This study uses pregnancy history information from a demographic surveillance
site in rural KwaZulu-Natal, along the eastern coastal board of South Africa, to
investigate the mortality levels, trends and selected factors associated with childhood
mortality. Life table analysis of the data reveals a reversal of the downward
trend in mortality rates over time that began around 1990 in this population.
Between 1990 and 2000 infant mortality increased from 43 to 65 per 1000 live
births and under-five mortality from 65 to 116 per 1 000 live births which translates
into a RR of 1.85 over the 10 year period (p-value <0.001). Maternal HIV
prevalence in this area is among the highest in South Africa and rose from 4.2%
to 26.0% during this period, making it probable that much of the increase in
child deaths is attributable to mother to child transmission of HIV. Negative binomial
regression identified the source of water, level of maternal education at the
time of the survey and being a recipient of the child support grant as important
factors associated with child mortality. However, their joint effect is attenuated
by the overwhelming impact of HIV which also appears to have swamped the
anticipated health benefit expected from various health care reforms.