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

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

来源：AIDS, 2013, 27(16): 2637-2648.

DOI：10.1097/01.aids.0000432987.53271.40

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

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%26apos;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.

• 出版日期2013-10-23