Report-in-lieu-of-Thesis (M.P.H.)--University of North Texas Health Science Center at Fort Worth, 2008. / Title from title page display. Bibliography: p. 29-31.

Issued also as thesis, Leyden.

Thesis (M.P.H.)--University of Michigan, 1944.

Thesis (M.S.P.H.)--University of Michigan, 1941.

Issued also as thesis, Leyden.

Thesis (M.P.H.)--University of Michigan, 1944.

Thesis (M.S.P.H.)--University of Michigan, 1941.

Icebergs - Why start a thesis thinking about icebergs? Death from medical conditions represents the tip of an iceberg. What causes death in some, will maim, injure or leave damaged in others. Death remains a parameter with which to measure part of the effect of a disorder on the mother or fetus. What will prevent mortality will prevent morbidity and it is largely towards the prevention of the latter that modern medicine is aimed.

Background: This study examines the socioeconomic factors associated with infant and postneonatal mortality in Kenya and tries to quantify these associations in order to put those factors in ranked order so as to prioritize them in health policy plans aiming to decrease infant and postneonatal mortality. The study has used wealth index, mother’s highest educational level, mother’s occupation and place of residence as exposures of interest. Methods: The study uses analytical cross-sectional design through secondary data analysis of the 2003 Kenyan Demographic and Health Survey (KDHS) dataset for children. Series of logistic regression models were fitted to select the significant factors both in urban and rural areas and for infant and postneonatal mortality, separately, through the use of backward stepwise technique. Then the magnitude of the significance for each variable was tested using the Wald’s test, and hence the factors were ranked ordered according to their overall P-value. Results: After excluding non-singleton births and children born less than one year before the survey, a sample size of 4 495 live births was analyzed with 458 infants died before the first year of life giving IMR of 79.6 deaths per 1000 live births. After adjusting for all biodemographic and other health outcome determining factors, the analyses show no significant association between socioeconomic factors and infant mortality in both urban and rural Kenya. The exclusion of deaths that occurred in the first month of ages shows that risk of postneonatal (OR 3.09; CI: 1.29 – 7.42) mortality, in urban Kenya, were significantly higher for women working in agricultural sector than nonworking women. While in rural Kenya, the risk of postneonatal (OR 0.42; CI: 0.20 – 0.90) mortality were significantly lower for mothers with secondary school level of education than mothers with no education. Conclusions: There is lack of socioeconomic differentials in infant mortality in both urban and rural Kenya. However, breastfeeding, ethnicity and gender of the child in urban areas on one hand and breastfeeding, ethnicity and fertility factors on the other hand are the main predictors of mortality in this age group. Furthermore, results for postneonatal mortality show that level of maternal education is the single most important socioeconomic determinant of postneonatal mortality in urban Kenya while mother’s occupation is the single most important socioeconomic determinant of postneonatal mortality in rural areas. Other determinants of postneonatal mortality are ethnicity and gender of the child in urban areas, while in rural areas; the other main predictors are ethnicity, breast feeding and fertility factors.

Background: This study examined the relationship between mothers’ age at first birth and infant mortality in Zimbabwe. Childbearing at a significantly young age has been noted to be a predictor of infant mortality, as children born to young mothers are at a greater risk of early death. Methods: This is a cross-sectional, secondary study which uses the data from the Zimbabwe Demographic and Health Survey 2005-2006. The population of interest in this study are women of reproductive ages in Zimbabwe, who have had children within the last five years prior to the survey. A total of 4074 women are used as the sample in this study. The dependent variable is infant mortality, which is understood as the deaths of infants between the period of birth and their first birthday. The independent variables include demographic, socio-economic and reproductive characteristics of the women. The analysis of data was undertaken at three levels. Univariate analysis, binary logistic regression and multivariate logistic regression were conducted. In addition, stepwise logistic regression was applied to the multivariate analysis to analyse the relationship between the significant variables found in the study in relation to infant mortality. Results: This study confirmed an association between mothers’ age at first birth and infant mortality as infants born to mothers of 18 years and younger suffer higher risk of infant mortality, as they have a 33% increased risk in comparison to infants born to older women. This indicates the need for policy development focused on the issue adolescent childbearing and how childbearing can be delayed in Zimbabwe in order to reduce infant mortality. Furthermore the reproductive characteristics of the mother prove to have great impact on infant mortality within the country. Thus the importance of policies focused on women’s reproductive health care. Conclusions: This study confirms that mothers’ age at first birth is a central influential factor in infant mortality in Zimbabwe. Infant mortality cannot be isolated from the characteristics of mothers, in particular her age at first birth, as they are more often the primary care-givers thus have immense influence on whether the infants survive or not.