title: South African child deaths 1990-2011: have HIV services reversed the trend enough to meet Millennium Development Goal 4?
abstract: 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 Africa's average annual rate of under-five mortality decline between 2006 and 2011 was between 6.3 and 10.2%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: aSchool of Public Health, University of the Western Cape, South Africa bSaving Newborn Lives, Save the Children, USA cChild Health Epidemiology Reference Group dMARCH (Maternal Reproductive & Child Health), London School of Hygiene and Tropical Medicine, UK eCentre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa fUNAIDS, Switzerland gCentre for Actuarial Research, University of Cape Town hUNAIDS iBurden of Disease Research Unit, Medical Research Council, South Africa jDepartment of Health Statistics and Informatics, World Health Organization, Switzerland kJohns Hopkins Bloomberg School of Public Health, USA.
authors.forename: Kate J
authors.initials: KJ
authors.lastname: Kerber
authors.forename: Joy E
authors.initials: JE
authors.lastname: Lawn
authors.forename: Leigh F
authors.initials: LF
authors.lastname: Johnson
authors.forename: Mary
authors.initials: M
authors.lastname: Mahy
authors.forename: Rob E
authors.initials: RE
authors.lastname: Dorrington
authors.forename: Heston
authors.initials: H
authors.lastname: Phillips
authors.forename: Debbie
authors.initials: D
authors.lastname: Bradshaw
authors.forename: Nadine
authors.initials: N
authors.lastname: Nannan
authors.forename: William
authors.initials: W
authors.lastname: Msemburi
authors.forename: Mikkel Z
authors.initials: MZ
authors.lastname: Oestergaard
authors.forename: Neff P
authors.initials: NP
authors.lastname: Walker
authors.forename: David
authors.initials: D
authors.lastname: Sanders
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
mesh_terms: D046688:Child Mortality; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality* / Q000517:prevention & control; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D013019:South Africa / Q000453:epidemiology