ABSTRACT: Temporary migration, especially men moving to their place of work, was an intrinsic feature of the former Apartheid system in South Africa. Since the demise of Apartheid an increasing proportion of women have also been migrating to their place of work, and oscillating between work place and home. Temporary migration can be defined as oscillating migration between a home base and at least one other place, usually for work, but also for other reasons like education. This study demonstrates that in the Agincourt study population, in the rural northeast of South Africa, adult female temporary migration is an increasing trend. By conducting a survival analysis, the study evaluates the mortality outcomes, specifically infant and child mortality rates, of children born to female temporary migrants compared with children of non-migrant women. Based on the findings presented we accept the null hypothesis that there is presently no discernable impact (positive or negative) of maternal temporary migration on infant and child mortality. There seems to be a slight protective factor associated with mother’s migration when tested at a univariate level. However, through multivariate analysis, it is shown that this advantage relates to the higher education status of migrating mothers. When women become tertiary educated there is a survival advantage to their children and these women are also more likely to migrate. The study highlights greater child mortality risks associated with settled Mozambicans (former refugees) and unmarried mothers. Both of these risk factors reflect the impact of high levels of social deprivation.

ABSTRACT: Background: Malaria is endemic throughout Ghana and continues to be a major public health concern especially among pregnant women and children under the age of five. The Ministry of Health (MoH) estimates that over the past ten years, there have been 2-3 million cases of malaria each year, representing 40 percent of outpatient cases, while severe malaria accounts for 33-36 percent of in-patients. Malaria also accounts for 25 percent of the deaths in children under the age of five (GHS, 2001). Correct identification of risk factors could focus interventions at reducing malaria mortality in children. Demographic Surveillance System (DSS) sites have been established and they generate high quality population based longitudinal health and demographic data. The DSS conduct Verbal Autopsies to determine probable causes of death. Objective: This study examines factors affecting childhood malaria mortality in Northern Ghana, using longitudinal data collected by the Navrongo DSS during the period 1995- 2000. It deals especially with the role of socioeconomic factors (mother’s education, family wealth index based on the possessions and housing characteristics and residence, and possession of bed net) and the demographic characteristics (child’s sex and age, and mother’s age). Design: Secondary data analysis of longitudinal data collected by the Navrongo Health Research Centre. Multinomial logistic regression was used to compare the relative risk in three groups of children i.e. those who died of Malaria and those who died of other causes to those who survived as base. Results: Overall, for the deaths due to malaria, older children (1-5years) had a higher risk (RRR 1.4, 95%CI 1.25-1.57 P <0.0001) of dying compared to the infants. Equally, children born of older mothers (maternal age at birth of child >30 years) had a higher risk (RRR 1.28, 95%CI 1.15-1.42 P <0.0001). However, maternal education and residence had a protective effect, with children born of mothers who had some education (RRR 0.79, 95%CI 0.67-0.93 P=0.004) and residing in urban area (RRR 0.61, 95%CI 0.46-0.82 P=0.001) having a lower risk. Similarly, those children whose families are in the highest wealth index had a lower risk (RRR 0.76, 95%CI 0.63-0.91 P=0.003). Interestingly, the same factors were associated with deaths occurring due to other causes, but with varying degree of association. Whereas sex of child was not associated with malaria deaths, being female offered a lower risk of dying from other causes (RRR 0.9, 95%CI 0.84-0.98 P=0.017). It was observed that children in the older age group (1-5 years) were at higher risk of dying (RRR 1.14, 95%CI 1.05-1.25 P=0.002) just as those born of older mothers (RRR 1.16, 95%CI 1.07-1.26 P <0.0001). Even in this group, maternal education (RRR 0.87, 95%CI 0.76-0.98 P=0.023), a higher wealth index (RR 0.87, 95%CI 0.77-0.99 P=0.032 and RRR 0.63 95%CI 0.54-0.73 P <0.0001 for the two highest categories of wealth indices respectively), and area of residence (RRR 0.67, 95%CI 0.55-0.83 P <0.0001) offered a reduction in the risk of dying. Conclusion: The study identified the risk factors (age and sex of the child and mother’s age, maternal education, wealth and residence of the family) associated with malaria mortality and other causes of death in childhood in northern Ghana and this should help formulate cost effective interventions such as health education.

Background and objectives: The current and projected burden of cardiometabolic diseases in Asia is high, with a notable and rapidly increasing prevalence of associated risk factors among children in this region. Comprehensive evidence on cardiometabolic disease risk factors among children in Asia is required to ensure well-informed strategies to address the future burden of disease in this region. This thesis aims to increase the current understanding of cardiometabolic disease risk factors among children in Asia. Methods: Using previously collected data on 6903 children and 17 656 adults participating in the South East Asia Community Observatory health and demographic surveillance system (SEACO HDSS) in Malaysia, the characterisation, prevalence and sociodemographic determinants of key child risk factors were examined. Furthermore, a feasibility study building upon the SEACO framework (N = 203) was designed and implemented to explore the possibility of increasing the range of cardiometabolic measures obtained from children through the collection and analysis of biological samples from individuals in the HDSS. Results: There was a high burden of cardiometabolic disease risk factors among both adults and children in this population. Among children, prevalence estimates for the four key risk factors (overweight, obesity, underweight and stunting) differed considerably depending upon the anthropometric reference used to classify these measures, but were notable regardless of reference. Nutritional and household environmental indices, including child underweight and household sanitation facilities, were strongly associated with stunting risk in this population. Furthermore, children with parents who were obese or centrally obese had an approximately twofold increased risk of being obese. There was no clear evidence of association between measures of socioeconomic position and cardiometabolic disease risk factors among children. Finally, effective procedures were established for the collection, analysis and storage of biological samples from children and their family members in the HDSS, with implications for potential scale-up to facilitate more detailed characterisation of cardiometabolic disease risk. Conclusions: This work indicates a high burden of cardiometabolic disease risk factors among children in this population, identifies modifiable sociodemographic influences on these risk factors, highlights opportunities to more comprehensively characterise child cardiometabolic disease risk in this population, and hence informs future directions for research and strategies to address the growing burden of risk factors among children in this region.

Background Knowledge of the state of health of a population is necessary for planning for health services for that population. It is  a paradox that the health of populations is most commonly measured by mortality and cause of death patterns, but the absence of medical services available to a majority of the world population has made it unavoidable to equate “state of health” with “cause of death pattern”. In the absence of population registration, mortality and causes of death must be studied in samples from the population. The research presented in this thesis mainly has been done within such a sample in a collaborative project between Umeå university and the Addis Ababa university in Ethiopia. This research started 1986 and has run continuously since then. The thesis attempts to measure the effect that social and geographical inequalities has had on the mortality of the children in the study population. Population and Methods The population that is included in the demographic surveillance is the children under five years of age in nine rural and one urban community in central Ethiopia. Mortality and causes of death among the children have been followed since 1987. Results The mortality of the children in the study is high by international comparisons. The most important reason for mortality differences within the population is the difference in living conditions and societal services between the rural and urban areas. Approximately 45% of the child deaths could have been prevented if living conditions and services had been equal to rural and urban children. Conclusions Information concerning mortality and cause of death patterns are essential to planning. In order to empower the population, knowledge of the mortality and most common causes of death must be known to them.

Thesis (M.A. (Population and Reproductive Health Research))--Mahidol University, 2003.

Thesis (M.A. (Population and Reproductive Health Research))--Mahidol University, 2003.

Thesis (M.A. (Population and Reproductive Health Research))--Mahidol University, 2003.

Thesis (M.A. (Population and Reproductive Health Research))--Mahidol University, 2003.

Thesis (M.A. (Population and Reproductive Health Research))--Mahidol University, 2004.

Thesis (Ph.D. (Demography))--Mahidol University, 2005.