School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa.
S Afr Med J. 2024 Jun 24;114(6b):e1337. doi: 10.7196/SAMJ.2024.v114i16b.1337.
The infant mortality rate (IMR) (24 per 1 000 live births) remains high in South Africa (SA), well above the recommended sustainable development goal (SDG) 3 of 12 deaths per 1 000 live births. High infant mortality is a poor indicator of the health of a population and will hamper attainment of the SDGs.
To investigate the trends and distribution patterns of IMR between 2007 and 2016 and its association with HIV-positive pregnant mothers in SA.
This study used a cross-sectional study design by analysing secondary data on infant mortality from the 2007 and 2016 Statistics South Africa Community Surveys (CSs), as well as data from the 2007 National Antenatal Sentinel HIV and Syphilis Prevalence Survey. (Antenatal HIV Sentinel Survey - ANCHSS). Line charts with descriptive statistics were used to detail trends in IMRs, and multiple logistic regression models were used to identify risk factors for infant mortality in the 2007 and 2016 CS datasets. Spearman's rank-order correlation (rho) was used to correlate infant mortality with data from the 2007 ANCHSS. All analyses were performed with Stata version 16.0.
A total sample of 87 805, comprising 43 922 males and 43 883 females, was included in the analysis. The results revealed a decline in IMR from 55 deaths per 1 000 live births in 2007 to 32 in 2016. Overall, there was a significant decrease in the mortality rate from 2007 to 2016. The infant mortality proportions by province showed KwaZulu-Natal Province having the highest IMR (17.5 deaths per 1 000 live births in 2007 and 6.3 in 2016). Males had a higher IMR (28 deaths per 1 000 live births in 2007 and 17.7 in 2016) compared with females at 26.7 deaths per 1 000 live births in 2007 and 13.8 in 2016. IMR data from the 2007 CS was correlated with the 2007 ANCHSS (28% HIV prevalence in 2007), using Spearman's rank-order correlation, which showed a moderate correlation of 0.58 (p<0.001).
The study findings showed a reduction in the trends of infant mortality between 2007 and 2016 in SA; despite the reduction, health inequalities persist. There is a correlation evident between maternal HIV prevalence and IMR in SA. We recommend the use of disability-adjusted life expectancy in SA to measure population health and introduce robust data sets that can better inform policy.
南非（SA）的婴儿死亡率（IMR）（每 1000 例活产 24 例死亡）仍然很高，远高于可持续发展目标（SDG）建议的每 1000 例活产 12 例死亡。婴儿死亡率高是人口健康状况不佳的一个指标，并且会阻碍实现可持续发展目标。
调查 2007 年至 2016 年间 IMR 的趋势和分布模式及其与南非 HIV 阳性孕妇的关系。
本研究使用了横断面研究设计，分析了 2007 年和 2016 年南非统计局（Stats SA）社区调查（CS）中婴儿死亡率的二级数据，以及 2007 年全国产前哨点 HIV 和梅毒患病率调查（产前 HIV 哨点调查-ANCHSS）的数据。（产前 HIV 哨点调查-ANCHSS）。使用线图和描述性统计数据详细说明 IMR 的趋势，并使用 2007 年和 2016 年 CS 数据集的多变量逻辑回归模型确定婴儿死亡的风险因素。使用斯皮尔曼等级相关（rho）来分析婴儿死亡率与 2007 年 ANCHSS 数据之间的相关性。所有分析均使用 Stata 版本 16.0 进行。
共纳入 87805 例样本，其中男性 43922 例，女性 43883 例。结果显示，IMR 从 2007 年的每 1000 例活产 55 例死亡下降到 2016 年的 32 例。总体而言，死亡率从 2007 年到 2016 年显著下降。按省份划分的婴儿死亡率比例显示，夸祖鲁-纳塔尔省（KwaZulu-Natal Province）的 IMR 最高（2007 年每 1000 例活产死亡 17.5 例，2016 年为 6.3 例）。与 2007 年女性每 1000 例活产 26.7 例死亡和 2016 年每 1000 例活产 13.8 例死亡相比，男性的 IMR 更高（2007 年每 1000 例活产死亡 28 例，2016 年为 17.7 例）。使用斯皮尔曼等级相关（Spearman's rank-order correlation），将 2007 年 CS 的 IMR 数据与 2007 年 ANCHSS 进行相关分析，结果显示两者之间存在中度相关，相关系数为 0.58（p<0.001）。
研究结果显示，南非 2007 年至 2016 年期间婴儿死亡率的趋势有所下降；尽管有所下降，但健康不平等仍在持续。在南非，母婴 HIV 流行率与 IMR 之间存在明显的相关性。我们建议在南非使用伤残调整生命年来衡量人口健康，并引入能够更好地为政策提供信息的稳健数据集。
