This study investigates the use of five broad accountability mechanisms by gathering the perceptions of charities involved in the Canadian effort to reduce under-5 mortality abroad. While annual deaths in children under the age of 5 declined from an estimate of over 24.0 million in 1960 to under 8.0 million in 2010, mortality reduction goals have been established and missed for decades. As worldwide economies worsen, the amount of funds available for development assistance can be expected to decrease. This study seeks to determine if having accountability mechanisms is perceived to improve organizational behaviour, results and/or reduce costs. It uses a mixed methods approach including: a literature review to gain an understanding of accountability, effectiveness, development and under-5 mortality; key informant interviews to gain an understanding of funders, charities and development; a survey to gather the information required to answer the research questions; and a multiple-case study to gain a better appreciation of how accountability is used and to gather evidence of survey responses. The study investigates: which accountability mechanisms charities have, why they have them and the associated accountability holders; standards body memberships; the relationship between accountability mechanisms and various organizational characteristics; and the perceived effects of accountability mechanisms on organizational behaviour, results and costs. The survey finds that: charities say that they adopt accountability mechanisms because it is a good management practice that is perceived to improve organizational behaviour and results while not incurring costs in excess of the benefits; charities are more likely to adopt accountability mechanisms due to internal pressures than external pressures; the use of accountability mechanisms increases with organization size; and there is a greater difference in use of accountability mechanisms between small and large charities than there is between medium and large charities. The multiple-case study confirms the survey results. This study fills a gap in the literature by providing a Canadian perspective on the use of accountability mechanisms and the relationships amongst them and their perceived effects on organizational behaviour, results and costs. As economic burdens increase, increased accountability may lead to improved results even with fewer dollars.

This study investigates the use of five broad accountability mechanisms by gathering the perceptions of charities involved in the Canadian effort to reduce under-5 mortality abroad. While annual deaths in children under the age of 5 declined from an estimate of over 24.0 million in 1960 to under 8.0 million in 2010, mortality reduction goals have been established and missed for decades. As worldwide economies worsen, the amount of funds available for development assistance can be expected to decrease. This study seeks to determine if having accountability mechanisms is perceived to improve organizational behaviour, results and/or reduce costs. It uses a mixed methods approach including: a literature review to gain an understanding of accountability, effectiveness, development and under-5 mortality; key informant interviews to gain an understanding of funders, charities and development; a survey to gather the information required to answer the research questions; and a multiple-case study to gain a better appreciation of how accountability is used and to gather evidence of survey responses. The study investigates: which accountability mechanisms charities have, why they have them and the associated accountability holders; standards body memberships; the relationship between accountability mechanisms and various organizational characteristics; and the perceived effects of accountability mechanisms on organizational behaviour, results and costs. The survey finds that: charities say that they adopt accountability mechanisms because it is a good management practice that is perceived to improve organizational behaviour and results while not incurring costs in excess of the benefits; charities are more likely to adopt accountability mechanisms due to internal pressures than external pressures; the use of accountability mechanisms increases with organization size; and there is a greater difference in use of accountability mechanisms between small and large charities than there is between medium and large charities. The multiple-case study confirms the survey results. This study fills a gap in the literature by providing a Canadian perspective on the use of accountability mechanisms and the relationships amongst them and their perceived effects on organizational behaviour, results and costs. As economic burdens increase, increased accountability may lead to improved results even with fewer dollars.

abstract: This dissertation examines associations between religious affiliation, religious community context and health of women and their children in Mozambique focusing on the following issues: (1) attending prenatal consultations and delivering children in a health facility; (2) women's symptoms of STDs; and (3) under-five mortality. Estimation of random intercept Poisson regression for the outcome about attending prenatal consultations demonstrated a favorable effect of affiliation to Catholic or Mainline Protestant and Apostolic religious groups. The concentration of Zionist churches in the community had a negative influence. Random intercept logistic regression was used to estimate the relationship between religion and institutional child delivery. Affiliation to Catholic or Mainline Protestant denominations as well as concentration of Catholic or Mainline Protestant churches in the community had some beneficial effect on giving birth in health clinics. The presence of Zionist churches in the community had some negative effect and that of other groups no significant influence. Random intercept logistic regression was also employed for investigating the influence of religion on women's symptoms of STDs. Belonging to the Catholic or Mainline Protestant church had some protective effect on reporting symptoms of STDs. There was no effect of religious context, except that the concentration of Other Pentecostal churches had a positive effect on reporting symptoms of SDTs. Event-history analysis was conducted for examining relationships between maternal religious affiliation with under-five mortality. Affiliation to Catholic or Mainline Protestant churches and to Apostolic denominations increased the odds of child survival, although, the influence of having a mother belonging to Catholic or Mainline Protestant churches lost statistical significance after accounting particularly for the average level of education in the community, for the period of 5 years preceding the survey date. Taken together, the results in this dissertation show some protective effect of religion that varies primarily by denominational group to which women are affiliated. They also indicate that religious community context may have some negative effect on health of women and children. The nature of the effect of religious community context varies with the type of outcome considered and the type of religious mixture in the community. / Dissertation/Thesis / Ph.D. Social Science and Health 2011

Article 334 of the Constitution of India (1950) stipulates that certain electoral districts in each state should be reserved for minority groups, namely the “Scheduled Caste”(SC) and the Scheduled Tribe”(ST), through the reservation of seats in the states' legislative assemblies. Even though the original article stated that the reservation policy would be in place for just twenty years, it has been amended several times and is still in effect. This dissertation examines the impact of the policy on the education and health outcomes of the SC population. Variations in seat quotas are generated by the timing of elections in different states and the states’ fluctuating SC populations. The first paper on education uses data from 25 Indian States and 3 Union Territories for the years 1990-2011 to form a panel dataset to estimate the impact of the quota system on both enrollment and dropout rates among SC students in all levels of schooling. I use the fixed effect regression to test the mechanisms through which an elected SC legislator could have an influence on the education outcomes for the SC population in the represented state. I then use the resulting variables as my controls to identify the causal relationship using the dynamic panel data model. I find that a SC legislator has the potential to influence the number of schools built, as well as the amount of education and welfare expenditure allocated to the SC population. Moreover, I find that the SC political reservation has a positive and statistically significant impact on the SC enrollment rates and a negative and significant impact on the dropout rates, in all levels of schooling. Likewise, I use the NFHS-3 dataset and the Cox Proportional Hazard Model to estimate the hazard rates (risks of dying) of children under the age of 12 months (IMR) and under the age of 60 months (U5MR) as influenced by different SC quota share quintiles. I find that the 50-60% quota-share quintile has the biggest impact in reducing the IMR and U5MR among the SC children.

Introduction: Lack of evidence-based information is an impediment to improve the food security and nutrition status of vulnerable tobacco tenant women and their children on smallholder farms in Malawi. Aim: To assess and describe the food accessibility and nutrition status of the tobacco tenant women of reproductive age and their under-five children on smallholder farms, as well as to determine and report correlational relationships amongst demographic and socio-economic factors, food accessibility measurements and nutrition status indicators. Design: Quantitative cross-sectional descriptive correlational study. Setting: Bwengu, Engucwini and Njuyu Extension Planning Areas, Mzimba North district, Malawi. Sample: 110 women of reproductive age sampled through a proportional systematic random sampling technique, and their 139 under-five children. The sample size was calculated using nQuery version 7 software based on 47% prevalence of malnutrition among under-five children in Malawi, estimated at 95% CI to the accuracy of 10%. Methodology: Data were captured through face-to-face interviews during the hunger season. Food accessibility was captured using the Household Food Insecurity Access Scale (HFIAS), Household Hunger Scale (HHS), Months of Adequate Household Food Provisioning (MAHFP) and Individual Dietary Diversity Scale (IDDS). Nutrition status was measured using anthropometry according to standard protocol. WHO Anthro software was used to compute Z-scores (W/A, H/A, W/H and BMI/A) for children, based on WHO standards. Microsoft Excel was used to calculate BMI for women, based on WHO cut-off points. Stata software was used to compute regression analyses to establish correlational relationships between independent and dependent variables. Ethical approval was obtained from the University of Pretoria, Natural and Agriculture Science Committee (Number EC151215- 028), as well as from the Mzuzu Agriculture Development Division in Malawi. Results: Mean age of the women was 27.3 ± 6 years and 28.8 ± 15 months for the children. The experience of food insecurity access was severe for 75% of the households. Nearly onefifth of households were severely hungry, and had adequate food for only about eight months of the year. The women and their children consumed a mean of two food groups in the previous 24 hours. For the women, 21% were malnourished. For the children, 20% were wasted, 31.3% were stunted and 34% were underweight. More male children were malnourished. For food accessibility measurements, the multivariable linear regression analysis was used. The significant factors influencing the severity of the experience of food insecurity access were loan access (P = 0.015) and household size (P = 0.000). For the prevalence of hunger, the significant factors were food security and nutrition training (P = 0.046), marital status (P = 0.045) and household size (P = 0.000). For the annual prevalence of hunger, the significant factors were labour (P = 0.038), income (P = 0.008) and household size (P = 0.001). For the dietary diversity, the significant factors were labour (P = 0.001), food security and nutrition decisions (P = 0.004), mother’s age (P = 0.033) and income (P = 0.000). Using the multivariable IV regression analysis, the significant factors influencing the BMI of the women were their age (P = 0.054), loan access (P = 0.004), HFIAS scores (P = 0.007) and HHS scores (P = 0.001). For the children’s weight-for-age, the significant factors were the mother’s BMI (P = 0.014), child’s sex (P = 0.005), assets (P = 0.014), mother’s age (P = 0.001) and child’s age (P = 0.015). Using the multivariable random-effects GLS regression analysis, the significant factors influencing the children’s height-for-age were the mother’s age (P = 0.004), child’s sex (P = 0.005), assets (P = 0.028) and HFIAS scores (P = 0.006). For the children’s weight-forheight, the significant factors were the mother’s BMI (P = 0.032), MAHFP scores (P = 0.029), child’s age (P = 0.008) and income (P = 0.001). For the children’s BMI-for-age, the significant factors were the mother’s BMI (P = 0.030), mother’s age (P = 0.029), income (P = 0.002) and assets (P = 0.047). Conclusion: The food accessibility and nutrition status of the tobacco tenant women and their children were seriously poor. The significant factors influencing food accessibility and nutrition status were loan access, household size, food security and nutrition training, marital status, labour, income, assets, food security and nutrition decisions, mother’s BMI, mother’s age, child’s age, child’s sex, HFIAS scores, HHS scores and MAHFP scores. The study findings offer clues to policy makers on where to direct interventions to improve food accessibility and nutrition status of the tobacco tenant women and their children in Malawi. / Dissertation (MSc)--University of Pretoria, 2017. / Human Nutrition / MSc / Unrestricted

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第20623号 / 社医博第81号 / 社新制||医||9(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 木原 正博, 教授 中川 一路, 教授 平家 俊男 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Background: Diarrhea is the passage of 3 or more loose or liquid stools per day. Globally, it is the second-leading cause of death among under-five children, accounting for 9% of all under-five deaths, and kills more young children than Acquired Immunodeficiency Syndrome (AIDS), malaria and measles combined. In developing countries, an estimated 1.8 million people die annually due to diarrheal diseases, and more than 80% of them are children under 5 years, while 88% of these deaths are in South Asia and Sub-Saharan Africa (SSA). There are limited studies that investigate the prevalence and factors associated with diarrhea in SSA despite the health burden. Method: The Demographic and Health Survey (DHS) children’s recode dataset of 2015 for Chad was used for this study. The predictor variables were; age of child, source of drinking water, maternal highest level of education, drank from bottle with nipple, and the outcome variable was diarrhea recently. Descriptive statistics for all variables were completed, and Chi-square analyses were conducted to determine associations between predictor variables and the outcome, diarrhea recently. Simple and multiple logistic regressions were completed to determine factors that predict diarrhea in the last two weeks. Odds ratios, 95% confidence intervals, and p-values were reported. Results: The total sample size was (N=16,710). About 3292 (19.70%) children had diarrhea, 13418 (80.30%) children had no diarrhea. A high prevalence of diarrhea in under-five children was observe particularly in those who drink water from unprotected well (1070 cases), had mothers with only primary level of education (796 cases), and did not drink from bottles with nipple (2961 cases). Based on the age of child, the odds of having diarrhea were over 60% lower in children 3 years old and below [aOR = 0.39, C.I (0.279-0.538), p <.0001] compared to 4 years old and above. Based on the source of drinking water, children that drank from a protected spring were 74% less likely to have diarrhea [0.26, 0.084-0.827, p=0.0223] compared to those that drank from other sources. The study also showed that children that drank from bottles with nipple were 16% less likely of having diarrhea [0.84, 0.726-0.968, p=0.0166] compared to those that did not drink from bottles with nipple. However, maternal highest level of education had no significant association with the odds of having diarrhea in these children. Conclusion: Caregivers should ensure absolute hygiene and provide safe drinking water to under-five children, especially those above 3 years who may easily access contaminated water sources themselves. We also encourage the use of bottles with nipple heads for drinking in children. Further studies are needed in SSA on other factors influencing diarrhea risk in those under five.

Measuring levels of childhood mortality is important for low and middle-income countries to monitor overall development and progress towards improved child health. The overall aim of this research is to estimate the level and trend of childhood mortality in South Africa over time, and to examine the factors associated with and the determinants of childhood mortality. The study discovered that significant progress has been made to reduce the levels of childhood mortality in the country. The estimates derived through direct estimation using the 2016 South African Demographic and Health Survey (SADHS) for the period between 2012-2016 revealed age-specific mortality rates were: Neonatal Mortality Rate (NMR) was 22.0 per 1 000 live births, Post-neonatal Mortality Rate (PNMR) 13.1, 1q0 34.9, 1q4 5.5 and 5q0 40.2 per 1 000 live births. Investigation of the factors associated with childhood mortality revealed significant differentials in age group, sex, population group, province, socio-economic status and household characteristics. Overall, children aged less than one month and those aged between one to two months had a higher mortality risk than the other age groups; male children had an increased risk of dying than females; Black and Coloured children had an increased risk of dying compared to children in other population groups; children in Mpumalanga, Eastern Cape and North West had a higher risk of dying compared to children in other provinces; children whose mothers had below secondary education had higher risks of mortality; and children with poor water source and toilet facility were more likely to die than other children with better facilities. The results were generally in agreement with the existing literature. Although the study found significant improvement in the level of childhood mortality over the period 1996-2016, further progress is achievable as many children still continue to die of preventable or treatable causes. The findings of this study may assist government, policymakers and researchers to plan, and implement targeted interventions that will further reduce the levels of childhood mortality in South Africa.

No description available.

This thesis strives to examine firstly if migration is a significant adaptation strategy to the experience of abundant precipitation, and secondly whether under-five mortality works attenuating or enhancing when being an intermediating factor. With cross-country panel data for precipitation and migration percentage for 169 countries over the world for the time period 1950-2005, a fixed effect model has been created for both parts of the analysis — in the first one to estimate the effects of abundant precipitation on migration flows, and in the second one to examine if and how the mortality rates of children under the age of five works as driver on the effect between abundant precipitation and migration. The results illustrated a positive and significant effect of precipitation on migration when same-year data was used. For the five-year lag data and the ten-year lag data, the null hypothesis which indicates that there is no relationship between the variables could not be rejected, but there were still results that indicated that the migration goes up in a five-year perspective and decreases in a ten-year perspective. The results from the first part of the analysis do not illustrate enormous effects. For the second part of the analysis, results show that the effect of precipitation on under-five mortality does, in contrary to the stated hypothesis, implicate an attenuation as opposed to an enhancement of the effect of precipitation on migration. Due to low precision and non-significant results, it is not possible to determine how exactly the effects are directly affecting each other. This thesis has however helped to prove that one can reject that the effects are strongly enhancing each other.