estimates were compared with available empirical data.

Results: Differences between the models resulted in varying point estimates for under-five mortality but the trends were similar, with mortality increasing to a peak around 2005. The three models showing the contribution of AIDS suggest a maximum of 37-39% of child deaths were due to AIDS in 2004-2005 which has since declined. Although the rate of progress from 1990 is not the 4.4% needed to meet Millennium Development Goal 4 for child survival, South Africa's average annual rate of under-five mortality decline between 2006 and 2011 was between 6.3 and 10.2%.

Conclusion: In 2005, South Africa was one of only four countries globally with an under-five mortality rate higher than the 1990 Millennium Development Goal baseline. Over the past 5 years, the country has achieved a rate of child mortality reduction exceeded by only three other countries. This rapid turnaround is likely due to scale-up of prevention of mother-to-child transmission of HIV, and to a lesser degree, the expanded roll-out of antiretroviral therapy. Emphasis on these programmes must continue, but failure to address other aspects of care including integrated high-quality maternal and neonatal care means that the decline in child mortality could stall.

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Figures

Fig. 1
Fig. 1
Trend in percentage of under-five deaths in South Africa due to AIDS in South Africa.
Fig. 2
Fig. 2
Under-five mortality rate trends in South Africa, 1990–2011.
Fig. 3
Fig. 3
Neonatal mortality rate trends in South Africa, 1990–2011.
Fig. 4
Fig. 4
Antenatal HIV prevalence and prevention of mother-to-child transmission (PMTCT) scale up in South Africa, 1990–2010.
Fig. 1
Fig. 1
Panel 1: Challenges in assessing neonatal mortality in settings with high HIV-prevalence
See this image and copyright information in PMC

References

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