child mortality

Every death counts: Saving the lives of mothers, babies and children in South Africa
A new report gives unified recommendations based on clinical audits of deaths that occur in hospitals and identifies specific actions for government officials and policymakers, health managers and healthcare providers to save lives. A supplementary information sheet gives the latest statistics on maternal and child mortality.

Child mortality is an important health and development indicator as it gives information about the health of a community and its children. Reducing child mortality is one of the 8 Millennium Development Goals. The health of children needs to be a priority, a principle adopted through ratification of the 1990 United Nations Convention of the Rights of the Child.  The level of mortality is a fundamental indicator of child health and understanding the causes of death of children provides insight as to how it can be reduced.

The lack of reliable statistics about child mortality has created a void when it comes to these indicators. In order to overcome this, the 2000 SA burden of disease study made use of available data from the emerging health information system to estimate the levels and causes of child mortality.  

Infant and under-5 mortality
HIV/AIDS is the leading cause of death among young children and accounts for 35% of the deaths in 2000 (see leading twenty causes for children under the age of 5). Although the percentage of deaths due to HIV/AIDS is higher in the 1-4 year age group, the largest number of deaths occurs in the under-1 age group. Neonatal causes account for 30% and childhood illnesses account for another 30%.

Older children (5-14 years)
As children get older, external causes (eg. road traffic injuries and drowning) rise in importance. This is particularly among boys, who die in greater numbers than girls. This pattern becomes particularly marked among the 10-14 year age group, where traffic accidents is the leading cause of death. Homicide and suicide feature in the top causes of deaths in these ages and among the 10-14 year age group, homicide is the second leading cause of death. HIV/AIDS is no longer a leading cause of death in this age group, although other infectious diseases make up a large proportion of the remaining top causes.

Recommendations
The mortality data indicates that many child deaths occurring in South Africa are preventable. There are three broad areas that require differing approached for intervention:

• The prevention of mother-to-child transmission of HIV.
• Avoiding pregnancy and childbirth complications.
• Reducing newborn illnesses particularly of small and preterm babies.
• The reduction of the diseases and conditions associated with under-development such as diarrhoea, respiratory infections and malnutrition. Poverty reduction initiatives are also important in this regard.
• The reduction of road traffic accidents and violence.

The MRC Maternal and Infant Health Care Strategies Research Unit developed a surveillance system to monitor perinatal deaths. This has been extended to monitor child deaths. See the Saving children reports and the Saving babies reports for an overview of the hospital deaths using the audit and Every death counts: Saving the lives of mothers, babies and children in South Africa for recommendations based on these audits.