Submitted by PPG Pediatria e Sa?de da Crian?a (pediatria-pg@pucrs.br) on 2019-03-12T12:24:17Z No. of bitstreams: 1 DISSERTA??O MariaRita Celiny 18_07_2018.pdf: 820907 bytes, checksum: 09346c615fe9651922e9d8fa8ab20b27 (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2019-03-18T11:12:08Z (GMT) No. of bitstreams: 1 DISSERTA??O MariaRita Celiny 18_07_2018.pdf: 820907 bytes, checksum: 09346c615fe9651922e9d8fa8ab20b27 (MD5) / Made available in DSpace on 2019-03-18T11:17:03Z (GMT). No. of bitstreams: 1 DISSERTA??O MariaRita Celiny 18_07_2018.pdf: 820907 bytes, checksum: 09346c615fe9651922e9d8fa8ab20b27 (MD5) Previous issue date: 2018-04-23 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Aims and Objectives: To evaluate the predictive capacity of Pediatric Risk of Mortality Score IV (PRISM IV) in a Pediatric Intensive Care Unit (PICU) in Southern Brazil. Secondarily compare this research to two other scores, Pediatric Index of Mortality (PIM) 2 and PIM 3 Methods: Longitudinal retrospective study, during one year, from January 1 to December 31, 2016. Children admitted to a PICU at a University Hospital in Southern Brazil. Patients older than 20 years and dying patients with vital signs incompatible with life after 2 hours of PICU admission were not included. Only the first entry into PICU during hospitalization was considered. Discrimination, calibration and comparison tests with other indexes and a PRISMIV / PIM2 concordance test were performed. The study was approved by the institution's ethics committee Results: There were 411 admissions in the year 2016, 378 patients were included in the study. Of these 378, 13 died, generating a mortality rate of 3.44%. PRISM IV estimated mortality of 3.18% with Standardised Mortality Ratio (SMR) of 1.08, zflora= -0.3. For the same sample, the PIM2 predicted a mortality of 2.78% and the PIM 3 of 2.51. In the same way, PIM 2 and PIM 3 presented SMR of 1.24 and 1.37, respectively, with zflora=-0.91 and -1.40. The Hosmer-Lemeshow (HL) adjustment test obtained a X? = 4,472 (p = 0.484) for PRISM IV. Similarly, the PIM 2 presented a good calibration with X? = 8,359 and p = 0.138. However, PIM 3 presented X?=16.013 and p = 0.007. The discrimination test with the area under the curve (AUC / ROC ? Receiver Operating Charateristic) of PRISM IV was 0.811 (95% CI 0.695-0.928). Similarly, the area of the PIM 2 was 0.779 (95% CI 0.645-0.913) and the PIM 3 obtained 0.759 (IC 95% 0.621-0.898). Among the three prognostic scores there was no statistical difference. The disagreement between the results of PRISM IV and PIM 2 was small. Conlusion: PRISM IV presented good predictive capacity in the study population, demonstrating good calibration and discrimination. In the comparative analysis, a similar predictive capacity was observed between this PRISM IV and PIM 2, which was not confirmed with PIM 3. It is suggested that PRISM IV be a validated tool for this population. / Objetivo: Avaliar a capacidade de predi??o do Pediatric Risk of Mortality Score IV (PRISM IV) em uma Unidade de Terapia Intensiva Pedi?trica (UTIP) no Sul do Brasil. Secundariamente comparar esta investiga??o a outros dois escores, Pediatric Index of Mortality (PIM) 2 e PIM 3. M?todos: Estudo retrospectivo longitudinal, de 01? de janeiro a 31 de dezembro de 2016 com crian?as admitidas em uma UTIP de um Hospital Universit?rio do Sul do Brasil. N?o foram inclu?dos pacientes com idade maior que 20 anos e pacientes moribundos, com sinais vitais incompat?veis com a vida ap?s 2 horas de admiss?o em UTIP. Apenas a primeira interna??o em UTIP durante a hospitaliza??o foi considerada. Foram realizados testes de discrimina??o, calibra??o e de compara??o com outros ?ndices e um teste de concord?ncia PRISM IV / PIM 2. O estudo foi aprovado pelo comit? de ?tica da institui??o. Resultados: Houveram 411 admiss?es no ano de 2016, 378 pacientes foram inclu?dos no estudo. Destes 378, 13 foram a ?bito, gerando uma taxa de mortalidade de 3,44%. O PRISM IV estimou mortalidade de 3,18% com Indice de Mortalidade Pad?o - (SMR) de 1,08, zflora= -0,31. Para a mesma amostra, o PIM 2 previu uma mortalidade de 2,78% e o PIM 3 de 2,51% e apresentaram SMR de 1,24 e 1,37, respectivamente, com valores para o zflora=-0,91 e -1,40. O teste de ajuste de Hosmer-Lemeshow (HL) obteve um X?=4,472 (p=0,484) para o PRISM IV. De forma semelhante, o PIM 2 apresentou boa calibra??o com X2=8,359 e p=0,138. Contudo, o PIM 3 apresentou X2=16,013 e p=0,007. O teste de discrimina??o com a ?rea abaixo da curva (AUC/ROC), do PRISM IV foi de 0,811 (IC95% 0,695-0,928). Por sua vez, a ?rea do PIM 2 foi de 0,779 (IC95% 0,645-0,913) e o PIM 3 obteve 0,759 (IC95% 0,621-0,898). Considerando a curva ROC, entre os tr?s escores progn?sticos n?o houve diferen?a estat?stica. A discord?ncia entre os resultados do PRISM IV e o PIM2 foi pequena. Conlus?o: O PRISM IV apresentou adequada capacidade preditiva na popula??o do estudo, demonstrando boa calibra??o e discrimina??o. Na an?lise comparativa observou-se semelhante capacidade preditiva entre este PRISM IV e PIM 2, o que n?o se confirmou com o PIM 3. O PRISM IV mostrou-se uma ferramenta validada para utiliza??o em UTIP no presente estudo.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

This paper uses state-level variation in the implementation of the 73rd amendment in India to observe the relationship between political reservations for women in local government and female child mortality. Nationally, reservations for women are not associated with a statistically significant difference in female child mortality. However, a state by state analysis shows variations in the level of impact of reservations on the topic of female child mortality. This paper examines the constraints on female representatives and their level of effectiveness in executing pro-female policies given the political and social environment. The two case studies on Kerala and Haryana explore women office holder’s abilities to administer public goods that favor women and children and the subsequent impact on female child mortality.

Cette thèse se donne pour objectif de contribuer à la compréhension des tendances démographiques en Afrique subsaharienne par l’examen de l’influence de la mortalité infantile sur les comportements de fécondité. Dans le premier chapitre, j’examine la relation entre mortalité infantile et fécondité à l’échelle micro-économique. Des modèles de données de comptage sont utilisés pour analyser les déterminants de la fécondité complète de femmes d’une communauté rurale sénégalaise. Je montre que l’effet global de la mortalité infantile est positif tant sur la fécondité totale que sur la fécondité nette. De plus, j’identifie une relation en U inversé entre mortalité infantile et fécondité nette. Dans le second chapitre, j’analyse les effets de la mortalité infantile sur les comportements reproductifs dans un modèle de fécondité endogène où la survie infantile est stochastique. J’adopte une forme fonctionnelle de coût des enfants englobant quatre scénarios différents, chacun représentant un contexte socio-économique distinct. Mon modèle peut prédire des réponses positives et négatives de la fécondité, selon que les enfants sont respectivement “intensifs en temps” ou “pourvoyeurs en temps”. Finalement, le troisième chapitre analyse les effets de la mortalité et de la morbidité infantiles sur le processus de décision de fécondité des femmes rurales sénégalaises. J’estime des modèles dynamiques non linéaires de données de panel. Je montre que la mortalité et la morbidité palustres à l’échelle de la communauté, ont un effet positif sur les décisions ultérieures de fécondité. Cet effet est d’autant plus fort que la maladie est létale pour les enfants infectés. / This dissertation attempts to contribute to the understanding of current demographic trends in sub-Saharan Africa by examining the role of child mortality in shaping fertility behavior. In the first chapter of this dissertation, I examine the relationship between child mortality and fertility at the micro level. Count data models are employed to investigate the determinants of completed fertility of women from a Senegalese rural community. The global effect of child mortality on total and net fertility is found to be positive. I also identify an inverted-U shaped relationship between child mortality and net fertility. In the second chapter of this dissertation, I analyze the effects of child mortality changes on fertility behaviors in an endogenous fertility model where child survival is stochastic. I adopt a functional form for the cost of children that allows for four different scenarios, each of which is representative of a particular socio-economic setting. My model can predict both positive and negative fertility responses to child mortality depending on whether children are “time-intensive” or “time-supplying”, respectively. Finally, the third chapter analyzes the effects of childhood mortality and morbidity on the fertility decision-making process among rural Senegalese women. I estimate nonlinear dynamic panel data models of fertility behavior. I find that community child mortality and morbidity attributable to malaria exert a joint influence on fertility behaviors. Community-level malaria incidence among children has a positive effect on subsequent fertility choices, and this positive effect is stronger the more the disease is fatal to children who are infected.

Background  Both Intimate partner violence and under 5- child mortality are alarmingly high in the world, Nigeria is one of the leading countries. The adverse health outcomes for both women and children as a result of living in a violent environment need to be addressed and combatted. This study aimed to investigate whether there was any association between maternal exposure of lifetime violence (Emotional, physical, sexual, and any violence) and under-5 child mortality.  Method  The study was a cross-sectional study based on secondary data from Nigerian demographic health surveys (DHS) from 2018. The study sample consisted of 8389 married and non-married women, aged 15-49 years who completed the domestic violence module, with a dead or alive first-born child. To assess the associations between maternal experience of lifetime exposure of different types of violence (Emotional, physical, sexual, and any violence) and under-5 child mortality Chi-squared tests were performed, followed by logistic regression. Result In this study, the prevalence of emotional violence was 33,6 %, physical violence 21,3 %, sexual violence 7,7 % and any violence 38,5 %. Moreover, 6,7 % of the children in the sample were dead. The results showed that emotional violence, physical violence, and any violence were not significantly associated with under-5 child mortality. However, sexual violence showed an association with under-5 child mortality (P-value: 0,002). In addition, logistic regression showed that religion was associated with under-5 child mortality (P-value: <0,001). Muslim women had increased odds of child death, compared with Christian women(aOR:0,63, CI:0,50-0,78). The oldest women aged 40-49 years were found to be associated with under-5 child mortality (P-value:< 0,001). High maternal age increased the odds for under-5 child mortality (aOR: 2,08, CI:1,58-2,75). Moreover, maternal working status was associated with under-5 child mortality (P-value: <0,001). Working women had increased odds for experiencing child death, compared with the non-working women (aOR: 7,04, CI: 4,99-9,92). Finally, wealth was negatively associated with the outcome of under-5 child mortality (P-value: 0,007). The richest women had the lower odds of under-5 mortality, compared with the poorest women (aOR: 0,62, CI: 0,44-0,88). Conclusion The study showed an association between sexual violence and under-5 child mortality. Both sexual IPV and under-5 child mortality must be addressed urgently because it has detrimental effects on both women’s and children’s health in Nigeria. The study also found that high maternal age increases the odds for under-5 child mortality, and adequate age for motherhood must be promoted, to save the lives of children. Moreover, belonging to a low wealth quintile increases the risk for child death, and therefore poverty must be relived in Nigeria, so SDG 3.2.1 can be reached: “End all preventable deaths under 5 years and not more than 25 child deaths per 1000 live births by 2030”.

Introducción: El presente proyecto de intervención en salud se realizó en el asentamiento humano Pacífico Villa parte alta, ubicado en el distrito de Chorrillos, donde la prevalencia y mortalidad por enfermedades respiratorias en niños menores de 5 años es alta y representa un problema en salud. Objetivos: El proyecto tuvo el objetivo de mejorar el conocimiento de la población sobre la prevención de enfermedades respiratorias agudas en niños menores de 5 años. Para lograr esto se incidió en las principales 3 causas encontradas que eran los inadecuados hábitos de higiene en niños y cuidadores involucrados, la baja cobertura de vacunación en los niños menores de 5 años y la malnutrición en los niños que los predispone a padecer todo tipo de enfermedades. Metodología: Se siguió la metodología del marco lógico, se realizó en primer lugar una priorización de problemas y el análisis de involucrados, se esquematizó el árbol de problemas y árbol de objetivos, a continuación, se analizaron las alternativas de solución y se graficó la estructura analítica del proyecto, luego se realizó la matriz del marco lógico y finalmente se plantearon las actividades y tareas resumidas en la matriz de programación. Actividades: Se realizaron 2 actividades principales que consistieron en la realización de afiches y videos para presentar a la comunidad vía online debido a la coyuntura actual de la pandemia por Sars-CoV-2. Resultados: Los resultados del proyecto a corto plazo se midieron por encuestas de conocimiento respondidas por la comunidad, una antes de la intervención y otra después, siendo el logro final la mejora de conocimiento de la comunidad en materia de prevención de enfermedades respiratorias, reconocimiento de sus signos de alarma, importancia de la vacunación, alimentación saludable, métodos de higiene, lactancia materna, entre otros. / Introduction: This health intervention project was carried out in the Pacific Villa upper part human settlement, located in the district of Chorrillos, where the prevalence and mortality from respiratory diseases in children under 5 years of age is high and represents a health problem. Objectives: The project had the objective of improving the population’s knowledge about prevention of acute respiratory diseases in children under 5 years of age. To achieve this, the main 3 causes found were involved, which were inadequate hygiene habits in children and their caregivers, low vaccination coverage in children under 5 years of age and malnutrition in children that predisposes them to suffer all kinds of diseases. Methodology: The logical framework approach was followed, first a prioritization of problems and the analysis of those involved were carried out, the tree of problems and tree of objectives were outlined, then the solution alternatives were analyzed and the analytical structure of the project, then the logical framework matrix was made and finally the activities and tasks summarized in the programming matrix were proposed. Activities: Two main activities were carried out, which consisted of making posters and videos to present to the community online due to the current situation of the Sars-CoV-2 pandemic. Results: The results of the short-term project were measured by knowledge surveys answered by the community, one before the intervention and another after, the final achievement being the improvement of the community's knowledge in the prevention of respiratory diseases, recognition of its warning signs, the importance of vaccination, healthy eating, hygiene methods, breastfeeding, among others. / Tesis

The purpose of this study is to investigate and get an overview of infant and child mortality in four smaller parishes in Småland County, Moheda, Slätthög, Vislanda and Skatelöv.The study will compare three different periods, 1889-1894, 1910-1915, and 1944-1940. The evidence has been collected from death and burial registers and birth and baptism registers from the parishes.The study's main question is "What proportion of Moheda's, Slätthög's, Vislanda's, and Skatelöv's children up to and including the age of six died during the periods 1889-1894, 1910-1915, and 1944-1949?". The result the study has achieved in relation to the main question is that during the first period 322 children died and during the last period 26 children died, thus the child mortality rate decreased.

In the first paper, the effects of trade openness and conflict risk on income inequality are investigated. I obtain that the effect of trade openness on inequality depends on the level of conflict risk. More precisely, there exists a threshold effect: trade openness worsens income inequality in countries where the risk of internal and external conflicts is high. Moreover, I find that countries with higher risk of conflicts are more unequal, and that more ethnically diverse countries increase income inequality. Finally, I obtain that democratic regimes decrease inequality. In the second paper, we analyze the general-equilibrium consequences of property right enforcement in the natural resource sector. Assuming that exclusion requires both private and public enforcement efforts, we compare states that differ by their ability to provide protection services. This ability is referred to as state capacity. We obtain that public protection services can effectively act as either substitutes or complements to private enforcement, and this strongly depends on state capacity. Under low state capacity, an increase in state protection services leads to a drop in national income as labor is drawn away from the directly productive activities. The opposite holds for high-capacity states. As a result, public protection services have an ambiguous effect on national income even though they can unambiguously increase resource rents. In the third paper, we argue that the right to hold dual citizenship can generate important social and economic benefits beyond its political dimension. We assemble a large panel dataset on dual citizenship. We find that in developing countries, dual citizenship recognition increases remittance inflows by US$1.19 billion, GDP and household consumption, and improves child survival. In developed countries, however, dual citizenship recognition decreases remittance inflows by US$1.44 billion, but increases FDI by US$828 billion, raises household consumption, gross capital formation and trade, and provides incentives for skilled workers to move to other countries.

La santé des enfants demeure une question prioritaire en Afrique sub-saharienne. Les disparités en matière de mortalité entre pays et au sein des pays persistent et se sont fortement accrues durant la dernière décennie. En dépit de solides arguments théoriques voulant que les variables contextuelles soient des déterminants importants de la santé des enfants, ces facteurs, et particulièrement les influences du contexte local, ont été étudiées beaucoup moins souvent que les caractéristiques individuelles. L'objectif principal de la présente thèse est d’identifier les déterminants individuels et contextuels associés à la mortalité des enfants de moins de 5 ans en Afrique sub-saharienne. L’analyse systématique est basée sur les données les plus récentes des enquêtes démographiques et de santé (DHS/EDS). Deux questions spécifiques sont examinées dans cette thèse. La première évalue la mesure dans la quelle le contexte local affecte la mortalité infanto-juvénile, net des caractéristiques individuelles. La seconde question est consacrée à l’examen de l’effet du faible poids à la naissance sur le risque de décès avant 5 ans. Par rapport à la première question, les analyses multi-niveaux confirment pour plusieurs pays étudiés l’importance simultanée de l’environnement familial et du contexte local de résidence dans l’explication des différences de mortalité infanto-juvénile. Toutefois, par comparaison au contexte familial, l’ampleur de l’effet de l’environnement local paraît assez modeste. Il apparaît donc que le contexte familial reste un puissant déterminant de la mortalité des enfants de moins de 5 ans en Afrique sub-saharienne. Les résultats indiquent en outre que certains attributs du contexte local de résidence influencent le risque de décès des enfants avant 5 ans, au-delà des facteurs individuels dans plusieurs pays. Cette thèse confirme l’effet contextuel de l’éducation sur la mortalité des enfants. Cet effet s’ajoute, dans certains pays, à l'effet positif du niveau individuel d’éducation de la mère sur la survie de l'enfant. Les résultats montrent aussi que le degré d’homogénéité ethnique de la localité influence fortement la probabilité de mourir avant 5 ans dans certains pays. Globalement, les résultats de cette thèse suggèrent que le défi de réduire la mortalité des enfants va au-delà des stratégies visant uniquement les facteurs individuels, et nécessite une meilleure compréhension de l’influence des facteurs contextuels. Par rapport à la deuxième question, les résultats montrent également que les facteurs individuels restent aussi très importants dans l’explication des différences de mortalité des enfants dans plusieurs pays étudiés. Nos résultats indiquent que les différences de mortalité selon le poids à la naissance sont significatives dans tous les pays inclus dans l’analyse. Les enfants nés avec un faible poids (moins de 2500 grammes) courent presque 2 à 4 fois plus de risques de mourir au cours des cinq premières années de vie que les enfants de poids normal, même après correction pour l’hétérogénéité non observée. Ce résultat suggère qu’en plus des mesures visant à réduire la pauvreté et les inégalités de revenus, la réduction de l’incidence du faible poids à la naissance pourrait apporter une contribution majeure aux Objectifs du Millénaire pour le développement; spécialement comme une stratégie efficace pour réduire le niveau de mortalité parmi les enfants de moins de cinq ans. / Child health remains a priority area for health policy in sub-Saharan Africa. Disparities in child mortality between and within countries have persisted and widened considerably during the last few decades. While researchers have devoted considerable attention to the impact of individual-level factors on child mortality, less is known about how community characteristics and institutions affect health outcomes for children, even though they have a prominent role in theoretical models. The aim of this thesis is to identify individual and contextual effects of child mortality by using data from the latest round of Demographic Health Surveys for all countries in sub-Saharan Africa. Two sets of questions are addressed in this research. First, we evaluate the impact of contextual factors on the risk of dying before age 5 net of the effect of individual factors. The results indicate that some attributes of the community influence the mortality risks of children, over and above the intermediate factors included in this investigation. For instance, in half of the countries under study a 1% increase in the proportion of children fully immunized in the community is associated with a decrease of 17-79% in the odds of dying before age 5. The proportion of women in the community completing secondary school also significantly increases child survival. This effect is, in some countries, in addition to the positive individual-level effect of the child’s own mother being educated. Net of individual and household characteristics, higher community-level ethnic homogeneity is associated with decreased odds of dying before age 5 in some countries. Overall, the results of this study therefore suggest that the challenge to reduce under-five mortality goes beyond addressing individual factors, and requires a better understanding of contextual factors. Second, the study exploits recent national survey data for nine countries in sub-Saharan Africa to investigate the association of LBW and mortality not only in infancy but also during childhood, using a standardized methodology to adjust missing birth weight data from household surveys while accounting for unobserved family-level factors (genetic or behavioral) that may modify the relationship between birth weight and under-five-years mortality. We find evidence of the impact of birth weight on the risk of dying not only in infancy but also during childhood, which remains strong and significant in all countries even after controlling for potential confounding factors. The main policy implication of our findings is that reducing the incidence of LBW may be an important prevention strategy to combating child mortality in sub-Saharan Africa countries.

In the first paper, the effects of trade openness and conflict risk on income inequality are investigated. I obtain that the effect of trade openness on inequality depends on the level of conflict risk. More precisely, there exists a threshold effect: trade openness worsens income inequality in countries where the risk of internal and external conflicts is high. Moreover, I find that countries with higher risk of conflicts are more unequal, and that more ethnically diverse countries increase income inequality. Finally, I obtain that democratic regimes decrease inequality. In the second paper, we analyze the general-equilibrium consequences of property right enforcement in the natural resource sector. Assuming that exclusion requires both private and public enforcement efforts, we compare states that differ by their ability to provide protection services. This ability is referred to as state capacity. We obtain that public protection services can effectively act as either substitutes or complements to private enforcement, and this strongly depends on state capacity. Under low state capacity, an increase in state protection services leads to a drop in national income as labor is drawn away from the directly productive activities. The opposite holds for high-capacity states. As a result, public protection services have an ambiguous effect on national income even though they can unambiguously increase resource rents. In the third paper, we argue that the right to hold dual citizenship can generate important social and economic benefits beyond its political dimension. We assemble a large panel dataset on dual citizenship. We find that in developing countries, dual citizenship recognition increases remittance inflows by US$1.19 billion, GDP and household consumption, and improves child survival. In developed countries, however, dual citizenship recognition decreases remittance inflows by US$1.44 billion, but increases FDI by US$828 billion, raises household consumption, gross capital formation and trade, and provides incentives for skilled workers to move to other countries.