Masters of Commerce / The provision of health care in South Africa is undergoing major restructuring. The aim is to achieve substantial, visible and sustainable improvements to the efficiency and accessibility of primary healthcare (PHC) services for all South Africans. One of the country's most critical problems is the weak and fragmented public sector PHC system. The most critical problems contributing to this are the maldistribution of resources (financial, physical and human) between hospitals and the primary care system, and between rural and urban areas. The health sector, therefore, faces the challenge of a complete restructuring and transformation of the national health care delivery system and related institutions. Choices need to be made about which services to cut, which to streamline and where savings can be made. Ways need to be found to use ALL of South Africa's resources optimally. This process of restructuring would be facilitated by the availability of accurate information on resource utilisation in the health sector. This study estimates the difference in the cost of primary diabetes treatment at dayhospitals and a provincial hospital in the Western Cape in 1992/93. Health economics is in its infancy in South Africa and serious data limitations exist. This study is therefore a pioneering effort in many ways. An appropriate methodological framework in which to conduct the costing had to be developed. The South African health sector, health spending arid the cost of primary diabetes treatment at day-hospitals and the provincial hospital are reviewed. Theoretical perspectives of the health care market and the methodologies of cost analysis are discussed. The cost analysis method of study is chosen, and arguments are advanced for its suitability in the South African context. A simple method of calculating the direct costs to obtain the average cost is proposed for the purpose of the study. Direct costs consist of staff costs and other related costs, such as medical supplies, non-medical supplies, building operations, equipment etc. These costs are then used to calculate the average costs per diabetic patient at the day-hospitals and the provincial hospital. The average cost per diabetic patient at day-hospitals amounted to R18.76, while at the provincial hospital the cost was R59.60. https://

Infant mortality (IM) rates in the United States remains high. The higher rates of IM among specific groups in the United States is believed to be fueled by the high rates of adverse birth outcomes including low birthweight (LBW) and preterm births (PTB) among these groups. Adverse birth outcomes have also been linked to the presence of hypertensive disorders during pregnancy. The purpose of this cross-sectional study was to explore the association between hypertensive disorders during pregnancy and adverse birth outcomes and the impact of the residential neighborhood of expectant mothers on this association. The life course health development theory guided the framework for this study. Study data were obtained from the 2010 New York City birth records and the 2010 US Census. Descriptive statistics and logistic regression analysis were used to address the 3 research hypotheses of the study. The study found that prepregnancy hypertension (HTN) (AOR: 2.84 & 3.25), gestational HTN (AOR: 2.28 & 3.33) and eclampsia (AOR: 4.41 & 6.70) were significantly associated with PTB and LBW respectively. Neighborhood segregation was not significant for PTB (AOR: 1.01) or LBW (AOR: 1.03). Neighborhood poverty was significant for PTB (AOR: 0.86) but not for LBW (AOR: 1.05). Neighborhood segregation and poverty had significant moderating effects on the prepregnancy HTN (p = 0.00), gestational HTN (p = 0.00), eclampsia (p = 0.00) and PTB and LBW association. Results from this study can help to address disparities in birth outcomes among women of differing races and ethnicities and thereby contribute to positive social change.

Although U.S. breastfeeding rates have steadily increased since 2000, there continues to be a disparity in breastfeeding rates for African American (AA) women compared to their non-Hispanic White counterparts. A male partner's perception, specifically his positive attitude toward breastfeeding, may influence breastfeeding initiation and duration rates. This study was an exploration of AA male perceptions and attitudes toward breastfeeding and what effect masculinity ideology (gender norms) has on such attitudes. The socio-ecological model (SEM) was used as the theoretical framework to examine the various environmental levels that intersect with one another to influence these attitudes. A mixed methods study design, using (a) an online survey combining the Iowa Infant Feeding Attitudes Scale (IIFAS) and the Male Role Norms Scales (MRNS) (N =206) and (b) 3 focus group sessions (N = 17), was used to collect data. African American men ages 18 and older were eligible to participate in the study. Results of the regression analysis showed a negative correlation between positive breastfeeding attitudes and traditional masculinity ideology. Nvivo analysis of focus group transcripts revealed themes of gender norms, knowledge of breastfeeding, and public opinions. The themes from the focus groups were categorized using the 4 levels of the SEM: Individual, Relationships, Community, and Societal; themes corresponded with Levels 1 (Individual) and 4 (Societal) of the SEM. These results indicate that a gender-transformative approach may be used to strengthen breastfeeding-promotion interventions targeting AA males. The positive social change implications of this research include a paradigm shift in views on gender norms and increased engagement of men in decisions that affect infant and child health and development.

The following study aims to examine the infant mortality in Kronoberg county in southern Sweden during four intervals 1820–1840, 1860–1880, 1900–1920 and 1930–1949, and thereby during the three latter stages of the demographic transition. The empirical data has been obtained from the region's central town, Växjö, and 16 different parishes on the countryside. As stated, the main issue is to study the development of infant mortality, but also to investigate whether there was any regional variation and whether the mortality was higher among the illegitimate children. The results show that infant mortality decreased from 173 to 35 per mille and that the urban parts of the study area initially had the highest mortality, but until the last interval it was lo­west in the urban environment. The highest infant mortality rate was observed among those born out of wedlock, which also declined from 262 to 65 per thousand throughout the studied periods.

This report examines the influence of parent’s migration status on childhood mortality in sending households in the South African rural sub-district of Agincourt. A survival analysis of a cohort of children born in Agincourt between 1 January 1997 and 31 December 2003 was conducted using the Cox proportional hazards model to estimate the influence of parent’s migration status on under-5 year mortality. Starting with a baseline census in 1992, the Agincourt Health and Demographic Surveillance System (AHDSS) data are collected and updated every 12 months wherein fieldworkers visit each household at the site to record the vital events, including births, deaths, and migrations that occurred since the previous census. Results of the survival analysis show that children born in households where the father was a temporary migrant while the mother remained at the rural household had a 35% lower risk of death compared to children in households where both parents were non-migrant (RR=0.647, 95% CI 0.439-0.954). The results also reveal that, controlling for parent migration status, children in single-parent (mother only) households had about 28% higher death hazard than children in two-parent households (RR=1.284, 95% CI 0.936-1.673). The findings suggest that temporary labour migration could be a means to improving household incomes and quality of life for children, particularly where the father is a temporary migrant while the mother remains behind taking care of the children. At the same time, children whose fathers are not indicated appear to be worse off whether their parents are temporary migrants or not.

This paper examined the nexus between health care expenditure and economic growth in Sub-Saharan Africa. It is widely acknowledged that health is a type of human capital and a critical factor in the process of economic growth. Health production, in turn, is a major determinant of health outcomes. While the former relationship has been extensively researched in developed countries, very few studies have attempted to investigate this relationship in developing countries, particularly Sub-Saharan Africa (SSA). Furthermore, very few studies have been conducted in SSA to investigate the relationship between health determinants, health outcomes, and economic growth. This study takes on the challenge of investigating this three-way relationship for SSA countries. Different variables like population, saving and foreign direct investment were found to be statistically significant determinants of economic growth using the Arellano-Bond Dynamic GMM technique for 26 SSA countries, while food availability were found to be significant determinants of life expectancy. On the other hand, none of the health indicators are significant determinants of economic growth in the region, implying that health outcomes must be improved in order to have a significant impact on growth. The findings should prompt immediate policy changes to harmful indicators in order to better stimulate health-led economic growth in SSA.

Introduction & Background Black infant mortality rate is 122% higher than that of non-Hispanic white infants. In a 2021 CDC study, Black women’s maternal mortality rate was 69.9 deaths per 100,000 live births, 2.6 times the rate for non-Hispanic White women. Purpose Statement & Research Question The purpose of our research was to explore reasons why Black maternal mortality is higher than White and non-Hispanic populations and what contributing health disparities are causing higher mortality rates in black infants and mothers compared to their non-Hispanic white counterparts, in the United States. Literature Review: We found articles under 5 years old from Cinhal database. Findings Examples of inclusion and exclusion criteria in our studies included: ages between 18-39, whether they had hypertension during pregnancy, or were between 22-43 weeks of gestation. Main findings from our studies include mistrust between health providers and the black pregnant women negatively impacted their adherence to safe sleep practice, and 32% of women in another study reported that they were not able to initiate their first prenatal care visit as early as preferred due to a myriad of barriers. Conclusions & Nursing Interventions The take-home message of our studies was that disparities are multifactorial. Some major nursing implications we found are that perinatal nurses should assess the psychological wellbeing in Black women throughout pregnancy and advocate for Black women who report high levels of stress, depressive symptoms, or psychological distress.

Measuring levels of childhood mortality is important for low and middle-income countries to monitor overall development and progress towards improved child health. The overall aim of this research is to estimate the level and trend of childhood mortality in South Africa over time, and to examine the factors associated with and the determinants of childhood mortality. The study discovered that significant progress has been made to reduce the levels of childhood mortality in the country. The estimates derived through direct estimation using the 2016 South African Demographic and Health Survey (SADHS) for the period between 2012-2016 revealed age-specific mortality rates were: Neonatal Mortality Rate (NMR) was 22.0 per 1 000 live births, Post-neonatal Mortality Rate (PNMR) 13.1, 1q0 34.9, 1q4 5.5 and 5q0 40.2 per 1 000 live births. Investigation of the factors associated with childhood mortality revealed significant differentials in age group, sex, population group, province, socio-economic status and household characteristics. Overall, children aged less than one month and those aged between one to two months had a higher mortality risk than the other age groups; male children had an increased risk of dying than females; Black and Coloured children had an increased risk of dying compared to children in other population groups; children in Mpumalanga, Eastern Cape and North West had a higher risk of dying compared to children in other provinces; children whose mothers had below secondary education had higher risks of mortality; and children with poor water source and toilet facility were more likely to die than other children with better facilities. The results were generally in agreement with the existing literature. Although the study found significant improvement in the level of childhood mortality over the period 1996-2016, further progress is achievable as many children still continue to die of preventable or treatable causes. The findings of this study may assist government, policymakers and researchers to plan, and implement targeted interventions that will further reduce the levels of childhood mortality in South Africa.

This three-essay dissertation examines racial disparities in infant health outcomes and exposure to air pollution in Texas. It also asks whether the EPA's Risk-Screening Environmental Indicators Geographic Microdata (RSEI-GM) might be used to assess the effects of little-studied toxic air pollutants on infant health outcomes. Chapter 1 contributes to the ``weathering'' literature, which has shown that disparities in infant health outcomes between non-Hispanic black and non-Hispanic white women tend to widen with age. In this study, we ask whether the same patterns are observed in Texas and among Hispanic women, since other studies have focused on black and white women from other regions. We find that black and Hispanic women in Texas do ``weather'' earlier than white mothers with respect to rates of low birthweight and preterm birth. This differential weathering appears to be mediated by racial disparities in the distribution and response to socioeconomic risk factors, though a large gap between black and white mothers across all ages remains unexplained. Chapter 2 extends the statistical environmental justice literature by examining the distribution of toxic air pollution across infants in Texas. We find that, within Texas cities, being black or Hispanic is a significant predictor of how much pollution one is exposed to at birth. We further find that, among mothers who move between births, white mothers tend to move to significantly cleaner areas than black or Hispanic mothers. In Chapter 3, we use geocoded birth records matched to square-kilometer pollution concentration estimates from the RSEI-GM to ask whether the pollution-outcome relationships that emerge through regression analysis are similar to the effects found in previous research. If so, the RSEI-GM might be used to study the health effects of nearly 600 chemicals tracked in that dataset. We conclude, based on instability of results across various specifications and lack of correspondence to previous results, that the merged birth record-RSEI data are not appropriate for statistical epidemiology research.

The first chapter examines donors’ motives for allocating foreign health aid. Do donor countries allocate foreign aid according to their economic interests or the needs of recipient countries?”. This paper analyzes the relevance of the donor country’s government ideology – namely, where it fits on the political spectrum – on how much its aid agencies can be influenced by industrial interest groups. Specifically, I follow Suzuki (2020) and consider to what extent countries with large pharmaceutical sectors structure aid so that recipient countries buy more pharmaceuticals. However, I allow results to differ not only on how autonomous aid agencies are in the donor countries but on whether the ruling government is left or right/center. Using a fractional logit model, the result shows that neither government ideology nor the structure of aid agencies is sufficient on its own in determining health aid allocation (either for economic interest or for the needs of the recipient countries). The allocation of foreign aid is dependent on the combination of government ideology and the structure of the aid agency. Also, regardless of the structure of the aid agency, a government with a right/center political ideology allocates more aid to basic needs than a left party. In the second Chapter, the paper considers to what extent infant mortality lessens for those near a facility financed by development aid. Using geocodes, the study matches household-level data taken from the Bangladesh Demographic and Health Surveys to the location of these aid-backed facilities. Therefore, this paper investigates if proximity to an aid-financed facility enhances the chances of infant survival at the sub-national level. Using a difference-in-difference strategy, the results indicate that geographical proximity to active aid projects reduces infant mortality. In addition, there is evidence of biases in the allocation of aid as the study shows that aid projects are established in areas that on average have lower infant mortality than non-aid locations. The result concludes that while aid is effective in reducing infant mortality in areas where development aid projects are established, there are biases in the allocation as aid is not reaching those that need it the most. The third chapter examines to what extent foreign direct investments worsen environmental pollution. Many see Foreign Direct Investment (FDI) as a source of economic development, income growth, and employment in developing countries. However, FDI could also cause pollution, hurting the environment and harming health. According to past studies, there appears to be no consensus on whether FDI has a positive or negative effect on the host’s environment in developing countries. Using a panel of 48 Sub-Saharan African (SSA) countries, this study examines to what extent inflows of FDI lead to greater pollution using carbon dioxide as a measure of pollution. To the best of my knowledge, this is the first attempt to study this issue for a group of sub-Saharan African countries from 1990 to 2018. The results from fixed effects models show that FDI has no effect on pollution in Sub-Saharan African Countries. These results do not support the Pollution Haven Hypothesis, suggesting that polluting industries leave countries where environmental regulations are strict to re-establish themselves in countries with lax environmental oversight. Given that many African countries are deemed to have ineffective governance (and so presumably less able to enforce environmental standards), the lack of a positive association is especially striking. However, the results show a significant positive relationship between FDI and pollution in more democratic countries while FDI pollutes less in countries that are less democratic.