Health

We were asked to provide the provincial child mortality rate for the years 2018 to 2022, and the causes of child mortality. Unfortunately, as outlined below, the data available to us only allows us to provide the rates for 2018 (latest data from Statistics South Africa). Furthermore, since births and deaths are reported a few years in arrears by Stats SA with several caveats ( including that cause of death information excludes unnatural causes of death), we are unable to report on more recent years or on the underlying causes of death without access to all cause of death data.

The most recent report of child deaths is the SAMRC National Rapid Mortality Surveillance Report 2019 & 2020. This report suggests that nationally infant and under 5 mortality increased slightly from 2017 to 2019, but dropped sharply in 2020 with a lack of the usual seasonal pattern of infectious cause deaths, probably as a consequence of the very restrictive lockdown implemented from the end of March 2020, which, limited social interaction, and infection (through non-pharmaceutical interventions). Nationally mortality rates for children, adolescents and young adults aged 5 to 24 years old remained fairly constant from 2017 to 2019, but declined sharply in males aged 15-24 years in 2020, reflecting the substantial reduction in unnatural deaths brought about by the severe limitations of travel and social interaction and alcohol consumption under the lockdown introduced in April 2020.

 For the Western Cape 2018:

Infant mortality rate (IMR; deaths per 1000 live births): 16.5

Under 5/child mortality rate (u5MR; deaths per 1000 live births): 19.7

 Looking at trends, this is lower compared to 2016 and earlier

Under 19: Total deaths in the province to under 19 year olds in 2018: 2964

Under 19 death rate: 134 per 100 000 population under 19

Sources: 2018 Stats SA mortality data; 2018 Stats SA mid-year estimates

 Reasons for lack of more detailed and recent data on child mortality and its causes in the Western Cape

In South Africa, Civil and Vital Registration (CVRS – Civil and Vital Registration System) is under the auspices of the Department of Home Affairs (DHA). The DHA maintains a national population register (NPR) including all South African citizen. The CVRS system comprises births and deaths. While DHA maintains the NPR, Statistics South Africa (Stats SA) processes these records and makes details available at a country and provincial level. These details include causes of death. Globally, there is a 2-3 year delay in CVRS mortality reporting. The most recent causes of death and mortality report available from Stats SA is 2018 (http://www.statssa.gov.za/?page_id=1854&PPN=P0309.3&SCH=7923). Aside from these official reports, and high-level aggregate numbers, sub-provincial, and sub-municipal data are not made available to provincial departments of health.

 When looking at the health and well-being of citizens, population-level metrics are vital. This includes mortality data. While health departments are able to report on deaths that occur in public health facilities, this does not include the entire population and thus the reported metric will be sub-par (and an undercount of both the total number of deaths, as well as the causes of death).  

Specifically looking at mortality data – the BI-1663 form is most often completed by a medical professional and submitted to the DHA. The 4^th page of this form includes demographics (age, sex, geography) as well as the cause of death. This is the detail that is processed by Stats SA. Only DHA and Stats SA have access to these forms and only Stats SA has access to the page where cause of death is reported.  A key distinction between DHA reporting via the NPR and Stats SA reporting, is that DHA only reports on SA citizens, while Stats SA reports on all death (and births) in the country. The South African Medical Research Council (SA-MRC) have used the NPR to conduct rapid mortality surveillance (https://www.samrc.ac.za/reports/rapid-mortality-surveillance-report-2019-2020). However, this is only available at a country-level and only distinguishes between natural or unnatural causes and does not include underlying cause of death. A review of available mortality data sources was published in 2012 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3532367/). A recent article by Dorrington et al (Dorrington et al. Genus (2021) 77:19 https://genus.springeropen.com/track/pdf/10.1186/s41118-021-00134-6.pdf notes the utility of rapid mortality surveillance to monitor excess deaths during the COVID-19 pandemic. This article also includes a brief background on CVRS in the country.

 Infant (under 1) and child (under 5) mortality are reported per 1000 live births. Both birth and death data are reliant on the CVRS via DHA and Stats SA. For both births and deaths there are late registrations i.e. year of registration is different from year of occurrence e.g. born in 2019, registered in 2020. Late registrations will impact these metrics and they tend to stabilise and be more correct over time. While the 2020 births have been reported

 (http://www.statssa.gov.za/?page_id=1854&PPN=P0305&SCH=73006), deaths are only available through to 2018. Unfortunately information is not readily available via Stats SA published reports, and the data needs to be sourced separately in order to provide the appropriate metric(s). The published causes of death and mortality report provides underlying natural causes of death by specified age groups. This excludes unnatural causes of death, and it is not easy to look at smaller age groupings (unless one has access to the source data).

 The child mortality (under 5) rate is therefore only available for 2018, as 2019-2021 data has not yet been made available by Stats SA (deaths; birth data available through to 2020). Data is not made available for part of year so 2022 will not be available. While in-hospital mortality will be available, this is not the population level child-mortality (under 5) rate. In addition, 2022 live births are not available (important as this is an annual metric). Unfortunately, underlying cause of death is not available.