AIDS mortality, its linkages as a determinant and consequence of food security and its impact on natural resource utilisation by mainly rural populations, has not been well researched, especially their effects on rural livelihoods. With the high epidemic prevalence and persistent food insecurity, natural resources are and will continue to play a key role as a buffer against stresses and shocks in rural livelihoods. Determining linkages between household food security, adult AIDS mortality, and how these affect natural resource utilisation at the village level was the objective of this research. The overarching goal of sustainable natural resource utilisation in Agincourt Demographic Surveillance Site (DSS) was determined through three research questions outlined as follows; What is the status of food security, AIDS mortality and Natural resource utilisation in Agincourt?; What is the relationship between dependence on natural resources as a source of food and or livelihood to resource degradation?; and What are the household and community drivers of household food security? Statistical analysis was used to evaluate the prevalence of food insecurity and the reliance on natural resources while remote sensing was used to assess resource availability and identification of possible natural resource degradation hotspots. More than half of the population in the DSS is food-secure, in 2004, with an even smaller hungry population in 2007. HIV/AIDS and non-HIV/AIDS adult mortality, analysed at village level are underlying drivers and determinants, affecting availability of income which is a direct driver of food insecurity. Availability of income, through social grants, remittances or wages, and delay or non-receipt of this income results in food insecurity in some households. Food production, affected and constrained by climate variability, is a less stable and less popular means of attaining food. More than half of the Agincourt population utilises natural resources to supplement dietary diversity and household income, although there is a significant reduction in households using natural resources in 2007 compared to 2004. Resource degradation is noted in the village commons especially between the highly food-insecure villages and are identified as environmental degradation hot spots. The identification of synergies among these factors in policy design and for interventions is essential for poverty alleviation, improved health and sustainable utilisation of natural resources and rural livelihoods. Glory be to GOD for making this work possible “Commit your work to the Lord and then your plans will succeed” (Proverbs 16:3) “Material poverty doesn‟t necessarily lead to a lack of capacity for creativeness and Inventiveness. Poor people survival by their wits and have much more to contribute to address complex problems than we tend to credit them with.” Dr. Maphela Ramphele (Destiny Magazine, 2010)

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

Background： Previous studies indicated that dietary habit or food-purchasing behaviors was associated with socioeconomic status. However, there is no study about potential association between social economic factors (individual and neighborhood levels) and dietary related mortality risks. Objective: 1) To provide population based information on food consumption pattern among Hong Kong people from a diversity of socio-economic background. 2) Investigate the dietary habits and different food related death in Hong Kong people who were 65 or over. 3) Investigate the association of socioeconomic factors and food related death at individual (SES) and neighborhood (SDI) level. Method: The subjects we recruited in a lifestyle and mortality (LIMOR)study forall deceased people aged 65 or older. The LIMOR data was conducted by The University of Hong Kong, School of Public health in the year of 1997. I got access to part of the data for my study from the leading investigator (Dr. Daniel SY Ho). Dietary habits were measured by using semi-quantitative food frequency questions on seven most commonly consumed food groups by Hong Kong residents: vegetables, fruits, soy and dairy products fish, meat and Chinese tea.Mortality in 1998 due to non-accidental causes (ICD9: 001—799) was examined. In my study, mortality due to specific categories of cardio-respiratory causes was regarded as the case and the due to pneumonia was regarded as the control. Binary logistic regression was used for assessment of odds ratio with adjustment for confounders. Result: Regular consumption of fruit was significantly (P<0.01) related to lower mortality due to COPD with adjusted OR =0.77 (95%CI 0.63-0.94) and regular consumption of vegetables was significantly(p<0.05) related to lower mortality due tocolon cancer with adjusted OR =0.58 (95%CI 0. 33-1.00). Milk consumption was significantly(p<0.05) related to higher mortality for both ischemicheart disease (adjusted OR=1.25; 95%CI 1.02-1.51) and COPD (p<0.01 adjusted OR=1.37; 95%CI 1.08-1.73) for people aged over 65. In my study, fish consumption was significantly (p<0.05) associated with lower mortality due to stomach cancer with adjusted OR=0.47 (95%CI 0.30-0.75). Meat consistently showed positive correlation with all f the causes of death, however, none of them were significant. Soy consumption was consistently and non-significantly shown to have a negative association with different causes of death, except COPD. Tea was negatively associated with COPD and hypertension, though none of them were significant. For those who lived in homeowner‘s scheme house, they were more likely (p<0.05) to have hypertension (OR=1.79; 95%CI 1.03-3.13). Also for people who lived in private houses, they were more likely (p<0.05) to died from IHD (OR=1.27; 95%CI 1.09-1.60) and colon cancer (OR=1.27; 95%CI 1.01-1.59) death. People who had primary (OR=1.45; 95%CI 1.12-1.86) and secondary and above education(OR=1.27; 95%CI 1.01-1.59) had a significantly (p<0.05) association with mortality due to colon cancer. People who had low SES and lived in high SDI area were less likely (p<0.05) to die fromischemic heart disease (OR=0.41; 95%CI 0.17-0.98). Conclusion: In Hong Kong, people who had higher education tended to consume more dairy products than lower education group and they were more likely to die from colon cancer. People who lived in private houses had higher consumption of dairy products than those lived in public estate and they were more likely to die from IHD and colon cancer. For people who had high SES, no matter which SDI areas they lived, they tended to have a more frequent consumption of fruit, bean, dairy products and meat than those oflow SES. People who had low SES and lived in high SDI area, as we considered as the poorest people, were less likely to die withischemic heart disease. / published_or_final_version / Public Health / Master / Master of Public Health

Doctorat en sciences sociales, politiques et économiques / info:eu-repo/semantics/nonPublished