South Africa's child mortality reduction deemed 'a successful failure'

The case of South Africa, which failed to meet the MDG4 child mortality goal due to the simultaneous onset of the HIV epidemic, suggests that success is partly determined by how the goal was formulated. In South Africa, under-five mortality was already low in 1990, but increased as the HIV epidemic emerged. Thus, despite considerable mortality reduction in the last 10 years, South Africa saw no appreciable change between 2015 and the beginning of the MDG period (see graph).

"Whether or not a country achieved MDG4 also depends on how narrowly that goal was defined," says Peter Byass, epidemiologist at Umeå University and lead author of the article. "Our statistical research shows that it is possible to be successful in terms of controlling the HIV epidemic and lowering child mortality, as has been the case in South Africa, but at the same time spectacularly failing to meet MDG4. Although South Africa was never likely to meet the arbitrarily defined goal of reducing under-five child mortality by two thirds, the country is nevertheless back to the child mortality level it had before the HIV epidemic, which objectively should be considered a huge success."

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. However, a unique set of health data from the population of the Agincourt sub-district, in northeastern South Africa, offers a rare exhaustive glimpse of a population through the MDG period. The data is based on annual household visits, which included verbal autopsies to determine the number and causes of deaths in each household.