Infant mortality rate inequalities in the Western Cape Province of South Africa

Abstract

Background. Cape Town is undergoing rapid urbanization. South African vital statistics have routinely been stratified by racial categories but intra-urban and peri-urban geographical variations have been neglected. Methods. To examine variations in infant mortality rates (IMR) and proportional infant mortality between urban, rural and informally settled areas, stratified by racial category, birth notifications and infant death certifications recorded by a large health authority were analysed. Results. The IMR per 1000 livebirths was as high for coloureds on rural farms (34, 95% confidence interval 29-40) as for blacks in informal settlements (35, 95% CI: 32-37) and an exceptionally high IMR (60, 95% CI: 43-82) was found for coloureds in informal settlements, inequalities between racial categories (11 (95% CI: 9-14) for whites, 19 (95% CI: 18-21) for coloureds and 33 (95% CI: 31-35) for blacks) were as expected from other South African studies. Of rural farm deaths, 22% were ascribed to ill-defined causes. Low birthweight was the most common defined cause of death in all areas except rural farm areas (14% ascribed to pneumonia), and gastro-enteritis was important in informally settled areas (18%). Conclusions. Routine mortality data are more informative if stratified by robust and readily available indicators of socioeconomic status such as residential area and racial category. Place of residence may distinguish risk strata as well as racial category, but the latter is helpful within socioeconomically heterogeneous residential areas.