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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.

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

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 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