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UN targets did not take HIV rise into account
Child mortality is down, but SA deemed a failure in terms of millennium goals
WHEN generic criteria to assess achievements are formulated long in advance of endpoints, unforeseen consequences may follow – one of which is South Africa’s failure to achieve the UN Millennium Goal of child mortality due to the simultaneous onset of the HIV epidemic.
This is according to a paper recently published in the scientific journal PLOS Medicine, in which researchers at the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) and PRICESSLESS-SA in the Wits University School of Public Health and Umeå University in Sweden, argue country-specific factors need to be considered in determining their success in reaching global goals.
In 1990, the under-five mortality in South Africa was low relative to other sub-Saharan African countries, but escalated rapidly with the HIV epidemic.
The paper is titled “A Successful Failure: Missing the MDG4 Target for Under-Five Mortality in South Africa”, and it begins by stating that the MDGS were “fairly arbitrarily defined” to be measured over the period from 1990 to the end of last year, with a target of reducing mortality in children under five years old by twothirds.
Professor Kathleen Kahn from the MRC/Wits-Agincourt Unit said last week: “The MDG targets did not anticipate major disruptions such as the HIV/Aids epidemic, that affected some countries more than others. In SA, there wasn’t a steady decline in child mortality, but initially a major increase”. Drawing conclusions from national child mortality data is difficult because it requires access to detailed, consistent and reliable data for the entire MDG period from 1990-2015. “Through its health and demographic surveillance system, the MRC/Wits-Agincourt Unit has collected mortality and cause of death information annually on a rural population in north-eastern South Africa for over 20 years.
“Even though South Africa in the last 10 years has successfully reduced the number of childhood deaths associated with HIV, bringing overall child mortality levels down, the country’s progress as measured against MDG4 is deemed a failure,” says Peter Byass of Umeå University and honorary professor at Wits.
“Countries such as South Africa should be evaluated more deeply.” According to the paper, in South Africa the under-five mortality for the country in 1990 was the lowest in sub-Saharan Africa. “But the intervening period has been pivotal, as the transition to democracy coincided with the start of the HIV pandemic.
“South Africa’s under-five mortality trajectory from 1980 to 1990 was effectively on track for the 2015 target, until a sharp rise in mortality was observed in the mid-1990s. “Nevertheless, South African child mortality levels remained substantially lower than in sub-Saharan Africa as a whole, despite neither the country nor the region being on track for their respective 2015 targets, and very rapid reductions in mortality were estimated for South Africa around 2010,” the paper continued.
“With wider roll-out of Prevention of Mother-to-Child Transmission programmes and antiretroviral treatment in the early to mid-2000s, so we began to see mortality declining,” Kahn added.
Nevertheless, South Africa’s child mortality levels remained substantially lower than the rest of sub-Saharan Africa and according to the paper, went on to record considerable reductions in child mortality during the latter part of the MDG period.
The UN’s Sustainable Development Goals (SDGs) have since superseded the MDGs as of January 1 this year, and the new child mortality goal is based on absolute numbers instead of a percentage reduction from the baseline rate.
The new goal calls for less than 25 deaths per 1 000 live births by 2030 in all countries.
Country-specific factors important in determining their success