Under-5 mortality

Local knowledge on fear and avoidance of the health system

Participants identified a range of influences on under-5 mortality. Fundamental root causes related to social contexts
and contributory influences related to the health system were identified as follows.

  Root causes: 

 Lack of education

unemployment and poverty

 Inadequate housing and



Lack of clean water

Unsafe environments

 Perceived neglect

Traditional medicine


Contributing factors:

Unreliable emergency transport

Delays in facilities

Poor quality care

Lack of medicines

Fear and avoidance of the health system

Circumstances of dearths

Acting to reduce under-5 mortality:knowledge partnerships for coordinated action

Wariri, O., D'Ambruoso, L., Van Der Merwe, M., Spies, B., Mtwunga, I., Masinga, S., Mdluli, D., Gosen, G., Moccoem, V., Khosa, S., Kahn. K., Byass, P., & Twine, R. (2017). 'Bridging the gap: connecting communities and health authorities with knowledge partnerships in Mpumalanga province, South Africa. Unpublished manuscript.

© 2018 VAPAR/Wits/DoH Mpumalanga


The research is supported by the Health Systems Research Initiative from Department for International Development (DFID)/ Medical Research Council (MRC)/ Wellcome Trust/ Economic and Social Research Council (ESRC) (MR/N005597/1, MR/P014844/1)