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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

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

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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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


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.

Correspondence to Kate Kerber, 2A King Street, Woodstock 7925, South Africa. E-mail:

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Received April 7, 2013

Accepted July 4, 2013

© 2013 Lippincott Williams & Wilkins, Inc.