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Globally, nearly 40% of under-five deaths occur in the first 28 days after birth. Neonatal mortality is concentrated in sub-Saharan Africa and South Asia with an estimated 80% of all neonatal deaths occurring in the two regions. Low quality of care has been associated with poor health outcomes in low-and middle-income countries (LMICs). Low quality of intrapartum care has been shown to be strongly associated with poor newborn outcomes. Improving access to high-quality neonatal care for small and sick newborns is crucial to reducing preventable deaths in the immediate newborn period. Over the last two decades, significant advances have been made in measuring the coverage, quality and equity of maternal health services. However, few studies to-date have explored the quality of care for small and sick newborns in resource-constrained settings. Those studies conducted in low-and middle-income settings demonstrate that in-patient service readiness for small and sick newborns is low. While there have been increasing efforts to develop and standardize metrics for measuring facility readiness for this population, few studies to-date have explored the effective coverage – a term used to denote utilization adjusted for quality – of services for emergency newborn care in such settings. Recommendations for intervention packages for small and sick newborns have largely focused on secondary and tertiary levels of care, leaving the role of community and peripheral facilities under-explored. Central to the agenda of improving the coverage of high-quality services for small and sick newborns is also strengthening the capacity of health workforce that participate in their care. A plethora of training packages and supervision strategies have been tried and tested in LMICs for improving emergency obstetric care with the focus on emergency newborn limited to a few complications. These human resources initiatives have been criticized for being fragmented in implementation. Little is known about the quality of training and supervision for emergency newborn care competencies for the rural health workforce in under-resourced settings. This dissertation is presented in three papers to help evaluate specific components of quality and coverage for the small and sick newborn population in LMICs. Paper one identifies and describes the breadth of strategies used to successfully translate evidence-based community interventions for the management of newborns with possible serious bacterial infections (PSBI), enabling the generation of a common and consistent taxonomy for practitioners and researchers in this domain. Paper two uses quantitative methods to examine the service readiness and effective coverage of services for small and sick newborns at the sub-district and district levels in rural Ghana. Paper three, using a mixed-methods design, assesses health worker perceptions of the quality and gaps in training, supervision and tele-mentoring activities for emergency obstetric and newborn care in rural Ghana.

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Indiana University-Purdue University Indianapolis (IUPUI) / Twice as many African American infants die each year when compared to white infants. While infant mortality rates have declined for all ethnic groups in the United States over the past fifty years, the racial gap has remained persistent, and is not fully understood despite numerous quantitative studies. The purpose of this study was to understand the lived experiences of African American women in relationship to the black gap in infant mortality. Thirteen African American women participated in either a focus group or in–depth interviews. Women were asked to use their life experiences to identify factors that would increase the understanding of African American infant mortality. Several themes emerged indicating that the experience of stress and racism are constant factors in African American women’s lives and are inseparable from their pregnancy experience.

Black health disparities are a salient public health issue with blacks in every socioeconomic level at a greater health disadvantage than their white counterparts. In particular, disparity in infant mortality rates between blacks and whites have widened in recent decades to differentials never before experienced in the United States. Social ecologists investigating the myriad of individual and environmental risk factors have failed to fully account for the persistent differential. This study examines the relationships between individual and environmental influences on the health risk experienced by blacks, whites, as well as the differential between the two populations. This multi-level analysis was conducted using five-year aggregate data centering on the 2000 decennial census (1998 - 2002) as the most recent census data available. During the study period, the 193 census tracts in Orange County, Florida, experienced 504 infant deaths which included 242 black and 241 white infant deaths. Using the infant mortality target rate developed for Healthy People 2000 as the ―normal‖ infant mortality rate, risk was calculated as the percentage of deviation from the ―normal‖. A rate was also calculated to demonstrate the difference between black and white percent deviations from the ―normal‖. Structural equation modeling was used to examine the relationship between socioeconomic influences (Socioeconomic Disadvantage), social risk factors (Social Disorganization), and behavioral risk factors (Poor Behavioral Choices) using a latent variable approach based on a conceptual model which integrated the social determinants of health framework and conflict theory. iv In this study, an inverse association was found between socioeconomic disadvantage and infant mortality risk for black infants. This finding is contradictory to the expected finding and may have been due to multicollinearity or the operationalization of the endogenous study variable for black infant mortality risk. Thus, this study highlights the complexity of unraveling the interrelationship between social and economic risk factors. The results of this study demonstrate the importance of the latent variable approach in public health research as well as the need to broaden the approach to selecting indicators. This study concludes with specific policy recommendations aimed at improving the health outcomes of vulnerable populations using the social determinants of health framework.

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Twenty Sierra Leonean rural illiterate mothers were querried about their perceptions of the factors related to Kwashiorkor. Demographic data was hand tabulated to determine the frequency of parents' occupations, pregnancies, live and stillbirths, living and dead children, and causes of children's deaths. Chi-square analyses were done to assess the distribution of responses to questions about 19 beliefs which the researcher thought were related to Kwashiorkor. Student t-test was used to determine the differences in the total number and outcome of pregnancies between women who agreed and disagreed about the role of four of the factors which tended to show or showed significance with chi-square analyses.The families were subsistence farmers. In addition, 65 percent or the husbands had other jobs. Combined, the 20 women had 191 pregnancies, 166 live births, (87 percent of pregnancies), 25 (13 percent) stillbirths, 82 living children (43 percent of pregnancies and 49 percent of live births). The women lost through death 84 (50.6 percent) of the 166 live born children.The average woman experienced 9.6 pregnancies, resulting in 8.3 live births, and 1.3 stillbirths, had an average of 4.1 living children and had lost an average of 4.2 live born children. The data indicated that the major problem with infant/child mortality occurred after birth. Protein-Energy Malnutrition accounted for 38.1 percent of the children's deaths.Of the 19 factors about which women were querried in relation to role in Kwashiorkor, to only 4, namely “Witchcraft,” “Religious beliefs,” “Grandmother's advice,” and “Mother-in-law's advice” did less than half of the women agree. The majority of women agreed that 15 of the factors were associated with Kwashiorkor.That indicated the women had supportable understanding of factors truly related to Kwashiorkor.Three constructs, beliefs about “Witchcraft,” “Introduction of other foods,” and “Immunizations,” differentiated incidence and outcome of pregnancy among women. However, belief about the importance of “Immunizations” differentiated infant/child mortality and will be most useful in future research to analyze differences and to identify groups at greatest risk of child mortality.Ball State UniversityMuncie, IN 47306

The introduction outlines the reasons for the priority of maternal and child health emphasizing the relatively simple resources required. The aims of such programmes must be identified and the results measured so that services can be monitored and evaluated. Categories of measurement are defined and indicators of maternal child health identified within these categories. A chapter is devoted to an outline of the principal non-medical determinants based on material from the Inter-American Investigation of Childhood Mortality. The significance of the principal indicators viz. the perinatal mortality rate, the infant mortality rate, the maternal mortality rate and growth and development data are compared. Chapter lV presents a report of a questionnaire study into local indices viz. Stillbirth rates, Caesarean Section rates and Maternal Mortality rates. The uptake of certain clinic services was also determined. Differences between groups and possible reasons for these are discussed. The final chapter points out the need for accurate birth and death registration and a reliable health information system and suggests methods for achieving this. Recommendations are made for upgrading the collection of data and for improving maternal and child health by research and peripheralization of services. / Thesis (M.Med.)-University of Natal, Durban, 1981.

Among the Baliem valley Dani of the central highlands of Irian Jaya, Indonesia, infants play a prominent role in social relations. Infant mortality rates among the Dani are above two hundred and fifty deaths per thousand live births and birth rates are low. To these patterns of infant survival and growth the Dani consistently ascribe complex meaning. Drawing from anthropological research conducted in 1994--1995 in the Baliem valley, this dissertation demonstrates that indigenous meanings about the infant body and assessments of infant health link the infant to political relations within polygynous families, to antagonistic gender relations, and to affiliations with powerful ancestor spirits. Gender relations play a prominent role in explanations about infants. When an infant dies, parents explain the death in ways that reflect the lower social status of women in relation to men. A study of sex ratios during the first year of life and biased use of health services by gender of the infant suggest that the Dani may generate and validate cultural patterns of gender inequality during the earliest months of life. / Infants also play an important role in national politics. In Indonesia's attempts to assimilate indigenous peoples into the country's economic development agenda, the infant appears in health promotions as a member of a contrived ideal family. These national cultural models, grounded in a concern with population control, translate into an applied health agenda for infants that has little impact on the mortality rates of the very young in Dani society. / The infant, though mute, is a powerful figure at the center of many social and political relations. The richness of meaning attributed to infants in the Baliem valley suggests that further research is needed to correct lacunae in anthropological theory about one of life's key social figures.

Background: The economic crisis that intensified in Zimbabwe between 2004 and 2009 could have exposed children under the age of 5 at an elevated risk of dying. The study investigates the determinants of childhood mortality in the country 4 years preceding the Zimbabwe Demographic and Health Survey of 2010-2011. Aims and Objectives: To establish child mortality determinants in Zimbabwe for the period 2006-2010 during the economic crisis. Methods: The study was a descriptive cross-sectional study which used data from the ZDHS 2010-2011. Using logistic regression and survival analysis, the study estimates the odds of dying and the survivorship probabilities for the birth cohort of 2006-2010. Results: The results indicate that children born to mothers age 40-49 had 88% higher chances of dying compared to children born to mothers in the age group 15-19 in a model that controls for age of mother and gender of child. Female children had 23% lower chances of dying compared to male children in a model that controls for gender and age of mother and was statistically significant at p-value<.05. Children born to mothers with higher levels of education had 16% lower chances of dying compared to children born to mothers with lower levels of education in a model that controls for maternal education, age of mother and gender of child. Children residing in households with higher socio-economic status had 12% lower chances of dying than children residing in households with lower socio-economic status in a model that controls for household socio-economic status, maternal education, age of mother and child’s gender. Children residing in rural areas had 17% lower chances of dying than children residing in urban areas in a model that controls for area of residence, household socio-economic status, maternal education, age of mother and gender of child. Children residing in some of the country’s poorest provinces namely Matabeleland North and South had 72% and 70% lower chances of dying respectively and both were statistically significant at p-value<.05 in a model that controls for province of residence, area of residence whether rural or urban, age of mother, maternal education, gender of child and household socio-economic status. Conclusions: The study established some of the determinants of childhood mortality during the country’s economic crisis. / Thesis (M.A.)--University of KwaZulu-Natal, Durban, 2013.