Subnational estimates of child mortality are difficult to produce and are rare in SubSaharan
Africa. It is the overall aim of this research to derive estimates of child mortality
rates for the municipalities and provinces of South Africa using the 2011 census data,
and to assess the results in relation to the level of poverty and inequality. The estimation
of child mortality rates is achieved through the use of direct synthetic cohort methods
with Bayesian spatial smoothing. The Bayesian spatial smoothing process is used to
generate municipal level estimates of child mortality rates. The model utilises
information from neighbouring municipalities by controlling the effects of women’s
education and HIV/AIDS. It is found that there are clear and significant spatial
differentials in child mortality in the country, where at province level the under-five
mortality rate ranges from 26 deaths per 1000 live births in the Western Cape (WC) to
71 deaths per 1000 live births in KwaZulu-Natal (KZN). At municipal level, it ranges
from as low as 24 deaths per 1000 live births in the City of Cape Town (in WC) to as
high as 109 deaths per 1000 live births in uPhongolo (in KZN). Furthermore, the
estimates obtained are reasonable, and those at national and province level are in
agreement with results from many other researches. In evaluating the spatial differentials
in child mortality with the levels of poverty and inequality, it is shown that child
mortality is higher in poorer areas and vice-versa, although there are some cases where
an inverse relationship is observed. For instance, several municipalities in Limpopo
province scored relatively lower child mortality rates though the level of poverty is very
high. It is also shown that the distribution of income similarly matters to some extent as
greater child mortality is observed in more unequal areas – although the degree of
association is not as strong as that of poverty. These results are confirmed by multilevel
logistic regression model of child mortality. The findings of this study may help the
government to implement policies more effectively and make more focused decisions in
the fight for the reduction of child mortality in the country.