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

Kerber KJ, Lawn JE, Johnson LF, Mahy M, Dorrington RE, Phillips H, Bradshaw D, Nannan N, Msemburi W, Oestergaard MZ, Walker NP, Sanders D, Jackson D - AIDS (2013)

Bottom Line: All estimates were compared with available empirical data.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.Over the past 5 years, the country has achieved a rate of child mortality reduction exceeded by only three other countries.

View Article: PubMed Central - PubMed

Affiliation: aSchool of Public Health, University of the Western Cape, South Africa bSaving Newborn Lives, Save the Children, USA cChild Health Epidemiology Reference Group dMARCH (Maternal Reproductive & Child Health), London School of Hygiene and Tropical Medicine, UK eCentre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa fUNAIDS, Switzerland gCentre for Actuarial Research, University of Cape Town hUNAIDS iBurden of Disease Research Unit, Medical Research Council, South Africa jDepartment of Health Statistics and Informatics, World Health Organization, Switzerland kJohns Hopkins Bloomberg School of Public Health, USA.

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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Trend in percentage of under-five deaths in South Africa due to AIDS in South Africa.
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Figure 1: Trend in percentage of under-five deaths in South Africa due to AIDS in South Africa.

Mentions: Despite the different assumptions and input data in the three AIDS models, the trend since the start of the HIV epidemic followed a similar pattern. The estimated proportion of child deaths due to AIDS reached a peak of 37–39% around 2005–2006 with a sharp decline towards the end of the decade (Fig. 1). There is less consistency between models in recent years; the estimated proportion of deaths in children under-five due to AIDS in 2011 ranged from 11.2% (plausibility bounds 9.3–14.3%) in Spectrum and 19.8% in ASSA2008, to 24.3% (95% confidence interval 19.9–28.0%) in the UCT model. The Spectrum and ASSA2008 models predict a faster decline in child deaths due to AIDS than the UCT model.


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

Kerber KJ, Lawn JE, Johnson LF, Mahy M, Dorrington RE, Phillips H, Bradshaw D, Nannan N, Msemburi W, Oestergaard MZ, Walker NP, Sanders D, Jackson D - AIDS (2013)

Trend in percentage of under-five deaths in South Africa due to AIDS in South Africa.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3815090&req=5

Figure 1: Trend in percentage of under-five deaths in South Africa due to AIDS in South Africa.
Mentions: Despite the different assumptions and input data in the three AIDS models, the trend since the start of the HIV epidemic followed a similar pattern. The estimated proportion of child deaths due to AIDS reached a peak of 37–39% around 2005–2006 with a sharp decline towards the end of the decade (Fig. 1). There is less consistency between models in recent years; the estimated proportion of deaths in children under-five due to AIDS in 2011 ranged from 11.2% (plausibility bounds 9.3–14.3%) in Spectrum and 19.8% in ASSA2008, to 24.3% (95% confidence interval 19.9–28.0%) in the UCT model. The Spectrum and ASSA2008 models predict a faster decline in child deaths due to AIDS than the UCT model.

Bottom Line: All estimates were compared with available empirical data.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.Over the past 5 years, the country has achieved a rate of child mortality reduction exceeded by only three other countries.

View Article: PubMed Central - PubMed

Affiliation: aSchool of Public Health, University of the Western Cape, South Africa bSaving Newborn Lives, Save the Children, USA cChild Health Epidemiology Reference Group dMARCH (Maternal Reproductive & Child Health), London School of Hygiene and Tropical Medicine, UK eCentre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa fUNAIDS, Switzerland gCentre for Actuarial Research, University of Cape Town hUNAIDS iBurden of Disease Research Unit, Medical Research Council, South Africa jDepartment of Health Statistics and Informatics, World Health Organization, Switzerland kJohns Hopkins Bloomberg School of Public Health, USA.

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.

Show MeSH
Related in: MedlinePlus