Burden and Impact of HIV and AIDS in South African children

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1 Solving Operational Bottlenecks to achieve the NSP targets for Children Infected and Affected by HIV and AIDS Burden and Impact of HIV and AIDS in South African children. more questions than answers Debbie Bradshaw Burden of Disease Research Unit

2 Outline of presentation What do we know about mortality in children? What do we know about prevalence in children? What do models say about the burden and impact of HIV and AIDS in children? What does this mean for monitoring the NSP?

3 Demographic and Health Surveys Under 5 mortality, South Africa Deaths per 1 livebirths ? SADHS 1998 SADHS SADHS 23 Source: Department of Health

4 Agincourt DSS 1 Death rate for children <5 years, Agincourt Death rate per Male Female Source: Kahn, 26

5 Registered deaths of children <5 8, Number of deaths under-5 years of age StatsSA and Population register 6, 4, 2, Population register Stats SA Source: Stats SA and MRC

6 Completeness of population register 1 Completeness of < 5 population registration HA compared with Stats SA data Percentage Source: Stats SA and MRC

7 Source: Stats SA Under 1 Deaths - STATS SA WC EC NC FS KZN NW GT MP LIM

8 Cause of death by age, 22 Causes of death under-5 years by age in 22, Stats SA 3 Other causes Number of deaths Endocrine, nutritional and metabolic diseases (E-E9) External causes of morbidity and mortality (V1-Y98) Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R-R99) Diseases of the respiratory system (J-J99) 5 Certain infectious and parasitic diseases (A-B99) 1-7 days 8-28 days 29 days - 11 months 1 year 2-4 year Certain conditions originating in the perinatal period (P-P96) Age group Source: Stats SA

9 Number of deaths under-5 years of age ASSA23, StatsSA and Population register 12, 1, 8, 6, 4, 2, StatsSA Population register ASSA23 Source: ASSA23, Stats SA and MRC

10 Estimated cause of death profile < 5 years, South Africa 2 Congenital abnormalities 4% Nutritional deficiencies 5% Noncommunicable 3% Injuries 5% HIV/AIDS 34% Perinatal conditions 28% Other infectious and parasitic excl HIV/AIDS 21% Source: Bradshaw et al., 24

11 Estimated child mortality by province, 2 3 Children under 5 years by province, 2 Deaths per 1 population EC FS GT KZN LP MP NW NC WC Injuries Non-communicable diseases HIV/AIDS Other communicable diseases, perinatal and nutritional conditions Source: Bradshaw et al., 24

12 Source: ASSA23, HSRC 25, UNAIDS 26 What do we know about the prevalence of HIV in children? 1.% 9.% 8.% 7.% 6.% 5.% 4.% 3.% 2.% 1.%.% ASSA23 HSRC5 UNAIDS

13 Projected impact of HIV - prevalence, incidence, AIDS deaths and orphans Number HIV+ and orphans New infections and AIDS deaths Total HIV+ AIDS orphans New infections AIDS deaths Source: ASSA23

14 Projected number of orphans (under age 18 years) Number of orphans (millions) Total orphans Paternal orphans Maternal orphans Double orphans Source: ASSA23

15 Projected proportion of all children whose mother has died under age 2, 6, 12 and 18 years 26% 24% 22% 2% 18% 16% 14% 12% 1% 8% 6% 4% 2% % Maternal orphans as % of all children under-2 under-6 under-12 under-18 Source: ASSA23

16 Projected number of infected babies Infected by breast-milk Infected perinatal Source: ASSA23

17 So what can we say? HIV is a major cause of the burden of disease in children and can be expected to continue Higher than expected child prevalence needs investigation including modes of transmission and the appropriateness of the models Data to monitor child mortality must be improved as part of the NSP Survey data needs to be improved Vital registration data needs to be improved for children

18 HMN Domains of Measurement Determinants of Health Socio-economic and demographic factors Environmental and behvioural risk factors Health System Inputs Outputs Outcomes Policy Information Coverage Financing Service Utilisation Human resources (availability Organisation and quality) Health status Mortality Morbidity/ Disability Well-being

19 Need to strengthen monitoring of the burden of HIV and AIDS on children Monitoring PMTPC in facilities Sentinel PCR testing of babies Facility based mortality audit through PIP and ChIP Population based surveys (programme coverage and mortality) Improve registration of deaths

20 Acknowledgments MRC Burden of Disease Research Unit MRC Biostatistics Unit UCT Center for Actuarial Research