This study presents an analysis of policies addressing child mortality in Pakistan focusing on problem structuring, using a comparison with Bangladesh. Pakistan's progress in addressing child mortality rate has been much slower than that of Bangladesh despite the fact that Pakistan has excelled in economic growth, and the two countries have comparable populations and share political history. This study analyzes and provides an explanation for differential outcomes in terms of problem structuring in the two countries. A comparative analysis of policy documents reviewed for the two countries illustrates the fact that Bangladesh, in formulating its child health policy, has emphasized the input factors such as nutrition and environmental aspects, besides health services. Pakistan, on the other hand, maintains a general problem formulation strategy focusing mainly on health service and ignoring the social, environmental, and other factors causing morbidity and mortality in children. Another comparison between policy formulation in each country and the extensive literature available on child mortality suggest that neither country pays as much attention to structural factors as the literature does. The analysis provides some insight into differentials in policy formulation associated with child mortality in the two countries, but more importantly, it provides an understanding of the underlying elements for inadequate policy outcomes in case of Pakistan.

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.

Na Folha de Aprova??o consta o t?tulo: "An?lise das a??es dos Comit?s de Preven??o ao ?bito Infantil e Fetal em uma Regi?o de Sa?de do Vale do Jequitinhonha, Minas Gerais". / Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2018-04-04T15:28:24Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) isabella_rodrigues_diamantino.pdf: 2271469 bytes, checksum: 6aa1269a10915ee8e6f7cc7e575910b3 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2018-04-09T18:53:54Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) isabella_rodrigues_diamantino.pdf: 2271469 bytes, checksum: 6aa1269a10915ee8e6f7cc7e575910b3 (MD5) / Made available in DSpace on 2018-04-09T18:53:54Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) isabella_rodrigues_diamantino.pdf: 2271469 bytes, checksum: 6aa1269a10915ee8e6f7cc7e575910b3 (MD5) Previous issue date: 2017 / Funda??o de Amparo ? Pesquisa do Estado de Minas Gerais (FAPEMIG) / Funda??o Diamantinense de Apoio ao Ensino, Pesquisa e Extens?o (Fundaepe) / A Taxa de Mortalidade Infantil (TMI) ? considerada um dos mais sens?veis indicadores de sa?de utilizados pela sa?de p?blica para avaliar as condi??es de vida de uma popula??o em geral, sendo determinada, principalmente, pelas condi??es socioecon?micas de uma regi?o. A investiga??o de mortes infantis ? considerada uma importante estrat?gia para a redu??o desse fen?meno, tendo em vista o fato de propiciar mais visibilidade ? real situa??o dos munic?pios e possibilitar a implanta??o de medidas de preven??o e controle. O presente estudo foi desenvolvido no per?odo de 2013 a 2016, com o objetivo de analisar a atua??o dos Comit?s de Preven??o ao ?bito Infantil e Fetal na Regi?o de Sa?de de Ara?ua?, Minas Gerais. Trata-se de um estudo descritivo, realizado em 06 comit?s/equipes de investiga??o municipais que comp?em a regi?o, pertencente ? mesorregi?o do Jequitinhonha, Minas Gerais. A informa??o foi obtida a partir da utiliza??o de fontes secund?rias em base de dados nacionais, como o SIM e o Painel de Monitoramento da Mortalidade Infantil e Fetal. Os dados obtidos foram tabulados no Excel, pacote Officce (Microsoft?), e receberam tratamento para estat?stica descritiva. Como resultados observou-se a redu??o da mortalidade em crian?as menores de um ano na regi?o, com frequ?ncia de 15 casos em 2013 e 10 casos em 2016; e a eleva??o do n?mero de mortes fetais, com 14 ?bitos em 2013 e 16 ?bitos em 2016. Houve aumento de 57,2% nos ?bitos infantis evit?veis na regi?o, no per?odo analisado. De todos os seis munic?pios estudados, apenas um apresentou investiga??o de 100% dos ?bitos infantis e fetais em tempo oportuno. A organiza??o do sistema/servi?o de sa?de da regi?o foi respons?vel pela maioria dos problemas identificados ap?s a investiga??o dos ?bitos (34,8%), sendo a cobertura da aten??o prim?ria o principal problema relacionado ? organiza??o desses servi?os. As mortes por causas evit?veis destacaram-se por serem as mais comuns, de acordo com a classifica??o de evitabilidade, realizada pelos ?rg?os investigativos, citada 47 vezes durante os quatro anos. Dentre essas causas, nenhum ?bito reduz?vel por a??es de imunopreven??o foi registrado. Como causa de ?bitos fetais e perinatais, predominou-se a prematuridade, na Regi?o de Sa?de de Ara?ua?, Minas Gerais. Conclui-se que a inexist?ncia dos comit?s na maioria dos munic?pios analisados traz in?meras defici?ncias no processo de vigil?ncia do ?bito infantil e fetal na regi?o. Apesar da presen?a de profissionais designados para a investiga??o dos casos em cada localidade, a falta de uma equipe multiprofissional capacitada dificulta a an?lise, discuss?o dos casos e execu??o de medidas efetivas para a redu??o de novas ocorr?ncias. Foram identificadas falhas assistenciais nos cuidados com o pr?-natal e parto e um alto percentual de evitabilidade dos ?bitos. A implanta??o do Comit? de Preven??o ? Mortalidade Infantil e Fetal em toda a Regi?o de Sa?de de Ara?ua?, al?m do fortalecimento daqueles j? existentes, e o apoio cont?nuo de gestores municipais, estaduais e sociedade a estes ?rg?os, s?o fatores imprescind?veis para a melhoria dos cuidados prestados ?s gestantes e crian?as no territ?rio estudado. / Disserta??o (Mestrado Profissional) ? Programa de P?s-Gradua??o em Sa?de, Sociedade e Ambiente, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2017. / The Child Mortality Rate (CMR) is considered to be one of the most sensitive health indicators used by Public Health services to assess the life conditions of the population in general, and is mainly determined by the socio-economic conditions of a region. The investigation of children death is regarded as an important strategy to reduce this phenomenon once it provides greater visibility to the cities real situation and enables the implementation of prevention and control measures. The current study was developed between 2013 and 2016, aiming to analyse the actions of the Children and Fetal Death Prevention Committees in Ara?ua?/MG health care territory. That is a descriptive study whose sample was composed for 06 municipal committees that comprehend Ara?ua? health care territory, belonging to the mesoregion of Jequitinhonha/ MG. The information was derived from secondary sources in national data bases such as the Mortality Information System (SIM) and the Children and Fetal Death Monitoring Panel. The survey data were organized on Microsoft Office Excel and were processed for descriptive statistics. The results observed were: The reduction of mortality among children under 1 year old in the region, being 15 cases in 2013 and 10 in 2016; and the increase of Fetal death rate, being 14 deaths in 2013 and 16 in 2016. There was an increase of 57,2% in preventable children death in the region in the period under review. Only one city out of the six studied presented in time a 100% investigation of children and fetal death. The health system organization of the region accounted for the majority of the problems identified after the death investigation ( 34,8%), being the primary - care coverage the main problem related to the organization of these services. The deaths for preventable causes excelled for being the most common, according to the avoidability rating carried out by investigative authorities, and they were mentioned 47 times during the 4-year period. Among these causes, it was not registered any death reducible for immunoprevention actions. As a cause of fetal and perinatal deaths prevailed prematurity, in Ara?ua? health care territory, Minas Gerais. The conclusion is that, the absence of committees in most studied cities brings several deficiencies in the process of monitoring child and fetal death in the region. Although there are professionals who perform the investigation of the cases in each locality, the lack of a capable multiprofessional team obstructs the analysis, discussion of cases and execution of effective measures to reduce new events. It has been identified care failures regarding prenatal and childbirth and a high percentage of death avoidability. The implementation of the Child and Fetal Death Prevention Committee in the whole Ara?ua? health care territory , the strengthening of those that already exist in conjunction with the permanent support from municipal, state managers and society to these bodies, are relevant factors to enhance the care provided to pregnant women and children in the studied area. / La Tasa de Mortalidad Infantil (TMI) es considerada uno de los m?s sensibles indicadores de salud utilizados por la salud p?blica para evaluar las condiciones de vida de una poblaci?n en general, siendo determinada, principalmente, por las condiciones socioecon?micas de una regi?n. La investigaci?n de muertes infantiles es considerada una importante estrategia para la reducci?n de ese fen?meno, teniendo en vista el hecho de propiciar m?s visibilidad a la real situaci?n de los municipios y posibilitar la implantaci?n de medidas de prevenci?n y control. El presente estudio fue desarrollado en el per?odo de 2013 a 2016, con el objetivo de analizar la actuaci?n de los Comit?s de Prevenci?n al ?bito Infantil y Fetal en la Regi?n de Salud de Ara?ua?, Minas Gerais. Se trata de un estudio descriptivo realizado en 06 comit?s / equipos de investigaci?n municipales que componen la regi?n, perteneciente a la mesorregi?n del Jequitinhonha, Minas Gerais. La informaci?n fue obtenida a partir de la utilizaci?n de fuentes secundarias en base de datos nacionales, como el Sistema de Informaci?n sobre Mortalidad (SIM) y el Panel de Monitoreo de la Mortalidad Infantil y Fetal. Los datos obtenidos fueron tabulados en Excel, paquete Officce (Microsoft?), y recibieron tratamiento para estad?stica descriptiva. Como resultados se observ? la reducci?n de la mortalidad en ni?os menores de un a?o en la regi?n, con frecuencia de 15 casos en 2013 y 10 casos en 2016; y la elevaci?n del n?mero de muertes fetales, con 14 muertes en 2013 y 16 muertes en 2016. Se observ? un aumento del 57,2% en las muertes infantiles evitables en la regi?n, en el per?odo analizado. De todos los seis municipios estudiados, s?lo uno present? investigaci?n del 100% de las muertes infantiles y fetales a tiempo oportuno. La organizaci?n del sistema / servicio de salud de la regi?n fue responsable de la mayor?a de los problemas identificados despu?s de la investigaci?n de los ?bitos (34,8%), siendo la cobertura de la atenci?n primaria el principal problema relacionado a la organizaci?n de esos servicios. Las muertes por causas evitables se destacaron por ser las m?s comunes, de acuerdo con la clasificaci?n de evitabilidad, realizada por los ?rganos investigativos, citada 47 veces durante los cuatro a?os. De entre estas causas, no se registr? ninguna muerte reducible por acciones de inmunoprevenci?n. Como causa de muertes fetales y perinatales, predomin? la prematuridad, en la Regi?n de Salud de Ara?ua?, Minas Gerais. Se concluye que la inexistencia de los comit?s en la mayor?a de los municipios analizados trae innumerables deficiencias en el proceso de vigilancia del ?bito infantil y fetal en la regi?n. A pesar de la presencia de profesionales designados para la investigaci?n de los casos en cada localidad, la falta de un equipo multiprofesional capacitado dificulta el an?lisis, discusi?n de los casos y ejecuci?n de medidas efectivas para la reducci?n de nuevas ocurrencias. Se identificaron fallas asistenciales en los cuidados con el prenatal y parto y un alto porcentaje de evitabilidad de las muertes. La implantaci?n del Comit? de Prevenci?n a la Mortalidad Infantil y Fetal en toda la Regi?n de Salud de Ara?ua?, adem?s del fortalecimiento de aquellos ya existentes, y el apoyo continuo de gestores municipales, estatales y sociedad a estos ?rganos, son factores imprescindibles para la mejora de los cuidados a las gestantes y ni?os en el territorio estudiado.

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)

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.

Thesis (M.Med. (Paediatrics and Child Health)) -- University of Limpopo, 2022 / Introduction: Pleural empyema in children is associated with high morbidity and high mortality. Staphylococcus aureus has been shown to be the most common causative organism in developing countries. Study design: This study applied a retrospective quantitative descriptive study design. Study population: The population of the study is comprised of children (between 1 years and 13 years) admitted to Pietersburg Provincial Hospital with pleural empyema from January 2016 until December 2020. Objectives: The study aimed to determine the causative organisms of pleural empyema, the treatment outcomes, and the relationship between pleural empyema, TB, and HIV infection. Data collection: The National Health Laboratory Services database was used to identify patients who had pleural empyema. A self-generated data collection tool was used to obtain secondary data related to all patients who met the operational definition of pleural empyema during the defined time period. Results: Eleven participants met inclusion criteria. The mean age of participants was 42 months with 43.8 standard deviation and 64% were males and females were 36% . Of these participants, 40% cultured S. Aureus in the pleural fluid, 10% Streptococcus pneumoniae, 30% were sterile and 20% cultured other organisms such as Klebsiella pneumoniae and Haemophilus influenzae. Cloxacillin was the most prescribed antibiotic. Intercostal drainage was inserted in 91% of the participants of which 18% were successful, no further surgical intervention needed,73% had thoracotomy and VATS was offered to 91% of participants and it was followed by thoracotomy. Fibrinolytics were not offered to the participants in this study. The majority of patients, 55%, were discharged back to their peripheral hospitals and 27% of them died. PCV immunisation status of the children was not documented hence the relationship between pleural empyema and PCV immunisation could not be established. There was a positive correlation between age of patients with pleural empyema and ICU length of stay (r=89%; p=0,01) while another strong correlation was depicted between HIV status and hospital length of stay (r=88%, p=0,019). Results further show a positive association between outcome and surgery intervention offered (Chi=7,00; p=0,02). Conclusion: Our study showed that S. aureus is the leading cause of pleural empyema, with a predominance of thoracocentesis and thoracotomy offered as surgical interventions.

Thesis (M.Sc. (Statistics)) -- University of Limpopo, 2014 / The health and survival of children are important measures of the social wellbeing and health status of the community. The World Community made a commitment to reduce under-five mortality by two-thirds between 1990 and 2015. The purpose of this study was to identify factors that have influence on child survival. The Dikgale Health and Demographic Surveillance System (HDSS) data for children born between 01 January 1996 and 31 December 2010 were analysed using cross-tabulation, logistic regression and survival analysis to determine factors that have influence on child survival. The findings revealed that mother’s survival status and child birth weight are significantly associated with child survival. The results showed that the odds that children born to mothers who are alive survive beyond five years are almost four times the odds that children born to mothers who are not alive survive beyond five years. The study also found that the odds that children born with birth weight 2.5kg or more survive beyond five years are almost two times that of children born with birth weight less than 2.5kg. The results of this study may help in formulating strategies and interventions that improve the lifespan of children and assist in the reduction of child mortality. KEY CONCEPTS Child survival, Health Demographic Surveillance System, Cross-tabulation, Logistic regression, Survival analysis, Mother’s survival status, Birth weight.

Shigella flexneri est une bactérie à Gram négatif responsable du décès d’environ un million d’individus par an dont la majorité est des enfants âgés de moins de 5 ans. A ce jour, aucun vaccin satisfaisant n’est disponible et la résistance aux antibiotiques ne cesse dangereusement d’augmenter. Pour éradiquer la shigellose il est impératif de comprendre les mécanismes moléculaires et cellulaires associés à la pathogénie de Shigella.<p>Dans le cadre de notre projet de thèse, nous nous sommes intéressés à la caractérisation de plusieurs gènes situés sur le plasmide de virulence de S. flexneri dont SfpgdA, Sfgtr4, virK et les gènes spa9, spa24 et spa29 localisés dans la région d’entrée spécifiant l’appareil de sécrétion de type 3 (AST3). Pour ce faire, nous avons dans un premier temps généré des souches de Shigella mutées (KO) de ces gènes et étudié ensuite leurs propriétés de virulence aussi bien in vitro, dans des modèles cellulaires, qu’in vivo, dans un modèle animal. Nos résultats montrent que le gène SfpgdA code pour une peptidoglycane (PG) déacétylase nécessaire à la survie de Shigella dans les polymorphonucleaire neutrophiles (PMNs). Nous avons également montré que le gène Sfgtr4 spécifie une lipopolysacharide (LPS) glycosyle transférase impliquée dans la résistance au lysozyme et dans la survie dans les PMNs. Des études antérieures avaient montré qu’une mutation à l’aide d’un transposon du gène virK abolissait la dissémination de Shigella entre les cellules épithéliales par un mécanisme restant inconnu. Afin d’investiguer ce mécanisme, nous avons construit un mutant non-polaire du gène virK et étudié son phénotype. A notre grand étonnement, nous avons démontré que ce mutant présente les mêmes propriétés de virulence que la souche sauvage de Shigella. Par contre, comme pour les gènes SfpgdA et Sfgtr4, nous avons montré que le mutant virK est également affecté dans sa résistance au lysozyme et dans sa persistance dans les PMNs. De plus, nous avons montré que l’ensemble des gènes SfpgdA, Sfgtr4 et virK, est impliqué dans la résistance au système immunitaire grâce à la régulation de la sécrétion des cytokines proinflammatoires TNF-α et IL-6. L’existence d’homologie frappante entre les 3 gènes étudiés et des gènes impliqués dans la formation de biofilm chez plusieurs bactéries nous a incités à investiguer cette propriété pour Shigella. Nous avons ainsi montré, pour la première fois, que la souche sauvage de Shigella forme des biofilms in vitro. De plus, nous avons montré que cette formation est accélérée dans les mutants SfpgdA, Sfgtr4 et virK. Finalement, nous avons identifié un réseau d’interactions entre SfPgdA, SfGtr4, VirK et MsbB2, suggérant l’existence d’un complexe localisé à la surface bactérienne qui serait responsable des modifications engendrées au niveau du PG et ou LPS. <p>Dans une autre partie de notre travail nous nous sommes intéressés aux gènes spa9, spa24 et spa29. Nous avons montré que ces 3 gènes sont nécessaires à la sécrétion des protéines de virulence et à l’invasion cellulaire. De plus, nous avons montré qu’un domaine central de la protéine Spa24 (Spa24SD) est nécessaire à l’assemblage de l’AST3 grâce à ces interactions avec différents composants de ce système.<p>La dernière partie de notre travail a porté sur l’étude du gène orf182 et du gène ushA qui existe en 2 copies dans le génome bactérien (un plasmidique et un chromosomique). Les souches de Shigella KO de ces gènes, dans les tests effectués in vitro, présentent approximativement le phénotype sauvage et devraient faire l’objet d’étude plus avancées. <p>En conclusion, nos travaux feront l’objet de 4 publications et représentent une contribution importante à la compréhension des mécanismes moléculaires associés à la pathogénie de Shigella. De plus, nos travaux dépasseront le cadre de Shigella puisque les gènes étudiés ici sont conservés chez plusieurs bactéries pathogènes.<p> / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished

Thesis (MA (Psychology))--Stellenbosch University, 2008. / South Africa’s violence and injury death rates pandemic are steadily growing. Global estimates reported by the World Health Organisation (2000) have revealed that there is an increase in worldwide deaths. Approximately 5 million people die as a result of injuries each year and hundreds of thousands more are left physically or psychologically scarred (World Health Organisation, 2000). There are alarmingly high incidences of violence, crime and injury deaths in South Africa and the impact of these injury fatalities is imposing an immense burden on government, communities, families and even individuals. The burden of fatal injury mortalities has not fallen evenly. In South Africa, low socio-economic communities have borne the brunt of this epidemic. This study presents a focus on mortality and injury patterns and emerging problem areas for children and youth in a peri-urban setting. The aim of this study was to provide an overview of the fatal injury mortality and suicide data of children and youth in the Stellenbosch district, in order to develop a comprehensive understanding of the problem areas of injury deaths such as the main causes and consequences and age, sex, race and other pertinent comparisons. The study also aimed to consider the impact and relationship between alcohol abuse and youth injury deaths. Mortuary data were compiled from 591 children and youth cases for the period 2001-2005 in the Stellenbosch district using the National Injury Mortality Surveillance System data form. The present study highlighted several key findings. Transport-related deaths were indicated as a serious cause for concern among both children and youth in peri-urban settings. The importance of specific road safety awareness initiatives within peri-urban areas and among specific age groups were also indicated. Violence-related deaths were determined to be a leading cause of death among the older age groups in the youth category, with sharp force objects being the leading external cause of violent deaths. This highlighted an additional key finding reporting that sharp force objects death are a more serious cause for concern than firearm deaths in peri-urban areas, which challenges previous urban data. vi Burns and drowning were indicated as pertinent cause of unintentional deaths among both children and youth within peri-urban areas. This was suggested to be due to the high use of paraffin enabled heating systems in house in peri-urban areas and the lack of safety surrounding materials such as matches in the home. In addition, suffocation deaths among infants were also identified as a concern. Furthermore, the link between alcohol abuse among the youth age group was indicated by a key finding that alcohol is a prominent risk factor for fatal injury mortalities among youth. However more studies are needed to explore the effects and risks of other substances on youth fatal injury deaths. Several implications of the research findings are identified for health care professionals, policy developers, government departments and non-government organisations to consider in reducing the mortality rates of children and youth. These implications are critical in informing preventative interventions and initiatives aimed at enhancing safety to children and youth living in peri-urban areas within South Africa. vii

The impact of environmental degradation on well-being is largely ignored in terms of economic costs of development. Due in large part to measurement difficulties, the environment in the daily welfare of the world's poorest remains inadequately accounted for in development policies. The aim of this work is, therefore, to advance our understanding of the relationship between the environment and human health. Anthropogenic activities in Central Asia have severely disrupted the natural environment. The poorest, most vulnerable members of society are at an increased risk of mortality and a life-time of illness associated with worsening ecological conditions in the region. The work is by nature inter-disciplinary and pulls from many social sciences in an attempt to provide new insight into the role of long term environmental degradation and the impact on social welfare. There are three main original contributions of this work. Firstly, the research demonstrates the traditional emphasis in the literature on socioeconomic factors in explaining high rates of child mortality in Central Asia is inadequate. Secondly, for the first time in an international cross-section examining the determinants of child survival, the macro-level environment is put forth as a key determinant of excess child mortality in Central Asia. An improved measure of income is used for the first time in such a study to control for important distributional effects within and between countries. The results confirm the hypothesis that traditional determinants do not account for endemically high rates of mortality in the region. Secondly, using administrative (oblast) data from Uzbekistan, Chapter 6 presents the first study of its kind to incorporate important geographic as well as socioeconomic information in explaining variation in infant mortality due likely to ecological degradation. Ultimately, the findings demonstrate the environment must be adequately considered in all policy making aimed at improving health outcomes in the region.