The case fatality rate for malnutrition at St Barnabas Hospital over the past years has been around 38%. The rates in other district hospitals in the Eastern Cape province were found to be in excess of 30%. In June 2000, the Eastern Cape Department of Health introduced a protocol for in-patient management of children with severe malnutrition, with the aim of reducing case fatality rate below 10%. St Barnabas Hospital introduced the Eastern Cape protocol in August 2003. An evaluation was done in November 2003 to assess the protocol's impact on the case fatality rate. The rate remained high, at 37.5%. This study descibed the current practices and attitudes of the nurses as St Barnabas Hospital paediatric ward, in the management of severely malnourished childen.

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)

Thesis (M.A.(Demography and Population Studies))--University of the Witwatersrand, Faculty of Humanities, School of Social Sciences, 2016 / BACKGROUND: Under-5 children in KwaZulu-Natal are highly exposed to dying before reaching five years of life. Studies have been conducted to understand the demographic and socioeconomic factors that influence under-5 mortality, both nationally and internationally, with some contradicting findings on the association between some socioeconomic and demographic factors and under-5 mortality. While some studies found child mortality to be significantly associated with rural geographical place of residence, the reverse has also been established. The purpose of this study was to examine the association between socioeconomic and demographic factors and under-5 mortality in KwaZulu-Natal, South Africa. DESIGN: The study was cross-sectional, and utilises 2011 Census secondary data set from Statistics SA. Overall, the census revealed that 55 476 children under the age of 5 had died in the 12 months prior to the census nationally. In KwaZulu-Natal this figure was 15 356. The 10% sample showed that 1 474 under-5 children had died in the same period in KwaZulu-Natal. STATA 12.0 was used for the analysis. Binary logistic regression model was used to examine the association between under-5 mortality and the independent variables. RESULTS: The major findings of the study indicated that (i) male children were 1.22 times more likely to die compared to female children under the age of 5 years; (ii) mothers who had no schooling (AOR=1.82); mothers with primary level of education (AOR=2.43); and mothers with secondary level of education (AOR=1.77), were more likely to experience under-5 mortality compared to mothers with tertiary level education; (iii) mothers whose age at first birth was between 15-19 years (AOR=1.47) and those whose age at first birth was between 25-34 years (AOR=2.14) were more likely to experience under-5 mortality compared to mothers whose age at first birth was between 35-49 years; (iv) Black mothers were more likely to experience under-5 mortality compared to Indian mothers (AOR=5.99); (v) mothers who were employed were 1.22 times more likely to experience under-5 mortality compared to unemployed mothers. Lastly, under-5 mortality was less likely amongst mothers in the medium households compared to those from low income households (AOR=0.65). CONCLUSION: This study found that socioeconomic and demographic factors substantively determine under-5 mortality in KwaZulu-Natal. Evidence from this study suggest that interventions aimed at reducing under-5 mortality should focus on black women, the younger women, the less educated and those with low household income. / MT2017

The case fatality rate for malnutrition at St Barnabas Hospital over the past years has been around 38%. The rates in other district hospitals in the Eastern Cape province were found to be in excess of 30%. In June 2000, the Eastern Cape Department of Health introduced a protocol for in-patient management of children with severe malnutrition, with the aim of reducing case fatality rate below 10%. St Barnabas Hospital introduced the Eastern Cape protocol in August 2003. An evaluation was done in November 2003 to assess the protocol's impact on the case fatality rate. The rate remained high, at 37.5%. This study descibed the current practices and attitudes of the nurses as St Barnabas Hospital paediatric ward, in the management of severely malnourished childen.

This study investigated the potential impacts of several anthropogenic stressors on the movement and survival of African penguins in Algoa Bay, taking into account prey availability and environmental conditions (sea surface temperature and chlorophyll productivity). The primary drive for the study was based on the seismic exploration, which took place in the habitat of the endangered African penguin. The research was also carried out to understand how pelagic fishing and prey availability influence the broader behavioural and mortality aspects of penguins. To achieve this goal, I used monthly beach surveys to assess seabird mortality, admissions of penguins in rehabilitation centres and the monitoring of breeding penguins’ movement at sea through individual GPS tracking. In addition, prey distribution and abundance were monitored with acoustic surveys to assess potential changes in relation anthropogenic stressors. Breeding African penguins did not react dramatically to seismic activities, except on St Croix Island where they changed their foraging direction during the seismic period. There was no evidence of a siginficant increase in African penguin carcasses encountered or strandings along the beaches during the period of seismic activity. However, a sharp increase in encounter rate was recorded soon after seismic operations, which may potentially indicate a delay between the effect of seismic activities on penguin mortality and the encounter of the related carcasses after the operation. However, the impact of seismic surveys on penguins may be long-term rather than short term, and additional studies would be needed to reveal long-term effects of seismic activities, if any. Foraging effort of breeding African penguins increased substantially in the presence of commercial fishing activities within close proximity to the colonies. To a greater extent, at-sea movement patterns and counts of beach cast carcasses were largely influenced by prey availability. Penguins spent more time at sea, traveled longer and covered a larger foraging area during periods of relatvely low pelagic fish abundance. There was also a sharp increase in African penguin mortality during periods of low prey availability in the Bay. However, environmental conditions showed some influence over these interactions. Foraging effort of breeding African penguins increased substantially in the presence of commercial fishing activities within close proximity to the colonies. To a greater extent, at-sea movement patterns and counts of beach cast carcasses were largely influenced by prey availability. Penguins spent more time at sea, traveled longer and covered a larger foraging area during periods of relatvely low pelagic fish abundance. There was also a sharp increase in African penguin mortality during periods of low prey availability in the Bay. However, environmental conditions showed some influence over these interactions. For example a red tide event during in period of low prey availability, made it difficult to understand impacts of prey on penguins difficult. Both anthropogenic stressors and environmental conditions influenced African penguins’ behaviour and survival. Due to the worrying trend of African penguins in South Africa for the past few years, all conservation management efforts to increase penguin numbers and limit their mortality are necessary. This study highlights the negative impact of industrial fishing on this Endangered species and the rapid increase in mortality of penguins during times of low prey availability. A network of Marine Protected Areas would certainly increase food availability to African penguins by limiting competition with fisheries, and contribute to increasing the population numbers.

Thesis (Ph. D. (Science)) -- University of Limpopo, 2015 / The objectives of the study were to examine the demographic profile and causes of death of people dying in a hospital and community; and to determine mortality rates, specifically age- and gender-specific mortality rates in a community. The study also compared causes of death assigned to hospital records with causes of death obtained from verbal autopsy reports. Methodology The data used in this thesis were collected in two phases. The first phase involved a retrospective review of all deaths that occurred in the Pietersburg/Mankweng Hospital Complex from 1st January, 2011 to 31st December, 2012. The second phase involved a community-based study using a verbal autopsyto determine cause of death in Dikgale HDSS for the same period. Results A total of 5402 deaths were reported in the hospital and 625 in the community. The majority of deaths in the hospital involved adults in the 15 to 49 year old age group, while in the community more deaths were recorded amongst adults aged 15 to 49 years of age and those in the 65+ year old age group. There were more male deaths in the hospital, while in the community a higher proportion of deaths occurred amongst females. v In children less than1 year old, the cause of death in the hospital was predominantly due to perinatal conditions, particularly preterm birth, low birth weight and birth asphyxia; while in the community, of the 5 deaths in this age group, infectious diseases were recorded as the main cause of death. Amongst children in the 1 to 4 year old age groups causes of hospital deaths were dominated by infectious diseases, injuries and malnutrition; while in the community infectious diseases were the main cause of death. Stillbirths were noted in the hospital with a stillbirth rate of 29.1/1000 deliveries. In the community no stillbirths were reported. More than half of the stillbirths were caused by unexplained intrauterine foetal causes followed by maternal hypertension in pregnancy and placenta abruption. For adults in the 15 to 49 year old age groups infectious diseases, such as HIV/AIDS and tuberculosis, were the leading causes of death in both the hospital and in the community. The proportion of deaths due to HIV/AIDS and tuberculosis was significantly greater in the community than in the hospital. Amongst adults in the 50+year old age group non-communicable diseases, particularly cardiovascular diseases and cancers were the most common causes of death. In this age group, the hospital recorded more cancer deaths than did the community; while the community recorded more cardiovascular deaths than did the hospital. vi The overall mortality rate in the community was 8.4 deaths per 1000 person-year, with more deaths occurring amongst males (8.9 deaths per 1000 person-year). The mortality rate was high amongst adults in the 65+ year old age group (48.9 deaths per 1000 person-year). When comparing cause-specific mortality between hospital cause of death notification forms and cause of death determined by verbal autopsy reviews, the same top five underlying causes of death were observed, namely: cardiovascular diseases, infectious diseases, diabetes mellitus, malignant neoplasms and respiratory infections. The agreement between causes of death reported on cause of death notification forms and cause of death as a result of a verbal autopsywas 48%. For individual causes, agreement of more than 80% was achieved between cause of death recorded on cause of death notification forms and from verbal autopsy reviews for respiratory infections, diabetes, malignancies and injuries. Infectious diseases (68.5%) and cardiovascular diseases (74.1%) achieved the lowest agreement. In other words, in only 68.5% and 74.1% respectively was the cause of death as recorded on the “cause of death notification” forms the same as the cause of death when reviewed verbally. Furthermore, 13 deaths were recorded as being due to cardiovascular diseases on the “cause of death notification” forms, however, in only 5 of these cases was the cause of death recorded as the same in the verbal autopsy report. In 21 cases cause of death was attributed to infectious diseases on the cause of death notification form, vii while in only 13 of these cases was the cause of death similarly ascribed after verbal autopsy review. Conclusion This study showed that the verbal autopsy instrument has the potential to identify causes of death in a population where deaths occur outside of health facilities. Procedures for death certification and coding of underlying causes of death need to be streamlined in order to improve the reliability of registration data. This will be achieved if medical students and trainee specialists are trained in the completion of cause of death notification forms. Foetal autopsies should be introduced at tertiary hospitals to determine the causes of stillbirths.Antenatal care education for pregnant women should be encouraged because the level of antenatal care has an influence on the health of mothers and their newborns. The government should continue to focus on improving the socio-economic status of the population, while adequate foetal monitoring by health workers may reduce neonatal deaths resulting from preterm births, low birth weight and birth asphyxia. Innovative injury prevention strategies, interventions to control infectious diseases, cancer screening and lifestyle program may reduce adult mortality.

The purpose of this study was to describe and evaluate the strategies used to reduce maternal mortality of the Fezile Dabi District in the Free State Province, South Africa. A quantitative descriptive study was conducted at three hospitals to describe and evaluate the strategies. Data collection was done by using the Maternal and Neonatal Programme Effort Index (MNPI) self-administered questionnaire. The study population comprised of 71 (midwives (52), doctors (13), management-operational managers (6). The overall response rate for the three hospitals was (43.5%). The study indicated that programme efforts for maternal health are similar across the three hospitals, however, there are particular areas in each hospital that need more attention. The ratings of all the strategies generally showed weak to partial effort. The findings revealed general poor performance under the following strategies: postpartum care, training arrangements, information, education, communication and hospital protocols. Based on the study results, the quality of maternal health care need to be improved / Health Studies / M.A. (Public Health)

The purpose of the research was to determine the underlying contributory factors in an obstetric unit at the district hospital in Mpumalanga province, South Africa, regarding neonatal deaths and to propose strategies for midwifery practice. Quantitative, nonexperimental, descriptive, exploratory and retrospective (ex-post facto) design was used to explore and describe the factors contributing to neonatal deaths. Data collection was done using an audit tool. The conclusions drawn from this study supported the assumptions that there are factors related to antenatal, intrapartum, postnatal and neonatal care that contribute to neonatal deaths, thus emphasizing the urgency of improving the care of pregnant mothers and their babies through effective implementation of programmes and protocols / Health Studies / M.A. (Health Studies)

The purpose of the research was to determine the underlying contributory factors in an obstetric unit at the district hospital in Mpumalanga province, South Africa, regarding neonatal deaths and to propose strategies for midwifery practice. Quantitative, nonexperimental, descriptive, exploratory and retrospective (ex-post facto) design was used to explore and describe the factors contributing to neonatal deaths. Data collection was done using an audit tool. The conclusions drawn from this study supported the assumptions that there are factors related to antenatal, intrapartum, postnatal and neonatal care that contribute to neonatal deaths, thus emphasizing the urgency of improving the care of pregnant mothers and their babies through effective implementation of programmes and protocols / Health Studies / M.A. (Health Studies)

MCur / Department of Advanced Nursing Science / ● BACKGROUND Maternal Mortality rate is defined as the death of a woman while pregnant within 42 days of termination of pregnancy irrespective of the duration/site of the pregnancy. South Africa like any other country, has high maternal mortality rate. Most deaths are caused by factors attributed to pregnancy and childbirth in health facilities. It is the practice in all public hospitals and clinics that women are discharged ±6 hours after delivery hence most problems are not detected thus the complications they may be having such as thromboembolism or sepsis that may arise during the post-partum period. ● AIM OF THE STUDY The purpose of the study was to determine perceived factors contributing to maternal mortality among women in rural areas of Musina Municipality within Limpopo Province. ● METHODS A quantitative, descriptive, exploratory, cross- sectional research was used to conduct the study. The target population consisted of all pregnant and lactating women who attended the sampled clinics (ANC) in Musina Municipality. Self- Administered questionnaire was used to collect data from the women who met the criteria for inclusion. A total of 342 women were recruited to participate in this research from all five (5) health iv facilities. Collected data was analysed using SPSS Version 23.0 computer software with the assistance of a Statistician. ● FINDINGS Findings of this study revealed that majority of the respondents 215 (53.0%) reported late booking for Ante-Natal Care (ANC), among the late booking 120 (25.0%) commenced ANC attendance at second trimester, while 95 (12%) commenced ANC at last trimester and only attended once only. Minority of the respondents 127 (24.2%) reported that they never attended ANC because of various reasons cited such as not accessing clinic because of distance and not having transport. Majority 232 (83.5%) of the respondents revealed that professional nurses ‘attitudes and unwelcoming postures make them to report during labour than attending ANC. Of the respondents, 49 (17.6%) reported lack of knowledge on engorged breast and mastitis. Various socioeconomic and knowledge factors influenced women, (28.5%) women indicated long distance to health facility, while (12.5%) arrived in labour ward with head on perineum because labour started suddenly, lack of money and transport by (48.4%). ● RECOMMENDATION Recommendation was made on the importance of in-service training of professional midwives on interpersonal relation, proper assessment of women to detect any complications. Recommended workshops for training and different courses in order to broaden their knowledge relating to pregnancy and childbirth and management of pre and post-partum. Also awareness sessions for women about dangers signs during puerperium were recommended. ● CONCLUSION This study has identified several factors that have an important influence on maternal mortality in the study area. Among these are variables such as place of consultation/diagnosis, the person who pays the treatment costs, awareness of pregnancy complications and knowledge of the place of ANC treatment, among others. / NRF