Thesis (M.A.(Population and Reproductive Health Research))--Mahidol University, 2005. / LICL has E-Thesis 0004 ; please contact computer services.

Thesis (M.A. (Population and Reproductive Health Research))--Mahidol University, 2005. / LICL has E-Thesis 0005 ; please contact computer services.

Thesis (Ph.D. (Demography))--Mahidol University, 2006. / LICL has E-Thesis 0012 ; please contact computer services.

Thesis (Ph.D. (Demography))--Mahidol University, 2007. / LICL has E-Thesis 0027 ; please contact computer services.

This report examines the influence of parent’s migration status on childhood mortality in sending households in the South African rural sub-district of Agincourt. A survival analysis of a cohort of children born in Agincourt between 1 January 1997 and 31 December 2003 was conducted using the Cox proportional hazards model to estimate the influence of parent’s migration status on under-5 year mortality. Starting with a baseline census in 1992, the Agincourt Health and Demographic Surveillance System (AHDSS) data are collected and updated every 12 months wherein fieldworkers visit each household at the site to record the vital events, including births, deaths, and migrations that occurred since the previous census. Results of the survival analysis show that children born in households where the father was a temporary migrant while the mother remained at the rural household had a 35% lower risk of death compared to children in households where both parents were non-migrant (RR=0.647, 95% CI 0.439-0.954). The results also reveal that, controlling for parent migration status, children in single-parent (mother only) households had about 28% higher death hazard than children in two-parent households (RR=1.284, 95% CI 0.936-1.673). The findings suggest that temporary labour migration could be a means to improving household incomes and quality of life for children, particularly where the father is a temporary migrant while the mother remains behind taking care of the children. At the same time, children whose fathers are not indicated appear to be worse off whether their parents are temporary migrants or not.

Background: The challenge of research in resource-poor settings remains a profound concern and is closely linked to African social development. Work of this thesis spans the end of apartheid and first decade of the democratic era in South Africa, along with emergence of the HIV/AIDS pandemic. It also covers the founding decade of the INDEPTH Network. Aims: Through appraising health and population research in a rural southern African sub-district over the past decade, to evaluate the utility of health and socio-demographic surveillance in rural African settings for: • capturing the dynamics of health, population and social transitions • supporting a mix of research designs, and • contributing to policy and programme development and evaluation. To extend this appraisal by examining the multi-site opportunities offered by the INDEPTH Network. Methods: Work was sited in the Agincourt sub-district, a heavily populated border area of rural north-eastern South Africa. Health and socio-demographic surveillance, introduced in 1992, involved prospective follow-up of the entire sub-district population of 70,000 people (including some 30% Mozambican immigrants) who lived in 11,700 households and 21 villages. Annual census rounds systematically updated household membership and recorded all vital events (births, deaths and migrations) since the previous census. A maternity history was asked of women of reproductive age and a verbal autopsy carried out on all deaths registered. The resulting ‘data and research platform’ – a core feature of all INDEPTH field sites – provided data for computation of trends in vital events and supported an extensive interdisciplinary project portfolio. The population under surveillance can be disaggregated into cohorts selected by age, sex or other criteria. Analyses are possible at multiple levels (individual, family/household or neighborhood) and can include socioeconomic factors. Findings: The Agincourt community experienced a serious worsening of mortality among most age-sex groups, rapidly declining fertility to near replacement level, and changing patterns of labour migration. This resulted in major changes in population structure and household composition. The rising burden of chronic disease involved both chronic infectious illness (HIV/AIDS and tuberculosis) and non-communicable disorders (such as stroke and related vascular disease). The burden of illness requiring chronic care increased disproportionately to that needing acute care. Potential contributions of field sites based on health and socio-demographic surveillance to local and national health policy are considerable yet remain underexploited. Interpretation: Rural South and southern Africa is in the midst of multiple, interrelated transitions with implications for health, social and development sectors. Health and socio-demographic surveillance systems are effective research instruments that can capture the rapidly-changing dynamics of health and social transitions in developing settings. Similarly, they can support a range of observational and intervention study designs including policy evaluations. The INDEPTH Network should boost much-needed comparative research; yet singly, and as a group, many of these sites have yet to fulfil their undoubted potential.

Background: The epidemic of chronic diseases is largely neglected. Although a threatening burden of chronic diseases is emerging, developing public health efforts for their prevention and control is not yet a priority for trans-national and national health policy makers. Understanding the population burden of risk factors which predict chronic diseases is an important step in reducing the impact of the diseases themselves. Objective: This thesis responds to the increasing burden of chronic diseases worldwide, and aims to illustrate the gap in chronic disease risk factor research in developing countries. The thesis describes and analyses the distribution of chronic disease risk factors in a rural setting in Indonesia. It also describes how smoking, one of the most common risk factors, is viewed by rural Javanese boys. Ultimately, therefore, this thesis aims to contribute to policy and programme recommendations for community interventions in a rural setting in Indonesia Methods: The studies were conducted in Purworejo District, where a Demographic Surveillance System (DSS) has been running since 1994. The Purworejo DSS is part of the INDEPTH network (International Network of field sites for continuous Demographic Evaluation of Populations and Their Health in developing countries). Two representative cross-sectional studies (in 2001 and 2005) were conducted to assess the chronic disease risk factors (including smoking, elevated blood pressure, and overweight and obesity). The first cross-sectional study was followed up in 2002 and 2004. In each study, a total of 3 250 participants (approximately 250 individuals in each sex and age group among 15–74 year olds stratified into 10-year intervals) were randomly selected from the surveillance database from each enumeration area in the surveillance area. Instruments were adopted from the WHO STEPS survey and adapted to local setting. Since many Indonesians start to smoke at an earlier age, a qualitative study using a focus group discussion approach was conducted among school boys aged 13-17 years old to describe and explore beliefs, norms, and values about smoking in a rural setting in Java. Result: Both the rural and urban populations in Purworejo face an unequal distribution of risk factors for chronic diseases. The burden among the most well-off group in the rural area has already reached a level similar to that found in the urban area. Most of the risk factors increased in all age, sex and socioeconomic groups during the period of 2001 to 2005. However, women and the poorest group experienced the greatest increase in risk factor prevalence. The qualitative study showed that cultural resistance against women smoking in Indonesia remains strong. Smoking is being viewed as a culturally internalised habit that signifies transition into maturity and adulthood for boys. Smoking is utilised as a means for socialisation and signifies better socioeconomic status. The use of tobacco in the construction of masculinity underlines the importance of gender specific interventions. National tobacco control policy should emphasise a smoking free society as the norm, especially among boys and men, and regulations regarding the banning of smoking should be enforced at all levels and areas of the community. Within the demographic surveillance setting, it is possible to assess the population and health dynamics. Utilisation of a standardised methodology across sites in INDEPTH will produce comparable population-based data in developing countries. Such comparisons are important in global health. A comparison of smoking transition patterns between a Vietnamese DSS and an Indonesian DSS shows that Indonesian men started smoking regularly earlier and ceased less than Vietnamese men. Compared with Vietnam, which has already signed and ratified the Framework Convention on Tobacco Control, tobacco control activities in Indonesia are still deficient. Conclusion: The thesis concludes that the rural population is not spared from the emerging burden of chronic disease risk factors. The patterning of risks across different socioeconomic groups provides a macro picture of the vicious cycle between poverty and chronic diseases. Understanding of risk factors in a local context through a qualitative study provides insight into cultural aspects relating to risk factor adoption, and will allow the fostering and tailoring of culturally appropriate interventions. Combining data from demographic surveillance sites with the WHO STEP approach to chronic disease risk factor Surveillance addresses basic epidemiological questions on chronic diseases. The use of such data is a powerful advocacy tool in public health decision-making for chronic disease prevention in developing countries. With substantial existing evidence on the effectiveness of chronic disease prevention and intervention programmes, it is vital that Indonesia to starts planning intervention programmes to control the impending chronic disease epidemic, and most importantly, to translate all this evidence into public health action. Keywords: chronic disease, risk factor, demographic surveillance system, smoking, elevated blood pressure, overweight and obesity, population-based intervention

Background. Pregnant women need adequate antenatal care (ANC) and delivery care fortheir own health and for healthy children. Availability of such care has increased in Vietnam but maternal mortality remains high and variable between population groups. Aims. The general aim of this thesis is to describe and discuss the use of antenatal and delivery care in relation to demographic and socio-economic status and other factors in two health and demographic surveillance sites (HDSS), one rural and one urban. One specificaim of the thesis is to present experiences of running the urban HDSS. Methods. Between April 2008 and December 2009, 2,757 pregnant women were identifiedin the sites. Basic information was obtained from 2,515 of these. The use of ANC was followed to delivery for 2,132. Three indicators were used. ANC was considered overall adequate if the women started ANC within the first trimester, used three or more visits and received all the six recommended core services at least once during pregnancy. Delivery care was studied for all the 2,515 women. Main Findings. Nearly all 2,132 participants used ANC. The mean numbers of visits were 4.4 and 7.7 in the rural and urban areas. Mainly due to less than recommended use of core ANC services, overall ANC adequacy was low in some groups, particularly in the rural area (15.2%). The main risk factors for not having adequate ANC were (i) living in a rural area,(ii) low level of education, (iii) low economic status and (iv) exclusive use of private ANC providers. Rural women accessed ANC mainly at commune health centers and private clinics. Urban women accessed ANC and gave birth at central hospitals and provincial hospitals. Caesarean section (CS) was common among urban women (38.5%). Good socioeconomic condition and male babies were associated with delivery in hospitals and CS births. Almost all women had one or more antenatal ultrasound examination, the mean was about 4.5. Rural women spent 3.0% and 19.0% of the reported annual household income percapita for ANC and delivery care, respectively, compared to 6.1% and 20.6% for urbanwomen. The relative economic burden was heaviest for poor rural women. Conclusion. The coverage of ANC was high in both contexts but with large variations between population subgroups. The major concerns are that poor women in the rural area received incomplete services according to recommendations and that many women, particularly the well-off, in the urban area appeared to overuse technology, ultrasound scanning, delivery in highlevel health care and CS delivery. National maternal healthcare programs should focus on improving ANC service content in rural areas and controlling technology preference in urban. The pregnant women with relatives and friends as well as ANC providers share the responsibility for a positive development. All parties involved must be targeted to improve knowledge, attitudes and practices.

Thesis (M.A.(Population and Reproductive Health Research))--Mahidol University, 2005. / LICL has E-Thesis 0004 ; please contact computer services.

Thesis (Ph.D. (Demography))--Mahidol University, 2007. / LICL has E-Thesis 0024 ; please contact computer services.