Current efforts to measure child mortality for municipalities in Brazil are hampered by the relative rarity of child deaths, which often results in unstable and unreliable estimates. As a result, it is not possible to accurately assess true levels of child mortality for many areas, hindering efforts towards constructing and implementing effective policy initiatives for the reduction of child mortality. However, with a spatial smoothing process based upon Bayesian Statistics it is possible to “borrow” information from neighboring areas in order to generate more stable and accurate estimates of mortality in smaller areas. The objective of this study is to use this spatial smoothing process to derive estimates of child mortality at the level of the municipality in Brazil. Using data from the 2000 Brazil Census, I derive both Bayesian and non-Bayesian estimates of mortality for each municipality. In comparing the smoothed and raw estimates of this parameter, I find that the Bayesian estimates yield a clearer spatial pattern of child mortality with smaller variances in less populated municipalities, thus, more accurately reflecting the true mortality situation of those municipalities. These estimates can then be used, ultimately, to lead to more effective policies and health initiatives in the fight for the reduction of child mortality in Brazil. / text

Revisión por pares

Magister Philosophiae - MPhil / Child mortality in Sierra Leone is the highest ranked in the world. Government officials and researchers have tried to understand how and why this has become such a big phenomenon in Sierra Leone. Researchers have come up with three main causes for child mortality in Sierra Leone: maternal factors, environmental factors and health factors. The majority of research has been carried out on maternal, as well as environmental factors. However, minimal research has been carried out on health factors in Sierra Leone. Therefore, the objective of this study is to see how maternal and environmental factors have an effect on health factors, which in turn causes child mortality. The data used was from the 2008 Sierra Leone Demographic and Household Survey (SLDHS). The child dataset was used as it contained the information required from both the mother and the child. Of the three categories that were used, the first was maternal factors, which included the mother’s age, the mother's occupation, the mother's education, the sex of the child, the birth number and religion. The second category was environmental factors, which included the source of water, type of toilet, place of residence, source of energy and the dwelling material used for the household. The final category was health factors, which included whether the child had a fever in the last 2 weeks, short rapid breaths, a cough or fever, a problem in the chest or runny nose and whether the child had Diarrhoea recently and still has Diarrhoea. The study showed that child mortality had four statistically significant factors associated with it: place of residence, birth number, religion and type of toilet facility. Furthermore, when it came to diseases affecting children, the SLDHS had not given much information, so we looked only at the effects it had on children. From our results, we concluded that ARI, Diarrhoea and Measles each had one variable that was statistically significant to it. As for Pneumonia, there were no variables associated with children contracting the disease.

The following study aims to examine the infant mortality in Kronoberg county in southern Sweden during four intervals 1820–1840, 1860–1880, 1900–1920 and 1930–1949, and thereby during the three latter stages of the demographic transition. The empirical data has been obtained from the region's central town, Växjö, and 16 different parishes on the countryside. As stated, the main issue is to study the development of infant mortality, but also to investigate whether there was any regional variation and whether the mortality was higher among the illegitimate children. The results show that infant mortality decreased from 173 to 35 per mille and that the urban parts of the study area initially had the highest mortality, but until the last interval it was lo­west in the urban environment. The highest infant mortality rate was observed among those born out of wedlock, which also declined from 262 to 65 per thousand throughout the studied periods.

This thesis examines the impact of social policies on child mortality. It argues that structural factors explain most of the variation in child mortality across countries and time. But that in Vietnam the state implemented effective social policies; leading to this country having low child mortality for its structural factors (income, income equality and women’s power). This thesis uses panel data econometrics to investigate the structural determinants of child mortality. Our model shows that national income and women’s power reduce, and income inequality increases, child mortality. These independent variables are significant at the 1% level and explain over 90% of the variation in child mortality when our dependent variable is under-five mortality from the World Development Indicators dataset. These results are robust to changes in the functional form, lag structure, dataset and measure of child mortality used in our model. Vietnam is an outlier in our model; it has low child mortality for its structural factors. We consider that Vietnam’s effective social policies may explain why it is an outlier. This thesis also undertakes a detailed case study of Vietnam’s social policies. We argue and provide considerable evidence that in Vietnam the government implemented effective family planning, child immunization and female education policies and that these reduced child mortality. Developing countries are currently committed through MDG4 to reducing under-five mortality by two thirds between 1990 and 2015. Our results show that developing countries are unlikely to achieve this goal because social policies have a small impact on child mortality relative to structural factors.

This dissertation examines three health and development issues in Sub-Saharan Africa. It analyzes the impact of policy changes and interventions on child mortality, household food consumption and cesarean section births. The study is motivated by the Millennium Development Goals and policies which could affect their achievement. In the first essay, I investigate the impact of debt relief on under-five mortality rate. A dynamic panel data estimator is employed in the analysis. The result shows that debt relief is associated with a statistically significant reduction in under-five mortality rate. I conclude that conditionality of debt relief or development aid can yield positive outcomes. The second essay examines the impact of private hospitals on the likelihood of cesarean section births in Uganda. The study is motivated by the increase in cesarean section births following the proliferation of private hospitals. The main method of estimation is a bivariate probit model. The results show that delivery at private hospitals increases the probability of cesarean section births, thus there is need to monitor private hospitals so that expectant mothers are protected from physician induced demand for avoidable cesarean section births. The final essay studies the impact of agricultural extension services on household food consumption in Uganda. The study exploits the variation in participation in the NAADS to estimate the impact of the program on household food consumption. I find that NAADS membership and training are associated with an increase in household food consumption, hence agricultural extension services can be used to reduce food insecurity. Policy recommendations and future studies are explored.

This study addressed important issues on infant and child mortality in Zimbabwe. The broad objective of the study is to establish levels and trends of under-5 mortality and to determine the impact of maternal, socioeconomic and environmental contamination variables on infant and child mortality. Data from four DHS surveys conducted in Zimbabwe were used. It was found that mortality at all ages below 5 years old remained more or less constant from the period 1990-1994 to the period 1995-1999 and declined from the period 1995-1999 to 2001-2005. Mortality below 5 years old declined from 102 deaths per 1,000 live births during 1995-1999 to 82 deaths in 2001-2005. This decline was unexpected and it is argued that this decline is probably not genuine. Various types of evidence are provided to support the view that this decline in mortality probably did not take place. Analysis of ZDHS 2005- 06 showed that births of order 6+ and short preceding interval (intervals of less than or equal to 18 months) had the highest infant mortality risk. Infants with these characteristics were significantly more likely (2.75 times) to die in infancy relative to births of order 2-5 and long preceding birth interval (p<0.001). The infant mortality risk associated with multiple births was 2.08 times more relative to singleton births (p<0.001). The results indicated that socioeconomic variables did not have a distinct impact on infant mortality. Determinants of child mortality were different in relative importance from those of infant mortality. The effect of maternal education, though not significant, implied a decline in child mortality with increasing maternal schooling. The provision of piped drinking water and flush toilets to the households had a stronger impact on child mortality than infant mortality. Including HIV prevalence in the models elevated the odds of dying in infancy and childhood stages by 10 percent and 63 percent, respectively. This suggests that HIV/AIDS directly and/or indirectly influences the current levels of under-5 mortality in Zimbabwe. This study supports health policy initiatives stimulating use of family planning methods to increase birth intervals. Family planning programmes should be aimed at educating women and men with low educational levels and those in rural areas about the potential benefits of long-term birth spacing. These and other results are expected to assist policy makers and programme managers in the child health sector to formulate appropriate strategies to improve the situation of under-5 children in Zimbabwe. / Thesis (PhD)--University of Pretoria, 2010. / School of Health Systems and Public Health (SHSPH) / PhD / Unrestricted

MSc (Med), Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, 2008

No description available.

Submitted by Johnny Rodrigues (johnnyrodrigues@ufcg.edu.br) on 2018-09-24T20:20:29Z No. of bitstreams: 1 MARIA LUCIANA BEZERRA SOUSA - DISSERTAÇÃO PPGCS 2014..pdf: 13547239 bytes, checksum: 71ef7e5e1cb02438b7fec494a412cb0c (MD5) / Made available in DSpace on 2018-09-24T20:20:29Z (GMT). No. of bitstreams: 1 MARIA LUCIANA BEZERRA SOUSA - DISSERTAÇÃO PPGCS 2014..pdf: 13547239 bytes, checksum: 71ef7e5e1cb02438b7fec494a412cb0c (MD5) Previous issue date: 2014 / Capes / A pesquisa foi desenvolvida com o objetivo de avaliar o impacto da Política de Atenção Básica a Saúde, em especial a Estratégia Saúde da Família (ESF), na taxa de mortalidade infantil nos municípios brasileiros. Trata-se de uma avaliação empírica da eficácia e efetividade da atenção básica, tendo como unidade de análise os municípios que integram o território nacional e as regiões geográficas do país. A variável dependente utilizada nesse estudo foi a taxa de mortalidade infantil; como variáveis explicativas foram utilizados os seguintes indicadores: municípios com ESF em todo período analisado, cobertura vacinai e as condições de saneamento básico. Também foram inseridas as seguintes variáveis de controle: o índice de desenvolvimento humano, o índice de Gini, a taxa de urbanização e a população. Os dados foram coletados junto ao Departamento de Informática do Sistema Único de Saúde (DATASUS), Programa das Nações Unidas para o Desenvolvimento (PNUD) e do Institulo Brasileiro de Geografia e Estatística (IBGE). Metodologicamente, dividiu-se os municípios brasileiros em dois grupos, o primeiro refere-se aqueles que receberam as equipes de saúde da família por todo período no Programa. No segundo grupo estão aqueles municípios que nunca haviam recebido tais equipes ou que receberam e sofreram interrupções. Nesse último grupo, verifícou-se que em média a taxa de mortalidade infantil era maior em torno de 10%. As regiões Nordeste e Sudeste estão entre as regiões que possuem o maior número de municípios que não sofreram oscilações no tempo de adesão ao programa, hoje denominada ESF; consequentemente, essas regiões apresentaram as menores taxa de mortalidade infantil (percentuais menores que a média nacional - 18,62). No modelo inferencial, verificou-se que de fato há significância estatística, apontando para uma relação de causalidade negativa entre ESF e taxa de mortalidade infantil. Sendo assim, os resultados obtidos sugerem que quanto maior o acesso a atenção básica menor a mortalidade infantil. A presente pesquisa configura-se em um dos poucos trabalhos realizados sobre a realidade dos municípios brasileiros e regiões geográficas do país que trazem de forma pioneira evidências sobre o impacto da atenção básica na taxa de mortalidade infantil. / The research was carried out to evaluate the impact of Primary Health Care Policy, in particular the Family Health Strategy, the rate of infant mortality in Brazilian municipalities. This is an empirical evaluation of the efficacy and effectiveness of primary care, with the unit of analysis, the municipalities of the country and geographical regions. The dependent variable used in this study was the infant mortality rate; municipalities with family health strategy throughout the period analyzed, vaccination coverage and sanitation conditions: as explanatory variables the following indicators were used. The following control variables were also entered: the human development index, the Gini index, the rate of urbanization and population. Data were collected from the Department of the Unified Health System, United Nations Program for Development and the Brazilian Institute of Geography and Statistics. Methodologically, we divided the municipalities into two groups, the first refers to those who received the family health teams throughout the program period. The second group are those municipalities that had never received such teams or have received and suffered outages. In this latter group, it was found that on average the rate of infant mortality was higher at around 10%. The Northeast and Southeast regions are among the regions with the highest number of municipalities that did not undergo oscillations in the time of joining the program, now called family health strategy; Therefore, these regions showed the lowest infant mortality rate (lower than the national average percentage - 18.62). In the inferential model, it was found that there is indeed statistically signifícant, pointing to a negative causal relationship between family health strategy and infant mortality rate. Thus, the results suggest that the greater access to primary care to lower infant mortality. This study sets up on one of the few studies about the reality of Brazilian municipalities and geographical áreas of the country that bring a pioneer in evidence on the impact of primary care on infant mortality.