A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand in partial fulfillment of the requirements for the degree of Master of Science in Medicine (Epidemiology and Biostatistics) Johannesburg, May 2014 / Objective: The objective is to estimate the magnitude and determinants of perinatal mortality in Agincourt, and determine whether there is a difference in perinatal mortality rate between South Africans and self-settled Mozambicans. Design: Case-control study of 134 cases and 136 controls using longitudinal data drawn from the Agincourt dataset for the period 1995-2000 Methods: All cases were matched against a random selection of 136 controls. Odds ratios were used to assess risk, with p-values for trend where necessary. Logistic regression was used to determine independent effects of significant risk factors. Limitations of the study: Probable under-reporting of stillbirths and early neonatal deaths. Results: The Agincourt perinatal mortality rate is estimated as 13.4 per 1000 births (95%CI, 11.23- 15.8) with an increasing trend from 1995-2000 (X2 for trend 19.487, p-value <0.001). Delivery by a nurse attendant is a protective factor but not independently so. Multivariate analysis indicates that babies of women who never attended antenatal clinic during the index pregnancy are at higher risk of perinatal death (OR= 7.55; 95%CI, 2.03-28.05) compared to others whose mothers attended antenatal clinic at least four times. Women with history of perinatal death are at a higher risk of experiencing it again, compared with those without (OR =13.68; 95%CI, 1.43-130.82). The difference in perinatal mortality rate for South Africans (13.3) and former Mozambican refugees (11.8) is not statistically significant (p-value = 0.522). Conclusion: Perinatal mortality is rising; key risk factors are non-attendance for antenatal care by mothers, and previous perinatal death. There is no significant difference in perinatal mortality rate between South Africans and self-settled Mozambicans in Agincourt.

Division of Forensic Medicine and Pathology, University of the Witwatersrand Submitted in fulfilment of the requirements for the degree of Masters of Science in Medicine In the Health Science Faculty University of Witwatersrand Johannesburg 2014 / Within the field of paediatric pathology dominant universal trends have emerged with child abuse related fatalities and child murders being at the forefront. However, several authors have noted that such trends have not been documented within the South African context. This is due to the lack of data collection and research within South Africa. Patterns of injury and prevalence of paediatric fatalities received at the Johannesburg Forensic Pathology Service (JHB FPS) over three years were observed through a descriptive, retrospective study. Data were collected from FPS case files and Police reports (SAPS180) accompanying the body to the mortuary. The results indicated that the majority of paediatric deaths were due to blunt force injuries, natural disease processes and drowning. Subdural and subarachnoid haematomas, multiple blunt force internal injuries, hyperinflation and consolidation of the lungs and features of dehydration were the dominant patterns of injuries and disease. Additionally, results exhibited a significant difference in age range when correlated to category of death as well as a high risk of mortality within the first year of life. This study highlights the alarming figures of accidental and socio-economic paediatric death cases which are received at the JHB FPS. Keywords: Child mortality, Injury patterns, Forensic Pathology

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.