Why children die: an under-5 health care survey in Mafikeng region

S Afr Med J. 2004 Mar;94(3):202-6.


Objective: To describe causes of under-5 deaths occurring in the health care system in Mafikeng region and modifiable factors related to these deaths.

Design: A prospective descriptive study.

Setting: The four public sector hospitals in Mafikeng health region in North West province (Gelukspan, Zeerust-Lehurutshe, Thusong, and Mafikeng Provincial Hospital).

Methods: This study of under-5 deaths used and piloted the Under-5 health care Problem Identification Programme.

Study period: 1 November 2000-31 October 2001.

Results: Two hundred and thirty-nine under-5 deaths occurred in the health system. The case fatality rate for the total of 4 226 under-5 admissions was 5.7%. Seventy-four per cent of the under-5 deaths occurred during the first year of life; 31% during the first 24 hours in hospital. The main causes of death were lower respiratory tract infections (31.4%), AIDS (21.3%) and sepsis (13.4%). When adding all causes of death and contributing conditions, 61.9% were AIDS- or HIV-related. Eighty-three per cent of cases had administrative modifiable factors, 67% had modifiable factors at primary care level, 47% during admission/emergency care in hospital, and 55% during routine care.

Conclusions: Priority problems identified in this study were case management of lower respiratory tract infections, failure to thrive, and insufficient documentation of patient care. As most under-5 deaths in this study were HIV/AIDS-related, it is an urgent necessity to expand effective programmes to prevent mother-to-child transmission and HIV infection in adults and to advocate comprehensive treatment programmes for HIV/AIDS.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Distribution
  • Cause of Death*
  • Child Health Services / standards*
  • Child Health Services / statistics & numerical data
  • Child, Preschool
  • Cohort Studies
  • Developing Countries
  • Female
  • Hospital Mortality
  • Hospitals, Public / standards
  • Humans
  • Infant
  • Infant Mortality / trends*
  • Infant, Newborn
  • Male
  • Medical Audit*
  • Medical Records
  • Primary Health Care / standards
  • Prospective Studies
  • Risk Factors
  • Sex Distribution
  • Socioeconomic Factors
  • South Africa / epidemiology