Background Preterm birth is a leading cause of perinatal morbidity and mortality worldwide, resulting in a pressing need to identify risk factors leading to effective interventions. Limited evidence suggests potential relationships between maternal sleep or vital exhaustion and preterm birth, yet the literature is generally inconclusive. Methods We examined the relationship between maternal sleep duration and vital exhaustion in the first six months of pregnancy and spontaneous (non-medically indicated) preterm birth among 479 Peruvian women who delivered a preterm singleton infant (<37 weeks gestation) and 480 term controls who delivered a singleton infant at term (≥37 weeks gestation). Maternal nightly sleep and reports of vital exhaustion were ascertained through in-person interviews. Spontaneous preterm birth cases were further categorized as those following either spontaneous preterm labor or preterm premature rupture of membranes. In addition, cases were categorized as very (<32 weeks), moderate (32–33 weeks), and late (34- <37 weeks) preterm birth for additional analyses. Logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results After adjusting for confounders, we found that short sleep duration (≤6 hours) was significantly associated with preterm birth (aOR = 1.56; 95% CI 1.11-2.19) compared to 7–8 hours of sleep. Vital exhaustion was also associated with increased odds of preterm birth (aOR = 2.41; 95% CI 1.79-3.23) compared to no exhaustion (Ptrend <0.001). These associations remained significant for spontaneous preterm labor and preterm premature rupture of membranes. We also found evidence of joint effects of sleep duration and vital exhaustion on the odds of spontaneous preterm birth. Conclusions The results of this case–control study suggest maternal sleep duration, particularly short sleep duration, and vital exhaustion may be risk factors for spontaneous preterm birth. These findings call for increased clinical attention to maternal sleep and the study of potential intervention strategies to improve sleep in early pregnancy with the aim of decreasing risk of preterm birth.

Faculty of Humanities School of Language and literature 0005333p PHP@worldonline.co.za / This research report consists of two parts: a theoretical introduction and a creative project. In the theoretical introduction I have examined various pregnancy and child-care manuals together with popular literature in an attempt to explore some of the representations of motherhood. The areas I touched on include: pregnancy, labour pain, natural birth, breastfeeding, postnatal depression, working mothers and child care. The creative project incorporates all these different facets of motherhood and consists of two chapters of a novel written in the popular form referred to as “chick lit”.

MSc (Med) (Population-Based Field Epidemiology), Faculty of Health Sciences, University of the Witwatersrand / Introduction: Studies of factors affecting infant mortality have rarely considered the role of birth order. Despite the recent gains in child mortality in Tanzania, infant mortality rate is still high (68 per 1000 live births) according to the Tanzania Demographic Health Survey (2004-5). This study investigated the risk factors associated with infant mortality in Ifakara Health and Demographic Surveillance Systems area in rural Tanzania from January 2005 to December 2007 with specific reference to birth order, and identified causes of infant death for the study period. Materials and Methods: The study was a secondary analysis of existing data from the Ifakara Health and Demographic Surveillance Systems (HDSS). Child data for 8916 live births born from 1st January 2005 to 31st December 2007 were extracted for analysis. The binary outcome variable was infant mortality. Tables and graphs were used to describe the distribution of maternal demographic and study population characteristics. Poisson regression analyses were used to establish the association between infant mortality and exposure variables. Results: We recorded 562 infant deaths. Neonatal mortality rate was 38 per 1000 person-years while infant mortality rate was 70 per 1000 person-years. Birth order of 2nd to 5th was associated significantly with 22% reduced risk of infant mortality (IRR=0.78, 95%CI: 0.64, 0.96; p=0.02) compared with first births. The infant mortality rates per 1000 person-years for first births was 84, 2nd to 5th was 66 and sixth and higher was 71 per 1000 person-years. Male infants were 17% more at risk of infant deaths as compared to their female counterparts, but not statistically significant (IRR=1.17, 95%CI: 0.99, 1.38; p=0.06). Mothers aged 20 to 34 years had 19% reduced risk of infant death (IRR=0.81, 95%CI: 0.65, 1.00; p=0.05) as compared v to mother of less than 20 years of age. Singleton births had 71% reduced risk of infant mortality (IRR=0.29, 95%CI: 0.22, 0.37; p<0.001) compared with twin births. Mothers who did not attend antenatal care had 2% reduced risk of infant deaths (IRR=0.98, 95%CI: 0.49, 1.97) but not statistically significant compared with mothers who attended antenatal care. Mothers who delivered at home were 1.05 times more at risk of infant deaths but not statistically significant (IRR=1.05, 95%CI: 0.89, 1.24; p=0.56). Mothers who had no formal education were 1.41 times more likely to have infant deaths (IRR=1.41, 95%CI: 0.72, 2.79; p=0.32) as compared to those who had education beyond primary. When adjusted for sex, maternal age and twin births, second to fifth birth order had 20% reduced risk of infant death (IRR=0.80, 95%CI: 0.61, 1.03; p=0.08), but statistically not significant as compared to first births. Malaria (30%), Birth injury/asphyxia (16%), Pneumonia (10%), Premature and/or low birth weight (8%), Anaemia (3%) and Diarrhoeal diseases (2%) were the major causes of infant deaths from 2005 to 2007. Discussion and conclusion: First births and higher birth orders were associated with higher infant mortality. Twin birth was a risk factor for infant mortality. The health systems should be strengthened in providing care for mothers and child survival. We recommend that the high-risk group, first or sixth or higher pregnancies, need special care and the existing health management system may be strengthened to create awareness among potential mothers for seeking appropriate health care from the beginning of pregnancy. Also, antenatal care follow-up can be emphasized for high-risk mothers. Efforts to control mosquitoes must be accelerated in the Ifakara sub-district.

MSc (Med), Child Health Community Paediatrics, Faculty of Health Sciences, University of the Witwatersrand / Objective: To identify determinants for the utilisation of delivery services by pregnant women in Rwanda, considering individual and demographic, socioeconomic and health service factors. Design: A secondary data analysis of the third (2005) Rwandan Demographic Health Survey (RDHS III) was conducted. Women who had at least one live birth during the fiveyear period prior to the survey were included in the analysis. Bivariate and multivariate analyses were undertaken. Results: A total of 5235 participants fulfilled the study eligibility criteria and were included in the analysis. Although more than 90% of participants attended an antenatal service, only 30% delivered at a health facility. The predictors of a home delivery were higher parity (OR=5.01, 95% CI: 4.11-6.31 for parity of 6 or more), place of residence (OR=1.86, 95% CI: 1.55-2.23 for rural women), lower household wealth (OR=4.37, 95% CI: 3.43-5.56 for the poorest quintile), lower education level (OR=3.61, 95% CI: 2.73-4.76 for no education), none or one antenatal care visit (OR=3.62, 95% CI: 2.76-4.74 for one antenatal care visit) and the lack of antenatal counselling about pregnancy complications (OR=1.83, 95% CI:1.40-2.40). Conclusion Utilisation of maternal health services, particularly health facility delivery services, remains low in Rwanda. The promotion of at least four standard antenatal care visits, as well as efforts targeting specific risk groups, such as higher parity, rural and less educated women living in poorer households are critical if the country wishes to reduce maternal and neonatal mortality and morbidity.

DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF REQUIREMENTS FOR A MASTER OF MEDICINE DEGREE IN PAEDIATRICS AND CHILD HEALTH (MMED PAED) / Survival of extremely low birth weight (ELBW) infants in a resource limited public hospital setting is still low in South Africa. The study aimed at establishing the determinants of survival in this weight category of neonates who, due to limited intensive care facilities, were not mechanically ventilated.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Introducción: La desnutrición crónica repercute en el crecimiento y desarrollo del niño menor de 5 años. Investigaciones afirman que la lactancia materna exclusiva junto con otras estrategias, como un intervalo de nacimiento mayor a 24 meses, favorecen al adecuado crecimiento del niño. Nuestro objetivo fue determinar la asociación entre el intervalo de nacimiento y el z-score de talla / edad en niños menores de 5 años, en presencia o ausencia de lactancia materna exclusiva. Materiales y métodos: Se utilizó la base de datos de la ENDES 2017. Para la asociación se trabajó con el intervalo de nacimiento y el z-score de la talla / edad, de niños menores de 5 años y se empleó la variable de estratificación lactancia materna exclusiva. Se aplicó un modelo de regresión lineal para estimar la asociación del z-score de la talla / edad e intervalo de nacimiento según presencia o ausencia de lactancia materna exclusiva. Resultados: Los resultados de la presente investigación sugieren que existe asociación entre el intervalo de nacimiento y el z-score de la talla / edad. Los niños con intervalo de nacimiento menor o igual a 24 meses tienen menor z-score de talla / edad en comparación a los niños con un intervalo de nacimiento mayor a 24 meses. Conclusión: Los niños con intervalo de nacimiento menor o igual a 24 meses se asociaron con un menor z-score de talla / edad independientemente si han lactado o no de forma exclusiva. / Background: Chronic malnutrition has an impact on the growth and development of children under 5 years of age. Research states that exclusive breastfeeding along with other strategies, such as a birth interval greater than 24 months, favor the development and proper growth of the child. Our objective was to determine the association between the birth interval and the z-score of height for age in children under 5 years of age, in the presence or absence of exclusive breastfeeding Methods: The database of the ENDES 2017 was used. For the association we worked with the birth interval and the z-score of the height for the age of each child under 5 years old and the stratification variable exclusive breastfeeding was used. A linear regression model was applied to estimate the association of height z-score for age and birth interval according to the presence or absence of exclusive breastfeeding. Results: The results of the present investigation suggest that there is an association between the birth interval and the z-score of the height for the age. Children with a birth interval of less than 24 months have a lower z-score of height for age compared to children with a birth interval greater than 24 months. / Tesis

Preterm birth (PTB) is a global public health problem that has significant adverse effects on neonatal mortality and morbidity. Progress in understanding the pathological mechanisms underlying PTB has been greatly hampered by the complex and polygenic nature of the disease. As a result, a multifaceted approach may hold promise for identifying true causal factors. The main objective of this thesis is to identify genes that play a role in the etiology of PTB using experimental data derived from different molecular levels (genome, transcriptome, and epigenome). To achieve this goal, we performed association studies using a candidate gene approach to identify genetic factors contributing to PTB. Our analysis of genetic variants in three OXT pathway genes (oxytocin (OXT), oxytocin receptor (OXTR), and leucyl/cystinyl aminopeptidase (LNPEP)) revealed several common polymorphisms in LNPEP that show significant association with prematurity. Large-scale sequence analysis of the OXTR gene identified several novel rare coding variants that might be of etiologic importance. Our results suggest that these variants, in aggregate, appear to make some contribution to susceptibility to PTB. We also examined the gene expression profiles in the human placenta to identify, at the transcriptomic level, candidate genes for PTB. Using splicing-sensitive microarray and deep sequencing technologies, we identified transcriptome signatures that differ between term (with and without labor) and preterm placental tissues and between placental and other human tissues. The transcriptome data were analyzed not only at the gene-level, but also at the exon-level, enabling the detection of alternative splicing events. The exon-level analysis revealed more frequent disruption of alternative splicing in preterm than term placental tissues, indicating that alternative splicing may represent one possible mechanism contributing to PTB. Our study at the epigenomic level was pursued through investigation of placental DNA methylation profiles. We, using a genome-wide approach, detected a panel of genes showing labor- and gestational age-associated methylation differences. Selected genes were validated using bisulfite sequencing and methylation-specific PCR. SLC30A3, a validated differentially methylated gene between term labor and preterm labor amnion tissues, for instance, may potentially play a role in the pathogenesis of PTB. Taken together, this thesis work provides a valuable source of novel candidate genes for PTB, and future research using integrative systems biology approaches may shed light on the molecular mechanisms underlying this complex, heterogeneous disease.

The purpose of this study was to compare the Utah maternal questionnaire and birth certificate as they relate to the identification of hearing impairment in infants. Comparative data relating to rate of return, number of high risk infants, number of at risk infants, number of hearing impaired infants, false positive rates, and item analysis were obtained for both screening instruments. Tabulation of the results showed the birth certificate to be a better neonatal screening device of hearing impairment than the maternal questionnaire. The birth certificate maintained a low false positive rate and a high rate of identification of hearing impairment in infants.

King Henry VIII (1487-1547) famously severed ties with Roman Catholocism and nationalized the church in England in order to secure an annulment from his wife. His decision instigated the Henrician Reformation (1527-1547), a subset of the English Reformation. The king assumed the title 'Supreme Head of the English Church' and vested himself with the power to reform his country's church/ Occasional liturgies - the formal religious ceremonies surrounding birth, marriage, and death - were prime opportunities to publicly display new doctrines and procedures. Instead, these rituals changed surprisingly little and largely mirrored the pageantry performed by his parents. Two conclusions are drawn from the results. First, the modern perception of Henry VIII as an all-powerful rebel is challenged due to his careful observance of the liturgy in order to achieve a desired outcome, whether it be a proper christening, wedding, or state funeral. Second, these royal rituals are shown to not only demonstrate religious beliefs, but also social and political realities as well. These two principles add complexity to understanding the course of the Henrician Reformation.