Burden and causes of ongoing paediatric infectious disease morbidity and mortality in the Western Cape Province of South Africa

Abstract

Under-five mortality has significantly decreased globally over the past 28 years, halving to 39
deaths per 1,000 live births in 2018, yet remains high, necessitating further progress to meet
the Sustainable Development Goal of reducing it to below 25 deaths per 1,000 live births by
2030. Improvements in healthcare access, nutrition, vaccinations, and socioeconomic
conditions have been key drivers of this observed reduction, but infectious diseases such as
lower respiratory tract infections (LRTIs) including pneumonia, diarrhoea, and malaria
continue to cause substantial childhood mortality. In South Africa, LRTIs, diarrhoea,
meningitis, and tuberculous meningitis (TBM) remain leading causes of childhood morbidity
and mortality. The Western Cape continues to bear a substantial burden from these infectious
diseases, but the available data is outdated and lacks granularity. Therefore, the aim of this
thesis was to explore the morbidity and mortality of LRTIs, diarrhoea, meningitis and TBM
among children younger than five years in the public sector in the Western Cape.
After a brief background chapter which lays out the key issues and overview of the South
African healthcare system, Chapter 2 provides a comprehensive literature review discussing
the morbidity and mortality of LRTIs, diarrhoea and meningitis (including TBM where
appropriate) in children under five years globally and in South Africa with a focus on the
Western Cape. Chapter 3 provides a detailed description of the data management required to
develop the de-duplicated dataset that was used for each of the results chapters (Chapter 4-7).
Chapter 4 explores causes of death using various death data sources, including routinely
collected and detailed audits, and found that routine hospital information systems had accurate
causes of death relying on International Classification of Diseases 10th Revision codes,
particularly for LRTIs and diarrhoea. Chapters 5 and 6 explore the impact of COVID-19 public
health and social measures (PHSM) on LRTI and diarrhoea admissions. COVID-19 surges and
their associated measures, including PHSM, were linked to declining LRTI admissions and infacility deaths, likely driven by a combination of reduced infectious disease transmission and
reduced use of healthcare services. Lastly, Chapter 7 identified associations with repeat
infectious disease admissions (LRTIs, diarrhoea and meningitis) among children who were first
admitted for an infectious disease in the first six months of life. Male children with lower
birthweight, whose first admission was due to LRTI or diarrhoea (versus meningitis),
experienced a longer length of stay during their initial admission, and were living with HIV
were more likely to be re-admitted for an infectious disease. Both individual- and population-
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level interventions are needed to reduce the prevalence and impact of factors associated with
infectious disease re-admissions and reduce infectious disease morbidity.
This thesis concludes that infectious disease morbidity and mortality persist among children
under five years in the Western Cape by presenting up-to-date and comprehensive data. It
highlights the need to address existing gaps to improve data quality and comprehensiveness,
as well as healthcare and health outcomes for these children.

Date of Award	1 Oct 2024
Original language	English
Awarding Institution	University of Bristol
Supervisor	Theresa Redaniel Redaniel (Supervisor) & Hayley E Jones (Supervisor)