This diploma thesis deals with the development of infant neonatal mortality in the social context in the Czech Republic. In theoretical part the indicators of prenatal mortality are introduced and the changes of definition of live and dead newborn are examined. In addition the socio-economic indicators are defined in this part. In the analytical part of this thesis we will examine dependence between infant neonatal mortality and socio-economic indicators using the regression analysis. A the end the results of the thesis will be summarized and made recommendations for reduction of infant neonatal mortality.

The existence of differences in the chance of survival of infants based on their ethnicity is a phenomenon known from various countries. The aim of this thesis is to add to the related body of research by conducting a complex differential analysis of infant mortality in main ethnic groups of New Zealand. Based on its findings, it should be possible to target supportive health and education programs more precisely. The analysis was performed using data supplied by the Ministry of Health of New Zealand and its results suggest that while some differences can be identified between ethnic groups under study based on age of infant, birth weight, length of pregnancy, age of mother, and primary cause of death, there does not seem to be a difference in the influence of infant's sex.

The objective of this study was to examine if intra-racial income inequality contributes to higher infant mortality rates (IMRs) for African-Americans. The conceptual framework for this study is derived from Richard Wilkinson's psychosocial environment interpretation of the income inequality and health link. The hypotheses examined were that race/ethnicity-specific IMRs are influenced by intra-race/ethnicity income inequality, and that these effects of income inequality on health are mediated by level of social mistrust and/or risk profile of the mother. Using state-level data from several sources, the 2000 National Center for Health Statistics Linked Birth Infant Death database, 2000 U.S. Census, and 2000 General Social Survey, a number of regression equations were estimated. Results indicated that the level of intra-racial/ethnic income inequality is a significant predictor of non-Hispanic Black IMRs, but not the IMRs of non-Hispanic Whites or Hispanics. Additionally, among Blacks, the effect of their intra-racial income inequality on their IMRs was found to be mediated by the risk profile of the mother, namely, the increased likelihood of smoking and/or drinking and/or less prenatal care by Black women during pregnancy. Implications of the findings are discussed.

La consanguinité, soit l'union productive de conjoints partageant des allèles identiques provenant d'un ancêtre commun, s'est accumulée au fil du temps au Québec ancien. Parallèlement, le Québec a été victime de plusieurs épidémies. Le but de cette étude est d'évaluer la relation entre la mortalité des enfants et la consanguinité dans les périodes épidémiques du Québec ancien entre 1720 et 1830. D'une part, l'hypothèse émise est que les enfants ayant des gènes homologues sur plusieurs loci auraient un taux de mortalité significativement plus élevé comparativement aux enfants non consanguins, en raison du désavantage des homozygotes. D'autre part, les individus consanguins peuvent avoir une survie plus favorable en raison de l'effet d’enracinement, combien de générations une famille est établie dans la colonie, présent dans la mesure de la consanguinité. De plus, l'avantage social d'une famille étroitement liée peut favoriser la survie de l'enfant en accordant plus de soutien social aux parents et de surveillance de l'enfant. Les courbes de survie de Kaplan-Meier sont représentées graphiquement et des modèles de régression de Cox sont exécutés pour explorer et démêler partiellement les rôles des facteurs génétiques et environnementaux. Les immigrants, les naissances multiples et les individus sans généalogie du Registre de la population du Québec ancien (RPQA) et de l'Infrastructure intégrée des microdonnées historiques de la Population du Québec (IMPQ) sont exclus. Au total, 610 412 individus sont analysés dans les modèles de Cox. Les rapports de risque pour les épidémies augmentent avec l'âge et les rapports de risque pour la consanguinité éloignée ressemblent souvent au groupe référence, les non consanguins. De plus, les effets diffèrent selon le sexe et le groupe d'âge. Généralement, si les enfants avec une consanguinité proche, ceux identifiés comme consanguins avec seulement trois générations ascendantes, ne subissent pas de surmortalité dans un groupe d'âge précédent, les modèles de Cox signalent une survie défavorable de ces individus lors des épidémies. Des effets sous-jacents tels que des processus de sélection et des variables de contrôle relatives à l’enracinement peu robustes guident les résultats de l'interaction entre les épidémies et la consanguinité, de sorte que la prémisse reste à valider. / Consanguinity, the productive union of spouses sharing identical alleles from a common ancestor, accumulated over time in Colonial Quebec. Concurrently, Quebec was the victim of several epidemics. The aim of this study is to evaluate the relationship between child mortality and consanguinity in epidemic periods of Colonial Quebec between 1720 and 1830. On the one hand, it is hypothesized that children with homologous genes on many loci would have a significantly higher mortality rate compared to non consanguineous children, due to homozygote disadvantage. On the other hand, consanguineous individuals may have a more favourable survival because of the effect of settlement, how many generations a family has been in the colony, present in the measure of consanguinity. Further, the social benefit of a closely bound family may favour child survival by providing more social support to the parents and child supervision. Kaplan-Meier survival curves are graphed, and Cox regression models are run to explore and partially disentangle the roles of genetic and environmental factors. Immigrants, multiple births and individuals lacking a genealogy from the Registre de population du Québec ancien (RPQA) and Infrastructure intégrée des microdonnées historiques de la Population du Québec (IMPQ) are excluded. Altogether, 610,412 individuals are analysed in the Cox models. Hazard ratios for epidemics increase with age and distant consanguinity hazard ratios often resemble the no consanguinity reference group. Further, the effects differ by sex and age group. Generally, if closely consanguineous children, those identified as consanguineous with only three ascending generations, do not undergo excess mortality in a previous age group, the Cox models signal an unfavourable survival of these individuals during epidemics. Underlying effects such as selection processes and unrobust control variables for settlement guide the results of the interaction between epidemics and consanguinity, so the premise, though convincing, remains to be validated.

The objectives of this study are to provide a comprehensive assessment of inequalities in infant and under-five years¿ child survival, access to and utilisations of child health services among different socio-economic groups in Ethiopia; and identify issues for policies and programmes at national and sub-national levels. This thesis examines the effect of parental socioeconomic status, maternal and delivery care services, mothers¿ bio-demographic and background characteristics on the level of differences in infant and under-five years¿ child survival and access to and utilisation of child health services. Descriptive and multivariate analyses were carried out for selected variables in the literature which were consider as the major determinants of infant mortality rate (IMR) and under-five years¿ child mortality rate (U5MR); access to and utilisations of child health services based on data from Ethiopian demographic and health survey (EDHS), covering the years 2000-2005. In the multivariate analysis a logit regression model was used to estimates inequalities in infant and under-five years¿ child survival, and inequalities in access to and utilisation of child health services. In Ethiopia, little was known about inequalities in IMR and U5MR, and inequalities in access to and utilisation of child health services. Besides, there is no systematic analysis of health inequalities and into its determinants using logistic regression. According to the available literature, this is the first comprehensive and systematic analysis of inequality of health in Ethiopia. The findings show that compared to under-five years¿ children of mothers¿ partners¿ with no work, mothers¿ partners¿ in professional, technical and managerial occupations had 13 times more chance of under-five years¿ child survival for 2000 weighted observations. In addition, compared to infants of mothers who were gave birth to one child in last 5 years preceding the survey, infants of mothers who were gave birth to 2 children in last 5 years preceding the survey had 70% less chance of infant survival while infants of mothers who were gave birth to 3 or more children had 89% less chance of infant survival for 2000 weighted observations. Moreover, this study finding also indicates that inequalities increased significantly in the five years period between 2000 and 2005 among mothers with different birth interval. Most of the relations between birth interval and receiving childhood immunisation for vaccine-preventable diseases were statistically significant. Moreover compared to non-educated mothers, mothers who completed secondary and higher education were nearly 10 times more likely to receive DPT3 immunisation for their young children. This study concludes that policy measures that tackle health inequalities will have a positive impact in the implementation of health sector strategy of Ethiopia. Health inequalities studies in Ethiopia and Sub-Saharan Africa (SSA) countries should focus on systematic analysis of different socio-economic groups. The finding of this study support investing in the Ethiopia¿s health extension package (HEP) is a necessary but not sufficient condition for addressing rural poor health problem. HEP is successful in increasing primary health care coverage in rural Ethiopia to 89.6% (FMOH, 2009) but unable to reduce Ethiopia¿s higher level of IMR and U5MR. HEP is one of the success stories that address the rural poor health problem and can also be adapted to developing countries of SSA. The finding also shows that the success stories such as health insurance programs like Rwanda (World Bank, 2008a) and Ethiopia (FMOH, 2009/10) will play a key role in achieving country¿s health care financing goal of universal coverage. This can also be replicated in the developing SSA countries.

American Indians are distinct in their current geographic isolation and history of exclusionary policies enacted against them. Citizenship and territorial policies from the 1700s through the early 1900s have manifested in the distinctive status of many American Indian communities as sovereign nations, a classification that no other ethnic group in the United States can claim. However, as a result of political and geographic isolation, disparities in heath and economic development have been an ongoing problem within these communities. Among the most distinctive health disparities are in infant mortality and obesity-related complications. This project will focus on South Dakota, a state that was late in its application of assimilationist policies, yet today is home to some of the least healthy reservation communities in the United States. An investigation into the making of reservation healthcare delivery systems and patterns of prenatal care utilization will hopefully reveal patterns of health and economic characteristics that predispose infant mortality. / Master of Science

High infant mortality (IM) rates in the U.S. have been a major public health concern for decades. Many studies have focused on understanding causes, risk factors, and interventions that can reduce IM. However, death of an infant is the result of the interplay between many risk factors, which in some cases can be traced to the infancy of their parents. Consequently, these complex interactions challenge the effectiveness of many interventions. The long-term goal of this study is to advance the common understanding of effective interventions for improving health outcomes and, in particular, infant mortality. To achieve this goal, I implemented systems and data science methods in three essays to contribute to the understanding of IM causes and risk factors. In the first study, the goal was to identify patterns in the leading causes of infant mortality across states that successfully reduced their IM rates. I explore the trends at the state-level between 2000 and 2015 to identify patterns in the leading causes of IM. This study shows that the main drivers of IM rate reduction is the preterm-related mortality rate. The second study builds on these findings and investigates the risk factors of preterm birth (PTB) in the largest obstetric population that has ever been studied in this field. By applying the latest statistical and machine learning techniques, I study the PTB risk factors that are both generalizable and identifiable during the early stages of pregnancy. A major finding of this study is that socioeconomic factors such as parent education are more important than generally known factors such as race in the prediction of PTB. This finding is significant evidence for theories like Lifecourse, which postulate that the main determinants of a health trajectory are the social scaffolding that addresses the upstream roots of health. These results point to the need for more comprehensive approaches that change the focus from medical interventions during pregnancy to the time where mothers become vulnerable to the risk factors of PTB. Therefore, in the third study, I take an aggregate approach to study the dynamics of population health that results in undesirable outcomes in major indicators like infant mortality. Based on these new explanations, I offer a systematic approach that can help in addressing adverse birth outcomes—including high infant mortality and preterm birth rates—which is the central contribution of this dissertation. In conclusion, this dissertation contributes to a better understanding of the complexities in infant mortality and health-related policies. This work contributes to the body of literature both in terms of the application of statistical and machine learning techniques, as well as in advancing health-related theories. / Doctor of Philosophy / The U.S. infant mortality rate (IMR) is 71% higher than the average rate for comparable countries in the Organization for Economic Co-operation and Development (OECD). High infant mortality and preterm birth rates (PBR) are major public health concerns in the U.S. A wide range of studies have focused on understanding the causes and risk factors of infant mortality and interventions that can reduce it. However, infant mortality is a complex phenomenon that challenges the effectiveness of the interventions, and the IMR and PBR in the U.S. are still higher than any other advanced OECD nation. I believe that systems and data science methods can help in enhancing our understanding of infant mortality causes, risk factors, and effective interventions. There are more than 130 diagnoses—causes—for infant mortality. Therefore, for 50 states tracking the causes of infant mortality trends over a long time period is very challenging. In the first essay, I focus on the medical aspects of infant mortality to find the causes that helped the reduction of the infant mortality rates in certain states from 2000 to 2015. In addition, I investigate the relationship between different risk factors with infant mortality in a regression model to investigate and find significant correlations. This study provides critical recommendations to policymakers in states with high infant mortality rates and guides them on leveraging appropriate interventions. Preterm birth (PTB) is the most significant contributor to the IMR. The first study showed that a reduction in infant mortality happened in states that reduced their preterm birth. There exists a considerable body of literature on identifying the PTB risk factors in order to find possible explanations for consistently high rates of PTB and IMR in the U.S. However, they have fallen short in two key areas: generalizability and being able to detect PTB in early pregnancy. In the second essay, I investigate a wide range of risk factors in the largest obstetric population that has ever been studied in PTB research. The predictors in this study consist of a wide range of variables from environmental (e.g., air pollution) to medical (e.g., history of hypertension) factors. Our objective is to increase the understanding of factors that are both generalizable and identifiable during the early stage of pregnancy. I implemented state-of-the-art statistical and machine learning techniques and improved the performance measures compared to the previous studies. The results of this study reveal the importance of socioeconomic factors such as, parent education, which can be as important as biomedical indicators like the mother's body mass index in predicting preterm delivery. The second study showed an important relationship between socioeconomic factors such as, education and major health outcomes such as preterm birth. Short-term interventions that focus on improving the socioeconomic status of a mother during pregnancy have limited to no effect on birth outcomes. Therefore, we need to implement more comprehensive approaches and change the focus from medical interventions during pregnancy to the time where mothers become vulnerable to the risk factors of PTB. Hence, we use a systematic approach in the third study to explore the dynamics of health over time. This is a novel study, which enhances our understanding of the complex interactions between health and socioeconomic factors over time. I explore why some communities experience the downward spiral of health deterioration, how resources are generated and allocated, how the generation and allocation mechanisms are interconnected, and why we can see significantly different health outcomes across otherwise similar states. I use Ohio as the case study, because it suffers from poor health outcomes despite having one of the best healthcare systems in the nation. The results identify the trap of health expenditure and how an external financial shock can exacerbate health and socioeconomic factors in such a community. I demonstrate how overspending or underspending in healthcare can affect health outcomes in a society in the long-term. Overall, this dissertation contributes to a better understanding of the complexities associated with major health issues of the U.S. I provide health professionals with theoretical and empirical foundations of risk assessment for reducing infant mortality and preterm birth. In addition, this study provides a systematic perspective on the issue of health deterioration that many communities in the US are experiencing, and hope that this perspective improves policymakers' decision-making.

Thesis (MScMedSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Background: Sudden infant death syndrome (SIDS) is considered the second most frequent cause of infant mortality worldwide. Research specifically pertaining to SIDS is limited in the South African setting. Identifiable causes for sudden infant death remain challenging despite full medico-legal investigations inclusive of autopsy, scene visit and ancillary studies. Viral infections could contribute to some sudden unexpected death in infancy (SUDI) cases, especially since a multitude of respiratory viruses have been detected from autopsy specimens. The specific contribution of viruses in the events preceding death, including the subsequent involvement of the immature immune response in infants, still warrants deciphering. Infancy is characterised by marked vulnerability to infections due to immaturities of their immune systems that may only resolve as infants grow older when these sudden deaths rarely still occur. In South Africa there is a lack of a standard protocol for investigations into the causes of SIDS, including the lack of standard guidelines as to which specimens should be taken, which viruses should be investigated and which laboratory assays should be utilised. Objectives: In this prospective descriptive study we aimed to investigate the prevalence of viruses in SUDI and SIDS cases at Tygerberg Forensic Pathology Service (FPS) Mortuary over a one year period. The primary aim was to explore possible respiratory viral infections in SUDI and SIDS cases and to determine the usefulness of molecular techniques to detect viruses from SUDI cases. To determine the significance of viruses, we assessed signs of infection from lung histology. The secondary objectives included collecting demographic data to investigate possible risk factors for SUDI and to look for possible similarities between viruses confirmed in living hospitalised infants at Tygerberg, during the study period compared to viruses detected from SUDI cases. Methods: Between May 2012 and May 2013 samples were collected from 148 SUDI cases presenting at Tygerberg FPS Mortuary. As part of the mandatory routine investigations into SUDI, shell vial culture (SVC) results were collected from lung and liver tissue specimens and bacterial culture results were collected from left and right lung and heart swabs at autopsy. To investigate the possibility of viruses implicated in some of the infant deaths we used the Seeplex® RV15 Ace detection multiplex polymerase chain reaction (PCR) assay to establish the frequency of 13 ribonucleic acid (RNA) respiratory viruses (influenza A and B, human parainfluenza 1-4, human coronavirus [OC43, 229E/NL63], human rhinovirus A, B and C, respiratory syncytial virus A and B, human enterovirus and human metapneumovirus) from RNA extracted from tracheal and lower left and right lung lobe swabs. Tissue from the lower left and right lung lobes were also assessed for histology signs of infection. Results: During our study we confirmed multiple known demographic risk factors for SIDS, such as the age peak around 1-3 months, the male predominance, bed-sharing, sleeping in the prone position, heavy wrapping in warm blankets, prenatal smoke exposure, and socio-economic factors. With the Seeplex® RV15 Ace detection assay between one and three viruses were detected in 59.5% (88/148) of cases. Of the 88 cases that had viruses detected, 75% (66/88) had one virus and 25% (22/88) had co-detections of two to three viruses. The most common viruses detected were HRV in 77% (68/88) of cases, RSV in 18% (16/88) of cases and HCoV in 14% (12/88) of cases. Many of the viruses we detected from our cases are included in the SVC test that forms part of the medico-legal laboratory investigation for all SUDI cases at Tygerberg FPS Mortuary. SVCs were positive in 9.5% (14/148) of all cases only. We showed that the SVC method is potentially missing most of the 13 respiratory viruses we investigated that could contribute to death in some of the SUDI cases. Conclusion: In some cases that had a Cause of Death Classification - SIDS, the PCR viruses detected cannot be ignored, especially when it is supported by histological evidence of infection. We thus propose that the use of PCR could alter a Cause of Death Classification from SIDS to Infection in some of these cases. Further research is needed to determine the significance of detecting viruses from SUDI cases wherein no significant histological evidence of infection was observed. This questions whether PCR may be too sensitive and is detecting past and latent viral infections that do not play any role in the cause of death. The histological picture also requires further characterisation to determine if it accurately predicts infections or lethal events and can truly support virology findings, especially in young infants whose immune systems are still maturing. Without determining the true prevalence of viruses in SUDI cases and the viral-specific immune response, the contribution of virus-specific infections to this syndrome will remain largely undetermined. / AFRIKAANSE OPSOMMING: Agtergrond: Wiegiedood (“SIDS/SUDI”) word beskou as die tweede mees algemene oorsaak van sterftes in kinders jonger as een jaar wêreldwyd. Toegewyde SIDS-spesifieke navorsing in die Suid-Afrikaanse samelewing is beperk. Dit bly steeds „n uitdaging om oorsake te probeer identifiseer vir hierdie onverwagte sterftes in kinders (SUDI) ten spyte van volledige medies-geregtelike ondersoeke, insluitende die lykskouing, ondersoek van die doodstoneel en aanvullende ondersoeke. Virusinfeksies kan aansienlik bydra tot sommige onverwagte sterftes in kinders, aangesien verskeie respiratoriese virusse alreeds aangetoon is in monsters verkry tydens outopsies. Die spesifieke rol wat virusse speel in die prosesse wat die dood voorafgaan, asook die bydraende rol van „n onder-ontwikkelde immuunrespons in babas, regverdig verdere ondersoek. Die eerste jaar van lewe word gekenmerk deur verhoogde vatbaarheid vir infeksies weens die ontwikkelende immuunstelsels soos wat babas ouer word, en die voorkoms van SUDI neem stelselmatig af met „n toename in ouderdom. In Suid-Afrika bestaan daar tans geen standaard protokol vir die ondersoek van wiegiedood nie en daar is ook nie standaard riglyne oor die tipe monsters wat geneem moet word, watter virusse ondersoek moet word en watter laboratorium toetse uitgevoer moet word nie. Doelstellings: In hierdie prospektiewe beskrywende studie is gepoog om die virusse wat in gevalle van wiegiedood of SUDI voorkom te ondersoek. Die studie is uitgevoer by die Tygerberg Geregtelike Patologie Dienste lykshuis oor 'n tydperk van een jaar. Molekulêre tegnieke om virusse aan te toon in hierdie gevalle is gebruik om spesifieke virusinfeksies te ondersoek. Die resultate is met histologiese tekens van infeksie in longweefsel gekorreleer. Demografiese data is verder versamel om moontlike risikofaktore vir wiegiedood te ondersoek. Dit is verder vergelyk met virusse wat met dieselfde diagnostiese tegnieke in babas geïdentifiseer is wat tydens die studieperiode in Tygerberg Hospitaal opgeneem was met lugweginfeksies. Metodes: Monsters van 148 SUDI gevalle wat by die Tygerberg lykshuis opgeneem is, is versamel tussen Mei 2012 en Mei 2013. As deel van die roetine ondersoeke in SUDI gevalle, was selkultuur resultate verkry van long en lewer weefsel, asook bakteriële kulture van deppers wat van beide longe en hart geneem was tydens die lykskouings. „n Seeplex® RV15 Ace polimerase kettingreaksie (PKR) toets is gebruik om die teenwoordigheid van virusse te ondersoek wat moontlik by die babasterftes betrokke kon wees. Trageale- en longdeppers wat tydens die lykskouings versamel was, was getoets vir 13 ribonukleïensure (RNS) respiratoriese virusse (influenza A and B, human parainfluenza 1-4, human coronavirus [OC43, 229E/NL63], human rhinovirus A, B and C, respiratory syncytial virus A and B, human enterovirus and human metapneumovirus). Resultate: Ons studie het verskeie bekende demografiese risikofaktore vir SUDI bevestig, byvoorbeeld „n ouderdomspiek tussen een en drie maande ouderdom, manlike predominansie, deel van „n bed met ander persone, slaap posisie op die maag, styf toedraai in warm komberse, blootstelling aan sigaretrook voor geboorte en sosio-ekonomiese faktore. Die Seeplex® RV15 Ace toets het tussen een en drie virusse geïdentifiseer in 59.5% (88/148) van die gevalle. Uit die 88 gevalle waarin virusse opgespoor was, was selgs een virus in 75% (66/88) van gevalle gevind en twee en drie virusse in 25% (22/88). Die mees algemene virusse was HRV in 77% (68/88) van gevalle, RSV in 18% (16/88) van gevalle en HCoV in 14% (12/88) van gevalle. Baie van die virusse wat tydens hierdie studie ondersoek was, was ingesluit in die roetine selkultuur toets wat deel vorm van die standaard medies-geregtelike laboratoriumondersoeke in alle SUDI gevalle by die Tygerberg lykshuis, alhoewel die selkulture positief was in slegs 9.5% (14/148) van gevalle. Ons het gevind dat baie respiratoriese virusse potensieel gemisdiagnoseer word wat „n rol kon speel in of bydra tot die dood van sommige SUDI gevalle. Gevolgtrekking: In sommige gevalle waarin SIDS geklassifiseer is as die oorsaak van dood, kan die virusse wat met PKR toetse opgespoor is nie geïgnoreer word nie, veral waar die bevinding ondersteun word deur histologiese bewyse van infeksie. Ons stel dus voor dat die gebruik van PKR toetse die oorsaak van dood klassifikasie kan verander van SIDS na Infeksie in sommige van hierdie gevalle. Verdere navorsing is nodig om die waarde van gelyktydige opsporing van virusse in SUDI gevalle te bepaal wanneer daar geen noemenswaardige histologiese bewyse van infeksie gevind word nie. Dit bevraagteken of die PKR toets dalk te sensitief is en gevolglik vorige en latente virusinfeksies identifiseer wat nie noodwendig 'n rol in die oorsaak van dood speel nie. Die diagnostiese en kliniese waarde van die histologiese beeld in terme van die rol van virusinfeksies as bydraende oorsaak van dood moet verder ondersoek word, veral in jong kinders wie se immuunstelsels nog nie volledig ontwikkel is nie. Indien die werklike voorkoms van virusse in SUDI gevalle en die virus-spesifieke immuunrespons nie bepaal word nie, sal die rol van virus-spesifieke infeksies in hierdie sindroom grootliks onbekend bly. / Harry Crossley Foundation / Poliomyelitis Research Foundation (PRF) / National Health Laboratory Services Research Trust

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Objective: The aim of the study was to determine the outcome of critically ill neonates and children admitted to a general intensive care unit in a large regional hospital (Worcester) in the Western Cape. A secondary aim of the study was to determine the risk factors for death in these neonates and children. Methodology: This was a retrospective descriptive survey of all paediatric admissions (under 13 years of age; July 2008 till June 2009) to an intensive care unit at a large regional hospital in Worcester, South Africa. Data collected included: demography, admission time, length of stay, diagnoses, interventions and outcome. Outcome was defined as successful discharge, death or transfer to a central hospital. Results: There were 194 admissions including children and neonates. The files of 185 children and neonates were analysed, while 8 children were excluded due to incomplete data set and one patient was a surgical admission. The male: female ratio was 1.3: 1 and the majority of patients (83%) admitted, were younger than 12 months of age at admission with a mean age of 8.5 months (median age 3.7 months; range 0 to 151 months). The majority (70%) of admissions were successfully discharged, nearly a quarter (24%) transferred to central hospitals in Cape Town and only 6% died (all younger than 5 years of age). Causes of death included acute lower respiratory tract infections (33%), acute gastroenteritis (25%), birth asphyxia complicated by pulmonary hypertension (16%) and prematurity (16%). Patients requiring airway assistance, were more likely to experience an adverse event (p=0.0001) and invasive ventilation was associated with an increased risk for a poor outcome (p=0.00). Conclusion: The majority of children requiring access to a paediatric ICU are younger than one year of age. The common causes of death are acute lower respiratory tract infections, acute gastroenteritis, prematurity and neonatal asphyxia. A regional hospital in South Africa should offer intensive care to children as the majority of their admissions can be successfully cared for without transfer to tertiary hospitals. To our knowledge, this is the first study reporting admissions and outcome of neonates and children cared for in a mixed intensive care unit in a large regional hospital in South Africa. This study suggests that large regional hospitals in South Africa should have mixed intensive care units to improve child survival.

Le Gabon affiche, paradoxalement à son niveau de PIB par tête élevé, des indicateurs de santépauvres. Fondée sur les données de l’enquête démographique et de santé du Gabon de 2000, laprésente étude a pour objectif d’examiner la relation entre la pauvreté et la santé. Premièrement,l’étude montre que le niveau de mortalité des enfants est préoccupant, et que la pauvreté nonmonétaire en termes d’actifs est associée à cette mortalité. Deuxièmement, les niveaux de retard decroissance et d’insuffisance pondérale des enfants posent problème. A cet égard, on observe que leretard de croissance représente le premier problème nutritionnel. D’ailleurs, les analyses révèlentl’existence d’une relation claire entre la pauvreté non monétaire et le retard de croissance. Par contre,l’impact de la pauvreté non monétaire sur l’insuffisance pondérale dépend du modèle économétriqueutilisé. Troisièmement, le test de Chow pour la mortalité et la malnutrition n’est pas significatif,montrant qu’une analyse économétrique de la relation entre la pauvreté et la santé selon de genre n’estpas justifiée. En d’autres termes, les ménages dirigés par une femme et ceux dirigés par un homme nese comportent pas différemment en matière de soins de santé. Quatrièmement, l’analyse de l’inégalitésocio-économique de la mortalité et celle de la malnutrition suggère quelques commentaires. Toutd’abord, cette inégalité est très forte. Ensuite, alors que l’inégalité de la mortalité est plus élevée enmilieu rural, l’inégalité de la malnutrition est plus prononcée en milieu urbain. Enfin, les disparités deniveau de vie ont un rôle secondaire quant à l’explication du niveau de cette inégalité. / Gabon displays, paradoxically to his high level of GDP per capita, poor health indicators. Based on thedata of the Demographic and Health Survey of Gabon of 2000, the present study had as objective toexamine the relation between poverty and health. Firstly, the study shows that the level of childmortality is worrying, and that the non-monetary poverty in terms of assets is associated with thismortality. Secondly, the levels of child stunting and underweight are problems. In this respect, oneobserves that stunting represents the first nutritional problem. Moreover, the analyses reveal theexistence of a net relationship between non monetary poverty and malnutrition in terms of stunting.On the other hand; the impact of non monetary poverty on the malnutrition in terms of underweightdepends on the econometric model used. Thirdly, the chow test for mortality and malnutrition are notsignificant, showing that an econometric analysis of the relation between poverty and health by genderis not justified. In other words, households headed by a woman and those headed by a man not behavedifferently as regards health care. Fourthly, the study of the socioeconomic inequality of mortality andthose of malnutrition suggests some comments. First of all, this inequality is very strong. Then, whilethe inequality in mortality is stronger in rural area, the inequality in malnutrition is more pronouncedin cities. Lastly, the welfare disparities of the households have a secondary role as for the explanationof the level of this inequality.