Child mortality in South Africa: Fewer deaths, but better data are needed

Abstract

South Africa is committed to reducing under-5 mortality rates in line with the Sustainable Development Goal (SDG) targets. Policymakers and healthcare service managers require accurate and complete data on the number and causes of child deaths to plan and monitor healthcare service delivery and health outcomes. This study aimed to review nationally representative data on under-5 mortality and the cause of deaths among children under 5 years of age. We also reviewed systems that are currently used for generating these data. Child mortality has declined substantially in the past decade. Under-5 mortality in 2015 is estimated at 37 -40 deaths per 1 000 live births, with an estimated infant mortality rate of 27 -33 deaths per 1 000 live births. Approximately one-third of under-5 deaths occur during the newborn period, while diarrhoea, pneumonia and HIV infection remain the most important causes of death outside of the newborn period. The proportion of deaths owing to non-natural causes, congenital disorders and non-communicable diseases has increased.However, many discrepancies in data collected through different systems are noted, especially at the sub-national level. There is a need to improve the completeness and accuracy of existing data systems and to strengthen reconciliation and triangulation of data.

Child mortality trends and causes of death in South Africa, 1997 - 2012, and the importance of a national burden of disease study

“…KwaZuluNatal, Free State, Mpumalanga and Eastern Cape had the highest rates at the beginning of the period, with levels close to 80 per 1 000 live births. These increased to levels >100 per [10] report the proportion for gastroenteritis as 10.1%.…”

“…Bamford et al [10] contrasted the cause ofdeath fractions for 2015 from the registered deaths reported by Stats SA [21] with estimates produced by the United Nations Children's Fund (UNICEF). [22] We compared the SA NBD estimates for 2012 with these profiles as well as estimates for SA in the 2015 Global Burden of Disease Study produced by the Institute for Health Metrics and Evaluation (IHME).…”

On the path to reach the SDG targets: Decreasing maternal and child mortality in South Africa

“…Part of the data problem is that as many as half of all deaths during the post neonatal period occur out of hospital and accurate population metrics are dependent on all child deaths being accurately reported to the Department of Home Affairs. McKerrow et al [7] highlight the importance of…”

“…In the paper on improvements in child mortality, McKerrow et al [7] highlight the need for improved data quality with which to quantify and measure child deaths. Part of the data problem is that as many as half of all deaths during the post neonatal period occur out of hospital and accurate population metrics are dependent on all child deaths being accurately reported to the Department of Home Affairs.…”

Strengthening the quality of paediatric primary care: A process evaluation of a complex health systems intervention in South Africa

“…However, in 2016 these rates were 42 and 35 and their decline has slowed. (2) The World Health Organisation's Integrated Management of Childhood Illness (IMCI) strategy played a role in shaping primary healthcare for children under five in LMICs for the past twenty years and has contributed to the decline in child mortality. Although it has seen many successes, (3)(4)(5)(6)(7) implementation was challenged by inadequate local adaptation and infrequent revision of content, insufficient staff training and supervision, variable uptake and inconsistent use in primary care.…”