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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

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