No description available.

Magister Public Health - MPH / Background: Malnutrition is a complex condition profoundly impacting child mortality and morbidity, especially in sub-Saharan Africa. Severe acute malnutrition is of growing concern locally where unacceptable mortality rates persist, despite reasonable standards of clinical care. Aim: To determine factors associated with morbidity and mortality in children under-five years admitted with severe acute malnutrition to a regional paediatric hospital in KwaZulu-Natal. Methodology: This was a quantitative study. A retrospective observational study design was used. Medical records of all children with severe acute malnutrition, under the age of five years, admitted between April 2015 and December 2016 to the regional paediatric hospital in KwaZulu-Natal were included. Data was obtained from medical records and admission books. A trained research assistant was used to extract and record data with a piloted data extraction tool. Data was entered and cleaned using Microsoft Excel and analysed using SPSS (v 20) and STATA (v 14). Descriptive summary statistics were used to describe the characteristics of the study population and bivariate analysis using t-tests and Chi-square tests to determine significance. Kaplan Meier and Multivariate Cox regression was used to assess the association of variables with morbidity and mortality. Results: Of the 276 eligible case records included in the study, 54% were male and 90% of all cases were younger than 2 years. Even though associations did not reach significance, teenage pregnancy and unemployment was high amongst the caregivers of the study population. Most of the malnourished children admitted (74%) presented with multiple comorbidities. Diarrhoea (43%), HIV- infection (30%) and respiratory tract infections (30%) were the top three comorbidities found, followed by tuberculosis (27%). The overall mortality rate was 8.7%. Survival probability was significantly reduced in children with pneumonia and those who presented with hypoglycaemia, dehydration, dermatosis, severe pallor, altered consciousness or shock on admission (p < 0.05). There was a significantly increased risk of death in males (HR = 0.174, 95%CI = 0.05 - 0.665), and in those who presented with dehydration (HR = 4.1, 95%CI = 1.25 - 13.59), evidence of lethargy or coma (HR = 4.2, 95%CI = 1.04 - 17.12) or multiple clinical signs (HR = 4.4, 95% CI =2.56 - 7.59) on admission (p < 0.05). The comorbidities HIV-infection (HR = 9.9, 95%CI = 1.39 - 70.68) and pneumonia (HR = 3.4, 95%CI = 1.56 - 7.43) showed a significantly increased mortality risk (p < 0.05). Conclusion: This study supports the body of evidence that despite reasonable standards of hospital care, it is difficult to obtain the target for severe acute malnutrition mortality (< 5%), likely due to the presence of contextually specific factors. Local interventions at hospital, primary health care and community level is needed, as well as further research to facilitate comprehensive policy-making.

A range of electronic databases and two journals were subjected to a detailed literature search, focusing on studies evaluating psychological interventions with children aged 0-5 years of age. Outcome studies, utilising experimental design, were included for critical review. The search strategy revealed predominantly attachment-informed intervention studies, prompting a review of this aspect of the literature. A total of twelve studies were identified for closer scrutiny: five with a preventative focus; four describing interventions with clinical populations and three detailing large-scale intervention programmes. This review found evidence that early interventions are effective in altering maternal sensitivity and insecure patterns of attachment. Moreover, interventions were effective in reducing the effects of postnatal depression on attachment security, reducing the incidence of placement breakdown in fostered and adopted children and preventing behaviour difficulties in school-age children. These findings indicate a burgeoning evidence base for attachment-based intervention models for the prevention or treatment of infant or child psychopathology.

No description available.

MPH / Department of Public Health / Background: Despite modest improvements in child health outcomes during the 20th century, infant and child mortality rates remain unacceptably high in South Africa. South Africa, like many other countries in sub-Saharan Africa, is challenged by high levels of under -five child mortality. Aim: The purpose of this study was to explore the determinants of under-five mortality in a selected village in Vhembe District, South Africa. Methodology: The study was conducted in Mhinga Village in Vhembe District, Limpopo province South Africa. A qualitative approach using a descriptive design was used for the study. A sample of 7 mothers who lost children under 5 years of age through death were selected from the target population by means of snowball sampling. Data was collected through a semi-structured interview. The data collected was analysed using the thematic analytical approach. Results: Four main themes emerged during data analysis namely, diseases and infections as causes of U5M in Mhinga, Maternal and perinatal health as determinants associated with U5M in Mhinga, Health care factors as determinants associated with U5M in Mhinga and cultural factors as determinants contributing to U5M in Mhinga, Conclusion and recommendation: The study recommends that a study be conducted on the factors that affect the utilisation of health and ANC services and strategies to promote the use of health and ANC services in Mhinga. The researcher further recommends that a study be conducted on strategies to reduce U5M in Mhinga. / NRF

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Background: The study examined the effects of the determinants of under-five mortality in Malawi. It therefore aimed to estimate the rate or prevalence of under-five mortality in Malawi and to examine differentials in infant and child mortality by socio-economic, demographic, environmental, health-seeking behaviour and nutritional value. Methods: This study involved a secondary data analysis of the 2010 Malawi Demographic and Health Survey (MDHS) data set of children under five years old and women who had given birth in the five years preceding the survey. The Kaplan-Meier survival analysis and multivariate hazard analysis were used to examine the relationship between under-five mortality and socio-economic. demographic, environmental, health-seeking behaviour and nutritional factors. Results: The results show that birth order, mother's education, place of residence. region and exclusive breastfeeding were significantly associated with under-five mortality. The results also show that there was no significant association between under-five mortality and other indicators of socio-economic. demographic. environmental, health-seeking behaviour. The results also show that more deaths of under-fives occurred during infancy than during childhood. Conclusion: The results show that more deaths occurred during the first months after birth than after 12 months of age. This showed that mother's education, birth order, place of residence, region and breastfeeding had a greater influence on the survival of the child. / Thesis (M.Soc.Sc. Population Studies) North-West University, Mafikeng Campus, 2014

Magister Philosophiae - MPhil / While several interventions have been implemented over the past decade to combat child mortality, under-five mortality remains a challenge especially in Sub-Saharan Africa. Global-ly, child mortality has decreased to half from 12.7 million in 1990 to 5.9 million per year in 2015. Despite these remarkable gains, more than 16,000 children are dying daily in the world (World Health Organisation, 2015). Previous studies on child survival have examined the contributing factors of child deaths and HIV/AIDS epidemic and socio-economic differentials such as the level of education, type of place of residence,and mother’s occupational status were identified as the contributing factor towards the high rate of under-five mortality. How-ever, there is a paucity of studies focusing on the impact of socio-economic and demographic factors on under-five mortality. Hence this study aims to explore the impact of socio-economic and demographic factors on under-five mortality in South Africa. There are underlying factors or background determinants (including direct and indirect) of under-five mortality. These factors influence under-five mortality in South Africa, and the direct causes are called proximate determinants or demographic factors. The conceptual framework of Mosley and Chen (1984) was adopted to explore the ways of influence of the underlying factors on under-five mortality in their study of determinants of child survival.

M.A. University of the Witwatersrand, Faculty of Humanities (Population Studies), 2012 / This study is based on secondary data analysis of the 1998 South African Demographic and Health Survey (SADHS) data set. The aim of the study was to identify socio-demographic, socio-economic and environmental variables that affect the survival of South African children under the age of five years. Descriptive analyses, frequency tables, Pearson’s chi-square tests of association and binary logistic regression analysis were used for data analysis in this study. Mothers who lost an under-five child were predominantly Black and rural. Such mothers were characterized by rural residential areas, relatively large family sizes, relatively poorer socioeconomic status, relatively poorer access to basic health services, relatively more child deliveries at home, and low level of education. The study showed that 269 of the 5, 066 children in the study died before celebrating their fifth birthday (5.31%). At the 5% level of significance, the survival of under-five children is significantly influenced by 2 of the 11 predictor variables found to be significantly associated in the univariate analysis and therefore included in the logistic regression analysis. These 2 predictor variables were: place of delivery of child [OR=0.97; P=0.000; CI = (0.96, 0.98)], and use of modern contraceptives by the mother [OR=0.73; P=0.002; CI = (0.59, 0.89)]. The study found that not using modern contraceptives gives a lower chance on death of a child under 5 as well as delivering at home, in the absence of a trained birth attendant. These findings are unexpected and contrary to what was found in the univariate analysis. No real explanation can be given for these findings and it would be interesting to see if the same results are found with more recent data. In order for the South African National Department of Health to fulfil its United Nations Millennium Development Goals, rural mothers and their under-five children must be provided with improved health as well as socioeconomic services.

This thesis is based on studies in Butajira district in the south central part of Ethiopia and one study in the Ethio-Swedish Children's Hospital in Addis Ababa. The Butajira project has a continuous demographic surveillance system, established in 1987 in a sample of 10 communities with a total baseline population of about 30,000. The project includes the development and evaluation of a system for continuous registration of vital events and provides a baseline population and sampling frame for health related research activities. The thesis used different study designs within the surveillance system. A carriership study was undertaken to determine the potential bacterial respiratory pathogens among under-five children. A clinical study was done to investigate aetiological agents among young infants (below 3 months) with pneumonia, sepsis and meningitis in a hospital setting. Interview studies were carried out on mothers' perceptions of illness and practices in the care of children with acute respiratory infections. Within the surveillance system, patterns of under-five mortality were analysed. A nested case-referent design was applied to assess public health and behavioural determinants of mortality. A cohort study was performed among under-fives in three communities to estimate the magnitude of illness burden, particularly from ARI, as well as to assess determinants of ARI morbidity. Among 1126 under-five children, 85% were found to harbour H. influenzae, 83% M. catarrhalis and 90% S. pneumoniae in the nasopharynx. The hospital-based study isolated S. pneumoniae, Streptococcus group A, Salmonella group B, E. coli and H. influenzae in the age group below 3 months. The study of mothers' perceptions and practices, showed that mothers do know the symptoms of measles and whooping cough, while they do not recognize pneumonia as an illness entity and are not aware of fast breathing as an important sign of pneumonia. The mortality studies showed a high infant and under-five mortality rate. ARI was responsible for one fifth of the under-five mortality and almost one third of the infant mortality rate. Cause of death in the case-referent study was determined using a validated verbal autopsy method. Breast-feeding and supplementary feeding were demonstrated to be strongly protective when controlling for parental and environmental determinants of mortality. A one year prospective home surveillance study showed that illness was reported in 5.8% of 1,216 person-years. ARI contributed half of this illness load and was particularly associated with parental factors. Among sanitation factors, the absence of piped water was an important determinant of morbidity. Among housing factors, the type of roof and lighting source for the house, and among parental factors, illiteracy of either parents and having a farmer as a father, were found to be independently associated with increased morbidity. Among health and behavioural factors, preterm delivery and lack of immunization were associated with increased morbidity. The results of the studies of this thesis have been utilized to design an intervention case management package. The intervention study and evaluation of its impact is now on-going. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1994, härtill 7 uppsatser.</p> / digitalisering@umu.se