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

Kate J. Kerber, Joy E. Lawn, Leigh F. Johnson, Mary Mahy, Rob E. Dorrington, Heston Phillips, Debbie Bradshaw, Nadine Nannan, William Msemburi, Mikkel Z. Oestergaard, Neff P. Walker, David Sanders, Debra Jackson

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


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 AfricaÊs 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.

Original languageEnglish (US)
Pages (from-to)2637-2648
Number of pages12
Issue number16
StatePublished - Oct 23 2013


  • AIDS models
  • Millennium Development Goals
  • South Africa
  • child mortality
  • epidemiology
  • neonatal mortality
  • prevention of mother-to-child transmission

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


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