Health and HIV - Child mortality (IMR & U5MR)
Health and HIV - Child mortality (IMR & U5MR)
Author/s:  Nadine Nannan (Burden of Disease Research Unit, MRC)
Date: October 2016
Definition

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.

Data
Data Source

Dorrington RE, Bradshaw D, Laubscher R & Nannan N (2015) Rapid Mortality Surveillance Report 2014. Cape Town: Medical Research Council. 

Notes
  1. The national infant mortality rate is given for the five-year period (1993-mid 98) preceding the SA Demographic and Health Survey. Due to small numbers, disaggregated data (by province, population group and sex) is given for the ten-year period (1988-1997) preceding the SADHS of 1998.
  2. Rates for three provinces (Western Cape, Free State and North West) were adjusted on the basis of the relationship between SADHS and the 1996 census data observed in the remaining provinces.
  3. In the population group delineation, the figure for "whites" is based on less than 500 cases and should be treated with caution. Results for the "Asian" group were suppressed in the SADHS report because they were based on less than 250 and could not be regarded as reliable.
What do the numbers tell us?

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.

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.

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.

Technical notes
The vital registration system and the Health Information System in South Africa remain inadequate for monitoring levels of and trends in infant and child mortality. South Africa is therefore reliant on survey data in this regard. The most reliable estimates of childhood mortality are collected from Demographic and Health Surveys (DHS), conducted every five years.

Demographic and Health Surveys are considered a ‘gold standard’ for measuring child mortality in developing countries 5. The last reliable empirical estimates come from the 1998 DHS. The failure of the 2001 census and the 2003 DHS to collect the information necessary for the calculation of childhood mortality rates, renders these estimates in 2009 severely outdated.
Strengths and limitations of the data
The last reliable empirical estimates come from the 1998 DHS. The failure of the 2001 census and the 2003 DHS to collect the information necessary for the calculation of childhood mortality rates, renders these estimates in 2009 severely outdated.
References and Related Links

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.


RELATED LINKS

Burden of Disease Research Unit
Medical Research Council
(www.mrc.ac.za/bod/bod.htm)

South African Department of Health
(
http://www.doh.gov.za/index.html)

South African HealthInfo™ network
Medical Research Council
(
http://www.sahealthinfo.org/sahealthinfo.htm)
Author: Nadine Nannan (Burden of Disease Research Unit, MRC)

Definition

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.

Commentary

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.

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.

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.

Strengths and limitations of the data
The last reliable empirical estimates come from the 1998 DHS. The failure of the 2001 census and the 2003 DHS to collect the information necessary for the calculation of childhood mortality rates, renders these estimates in 2009 severely outdated.
Technical notes
The vital registration system and the Health Information System in South Africa remain inadequate for monitoring levels of and trends in infant and child mortality. South Africa is therefore reliant on survey data in this regard. The most reliable estimates of childhood mortality are collected from Demographic and Health Surveys (DHS), conducted every five years.

Demographic and Health Surveys are considered a ‘gold standard’ for measuring child mortality in developing countries 5. The last reliable empirical estimates come from the 1998 DHS. The failure of the 2001 census and the 2003 DHS to collect the information necessary for the calculation of childhood mortality rates, renders these estimates in 2009 severely outdated.
References

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.


RELATED LINKS

Burden of Disease Research Unit
Medical Research Council
(www.mrc.ac.za/bod/bod.htm)

South African Department of Health
(
http://www.doh.gov.za/index.html)

South African HealthInfo™ network
Medical Research Council
(
http://www.sahealthinfo.org/sahealthinfo.htm)