Where do Children Die and what are the Causes? Under-5 Deaths in the Metro West Geographical Service Area of the Western Cape; South Africa; 2011

BACKGROUND:Accurate child mortality data are essential to plan health interventions to reduce child deaths.OBJECTIVES:To review the deaths of children aged etlt;5 years during 2011 in the Metro West geographical service area (GSA) of the Western Cape Province (WC); South Africa; from routine data sources.METHODSA retrospective study of under-5 deaths in the Metro West GSA was done using the WC Local Mortality Surveillance System (LMSS); the Child Healthcare Problem Identification Programme (Child PIP) and the Perinatal Problem Identification Programme (PPIP); and linking where possible.RESULTS:The LMSS reported 700 under-5 deaths; Child PIP 99 and PPIP 252; with an under-5 mortality rate of 18 deaths per 1 000 live births. The leading causes of death were pneumonia (25%); gastroenteritis (10%); prematurity (9%) and injuries (9%). There were 316 in-hospital deaths (45%) and 384 out-of-hospital deaths (55%). Among children aged etlt;1 year; there were significantly more pneumonia deaths out of hospital than in hospital (144 (49%) v. 16 (6%); petlt;0.001). Among children aged 1 - 4 years there were significantly more injury-related deaths out of hospital than in hospital (43 (47%) v. 4 (9%); petlt;0.001). In 56 (15%) of the cases of out-of-hospital death the child had visited a public healthcare facility within 1 week of death. Thirty-six (64%) of these children had died of pneumonia orgastroenteritis. CONCLUSIONS:Health interventions targeted at reducing under-5 deaths from pneumonia; gastroenteritis; prematurity and injuries need to be implemented across the service delivery platform in the Metro West GSA. It is important to consider all routine data sources in the evaluation of child mortality

Declining child mortality in northern Malawi despite high rates of infection with HIV

Objective:To determine whether routine surveys; such as the Demographic and Health Surveys (DHS); have underestimated child mortality in Malawi : Methods :Rates and causes of child mortality were obtained from a continuous-registration demographic surveillance system (DSS) in Malawi for a population of 32 000. After initial census; births and deaths were reported by village informants and updated monthly by project enumerators. Cause of death was established by verbal autopsy whenever possible. The likely impact of human immunodeficiency virus (HIV) infection on child mortality was also estimated from antenatal clinic surveillance data. Overall and age-specific mortality rates were compared with those from the 2004 Malawi DHS. Findings:Between August 2002 and February 2006; 38 617 person-years of observation were recorded for 20 388 children aged 15 years. There were 342 deaths. Re-census data; follow-up visits at 12 months of age and the ratio of stillbirths to neonatal deaths suggested that death registration by the DSS was nearly complete. Infant mortality was 52.7 per 1000 live births; under-5 mortality was 84.8 per 1000 and under-15 mortality was 99.1 per 1000. One-fifth of deaths by age 15 were attributable to HIV infection. Child mortality rates estimated with the DSS were approximately 30 lower than those from national estimates as determined by routine surveys Conclusion: The fact that child mortality rates based on the DSS were relatively low in the study population is encouraging and suggests that the low mortality rates estimated nationally are an accurate reflection of decreasing rates