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Homicide of children is a global problem. The under-5-y age group is the second largest homicide age group after 15-19 y olds, but has received little research attention. Understanding age and gender patterns is important for assisting with developing prevention interventions. Here we present an age and gender analysis of homicides among children under 5 y in South Africa from a national study that included a focus on neonaticide and infanticide. A retrospective national cross-sectional study was conducted using a random sample of 38 medico-legal laboratories operating in 2009 to identify homicides of children under 5 y. Child data were abstracted from the mortuary files and autopsy reports, and both child and perpetrator data data were collected from police interviews. We erred towards applying a conservative definition of homicide and excluded sudden infant death syndrome cases. We estimated that 454 (95% CI 366, 541) children under the age of 5 y were killed in South Africa in 2009. More than half (53.2%; 95% CI 46.7%, 59.5%) were neonates (0-28 d), and 74.4% (95% CI 69.3%, 78.9%) were infants (under 1 y), giving a neonaticide rate of 19.6 per 100,000 live births and an infanticide rate of 28.4 per 100,000 live births. The majority of the neonates died in the early neonatal period (0-6 d), and abandonment accounted for 84.9% (95% CI 81.5%, 87.8%) of all the neonates killed. Distinct age and gender patterns were found, with significantly fewer boy children killed in rural settings compared to urban settings (odds ratio 0.6; 95% CI 0.4, 0.9; p = 0.015). Abuse-related killings and evidence of sexual assault were more common among older girls than in all other age and gender groups. Mothers were identified as the perpetrators in all of the neonaticides and were the most common perpetrators overall (71.0%; 95% CI 63.9%, 77.2%). Abandoned neonates were mainly term babies, with a mean gestational age of 38 wk. We did not have information on abandonment motives for all newborns and did not know if babies were abandoned with the intention that they would die or with the hope that they would be found alive. We therefore considered all abandoned babies as homicides. Homicide of children is an extreme form or consequence of violence against children. This national study provides one of the first analyses of neonaticide and infanticide by age and gender and shows the failure of reproductive and mental health and social services to identify and help vulnerable mothers. Multi-sectoral prevention strategies are needed.

Verbal autopsy (VA), though imperfect, serves as a vital tool to determine cause-of-death, particularly for out-of-facility deaths, but challenges persist in integrating VA into Civil Registration and Vital Statistics systems. To describe the challenges and successes of collecting a national sample of verbal autopsy interviews in South Africa to obtain the cause of death profile in 2017/18. We recruited next of kin from 27 randomly selected sub-districts (10.5%) across South Africa between September 2017 and April 2018. Trained fieldworkers conducted face-to-face interviews using the WHO2016 VA instrument, with physicians certifying underlying causes of death. Feasibility was evaluated based on response rates, participation, and data quality. Of the total 36,976 deaths registered, only 26% were identified during recruitment, with a 55% overall response rate for VA interviews. Physician-reviewed VA data were deemed of good quality for assigning underlying causes of death in 83% of cases. By comparing cause-specific mortality fractions, physician-reviewed VA identified 22.3% HIV/AIDS and InterVA-5 identified 18.5%, aligning with burden of disease estimates, while Statistics South Africa reported 4.9% HIV/AIDS. The study demonstrated the feasibility of using VA on a national scale, but immense challenges in identifying and recruiting next of kin highlight the importance of formalising VAs within the country's death notification system.

To estimate the completeness of live birth registration through South Africa's civil registration and vital statistics system between 1996 and 2011. The number of births registered by the civil registration and vital statistics system was compared with independent estimates of the true number of births derived using: (i) the reverse survival method applied to 2011 census data; (ii) the application of estimated age-specific fertility rates to population estimates from censuses and surveys; and (iii) data from the public-sector district health information system. In 1996, an estimated 25% of births were registered within the calendar year of birth and 33% were registered before the end of the subsequent calendar year. By 2008, 76% of registrations occurred within the calendar year of birth, 84% occurred by the end of the following year and 90% occurred before the child's fifth birthday. These improvements were seen in all provinces and differences in completeness between provinces narrowed markedly. Improvements in the completeness of registration coincided with government efforts to strengthen the system, new legislation on vital registration and the introduction of child support grants, which required birth certificates. Interprovincial migration of children influenced the completeness of registration in affected provinces. There was some terminological confusion among government agencies on defining the timeliness of registration and the year of birth. The completeness of birth registration in South Africa increased rapidly between 1996 and 2004. To allow international comparison, the method for measuring the completeness of birth registration needs to be standardized.

Metodos El numero de nacimientos registrados por el sistema de registro civil y de estadisticas vitales se comparo con estimaciones independientes del numero real de nacimientos mediante el uso de: (i) el metodo inverso de supervivencia aplicado a los datos del censo de 2011; (ii) la aplicacion de tasas de fecundidad estimadas por edad a las estimaciones de poblacion de los censos y encuestas; y (iii) los datos del sistema de informacion sanitaria del sector publico de los distritos.

Global Burden of Diseases, Injuries, and Risk Factors Study 2010 results show continued limitations of data quality and availability in most of the African region. Focused efforts in South Africa, however, have contributed to improved completeness and availability of mortality data, such that South Africa is currently undertaking a second National Burden of Disease Study. Mortality estimates have been developed nationally and for the nine provinces for 1997–2009. Vital registration data obtained for 1997–2009 were adjusted for completeness using indirect demographic techniques. A regression approach was used to identify misclassified AIDS deaths, and garbage codes were proportionally redistributed by age, sex, and population group. Injury deaths were estimated from additional data sources. Age-standardised mortality rate (ASMR) trends for the nine provinces were calculated using ASSA 2008 population estimates and the WHO age standard. All-cause mortality peaked in 2006 and thereafter started to decline. ASMRs showed a two-fold difference between the highest-affected and lowest-affected provinces for the 1997–2009 period. ASMR from HIV/AIDS increased threefold since 1997 with provincial variation, while mortality from non-HIV-related tuberculosis declined. Mortality rates from non-communicable diseases decreased over the period nationally but increased for some provinces and remained stable for others as a result of differing trends in hypertensive heart disease and respiratory diseases. Nationally, preliminary analyses for 2009 show that HIV/AIDS was responsible for the highest number of deaths (31·2%; n=194 322 of 622 300 deaths), followed by cerebrovascular disease (6·2%; n=38 666), tuberculosis (5·4%; n=33 375), lower respiratory infections (5·2%; n=32 568), and ischaemic heart disease (4·4%; n=27 688). However, tuberculosis and interpersonal violence ranked among the top five causes for males, while hypertensive heart disease and ischaemic heart disease featured for females. The downward trend in HIV/AIDS mortality can be attributed to the extensive antiretroviral treatment rollout since 2005. Differential provincial mortality trends reflect the different stages of epidemiological transition and differential health services in the provinces, providing relevant information for policy makers to address inequalities. South African Medical Research Council.

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. Cette étude utilise des informations historiques sur les naissances dans un site rural de surveillance démographique au KwaZulu-Natal sur la cote orientale de l'Afrique du Sud pour evaluer le taux de mortalité et leurs tendances et identifier les facteurs associés à la mortalité infantile. L'analyse des table de vie révèle une inversion de la tendance à la baisse du taux de mortalité entre 1990 et 2000 ., Pendant cette periode, la mortalité infantile a augmenté de 43 à 65 par 1000 naissances et celle des moins de 5 ans de 65 à 116 pour 1 000 naissances, ce qui se traduit par un RR de 1,85 pour la periode etudiee. (p-valeur < 0,001). La prévalence du VIH dans cette region est parmi les plus élevées en Afrique du Sud et a augmenté de 4,2 % à 26,0 % pendant cette période, il est donc probable que l'augmentation des décès d'enfants est en grande partie attribuable à la transmission du VIH de la mere a l'enfant. Une régression binomiale négative a identifie l'acces a léau potable , le niveau d'éducation de la mere au moment de l'enquête et à si la mere est bénéficiaire d' allocation sociale pour lénfant comme des facteurs importants associés à la mortalité infantile. Cependant leur effet meme combine, est atténué par l'immense impact du VIH qui semble avoir submerge les bénéfices attendus des diverses réformes de la santé.

The strength of the association between maternal height and child mortality (and growth failure) implies that the strategies and timeframe for achieving MDG 4 need to be reassessed, with appropriate weight given to interventions that have inter gener ational payoff s.3 As we assess the success and lessons learned in light of the failure to accomplish the goal by 2015, the need to adopt a holistic and intergener ational perspective towards the health-related MDGs is extremely important.4 We declare that we have no confl icts of interest. *S V Subramanian, Emre Özaltin svsubram@hsph.harvard.edu Harvard School of Public Health, Boston MA 02115, USA 1 Lozano R, Wang H, Foreman KJ, et al. Because we are committed to gathering the most and best data for measuring population health, we would applaud any eff orts to study further the association between maternal height and child mortality and the eff ect of that association on the ability of countries to achieve the Millennium Development Goals.

This study uses the 1996 Census and the 1998 Demographic and Health Survey (DHS) to investigate the level of and trend in infant and child mortality and their covariates in South Africa. Census estimates of childhood mortality are higher than those from the DHS. Analysis suggests that the former overestimate mortality while the latter are probably slightly too low. Both inquiries document a reversal of the trend toward lower mortality in the 1990s. Under-five mortality increased by about a third during the five years up to early 1998. By then the infant mortality rate was about 55 per 1000 and under-five mortality 72 per 1000. Other factors may explain the tapering off of the decline in mortality after the late 1980s but AIDS deaths account for its increase. Inequalities in childhood mortality between population groups, rooted in past discriminatory apartheid policies, shrank between the late-1970s and mid-1990s. However, they remain substantial and are largely unaccounted for by province, metropolitan residence and inter-group differences in mothers’ education. The HIV/AIDS epidemic is likely to offset the beneficial impact of post-apartheid pro-poor policies and may exacerbate racial differences in childhood mortality in South Africa. There is an urgent need to improve the routine collection of statistics to monitor child mortality so as to assess progress towards the Millennium Development Goals and track inequalities.

This paper presents estimates of South African provincial child and adult mortality, and fertility for 1986 to 1996. Fertility and child mortality rates are derived using data from the 1996 census adjusted where necessary using information from the 1998 Demographic and Health Survey. Adult mortality rates for 1996 were produced using the vital registration data in combination with the population data from the 1996 census and completeness of the registration of child deaths. These estimates suggest that the national total fertility rate fell from 3.67 in 1986 to 3.29 in 1996 and ranged between 2.63 to 4.01 for the individual provinces in 1996. Child mortality (₅q₀) fell from 73 per 1000 in 1986 to 57 per 1000 in 1992 before increasing to 70 per 1000 by 1996, and ranged between 40 and 95 for individual provinces in 1996. Life expectancy at birth in 1996 was 57 years for males (ranging from 53 to 61.5 for individual provinces) and 65 for females (ranging from 62 to 69 for individual provinces).