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Background: Maternal employment has been highlighted in numerous studies as an important determinant of childhood mortality but in contexts which do not have regional significance to Swaziland. Studies such as those conducted in India (Sivakami, 1997) and China (Short et al. 2002) considered maternal employment as an important predictor of childhood mortality. Childhood mortality is still high in Swaziland and with increasing poverty and disease the under-five mortality rate continues to increase. The aim of this study was to investigate the relationship between maternal employment and childhood mortality in Swaziland. Methodology: the Swaziland Demographic and Household Survey (SDHS) conducted in 2006/7 interviewed 4,987 women. Due to the nature of this study, only women who had given birth to at least one child five years preceding the SDHS 2006/7 interviews were included. The sample size used for the study was of 2,136 mothers. Main conclusions of the study were drawn based on the use of a binary logistic regression model in the multivariate section. With the use of a conceptual framework adapted from the classic theoretical model developed by Mosley and Chen (1984) key variables were identified as determinants of childhood mortality. Use of the STATA 11 software was employed to obtain the results. Results: results showed 58.88 percent unemployment rate amongst mothers in Swaziland. The main results showed mother’s employment as having an adverse impact on childhood mortality. Bivariate results showed that mothers who were employed experienced higher childhood mortality and the adjusted regression model showed mothers who work have a 38 percent increased likelihood of childhood mortality compared to mothers who do not work. Maternal education also showed its importance as a predictor of childhood mortality; the higher the level of maternal education the less chances mothers have of experiencing childhood mortality. Maternal age also demonstrated significance as mothers ages increase so too do the chances of childhood deaths. Other significant factors include number of household members, the number of children born as well as breastfeeding duration. Conclusion: The results confirmed the alternative hypothesis to be true which states that mothers who work experience significantly higher childhood mortality in Swaziland. The study also highlighted that in contemporary society, child rearing and maternal employment are incompatible and need to re-evaluate policy concerning this matter is essential to better childhood survival.

Student Number : 0310359D - MSc project report - School of Public Health - Faculty of Health Sciences / Background: Studies into childhood mortality present the opportunity to identify the leading and common causes of childhood mortality in different populations. Objectives: To study the trends in all-cause mortality, and patterns of cause-specific mortality, in children 0-14 years living in the Agincourt sub-district of South Africa over the period 1992-2000. Methods: Secondary data analysis based on the longitudinal database from the Agincourt Demographic and Health Surveillance System was used to study trends in childhood mortality between 1992 and 2000, and a comparison was made between the earlier period (1992-96) and the later period (1997-2000). Results: Seven hundred and twenty four deaths occurred over the 9 year period, 1992 to 2000, in children aged 0-14 years in the Agincourt sub-district of South Africa. Over 80% of the deaths occurred in children under-five years of age. Death rates in children under one year in the periods 1992-1996 and 1997-2000 were 8.9/1000 live births and 18.0/1000 live births respectively. Children under five years between 1992-1996 and 1997-2000 had death rates of 18.0/1000 live births and 35.0/1000 live births respectively. There was a statistically significant difference in death rate in infants, and in children less than five years, in those who died over the period 1992-1996 and those who died during the later period 1997-2000, with mortality showing an increasing trend (p-values <0.0001 for infants and for children under five years). Overall mortality rates in all children under 14 years between 1992-1996 and 1997-2000 were 26.4/10000 person-years and 37.7/10000 person-years respectively. There was no significant statistical difference in the overall mortality trend among children aged 0-14 years between the two periods of time (p-value 0.614). Infectious and communicable diseases were the leading causes of death with diarrhoeal deaths accounting for 15.2%, HIV/AIDS 9.7% and malnutrition 7.6%. Deaths from diarrhoeal disease between 1992-1996 and 1997-2000 were 481/million and 449/million person-years respectively. Deaths from HIV/AIDS within the same time periods were 107/million and 607/million person-years respectively. HIV/AIDS showed a statistically significant difference over the two periods with an increased risk ratio of 5.59 (95% confidence interval of 4.6 to 70). Conclusion: This analysis reinforced previous findings pointing to the fact that infectious and communicable diseases are the leading causes of childhood mortality in South Africa and other developing countries. HIV/AIDS and diarrhoeal diseases have emerged as major causes of mortality in this analysis. Efforts to control the HIV epidemic and prevent the spread of HIV/AIDS must be accelerated in the Agincourt sub-district.

Undernutrition in prevalent in Aboriginal communities, in utero, infancy and childhood. It influences childhood morbidity and mortality and growth patterns. Undernutrition and poor socio-economic status also contribute to endemic and epidemic infectious disease, including scabies and streptococcal infection. It has been suggested that early undernutrition, and streptococcal and scabies infection are risk factors for renal disease, which is at epidemic levels and increasing. This thesis examines the prevalence of undernutrition in newborns and infants in an Aboriginal community over time, and its impact on childhood growth and child and adult renal markers. The association between skin lesions, streptococcal serology, post-streptococcal glomerulonephritis (PSGN) and renal markers as evaluated through a community wide screening program in 1992-1995 is also examined. Birthweights have increased since the 1960s, but they are still much lower than the non-Aboriginal values. Weights in infancy have decreased since the 1960s. At screening in childhood stunting was common, reflecting the presence of long-term poor nutrition in infancy. In both adults and children, birth weight and infant weights were negatively associated with albuminuria measured by the albumin to creatine ratio (ACR).

<p>Given the question of how to further decrease childhood mortality and attain the fourth MDG in Bangladesh, the determinants of childhood mortality and successful health intervention programmes in a rural area of Bangladesh are examined in this paper. The binominal logit regression analysis, on Matlab HDSS data from 2001 to 2005, indicates that the child’s birth order, outcome of mother’s previous pregnancy, mother’s age, mother’s education, economic condition of the household, immunization, and place of delivery are important determining factors of childhood mortality. Interview discussions show that the delivery of health services is a determining factor for successful health intervention programmes. It is worth to note that childhood mortality levels are no longer significantly lower in the treatment area of Matlab. Furthermore, the intervention programmes in the area require continuous reform, especially in the fields of birth assistance and injury prevention.</p>

Given the question of how to further decrease childhood mortality and attain the fourth MDG in Bangladesh, the determinants of childhood mortality and successful health intervention programmes in a rural area of Bangladesh are examined in this paper. The binominal logit regression analysis, on Matlab HDSS data from 2001 to 2005, indicates that the child’s birth order, outcome of mother’s previous pregnancy, mother’s age, mother’s education, economic condition of the household, immunization, and place of delivery are important determining factors of childhood mortality. Interview discussions show that the delivery of health services is a determining factor for successful health intervention programmes. It is worth to note that childhood mortality levels are no longer significantly lower in the treatment area of Matlab. Furthermore, the intervention programmes in the area require continuous reform, especially in the fields of birth assistance and injury prevention.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2017-08-31T13:35:00Z No. of bitstreams: 2 Dissertação - Paulo Jackson Bezerra Vianna - 2017.pdf: 1534572 bytes, checksum: 8d00e90b21a048afb7b7ad444c498617 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Cláudia Bueno (claudiamoura18@gmail.com) on 2018-01-25T14:16:20Z (GMT) No. of bitstreams: 2 Dissertação - Paulo Jackson Bezerra Vianna - 2017.pdf: 1534572 bytes, checksum: 8d00e90b21a048afb7b7ad444c498617 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-01-25T14:16:20Z (GMT). No. of bitstreams: 2 Dissertação - Paulo Jackson Bezerra Vianna - 2017.pdf: 1534572 bytes, checksum: 8d00e90b21a048afb7b7ad444c498617 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-06-30 / The Family Health Program (FHP) was presented as the main program of the reorganization of Basic Care in Brazil, with the effort to provide municipalities and the population access to health services in a preventive and not just curative way. Today, in a long-term context of the implementation of the PSF, for the state of Goiás, the PSF is present in all municipalities in Goiás and with a population coverage of 67% in 2015. In the context, the present study seeks to assess the impact of the Family Health Program on indicators of infant mortality rate (under one year) and childhood mortality rate (under five years) between 2006 and 2014 of the municipalities of Goiás. For this, we use the panel data methodology with negative binomial distribution considering the fixed effects, for which five models were considered. The results show that the Family Health Program contributed to the reduction of the infant mortality rate and the childhood mortality rate in the municipalities of Goiás, as well as other control variables such as municipal health expenditure, the proportion of families followed with health profile in the CadÚnico. These results show that prevention-related health actions through primary care have contributed to the reduction of child-related mortality. It is also worth mentioning this study, when conducting the discussion and analyzing the effect of the PSF for a state in the Midwest. / O Programa Saúde da Família (PSF) foi apresentado como o principal programa da reorganização da atenção básica no Brasil, com o esforço de levar aos municípios e à população o acesso aos serviços de saúde de forma preventiva e não apenas curativa. Hoje, o PSF encontra-se em um contexto de longa data da implementação, no estado de Goiás, em específico, o programa está presente em todos os municípios goianos e com uma cobertura populacional de 67% em 2015. Nesse contexto, o trabalho busca avaliar o impacto do Programa Saúde da Família sobre os indicadores de taxa de mortalidade infantil (menores de um ano) e taxa de mortalidade na infância (menores de cinco anos), entre 2006 e 2014, para os municípios goianos. Para isto, utiliza-se a metodologia de dados em painel com distribuição binomial negativa considerando os efeitos fixos, para o qual foram considerados cinco modelos. Os resultados demonstram que o Programa Saúde da Família contribuiu para a redução da taxa de mortalidade infantil e a taxa de mortalidade na infância nos municípios goianos. De modo análogo outras variáveis de controle demonstraram contribuições para esta redução, tal como: despesa de recursos próprios municipais em saúde, a proporção de famílias acompanhadas com perfil saúde no CadÚnico. Esses resultados evidenciam que as ações em saúde relacionadas à prevenção, através da atenção primária, têm contribuído para a redução das mortalidades relacionada às crianças. Ressalta-se, também este estudo, ao realizar a discussão e analisar o efeito do PSF para um estado da região Centro-Oeste.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-09-21T12:10:35Z No. of bitstreams: 2 Dissertação - Paulo Jackson Bezerra Vianna - 2017.pdf: 1534572 bytes, checksum: 8d00e90b21a048afb7b7ad444c498617 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-09-21T12:14:11Z (GMT) No. of bitstreams: 2 Dissertação - Paulo Jackson Bezerra Vianna - 2017.pdf: 1534572 bytes, checksum: 8d00e90b21a048afb7b7ad444c498617 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-09-21T12:14:11Z (GMT). No. of bitstreams: 2 Dissertação - Paulo Jackson Bezerra Vianna - 2017.pdf: 1534572 bytes, checksum: 8d00e90b21a048afb7b7ad444c498617 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-06-30 / The Family Health Program (FHP) was presented as the main program of the reorganization of Basic Care in Brazil, with the effort to provide municipalities and the population access to health services in a preventive and not just curative way. Today, in a long-term context of the implementation of the PSF, for the state of Goiás, the PSF is present in all municipalities in Goiás and with a population coverage of 67% in 2015. In the context, the present study seeks to assess the impact of the Family Health Program on indicators of infant mortality rate (under one year) and childhood mortality rate (under five years) between 2006 and 2014 of the municipalities of Goiás. For this, we use the panel data methodology with negative binomial distribution considering the fixed effects, for which five models were considered. The results show that the Family Health Program contributed to the reduction of the infant mortality rate and the childhood mortality rate in the municipalities of Goiás, as well as other control variables such as municipal health expenditure, the proportion of families followed with health profile in the CadÚnico. These results show that prevention-related health actions through primary care have contributed to the reduction of child-related mortality. It is also worth mentioning this study, when conducting the discussion and analyzing the effect of the PSF for a state in the Midwest. / O Programa Saúde da Família (PSF) foi apresentado como o principal programa da reorganização da atenção básica no Brasil, com o esforço de levar aos municípios e à população o acesso aos serviços de saúde de forma preventiva e não apenas curativa. Hoje, o PSF encontra-se em um contexto de longa data da implementação, no estado de Goiás, em específico, o programa está presente em todos os municípios goianos e com uma cobertura populacional de 67% em 2015. Nesse contexto, o trabalho busca avaliar o impacto do Programa Saúde da Família sobre os indicadores de taxa de mortalidade infantil (menores de um ano) e taxa de mortalidade na infância (menores de cinco anos), entre 2006 e 2014, para os municípios goianos. Para isto, utiliza-se a metodologia de dados em painel com distribuição binomial negativa considerando os efeitos fixos, para o qual foram considerados cinco modelos. Os resultados demonstram que o Programa Saúde da Família contribuiu para a redução da taxa de mortalidade infantil e a taxa de mortalidade na infância nos municípios goianos. De modo análogo outras variáveis de controle demonstraram contribuições para esta redução, tal como: despesa de recursos próprios municipais em saúde, a proporção de famílias acompanhadas com perfil saúde no CadÚnico. Esses resultados evidenciam que as ações em saúde relacionadas à prevenção, através da atenção primária, têm contribuído para a redução das mortalidades relacionada às crianças. Ressalta-se, também este estudo, ao realizar a discussão e analisar o efeito do PSF para um estado da região Centro-Oeste.

L’amélioration de la survie des enfants demeure au cœur des préoccupations sanitaires en Afrique subsaharienne où la transition sanitaire est en panne depuis 1990. Ce contexte de crise sanitaire est concomitant à une récession économique et à une forte croissance urbaine. L’expansion rapide de la population citadine constitue aujourd’hui un défi majeur de santé publique. A l’instar de ses pairs africains, la Côte d’Ivoire, qui a expérimenté une forte croissance urbaine depuis 1960, a connu au cours des deux dernières décennies une absence de progrès notable en matière de réduction de la mortalité des enfants. L’analyse des tendances selon le milieu de résidence révèle un recul de la mortalité relativement plus important en milieu rural que dans les villes ivoiriennes. Cette situation amène à s’interroger sur les facteurs explicatifs de l’évolution de la mortalité des enfants vivant en milieu urbain ivoirien. L'objectif principal de la thèse est d’appréhender les facteurs explicatifs du ralentissement de la baisse de la mortalité des enfants vivant en milieu urbain ivoirien. L’analyse, basée sur les données démographiques et sanitaires réalisées entre 1994 et 2005, apprécie les effets de l’environnement contextuel démo-économique et sanitaire sur la dynamique de la mortalité et examine l’hypothèse d’une dégradation de la survie dans les milieux urbains pauvres. Deux constats ressortent des analyses. D’une part, il existe un réel ralentissement des progrès en matière d’amélioration de la survie des enfants dans les villes ivoiriennes, notamment à Abidjan. D’autre part, si les inégalités socio-économiques conduisent à des inégalités sanitaires, la dégradation de la survie concerne davantage les enfants des classes moyennes et aisées que ceux des ménages les plus démunis. En outre, la dimension sociale joue un rôle davantage important dans le comportement maternel en matière de recours aux soins: l’utilisation des services de santé étant relativement plus fréquente chez les mères issues de ménages de grande taille ou chez les migrantes. L’analyse révèle également une accentuation de l’influence des facteurs environnementaux sur la survie des enfants entre 1994 et 2005 et une précarité des conditions d’habitat. / Improving child survival remains at the core of health concerns in sub-Saharan Africa where the health transition is down since 1990. This health crisis is concomitant to an economic recession and a rapid urban growth. The rapid expansion of the urban population is now a major public health challenge. Like its African peers, Côte d'Ivoire, which has experienced a rapid urban growth since 1960 has failed to significantly reduce child mortality over the two past decades. The analysis of trends by area of residence reveals a decline in mortality, which is relatively larger in rural areas than in Ivorian cities. This raises questions about the factors explaining the evolution in the mortality of Ivorian city children. The main objective of this thesis is to understand the factors slowing the decline in the mortality of children who live in urban Ivory Coast. The analysis, based on demographic and health data collected between 1994 and 2005, assesses the effects of demographic, economic, contextual environment and health on the dynamics of mortality and examines the hypothesis of deterioration in the survival in poor urban area. Two conclusions emerge from the analysis. On the one hand, there is a real decrease in the progress regarding the improvement of child survival in Ivorian cities, mainly in Abidjan. On the other hand, if the socio-economic disparities lead to health inequalities, the degradation of child survival concerns more middle and upper classes than those of the poorest households. In addition, the social dimension plays a more important role in the maternal behavior regarding health care: the use of antenatal health services is relatively more frequent among mothers from large-size households or among migrants. The analysis also reveals an emphasis of the influence of environmental factors on child survival between 1994 and 2005 and precarious living conditions.