A thesis submitted to the faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa; in fulfillment of the requirements for the award of PhD in Demography and Population Studies. September, 2016. / Background: While there has been a significant global reduction in maternal mortality rates from 546 000 in 1990 to 287 000 in 2010 (Zureick-Brown et al., 2013;Merdad, et al., 2013), maternal mortality in Zambia continues to be above at 483 per 100 000 live births, eluding the millennium development target of 162 (CSO, 2012). Data on maternal mortality are not disaggregated by provinces. Various studies on maternal mortality conducted in Zambia (Ahmed et al., 1999; Banda et al., 2007; Hazemba & Siziya, 2009; Kilpatrick, Crabtree & Kemp, 2002) have evaluated maternal deaths at national level using direct death inquiry and though it is useful for international comparisons, neither one of these approaches are appropriate for evaluating maternal mortality in small districts where safe motherhood initiatives are often carried out. These studies have rarely included neighbourhood influence on maternal mortality risks. Moreover, no known study has attempted to use the Zambia Demographic and Health Survey maternal health indicators to evaluate maternal mortality by regions in Zambia. Yet, analyses of differentials within small districts provide an improved awareness of the social situation in which the risks are high for regional priority interventions. In addition, other researchers (Achia & Mageto 2015; Stephenson & Elfstrom 2012) have all posted that inclusion of neighbourhood level variables is helpful to understand several maternal health outcomes. Objective: Guided by the conceptual framework developed by McCarthy & Maine (1992), this study contributes the new method of use of the mean Maternal Death Risk Factor Index model to estimate the levels and differentials in the risks of maternal mortality by regions and enhance the understanding of determinants of maternal mortality risks. This model is helpful in that it highlights regional and socioeconomic differentials in maternal mortality risks and ranks regions according to their potential maternal mortality burdens. Benchmarks are set by using this model and indicators are used to identify probable high-risk areas or regions. Methodology: The study utilised existing data sources from the 2007 Demographic and Health Surveys (DHS) and 2011-2013 Health Management Information System Routine Data (HMIS). Bivariate analysis was utilised to investigate the distribution and differentials in exposure to maternal mortality risks. Multilevel logistic regression was performed to investigate the independent and moderating functions of neighbourhood aspects on exposure to maternal mortality risks and the moderating functions of neighbourhood causes on the relationship between individual circumstances and exposure to maternal mortality risks. The mean Maternal Death Risk Factor Index (MDRFI) model that uses the history of individual women health indicators was used to predict maternal mortality and highlight regional and socioeconomic differentials of maternal mortality risks. The analysis was based on 5 410 women aged 15 to 49 who had a live birth in the five years prior to the 2007 Zambian Demographic and Health Surveys. The HMIS 2011-2013 data was also utilised for a comparative analysis and complementing DHS data on maternal health matters in Zambia. Results: The predicted maternal mortality ratios (MMRs) values by region showed larger regional disparities. All the seven rural regions had MMR above the national average (591/100 000 live births); the highest being in Northern Zambia (738 per 100 000 live births) and Central Zambia (679 per 100 000 live births). The predicted ratios in the two urban regions of Lusaka and Copper-belt were significantly below the national average. The findings of both bivariate and multivariate analyses showed that skilled birth attendance at delivery significantly lowered the risks of exposure to adverse pregnancy outcome. The likelihood of using skilled personnel at birth was advanced for women who resided in neighbourhoods, with advanced proportion of women who utilized skilled delivery at birth compared to women who lived in neighbourhoods that had a high proportion of women giving birth at home. The outcome from the multilevel analysis showed that the consequence of individual and neighbourhood influences on the exposure to high risk pregnancy in Zambia operates at different levels. Women with no education were found to be more exposed to high risk pregnancy than women with post primary education. The rate of women in the neighbourhood who utilized skilled birth attendance had a strong positive impact on the reduction of exposure to high risk pregnancy. In the analysis of autonomy level – although results indicated that women with low autonomy had higher odds of exposure to high risk pregnancy compared to women with high autonomy – the results were not significant, and therefore autonomy level in terms of exposure to high risk pregnancy was not supported in this study. Conclusion: The MDRFI model is much easier to use at any level and quicker to forecast interventions as well as prevent probable risks compared to the use of the sisterhood method. The model proposed here could serve as the basis for a new and better system of mortality estimation for populations with incomplete data. The results reveal a number of challenges to confront with the purpose of reducing maternal mortality in Zambia. Women’s high risk reproductive behaviours and the use of imperative fertility healthcare utilities have yet to increase considerably to result in a decrease in maternal deaths in the nation. The continuous disparities in maternal death hardship by province, rural-urban dwelling and socioeconomic position of the society further heightened the issue, making attempts to enhance maternal health and thereby decrease maternal deaths more demanding. Advancements to lower maternal mortality should either lessen the probability that a woman will become pregnant or lower the possibility that a pregnant woman will experience adverse reactions during pregnancy or childbirth or better the outcomes for women with complex pregnancies. This research makes it evident that programs to combat maternal mortality risks in the country require several avenues that embrace diverse protective measures looking beyond the individual level as women’s health is essentially affected by their social environment. The amount of differential at neighbourhood and individual level found in our study indicates the need to contextualise efforts to increase resources towards mitigating exposure to high risk pregnancy. Hence, adopting neighbourhood-specific strategies along with identifying and addressing neighbourhood factors affecting the exposure to high risk pregnancy would give better results. The use of multilevel analysis in this research has shown that individual and neighbourhood aspects are crucial components associated with the exposure to high risk pregnancy. The multilevel framework demonstrated crucial neighbourhood differentials in the exposure to high risk pregnancy. Improving quality and access to health services is essential if the most deprived are to benefit. The Ministry of Health should align its plans of action to Zambia’s development strategy articulated in its own Vision 2030. Neighbourhood health workers need to be involved in sensitising pregnant women about the risks of maternal mortality, for instance short birth interval, risky maternal age and danger signs during pregnancy. To close the gap in exposure to high risk pregnancy between neighbourhoods, interventions should aim at poverty reduction, increasing neighbourhood maternal education and facility delivery in deprived neighbourhoods. The model used in this study could serve as the basis for a new and better system of mortality estimation for populations with incomplete data and will be much easier to use at any level, as well as vital for quick forecasting of priority interventions. / GR2017

Alcohol use during pregnancy is common and its consequences often result in a broad range of negative, lifelong developmental outcomes. This study describes the effects of prenatal alcohol exposure and interacting socio-demographic factors on early childhood development. One hundred and twenty one children from the Northern Cape, South Africa, were clinically examined using standard diagnostic procedures and assessed using the Griffiths Mental Development Scales (GMDS/ER) at 7-12 months (Time 1) and 5 years of age (Time 2). Participants were assigned to either: a Fetal Alcohol Syndrome (FAS/Partial Fetal Alcohol Syndrome (PFAS); a Prenatal Alcohol Exposed (PAE); or a Control group based on the diagnosis at 5 years. Mothers/caregivers were interviewed to ascertain socio-demographic information, including prenatal alcohol exposure. During infancy, the FAS/PFAS group showed significantly lower gross motor and language abilities, with delays in higher-order executive functioning becoming more apparent with age. No significant differences were noted during infancy between the PAE and Control groups over any developmental subscales. However, with age, higher-order executive function delays were reported in the PAE group. Performance on the infant and child versions of the GMDS was not significantly correlated, suggesting that the tests may be measuring different developmental constructs. Lower maternal education, unemployment and later recognition of pregnancy were associated with reduced social adaptive functioning, and language and eye hand coordination abilities, irrespective of amount of prenatal alcohol exposure over both time points. Larger anthropometric birth measurements and longer duration of breastfeeding were significantly related to increased performance on the GMDS at 5 years within the groups exposed to prenatal alcohol. Socio–demographic variables are likely to complicate developmental profiles for all three groups, with prenatal and postnatal nutrition emerging as possible protective factors for positive developmental outcomes at 5 years of age.

Geographic Information Systems (GIS) can assist in using information from census data to investigate questions for national and local government planning purposes, such as socio-economic profiles and needs of communities. I will be doing this on the data from the Ethiopian census, scheduled for 2006. . As no Ethiopian geo-referenced data is available at this stage. I am using the 10% sample of the South African Census 2001 data for KwaZulu-Natal (KZN), as a hypothetical population. KZN was chosen as this provides a setting with urban and rural populations, as well as mountainous and flat areas, and so is in some ways similar to Ethiopia. The questions to be asked of the Ethiopian census data are of the form: · What exists at a specific location or in a specific area? (eg what health facilities are there, what is the population)? · What access does the population have to facilities in the area? Does the road network need to be improved to resolve the problem of access · Where are groups of people in greatest need of … (eg where are there clusters of people with disabilities, and are there facilities for them) · What are the characteristics of ... (eg female headed households) and what are these related to (eg HIV/AIDS or migrant labour?) · What changes need to be made to infrastructure to increase service to communities in need? The results for the hypothetical population show that there are areas with high unemployment rates, low school attendance and education levels, high levels of female headed household, and difficulties of access to educational and health facilities. Many households do not have toilet facilities, and obtain water from rivers, which could impact on the health of the communities. Migrant workers were investigated to see if these were likely to be migrants from neighbouring countries, or from other provinces. The numbers in the hypothetical population in these cases are small, so little can be concluded from this.

No description available.

INTRODUÇÃO: A distonia é caracterizada por contrações musculares sustentadas, frequentemente gerando movimentos de torção, repetitivos ou posturas anormais. A classificação de distonia é baseada em três eixos: idade de início, distribuição e etiologia. A definição criada pelo Comitê da Fundação de Pesquisa Médica em Distonia, em 1984, ainda está em uso atualmente. Questionamentos têm sido feitos para uma nova proposta de classificação de distonia. MATERIAIS E MÉTODOS: Trata-se de um estudo transversal descritivo de uma série de pacientes com diagnóstico de distonia primária e distonia-plus acompanhados em uma clínica brasileira especializada em distúrbios do movimento, no período de março de 2015 até fevereiro de 2016. Foi realizada a coleta de dados demográficos, clínicos e da gravidade da distonia. Os pacientes foram reavaliados e reclassificados segundo a nova proposta de classificação para as distonias. Utilizamos métodos descritivos para apresentarmos as características da amostra, o teste de Shapiro-Wilk para distribuição normal, o teste de Kruskal-Wallis para comparar grupos independentes e variáveis sem distribuição normal e o teste do X2 para comparar variáveis nominais. RESULTADOS: Dos 289 pacientes, foram 235 pacientes avaliados segundo a distribuição corporal, sendo blefaroespasmo 60 pacientes (26%), distonia cervical 51 pacientes (22%), distonia de membro 28 pacientes (12%), distonia laríngea 10 pacientes (4%), distonia oromandibular 3 pacientes (1%), distonia segmentar 46 pacientes (20%), distonia multifocal 23 pacientes (9%) e distonia generalizada 14 pacientes (6%). Foram 227/235 (97%) pacientes com distonia primária e 8 (3%) pacientes com distonia-plus. Houve maior prevalência no sexo feminino com 144 pacientes. Os pacientes com distonia generalizada, multifocal, distonia dopa-responsiva e distonia-parkinsonismo tiveram a idade de início da distonia inferior a todos os demais grupos (p=0,0001). Os pacientes com distonia do membro superior e distonia tarefa-específica tiveram a idade de início da distonia inferior às outras distonias focais e distonias segmentares (p=0,0001). Os pacientes com distonia tarefa-específica e distonia focal do membro superior têm escolaridade superior aos demais grupos (p=0,0001). Em média, foram 5±7,8 anos para o diagnóstico definitivo de distonia e 2±1,5 médicos até que o diagnóstico de distonia fosse confirmado. O truque sensorial foi mais frequente na distonia cervical 30/51 (59%) pacientes. Segundo a nova classificação, encontramos apenas mudança de resultados na distonia multifocal com 21/235 (9%) pacientes e na distonia generalizada com 16/235 (6%) pacientes. Foram 164/235 (70%) pacientes na faixa etária maior que 40 anos. Todos os pacientes tiveram curso da doença com padrão estático e a maioria com variabilidade persistente em 186/235 (79%) pacientes. Foram 227/235 (97%) pacientes com distonia isolada. Nenhum paciente apresentou lesão adquirida ou degenerativa. Foram 211/235 (90%) pacientes que apresentaram diagnóstico etiológico idiopático esporádico. CONCLUSÃO: A nova classificação de distonia não apresentou novos benefícios na prática clínica diária, comparada com classificações anteriores. O benefício maior foi uma reorganização e formação de novas definições e critérios para atividade de pesquisas científicas e identificação de casos mais raros. / INTRODUCTION: Dystonia is characterized by sustained muscle contractions, frequently causing twisting movements, repetitive or abnormal postures. Dystonia rating is based on three axes: age of onset, distribution and etiology. The definition established by the Committee of the Medical Research Foundation in dystonia in 1984, is still in use today. Claims have been made for a new proposal for dystonia rating. MATERIALS AND METHODS: This is a descriptive cross-sectional study of a number of patients with primary dystonia and dystonia-plus assisted in a Brazilian clinic specializing in movement disorders, from March 2015 to February 2016 data collection was performed demographic, clinical and severity of dystonia. The patients were re-evaluated and reclassified according to the new proposed classification for dystonia. We used descriptive methods to present the characteristics of the sample, the Shapiro-Wilk test for normal distribution, the Kruskal-Wallis test to compare independent groups and variables without normal distribution and the X2 test to compare nominal variables. RESULTS: Of the 289 patients, there were 235 patients evaluated according to body distribution, with blepharospasm 60 patients (26%), cervical dystonia 51 patients (22%), a member of dystonia 28 patients (12%), laryngeal dystonia 10 patients (4%), oromandibular dystonia 3 patients (1%), segmental dystonia 46 patients (20%), dystonia multifocal 23 patients (9%) and generalized dystonia 14 patients (6%). Were 227/235 (97%) patients with primary dystonia and 8 (3%) patients with dystonia-plus. There was a higher prevalence in females with 144 patients. Patients with generalized dystonia, multifocal, dopa-responsive dystonia and dystonia-parkinsonism had the age of onset of dystonia lower than all other groups (p = 0.0001). Patients with dystonia of the upper limb and task-specific dystonia had the early age of less dystonia other focal dystonias and segmental dystonia (p=0.0001). Patients with task-specific dystonia and focal upper limb dystonia have higher education to other groups (p=0.0001). On average, there were 5 ± 7.8 years for the definitive diagnosis of dystonia and 2 ± 1.5 doctors until the diagnosis of dystonia were confirmed. The sensory trick was more frequent in cervical dystonia 30/51 (59%) patients. According to the new classification, we found only change results in multifocal dystonia with 21/235 (9%) patients and generalized dystonia with 16/235 (6%) patients. Were 164/235 (70%) patients aged greater than 40 years. All patients had disease course with static standard and most with persistent variability in 186/235 (79%) patients. Were 227/235 (97%) patients with dystonia isolated. No patient had acquired or degenerative injury. Were 211/235 (90%) patients with sporadic idiopathic etiologic diagnosis. CONCLUSION: The new dystonia rating showed no new benefits in clinical practice compared with previous ratings. The greatest benefit was a reorganization and training of new definitions and criteria for scientific research activity and identification of rare cases.

Les Samburu, une communauté pastorale traditionnelle, connaissent une transformation démographique qui s'accélére vers la fin du XXème siècle : les changements s'insèrent alors dans une modernité ambiante caractérisée par des changements dans l'éducation, la santé, l'urbanisation et par une politique publique en pleine évolution (décentralisation) à un moment où les systèmes économiques pastoraux sont fragilisés, évoluent en fonction des changements climatiques, de l'intrusion du marché, des situations géopolitiques entre autres. Les travaux visent à comprendre la et les dynamiques démographiques et l'évolution démographique dans une région considérée comme marginale, éloignée, vaste et largement dépendante des variations climatiques. Cette étude s'interroge sur la dynamique démographique de 1984 à 2018 et sur l'évolution de la situation démographique au cours du XXème siècle, elle identifie et interroge les choix traditionnels de reproduction, les examine par rapport à la modernité, des changements qui affectent tous directement la société. L'étude a été entreprise dans un contexte où les données démographiques, en particulier pour la période précoloniale et coloniale, sont inadéquates en raison de la faible fiabilité des données administratives, fiscales. En raison du manque de données démographiques quantitatives précoloniales et coloniales, l'étude a recouru à une reconstitution ethnographique et anthropologique pour la période précoloniale et coloniale, tandis qu'elle s'est appuyé sur les rapports, les recensements et les enquêtes démographiques sur les ménages pour la période post- indépendance et plus particulièrement au lendemain de la crise de 1984. / The Samburu, an otherwise traditional pastoral community are undergoing demographic transformation: the changes are propelled through modernity typified by education, health provision, urbanization, and an evolving public policy. The work is undertaken at a time when pastoral systems in the world are undergoing tremendous changes. The transformation is epitomized through climate change, intrusive capitalist economies, regional geopolitical contestations and a consumptive global population among others. The work answered set of questions that are important to our understanding of demographic dynamics and population changes over time in a region that is considered remote, vast and majorly dependent on climatically sensitive system. Thus, it sought to understand the Samburu through answering five objectives: as an investigation of the traditional demographic dynamics and regulation prior to 1984; interrogate demographic dynamics in Samburu from 1984 to 2018; investigate how modernization processes may have influenced Samburu 1984 to 2018; analyse population growth among Samburu and howit affects relationship with other communities in the region, and finally to examine continuity and change in demographic situation within the two time frames. Further, the work identifies and interrogates the traditional reproduction choices, examining them in relation to modernization disseminated through education, health, urbanization, and public policy. The study was undertaken in a context where population data particularly for the pre- colonial and colonial period is inadequate. As a result of the dearth in quantitative data, ethnographie descriptions were employed for the pre­ colonial and colonial period, while census reports and demographic household surveys for the post- independence period, more particularly in the aftermath of 1984 crisis.

We provide an analysis of the main sources of data used to estimate fertility schedules in developing countries, giving special attention to Brazil. In addition to the brief history of various data sources, we present several indirect demographic methods, commonly used to estimate fertility and assess the quality of data. From the methods used, the Synthetic Relational Gompertz model gives the most robust estimates of fertility, independent of the data source considered. We conclude that different demographic data sources and methods generate differing estimates of fertility and that the country should invest in quality of birth statistics.

The first chapter assesses the impact of the cohort size on labour market outcomes. Using exogenous variation and micro-level data for France, the UK and the US, we study the effect of supply shocks measured at different ages on unemployment rates and wages during a cohort's life cycle. The results from an IV estimation show that the largest magnitude of the effects is found when the cohort size is measured at age 25. The impact of both wages and unemployment rates are temporary, however, both decreasing with time. The second chapter analyses the effects of large inflows of foreign students on English undergraduates. Our results confirm previous findings that there is no overall effect, but we identify changes in the distribution of natives. We find that top performing English students are crowded in by foreign students. It is also mainly English-born males, natives who do not have English as their mother tongue and those of Asian ethnic origins that are crowded in by foreign students. In chapter three, we aim to understand the short-term effects of changes in the level of the tuition fees charged by English universities on students' geographic mobility. Our results suggest that the increase in tuition fees in 2006/07 charged by English universities led students to enrol into universities that are closer to home, with a larger effect experienced by men and White students. Moreover, we find that students are less likely to move to universities located in rich areas.

Having largely achieved the goal of "controlling population quantity," and faced with slowing economic growth, serious demographic problems, and the changes brought about by the deepening marketization of Chinese society, China's central-level leaders have, in recent years, turned their attention to the lesser known twin objective of their population policy, "improving population quality." To this end, they have introduced program reform aimed at improving the quality of services. They have adopted an eclectic approach to program reform, drawing selectively on global discourses and practices on sexual and reproductive health and rights and at the same time relying on their own model of experimental governance, namely, conducting "pilot experiments" in carefully selected sites. Developments at the central-level have been a subject of scholarly attention, but until now, relatively little attention has been paid to grassroots implementation, making it difficult to assess the degree to which practice has in fact changed. This dissertation examines how global discourses and practices on sexual and reproductive health and rights, articulated in global forums and consensus documents, have been taken on, interpreted, and experienced by people at the grassroots level in China. It is based principally on six months of fieldwork, July - December 2009, in Deqing, a rural county, located in the northern part of Zhejiang Province, in the Jiangnan region of China. Deqing is a pilot site for the introduction of "client-centered" approaches to implement the population program. Data were derived from participant observation, analysis of documents, semi-structured interviews with 17 local-level providers working at the county, township, and village-levels in clinical and administrative capacities, and 17 married women of reproductive age residing in three townships. I documented many innovative approaches that the local program developed to promote "quality service" and its various components, such as "information," "choice," and "rights," as they understood them. I also found that the range of services that the program now provides extends well beyond birth planning and that in addition to its core demographic, married women of reproductive age, the program now targets new populations including those that have been a focus of global attention in recent years such as migrants and adolescents. For the populations that the program targets, migrants being a notable exception, the mode of governance has begun to shift from direct to more indirect means, the latter being considered a more efficient way to implement the program in the current environment. Unlike earlier efforts to "control population quantity," which were often forcefully implemented and fiercely resisted, efforts to "improve population quality," have received a warm reception by providers and clients alike in Deqing. While there are some continuities, overall, the changes that have been introduced are an explicit departure from past practice. Taken together, these findings contribute to ongoing debates regarding the dynamics and effects of globalization.

Mass demographic changes in the ethnic and racial composition of the United States since the 1960s are commonly considered a force driving major transformations in contemporary American politics. In political science, there are longstanding research traditions that examine the political implications of demographic change: how demographic change leads to growing intergroup political contestation over political power and public policies; how demographic changes lead to shifts in the group bases of partisan support; how demographic changes are associated with changes in the demographic composition of politicians and elected officials; and how the changing face of America affects the political responsiveness of elected officials to historically underrepresented but increasingly prominent segments of the population. Despite the proliferation of empirical studies on these topics, numerous causal claims central to broader arguments about the political implications of demographic change deserve greater theoretical and empirical scrutiny. In this dissertation, I make use of novel datasets and methods for descriptive and causal inference to contribute more credible evidence that test these claims and develop new avenues of research.