Multivariate statistical methods, including recent computing-intensive techniques, are explained and applied in a medical sociology context to study infant death in relation to socioeconomic risk factors of households in Sri Lankan villages. The data analyzed were collected by a team of social scientists who interviewed households in Sri Lanka during 1980-81. Researchers would like to identify characteristics (risk factors) distinguishing those households at relatively high or low risk of experiencing an infant death. Furthermore, they would like to model temporal and structural relationships among important risk factors. Similar statistical issues and analyses are relevant to many sociological and epidemiological studies. Results from such studies may be useful to health promotion or preventive medicine program planning. With respect to an outcome such as infant death, risk groups and discriminating factors or variables can be identified using a variety of statistical discriminant methods, including Fisher's parametric (normal) linear discriminant, logistic linear discrimination, and recursive partitioning (CART). The usefulness of a particular discriminant methodology may depend on distributional properties of the data (whether the variables are dichotomous, ordinal, normal, etc.,) and also on the context and objectives of the analysis. There are at least three conceptual approaches to statistical studies of risk factors. An epidemiological perspective uses the notion of relative risk. A second approach, generally referred to as classification or discriminant analysis, is to predict a dichotomous outcome, or class membership. A third approach is to estimate the probability of each outcome, or of belonging to each class. These three approaches are discussed and compared; and appropriate methods are applied to the Sri Lankan household data. Path analysis is a standard method used to investigate causal relationships among variables in the social sciences. However, the normal multiple regression assumptions under which this method is developed are very restrictive. In this thesis, limitations of path analysis are explored, and alternative loglinear techniques are considered. / Science, Faculty of / Statistics, Department of / Graduate

This study aimed to provide empirical verification to the hypothesis that unwanted fertility could lead to mortality, with underinvestment as an intervening mechanism. Unwanted fertility was defined as a live birth that deviated from parental expectation in some distinguishable characteristics or set of characteristics. Births defined as unwanted were: 1) births which respondent indicated she preferred to have occurred later or births which she did not want at all, 2) those whose birth order exceeded the mother’s desired family size, and 3) those which exceeded the number of desired boys of the number of desired girls of the mother. Underinvestment as defined by Scrimshaw (1978) involved the idea that mothers would not go to extremes to save the life of a child and might invest more time and resources in other children. To measure underinvestment, a scale was constructed made up of the following items: 1) source of prenatal care, 2) frequency of prenatal care, 3) age started supplementary feeding, 4) length of breastfeeding, 5) source of medical treatment, 6) length of time before treatment was sought, and 7) time spent cuddling and playing with child. Mortality was classified into two types: postneonatal mortality and childhood mortality. Postneonatal mortality involved deaths from ages one to eleven months. Childhood mortality involved deaths at ages one to four years. Thus, analysis proceeded in two ways: 1) that involving all live births born at least a year before the time of the interview and 2) that involving only live births born at least five years before the time of the interview. Results of the study did not support the hypothesis that unwanted fertility could lead to mortality, with underinvestment as an intervening mechanism. In general, no significant association was found between unwantedness and mortality. However, underinvestment and mortality (postneonatal and childhood) were significantly associated for both wanted and unwanted births. Underinvestment and childhood mortality were significantly related for births in lower class families and for births in middle and upper class families. Postneonatal mortality was significantly related to underinvestment among lower class births only. Postneonatal mortality was not significantly related to SES. Childhood mortality was significantly related to SES with underinvestment as an intervening variable. The study underscored the difficulties involved in measuring the variables of interest -- unwantedness and underinvestment. Several limitations of the study were pointed out and recommendations for further research were stated. / Ph. D.

Ethiopia is one of the five nations that bear the global burden of nearly 50% maternal mortalities and newborn deaths. Cause-specific maternal mortality and newborn death information are vitally important for prevention, but little is known about the causes of deaths. Many maternal mortalities and newborn deaths occur at home, outside the formal health sector, and few are attended by qualified medical professionals. Despite the fact that, non-medical factors are often more important in determining whether a woman/newborn lives or dies than the medical cause of death itself. This study determines and explores factors contributing to maternal mortalities and newborn deaths in Ethiopia with the aim of developing a community-based model for averting maternal mortalities and newborn deaths in Ethiopia. The study was organised in three phases. In Phase 1, a community-based-retrospective approach using explorative, descriptive and contextual study design, combining both qualitative and quantitative methods (mixed methods) were used to make an in-depth investigation and analysis of the circumstances and events surrounding individual cases of maternal mortality and newborn deaths. The result of the study revealed various direct and indirect as well as possible contributing factors to maternal mortalities and newborn deaths which outlined bases for forwarding Phase 2 of the study called concept analysis. In Phase 3, a prototype model was developed according to Chinn and Kramer’s approach to theory generation: initially, based on the empirical perspectives of the study, concept analysis was conducted. The structure and process of a model to avert maternal mortality and newborn death were described; and, six survey list; namely, agent, recipient, context, procedure, dynamic and terminus of Dickoff, James and Wiedenbach (1968) form the basis for development and description of a model for averting maternal mortality and newborn deaths in Ethiopia. Impediment in receiving prompt, adequate and appropriate care were common problems encountered even after reaching an appropriate medical facility. For any attempt to attain a significant reduction in maternal mortality and newborn death, the health care system in Ethiopia must assume its tasks to institute critical changes in both the structure and process of health care delivery services. / Health Studies / D. Litt. et Phil. (Health Studies)

Thesis (M. A. (Nursing Science)) -- University of Limpopo, 2016. / Perinatal morbidity is a public health indicator of the level of equality in a country. Its prevention has major medical, social and economic costs. The aim of this study was to describe factors contributing to high perinatal morbidity rates in Mankweng-Polokwane Complex of the Capricorn district, Limpopo Province, South Africa. A quantitative, descriptive cross-sectional research method was used to describe factors contributing to high perinatal morbidity. The study population comprised 80 registered midwives. Simple random sampling was used to select the 66 respondents. Data were collected using a self-developed questionnaire. Questionnaires were completed and returned, and only one questionnaire was not returned, and two were spoiled as they were incomplete, then 63 questionnaires were analysed. Ethical clearance was obtained from Medunsa Research and Ethics Committee, Limpopo Province Department of Health Ethics Committee and Hospital management. The Statistical Package for Social Sciences (SPSS, version 22) was used for data analysis. Descriptive statistics were used to analyse and describe and summarise data whereby the findings were presented in the form of distribution tables and graphs. Inferential statistics were used based on probability and allowed judgement to be made about the variables. The study revealed that shortage of staff, absenteeism, resignation, bad staff-patient ratio and overcrowding of patients, long waiting periods for caesarean sections, long waiting period for babies operation, work overload of staff, lack of equipment and supplies, congenital anomalies, perinatal asphyxia, prematurity and neonatal sepsis were contributory factors to high perinatal morbidity rates. The study recommended that all staff should be able to resuscitate newborn babies, be able to use Partograph effectively, further research on factors contributing to high perinatal morbidity and education training on speciality qualifications. Key-words: Factors, High, Perinatal, Morbidity rates

Thesis (MPH.) -- University of Limpopo, 2022 / Background: Stillbirth rates are a health problem and they cause distractions in the families. There are more than 5 million perinatal deaths occurring each year, ending preventable stillbirths and neonatal deaths continues to form a significant part of the international public health agenda beyond 2015. There are several risk factors which are associated with stillbirths and this could be classified as maternal, foetal and external risk factors. Therefore, the focus of the study was on the prevalence and determinants of stillbirths in Dilokong Hospital of the Limpopo Province. Methods: A retrospective descriptive study was conducted which followed a quantitative approach. This study used secondary data from patient clinical records from the maternity ward in Dilokong Hospital. Comparison between groups for continuous and categorical variables was performed using student t-test, and chisquare test, respectively. P-value less than 0.05 at 95% confidence level was regarded as significant. Findings: The prevalence of stillbirth amongst women who delivered at Dilokong hospital between period 2016 and 2019 was 13.5 % (CI: 0.12 – 15.2). The prevalence of stillbirth is stratified by year and it shows that highest prevalence was in 2018 at 42.5% followed by 2017, 2019 and 2016 at 23.2%, 19.7% and 14.6 respectively. The prevalence of stillbirth increased with increasing maternal age from 0.4% in the age group ≤14 years to 26.2% then decreased to 21.5% in the age group 30 – 34 years. The prevalence of macerated stillbirth between period 2016 and 2019 was 11.0%, for fresh stillbirth was 2.6 %. There was significant association of age, marital status of pregnant women, level of education, parity, gravidity, syphilis and HIV status. Older women at age 18 years and above were 1.4 times more likely to have stillbirth and 1.9 times more likely to have fresh stillbirth at p<0.05. Single women were 3.3 times more likely to have stillbirth and 3 times more likely to have macerated stillbirth as compared to married women. Fresh stillbirth was not significantly associated with marital status of pregnant women. Educational level was significantly associated with both stillbirth and macerated stillbirth as those women with no education or having primary educational level were 12.3 times more likely to have stillbirth and 14 times more likely to have macerated stillbirth as compared to women with tertiary educational level. vi Women who had pregnancies that have each resulted in the birth of an infant capable of survival (parity) for four or more times were 2.4 times more likely to have stillbirth and women who were in their fifth or more pregnancies (gravida) were 1.8 times more likely to have stillbirth and 3 times more likely to have fresh stillbirth. Lastly, women who had tested positive for syphilis were 4.1 times more likely to have stillbirth and 3.7 times more likely to have macerated stillbirth and women who were HIV positive were 3.1 times more likely to have stillbirth and 2.3 times more likely to have macerated stillbirth. CONCLUSION: The prevalence of stillbirth was very high in the current study and there is a need for studies on stillbirth and related factors in rural areas of Limpopo Province. This study showed that maternal age, low educational level, marital status of pregnant women, high parity, gravidity, syphilis and HIV status were statistically associated with stillbirth. The factors associated with stillbirth in the current study are preventable if quality focused antenatal care, intrapartum care is provided. Therefore, identification of pregnancy complications and facilitation of proper method of delivery is key to improve quality of care. Efforts to reduce unacceptably high stillbirth in the current study are needed. This study recommends that pregnant mothers need to be educated about the dangers in pregnancy and importance of antenatal visits.

Thesis (MScMedSc)--Stellenbosch University, 2012. / Includes bibliography / ENGLISH ABSTRACT: Infection is a major cause of morbidity and mortality in infants within the first few months of life. Susceptibility to infectious disease in this vulnerable population is more prevalent in resource-limited regions, with a higher disease burden. Due to certain deficiencies in their adaptive immune system, neonates rely predominantly on their innate immune system for protection against infection, a vital component in the early host defence against pathogens. Several studies have described differences in neonatal innate toll-like receptor-mediated responses compared to adult counterparts, though very little is known about these receptor responses within resource-limited settings. To address this issue, we assessed the longitudinal development of cytokine-specific responses of TLR4 and TLR7/8 in monocytes, myeloid dendritic cells and plasmacytoid dendritic cells in infants from a resource-limited setting, South Africa, within the first 12 months of life and compared it to adults. Contrary to previously published literature, we observed heightened production of TH-1 cytokines: we showed increased responsiveness to TLR4 and TLR7/8 stimulation in infants at two and six weeks of age, which may be due to vaccination administered at birth. Unexpectedly, the hyper-inflammatory response persisted at six months in response to the LPS (TLR4) stimulus. This increased response at six months may be attributed to decreased passive immunity through infant weaning as well as increased exposure to microbial pathogens in this setting. Maturation of most cytokine responses was reached at twelve months for the TLR4 receptor, and at six months for the TLR7/8 receptor. The first year of life represents a critical period for maturation of the immune response. Data from this study point towards an elevated response within the first six months of life. This heightened response reflects both an ability to mount a sufficient TH-1 response in infancy, but more likely, the increased exposure to microbial stimuli in the environment. Thus, we speculate that these age-specific inflammatory responses may influence the outcome of immune responses to various vaccines administered, which may result in altered responsiveness to immunisation in infancy. / AFRIKAANSE OPSOMMING: Die hoof oorsaak vir morbiditeit en mortaliteit in babas binne die eerste paar maande van hul lewe word toegeskryf aan infeksie. In hulpbron beperkte gebiede, gekenmerk deur `n groter siektelas, is daar `n verhoogde vatbaarheid vir infeksie in hierdie kwesbare populasie. As gevolg van sekere gebreke in die verworwe immuunstelsel, maak pasgebore babas hoofsaaklik staat op hul aangebore immuunstelsel vir beskerming teen infeksie, ’n belangrike komponent vir die vroeë verdediging teen patogene. Verskeie studies het al die verskille in toll-tipe reseptor (TTR) bemiddelde reaksies tussen pasgebore babas en volwassenes vergelyk, maar nie veel is bekend oor hierdie reaksies in areas waar hulpbronne beperk is nie. Om hierdie kwessie aan te spreek is die longitudinale ontwikkeling van sitokien-spesifieke reaksies van die TTR4 en TTR7/8 reseptore van monosiete, miëloïede en plasmasitoïede dendritiese selle van babas in die hulpborn beperkte land Suid-Afrika, oor die eerste 12 maande geëvalueer en dit vergelyk met volwassenes. In teenstelling met vorige literatuur, het hierdie studie ’n polarisasie tot TH-1-sitokien produksie gevind: verhoogde reaktiwiteit van die TTR4 en TTR7/8 is gevind in babas van twee en ses weke oud, wat gedeeltelik as gevolg van die inenting kan wees wat toegedien was na geboorte. Hierdie hiper-inflammatoriese reaksie teen die TTR4 stimulus (Lipopolisakkaried (LPS), het teen verwagting voortgeduur tot op ses maande en kan toegeskryf word aan die vermindering van passiewe immuniteit deur spening, sowel as die toenemende blootstelling aan mikrobiese patogene in die omgewing. Maturasie vir die meerderheid van die sitokiene reaksies, is bereik op 12 maande vir TTR4, en op ses maande vir TTR7/8. Die eerste lewensjaar is ‘n kritiese periode vir die ontwikkeling van die immuunstelsel. Data van hierdie studie dui op ‘n verhoogde reaksie binne die eerste ses maande van ‘n baba se lewe. Hierdie verhoogde reaksie dui op die vermoë om `n voldoende TH-1 reaksie te ontlok, maar meer waarskynlik, verhoogde blootstelling aan mikrobiese stimuli in die omgewing. Dus spekuleer ons dat hierdie ouderdom-spesifieke reaksies dalk die uitkoms van die immuunreaksie teen verskeie entstof toediening kan beïnvloed in babas.

The purpose of this study was to investigate the determinants of high neonatal mortality rates in Migori County, Kenya. The neonatal mortality cases were utilised as the target population to the study. A quantitative, descriptive, cross-sectional, non-experimental research design was used. A systematic sampling technique was employed to draw a sample of 201 archived neonatal cases out of 420 neonatal mortality medical records, which constituted the study population. Data were collected by means of a developed questionnaire. The Statistical Package for Social Sciences (SPSS) Version 21 was used to analyse data. The main findings revealed the leading determinants of neonatal mortality were early neonatal period, prematurity, poor 1st Apgar score, low birth weight and neonates with intrapartum complications. Obstetrical haemorrhage and HIV were the main maternal complications associated to neonatal mortalities, while the leading direct causes of death in this study were birth asphyxia and sepsis. Other determinants were gender, rural residence, lowly educated and informally employed mothers. To reduce mortalities, a multifaceted approach is needed to establish quality improvement in neonatal intensive care, reduce preterm birth incidences, and empower mothers socio-economically. / Health Studies / M.A. (Nursing Science)

In order to better understand the statistical relationship between measures of birthweight and gestational age and their effects on infant mortality, national vital statistics data was examined using non-parametric regression techniques (GAM) that allow for a sophisticated and detailed analysis of infant mortality models. These models allow for various non-linear effects of birthweight and gestational age on infant mortality to be quantified based upon extant methodologies (Solis, Pullum and Frisbie, 2000). Utilizing over-time, race/ethnicand sex-specific approaches, the identification of "zones" of optimal birth outcomes based upon infant mortality probabilities is successfully accomplished. This process results from the creation of a rigorous cross-classification of GAMsupplied birthweight and gestational age parameters. From these results, I find that Non-Hispanic Black infants still exhibit an infant mortality disadvantage relative to Non-Hispanic Whites and Mexican American infants. For the four birth outcome parameters and their interactions, I find evidence of infant mortality disadvantage for infants that are early or late as well as small or heavy relative to their race/ethnic-specific, birthweight-adjusted optima.

The objective of this study was to examine if intra-racial income inequality contributes to higher infant mortality rates (IMRs) for African-Americans. The conceptual framework for this study is derived from Richard Wilkinson's psychosocial environment interpretation of the income inequality and health link. The hypotheses examined were that race/ethnicity-specific IMRs are influenced by intra-race/ethnicity income inequality, and that these effects of income inequality on health are mediated by level of social mistrust and/or risk profile of the mother. Using state-level data from several sources, the 2000 National Center for Health Statistics Linked Birth Infant Death database, 2000 U.S. Census, and 2000 General Social Survey, a number of regression equations were estimated. Results indicated that the level of intra-racial/ethnic income inequality is a significant predictor of non-Hispanic Black IMRs, but not the IMRs of non-Hispanic Whites or Hispanics. Additionally, among Blacks, the effect of their intra-racial income inequality on their IMRs was found to be mediated by the risk profile of the mother, namely, the increased likelihood of smoking and/or drinking and/or less prenatal care by Black women during pregnancy. Implications of the findings are discussed.

In this dissertation I analyze patterns of maternal-infant health in developing contexts. My first chapter uses child hemoglobin as a bio-marker for maternal malnutrition in Senegal during the 2008 food price crisis. In early 2008, world rice prices skyrocketed, causing people around the world to plunge into poverty. Senegal, in particular, depends heavily on imported foodstuffs. I find that the crisis had a large, negative impact on child anemia in urban Senegal, most likely reflecting a deterioration of maternal nutrition caused by rising food prices. In the second and third chapters, we introduce a novel indicator of maternal-infant health: childhood sex ratios. Because infant females have lower rates of mortality than infant males, the sex ratio of the surviving population reflects the level of infant mortality. Childhood sex ratios are widely available from census data, meaning we can use them to shed new light on historical populations who lack traditional sources of data on infant mortality, like birth and death records. We apply this new method to the 19th-century US, where the lack of vital statistics has left uncertainty over even approximate levels of infant mortality. We find that the level of infant mortality in the pre-industrial US was much lower than previously thought, but that racial health disparities were much greater.