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Piaget first observed and described the problems which young infants have in understanding the nature of objects forty years ago. Both his description and his analysis of the development of the object concept are still widely supported today. This thesis, while accepting the Piagetian description of the behaviours involved, suggests that Piaget's account of the underlying cognitive processes is no longer tenable. Alternative theories of object concept development which have been put forward in recent years are also examined and rejected. An identity theory of object concept development is proposed and a series of six interlinked experiments presented in an attempt to provide support for this theory. On the basis of these and the many other experiments reported in the literature, it is suggested that an identity theory alone can adequately cover the variety of appropriate and inappropriate object-related behaviours seen in the first two years of life.

The subject of rickets is one to which I have given much thought during several years of an intimate experience in the management of the disease. I have been particularly impressed by its great prevalence amongst the more crowded districts and lower classes of our city population as compared with the less populous, but not necessarily less fortunately circumstanced country localities. I have likewise observed marked differences in physique between the parents of the city and those of the country; also the apparent contempt of the citizen parent for the health-giving influences of fresh air. Even more so have I noticed the crass ignorance exhibited in the choice of proper articles of diet for the rearing of children of tender years. Another striking factor is the appalling death-rate amongst young children from this disease and its protean consequences, a death-rate which, in this so called enlightened age, is not showing the diminution it should do: largely, in my opinion, owing to the invincible ignorance and obstinacy of the lower-class mother. She, in not a few instances, insists in bringing up her infant in the same faulty way as she herself was reared. In these cases the fussy grandmother is the bugbear of every family practitioner. "Children are not reared nowadays as they were in my time," she says. Granted; and it is well for the present-day pediatric prospects that usually they are not. The grandmother-empiric, when inclined to practice her domestic medicine with its nonsensical basis, is an everyday evil, and should be fought at every turn. There is too great a tendency on the part of some practitioners to agree with her for the sake of peace and popularity and recommendation: this fact, particularly in slum experience, I have from time to time observed. "Look at me," she commands the anxious mother, "I was reared on such and such a food or in this or that way, and what's good enough for your mother should be good enough for your bairn." Authority has spoken and nothing more can be said.

Introduction The fourth Millennium Development Goal (MDG) calls for a reduction in newborn mortality but newborn mortality is one of the world’s most neglected health problems. While there has been significant progress in reducing deaths among children under age five over the past decade, the proportion of under five mortality that occur in the neonatal period, an estimated 38% in 2000, is increasing. Therefore the Millennium Development Goal for child survival cannot be met without substantial reductions in neonatal mortality. It is therefore extremely important to make available the much needed epidemiological information regarding the time, place and causes of neonatal deaths which will enable greater attention to policies aimed at reducing levels of mortality and programme planning. Objectives The objective of this study was to investigate the relationship between neonatal mortality and place of delivery in Rufiji in rural Tanzania. The specific objectives were: 1.to measure and compare the neonatal mortality rates among neonates born in and outside health facilities, 2. to compare the maternal characteristics of those who deliver in and outside health facilities, 3. to compare cause-specific neonatal mortality among neonates born in and outside health facilities and 4.to measure the association between place of delivery and neonatal mortality. Methods Data from the Rufiji Demographic Surveillance System (RDSS), Tanzania, was used for the analysis. A total of 5124 live births and 166 neonatal deaths were recorded from 1st January, 2005 to 31st December, 2006. Place of delivery and place of death were categorized as either health facility or outside health facility. Neonatal mortality rates were calculated by dividing the number of neonatal deaths to the total number of live births and multiplied by 1000. Data on causes of death were collected using verbal autopsies. Cause specific mortality was determined by using physician coding according to a list of causes of death based on the 10th revision of International Classification of Diseases. Household characteristics and assets ownership of the mothers of the neonates were used to construct a wealth index as proposed by Filmer and Pritchett in 20011. The index was calculated using Principal Component Analysis (PCA) in Stata version 10 software. A chi-square (x2) test at 5% significant level was also used to compare the maternal characteristics by place of delivery and neonatal characteristics and place of delivery. Univariate and multivariate logistic regression models were also used to assess the association between neonatal mortality and place of delivery as well as between neonatal mortality and maternal risk factors, while adjusting for potential confounders. Results The highest number of neonatal deaths occurred during the first week of life 111(67%), the remainder occurred from the second week to the fourth weeks of life 55(33%). The overall neonatal mortality rate was 32/1000 live births. Neonatal mortality rate was higher in children born outside heath facilities 43/1000 live births compared with those born in health facilities 27/1000 live births. The two major causes of deaths in both health facility deliveries and outside health facility deliveries were birth injury or asphyxia n=29 (26%) and prematurity/low birth weight n=25 (22%). Mothers who delivered out-side a health facility were 1.6 times more likely to have experienced neonatal death [unadjusted OR=1.6, p-value = 0.002, 95% CI 1.2, 2.2] compared to mothers who delivered in health facility and this was statistically significant. After adjusting for maternal risk factors, mothers who delivered outside a health facility were 1.7 times more likely to have experienced neonatal death [adjusted OR=1.7, p-value = 0.002, 95% CI 1.2, 2.4] compared to mothers who delivered in a health facility and this was statistically significant. Maternal household socio-economic status and parity were the only other factors that were found to be statistically significantly associated with neonatal mortality in the multivariate analysis. For instance, least poor mothers were found to be 40% less likely to have experienced neonatal death [adjusted OR = 0.6, pvalue = 0.046, 95% CI 0.4, 1.1] compared to the poorest mothers and this was statistically significant. Less poor mothers were also found to be 50% less likely to experience neonatal mortality [adjusted OR =0.5, p-value = 0.002, 95% CI 0.3, 0.8] compared to the poorest mothers. Mothers who had parity of three to four (3-4) were found to be 40% less likely to have experienced neonatal death compared to mothers who had parity of one to two (1-2). Mothers who had parity of five (5) and above were also found to be 50% less likely to have experienced neonatal death compared to those who had parity of one to two (1-2). Conclusion Place of delivery has a very important role in neonatal survival in this rural setting. In order to reduce neonatal mortality, pregnant women should be encouraged and supported to give birth to their newborns in a health facility while discouraging deliveries that occurred outside health facility. Infrastructure, such as emergency transport, to facilitate health facility deliveries requires attention.

Background Disparities in health outcomes between the poor and the rich are increasingly attracting attention from researchers and policy-makers. However, policies aimed at reducing inequities need to be based on a sound assessment of the nature, magnitude and determinants of the problem, as policy decisions based on intuition are likely to be misguided. Objective The work investigates the relationship between household socio-economic status and under-five mortality at Rufiji DSS in year 2005. The specific objectives were; 1.To construct wealth and concentration indices for households with children under age five. 2. To measure health inequality by poorest / least poor mortality rate ratio and the use of concentration index 3. To determine significance in gradient of mortality rates across wealth index quintiles by a trend test (chi-square) 4. To assess the magnitude of association between socio-economic status of households and under-five mortality. Methods Data from Rufiji DSS, Tanzania was used for the analysis. Out of 11,189 children under five years of age from 7298 households, 251 died in the year 2005. These yielded a total of 9341.6 PYO in 2005 which was used in the analysis. Household wealth index was constructed by use of Principal Component Analysis (PCA), as a proxy measure of each household SES. From this index households were categorized into five quintiles (i.e., poorest, poorer, poor, less poor and least poor). Kaplan-Meier (K-M) survival estimates of incidence rates were used to estimate mortality rates per 1000 PYO for infants (0-1), children (1-4) and under-fives. Health inequality was measured by poorest to least poor mortality rate ratio and by computing mortality concentration indices. Trend test chi-square was used to determine significance in gradient of mortality rates across wealth index quintiles. Risk factors of child mortality were assessed by the use of Poisson regression taking into account potential confounders. Results The result indicates that the mortality rate was higher for infants (123.4 per 1000 PYO, 95% CI (104.3, 146.1)) than for children aged 1-4 years (17.3 per 1000 PYO, 95% CI (14.3, 20.9)). Under-five mortality was 26.9 per 1000 PYO (95% CI (23.7, 30.4)). The poorest to least poor ratio were 1.5, 3.8 and 2.4 for infants, children, and under-five year olds, respectively indicating that children in the poorest quintile were more likely to die as compared to those in the least poor household. Computed values for concentration indices were negative (infant C= -0.07, children C= -0.24 and under-five C= -0.16) indicating a disproportionate concentration of under-five mortality among the poor. The mortality rates trend test chi-square across wealth index quintiles were significant for both children (P<0.001) and under-five year old children (P<0.001) but not for infants (P=0.10). In univariate Poisson regression, children in the least poor households were shown to have a 58% significantly reduced risk of dying as compared to the poorest households [crude RR=0.42, P < 0.001, 95% CI (0.27 - 0.62)]. The effect of household socio-economic status attenuated after adjusting for maternal education, maternal age and occupation. Children in vi the least poor households had a 52% significantly reduced risk of dying as compared to the poorest households [adjusted RR=0.48, P = 0.002, 95% CI (0.30 - 0.80)]. Conclusion The study shows that household socio-economic inequality is associated with under-five mortality in Rufiji DSS in 2005 and that the survival advantage of under-five year old children is associated with maternal education. Reducing poverty and making essential health services more available to the poor are critical to improving overall childhood mortality in rural Tanzania.