Introduction A future healthy world is highly associated with the children and their mothers, the Millennium Development Goals (MDGs) prioritize the child and maternal health with the targets “the under-five mortality rate should be reduced by two thirds from 1990 to 2015”. A transform program in the Philippines, launched by a NGO, aims to change the life of ultra-poor, and the interventions’ impact was measured in this study. Method The study selected participants who had completed the surveys in the short term (n=2183) and long term (n=196). The Chi-square test, Cochran-Armitage trend test, and Generalized Estimating Equation (GEE) model were applied to examine the hypotheses: (1) the program would have positive impacts on child health, (2) the child mortality is related to the maternal social-demographic factors and health behaviors. In the GEE model, the univariate and multivariate binary logistic regression was used to estimate the crude and adjusted odds ratio (OR). Result The univariate and multivariate analysis both show the maternal age is closely associated with the child mortality, and the child mortality of older women is higher than the younger in the short term survey (univariate: OR:8.36, 95%CI:4.17-16.77, multivariate: OR: 8.89, 95%CI: 4.27-18.54). In the long term, the results demonstrate that the child mortality of delivering in hospital (OR:0.29, 95%CI:0.11-0.76) and birthing home (OR: 0.46, 95%CI: 0.21-0.98) both lower than home (reference group). Compared to Bacolod, the child mortality rate of Gensan and Koronadal is lower in the short term. We found no difference in other maternal social-demographic factors and health behaviors. During the survey period, the literacy, PhilHealth, institutional delivery, delivery care provider, postnatal home visits, breastfeeding, and child mortality all improved, and the improvements of PhilHealth, postnatal home visits, breastfeeding were statistically significant. Conclusion The findings suggest that the program needs to constantly deliver more community-based interventions, such as: institutional delivery, skilled birth attendance, postnatal care, which would transform the children health of ultra poverty in the long run. / published_or_final_version / Public Health / Master / Master of Public Health

Background: Most of the previous studies about risk factors associated with death in pediatric intensive care unit (PICU) were done in western countries and focused on physiological and laboratorial indexes. Some of them had inconsistent results. There were few studies about the epidemiologic profile of mortality and risk factors associated with death in the PICU in China. Compared with other countries, China has different health care policy, insurance system, population, culture, and socioeconomic situation that may affect disease outcomes differently. Some data showed that Chinese PICUs had higher mortality. It is important to know more about the possible factors associated with excess death in PICU in a Chinese setting. Objectives: The objectives of this study were to estimate mortality (incidence proportion of death) in pediatric intensive care unit (PICU) in a tertiary hospital and identify the main risk factors associated with death in PICU. Methods: This was a case-control study. We retrospectively investigated the clinical data of patients who were admitted to the PICU during January 2010 to December 2013 in a tertiary hospital in Guangzhou, China. All the dead cases in PICU during the studied period were chosen as cases, and the controls were randomly selected from the patients who were alive when they were discharged from the PICU during the same period. The incidence proportion of death was estimated, and then logistic regression model was carried out to explore the risk factors for death. Results: The overall mortality in this PICU was 6.5% (95% CI 5.6 % - 7.4%) during January 2010 to December 2013. The following factors were found to have significant association with higher risk for death: middle level socioeconomic status (OR 2.51, 95% 1.07 - 5.87) and low level socioeconomic status (OR 5.86, 95% CI 2.32 - 14.77) compared with the high level socioeconomic status; admission from pediatric emergency observation unit (OR 2.08, 95% CI 1.10 - 3.91) compared with admission from transfer system (i.e. other hospital); critical severity of disease (OR 2.62 , 95% CI 1.48 - 4.64), and seriously critical severity of disease (OR 8.41, 95% CI 3.26 - 21.67) compared with non-critical severity of disease ; existence of multiple organ dysfunction syndrome (OR 3.64, 95% CI 1.91- 6.91) compared with absence of multiple organ dysfunction syndrome; existence of comorbidity (OR 3.14, 95% CI 1.68 - 5.86) compared with absence of comorbidity; infectious disease (OR 2.42, 95% CI 1.07- 5.49), neoplasm (OR 4.53, 95% CI 1.63 - 12.62), neurological disease ( OR 4.21, 95% CI 1.85 - 9.59) and endocrine, immune and nutritional disease (OR 7.56, 95% CI 2.10 - 27.20 ) compared with respiratory disease . Conclusion: Our study was the first one to comprehensively investigate the risk factors for death in PICU of a tertiary hospital in China. We described profile of dead cases, estimated the mortality and investigated the risk factors associated with death in PICU. During January 2010 to December 2013 the mortality in the PICU was found to be 6.5%, and risk factors for higher mortality in PICU included lower level socioeconomic status, admission from the pediatric emergency observation unit, more severe conditions of disease, presence of comorbidity and multiple organ dysfunction syndrome, and disease categories of infectious diseases, neoplasm, neurological disease, and endocrine, immune and nutritional disease. Our study provided information for developing preventive strategy to reduce the mortality in PICU. / published_or_final_version / Public Health / Master / Master of Public Health

A Doctoral Thesis submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa; in fulfillment of the requirements for the award of PhD in Demography and Population Studies September 2013. / Background: Despite modest improvements in child health outcomes during the 20th century, infant and child mortality rates remain unacceptably high in Nigeria. With about 1 in 6 children dying before the age of five, Nigeria, like many other countries in sub-Saharan Africa, is not on track to achieve the Millennium Development Goal 4 (MDG 4) (i.e. reducing childhood mortality by 2015). Nigeria’s under-five mortality rate is among the highest in the world. Addressing poor infant and child health outcomes requires scientific evidence on how best to tackle its determinants. Literature shows that knowledge about the determinants of child mortality at the individual level is insufficient to address the problem. This is because the characteristics of the household and community context where a child is born or raised tend to modify individual-level factors and therefore affect child survival. However, there are gaps in evidence on the effects of characteristics of the community contexts on child survival in Nigeria. Hence, this study examined the contextual determinants of infant and child mortality in Nigeria with a focus on individual, household and community-level characteristics. The study addressed three specific objectives: (1) to examine the levels and magnitudes of infant and child mortality in Nigeria; (2) to identify the individual, household, and community-level factors associated with infant and child mortality in Nigeria; and (3) to determine the extent to which the contextual factors account for regional variations in infant and child mortality in Nigeria. Methodology: The study utilized data from 2003 and 2008 Nigeria Demographic and Health Survey (NDHS). The target population for this study (women aged 15-49 years who had at least a live birth in the five years preceding the survey) were extracted from the whole 2003 and 2008 NDHS datasets. Out of the survey’s total sample size of 7620 women contained in 2003 dataset, analysis was restricted to the live born children of 3775 women amounting to 6028 live births within the five years before the survey. Similarly, from a total of 33,385 women contained in 2008 dataset, analysis was restricted to the live born children of 18,028 women who were 28,647 children delivered in the five years before 2008 survey. In order to achieve the objectives of this study, analysis was restricted to births in the five years before the survey. All analyses were completely child-based. That is, child was the unit of analysis. The dependent variables in this study are: (i) infant mortality – defined as the risks of dying during the first year of life; (ii) child mortality – defined as the risk of dying between ages 12 and 59 months; and (iii) under-five mortality – defined as the risks of dying between birth and the fifth birthday. All the outcome variables were measured as the duration of survival since birth in months. Guided by the reviewed literature and the conceptual framework, relevant independent variables were selected at the individual-, household- and community-levels. Three levels of analysis – univariate, bivariate and multivariate – were conducted. At the multivariate level, Cox proportional hazards regression analysis was employed because of its suitability for analysing time-to-event data and censored observations. In addition, using generalized linear latent and mixed models (GLLAMM) implementable in Stata, multilevel survival analysis was employed to consider the hierarchical structure of the DHS mortality data; and to identify contextual factors influencing regional variations in infant and child mortality in Nigeria. Data were analyzed using Stata software (version 11.1). Indirect estimations were obtained using MortPak-Lite, Microsoft Excel, and Model Life Tables. Key findings addressing objective 1: Indirect techniques gave the levels of infant mortality for both sexes in 2002-2003 as 93 per 1000 live births (male: 95/1000, female: 91/1000), and 78 per 1000 live births (male: 80/1000, female: 75/1000) in 2007-2008. Probabilities of dying between ages 1 and 5 were estimated at 0.049 (male: 0.051, female: 0.047) in 2002-2003, and 0.036 (male: 0.038, females: 0.033) in 2007-2008. Indirectly computed estimates of infant/child mortality were not substantially different from the estimates obtained from direct techniques. Using INDEPTH life table, e0 (i.e. expectation of life at birth) in 2008 was estimated at 55.6 years for females and 51.6 years for males. This suggests that the data utilized in this study are of good quality. Bivariate results indicated a slight reduction in the proportion of infant and child death over the 1999-2003 and 2004-2008 periods. Key findings addressing objective 2: Using both 2003 and 2008 data, region of residence, place of residence, ethnic diversity, community education, community infrastructures, and community health contexts were identified as important contextual determinants of infant and child mortality in Nigeria during the periods under study. For instance, results from 2008 NDHS data showed that children of mothers residing in the North-east were having significantly higher risks of infant (hazard ratio - HR: 1.54, p<0.05) and child (HR: 3.19, p<0.05) mortality compared to children in the South-west. Residence in communities with high proportion of hospital delivery was associated with lower risks of infant (HR: 0.73, p<0.05) and child (HR: 0.62, p<0.05) mortality. In addition, residence in communities with high concentration of poor households was significantly associated with higher risks of death during childhood (HR: 1.40, p<0.05). Many of the selected variables remained significantly associated with infant and child mortality after adjusting for the effects of the selected important characteristics, although some to a lesser degree. Results also showed that demographic factors were more important in explaining infant mortality while socio-economic factors were more important for child mortality. Key findings addressing objective 3: Results from both 2003 and 2008 data indicated that substantial variations in the risks of infant and child mortality exist across regions in Nigeria, and that characteristics of the community contexts were important in explaining the observed regional variations. For instance, results from 2003 data indicated that the proportional change in variance (PCV) of 43.5% in the hazards of dying during infancy, and PCV of 44.4% in the risks of dying during childhood, could be attributed to community-level contextual determinants. Also, analysis of 2008 data showed that the PCV of 43.3% in the risks of dying before age one and PCV of 50.0% in the hazards of dying during childhood could be explained by community-level characteristics. Although, community factors appear to moderate the association between individual-level factors and death during infancy and childhood, adjusting for the effects of child-, mother- and community-levels characteristics in the final models indicated higher child mortality clustering at the community level relative to individual level. Conversely, higher infant mortality clustering was found at the individual level compared with the community level. This result suggests that community-level attributes appear to play more important role in child survival during childhood than in infancy. Plausible explanation for this is that children’s interaction with community environment or neighbourhood contexts is likely to be higher during age 12-59 months compared to the period under age one. Conclusion: The study’s findings showed that insufficient progress was made in infant and child mortality reduction over the 1999-2003 and 2004-2008 periods. Besides, increased variations in the risks of infant and child death were observed across the six regions of the country. Results demonstrated that characteristics of the community contexts tend to mitigate infant and child mortality risks in the South-west while community characteristics appear to exacerbate infant and child mortality risks in other regions, particularly in the North-east and North-west. Study’s findings suggest that policies that will ensure substantial reduction in infant and child mortality in Nigeria must include strategies and programmes that rectify characteristics of the community contexts which exacerbate infant and child mortality risks, particularly in the socially and economically disadvantaged communities and regions of Nigeria. Keywords: Infant, child, under-five, neighbourhood, community, context, mortality, demography and health survey, Nigeria

Zero-inflated (ZI) count data models overcome the restriction of equality relationship between mean and variance, but functional relationship still exists. For ZI models it is important to know whether the proportion of zeros and the rate of counts have any influence on the fit of the model. In this study we have considered three zero-inflated models, namely, ZIP, ZINB, and Hurdle model. We also considered Poisson and negative binomial model as classical count data models. Our simulation experiment suggests that the proportion of zeros for given rate parameter does not a↵ect the fit of the models as long as model is correctly specified. In case of misspecification of the model, it does not perform well for large rate parameter. These three zero-inflated models performed better than the classical models as the rate parameter and the proportion of zeros become larger. We applied five models to the BDHS 2011 survey data to understand the social determinants associated with a mother to experience under-5 deaths of her children. The classical models failed to di↵erentiate between mothers who have experienced under-5 deaths of their children and who have never experienced under-5 deaths. While zero-inflated models were able to di↵erentiate between those two groups of mothers in terms of zero counts and positive counts of number of under-5 deaths of their children with associated covariates in opposite slope of coefficients. Among the three zero-inflated models, Hurdle model performed best in fitting the data compared to the ZIP and ZINB models.

Although the Indian infant mortality rate has dropped from 66 deaths per 1000 live births in 1960 to 24.6 deaths per 1000 live births in 1980, considerable discrepancies continue to exist between the Indian and Non-Indian population in British Columbia. The high incidence of Indian infant mortality is an important issue to B.C.'s native population. While governments have instituted programs in an effort to improve the health status of Indian infants, no studies have been undertaken in British Columbia to identify those factors which influence Indian infant mortality. This study examines the theoretical and empirical relationship between Indian infant mortality and a variety of socio-economic and health care factors. Using data derived from matched birth and death certificates and information acquired from the Department of Indian Affairs, this study assesses the effects of the following variables on neonatal and post neonatal mortality: 1. Maternal Age/Live Birth Order, 2. Marital Status, 3. Place of Delivery, 4. Region, 5. Welfare Dependency, and 6. Health Jurisdiction. Tests of partial and marginal association were performed initially to identify those variables which were not significantly related to the Birth Outcome. As the results of these tests revealed that Place of Delivery was the only significant variable, various regression models were constructed to estimate the effects of non-hospitalization and hospitalization on neonatal and postneonatal mortality. The findings a from these tests indicated that when non-significant factors were eliminated from the regression model, the variable, Place of Delivery, was not significantly related to the Birth Outcome. Factors to account for these results were then discussed. In particular, consideration was given to the extent to which shortcomings in the data and study methodology may have affected the results of statistical tests. To develop a better understanding about the nature of Indian infant mortality, the major causes of Indian infant deaths were examined over various historical periods. After reviewing changes in the distribution of deaths this study described, theoretically, how changes in the social and economic structure in Indian communities affected Indian health and more specifically Indian infant health. It was argued that while life style factors and certain aspects of the physical environment may affect infant mortality, these factors should not be viewed in isolation. Changes in Indian economic and social systems have had direct and indirect consequences on the physical and mental health of native people. To the extent that these changes are on-going they still may have some bearing on Indian infant health problems today. Based on this theoretical perspective this study examined the adequacy of past and present health programs and described some of the limitations of government intervention strategies. The concluding section argues that self-help preventive programs and medical/technical solutions are of limited utility in terms of reducing infant morbidity and mortality. Furthermore, while it may be possible to improve the standard of living of Indian people through transfer payments or other social welfare schemes, these strategies may provide only partial solutions if broader social problems are direct and indirect causal factors of ill-health. To the extent that social problems may be related to certain aspects of their psycho-social environment, it is essential that governments adopt strategies which provide the opportunities for Indians to regain self-respect and control over the institutions which affect their daily lives. / Applied Science, Faculty of / Community and Regional Planning (SCARP), School of / Graduate

Thesis (Ph.D. (Statistics)) -- University of Limpopo, 2022 / This thesis is based on application of frailty and copula models to under five child mortality data set in South Africa. The main purpose of the study was to apply sample splitting techniques in a survival analysis setting and compare clustered survival models considering left truncation to the under five child mortality data set in South Africa. The major contributions of this thesis is in the application of the shared frailty model and a class of Archimedean copulas in particular, Clayton-Oakes copula with completely monotone generator, and introduction of sample splitting techniques in a survival analysis setting. The findings based on shared frailty model show that clustering effect was sig nificant for modelling the determinants of time to death of under five children, and revealed the importance of accounting for clustering effect. The conclusion based on Clayton-Oakes model showed association between survival times of children from the same mother. It was found that the parameter estimates for the shared frailty and the Clayton-Oakes models were quite different and that the two models cannot be comparable. Gender, province, year, birth order and whether a child is part of twin or not were found to be significant factors affect ing under five child mortality in South Africa. / NRF-TDG Flemish Interuniversity Council Institutional corporation (VLIR-IUC) VLIR-IUC Programme of the University of Limpopo

Thesis (MCur)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Pneumonia is the greatest single cause of mortality in children less than five years of age throughout the world causing more deaths than those due to AIDS, malaria and tuberculosis combined. Approximately 50% of all childhood pneumonia deaths occur in sub-Saharan Africa. Children in developing countries being treated for pneumonia frequently have one or more comorbid conditions which increases their risk of dying. The proper management of the child with severe or very severe pneumonia is essential to reduce case fatality. Standard case management (SCM) of pneumonia, has been shown to be an effective intervention to reduce deaths from pneumonia, but what is lacking is a means of delivering it in low-resource/high burden countries. A major barrier to wide application of this intervention in low-income countries is weak health-care systems with insufficient human and financial resources for implementing SCM to a sufficient number of children at a level of quality and coverage that would result in a significant impact. The objective of this dissertation is to address this issue by investigating ways of improving delivery of standard case management of pneumonia in district hospitals throughout Malawi, a high HIV-prevalent country which would result in a decrease in the in-hospital case fatality rates (CFR) from pneumonia in children less than five years of age. We reviewed the evidence base for SCM. Then we evaluated the development and implementation of a national Child Lung Health Programme (CLHP) to deliver SCM of severe and very severe pneumonia and a programme to provide uninterrupted oxygen supply in all paediatric wards at District Hospitals throughout Malawi. We demonstrated that it was feasible to implement and maintain both programmes country-wide. Thirdly we evaluated the trend in case fatality rates in infants and young children (0 to 59 months of age) hospitalized and treated for severe and very severe pneumonia over the course of the implementation of the CLHP. The findings from this study showed that in the majority (64%) of cases, who were aged 2-59 months with severe pneumonia there was a significant effect of the intervention that was sustained over time whereas in the same age group children treated for very severe pneumonia there was no interventional benefit. No benefit was observed for neonates. Fourthly we investigated factors associated with poor outcome reported in the previous study, in a subset of this cohort to determine the individual factors including demographics of the study population, recognised co-morbidities and clinical management that were associated with inpatient death. This study identified a number of factors associated with poor pneumonia-related outcomes in young infants and children with very severe pneumonia. They included co-morbidities of malaria, malnutrition, severe anaemia and HIV infection. The study found that the majority of reported comorbid conditions were based on clinical signs alone indicating a need for more accurate diagnosis and improved management of these comorbidities that may lead to improved outcomes. Other identified factors included a number of potentially modifiable aspects of care where adjustments to the implementation of SCM are indicated. These included enhancing correct classification of the severity of the disease, the use of correct antibiotics according to standard case management, more extensive availability and use of oxygen together with oximetry to guide its use,. Finally recommendations were made to address the identified reasons for poor outcomes and suggested future research. / AFRIKAANSE OPSOMMING: Pneumonie is die grootste enkele oorsaak van sterftes by kinders jonger as 5 jaar in die wêreld en veroorsaak meer kindersterftes as die menslike immuungebrekvirus (MIV), malaria en tuberkulose saam. Ongeveer 50% van kindersteftes van pneumonie kom in sub-Sahara-Afrika voor. Kinders in ontwikkilende lande, wie vir pneumonie behandel word, het dikwels een of meer bydraende toestande wat die doodsrisiko verhoog. Kinders wie ernstige of baie ernstige pneumonie onderlede het moet korrek behandel word om sterfte te voorkom. Die standaard protokolle om kinderpneumonie korrek te behandel het getoon om effektief te wees om die sterftesyfers te verlaag. In lae inkomste lande bestaan die strategieë nie om die protokolle aan te wend nie. ‘n Groot struikelblok in die aanwending van die pneumonie behandelingsprotokolle in lae-inkomste lande is die swak gesondheidsorgsisteme met onvoldoende menslike en finansiële hulpbronne. Die tekorte gee aanleiding tot die beperkte implementering van pneumonie protokolle wat die omvang en kwaliteit van die pneumonie protokolle beperk en daarom impakteer die protokolle nie op die kindersterftesyfer nie. Die doel van die verhandeling is om hierdie probleem aan te spreek deur navorsing hoe om die pneumonie protokolle landwyd in alle distrikhospitale in Malawi, ‘n land met ‘n hoë MIV prevalensie, aan te wend om sodoende die kindersterftesyfer (kinders jonger as 5 jaar) as gevolg van pneumonie te verlaag. Ons het die getuienis van die pneumonie protokolle ondersoek. Hierna is ‘n nasionale Kinderlong Gesondheidsprogram ontwikkel en landwyd geïmplementeer. Volgens die program is kinders met ernstige en baie ernstige pneumonie volgens Wêreldgesondheidsorganisasie (WGO) protokolle behandel. Ononderbroke suurstoftoevoer in alle pediatriesesale in distrikshospitale in Malawi veskaf. Die navorsing het getoon dat die implementering en instandhouding van pneumonie behandelingsprotokolle is landwyd moontlik. Verder het ons die tendens ondersoek of die kindersterftesyfer in babas en jong kinders (0 tot 59 maande) wat in die hospital opgeneem en behandel is vir ernstige en baie ernstige pneumonie tydens die implementering van pneumonie protokolle verminder het. Die bevindinge van hierdie verhandeling wys dat in die meerderheid (64%) van die kinders tussen 2 en 59 maande met ernstige pneumonie, en met die toepassing van die pneumonie protokolle, statistiesbetekenvol die sterfte syfer verlaag het. Die protokolle vir die behandeling van baie erstige pneumonie het nie dieselfde wenslike effek gehad nie. In neonate (jonger as 2 maande) was daar ook geen verlaging in die sterftesyfer nie. Laastens het ons die redes vir die swak uitkomste ondersoek in ‘n substudie en veral klem gelê op bydraende siektes en kliniesesorg tekorte geassosieer met pneumonie sterftes. Die studie het ‘n aantal faktore geïdentifiseer wat bygedra het tot die sterftesyfer in kinders met baie ernstige pneumonie en in neonate. Die geïdentifiseerde bydraende faktore het malaria, wanvoeding, erge anemie en MIV-infeksie ingesluit. Voorkomende maatreëls moet vir die geïdentifiseerde faktore ingestel word. Aanpassings in die pneumonie protokolle is voorgestel. Ten slotte word aanbevelings gemaak om die geïdentifiseerde redes vir swak uitkomste aan te spreek en verdere navorsingidees word aanbeveel.

This dissertation focuses on using one tangible component of filicide, the method or weapon used by a parent to kill a child, as a means by which to understand parental psychology. An evolutionary psychological perspective (e.g., Buss, 2004; Bjorklund & Pellegrini, 2002; Daly & Wilson, 1988; Tooby & Cosmides, 1992) can provide insight into our understanding of filicide. Questions that have not been asked by previous researchers may come to the fore by using an evolutionary perspective as a guide for investigating filicide and its surrounding circumstances and contexts. I present the results of three empirical studies using archival data on filicides recorded in Chicago, Illinois. In Study 1, I present the results of an investigation of parental psychological differences evidenced by the methods of filicide, for filicides recorded between 1965 and 1994. The key results of Study 1 are: (a) while overall (i.e., non-genetic and genetic parents combined), beating was the method of filicide used most often, the percentage of filicides committed by non-genetic parents by beating significantly exceeded the percentage of filicides committed by genetic parents; (b) in contrast, the percentage of filicides committed by non-genetic parents by asphyxiation was significantly less than the percentage of filicides committed by genetic parents. In Studies 2A and 2B, I present the results of an investigation using the 1965-1994 dataset as well as a dataset of filicides-suicides recorded between 1870 and 1930. The key results of these two studies indicate that filicide-suicide may be more likely to occur in certain contexts (e.g., multiple-victim killings) and in certain circumstances (e.g., following paternal filicide). In the final chapter, I discuss the key findings, identify limitations of the current research, and present several future directions for research. / by Viviana A. Weekes. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

In conclusion, SED is a predictor of stroke mortality. Both childhood and adulthood SED were related to the risk of stroke. Stroke mortality increased with improving SED at a lower stage of development, while it decreased with SED improvement at a higher stage of development. The analysis was conducted among middle- or high-income countries/regions as data only available there. Investigation for low-income countries is warranted as data become available. / Keywords. Socioeconomic development; stroke; mortality / Socioeconomic development (SED) relates to the prevalence of risk factors of stroke and influence health policy. We aim to explore the association of (SED) in childhood and adulthood with stroke mortality among countries/regions, and to examine its impact on time trend of stroke mortality. / The ecological study used data on stroke mortality in five-year age group among countries/regions with death registry covering > 70% population provided by the World Health Organization. SED was measured by Human Development Index (HDI), a composite indicator with longevity, education and standard of living, obtained from the United Nations. Mortality rates (1950-2003) were averaged over three years and in logarithmical scale. HDI from 1960 to 2003 were available for this analysis. The effect of HDI on stroke mortality was analyzed and the major confounders, such as prevalence of hypertension, smoking, diabetes, obesity, and the level of dietary fat and alcohol consumption were adjusted for using regression model. / The results revealed that stroke mortality was inversely associated with HDI in childhood and adulthood respectively. Childhood HDI explained 36% of variance of stroke mortality among countries/regions in men and 35% in women; while adulthood HDI interpreted 34% in men and 52% in women (P &lt; 0.01); annual change of stroke mortality was inversely associated with that of HDI. The peak of stroke mortality was exhibited at HDI = 0.79-0.83 for men and 0.80-0.83 for women. Stroke mortality increased with HDI where HDI &lt; 0.79 for men and 0.80 for women, while it decreased with HDI improvement where HDI > 0.83 for men and women. Controlling for confounders did not materially change the results. / Wu, Shenghui. / Adviser: Xin-Hua Zhang. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3468. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 189-218). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

The primary purpose of this dissertation is to assess the extent to which household characteristics and behaviours exert their effects both directly and indirectly on childhood mortality through the more proximate factors that can be measured within the context of society. A child mortality model, primarily based on Mosley and Chen's framework, is developed by linking individual and societal factors. Then the model is tested with empirical data from the Fars Province of Iran. The survey data were collected in 1991--92 in five counties of Fars. It consisted of 10665 interviews and covered 67 villages 14 towns and one city. Three sampling techniques were employed: (1) proportional stratified sampling; (2) cluster sampling; and (3) simple random sampling. / Three levels of analysis were carried out in this thesis: individual, societal and contextual. Bivariate and multivariate logistic regression analysis were done for subsets of variables based on the child mortality model that were identified to be good predictors of child mortality and which were also identified theoretically as proximate and intervening variables. / The individual level analysis reveals that place of residence, education of the mother, and occupation of the father from the socio-economic, factors; and age of marriage of mothers, pregnancy order, and pregnancy age from demographic factors; and visiting doctors during pregnancy, type of delivery, pregnancy duration, birth weight, and vaccination from the health status factors; and housing quality are the important determinants of child mortality in Fars. / At the societal level, rural setting, the literacy rate of the villages and assets indexed by sheep per capita are the important determinants of child mortality. Also child mortality rate differentials were found to be compatible with that of additive developmental index of regions (counties). / Contextual analysis shows that birth weight, pregnancy duration, pregnancy order, and house facilities are, in Iran, significant predictors of child mortality. Among all the variables, these variables appear to be the most proximate variables and the other variables, including socio-economic and demographic variables, significant intervening variables. / The results of this dissertation support the claim that child mortality can be a sensitive indicator of human development and quality of life both at the individual and societal levels. Most significantly it appears to be prerequisite to fertility decline. The most important finding from these analyses is that child mortality is influenced both by the individual's characteristics as well as by community characteristics. In better words, social organisation as proposed in the child mortality model matters.