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doi: 10.1097/01.aids.0000432987.53271.40
Epidemiology and Social

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

Kerber, Kate J.a,b,c; Lawn, Joy E.b,c,d; Johnson, Leigh F.e; Mahy, Maryf; Dorrington, Rob E.g; Phillips, Hestonh; Bradshaw, Debbiei; Nannan, Nadinei; Msemburi, Williami; Oestergaard, Mikkel Z.j; Walker, Neff P.k; Sanders, Davida; Jackson, Debraa

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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.

© 2013 Lippincott Williams & Wilkins, Inc.


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