Background: The study examines the differentials in child mortality existing in the different settlements in Soweto Townships as at May 2002. It attempts to establish the association existing between housing settlement and under-five mortality and as well examine how household characteristics such as building materials, source of drinking water, sanitation facilities and source of energy is associated with under-five mortality. Methods: The research comprises secondary data analysis of a household survey conducted in Soweto in May 2002 by Perinatal HIV Research Unit. The aim of the study is to describe child mortality and explore its relationship to five different housing settlements in Soweto Townships. Kaplan Meier curves were fitted to examine differentials in child mortality in the different housing settlements and Log rank test was used to compare the survival curves. Logistic regression models were fitted to establish factors that were associated with under-five mortality in Soweto Townships as a whole. Results: A total of 2741under-five surviving children and 84 under-five deaths were studied. Informal settlements recorded the highest overall under-five mortality rate (15.9 per 10000 child years) while private sector housing settlement recorded the least (3.3 per 10000 child years) of all the housing settlements. The overall under-five mortality in Soweto Townships was 10.4 per 10000 child years. After controlling for other household characteristics settlement was significantly associated with high under-five mortality (Council settlement OR 3.3, P=0.032, 95 CI; 1.113, 10.24, Informal settlement OR 5.10, P=0.005, 95% CI; 1.633, 15.99 and Hostel settlement OR 4.09, P=0.012, 95% CI; 1.357, 12.35). Use of paraffin and candles were also significantly associated with high under-five mortality (OR 3.4, P-value<0.001, 95% CI; 2.416, 19.15 and OR 7.2 P-value=0.014, 95% CI; 1.25, 8.88 respectively). Conclusions: Private sector housing settlements reported lower under-five mortality rates in Soweto Townships (3.3 per 10,000 child years) and was less associated with high mortality in comparison to the other housing settlements (Informal, council and hostel housing settlements) in Soweto Townships. Use of paraffin and candles for lighting in households were mainly associated with high under-five mortality in Soweto Townships in comparison to those households that used of electricity.

No description available.

A research report submitted to the Faculty of Health Science, in partial fulfillment of the requirement for the award of a Master’s Degree in Nursing Sciences by the Witwatersrand University of Johannesburg, South Africa. / This study, entitled “Knowledge of and challenges of health workers managing maternity patients at PHC facilities of Yobe State, Nigeria,” had the following objectives:  To describe the socio-demographic characteristics of the health workers in the Primary health care (PHC) facilities in the state.  To determine the level of knowledge of the health workers regarding the management of maternity patients in Primary health care facilities in Yobe State.  To determine the challenges experienced by the health workers in the Primary health care facilities in the state. The study was primarily aimed at exploring the health workers level of knowledge, skills and competencies in the management of maternity patients and their contributions towards the control and reduction of maternal mortality in the state. METHODS: A cross sectional survey study in PHC clinics of six selected local government areas of the state, namely Gujba, Geidam, Fune, Fika, Nguru and Jakusko local government areas. A total of 221 health workers (n=221) were interviewed using structured questionnaires, whilst 46 facility managers (n=46) were given self-administered questionnaires while on duty, and data were collected concurrently from clinic records. The data were cleaned, entered in to Epi info statistical software, imported and analysed using STATA. Descriptive and inferential statistics were used to interpret the outcomes of the analysis. RESULTS: More than half of the respondents were female (65.61%) with an average age of 33 years (SD± 8.1). Categories of the health workers who participated in the study were SCHEW, JCHEW, SSCE, TBAS, EHA/EHO and others who were not trained in any form as health workers, but were found running the affairs of maternity patients. More than 80% of the clinics did not have functional ambulances and there was gross inadequacy of basic services in most of the clinics; only 14 out of 46 clinics had portable water supply and electricity. There was a large seasonal turnout of patients in the clinics but poor patronage by maternity clients. The health workers in the maternity unit were found to be deficient in the knowledge, skills and competencies to manage maternity patients. Protocols were not followed (68.78%), some significant information about ante-natal care was not given to v clients and maternity clients were not adequately informed of some of the danger signs of pregnancy. There was a poor standard of institutional deliveries and the majority of the Health Workers had no training on EOC or conducting a clean and safe delivery. CONCLUSION: Examining the background of the current health workers in the primary health care facilities, the attainment of MDG 5 by 2015 will not be a reality, unless urgent measures are put in place, including large recruitment and motivation midwives, and deployment of these midwives to the rural health clinics. There is a need for the existing health workers to be supported by government and enrolled in short course training in Colleges of Midwifery to acquire the much needed skills and competencies for the care of maternity patients.

o presente estudo teve como objetivo a identificação de fatores de risco relativo de morte em criancas de um a sessenta meses de idade residentes em áreas de pobreza da cidade de Recife. O delineamento utilizado é do tipo caso-controle. Estudou-se o papel de variáveis relacionadas com o saneamento básico, bem como a renda, a educacão dos pais, a densidade demográfica intra-familiar, a história reprodutiva da mãe, o aleitamento materno e a assistência à saúde. Foram estudados 149 óbitos - \"casos\", e número igual de sobreviventes - \"controles\", pareados segundo a idade e o local de residência. Estimaram-se riscos relativos de morrer em análises univariadas para o total da amostra e para estratos segundo faixas etárias e causas básicas de ocorrência do óbito. Mediante modelos de regressão logística foram conduzidas análises multivariadas para todas as causas e idades e para dois sub-qrupos: o de menores de um ano e o de óbitos por causas gastrointestinais e seus \"controles\". Foi constatado elevado risco relativo de morte nas criancas das famílias com mais de três pré-escolares no domicílio. Em todas as análises univariadas realizadas o risco dessas criancas foi superior a 3.6 (P < 0.01) cheqando a 7.8 (P < 0,01) na análise multivariada conduzida para estimar o risco de morte por causas gastrointestinais. Com relacio ao tratamento intra-domiciliar da água, foi observado risco relativo superior a 3.8 (P < 0.01) na análise univariada; porém, nos modelos ajustados pela condição de amamentação e alfabetismo materno o risco de óbito gastrointestinal tornou-se inexistente. Na maioria das análises, foi também elevado o risco relativo nas crianças das mães com alta fecundidade materna. Igualmente o acesso aos servicos de saúde - medidas através da falta de atenção pré-natal - constitui risco relativo de morte, confirmando-se nas análises multivariadas finais, referentes à morte por causas gastrointestinais (OR = 11.11; P < 0.05). O aleitamento também mostrou ser fator preditivo de morte pós-neonatal por causas gastrointestinais (OR = 3.3;P < 0,05). Com base nestes resultados recomenda-se: (a) realizar investimentos de base ampla destinados a melhorar as condições de saneamento básico da cidade; (b) fornecer uma infra-estrutura de apoio para os cuidados das criancas a nível comunitário e/ou nos lugares de trabalho; (c) promover o espaçamento adequado entre os nascimentos; (d) aumentar a cobertura dos serviços de saúde, fomentando estratégias simplificadas de atenção primária com ativa participacão comunitária; (e) estimular ações permanentes e rotineiras de promoção do aleitamento ademais das campanhas eventuais. Estes resultados fornecem subsídios para a elaboração de políticas sociais destinadas a acelerar o processo de queda da mortalidade nos menores de cinco anos e identifica novos indicadores para entender os mecanismos que levam ao óbito nos estratos sócio-econômicos urbanos dos países em vias de desenvolvimento. / The aim of this case-control study was the identification of relative risk factors of mortality in children of 1 to 60 months of age resident in poor areas of the city of Recife. Sanitation, income, parent´s education, family density, mother´s reproductive history, breastfeeding and health care were studied and their roles as exposure factors were established. The sample consisted of 149 \"cases\" (dead children) and of the same number of \"controls\" (survivors) case-matched according to age and place of residence. Odds ratios (OR) were estimated through univariate analysis for the whole sample and for specific strata by age and cause of death. Multivariate modelling was then performed for infants and for gastrointestinal deaths and their \"controls\". High relative risk of death in families with more than three preschool children was verified. According to the univariate analysis the relative risk for multivariate analysis performed for gastrointestinal causes of death. Children whose families were not in the habit of treating water at home had a relative risk of gastrointestinal death of more than 3.8 (P < 0.01) in the univariate analysis. Whe adjusted for breast-feeding and mother´s literacy condition - through multivariate analysis - this risk was negligible. Most analysis showed important relative risk for children whose mothers had high fecundity. Likewise lack of access to health care - measured in terms of pre-natal care - was associated to a significant gastrointestinal causes (OR = 11,11; P< 0.05). Breastfeeding also shown to be a predictive factor of post-neonatal death due to gastrointestinal causes (OR = 3,3; P < 0.05). Based on these results it is recommended that: a) Sanitation be improved; b) an infrastructure for the day-care of children at community level be improved; c) an adequate intergestational interval be promoted; d) increase of health service coverage throught the strategy of primari health care with active comunity participation; e) the implementation of permanent activities (integrated to health service routine) with the aim of encouraging the practive of breastfeeding. It is, this considered that these results provide a basis for the formulation of social policies aiming at the acceleration of the decrease infant mortality. Also this study indicates new elements for understanding of the mechanism of death in poor urban areas.

MSc (Med), Population-Based Field Epidemiology, School of Public Health, University of the Witwatersrand, 2009 / Background: MDG 4 commits the international community to reducing mortality in children younger than 5 years by two-thirds by 2015.The biggest burden of child mortality lies in Saharan Africa. Objective: To investigate how distance from home to the nearest health facility is associated with infant and child (1-4 years) mortality in a typical rural setting of sub Saharan Africa. Methods: A secondary analysis of 28,823 under five children in Ifakara Health and Demographic surveillance system between 2005 and 2007 was carried out. Both Euclidean and networked distance from the household to the nearest health facility was estimated using geographical information system methods. Cox proportional hazard regression models were used to investigate the effect of distance from home to the nearest health facility on infant and child mortality. Results: Children who lived in homes with networked distance >5KM experienced about 18% increased mortality risk [HR=1.18;95%CI 1.02-1.38 p-value 0.05] compared to those who lived less than 5KM networked distance to the nearest health facility. Death of mother, death of preceding sibling and multiple births were the strongest independent predictors of child mortality. Malaria/AFI and pneumonia/ARI were the leading causes of death in children although there was no evidence to show association of cause specific mortality with networked distance in the study. vi Conclusions: Staying closer to the health facility improved the survival probability of the children. This effect was similar to that reported elsewhere in other studies which re-emphasize the usefulness of having fully functional health facilities closer to the populations that need them. The inconsistency of the Euclidean distance in the study further suggests that the networked distance is a better estimator of geographical accessibility and should be the preferred proxy distance measurement option in public health research. 1 Faculty of Health Sciences, University of the Witwatersrand; South Africa. 2 Ifakara Health & Demographic Surveillance System; Tanzania. 3 Iganga/Mayuge Health & Demographic Surveillance System; Uganda

o presente estudo teve como objetivo a identificação de fatores de risco relativo de morte em criancas de um a sessenta meses de idade residentes em áreas de pobreza da cidade de Recife. O delineamento utilizado é do tipo caso-controle. Estudou-se o papel de variáveis relacionadas com o saneamento básico, bem como a renda, a educacão dos pais, a densidade demográfica intra-familiar, a história reprodutiva da mãe, o aleitamento materno e a assistência à saúde. Foram estudados 149 óbitos - \"casos\", e número igual de sobreviventes - \"controles\", pareados segundo a idade e o local de residência. Estimaram-se riscos relativos de morrer em análises univariadas para o total da amostra e para estratos segundo faixas etárias e causas básicas de ocorrência do óbito. Mediante modelos de regressão logística foram conduzidas análises multivariadas para todas as causas e idades e para dois sub-qrupos: o de menores de um ano e o de óbitos por causas gastrointestinais e seus \"controles\". Foi constatado elevado risco relativo de morte nas criancas das famílias com mais de três pré-escolares no domicílio. Em todas as análises univariadas realizadas o risco dessas criancas foi superior a 3.6 (P < 0.01) cheqando a 7.8 (P < 0,01) na análise multivariada conduzida para estimar o risco de morte por causas gastrointestinais. Com relacio ao tratamento intra-domiciliar da água, foi observado risco relativo superior a 3.8 (P < 0.01) na análise univariada; porém, nos modelos ajustados pela condição de amamentação e alfabetismo materno o risco de óbito gastrointestinal tornou-se inexistente. Na maioria das análises, foi também elevado o risco relativo nas crianças das mães com alta fecundidade materna. Igualmente o acesso aos servicos de saúde - medidas através da falta de atenção pré-natal - constitui risco relativo de morte, confirmando-se nas análises multivariadas finais, referentes à morte por causas gastrointestinais (OR = 11.11; P < 0.05). O aleitamento também mostrou ser fator preditivo de morte pós-neonatal por causas gastrointestinais (OR = 3.3;P < 0,05). Com base nestes resultados recomenda-se: (a) realizar investimentos de base ampla destinados a melhorar as condições de saneamento básico da cidade; (b) fornecer uma infra-estrutura de apoio para os cuidados das criancas a nível comunitário e/ou nos lugares de trabalho; (c) promover o espaçamento adequado entre os nascimentos; (d) aumentar a cobertura dos serviços de saúde, fomentando estratégias simplificadas de atenção primária com ativa participacão comunitária; (e) estimular ações permanentes e rotineiras de promoção do aleitamento ademais das campanhas eventuais. Estes resultados fornecem subsídios para a elaboração de políticas sociais destinadas a acelerar o processo de queda da mortalidade nos menores de cinco anos e identifica novos indicadores para entender os mecanismos que levam ao óbito nos estratos sócio-econômicos urbanos dos países em vias de desenvolvimento. / The aim of this case-control study was the identification of relative risk factors of mortality in children of 1 to 60 months of age resident in poor areas of the city of Recife. Sanitation, income, parent´s education, family density, mother´s reproductive history, breastfeeding and health care were studied and their roles as exposure factors were established. The sample consisted of 149 \"cases\" (dead children) and of the same number of \"controls\" (survivors) case-matched according to age and place of residence. Odds ratios (OR) were estimated through univariate analysis for the whole sample and for specific strata by age and cause of death. Multivariate modelling was then performed for infants and for gastrointestinal deaths and their \"controls\". High relative risk of death in families with more than three preschool children was verified. According to the univariate analysis the relative risk for multivariate analysis performed for gastrointestinal causes of death. Children whose families were not in the habit of treating water at home had a relative risk of gastrointestinal death of more than 3.8 (P < 0.01) in the univariate analysis. Whe adjusted for breast-feeding and mother´s literacy condition - through multivariate analysis - this risk was negligible. Most analysis showed important relative risk for children whose mothers had high fecundity. Likewise lack of access to health care - measured in terms of pre-natal care - was associated to a significant gastrointestinal causes (OR = 11,11; P< 0.05). Breastfeeding also shown to be a predictive factor of post-neonatal death due to gastrointestinal causes (OR = 3,3; P < 0.05). Based on these results it is recommended that: a) Sanitation be improved; b) an infrastructure for the day-care of children at community level be improved; c) an adequate intergestational interval be promoted; d) increase of health service coverage throught the strategy of primari health care with active comunity participation; e) the implementation of permanent activities (integrated to health service routine) with the aim of encouraging the practive of breastfeeding. It is, this considered that these results provide a basis for the formulation of social policies aiming at the acceleration of the decrease infant mortality. Also this study indicates new elements for understanding of the mechanism of death in poor urban areas.

No description available.

Background: When children experience food insecurity, in addition to poverty, their resultant inadequate food intake and disease often leads to the development of proteinenergy malnutrition and ultimately to death. In South Africa, where three out of every four children live in poverty, food insecurity and its multiple negative effects are consequently among the most urgent social issues affecting households and their children. Since household food insecurity is thought to be associated with increased child mortality, it is important to study any such associations amongst South African children to determine additional risk factors for child mortality. Objectives: The main objective of this study was to establish the relationship between household food security and mortality in children under the age of five years in the Agincourt field site, Limpopo Province, in 2004. Methods: An analytical cross-sectional study of secondary data obtained from the 2004 census questionnaire and food security module of the Agincourt Health and Demographic Surveillance System in rural Limpopo Province was conducted, involving a total of 7,790 black children under the age of five years. Certain exposure variables were selected for use as indicators of food security and these were analysed with respect to child mortality using univariate and multivariate logistic regression. Results: Based on the outcome indicators of food consumption, 37% of the study population were found to have experienced household food insecurity in 2004, reporting insufficient food for the entire household in the previous month and year. The limited dietary diversity and insufficient quantities of food experienced by the majority of the population were supplemented by the local growth of food crops and the gathering of food from the bush. Of the 79 children (1%) under the age of five years who died in 2004, the majority (24%) died of HIV-related diseases, in addition to deaths caused by diarrhoea, respiratory infections, and malnutrition. Child mortality was found to be associated with the reporting of “unknown” for several indicators of food security. Additionally, expecting the food availability of the household in the coming year to be less than that of the current year (that is, the prediction of future household food insecurity) was significantly associated with an increased risk of under-five child mortality compared to the expectation of the same amount of food the following year (adjusted odds ratio (OR) 2.0), and with a greatly increased risk of mortality compared to the prediction of more food (future household food security) (adjusted OR 4.4). The latter association was age-specific to infants under the age of one year (adjusted OR 5.6) and cause-specific to HIV deaths (adjusted OR 5.9). Conclusions: Following a significant trend in this study in the rural north-east of South Africa, future household food security was inversely related to, and hence protective over, childhood mortality in 2004, even after controlling for confounding factors. Further research on the associations between household food security and under-five child mortality, conducted following the development of a standard nation-wide food security measurement tool specific to South African household conditions, would confirm household food insecurity as a significant risk factor for under-five child mortality and, consequently, as a target for future policies in the reduction of child mortality in this country.

MSc (Med) , Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, 2009

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Epidemiology (Epidemiology and Biostatistics). 2016 / Background Reducing severe acute respiratory illness (SARI)-associated mortality in African children remains a public health priority and an immense challenge. The pneumococcal conjugate vaccine (PCV) was introduced into the South African routine immunization programme in 2009. The objectives of this study were: I. To describe the demographic characteristics, clinical presentation, respiratory pathogens of children aged <5 years hospitalized with SARI in an urban (Chris Hani-Baragwanath Hospital, Soweto) and a rural (Matikwana and Mapuleng Hospitals, Mpumalanga) setting in South Africa from 2009-2013 and II. To compare the factors associated with mortality among children aged <5 years hospitalized with SARI in these two sites separately. Methods Hospitalized children with SARI were enrolled into an active, prospective sentinel surveillance program. Clinical and epidemiologic data were collected until discharge. Nasopharyngeal aspirates were tested for influenza (A and B) and eight other respiratory viruses. In-hospital case-fatality proportion (CFP) and risk factors for mortality were determined for each hospital site separately using unconditional logistic regression. Results The in-hospital CFP was significantly higher in the rural (6.9%, 103/1486) than the urban (1.3%, 51/3811) site (p<0.001). This was observed among both HIV-infected (urban: 6.6%, 17/257) vs. (rural: 12.9%, 30/233) (p=0.019) and HIV-uninfected children (urban: 0.6%, 13/2236) vs. (rural: 4.2% 36/857) (p<0.001). In the urban site the only factor that is independently associated with death on multivariate analysis was HIV infection (odds ratio (OR) 12.1, 95% confidence interval (CI) 5.8-25.2). In the rural site HIV infection (OR 3.5, 95% CI 1.7-6.9), age <1 year (OR 3.5, 95% CI 2.0-6.1) vs. 1-4 years, any respiratory virus detected (OR 0.4, 95% CI 0.2-0.6), pneumococcal infection(OR 4.5, 95% CI 1.8-10.8) and malnutrition (OR 12.8, 95%CI 1.2-134.6) were independently associated with mortality. Conclusion SARI mortality was higher in the rural setting. Even in the era of PCV availability pneumococcus is still associated with mortality in rural areas. Efforts to prevent and treat HIV infections in children and reduce malnutrition may reduce SARI deaths. / MT2017