Infant and child mortality in the Elim District, northern Transvaal, 1976-1986, and a comparison of trends.

Childhood mortality rates among rural blacks in South Africa are currently not based on a reliable registration system. National childhood mortality statistics rely on mortality extrapolations and population estimates. This study attempts to provide further information on infant and child mortality among rural blacks in the northern Transvaal, using a direct method. Currently available obstetric histories from hospital and clinic records of the Elim Hospital Health Ward were reviewed, covering the years 1976-1988 and approximately 28,000 pregnancies. The mean infant mortality rate was 88/1,000 live births, and did not change significantly over 10 years, in contrast to other populations in South Africa with documented decreases. Components of the infant mortality rate were also calculated. There was a 1 in 10 risk of death among children less than 5 years of age over this period, although the risk had declined slightly over 10 years. Mortality among boys was higher than that among girls in all age groups studied. Conclusions include that small but measurable changes have occurred in rural South African black childhood mortality rates, although there has been no discernible change in infant mortality, and that a simple direct method can illustrate levels as well as trends in mortality. This has implications for health policy.