Background: Reducing neonatal mortality rates [NMR] (deaths/1,000 live births within 28 days of delivery) is a key global health goal. Using comparable data from Ghana (West Africa) and Scotland, I investigated NMR, specific causes of death and risk factors in the two countries. By identifying the main causes of excess mortality in Ghana and where they occur, it is hoped more effective strategies can be developed. Methods: This thesis used a multilevel mixed methods study design. Data on live births were obtained from three Health and Demographic Surveillance Systems (HDSS) in the north, middle and south of Ghana respectively: Navrongo (2004-12; 17,016 live births, 320 deaths); Kintampo (2005-10; 11,207 live births, 140 deaths); Dodowa (2006-14; 21,647 live births, 135 deaths). Comparable Scottish data were obtained from the Information Services Division (1992 to 2015; 1,278,846 live births, 2,783 deaths). Each dataset was analysed by neonatal death (dead/alive), using univariate and multivariable logistic regression. The multivariable analyses adjusted for maternal demographic and obstetric characteristics. Missing data were analysed using multiple imputation techniques. Data analyses were complemented by a researcher-developed questionnaire survey of 71 maternity care providers in the three regions of Ghana followed by face-to-face in-depth interviews with 48 maternity care providers who had experience of prematurity, birth asphyxia, neonatal infection and neonatal death. Results: The NMRs in the three HDSS were: Navrongo: 18.8; Kintampo: 12.5; and Dodowa 6.2 and in Scotland it was 2.2; the NMR in both countries is reducing. More than 99% of the neonatal deaths in Scotland occurred in the first week compared to 74% in Ghana. The leading causes of neonatal deaths (NMR) in Ghana were infection (4.3), asphyxia (3.7) and prematurity (2.2). In Scotland, they were congenital malformations (0.6), asphyxia (0.4) and prematurity (0.3). Only 88 deaths (0.07) of neonatal deaths in Scotland were due to infection. Ninety-eight percent of babies born in Scotland were born in a health facility compared to 60% of babies born in Ghana (hospital: 38.1%; clinic: 21.1%). In Ghana, babies born in hospitals had a higher risk of neonatal mortality compared to those born at home (NMR-hospital: 15.6; clinic: 7.1; home: 11.8). Most of the neonatal deaths in Ghana occurred at home (54%); there were more deaths among babies who were born in a hospital but died at home (hosp/home) compared to those born at home but died in a hospital (home/hosp). Asphyxia was the leading cause of death among hosp/hosp, and infection was the leading cause of death among hosp/home, home/home and home/hosp. Neonatal mortality in Ghana was largely influenced by where mothers sought maternity service, or the type of personnel who provided maternity care service. Mothers and babies who were cared for in hospitals by doctors and midwives received relatively better care and proper management of birth complications. Those who were cared for in clinics received basic delivery services and management of uncomplicated asphyxia. Mothers and babies who were cared for at home by traditional birth attendants (TBA) received poor care and poor management of neonatal illnesses based on traditional approaches which increased the risk of death. Women’s maternity choices were influenced by wider societal factors including prominent cultural values, family hierarchical structures and the cost of maternity services, and individual/ family factors including place of residence and availability of transport and beliefs about the cause of disease. Conclusion: There is considerable opportunity for reducing NMR in Ghana, especially deaths due to asphyxia and infections. Most uncomplicated deliveries should be performed by midwives in community clinics. The number of community maternity clinics should gradually be increased to enable home deliveries by TBAs to be phased out. Facilities should be improved for delivery and postnatal care in hospitals and the proportion of sick babies managed by health care workers trained in their care should be increased. Regular postnatal checks in the community by trained staff should be standard.

This thesis explored internal and external predictors of fruit and vegetable intake in children of different age groups. The first sample were toddlers between 2-3 years old and the second sample were children between 5-9 years old. Intake of fruit was analysed separately from intake of vegetables, and subgroups of fruit and vegetables with strong sensory properties were also analysed separately. The results showed that in the older sample lifetime exposure to variety of different fruit and vegetables was positively associated with quantity and diversity of fruit and vegetables consumed. In toddlers, liking of fruit and vegetables was not directly linked to their intake. In children of less controlling mothers fruit liking was positively associated with fruit intake and children of the more controlling mothers ate fruit independent of fruit liking. Past history of middle ear infections may affect adiposity and fruit and vegetable intake. Finally, individual levels of sensitivity to sweet taste may affect adiposity and intake of cruciferous vegetables and non-astringent fruit in school-age children. Parental intake was the strongest predictor of intake in both age groups. The results of this thesis show that fruit and vegetables have different predictors of intake and need to be considered separately.

Inherited metabolic diseases (IMD’s) are a large class of heterogeneous genetic disorders caused by dysfunction within a single pathway of intermediary metabolism. In many of these diseases, the dysfunction of metabolic enzymes leads to the accumulation of toxic metabolites which disrupts the normal development of the central nervous system. With the advent of treatments that positively influence neuropsychological outcomes, there is a need for sensitive and objective neuropsychological measures that allow patients to be systematically tracked in order to understand the efficacy of existing treatments. In this thesis, a neuropsychological test battery consisting of attention, language and oculomotor measures was developed to accurately describe individual and developmental differences between IMD patients and healthy developing controls. The functioning of five diseases was examined: Morquio syndrome (\(N\) = 12), Hurler syndrome (\(N\) = 3), Maroteux-Lamy syndrome (\(N\) = 2), Tyrosinemia type I (\(N\) = 13) and Tyrosinemia type III (\(N\) = 5). Findings indicated that disease effects were not homogeneous across tasks, and that performance on the same tasks was not uniform across diseases. The obtained data offers a promising basis for understanding how biological factors influence the severity and timecourse of developmental effects in future research.

Children are largely ignored in medical ethics, which concentrates on adults with capacities that children lack (including competence, or rationality). This thesis answers how medical decisions should be made for unquestionably incompetent children. The dominant approach to medical ethics in the West depends on respect for autonomy and this distorts medical ethics for children in two ways. Firstly, parental decisions for children may be taken to have the same authority as respect for autonomy. Secondly, theories of general well-being have focused on adult’s well-being with an endorsement of the components of that well-being by the adult themselves. This has hindered the development of an objective, impartial, conception of interests, arguably, the best fit for making decisions for very young children. I argue that although children are clearly demarcated from adults in medical ethics, there is not a clear explanation of why this is. For young children others must make decisions or be prepared to override the child’s decisions. More recently, the distinction between adults and children have become blurred, exemplified by the use of terms such as ‘young person’. Children’s rights at best draw attention to children and their interests, but do not help in resolving the medical treatment of incompetent children. The most promising approach depends on articulating an account of children’s interests. For several reasons the best interests standard is not defensible. I argue that a reasoned, or reasonable, agreement upon the child’s interests should determine medical treatment. Neither the child’s parents (nor the clinicians) can be taken to have an incorrigible grasp of the child’s interests, all should justify the reasons for their choices.

Att bli förälder är en omtumlande upplevelse. För de föräldrar som vill ha stöd ska detta också finnas tillgängligt för att de med trygghet ska kunna möta barnets behov och stärka dess utveckling. BVC-sjuksköterskan har en central uppgift när det gäller att ge stöd till föräldrar med barn i åldrarna 0-6 år. Syftet med studien var att beskriva BVC-sjuksköterskors erfarenheter av att ge stöd i föräldraskapet. Metoden som användes var en kvalitativ innehållsanalys med induktiv ansats beskriven av Lundman och Hällgren Graneheim. Datainsamling gjordes genom intervjuer med fyra BVC-sjuksköterskor. Resultatet visade att BVC-sjuksköterskan upplevde att föräldrastöd var något som utfördes varje gång hon träffade föräldrarna. Genom att finnas till för familjen och stärka föräldrarnas egna resurser kunde hon stödja dem i föräldraskapet. Ett förändrat samhälle krävde dock en förändrad barnhälsovård och de resurser som gavs påverkade det stöd som kunde erbjudas föräldrarna. / Becoming a parent is an overwhelming experience. It is important to have support available for those who need it in order for parents to safely meet the needs of their child, and to strengthen the development of their child. The Child Health Nurse has a central role in supporting parents with childen aged 0-6 years. The aim of this study was to describe Child Health Nurses experiences of supporting parents. The method being used was a qualitative content analysis with an inductive approach described by Lundman and Hällgren Graneheim. The data was collected through interviews with four Child Health Nurses. The result shows that the Child Health Nurses experienced that parenting support was something which took place each time they met with the parents. By being there for the family and by strengthening the own resources of the parents, she could support their parenting. A changed society demanded a change in child health care and the conditions given influenced the support available for parents.

<p>Att bli förälder är en omtumlande upplevelse. För de föräldrar som vill ha stöd ska detta också finnas tillgängligt för att de med trygghet ska kunna möta barnets behov och stärka dess utveckling. BVC-sjuksköterskan har en central uppgift när det gäller att ge stöd till föräldrar med barn i åldrarna 0-6 år. Syftet med studien var att beskriva BVC-sjuksköterskors erfarenheter av att ge stöd i föräldraskapet. Metoden som användes var en kvalitativ innehållsanalys med induktiv ansats beskriven av Lundman och Hällgren Graneheim. Datainsamling gjordes genom intervjuer med fyra BVC-sjuksköterskor. Resultatet visade att BVC-sjuksköterskan upplevde att föräldrastöd var något som utfördes varje gång hon träffade föräldrarna. Genom att finnas till för familjen och stärka föräldrarnas egna resurser kunde hon stödja dem i föräldraskapet. Ett förändrat samhälle krävde dock en förändrad barnhälsovård och de resurser som gavs påverkade det stöd som kunde erbjudas föräldrarna.</p> / <p>Becoming a parent is an overwhelming experience. It is important to have support available for those who need it in order for parents to safely meet the needs of their child, and to strengthen the development of their child. The Child Health Nurse has a central role in supporting parents with childen aged 0-6 years. The aim of this study was to describe Child Health Nurses experiences of supporting parents. The method being used was a qualitative content analysis with an inductive approach described by Lundman and Hällgren Graneheim. The data was collected through interviews with four Child Health Nurses. The result shows that the Child Health Nurses experienced that parenting support was something which took place each time they met with the parents. By being there for the family and by strengthening the own resources of the parents, she could support their parenting. A changed society demanded a change in child health care and the conditions given influenced the support available for parents.</p>

No description available.

Thesis (M.S.P.H.)--University of Michigan, 1939.

Thesis (M.P.H.)--University of Michigan, 1946.

Thesis (M.S.P.H.)--University of Michigan, 1941.