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 underfive
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.