Dissertation submitted in fulfilment of the requirements for the degree Doctor of Technology: Informatics in the Faculty of Informatics and Design at the Cape Peninsula University of Technology / Background: Daily activities within a health care organization are mediated by information communication processes (ICP), which involve multiple health care professionals. During pregnancy, birth and motherhood a woman may encounter different professionals including midwives, doctors, laboratory personnel and others. Effective management requires critical information to be accurately communicated. If there is a breakdown in this communication patient safety is at risk for various reasons such as; inadequate critical information, misconception of information and uninformed decisions being made. Method: Multi method, multiple case study approach was used to explore and describe the complexities involved in the (ICP), during the management of the intrapartum period. During the study the expected ICP, the actual ICP, the challenges involved and the desired ICP were analysed. 24 In-depth interviews with skilled birth attendants were conducted, observer- as- participant role was utilized during the observation, fild notes, reflective diaries and document review methods were used to gather the data. Thematic analysis and activity analysis were applied to analyse the data. Findings: The findings illuminated that there are expectations of accessibility to care of the woman during pregnancy birth and the intrapartum, especially linked to referral processes. The actual ICP focused on documentation and communication of the information within and between organizations. Communication was marked by inadequate documentation and therefore errors in the information communicated. The desires for communication were illuminated by the need to change the current situation. Further a framework for effective information communication was developed: the FAAS framework for the effective management of the intrapartum period. Conclusion: In conclusion what is expected is not what is actually happening. The skilled birth attendants (SBAs) do not necessarily have the answers for change but the challenges were identified as desires for change. I urge that the framework will provide a basis for the evaluation of the effectiveness involved in the ICP for the effective management of the intrapartum period.

A taxa de mortalidade perinatal (TMP) é um dos importantes indicadores de saúde que refletem a qualidade da assistência prestada durante a gestação, o parto e ao recém nascido. A TMP possui dois componentes: a taxa e mortalidade fetal e a taxa de mortalidade infantil neonatal precoce. O objetivo do presente estudo foi analisar a mortalidade perinatal na região do Médio Paraíba, estado do Rio de Janeiro, Brasil no período de 2005 a 2009, segundo causa básica dos óbitos, componentes do período perinatal e critérios de evitabilidade. Foram utilizados os dados referentes aos óbitos fetais e infantis neonatais precoces e de nascidos vivos, registrados, respectivamente, nos Sistemas de Informações sobre Mortalidade (SIM) e Nascidos Vivos (SINASC). A TMP na região foi de 18,4 óbitos por mil nascimentos totais. As taxas de mortalidade fetal e infantil neonatal precoce no período alcançaram, espectivamente 10,7 óbitos por mil nascimentos totais e 7,7 óbitos por mil nascidos vivos. A TMP apresentou redução ao longo do quinquênio analisado associada à queda do componente neonatal precoce, mantendo-se estável o componente fetal. As principais causas básicas dos óbitos perinatais, segundo a lista de mortalidade CID BR, foram as afecções originadas no período perinatal (89%) e as malformações congênitas, deformidades e anomalias cromossômicas (10,5%). Utilizando os critérios de evitabilidade segundo Ortiz, para os óbitos infantis neonatais precoces foi observado que mais de 41% eram reduzíveis por diagnósticos e tratamento precoces. Ressalta-se a necessidade da implementação de ações de assistência à saúde da gestante e de cuidados com o recémnascido com vistas à redução da mortalidade perinatal na região do Médio Paraíba. / The perinatal mortality rate (PMR) is an important health indicator that reflects the quality of health care provided during pregnancy, childbirth and to the newborns. The PMR has two components: the fetal mortality rate and the early neonatal mortality rate. The objective of this study was to analyze the perinatal mortality in the Médio Paraíba region, Rio de Janeiro state, Brazil between 2005 and 2009, according to the underlying cause of deaths, components of the perinatal period and criteria of avoidability. Data regarding fetal and early neonatal deaths and live births was provided by the National Death (SIM) and Live Birth (SINASC) Information Systems, respectively. The PMR in the region was 18.4 deaths per thousand total births. Fetal and early neonatal mortality rates reached 10.7 deaths per thousand total births and 7.7 deaths per thousand live births, respectively. The PMR declined during the five year period, associated with the fall of its early neonatal component, remaining stable the fetal component. The main underlying causes of perinatal deaths, according to the ICD Mortality List for use in Brazil - ICD BR, were certain conditions originating in the perinatal period (89%) and congenital malformations, deformations and chromosomal abnormalities (10,5%). Using the criteria of avoidability according to Ortiz, for early neonatal infant deaths was observed that over 41% were avoidable through early diagnosis and treatment . Efforts aimed at improving health care during pregnancy and childbirth are needed in order to reduce perinatal mortality levels in the Médio Paraíba region.

As informações de mortalidade são úteis para avaliar a situação de saúde de uma população. Dados de mortalidade confiáveis produzidos por um sistema de informação de saúde nacional constituem uma ferramenta importante para o planejamento de saúde. Em muitos países, sobretudo em desenvolvimento, o sistema de informação de mortalidade continua precário. Apesar dos esforços feitos em Moçambique para melhoria das estatísticas de mortalidade, os desafios ainda prevalecem em termos de tecnologias de informação, capacidade técnica de recursos humanos e em termos de produção estatística. O SIS-ROH é um sistema eletrônico de registro de óbitos hospitalares de nível nacional, implementado em 2008 e tem uma cobertura de apenas 4% de todos os óbitos anuais do país. Apesar de ser um sistema de nível nacional, ele presentemente funciona em algumas Unidades Sanitárias (US), incluindo o Hospital Central da Beira (HCB). Dada a importância deste sistema para monitorar o padrão de mortalidade do HCB e, no geral, da cidade da Beira, este estudo avalia a qualidade do SIS-ROH do HCB. É um estudo descritivo sobre a completitude, cobertura, concordância e consistência dos dados do SIS-ROH. Foram analisados 3.009 óbitos de menores de 5 anos ocorridos entre 2010 e 2013 e regsitrados no SIS-ROH e uma amostra de 822 Certificados de Óbitos (COs) fetais e de menores de 5 anos do HCB. O SIS-ROH apresentou uma cobertura inferior a 50% calculados com os dados de mortalidade estimados pelo Inquérito Nacional de Causas de Morte (INCAM). Verificamos a utilização de dois modelos diferentes de CO (modelo antigo e atual) para o registro de óbitos referentes ao ano de 2013. Observou-se completitude excelente para a maioria das variáveis do SISROH. Das 25 variáveis analisadas dos COs observou-se a seguinte situação: 9 apresentaram completitude muito ruim, sendo elas relativas à identificação do falecido (tipo de óbito e idade), relativas ao bloco V em que dados da mãe devem ser obrigatoriamente preenchidos em caso de óbitos fetais e de menores de 1 ano (escolaridade, ocupação habitual, número de filhos tidos vivos e mortos, duração da gestação) e relativas às condições e às causas de óbito (autópsia e causa intermédiacódigo); 3 variáveis apresentaram completitude ruim relativas à identificação do falecido (NID) e relativas às condições e causas de morte (causa intermédia - descrição e causa básica - código); 9 apresentaram completitude regular relativas à identificação do falecido (data de nascimento e idade), relativas ao bloco V (idade da mãe, tipo de gravidez, tipo de parto, peso do feto/bebé ao nascer, morte do feto/bebé em relação ao parto) e relativas às condições e causa de óbito (causa direta- código, causa básica descrição); 2 apresentaram completitude bom relativas à identificação do falecido (sexo e raça/cor) e, por último, 2 apresentaram completitude excelente relativas ao local de ocorrência de óbito (data de internamento e data de óbito ou desaparecimento do cadáver). Algumas variáveis do SIS-ROH e dos COS apresentaram inconsistências. Observou-se falta de concordância para causa direta entre o SIS-ROH e os COs. Conclusão: Moçambique tem feito esforços para aprimorar as estatísticas de mortalidade, porém há lacunas na qualidade; a análise rotineria dos dados pode identificar essas lacunas e subsidiar seu aprimoramento. / The mortality information is useful to assess the health status of a population. Reliable mortality data produced by a national health information system is an important tool for health planning. In many countries, especially developing countries, the mortality information system is still precarious. Despite efforts in Mozambique to improve mortality statistics, challenges still prevail in terms of information technology, technical capacity and human resources and statistical production. The SIS-ROH is an electronic system of national-level hospital deaths registration, implemented in 2008 and has a coverage of only 4% of all annual deaths in the country. Despite being a national system, it currently works in some health units (US), including Beira Central Hospital (HCB). Given the importance of this system to monitor the mortality pattern of HCB and, in general, the city of Beira, this study evaluates the quality of SIS-ROH HCB. It is a descriptive study on the completeness, coverage, compliance and consistency of the SIS-ROH data and examined a sample of 822 HCB deaths Certificates (COs) of fetal and children under 5 years of age. We find the use of two different models of CO (former and current model) for the registration of deaths related to the year 2013. We observed excellent completeness for most SIS-ROH variables. Of the 25 variables of COs there was the following situation: 9 had very bad completeness, which were relating to the identification of the deceased (type of death and age) on the V block in the mother\'s data, where must be filled in case of stillbirths and children under 1 year of age (education, usual occupation, number of living children taken and killed, gestational age) and on the conditions and causes of death (autopsy and intermediate-code causes); 3 variables had bad completeness concerning the identification of the deceased (NID) and on the conditions and causes of death (intermediate cause - description and basic cause - code); 9 showed regular completeness concerning the identification of the deceased (date of birth and age) on the V block (mother\'s age, type of pregnancy, mode of delivery, weight of the fetus / baby birth, death of the fetus / baby compared to delivery) and on the conditions and causes of death (direct cause code, basic cause description); 2 showed good completeness concerning the identification of the deceased (sex and race / color) and, finally, 2 showed excellent completeness concerning the place of occurrence of death (date of admission and date of death or the disappearance corpse). The SIS-ROH had coverage below 50% calculated on mortality data estimated by the National Survey of Causes of Death (INCAM). Some SIS-ROH variables and COS showed inconsistencies. There was a lack of agreement to direct cause between SIS-ROH and COs.

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / Objetivo. Analisar os Ãbitos maternos no Hospital Geral CÃsar Cals no perÃodo 2004 a 2008 quanto aos aspectos sociodemogrÃficos, assistenciais e a opiniÃo do comità de morte materna, constituindo o perfil epidemiolÃgico e clÃnico desta populaÃÃo. Metodologia. Estudo transversal, de carÃter descritivo e analÃtico de 70 Instrumentos de NotificaÃÃo de Ãbito de Mulher em Idade FÃrtil e de InvestigaÃÃo Confidencial do Ãbito Materno. Foram comparados os Ãbitos ocorridos por causas diretas e indiretas e aqueles ocorridos em pacientes provenientes de Fortaleza com aqueles de outros municÃpios. Foram empregados os testes qui-quadradro de Pearson e de Yates, teste exato de Fisher e teste nÃoparamÃtrico de Mann-Whitney. Considerou-se p< 0,05 como significativo. Resultados. A idade variou de 15 a 43 anos (mÃdia de 27,0  7,4 anos). Vinte e cinco (35,71%) eram procedentes da prÃpria Capital Fortaleza, e 45 (64,29%) de outros municÃpios. A maioria era de cor parda, vivia com companheiro, primÃparas ou secundÃparas. A maioria frequentou o prÃ-natal: elas iniciaram o prÃ-natal ainda no primeiro trimestre, mas realizaram menos de seis consultas. A maioria teve o parto por via abdominal com recÃm-nascidos vivos. A RMM foi de 227,37/100.000 NV (causas diretas 129,37/100.000 NV e indiretas 74,48/100.000 NV). As RMM geral e especÃficas (diretas e indiretas) apresentaram linhas de tendÃncia crescente ao longo dos anos avaliados. O tempo de internamento foi menor para os Ãbitos de causas diretas (p = 0,008) e para pacientes provenientes de municÃpios diferentes de Fortaleza (p<0,002). O inÃcio do prÃ-natal no primeiro trimestre foi mais frequente para as pacientes de fora da Capital (p = 0,027). Quanto a assistÃncia prÃ-natal, ao parto ou aborto e ao puerpÃrio, foi possÃvel realizar somente anÃlise descritiva para as pacientes da cidade de Fortaleza, segundo opiniÃo do Comità de Ãtica. ConclusÃes. A RMM no HGCC foi muito alta, com tendÃncia crescente. O tempo de internamento foi maior para as pacientes que evoluÃram para Ãbito por causas indiretas e de Fortaleza. Segundo o ComitÃ, a assistÃncia foi considerada inadequada para as pacientes provenientes de Fortaleza.

Introdução: O presente estudo trata da evolução da mortalidade perinatal hospitalar do município de Fortaleza-Ceará em dois momentos: 1995 e 2005. O interesse para a realização desta pesquisa parte da relevância dos cuidados oferecidos à mulher grávida e ao recém nascidocomo importante indicador da saúde materno infantil.Objetivos: Avaliar a evolução dos indicadores de saúde perinatal referentes aos nascimentos hospitalares de Fortaleza, Ceará, ocorridos em 1995 e em 2005.Metodologia: Estudo epidemiológico, do tipo ecológico, que estuda a evolução da saúde perinatal em Fortaleza, de 1995 a 2005, a partir da análise dos dados de dois estudos de base hospitalar. Todos os nascimentos foram acompanhados desde o parto até a alta ou óbito em hospital.Fizeram parte da população, todos os nascimentos e respectivos óbitos perinatais ocorridos em hospitais/maternidades públicas e particulares, conveniados com o SUS, no município de Fortaleza, CE, em 1995 e em 2005, disponíveis em dois bancos de dados já existentes.Resultados: Os resultados evidenciaram que nos dez anos (1995-2005) houve melhoria nos indicadores de saúde perinatal em Fortaleza. Os coeficientes de mortalidade perinatal hospitalar, fetal e neonatal precoce tiveram redução de 29 por cento, 19,0 por cento e de 42 por cento respectivamente. Em crianças com baixo peso ao nascer,observou-se declínio na mortalidade perinatal, fetal e neonatal precoce em todas as categorias. Chama-se atenção para a redução do coeficiente de mortalidade perinatal no grupo de recém nascidos de muito baixo peso (< 1500g), que passou de 821,1/1000 NV em 1995 para 532,2/1000 NV em 2005, com um declínio de 35,2 por cento. Quanto ao coeficiente de mortalidade neonatal precoce, a redução foi de 53,8 por cento, passando de 703,0/1000 NV para 324,7/1000 NV. Foi possível evidenciar mudanças referentes à reorganização da atenção perinatal em Fortaleza, quando se detectou uma maior participação dos hospitais públicos, que realizou um maior número de partos nos dez anos em 121 por cento por cento. Em 1995 a proporção de partos foi de 32,4 por cento e em 2005 de 71,7 por cento. Quanto à idade materna, os coeficientes de mortalidade perinatal, fetal e neonatal precoce nos dez anos tiveram reduções, com ênfase entre os filhos de mães adolescentes (10 a 19 anos). Para este grupo, o coeficiente de mortalidade perinatal obteve declínio de 54,2 por cento o de mortalidade fetal de 16,2 por cento e o de mortalidade neonatal precoce de 36,8 por cento. Conclusões: A mudança nos indicadores da saúde perinatal no município de Fortaleza mostra que houve uma melhora da atenção ao longo dos dez anos, revelando um cenário favorável na atenção prestada à mulher grávida e ao recém nascido na capital. Contudo, sabe-se que aspectos relacionados com o processo de trabalho e a organização da rede, ainda permanecem em níveis inferiores em relação , quando compara-se com outras capitais brasileiras, sendo necessárias medidas governamentais para que estas lacunas sejam remediadas / Introduction: This study deals with the evolution of perinatal mortality hospital in Fortaleza, Ceara on two occasions: 1995 and 2005. The interest for this research part of the relevance of care offered to pregnant women and newborn care as an important indicator of maternal and infant health.Objectives: To evaluate perinatal health indicators relating to hospital births in Fortaleza, occurring in 1995 and 2005.Methodology: Epidemiological study of ecological type, which studies the evolution of perinatal health in Fortaleza, from 1995 to 2005, based on the analysis of data from two hospital-based studies. All births were followed from birth until discharge or death in hospital. The population was composed of all births and perinatal deaths occurred in their hospitals / public hospitals and private contracts with the SUS in the city of Fortaleza, in1995 and 2005, available in two databases that already exist.Results: The results showed that within ten years (1995-2005) found a reduction in perinatal health indicators in Fortaleza. The hospital perinatal mortality rates, fetal and early neonatal fell by 29 per cent, 19.0 per cent and 42 per cent respectively. As birth weight were obtained decline in perinatal mortality, fetal and early neonatal in all categories. Attention is drawn to the reduction of perinatal mortality rate in the group of infants with very low birthweight (<1500g), now 821.1 / NV in 1000 to 532.2 in 1995 / 1000 NV in 2005, with a declining 35.2 per cent. As for early neonatal mortality rate, the reduction was 53.8 per cent, from 703.0 / 324.7 for 1000 NV / NV 1000. The results showed changes related to the reorganization of perinatal care in Fortaleza, when it detected a greater involvement of public hospitals, which increased the number of births in the ten years 121 per cent per cent. In 1995 the proportion of births was 32.4 per cent and 71.7 per cent in 2005. As for maternal age, perinatal mortality rates, fetal and early neonatal ten years have had reductions, with emphasis among the children of teenage mothers (10-19 years). For this group, the perinatal mortality rate decline of 84.7 per cent was obtained, the fetal mortality of 46.8 per cent and early neonatal mortality rate of 88.7 per cent.Conclusions: The change in perinatal health indicators in Fortaleza shows that there was an improvement of attention over the ten years, revealing a favorable outlook on care provided to pregnant women and newborn in capital.Contudo, it is known that aspects related to the work process and organization of the network, are still inconsistent when it is compared with other Brazilian cities, requiring government measures to these deficiencies are remedied

Title: Stochastic mortality modelling for multiple populations Abstract: This thesis deals with the possibilities of modelling and forecasting of age-specific mortality rates. The introductory part summarizes the basic terms from demo- graphy, which are related to mortality, and specifies elementary approaches to the mortality modelling. Subsequently there are in detail described the three most commonly used stochastic mortality models - Lee-Carter, Renshaw-Haberman and Cairns-Blake-Dowd. The fundamental part of this thesis deals with the possi- bilities of using these models for mortality modelling simultaneously in correlated populations. These theoretical bases are in the final part of this thesis numerically illustrated on the mortality models for populations of Czech and Slovak Republic. 1

Master of Science / Department of Grain Science and Industry / Subramanyam Bhadriraju / Stored-grain insects were managed traditionally with grain protectants and the fumigant phosphine. Protectant use leads to undesirable pesticide residues on grain. Many stored-grain insects are resistant to grain protectants and phosphine. Therefore, novel technologies are needed in the future to replace traditionally used methods. Preliminary laboratory and pilot scale field trials have shown catalytic infrared radiation of 2.8 to 7 μm wavelength to be effective in killing insects associated with stored wheat. The effectiveness of catalytic infrared radiation in killing life stages of three economically-important stored-grain insects in hard red winter wheat were evaluated. Wheat (113.5 or 227.0 g) infested with eggs, various ages of larvae, pupae, and adults were exposed for 45 or 60 sec at a distance of 8.0 or 12.7 cm from the catalytic infrared emitter. Infested wheat samples unexposed to infrared radiation served as the control treatment. Temperatures attained by the wheat samples during infrared exposure were monitored continuously using a non-contact infrared thermometer. The three insect species tested were the lesser grain borer, Rhyzopertha dominica (F.); rice weevil, Sitophilus oryzae L.; and red flour beetle, Tribolium castaneum (Herbst). The life stages of R. dominica and S. oryzae developing within wheat kernels were age-graded using radiographic techniques. The mean temperatures attained by wheat at the various treatment combinations ranged from 80[degrees] to 114[degrees]C. Both the time-dependent temperature profiles and mean wheat temperatures were greater in 113.5 g of wheat, exposed at a distance of 8.0 cm from the infrared emitter for 60 sec. The most heat tolerant stage in R. dominica was the older larvae, whereas in S. oryzae it was the egg, and in T. castaneum it was the pupa. In general, older larvae of all three species were less susceptible to infrared radiation than young larvae. The differences in susceptibility among life stages of all species to infrared radiation decreased with an increase in the mean temperature attained, and temperatures ≥105[degrees]C were needed to obtain 98 to 100% mortality of all life stages. Exposure to catalytic infrared radiation at the temperatures used to disinfest wheat did not adversely affect wheat, flour, and baking quality.

Explaining the origin and maintenance of biodiversity is a central goal in ecology and evolutionary biology. Some of the most important, theoretical explanations for this diversity centre on the evolution of life histories. Comparative studies on life history evolution, have received significant attention in the zoological literature, but have lagged in plants. Recent developments, however, have emphasised the value of comparative analysis of data for many species to test existing theories of life history evolution, as well as to provide the basis for developing additional or alternative theories. The primary goal of this study was to explore existing theories of life history evolution using a dataset of demographic information in the form of matrix population models for a large number of plant species. By projecting average matrix population models for 207 plant species, life tables and fecundity schedules were obtained and, in turn, were used to estimate relevant life history parameters. These parameters were then used to explore the i) lability of life history traits in plants ii) their continuum of life history variation, iii) the evolution of senescence and iv) the significance of demographic entropy in population ecology. Elasticities and sensitivities of life history traits showed significant phylogenetic signal compared to other life history traits, although, all the values of phylogenetic signal observed were &lt; 1 indicating that life history traits are generally labile. Eighty one percent of species in the datset had mortality curves that increased with age compared to one hundred percent of species that showed a reproductive value curve that decreases with age at the end of life. In particular, the parameters that measured pace and duration were inversely related suggesting in general, the presence of senescence in our data set. Finally, the tenets of the directionality theory based on demographic entropy were generally not confirmed. This study provides an important contribution to the life history evolution of iteroparous perennial plants and confirms existing theories on life history evolution.

Examining Exclusive Breastfeeding Practice in Indonesia, and its Association to Maternal Socio-demographic Determinants, to Inform Intervention Efforts Aimed at Reducing Infant Mortality Introduction Exclusive breastfeeding, the gold standard of infant feeding practices, has been identified as the single most effective strategy to improve child survival. However, this recommendation is not highly practiced in Indonesia, while Indonesia’s infant and under five mortality is still high. Interventions to promote, protect, and support breastfeeding practice are critical public health needs in Indonesia. Aim The current study examined socio-demographic factors associated with exclusive breastfeeding practice in Indonesia: whether maternal age, level of education, occupation status, wealth index, and region of residence, as well as breastfeeding initiation are associated with exclusive breastfeeding practice in Indonesia for mothers having infants up to age five months. Methods This study analyzed 1695 women having infant aged 0-5 month old data from the 2012 Indonesia Demographic Health Survey. Chi-square test was used for preliminary analysis and logistic regression analyses were used to primary analysis by using SAS 9.4 program. Results Exclusive breastfeeding practice in Indonesia was low (36.1%). Mothers aged 30-39 years old were more likely to exclusively breastfeed compare to mothers under 20 years old (OR=1.56, 95% CI 1.04-2.35). Mothers with high education level had higher odds to exclusively breastfeed compare to low education mothers. Unemployed mother were more likely to exclusively breastfeed than working mothers (OR=1.65, 95% CI 1.28-2.13). Mothers coming from richer wealth index were less likely to exclusively breastfeed compare to mothers having poorest wealth index (OR= 0.49, 95% CI 95% 0.34-0.72). Those who initiated breastfeeding early had increased odds to exclusively breastfeed than mothers who delayed breastfeeding initiation (OR=1.47 95% CI 1.19-1.83). Finally, mothers who lived in Eastern Indonesia were more likely to exclusively breastfeed compare to mothers who lived in Sumatera and Kalimantan (OR=1.82, 95% CI 1.30-2.55). Conclusion This study found characteristics of Indonesian mothers who were more likely to exclusively breastfeed compared to the reference group: aged 30-39 years old, high education level, unemployed, richer wealth index, and those who live in Eastern Indonesia; as well as, mother who initiate breastfeeding early. Having tailored strategies and interventions to targeted at-risk populations may increase the likelihood of exclusive breastfeeding practices, and ultimately, decreasing infant mortality rates in Indonesia.

Aims The overall aim of this thesis was to extend current knowledge about the prevalence of malnutrition, to identify possible risk factors for development of malnutrition, and to describe the consequences of malnutrition in relation to all-cause and cause-specific mortality among older adults admitted to hospital. Methods The prevalence of malnutrition was estimated in a cohort of 1771 older adults (≥65 years) who were admitted to a Swedish hospital during 2008–2009 (15 months) and screened for malnutrition using the Mini Nutritional Assessment (MNA) instrument. Possible risk factors for malnutrition were recorded during the hospital stay (Study I). Dietary intake 10 years earlier (in 1997) was collected for 725 of these older adults (Study II). All-cause (Study III) and cause-specific (Study IV) mortality were followed up after medians of 3.5 and 5.1 years, respectively, for 1767 of the participants. Results The prevalence of malnutrition was 9.4% while 55.1% were at risk of malnutrition. Risk factors for malnutrition was an overnight fast &gt;11 hours, &lt;4 eating episodes a day, and not cooking independently. In middle-aged and older adults with a body mass index &lt;25 kg/m2 in 1997, the risk of malnutrition increased for each additional percentage point of energy from total, saturated and monounsaturated fat at follow-up after 10 years. Malnourished older adults had almost four times higher risk of death during follow-up, while those at risk of malnutrition had a 56% higher risk, compared to well-nourished. Furthermore, well-nourished older adults had consistently lower risk of death, regardless of the cause of death. Conclusions Only 35.5% of older adults admitted to hospital were well-nourished. The identified risk factors could be used in interventions aimed at preventing malnutrition. Normal-weight and underweight middle-aged and older adults should consider limiting the intake of total fat and/or improve the quality of the fat in the diet in order to decrease the risk of becoming malnourished later in life. Malnutrition and risk of malnutrition were associated with increased overall and cause-specific mortality. These relationships emphasize the need for nutritional screening to identify individuals who may require nutritional support in order to avoid preterm death.