Limits...
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.

Show MeSH

Related in: MedlinePlus

Neonatal mortality rate trends in South Africa, 1990–2011.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3815090&req=5

Figure 3: Neonatal mortality rate trends in South Africa, 1990–2011.

Mentions: Of the three AIDS models reviewed, only the UCT paediatric HIV model estimates NMR. This output was compared against UN-IGME and IHME estimates and vital registration data. The UN-IGME NMR trend remains higher than the trend from the UCT model but both show minimal decline over the past two decades (Fig. 3). The IHME NMR estimates follow the IHME U5MR trend with a peak in 2005. The rate of decline for neonatal mortality is significantly slower than under-five mortality after the neonatal period (Table 3). The ARR for NMR between 1990 and 2011 is 2.3% per year predicted by the UCT model, compared to 1.5% per year predicted by UN-IGME (Table 3). Data from vital registration combined with data from the District Health Information System confirms slow progress and suggests that the NMR has been virtually stagnant over the past decade [23]. Contrary to other estimates and empirical data, the neonatal ARR according to IHME between 1990 and 2010 is 7.2% per year.


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)

Neonatal mortality rate trends in South Africa, 1990–2011.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Neonatal mortality rate trends in South Africa, 1990–2011.
Mentions: Of the three AIDS models reviewed, only the UCT paediatric HIV model estimates NMR. This output was compared against UN-IGME and IHME estimates and vital registration data. The UN-IGME NMR trend remains higher than the trend from the UCT model but both show minimal decline over the past two decades (Fig. 3). The IHME NMR estimates follow the IHME U5MR trend with a peak in 2005. The rate of decline for neonatal mortality is significantly slower than under-five mortality after the neonatal period (Table 3). The ARR for NMR between 1990 and 2011 is 2.3% per year predicted by the UCT model, compared to 1.5% per year predicted by UN-IGME (Table 3). Data from vital registration combined with data from the District Health Information System confirms slow progress and suggests that the NMR has been virtually stagnant over the past decade [23]. Contrary to other estimates and empirical data, the neonatal ARR according to IHME between 1990 and 2010 is 7.2% per year.

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