MRC PhD students

Trends and determinants of childhood mortality in rural South Africa: What can it tell us about the impact of government programs?

The global trend in childhood mortality, show that in most countries of the world substantial improvements in levels of child mortality were achieved throughout the 1970’s and 1980’s. This is also true of South Africa where a decade of rapid declines in child mortality rates was experienced from 1975. The declines in under-five mortality that took place from 1985 to the early nineties were less steep than the previous decade. The gradual decline continued until about 1992 when the downward trend in childhood mortality reversed. The reversal in the trend occurred in infants mostly during the post-neonatal period and this is likely to be the early results of the rapidly spreading HIV epidemic experienced in this rural part of South Africa.

It has been possible to explore the determinants of child mortality among a relatively homogenous rural population in rural KwaZulu Natal using the birth history data from the Africa Centre Demographic Information Surveillance (ACDIS) to investigate socioeconomic and other factors known to impact on child mortality. This analysis shows that after having adjusted for age, sex and period all of the selected socioeconomic factors display statistically significant associations with child mortality. However, the model building process reveals that certain factors impact more on child survival outcomes than others. Although water source is important, sanitation has a greater protective effect as does the level of the mother’s education, whereas the assets of a household no longer play a role in the survival of under-five year olds.

The PhD thesis will develop a framework of determinants of childhood mortality and analyse the prospective data for this population to assess what impact government programmes have had on child survival. It will also investigate which age groups are particularly sensitive to conditions of poverty.

Prof Rob Dorrington, Centre for Actuarial Research, UCT and Prof Debbie Bradshaw, MRC Burden of Disease Research Unit.