Rates and causes of child mortality in an area of high HIV prevalence in rural South Africa

Objective: To determine child mortality rates in a rural area of South Africa with high HIV prevalence. Methods: A community-based survey was conducted between 1 January 2000 and 31 December 2002 on deaths in children under the age of 15 years. Children were followed up through four monthly home visits. Cause of death was ascertained by verbal autopsy. Rates were calculated using Poisson regression. Results: Mortality ratios were 59.6 deaths per 1000 live births for infants and 97.1 for children under 5 years of age. Infant and under-5 mortality rates were, respectively, 67.5 and 21.1 deaths per 1000 person-years. HIV/AIDS was attributed to 41% of deaths in the under-5 age group, with a mortality rate of 8.6 per 1000 person-years. Lower respiratory infections caused an estimated 24.9 deaths per 1000 person-years in children under 1 year of age. Conclusions: In rural South Africa, infant and child mortality levels are high, with HIV/AIDS estimated as the single largest cause of death. Interventions to reduce child mortality are required urgently. © 2006 Blackwell Publishing Ltd.