Factors a associated wit ith i infant m mortalit ity i in S - PDF document

Factors a associated wit ith i infant m mortalit ity i in S South A Africa: A A provin incia ial perspective Pris iscil illa B Bartus Statistics South Africa: Population Statistics Division Abstract The sustainable development goal 3 adopted by countries in 2015 seeks to ensure healthy lives and promote well-being for all at all ages by 2030. For South Africa to achieve this there is a need to reduce infant mortality which will result in a decline in child mortality. Addressing specific challenges to the provinces will ensure that the national mortality rate is reduced. The aim of the study was to determine which factors are associated with infant mortality in South Africa from a provincial perspective by applying the Cox regression. Infant mortality rates were found to be high in Free State and North West provinces. The rates were estimated to be 44.2 in Free State and 41.9 in North West. The p-value was (0.2733) greater than 0.05 indicating that the chi-square is not significant at the 5% level of significance. The findings suggest the fitted models can be used to assess provinces that are experiencing high infant mortality. By including covariates that are related to basic services the environmental factors that contribute to mortality are highlighted for government interventions. Key words: : Infant, mortality rate, factors 1. 1. Introductio ion 1.1 Backgro round nd African children face higher risk of death as compared to European children. Child mortality was estimated to be 55 per 1000 live births in World Health Organisation (WHO) African countries while that of WHO European countries was 10 per 1000 live births (WHO, 2015). The reduction of child mortality is one problem many countries especially in Africa continue to battle with. Better health care services are not available to many and governments struggle to provide this basic service. Goal 4 of the millennium development goals (MDG 2015) aimed at reducing child mortality. In 2015 it was reported that globally under five mortality rate had declined between the period 1990 and 2015. Over the 25 year period child mortality decreased from 90 to 43 deaths per 1,000 live births (United Nations, 2015). Like many Sub-Saharan countries South Africa by 2010 was failing to reach the target to reduce

child mortality. The MDG Country Report 2010 revealed that under five mortality rates for South Africa were high and the country was far from achieving the international target of 20 per thousand deaths (MDG Country Report 2010). A comparison of provinces showed that Limpopo had the highest under five mortality rate of 110 per 1000 deaths with infant mortality rate (IMR) contributing 55% to the under five mortality (MDG Country Report 2010). Also, in South Africa, studies exist identifying the factors associated with infant mortality, but none has done so from a provincial perspective, using the census 2011 data. Thus, creating a gap which this study is aimed to address. Therefore, this paper seeks to examine the determinants of infant mortality in provinces. 1.2 Li Litera rature re Revie iew The study of infant and child mortality is one that has been much researched about by demographers because for a population to grow it is important that children born survive and develop to reproduce children of their own. This forms the bases for the need to understand factors associated with mortality as to be able to decrease child mortality (Tymicki, 2009). However this does not mean that women should give birth too many children. Birth intervals is also an important factor to consider. A study by Nsejje et al 2015 found children born to women who give birth in shorter intervals were at a higher risk of death within the first five years of life indicating a need for education on family planning in Uganda. This case would be no different in rural provinces of South Africa like Eastern Cape, KwaZulu-Natal and Limpopo. Muriithi D. M and Murrithi D. K (2015) found that poor mothers were more likely to have their infant die than rich mothers and age of mother was found to be a contributing factor in Kenya. A study by Ntuli et al 2013 found that infant mortality accounted for 31% of the under five mortality and the leading causes of death were found to be diarrhoea, pneumonia and HIV/AIDS. South Africa faces similar challenges regarding health care services in certain provinces. Th e Western Cape Health Department (2005) reported that Khayelitsha had an IMR of 44 per 1000 live births which was the highest in the province. These results implies that even though the Western Cape is highly urbanised there are certain areas or communities that are experiencing challenges in terms of service delivery and health care services. In 2003, Eastern Cape was found to have an IMR of 55.1 per 1000 live births whilst the national figure was 41 per 1000 live births (SANRAL, 2007). Northern Cape is among the provinces that reported that 50 per 1000 children were underweight (The Triennial Report 2015). Underweight babies have a higher likelihood of death as compared to infants that are born healthier. Analysis of mortality in Free State found that the mortality rates were higher in children and the elderly population. Sex disparity was evident in infant mortality with regards to infectious diseases, maternal and perinatal diseases and nutritional deficiencies (Bradshaw et al 2000). A study conducted in KwaZulu-Natal estimated infant mortality to be 92 per 1000 live births and under five

mortality of 132 per 1000 live birth. These rates were highest in rural districts as compared to EThekwini metropolitan district (Hoque, 2001). There has been a growth of informal settlements in North West from 12.3% in 2002 to 22.8% in 2011 (The Triennial Report 2015). Informal settlement do not have access to services and live under poor conditions which are associated with infant mortality. Tshwane metropolitan district is among the districts with the lowest infant mortality in the Gauteng, 17 per 1000 live births, however the growing levels of poverty account for children being malnutrition which is a contributing factor to infant mortality (The Triennial Report 2015). HIV/AIDS with diarrhoeal diseases, low birth weight, lower respiratory infections and protein-energy malnutrition was reported to be the leading causes of death in under-fives in Mpumalanga province (Bradshaw et al 2000). The Limpopo Provincial Department partnered with other stakeholders to form the Limpopo Initiative for New-born Care (LINC) in 2003 with aim of improving child care in hospitals. The program has resulted in neonatal deaths being reduced by 8.0%. Hospital staff and mothers were trained on infant care (UNICEF for South Africa, 2015). The Triennial Report 2015 indicated that 6.5% of children die from non-natural deaths in Limpopo. Most of these deaths do not happen in a health facility. Cultural beliefs leads to preference of traditional healer and parents delay consulting a medical doctor which may resulting in the death of the child or infant in the province (The Triennial Report 2015). The conceptual framework on childhood mortality is influenced by bio-genetic factors and environment factors (Tymicki, 2009). This paper focuses on environment factors by considering the social economic level of households and the demographic factors. 1.3 Pro robl blem Statement The sustainable development goal 3 adopted by countries in 2015 seeks to ensure healthy lives and promote well-being for all at all ages by 2030. For South Africa to achieve this, there is a need to reduce infant which will result in a decline in child mortality. Addressing specific challenges to the province will ensure that the national mortality rate is reduced. The paper seeks to find the determinants of infant mortality in South Africa.