1990-2011 年南非儿童死亡情况：艾滋病毒服务是否足以扭转趋势以实现千年发展目标 4？
South African child deaths 1990-2011: have HIV services reversed the trend enough to meet Millennium Development Goal 4?
机构信息
aSchool of Public Health, University of the Western Cape, South Africa bSaving Newborn Lives, Save the Children, USA cChild Health Epidemiology Reference Group dMARCH (Maternal Reproductive & Child Health), London School of Hygiene and Tropical Medicine, UK eCentre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa fUNAIDS, Switzerland gCentre for Actuarial Research, University of Cape Town hUNAIDS iBurden of Disease Research Unit, Medical Research Council, South Africa jDepartment of Health Statistics and Informatics, World Health Organization, Switzerland kJohns Hopkins Bloomberg School of Public Health, USA.
出版信息
AIDS. 2013 Oct 23;27(16):2637-48. doi: 10.1097/01.aids.0000432987.53271.40.
OBJECTIVE
To analyse trends in under-five mortality rate in South Africa (1990-2011), particularly the contribution of AIDS deaths.
METHODS
Three nationally used models for estimating AIDS deaths in children were systematically reviewed. The model outputs were compared with under-five mortality rate estimates for South Africa from two global estimation models. All estimates were compared with available empirical data.
RESULTS
Differences between the models resulted in varying point estimates for under-five mortality but the trends were similar, with mortality increasing to a peak around 2005. The three models showing the contribution of AIDS suggest a maximum of 37-39% of child deaths were due to AIDS in 2004-2005 which has since declined. Although the rate of progress from 1990 is not the 4.4% needed to meet Millennium Development Goal 4 for child survival, South Africa's average annual rate of under-five mortality decline between 2006 and 2011 was between 6.3 and 10.2%.
CONCLUSION
In 2005, South Africa was one of only four countries globally with an under-five mortality rate higher than the 1990 Millennium Development Goal baseline. Over the past 5 years, the country has achieved a rate of child mortality reduction exceeded by only three other countries. This rapid turnaround is likely due to scale-up of prevention of mother-to-child transmission of HIV, and to a lesser degree, the expanded roll-out of antiretroviral therapy. Emphasis on these programmes must continue, but failure to address other aspects of care including integrated high-quality maternal and neonatal care means that the decline in child mortality could stall.
目的
分析南非（1990-2011 年）5 岁以下儿童死亡率的趋势，特别是艾滋病死亡的影响。
方法
系统综述了三种用于估计儿童艾滋病死亡的国家使用模型。将模型输出与两种全球估计模型的南非 5 岁以下儿童死亡率估计值进行比较。所有估计值均与现有经验数据进行比较。
结果
模型之间的差异导致 5 岁以下儿童死亡率的点估计值存在差异，但趋势相似，死亡率在 2005 年左右达到峰值。三个显示艾滋病影响的模型表明，2004-2005 年，艾滋病导致儿童死亡的比例最高可达 37-39%，此后这一比例有所下降。尽管从 1990 年开始的进展速度未能达到儿童生存的千年发展目标 4 规定的 4.4%，但南非在 2006 年至 2011 年期间的 5 岁以下儿童死亡率平均年下降率在 6.3%至 10.2%之间。
结论
2005 年，南非是全球仅有的四个 5 岁以下儿童死亡率高于 1990 年千年发展目标基线的国家之一。在过去的 5 年里，该国实现了儿童死亡率下降速度超过其他三个国家的速度。这种快速转变可能是由于预防母婴传播艾滋病毒方案的扩大，以及在一定程度上扩大了抗逆转录病毒治疗的推广。必须继续强调这些方案，但如果不解决包括综合高质量母婴保健在内的其他方面的护理问题，儿童死亡率的下降可能会停滞。
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