These and other statistics are contained in the 2010 South African Health Review (SAHR), an annual measure of the country’€™s health status.

The 2010 SAHR focuses on South Africa’€™s progress towards the Millennium Development Goals. Reducing child mortality is a central goal.

Child mortality is a crude reflection of the health status of children and is generally credited as a surrogate marker for the quality of care within a health service. However, data needs to be accurate and there is concern that the quality of data collected in the South African health system is extremely variable.

SAHR authors Neil McKerrow of the University of KwaZulu-Natal and Mphele Mulaudizi of the University of Pretoria reflect of child mortality data from five sources including the SA Demographic and Health Survey and the Death Notification System as recorded in 2007. The year 2007 presented the most up to date data from the sources that make this type of information available.

Analysis of the 2007 data revealed that while the majority of deaths occur in Gauteng and KwaZulu-Natal, the under-5 mortality rate is actually highest in the Free State (110.6 per 1 000) and the Northern Cape (100.3 per 1 000) with a national figure of 62.1 per 1 000.

A fifth of under-5 deaths were in the neonatal period and almost three quarters before one year of age. In all age groups almost half of the deaths occurred outside the health system.

All nine provinces have a similar ratio of stillbirths, infant and child deaths with 70 to 80% of under 5 deaths occurring in the first year of life.

The majority of neonatal deaths were due to respiratory and cardiovascular disorders followed by disorders related to growth and prematurity.

After the first year of life, a quarter of deaths are due to intestinal infections with respiratory infections, malnutrition and tuberculosis being the next most common cause.

McKerrow and Mulaudzi said the data from death notification forms underestimate the contribution of malnutrition and HIV and AIDS to childhood mortality.

In the under-five age group the top three causes of death are similar in all provinces, namely intestinal infections, influenza and pneumonia, and neonatal cardiovascular and respiratory disorders.

The data presented by McKerrow and Mulaudzi also revealed massive inequities when it came to accessing health care. Overall, the majority of children in all provinces are dependent on the public health system where between 7 and 8% live more than 30 minutes from a primary health care clinic. In the public health sector there is one paediatrician for every 40 180 children, though this ratio ranges from 1:9 856 in the Western Cape to 1:1.1-million in Mpumalanga.

Factors identified via the data, that could have prevented the child’€™s death if corrected, included failure to recognise the severity of the illness, late presentation to the health service or delay in transfer to more specialized care.

McKerrow and Mulaudzi said it was critical to strengthen the Community Health Worker programme as health care had to be extended into the community and home.

These workers should be trained to among others dispense oral rehydration solution to children with diarrhea and first-line antibiotics for children with acute respiratory infections.