The uThukela District in the province of Kwazulu-Natal, Republic of South Africa, has been involved in improving Primary Health Care (PHC) in the district through evaluation surveys carried out at regular intervals during the past six years. World Vision's uThukela District Child Survival Project (TDCSP) began in November 16, 1999. This has been made possible by a Child Survival Grants Program from the Unites States Agency for International Development (USAID). In all previous surveys a 30-cluster sampling methodology was used to select individuals from the survey population. This time however, the Lot Quality Assurance Sampling (LQAS) methodology was used. The recent re-organization of the District into municipalities enabled each municipality to function as one Supervision Area (SA) or Lot. Even with a small sample size (in this case 24 per SA), poor health service performance could be identified so that resources are appropriately distributed. Furthermore, people from the community such as Community Health Workers (CHW) were involved in all phases of the study, including the manual analysis of the results, upon being trained appropriate. However, it is questionable as to how accurate and reliable such a manual analysis was. In this dissertation, the manual results of the study were evaluated by doing an electronic analysis. In addition, a more refined analysis of the data has been produced (e.g. population-weighted coverage, graphs and stratified analyses in some cases). From the comparisons made, it was concluded that the manual analysis was very similar to the electronic analysis and that differences obtained were not statistically significant. In addition, due to each municipality varying in population size, it was queried as to whether population-weighted results would produce a marked difference from the un-weighted, manual results. Again, the differences produced were in most cases not statistically significant. This concluded that the manual analysis carried out by the TDCSP team was accurate and that it is appropriate to use such results in determining individual municipality performance and overall District performance so that responsive action can then be taken immediately, without necessarily having to wait for electronic results. / Thesis (M.P.H.)-University of KwaZulu-Natal, 2005.

No abstract available. / Thesis (M.P.H.)-University of KwaZulu-Natal, Durban, 2006.

Background Recent gains in child survival are being threatened by the RN epidemic. Monitoring child mortality rates is essential to understanding the impact of the epidemic, but is constrained by a lack of data. A community-based survey was used to determine child mortality rates in a rural area with high RN prevalence, located in the Rlabisa subdistrict of the KwaZulu-Natal Province, South Africa. ii. Methods The study was conducted between 1 January 2000 and 31 December 2002 on deaths in children under the age of 15 years. Children were followed up through 4-monthly home visits. Cause of death was ascertained by verbal autopsy. Rates were calculated using Poisson methods. iii. Results Infant and under-5 mortality ratios were respectively, 59.6 and 97.1 deaths per 1000 live births. Infant and under-5 mortality rates were, respectively, 67.5 and 21.1 deaths per 1000 child-years. RN/AIDS was attributed to 41% of deaths in the under-5 age group, with a mortality rate of 8.6 per 1000 person years. Lower respiratory infections caused an estimated 24.9 deaths per 1000 person years in children under 1 year of age. iv. Discussion In rural South Africa, infant and child mortality levels are high, with RN/AIDS estimated as the single largest cause ofdeath. Improving the coverage of interventions known to impact on child mortality is required urgently. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2007.

The issue of child mortality is currently under international spotlight, as the rates of neonatal and under five mortality are sobering. „About 29,000 children under the age of five [approximately] 21 each minute die every day, mainly from preventable causes‟. Although there has been a decline in global child mortality rates since 1990, sub-Saharan Africa still has the highest rates, where one child in eight dies before age five. As contained in the Millennium Development Goals (MDGs) 2010 report, in 2008, sub-Saharan Africa bore half of the 8.8 million deaths in children under five. / Thesis (LLM (Human Rights and Democratisation in Africa))--University of Pretoria, 2012. / http://www.chr.up.ac.za/ / nf2012 / Centre for Human Rights / LLM

No description available.

Thesis (MSc. (Statistics)) -- University of Limpopo, 2022 / Under-Five Mortality (U5M) remains a major health challenge in most sub Saharan African countries including SouthAfrica,despite the significant progress made in child survival and the government’s efforts and commitment to reduce U5M. The failure of achieving the fourth Millennium Development Goal (MDG) by 2015 has led to an implementation of Sustainable Development Goal 3 (SDG3) which aims to have no more than 25 deaths per 1000 live births by 2030. To achieve this goal, more information is needed. Hence, the purpose of this study was to apply count models to identify the determinants of underfive mortality rate in South Africa. To identify these determinants, the study reviewed generalized linear models and utilised the 2016 South African Demographic and Health Survey data. The models studied were Logistic Regression (LR), Poisson Regression (PR) and Negative Binomial Regression (NBR). The findings revealed that baby postnatal check-up, child’s health prior discharge, child birth size, toilet facility, maternal education, province, residence and water source were significantly associated with U5M in South Africa. It was further concluded that children who are at high risk of dying before the age of five are those who did not attend their postnatal check-up within the first two months, those whose health was not checked prior discharge, whose birth size was very small, whose household utilised bucket toilets, who resided in Western Cape, North West and Mpumalanga province, who resided in urban areas as well as those whose household utilized piped, tube well and spring water as source of drinking water. / Department of Science and Technology(DST) National Research Foundation Centre of excellence in mathematical and statistical sciences(CoE-NasS) of South Africa.

The purpose of this study was to show how information from the District Health Information System can be used to empower managers to make evidence-based decisions that will strengthen the health care system to reduce the under-five mortality rate. A quantitative, contextual, exploratory evaluative and descriptive approach was followed and a data extraction framework, based on systems theory, was developed to guide the process of extracting existing routine data. A results-based approach was used to measure under-five mortality related health care in terms of impact, outcomes, outputs, processes and inputs. The study has highlighted that proxy indicators obtained this way places health care managers in the position to monitor progress towards achieving the Millennium Development Goal for child mortality in the interim periods between large population surveys. The findings displayed in the diagnostic performance profile revealed that drastic interventions are required to reduce the under-five mortality rate. / Health Studies / M.A. (Health Studies)

The case fatality rate for malnutrition at St Barnabas Hospital over the past years has been around 38%. The rates in other district hospitals in the Eastern Cape province were found to be in excess of 30%. In June 2000, the Eastern Cape Department of Health introduced a protocol for in-patient management of children with severe malnutrition, with the aim of reducing case fatality rate below 10%. St Barnabas Hospital introduced the Eastern Cape protocol in August 2003. An evaluation was done in November 2003 to assess the protocol's impact on the case fatality rate. The rate remained high, at 37.5%. This study descibed the current practices and attitudes of the nurses as St Barnabas Hospital paediatric ward, in the management of severely malnourished childen.

Thesis (M.A.(Demography and Population Studies))--University of the Witwatersrand, Faculty of Humanities, School of Social Sciences, 2016 / BACKGROUND: Under-5 children in KwaZulu-Natal are highly exposed to dying before reaching five years of life. Studies have been conducted to understand the demographic and socioeconomic factors that influence under-5 mortality, both nationally and internationally, with some contradicting findings on the association between some socioeconomic and demographic factors and under-5 mortality. While some studies found child mortality to be significantly associated with rural geographical place of residence, the reverse has also been established. The purpose of this study was to examine the association between socioeconomic and demographic factors and under-5 mortality in KwaZulu-Natal, South Africa. DESIGN: The study was cross-sectional, and utilises 2011 Census secondary data set from Statistics SA. Overall, the census revealed that 55 476 children under the age of 5 had died in the 12 months prior to the census nationally. In KwaZulu-Natal this figure was 15 356. The 10% sample showed that 1 474 under-5 children had died in the same period in KwaZulu-Natal. STATA 12.0 was used for the analysis. Binary logistic regression model was used to examine the association between under-5 mortality and the independent variables. RESULTS: The major findings of the study indicated that (i) male children were 1.22 times more likely to die compared to female children under the age of 5 years; (ii) mothers who had no schooling (AOR=1.82); mothers with primary level of education (AOR=2.43); and mothers with secondary level of education (AOR=1.77), were more likely to experience under-5 mortality compared to mothers with tertiary level education; (iii) mothers whose age at first birth was between 15-19 years (AOR=1.47) and those whose age at first birth was between 25-34 years (AOR=2.14) were more likely to experience under-5 mortality compared to mothers whose age at first birth was between 35-49 years; (iv) Black mothers were more likely to experience under-5 mortality compared to Indian mothers (AOR=5.99); (v) mothers who were employed were 1.22 times more likely to experience under-5 mortality compared to unemployed mothers. Lastly, under-5 mortality was less likely amongst mothers in the medium households compared to those from low income households (AOR=0.65). CONCLUSION: This study found that socioeconomic and demographic factors substantively determine under-5 mortality in KwaZulu-Natal. Evidence from this study suggest that interventions aimed at reducing under-5 mortality should focus on black women, the younger women, the less educated and those with low household income. / MT2017

A dengue é um importante problema de saúde pública, responsável por cerca de 25.000 mortes anuais em áreas subtropicais do mundo. Desde 2001, há uma tendência de aumento da incidência de formas fatais de febre hemorrágica da dengue (FHD) no Brasil, com aumento dramático de casos graves em menores de 15 anos de idade a partir de 2007, especialmente na região nordeste do país. O objetivo deste estudo caso-controle foi avaliar fatores de risco associados a óbito em crianças com dengue grave. Avaliamos a condição clínica de pacientes internados que morreram de dengue (n=18) e comparamos com pacientes internados com dengue grave que sobreviveram (controles, n=77). Os pacientes incluídos no estudo foram menores de 13 anos de idade internados em hospitais de São Luís, nordeste do Brasil, com diagnóstico laboratorial confirmado de dengue. O diagnóstico de infecção aguda de dengue foi confirmado pela detecção de anticorpos IgM específicos de dengue através do MAC-ELISA (IgM Antibody Capture Enzyme-Linked Immunosorbent Assay) ou pela detecção do DENV em soro, sangue ou víscera pela técnica de Transcrição Reversa - Reação em Cadeia de Polimerase (RT-PCR). Sinais de choque descompensado (extremidades frias, cianose e letargia) e hemoptise foram fortemente associados a óbito, o que está de acordo com a mais recente classificação da Organização Mundial de Saúde (OMS) para dengue grave. Epistaxe e vômitos persistentes também foram fortemente associados a óbito. Embora incluídos na mais recente classificação de dengue da OMS como sinais de alarme, epistaxe e vômitos incoercíveis não estão incluídos na definição da OMS para dengue grave. Estes achados necessitam ser explorados em estudos posteriores. Como unidades de terapia intensiva são frequentemente limitadas em cenários com poucos recursos, qualquer informação que possa distinguir, dentre os pacientes com dengue grave, aqueles com maior risco de evolução a óbito, pode ser crucial. / Dengue is a major public health problem, responsible for about 25,000 deaths in subtropical areas every year. In Brazil, the incidence of fatal forms of dengue hemorrhagic fever has increased since 2001. In particular, there has been a dramatic increase in severe cases in patients younger than 15 years of age since 2007, especially in the Northeastern region of the country. The purpose of this case-control study was to evaluate risk factors associated with death in children with severe dengue. The clinical condition of hospitalized patients with severe dengue who died (cases, n=18) was compared with that of hospitalized patients with severe dengue who survived (controls, n=77). Inclusion criteria for this study were: age under 13 years; hospital admission in São Luis, Northeastern Brazil; and laboratory-confirmed diagnosis of dengue. The diagnosis of acute dengue infection was confirmed by detection of dengue-specific IgM antibodies using an IgM Antibody Capture Enzyme-Linked Immunosorbent Assay (MAC-ELISA) or by DENV detection in serum, blood, or viscera by a Reverse Transcription - Polymerase Chain Reaction (RT-PCR). Death was strongly associated with signals of hypotensive shock (cold extremities, cyanosis and lethargy) and hemoptysis. These associations are in accordance with the most recent World Health Organization (WHO) case classification for severe dengue. We also found that epistaxis and persistent vomiting were strongly associated with death, both are included as warning signs in the WHO classification of dengue, but they are not included in the most recent WHO definition of severe dengue. These findings should be explored in further studies. Because intensive care units are often limited in resource-poor settings, any information that can help to distinguish patients with severe dengue with higher risk to progress to death may be crucial.