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.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Paediatrics Johannesburg, 2014. / Background: To describe the relative frequency and distribution of neonatal tumours; to determine the age at presentation to the oncology unit and to determine the extent of the delay in referral. To describe any associated syndromes in individual malignancies. Material and methods: A retrospective case series was performed covering 24 years. Demographics, means of diagnosis, treatment and outcome details were reviewed. Results: There were a total of 2626 patients that presented to the oncology department with suspected malignancies. Out of that, 2308 patients were diagnosed with a malignancy and 318 patients had benign tumours. Over the 24 year period 117 tumours were diagnosed in neonates (4,4%). Due to incomplete data 29 patients were excluded. Of the remaining patients, 61 were diagnosed with benign tumours and 27 with malignant tumours. The male to female ratio was 1: 1,5. The mean age at presentation was 16 days. The mean age at diagnosis was 36 days. Histology and radiology were diagnostic in 40,9% and 19,3% respectively. A combination of histology and radiology was used to make a diagnosis in 21,6% of patients, 11,4% of diagnoses were based on clinical examination and 6,8% on biochemistry and haematology. Malignant soft tissue tumours were the most common malignancy (25,9%) followed by renal tumours (18,5%), leukaemia (14,8%), neuroblastomas (11,1%) and retinoblastomas (11,1%). Teratomas (45,9%) and benign vascular tumours (44,3%) were the most common benign tumours. Chemotherapy was used to treat 22 neonates, while 50 underwent surgical removal of the tumour. Half (51,9%) of the patients diagnosed with a malignant tumour died, while 11,1% of patients were iv lost to follow up. Just under 10% (8,2%) of the patients diagnosed with a benign tumour died, while 44,3% of patients were lost to follow up. The overall mortality amongst patients diagnosed with benign or malignant tumours was 21,6%. Conclusion: There is a much higher incidence of benign tumours diagnosed in neonates (69,3%) compared to older children (12,1%). Only 1,2% of all childhood malignancies in our unit occurred in the neonatal period, which is slightly lower than the reported 2%. Two of the major issues that need to be addressed in the future management of neonatal tumours are prompt referral for prompt diagnoses and better follow up.

Background: This study examines the association between place of delivery, delivery assistants and perinatal mortality in Nigeria. Previous studies have found these factors to be associated with the risk of perinatal mortality. This study therefore aims to determine the extent to which these two factors predict perinatal mortality in the Nigerian context as this information will be useful in informing health policy decisions and actions in so far as a desirable reduction in childhood mortality in Nigeria is concerned. Methods: This study uses cross sectional design through secondary analysis of the 2003 Nigerian Demographic and Health Survey (NDHS). The variables representing place of delivery and delivery assistants have been fitted into logistic regression models to determine their association with perinatal mortality. Several other known risk factors for perinatal mortality such as maternal education and birth weight, to mention a few, have also been investigated using the logistic regression analysis. Results: 5783 live singleton births were analyzed with 194 newborns dying within the first seven days of life giving an early neonatal mortality rate (ENMR) of 33.5 per 1000 and an estimated perinatal mortality rate (PNMR) of 72.4 per 1000 live births. The results also show that place of delivery [p=0.8777] and delivery assistants [p=0.3812] are not significantly associated with perinatal mortality even after disaggregating the analysis by rural and urban areas. However being small in size at birth [AOR= 2.13, CI=1.41 – 3.21], female [AOR=0.57, CI= 0.42 – 0.77] and having a mother who practiced traditional religion [AOR= 4.37, CI= 2.31 – 8.26], were all significantly associated with perinatal mortality. Conclusions: Place of delivery and delivery assistants are not good predictors of perinatal mortality in the Nigerian context. However various limitations of the study design used such as the issue of uncontrolled confounding may have affected the findings. Nonetheless, the increased risk of perinatal deaths in small babies and the decreased risk of death among female babies are consistent with other studies and have both been attributed elsewhere to biologic mechanisms.

Background: This study examines the socioeconomic and biodemographic determinants of infant, neonatal and post neonatal mortality in Egypt. It also tries to reach better understanding on the relative importance of these factors. Methods: Population-based cross-sectional secondary data analysis of the 2005 Egypt Demographic and Health Survey (EDHS). Cox’s proportional hazard models have been fitted to select the significant determinants of infant and post neonatal mortality, while logistic regression models were adopted for the neonatal period. Results: 13,851 live births were analyzed with 463 deaths before the first birthday; the total follow up time is 144,835 babymonths, giving an IMR of 32 per 10,000 baby-months. After adjusting for all socioeconomic and biodemographic factors, the analyses reveal strong association between infant mortality and biodemographic factors, while the only significant socioeconomic determinant is the mother’s education. Also it has been shown that mother’s education, child’s sex and place of delivery are time dependent covariates. Analyses of neonatal period indicate no association with any socioeconomic factor, while child’s sex and place of delivery are significant predictors. Exclusion of neonatal deaths shows that the risk of post neonatal mortality is inversely related to mother’s education, and not determined by sex of the child nor place of delivery. The risk of infant, neonatal and post neonatal death is consistently related to birth interval and birth size. Conclusions: Biodemographic characteristics represent the most substantial impacts on infant mortality. The only significant socioeconomic predictor (maternal education) has a modest impact, at best, on infant mortality, which appears at later stages of infancy period (namely post neonatal period); since the later proved to be a time varying covariate. Unlike neonatal period, analysis indicates lack of association between post neonatal mortality and child’s sex contradicting the biological knowledge, and supporting the hypothesis of gender discrimination and male sex preference.

Thesis advisor: June Horowitz / Pain in extremely low gestational age (ELGA) infants remains under-assessed and poorly managed despite the fact that pain may have profound consequences with regard to infants' neuro-development (Als, 1982). Pain prevention is a critical goal of pain assessment, yet barriers exist. Most critical is the lack of valid, reliable, and clinically useful pain tools. This observational descriptive study focused on the development of a gestational age appropriate instrument for 24-29 6/7 week infants and evaluation of the new instrument, Pain Assessment and Care for the Extremely Low Gestational Age Infant Focused Instrument (PACEFI). Additionally, differences in behavioral cues and physiologic indicators were evaluated for ELGA infants and very low gestational age (VLGA) infants for non-invasive and invasive procedures. Nurse raters used the PACEFI to rate these infants during both procedures at baseline, during, and recovery to assess variation in expected pain. The PACEFI demonstrated a high internal consistency (.879) and appeared to be contributing to the measurement of pain. A RANOVA found a significant difference in rating scores ( p < .001) for both procedures. Baseline and recovery scores were lower than during scores. ELGA infants demonstrated a dampened response (p < .023) as compared to the VLGA infants during the invasive procedure. Alternatively, ELGA infants demonstrated a more vigorous response for non-invasive procedure and dropped below baseline scores at recovery. The whole care experience during the non-invasive procedure may have led to sensitization for the VLGA infant and overwhelming energy expenditure for the ELGA infant. Furthermore, physiologic indicators and behavioral cues were inconsistent arguing for independent assessment of these parameters. Knowledge gained from this study: 1) provides information regarding gestational age differences in pain behaviors; and (2) clarifies if the measurement of these behaviors addresses the immediate need for pain assessment for this vulnerable population. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

by Nancy Cheung. / Abstract in Chinese. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1980. / Bibliography: leaves 84-87.

by Warren, Tak-keung Lee. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1990. / Bibliography: leaves 140-154. / Acknowledgements / List of Abbreviations / Summary / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Calcium Nutrition and Bone Health --- p.1 / Chapter 1.2 --- Calcium Requirements in Children --- p.4 / Chapter 1.3 --- Concern for Calcium Intakes in Hong Kong Chinese --- p.8 / Chapter 1.3.1 --- In Adults --- p.8 / Chapter 1.3.2 --- In Children --- p.9 / Chapter 1.4 --- Aims of the Study --- p.11 / Chapter Chapter 2 --- Calcium Homeostasis --- p.12 / Chapter 2.1 --- Calcium in Body Skeleton --- p.12 / Chapter 2 .2. --- Hormonal Regulation of Calcium Concentration in the Extracellular Fluid Compartment --- p.13 / Chapter 2.3 --- Calcium Absorption --- p.14 / Chapter 2.3.1 --- Calcium Transport Across the Intestine --- p.14 / Chapter 2.4 --- Effects of Age on Calcium Metabolism --- p.17 / Chapter 2.5 --- Effects of Nutrients on Calcium Bioavailability --- p.18 / Chapter 2.5.1 --- Calcium Nutritional Status --- p.19 / Chapter 2.5.2 --- Vitamin D Nutritional Status --- p.20 / Chapter 2.5.3 --- Protein --- p.21 / Chapter 2.5.4 --- Phosphorous and Calcium to Phosphorus Ratio --- p.22 / Chapter 2.5.5 --- Sodium --- p.22 / Chapter 2.5.6 --- Lactose --- p.23 / Chapter 2.5.7 --- Glucose and Glucose Polymers --- p.24 / Chapter 2.5.8 --- Phytate --- p.24 / Chapter 2.5.9 --- Oxalate --- p.25 / Chapter Chapter 3 --- Methods of Evaluating Calcium Nutritional Status And Bone Mineral Content --- p.27 / Chapter 3.1 --- Methods of Evaluating Calcium Nutrition Status --- p.27 / Chapter 3.1.1 --- Blood Biochemistry --- p.27 / Chapter 3.1.2 --- Total Body Neutron Activation --- p.27 / Chapter 3.1.3 --- Metabolic Balance Study --- p.28 / Chapter 3.1.4 --- Dietary Assessment --- p.29 / Chapter 3.2 --- Methods of Evaluating Bone Mineral Content --- p.29 / Chapter 3.2.1 --- In Vivo Measurement of Bone Mineral Content --- p.29 / Chapter 3.3 --- Review on Adopted Methods --- p.31 / Chapter 3.3.1 --- Single Photon Absorptiometry (SPA) --- p.31 / Chapter 3.3.2 --- Review on Methods in Dietary Assessment --- p.36 / Chapter 3.3.3 --- Dietary Assessment Methods Adopted in the Present Study --- p.49 / Chapter 3.3.4 --- Food Composition Tables --- p.51 / Chapter Chapter 4 --- "Subjects, Materials and Methods" --- p.54 / Chapter 4.1 --- Subjects --- p.54 / Chapter 4.2 --- Weight and Height Measurement --- p.57 / Chapter 4.3 --- Dietary Assessment --- p.58 / Chapter 4.3.1 --- Dietary History Record --- p.59 / Chapter 4.3.2 --- Food Frequency --- p.62 / Chapter 4.3.3 --- 24-Hour Recall --- p.64 / Chapter 4.3.4 --- Estimation of the Amount of Food --- p.64 / Chapter 4.3.5 --- Nutrient Analysis --- p.65 / Chapter 4.4 --- Measurement of Bone Mineral Mass by Single Photon Absorptiometry (SPA) --- p.66 / Chapter 4.4.1 --- The Instrument --- p.66 / Chapter 4.4.2 --- Calibration of the Instrument --- p.68 / Chapter 4.4.3 --- Subject Positioning --- p.68 / Chapter 4.4.4 --- Setting Up Pre-Scan Parameters --- p.70 / Chapter 4.4.5 --- Bone Scanning: Search Scan and Measure Scan --- p.73 / Chapter 4.4.6 --- Evaluation of the Accuracy and Precision of Bone Mineral Content Measurement --- p.73 / Chapter 4.4.7 --- Radiation Exposure --- p.75 / Chapter Chapter 5 --- Results --- p.77 / Chapter 5.1 --- Sample Size --- p.77 / Chapter 5.2 --- Representative of the Sample --- p.77 / Chapter 5.3 --- Weight and Height --- p.78 / Chapter 5.4 --- Validity of the Food Composition Table --- p.78 / Chapter 5.5 --- Calcium Intake of Children at Five --- p.78 / Chapter 5.6 --- "Bone Mineral Content (BMC), Bone Mineral Density (BMD), and Bone Width (BW) of 128 Hong Kong Children at Five" --- p.80 / Chapter 5.7 --- Comparisons of Bone Mineral Content (BMC) in Children with High and Low Calcium Intake --- p.81 / Chapter 5.8 --- "Relationships between Bone Mineral Density (BMD), Body Size and Dietary Intakes of Calcium, Protein and Energy" --- p.85 / Chapter 5.9 --- "Inter-correlations between Bone Mass Measurements, Body Size and Dietary Intakes in Hong Kong Children" --- p.87 / Chapter 5.10 --- Planning for Further Investigation --- p.88 / Chapter Chapter 6 --- "A Study of Calcium Intake and Bone Mineral Content of Children at Five Years Old in Jiangmen, Guangdong, China" --- p.107 / Chapter 6.1 --- Introduction --- p.107 / Chapter 6.2 --- "Subjects, Materials and Methods" --- p.108 / Chapter 6.2.1 --- Subject Selection --- p.108 / Chapter 6.2.2 --- Weight and Height Measurements --- p.109 / Chapter 6.2.3 --- Dietary Assessment --- p.109 / Chapter 6.2.4 --- Measurement of Bone Mineral Content --- p.111 / Chapter 6.2.5 --- Results --- p.112 / Chapter Chapter 7 --- Discussions --- p.120 / Chapter 7.1 --- Reliability of Dietary Calcium Assessment --- p.120 / Chapter 7.2 --- Reliability of Bone Mineral Measurement --- p.121 / Chapter 7.3 --- Representative of Studied Children in Hong Kong --- p.122 / Chapter 7.4 --- Implications of the Study --- p.123 / Chapter 7.4.1 --- Calcium Intake and Bone Mineral Content in Hong Kong Chinese Pre-school Children --- p.123 / Chapter 7.4.2 --- Calcium Intake and Bone Mineral Content of Jiangmen Pre-school Children --- p.131 / Chapter 7.5 --- The Use of Bone Mineral Density (BMD) As A Parameter in Representing Bone Mineral Mass --- p.134 / Chapter 7.6 --- A Need for Further Studies --- p.135 / Chapter 7.7 --- Conclusions --- p.136 / References --- p.140 / Chapter Appendix I --- Dietary Record Form Used in Hong Kong Study --- p.155 / Chapter Appendix II --- Dietary Questionnaire Used in Jiangmen Study --- p.160 / Chapter Appendix III --- Validity of the Compiled Food Composition Table --- p.165 / List of Figures / List of Tables

This work examines the individual and comprehensive effects of oxytocin, maternal depression, and breastfeeding on the mother-infant bond. Self-report measures are used to illustrate differences in behavior, temperament, and maternal feelings towards her infant and her experiences associated with motherhood. Based on previous literature highlighting the protective and beneficial effects of oxytocin during maternity, results from this longitudinal study examining mother-infant dyads from prenatal to three-months postpartum are aimed to combine psycho-social and biological components associated with child rearing to form a complete understanding of the mother-infant bonding system. While our research provides support for certain psycho social components by demonstrating an irrefutable impact of depressive symptoms and breastfeeding self-efficacy on later displays of postpartum attachment, there is still room for question in regards to the role that oxytocin may play. / Includes bibliography. / Thesis (M.A.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

acase@tulane.edu / Community Based Nutrition (CBN) began implementation in Ethiopia in 2009 in four regions with the objective of improving maternal and child nutrition. Among other interven-tions, CBN scaled up behavior change communication (BCC) to promote household practices and behaviors known to be associated with improved child nutrition. Nutrition BCC was pri-marily delivered through a cadre of Voluntary Community Health Workers (VCHWs). Program exposure was measured using household reports of contact with VCHWs for nutrition BCC. This quasi-experimental study used data collected from two rounds of household surveys be-fore and after program implementation. The design of this study used the natural variation in CBN implementation to allow post hoc categorization of communities into high/low program intensity groups. This enabled an evaluation of the differences in nutrition outcomes associated with the different categories of program intensity that were observed in the sample. Community-level program intensity was measured using the percentage of households reporting VCHW exposure in each community, dichotomized into high or low at the sample mean. We found evidence of a scale up in CBN over the two survey rounds: Mean households reporting exposure to a VCHW in the previous six months increased significantly, as did the mean households in communities with high VCHW intensity. The association between selected nutrition behavior outcomes and the program was evaluated using three approaches: (i) an examination of the association between cluster change in the outcomes and community intensity of Volunteer Community Health Workers (VCHWs); (ii) examination of the association be-tween individual-level outcomes and community intensity of VCHWs; and (iii) examination of the association between the outcomes behaviors and household exposure to VCHWs. We found plausible evidence that CBN scale up was associated with greater dietary di-versity and more women eating the same or more in pregnancy. We also found that living in a higher VCHW intensity community or having exposure to VCHWs was associated with more women receiving IFA in pregnancy, but that this association was not modified by the survey round. We did not find consistent evidence that that the increases in VCHW intensity or expo-sure were associated with improvements in colostrum, hand washing, or minimum meal frequency. These results imply that community-based programs of this intensity can bring about change in nutrition behaviors linked to improved nutrition. / 1 / Lisa Saldanha