Magister Curationis - MCur / Background: The neonatal period starts at birth and ends 28 days after birth, and is the most defence less period in the newborn's life. Improving newborn health is a priority for the Ministry of Health and Social Services (MoHSS) in Namibia. The national neonatal mortality rate stood at 21.80 per 1000 live births in the country, and Namibia was unable to attain Millennium Development Goal 4 which focused on reduction of the child mortality rate by two-thirds between 1990 and 2015. Aim: This study investigated the factors contributing to neonatal deaths at a national hospital in the Khomas region of Namibia, with the following objectives: (i) to identify causes of early neonatal deaths; (ii) to identify the causes of late neonatal deaths; and (iii) to identify avoidable and unavoidable factors contributing to neonatal deaths. Methodology: The study used a quantitative research approach with a retrospective descriptive design to investigate factors contributing to neonatal deaths. The primary data were collected from a population of 231 record files of all neonates who died during the period 1 January to 31 December 2013 while admitted to the national hospital before 28 completed days of life. Results: The study identified that of the neonates who died, 67.1% (n=155) were early neonatal deaths (during the first 0–7 days of life), while 32.9% (n=76) died during the late neonatal period (from 8–28 days of life). Of the neonates who died, 50.6% (n=117) were male and 48.48% (n=112) were female. The causes of early and late neonatal deaths were similar, although they happened at different stages. The causes of early neonatal deaths have been identified as respiratory distress syndrome (RDS) – 24.2% (n=56); neonatal sepsis – 12.1% (n=28); birth asphyxia – 11.7 % (n=27); congenital abnormalities – 14.7 % (n=34); hemorrhagic diseases of newborns – 3.9% (n=9); and unknown – 0.6% (n=1). Neonatal sepsis caused the highest number of late neonatal deaths 17.7 %,( n=41); followed by RDS – 7.4% (n=17); congenital abnormalities – 3.9% (n=9); birth asphyxia – 3.1% (n=7); birth trauma – 0.4% (n=1); and unknown factors – 0.4 % (n=1). The study revealed that avoidable factors related to healthcare providers had a severe impact on neonatal deaths, while congenital abnormalities were unavoidable factors. Conclusion: The study concluded that most neonatal deaths are related to actions or inactions of the healthcare providers and could be avoided. Recommendations: Based on the results of the study, further research is required to assess the knowledge, skills, and behaviors of the healthcare providers. Training and education about neonatal resuscitation needs to be carried out on a regular basis.

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Thesis (M Med.(Community Health))--University of Limpopo, 2009. / AIM: To establish the epidemiological and demographic profiles of natural deaths in Limpopo province. SETTING: Limpopo province METHOD: Data was captured from records of deaths kept by the Statistics South Africa from the 1st of January 2000 to the 31st of December 2005 excluding unnatural deaths. FINDINGS: There were 228 626 natural deaths during the study period. The gender distribution was 48% males and 52% females. The mean age of death for the population has decreased from 50.11(95%CI: 49.82 50.41) in 2000 to 45.10 (95%CI: 44.88 45.33) in 2005. The crude mortality rate has increased from 7, 2 per 1000 in 2001 to 9, 5 per 1000 in 2005. The highest numbers of deaths are at the age group 30-44 years which contributed to 23% of all deaths. Infectious and parasitic diseases, respiratory tuberculosis as well as diarrhoea and gastroenteritis presumed infectious in origin are the major causes of death for males and females. Amongst the top 10 causes of death are combinations of infectious and parasitic, non-communicable diseases and ill defined causes. This finding suggests a double burden of disease. CONCLUSION: Deaths are on the increase and claims the lives of the young persons in the population. The age of death is on the decline, caused by mainly ill-defined causes, parasitic and infectious diseases as well as noncommunicable and perinatal conditions. This trend mirrors the HIV epidemic, and calls for further intensification of preventive, promotive and treatment programmes.

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abstract: Recent events in places such as Ferguson, Missouri, and Baltimore, Maryland, have focused the public's attention on citizen deaths during arrest encounters with officers in police departments across the United States. Riots and protests have broken out across the nation and resulted in a recent President's Task Force on 21st Century Policing to address some of these major issues. Arrest-related deaths (ARDs), however, are not a new phenomenon and have long generated controversy among the public. Despite the reoccurring nature of ARDs, no publicly available, central national registry of ARDs exists to allow for an in-depth analysis of such cases, as well as the development of training and policies to decrease police and citizen harms. In an effort to fill this gap, the current study conducts a retrospective, open-source, web-based search of media reports to explore the prevalence and nature of all types of ARDs that occurred through the United States in 2005 and 2006. The purpose of the study is to investigate ARDs, but to also assess the reliability of media reports as a source of data. The study finds that media reports are not adequate for identifying the prevalence of ARDs, but are useful when investigating circumstances surrounding deadly police-citizen encounters to an extent. / Dissertation/Thesis / Doctoral Dissertation Criminology and Criminal Justice 2015

FACULTY OF HEALTH SCIENCES MASTER OF PUBLIC HEALTH 0209663k / Background: Tobacco use is one of the single biggest causes of preventable deaths and is increasingly affecting developing countries and men and women alike. Tobacco use is historically more common in men but is becoming more common among women. In the absence of population-based health information in many dev eloping countries and sub- Saharan Africa in particular, public health planning and priority setting is in disarray. Most of the prevalence studies on tobacco have concentrated on smoked tobacco and men in particular. This cross-sectional study design looked at the prevalence, patterns and determinants of tobacco use among women in Benin City, an urban area in Nigeria. Methods: 491 face-to-face interviews were conducted in 45 enumeration areas randomly sampled in Oredo LGA in Benin City, Nigeria. Twelve households were randomly sampled in each EA and eligible woman over the age of 18 years was identified in each household. Results: The prevalence of tobacco use was 8.8% comprising of smoking (3.3%) and smokeless (5.5%) initiation occur during the teenage years mostly. Smoking cigarettes was more common among the younger, more educated women and Tabba (a mixture of powdered dry tobacco leaf and sodium bicarbonate) used mostly by older less educated women (RR = 3.10, CI = 1.01 - 9.48). The participants perceived friends using tobacco as a reason for their starting to use tobacco. Determinants of tobacco use were education, exposure to tobacco advertising and / or promotions which occurs almost unrestricted despite some tobacco control legislations. Dr. OV Okwuolise; 0209663K/2005 Page 2 of 2 Conclusions: The findings suggest that tobacco use is going on unhindered and unless something is done to curtail the activities of the tobacco industry, a major public health catastrophe is looming.

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Background Respiratory viruses are a leading cause of acute lower respiratory infections (ALRI) in young children. The role of seasonal influenza virus in childhood ALRI is generally underappreciated. This is because the global burden of disease due to ALRI attributable to seasonal influenza virus in children is unknown. This thesis aims to estimate the global and regional hospital admissions for seasonal influenzaassociated ALRI and the possible boundaries for influenza-associated ALRI mortality in children younger than five years. The WHO has developed guidelines for influenza surveillance using severe acute respiratory infections (SARI) sentinel surveillance network. However, data from sentinel surveillance are not routinely used in estimating disease burden in a population. This thesis also aims to provide tools for estimating influenza disease burden using data from SARI sentinel surveillance in developing country settings. Methods Incidence data for influenza-associated ALRI (from passive, hospital-based studies) were collected using a systematic review of studies published between January 1, 1995 and October 31, 2010. These data were supplemented by unpublished data from 15 population-based studies that were obtained by forming a consortium of researchers (Influenza Study Group) working in developing countries. The incidence meta-estimates were applied to global and regional population estimates for 2008 to calculate the estimated number of hospitalised influenza-associated ALRI cases that year. The possible bounds for influenza-associated mortality were estimated by combining incidence estimates with in-hospital case fatality ratios and identifying studies with population-based data for influenza seasonality and monthly ALRI mortality. The data to estimate the incidence of all-cause hospitalised ALRI were collected using a systematic literature review that was supplemented with unpublished data from 24 population-based studies that were obtained by collaborating with research sites in developing countries (Severe ALRI Working Group). The hospitalised ALRI incidence meta-estimates were applied to global and regional population estimates for 2008 to calculate the estimated number of all-cause hospitalised ALRI cases that year. Data on the proportion of hospitalised ALRI cases that were positive for influenza were collected using a systematic review of the studies published between January 1, 1995 and December 31, 2011. The meta-estimates of the proportion of hospitalised ALRI cases positive for influenza were applied to the estimated number of hospitalised ALRI cases in the year 2008 to estimate the number of hospitalised influenza-associated ALRI cases globally and for the six WHO regions using this alternative method. The tools for estimating influenza disease burden using surveillance data were developed after a literature review and a survey of 27 end-users (influenza epidemiologists) in 24 countries. Results Thirty nine studies (21 from developing and 18 from industrialised regions) satisfying the eligibility criteria, provided data on the incidence of influenza-associated hospitalised ALRI. The incidence is highest in infants in the first six months of life, both in developing as well as industrialised countries. It is estimated that the incidence of hospitalised influenza-associated ALRI in children under the age of five years was about 1.5 (95% CI 1.0 to 2.3) and 1.2 (95% CI 0.9 to 1.6) per 1000 children in developing and industrialised countries respectively. This translates to about 911,000 (95% CI 617,000 to 1.4 million) hospitalisations worldwide due to influenza-associated ALRI in children younger than five years in 2008, 93% of the cases occurring in developing countries (where 90% of the global under-5 population reside). An estimated 21,500 (based on 20 studies) to 115,000 deaths (based on only 1 study) in under-five children were attributable to influenza-associated ALRI in 2008. Incidence and mortality varied substantially from year to year in any one setting. Eighty five studies (61 from developing and 24 from industrialised) reported incidence of hospitalised ALRI in children aged 0 to 4 years. It is estimated that about 11.3 (95% CI 9.5 to 13.5) million episodes of ALRI resulting in hospitalisation occurred worldwide in children aged 0 to 4 years in 2008, 92% of these occurring in developing countries. Twenty three studies (19 from developing and 4 from industrialised) reported data on proportion of hospitalised ALRI cases testing positive for influenza using laboratory tests. The estimated proportion of influenza-positive hospitalised ALRI cases was about 5.0 (95% CI 3.6 to 7) percent and 8.4 (95% CI 4.2 to 16.7) percent in developing and industrialised countries respectively. This translates to about 772,000 (95% CI 343,000 to 1.8 million) cases of influenza-associated hospitalised ALRI in children younger than five years worldwide in the year 2008. A manual (targeted at developing countries) describing the methods to estimate the disease burden associated with seasonal influenza using the various surveillance data was developed after considering the results of the preliminary survey. An electronic tool (based on a spread sheet model) to help the end-users (epidemiologists at sentinel surveillance sites and Ministries of Health) to estimate the disease burden at local and national levels was developed as an adjunct to the manual. The manual along with the electronic tool were piloted at three different sites in two developing countries (India and Ghana) and feedback from the end-users was obtained to make the version more user-friendly. The final draft of the manual along with the tool has been submitted to the WHO for final clearance. The member states and the WHO Eastern Mediterranean Regional Office decided to adopt the manual and in the first instance estimate the influenza disease burden in 8 member states having the requisite data for undertaking disease burden estimation. Conclusions Influenza is a common pathogen identified in children with ALRI and results in a substantial burden on hospital inpatient services worldwide. There are significant gaps in published data from developing countries (especially the African and Eastern Mediterranean regions of the WHO). Sufficient data to precisely estimate the role of influenza in childhood mortality from ALRI are not presently available. Effective use of sentinel surveillance data for disease burden estimation would greatly improve the quality and precision of disease burden estimates (especially those resulting in hospitalisation). Improved disease burden estimates (particularly at the national level) would inform policy makers and national governments in formulating immunization policies for vaccinating high-risk groups, and planning annual requirements for vaccines and anti-viral drugs against seasonal influenza.