Multilevel determinants of under-five deaths in South Africa : evidence from 2016 Demographic Health Survey

Abstract

Background: The world has made significant progress in reducing under-five mortality rates. On the contrary, the under-five mortality rate remains high in sub-Saharan Africa. Although South Africa has a low under-five mortality rate in the region, the national target has failed to meet the required global standards. The main objective in this study was to determine multilevel determinants of deaths of children under-five years old in South Africa. Methods: The study used secondary data from the South Africa Demographic Health Survey which was conducted in 2016. The bivariate and multivariate (multilevel logistic regression) analyses were used. Results: The findings show that the sex of a child, population group, level of education, household wealth, type of toilet facility, place of residence and province were associated with under-five deaths. About 5.6% of male children died before the age of five years, while 4.4% of female children died before the age of five years. The study revealed that black women reported the highest under-five deaths (5.3%) compared to other population groups. The prevalence of under-five deaths was higher for women with primary education (7.4%) Under-five deaths decreased with increase in household wealth status; the prevalence of under-five deaths was higher among women from poor households (6.0%). Furthermore, children who used toilet facilities were more likely to die before the age of five compared to children with no toilet facilities. Under-five mortality rate showed variations at the provincial level. Children from the Eastern Cape province as well as from the North West province were more likely to die under the age of five years compared to children from the Gauteng province. Conclusion: The study identified factors associated with under-five the deaths. The results demonstrated that there is a slow progress in reducing under-five mortality rate. The study calls for the improvement of child health services in rural areas, further improvement in ambulance services, and a functional rapid response system for emergencies in remote rural areas.