Research question
What is the contribution of HIV mortality to overall mortality among children aged under-5 years in Africa Centre and Navrongo demographic surveillances from 2000-2008?  

This study fits into objective 1 of the Africa Centre research strategy, namely, to further improve understanding of the HIV epidemic.

Rationale
The Millenium Development Goal (MDG) 4 focuses on reducing the under-5 mortality by two-thirds between 1990 and 2015. Reliable and timely estimates of childhood mortality are therefore needed to help countries set priorities and monitor progress towards achieving the targets. Worldwide, the decline in rates of child mortality peaked in about 1980. The number of child deaths fell by 1.1% annually in 1990-2001, compared to 2.5% per year during 1960-1990. It has been suggested that any HIV effect on child mortality will be more noticeable in Southern Africa due to the lower underlying non-HIV mortality than in other parts of Africa. We therefore aim to estimate the under-5 mortality patterns using Demographic Surveillance Systems (DSS) data from two largely rural populations, with different HIV prevalence and different underlying mortality; Africa Centre (South Africa) has a high HIV prevalence, but lower non-HIV mortality while Navrongo (Ghana) has a low HIV prevalence, but higher non-HIV mortality.

Data sources and methods
The two sites collect demographic information on vital events which are updated bi-annually or quarterly in Africa Centre and Navrongo respectively. These data will be used to compute mortality rates in the two sites. Both sites also collect verbal autopsy (VA) data on all registered deaths to obtain information on the circumstances leading to the death. These VA data will be used to compute cause-specific mortality and to determine HIV-related mortality. The validity of VA-derived mortality estimates for child deaths has been assessed previously. All notified deaths are followed up by a verbal autopsy interview, which includes a disease narrative, a checklist of signs and symptoms, and a standard structured questionnaire based on the INDEPTH standard verbal autopsy questionnaire.

Expected findings
We anticipate that Navrongo will have higher under5-mortality but lower HIV-related mortality and consequently lower HIV-attributable effect compared to the ACDIS where the HIV prevalence rates are much higher. The most common cause of death among children aged under-5 in ACDIS are expected to be HIV (or HIV-related), while in Navrongo malaria might be the most common cause. The malaria effect in Navrongo might have a similar effect on U5MR to the child’s HIV status effect in ACDIS.

Policy implications
The findings of this study will inform on priority areas and progress made towards achieving MDG4 in these two sites which have different HIV prevalence and non-HIV mortality estimates.