Provincial differences in infant deaths in South Africa - An effect of antiretroviral interventions?
Objective. It has previously been demonstrated that a peak in registered infant deaths, at 2-3 months of age at death, developed between 1997 and 2002 in South Africa, alongside the evolving HIV epidemic. The objective of this analysis was to explore the age distribution of post-neonatal infant deaths in South Africa by province, and relate the observed distributions to HIV and intervention characteristics. Design. Ecological study based on registered infant deaths and published HIV and intervention characteristics. Methods. Numbers of registered infant deaths beyond 1 month of age at death were plotted by year of death, province of South Africa and age at death in months, for the years 1997-2007. Results. The total number of registered deaths in infants aged 1-11 months increased from 15 404 in 1997 to 34 479 in 2006. Eight of the 9 provinces experienced an annual peak in registered infant deaths at 2-3 months of age between 1997 and 2007. This peak in mortality was not observed in the Western Cape. In 7 of 9 provinces registered post-neonatal infant deaths did not rise markedly in 2007 compared with 2005. Conclusions. We identified a single province out of 9 South African provinces in which a peak in early infant deaths at age 2-3 months did not occur during the period 1997-2007. This was the province with the earliest and highest coverage of antiretroviral interventions from 1999 onwards. It is possible that these interventions have averted the greater increase in early infant deaths seen in the rest of South Africa over this period.