Rates and causes of child mortality in an area of high HIV prevalence in rural South Africa

Abstract

Summary Objective To determine child mortality rates in a rural area of South Africa with high HIV prevalence. Methods A community‐based survey was conducted between 1 January 2000 and 31 December 2002 on deaths in children under the age of 15 years. Children were followed up through four monthly home visits. Cause of death was ascertained by verbal autopsy. Rates were calculated using Poisson regression. Results Mortality ratios were 59.6 deaths per 1000 live births for infants and 97.1 for children under 5 years of age. Infant and under‐5 mortality rates were, respectively, 67.5 and 21.1 deaths per 1000 person‐years. HIV/AIDS was attributed to 41% of deaths in the under‐5 age group, with a mortality rate of 8.6 per 1000 person‐years. Lower respiratory infections caused an estimated 24.9 deaths per 1000 person‐years in children under 1 year of age. Conclusions In rural South Africa, infant and child mortality levels are high, with HIV/AIDS estimated as the single largest cause of death. Interventions to reduce child mortality are required urgently.

Ascertaining causes of neonatal deaths using verbal autopsy: current methods and challenges

“…VA interviewer training ranged from several days to 1-3 weeks. [12][13][14][15] Local women with secondary level schooling [12][13][14][15][16][17][18][19] were primary interviewers, however, nurses, physicians [20][21][22][23][24] and men 14,23,25 -27 were sometimes used. Interviews were conducted from several days 24 or weeks after the death 10,12,13,15,19,20,23,25,26,28 -30 to 5 years postmortem.…”

“…Physician review with 2-3 physicians was the most common method used to assign cause of death from the VA. 10,13,14,18,[20][21][22][23][24][25][26][27][28][29][30][32][33][34] In the event of conflicting diagnoses among physician reviewers, discussions to reach consensus 7,16,26,32 or a third party 'majority rules' were applied. 22,25 In cases where all three disagreed, the cause was often labeled as 'undetermined'.…”

“…22,25 In cases where all three disagreed, the cause was often labeled as 'undetermined'. 18,21 Predefined diagnostic categories and clinical guidelines, 7,21,24 prescribed lists of cause of death criteria, 26 and International Classification of Disease, 10th Edition (ICD-10) codes, 23,29,34 or reference articles, 13 helped guide cause of death assignment; however, in some studies, criteria to reach the diagnosis was left to the physician's discretion. 28 Computer-programmed combinations of signs and symptoms (computer algorithms) of the fatal illness were also used to assign neonatal causes of death.…”

“…29 In addition to the lack of a validated algorithm for stillbirths, deaths due to some causes are often included as a subset of another condition due to a lack of cases. For example, birth injury is often grouped with birth asphyxia, 12,18,21,32 Thus, the data for a single category of death may reflect more than one distinct condition with different risk factors. Similarly, deaths attributed to prematurity may involve a variety of disease processes including respiratory distress syndrome (RDS), intracranial hemorrhage, necrotizing enterocolitis, hypothermia and hypoglycemia, for which different interventions are needed.…”

The Impact of HIV/AIDS on the Health Transition Among Under-Five Children in Africa

“…[updated from Kahn et al 2007] In Hlabisa, a DSS located in Kwazulu Natal, some 41% of deaths of under-five children were attributed to HIV/AIDS. [Garrib et al, 2006] However, in Manhiça, a DSS located in Mozambique heavily affected by malaria, HIV/AIDS accounted for only 8.3% of the deaths of children age 0-14 years, but possibly more if one considers that deaths attributed to other causes (tuberculosis, malnutrition, diarrhoea, pneumonia) could be also HIV/AIDS deaths. [Sacarlal et al, 2009] The large differences in HIV prevalence among African countries remain to be explained.…”