Author/s: Nadine Nannan (Burden of Disease Research Unit, MRC) Date: October 2016
The infant mortality rate (IMR) is defined as the probability of dying within the first year of life, and refers to the number of babies under 12 months who die in a year, per 1,000 live births during the same year. Similarly, the under-five mortality rate (U5MR) is defined as the probability of a child dying between birth and the fifth birthday. The U5MR refers to the number of children under five years old who die in a year, per 1,000 live births in the same year.
Dorrington RE, Bradshaw D, Laubscher R & Nannan N (2015) Rapid Mortality Surveillance Report 2014. Cape Town: Medical Research Council.
The infant and under-five mortality rates are key indicators of heath and development. They are associated with a broad range of bio-demographic, health and environmental factors which are not only important determinants of child health but are also informative about the health status of the broader population.
This information is ideally obtained from vital registration systems. However, like many middle-and lower-income countries the under-reporting of births and deaths renders the South African system inadequate for monitoring purposes. South Africa is therefore reliant on alternative methods, such as survey and census data, to measure child mortality. Despite several surveys which should have provided information to monitor progress, the lack of reliable data since 2000 led to considerable uncertainty around the level of childhood mortality for a prolonged period, however, the second South Africa National Burden of Disease Study has produced national and provincial infant and under-five mortality trends from 1997 up until 2010. These profiles can be seen: http://www.mrc.ac.za/bod/reports.htm
An alternative approach to monitor age-specific mortality nationally since 2009 is the rapid mortality surveillance system (RMS) based on the deaths recorded on the population register by the Department of Home Affairs.1 The RMS data have been recommended by the Health Data Advisory and Co-ordinating Committee because corrections have been made for known biases. In other words, the indicators shown in the table above are nationally representative. The RMS reports vital registration data adjusted for under-reporting which allow evaluation of annual trends. They suggest the infant mortality rate peaked in 2003 when it was 53 per 1,000 and decreased to 28 per 1,000 in 2014. During the same period the under-five mortality rate decreased from 81 per 1,000 to 39 per 1,000, which equates to a 10% annual rate of reduction up until 2011, with no further noteworthy decline since 2012.
The neonatal mortality rate (NMR) is the probability of dying within the first 28 days of life, per 1,000 live births. The NMR was 11 per 1,000 live births in 2014. Estimates on the NMR are based on registered deaths for the period 2006–2013 and the District Health Information System for 2011– 2014.
1Goga AE, Dinh TH & Jackson DJ for the SAPMTCTE study group (2013) Early (4-8 weeks post-delivery) Population-level Effectiveness of WHO PMTCT Option A, South Africa, 2011. Medical Research Council, Department of Health and PEPFAR/US Centers for Disease Control and Prevention.
2South Africa Every Death Counts Writing Group (2008) Every death counts: use of mortality audit data for decision making to save the lives of mothers, babies and children in South Africa. The Lancet, 371(6920): 1294-1304.
3Statistics South Africa (2009) Mortality and Causes of Death in South Africa, 2007. Findings from death notification.Statistical release P0309.3. Pretoria: StatsSA.
4Statistics South Africa (2014) Mortality and Causes of Death in South Africa, 2011. Findings from death notification.Statistical release P0309.3. Pretoria: StatsSA.
5United Nations (2000) United Nations Millennium Declaration. Resolution adopted by the General Assembly. A/RES/55/2, 18 September 2000. UN: New York.
6Nannan N, Dorrington RE, Laubscher R, Zinyakatira N, Prinsloo M, Darikwa TB, Matzopoulos R & Bradshaw D (2012)Under-5 Mortality Statistics in South Africa: Shedding some light on the trends and causes 1997 – 2007. Cape Town: Medical Research Council.
7Dorrington RE, Bradshaw D, Laubscher R & Nannan N (2015) Rapid Mortality Surveillance Report 2014. Cape Town: Medical Research Council.