Introdução A mortalidade infantil (MI) no Município de São Paulo (MSP) apresenta queda, principalmente a partir da década de 80, entretanto é possível que existam diferenças regionais importantes entre Subprefeituras uma vez que estas apresentam características sócio-ambientais que podem influenciar neste indicador. Objetivo Descrever e analisar a evolução da MI no período de 2000 a 2007, segundo Subprefeituras do MSP. Métodos Estudo ecológico longitudinal, com 31 unidades de análise (Subprefeituras). Utilizou-se, para a análise estatística, o modelo de regressão linear multinível, considerando-se, como variável resposta, o CMI e oito anos de observação (2000 a 2007). O modelo incluiu variáveis relacionadas aos serviços de saúde. Resultados A queda da MI não ocorre de modo homogêneo entre as Subprefeituras evidenciadas pelas diferentes inclinações das retas e interceptos observados e estimados. Após a análise pelo modelo multinível observou-se redução da MI no período de 18,8% com declínio médio de 0,300/00nv ao ano Pelo modelo, 51% da variabilidade da MI se explica por características contextuais das Subprefeituras. No período de estudo, o CMI aumenta: 0,0560/00nv para cada 1% de aumento na proporção de mães com pré-natal inadequado, 0,2140/00nv para cada 1% de aumento na proporção da população exclusivamente usuária SUS, 0,0390/00nv para cada aumento na taxa de leitos obstétricos SUS. O CMI diminui: 0,1910/00nv para cada 1% de aumento na proporção de recuperação da vitalidade do nv. Conclusão A MI apresenta tendência de queda no período de 2000 a 2007 de modo não homogêneo segundo Subprefeitura. As variáveis que apresentaram associação com a MI são: o ano de observação, proporção de nascidos vivos de mães que realizaram até 6 consultas pré-natal (pré-natal inadequado); taxa de leitos obstétricos do Sistema Único de Saúde (SUS); proporção da população exclusivamente usuária do SUS e proporção de recuperação da vitalidade do nascido vivo. Na região periférica do MSP onde se encontram as maiores proporções da população exclusivamente usuária SUS, é também onde se apresentam os maiores CMI. / Introduction - Infant mortality (IM) in São Paulo (MSP) has declined, especially from the 80s. However, there may be important regional differences between Districts as their socio-environmental characteristics may influence this indicator. Objective - To describe and analyze IM trend in the period from 2000 to 2007, according to the Districts of MSP. Method - Ecological longitudinal study comprising 31 units of analysis (Districts). Linear multilevel regression model was used for statistical analysis. Infant Mortality Rate (IMR) and eight years of observation (2000-2007) were used as dependent variables. The model included variables related to health services. Results The decrease in IM does not occur homogeneously between Districts as evidenced by the different slopes and intercepts of the observed and estimated lines. A multilevel model showed an 18.8% reduction in IM in the period with an average decline of 0,300/00 living born (lb) per year. According to the model, 51% of the IM variability can be explained by contextual features of districts. During the study period, IMR increases: 0,0560/00lb for every 1% increase among mothers with inadequate prenatal care, 0,2140/00lb for every 1% increase among users of the Unified Health System (UHS), 0,0390/00lb for each increase in the UHS obstetric beds rate. IMR decreases 0,1910/00lb for every 1% increase in the vitality proportion of recovery of live births. Conclusion - IM shows a declining trend over the period from 2000 to 2007 in a non-homogeneous way according to District. The variables that were associated with IMR: year of observation, proportion of live births from mothers who had up to 6 prenatal visits (inadequate prenatal care), Unified Health System (UHS) obstetric beds rate, proportion of UHS users and vitality recovery of live birth proportion. The highest IMR is found in peripheral region of MSP where the largest proportion of UHS users is found.

Introdução A mortalidade infantil (MI) no Município de São Paulo (MSP) apresenta queda, principalmente a partir da década de 80, entretanto é possível que existam diferenças regionais importantes entre Subprefeituras uma vez que estas apresentam características sócio-ambientais que podem influenciar neste indicador. Objetivo Descrever e analisar a evolução da MI no período de 2000 a 2007, segundo Subprefeituras do MSP. Métodos Estudo ecológico longitudinal, com 31 unidades de análise (Subprefeituras). Utilizou-se, para a análise estatística, o modelo de regressão linear multinível, considerando-se, como variável resposta, o CMI e oito anos de observação (2000 a 2007). O modelo incluiu variáveis relacionadas aos serviços de saúde. Resultados A queda da MI não ocorre de modo homogêneo entre as Subprefeituras evidenciadas pelas diferentes inclinações das retas e interceptos observados e estimados. Após a análise pelo modelo multinível observou-se redução da MI no período de 18,8% com declínio médio de 0,300/00nv ao ano Pelo modelo, 51% da variabilidade da MI se explica por características contextuais das Subprefeituras. No período de estudo, o CMI aumenta: 0,0560/00nv para cada 1% de aumento na proporção de mães com pré-natal inadequado, 0,2140/00nv para cada 1% de aumento na proporção da população exclusivamente usuária SUS, 0,0390/00nv para cada aumento na taxa de leitos obstétricos SUS. O CMI diminui: 0,1910/00nv para cada 1% de aumento na proporção de recuperação da vitalidade do nv. Conclusão A MI apresenta tendência de queda no período de 2000 a 2007 de modo não homogêneo segundo Subprefeitura. As variáveis que apresentaram associação com a MI são: o ano de observação, proporção de nascidos vivos de mães que realizaram até 6 consultas pré-natal (pré-natal inadequado); taxa de leitos obstétricos do Sistema Único de Saúde (SUS); proporção da população exclusivamente usuária do SUS e proporção de recuperação da vitalidade do nascido vivo. Na região periférica do MSP onde se encontram as maiores proporções da população exclusivamente usuária SUS, é também onde se apresentam os maiores CMI. / Introduction - Infant mortality (IM) in São Paulo (MSP) has declined, especially from the 80s. However, there may be important regional differences between Districts as their socio-environmental characteristics may influence this indicator. Objective - To describe and analyze IM trend in the period from 2000 to 2007, according to the Districts of MSP. Method - Ecological longitudinal study comprising 31 units of analysis (Districts). Linear multilevel regression model was used for statistical analysis. Infant Mortality Rate (IMR) and eight years of observation (2000-2007) were used as dependent variables. The model included variables related to health services. Results The decrease in IM does not occur homogeneously between Districts as evidenced by the different slopes and intercepts of the observed and estimated lines. A multilevel model showed an 18.8% reduction in IM in the period with an average decline of 0,300/00 living born (lb) per year. According to the model, 51% of the IM variability can be explained by contextual features of districts. During the study period, IMR increases: 0,0560/00lb for every 1% increase among mothers with inadequate prenatal care, 0,2140/00lb for every 1% increase among users of the Unified Health System (UHS), 0,0390/00lb for each increase in the UHS obstetric beds rate. IMR decreases 0,1910/00lb for every 1% increase in the vitality proportion of recovery of live births. Conclusion - IM shows a declining trend over the period from 2000 to 2007 in a non-homogeneous way according to District. The variables that were associated with IMR: year of observation, proportion of live births from mothers who had up to 6 prenatal visits (inadequate prenatal care), Unified Health System (UHS) obstetric beds rate, proportion of UHS users and vitality recovery of live birth proportion. The highest IMR is found in peripheral region of MSP where the largest proportion of UHS users is found.

[Truncated abstract] The aims of the study were twofold; firstly, to describe the inequality in infant mortality in Indonesia namely, to look at the extent and magnitude of the problem in terms of the estimated number of infant deaths, the differentials in infant mortality rates, the probability of infant deaths across provinces, urban and rural areas, and across regions of Indonesia. Secondly, to examine the effect of family welfare status and maternal educational levels on the probability of infant deaths. The study design was that of a population-based multistage stratified survey of the 1997 Indonesian Demographic and Health Survey. Results of the study were obtained from a sample of 28,810 reproductive women aged 15 to 49 years who belonged to 34,255 households. A binary outcome variable was selected, namely, whether or not each of the live born infant(s) from the interviewed women was alive or dead prior to reaching one year of age. Of interest were the variables related to socio-economic status, measured by Family Welfare Status Index and maternal educational levels. The following risk factors were also investigated: current contraceptive methods; birth intervals; maternal age at first birth; marital duration; infants’ size perceived by the mothers; infants’ birth weight; marital status; prenatal care by health personnel; antenatal TT immunization; place of delivery; and religion. Geographical strata (province) and residence (urban and rural areas) were also considered. Both descriptive and multivariate analyses were undertaken. Descriptive analysis was aimed at obtaining non-biased estimates of the infant mortality rates at the appropriate levels of aggregation. Multivariate analysis involved a logistic regression model using the Generalized Estimating Equations (GEE) model-fitting technique. The procedure, a multilog-cumlogit , uses the Taylor Series Linearization methods to compute modelbased variance, and which adjusts for the complex sampling design. Results of descriptive analysis indicate that, indeed, there are inequalities in infant mortality across administrative divisions of the country, represented by provinces and regions, as well as across residential areas, namely urban and rural areas. Also, the results suggested that there is socio-economic inequality in infant mortality, as indicated by a dose-response effect across strata of family welfare and maternal educational levels, both individually and interactively. These inequalities varied by residence (urban and rural), provinces and regions (Java Bali, Outer Java Bali I and Outer Java Bali II). Furthermore, the probability of infant mortality was significantly greater among highrisk mothers, characterized by a number of risk factors used in the study

Made available in DSpace on 2014-12-17T14:23:30Z (GMT). No. of bitstreams: 1 AntoninoMS_DISSERT.pdf: 2409934 bytes, checksum: 8deb32c4b1c79a7f200d0575c1f33625 (MD5) Previous issue date: 2013-06-07 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The study aims to answer the following question: what are the different profiles of infant mortality, according to demographic, socioeconomic, infrastructure and health care, for the micro-regions at the Northeast of Brazil? Thus, the main objective is to analyze the profiles or typologies associated mortality levels sociodemographic conditions of the micro-regions, in the year 2010. To this end, the databases of birth and death certificates of SIM and SINASC (DATASUS/MS), were taken from the 2010 population Census microdata and from SIDRA/IBGE. As a methodology, a weighted multiple linear regression model was used in the analysis in order to find the most significant variables in the explanation child mortality for the year 2010. Also a cluster analysis was performed, seeking evidence, initially, of homogeneous groups of micro-regions, from of the significant variables. The logit of the infant mortality rate was used as dependent variable, while variables such as demographic, socioeconomic, infrastructure and health care in the micro-regions were taken as the independent variables of the model. The Bayesian estimation technique was applied to the database of births and deaths, due to the inconvenient fact of underreporting and random fluctuations of small quantities in small areas. The techniques of Spatial Statistics were used to determine the spatial behavior of the distribution of rates from thematic maps. In conclusion, we used the method GoM (Grade of Membership), to find typologies of mortality, associated with the selected variables by micro-regions, in order to respond the main question of the study. The results points out to the formation of three profiles: Profile 1, high infant mortality and unfavorable social conditions; Profile 2, low infant mortality, with a median social conditions of life; and Profile 3, median and high infant mortality social conditions. With this classification, it was found that, out of 188 micro-regions, 20 (10%) fits the extreme profile 1, 59 (31.4%) was characterized in the extreme profile 2, 34 (18.1%) was characterized in the extreme profile 3 and only 9 (4.8%) was classified as amorphous profile. The other micro-regions framed up in the profiles mixed. Such profiles suggest the need for different interventions in terms of public policies aimed to reducing child mortality in the region / O estudo prop?e-se responder ? seguinte quest?o: quais os diferentes perfis da mortalidade infantil, segundo vari?veis demogr?ficas, socioecon?micas, de infraestrutura e de assist?ncia ? sa?de, das microrregi?es do Nordeste brasileiro? Assim, o objetivo principal ? analisar os perfis ou tipologias de mortalidade associados aos n?veis de condi??es sociodemogr?ficas das microrregi?es, no ano de 2010. Para tanto, fez-se uso das bases de dados do SIM e SINASC (DATASUS/MS), dos microdados do Censo populacional de 2010 e do SIDRA/IBGE. Utilizou-se como vari?vel resposta, a mortalidade infantil e, como independentes, vari?veis demogr?ficas, socioecon?micas, de infraestrutura e de assist?ncia ? sa?de das microrregi?es. Como metodologias de an?lise, foram empregadas: a regress?o linear m?ltipla ponderada, para encontrar as vari?veis mais significantes na explica??o da mortalidade infantil, para o ano de 2010 e a an?lise de clusters, buscando encontrar ind?cios, inicialmente, de grupos homog?neos de microrregi?es, a partir das vari?veis significantes. Utilizou-se como vari?vel resposta, o logito da taxa de mortalidade infantil e, como independentes, vari?veis demogr?ficas, socioecon?micas, de infraestrutura e de assist?ncia ? sa?de das microrregi?es. A t?cnica de estima??o Bayesiana Emp?rica foi aplicada ?s informa??es de ?bitos e nascimentos, devido ao fato inconveniente da subnotifica??o e das flutua??es aleat?rias de pequenos n?meros existentes nas pequenas ?reas. As t?cnicas de Estat?stica Espacial foram usadas para apurar espacialmente o comportamento da distribui??o das taxas a partir de mapas tem?ticos. Concluindo, empregou-se o m?todo GoM (Grade of Membership), para encontrar tipologias de mortalidade associadas ?s vari?veis, selecionadas por microrregi?o, buscando responder ? quest?o principal do estudo. Os resultados apontam para a forma??o de tr?s perfis: o perfil 1, de alta mortalidade infantil e condi??es sociais de vida desfavor?veis; o perfil 2, de baixa mortalidade infantil, com medianas condi??es sociais de vida; e o perfil 3, de mediana mortalidade infantil e altas condi??es sociais de vida. Com esta classifica??o, encontrou-se que, das 188 microrregi?es, 20 (10%) enquadraram-se ao perfil extremo 1, 59 (31,4%) caracterizaram-se no perfil extremo 2, 34 (18,1%) caracterizaram-se no perfil extremo 3 e apenas 9 (4,8%) classificaram-se como perfil amorfo. As demais microrregi?es enquadraram-se nos perfis mistos. Tais perfis sugerem a necessidade de diferentes interven??es em termos de pol?ticas p?blicas voltadas para a redu??o da mortalidade infantil na regi?o

The aim of this thesis was to analyse detailed data on the development of infant mortality for different countries and their comparison. The countries were selected from several parts of Europe to provide high quality data for analysis. Different components of infant mortality with respect to data availability were examined as well as infant mortality by gender. Comparisons among selected countries were made based on different variability measures. Largely, the thesis deals with infant mortality depending on the level of development of the countries. Using regression and correlation analysis, infant mortality dependence was determined on various determinants with prerequisites to explain part of the infant mortality variability. The selected determinants include, for example, GDP per capita, unemployment rate or life expectancy.

The life expectancy development during the past 150 years has been remarkable in many parts of the world. These developments, however, have been very different across countries. In Europe, the diverse historical and political changes lead to clusters of regions that followed different mortality developments. The aim of this study was to examine how countries that entered the European Union in 2004 and 2007 differ in terms of mortality from continuous members of the EU and from Eastern European countries that have never joined the EU. Moreover, I studied a possible convergence in mortality indicators between these groups of countries. The data used to explore mortality conditions in those groups of countries was derived from two sources: The Human Mortality Database and European Health for All Database. Descriptive statistics and calculations of average yearly pace of change for groups of countries have been applied for each mortality indicator. Furthermore, regression models have been conducted to estimate the impact of belonging to a country group on mortality indicators, adjusted for some macro-level indicators of economic progress and health expenditure. The results verified previous research implying the importance of period factors which can affect mortality in the short term. For all mortality indicators, accelerated improvements between 1995 and 1999 have been found in countries who became EU members in 2004. Moreover, life expectancy convergence was observed for life expectancy at birth but not for the older ages which could imply that the positive progress affected older ages to smaller degree. My findings confirm the importance of social environment and imply that the process of joining the EU possibly could reduce social stress and affect mortality conditions positively.

This thesis investigates the relationship between violent conflicts and sexual and reproductive health in Rwanda and the Democratic Republic of Congo (DRC). The aim of the thesis is to investigate how war affects demographic outcomes across individual life courses. The thesis contributes to the research field by linking macro level conflict data measuring the intensity and frequency of violent conflict with micro level data on women’s sexual and birth histories and infant deaths across time and place. The results show that war affects infants’ survival and women’s sexual and reproductive health and behavior. The first study finds an increase of premarital first sexual intercourse during the violent conflicts in Rwanda. The second study finds evidence of a delay in the fertility transition due to the Congolese war and the lingering conflicts in East DRC. The third study suggests that the Congolese war affects infant mortality, but only post-neonatal mortality. Despite consistent evidence that conflict affects the everyday life of women and children, the mechanisms that explain this relationship are largely unknown. This thesis identifies important gaps in the research that limit our understanding of the mechanisms at work. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: Manuscript. Paper 3: Submitted.</p>

Magister Philosophiae - MPhil / Skilled birth attendance at childbirth is vital for decreasing maternal and child mortality in Zimbabwe. Infant mortality and maternal mortality in Zimbabwe are quite high due to low- use of skilled birth attendance. Based on different study sources, home delivery with complications are high, with many socio-economic and demographic associated factors including lack or no use of skilled birth attendance at childbirth in Zimbabwe. Therefore, the study looked at "preventive" which refers to an action taken to reduce or eliminate the probability of specific undesirable events or dangers from happening in the future and the present time in Zimbabwe. The objective of the study was to highlight the significance of the crucial function within the health systems of saving both the lives of a mother and the child. Furthermore to determine the frequent use of maternal health care services (skilled birth attendant) and identify factors affecting them. The data that was used was nationally represented large scale secondary data ZDHS of Zimbabwe with sample population n = 9,171. It was a secondary data that included all the provinces of Zimbabwe, simple random sampling was used that had questionnaires of both man, women and household questionnaires, these questionnaires helped in examining the socio-economic factors and determinants that leads to low-use of skilled birth attendants at childbirth. The prosed statistics analysis that were used were univariate, bivariate and multivariate techniques. The statistical analysis showed that demographic variables such age, place of delivery and socio-economic factors such as level of education of a mother and wealth index (occupation of a parent) and region has a significant effect on the use of skilled birth attendant during birth. Women with higher level of education were found to have high use rate of maternal health care services (Skilled birth attendants), while women with primary and secondary education were found to have high use rate of less ( traditional birth attendant) or no use of skilled birth attendant. Therefore, the female age at birth, place of delivery, level of education and wealth index played a major role in decision making about the importance of having a skilled birth attendant when giving birth. The access to skilled birth attendance was found to be a significant factor in reducing maternal and child mortality in Zimbabwe. Furthermore women need to be educated about the importance of maternal health care services use and postnatal care and the department of health in Zimbabwe can implement mobile clinics for those who are residing far from health facilities.

Division of Forensic Medicine and Pathology, University of the Witwatersrand Submitted in fulfilment of the requirements for the degree of Masters of Science in Medicine In the Health Science Faculty University of Witwatersrand Johannesburg 2014 / Within the field of paediatric pathology dominant universal trends have emerged with child abuse related fatalities and child murders being at the forefront. However, several authors have noted that such trends have not been documented within the South African context. This is due to the lack of data collection and research within South Africa. Patterns of injury and prevalence of paediatric fatalities received at the Johannesburg Forensic Pathology Service (JHB FPS) over three years were observed through a descriptive, retrospective study. Data were collected from FPS case files and Police reports (SAPS180) accompanying the body to the mortuary. The results indicated that the majority of paediatric deaths were due to blunt force injuries, natural disease processes and drowning. Subdural and subarachnoid haematomas, multiple blunt force internal injuries, hyperinflation and consolidation of the lungs and features of dehydration were the dominant patterns of injuries and disease. Additionally, results exhibited a significant difference in age range when correlated to category of death as well as a high risk of mortality within the first year of life. This study highlights the alarming figures of accidental and socio-economic paediatric death cases which are received at the JHB FPS. Keywords: Child mortality, Injury patterns, Forensic Pathology

Objetivo: Discutir criticamente, descrever e analisar os dados de óbitos infantis disponibilizados pelos serviços públicos da província de Cabinda-Angola. Método: Foram estudados nascimentos vivos em hospitais da província de Cabinda, e óbitos de menores de um ano de idade, nos anos 2007 e 2008. Como fonte de dados foram utilizados os registrados nos livros de registro dos hospitais municipais, d o hospital provincial e do escritório provincial da OMS de Cabinda. Os dados são contextualizados pela experiência do autor como habitante da região. Resultados: Os resultados deste trabalho mostram que em 2008 morreram mais crianças no primeiro dia de vida (109) que nos 11 meses restantes (97). Contudo, evidencia-se que 200 óbitos (54,64 por cento ) ocorreram em menores de 28 dias de idade em 2007 enquanto que para o mesmo período em 2008 morreram 178 crianças, Quanto às causas básicas de mortes infantis, a malária é destacada como principal causa. Isoladamente a malária responde aproximadamente por uma morte a cada três crianças falecidas. Dentre as doenças evitáveis por vacinação, o tétano responde por cerca de 5 por cento das mortes. Entre as doenças controláveis por saneamento básico, as diarréias ocupam posição de destaque 9,83 por cento em 2007 e 3,27 por cento em 2008. A redução de 65 para 40 óbitos por pneumonia entre as crianças inscreve-a como segunda ou terceira causa mais importante de óbito entre as crianças cabindenses, partilhando espaço com a asfixia neonatal (17,75 por cento em 2007 e 26,90 por cento em 2008). Apesar das dificuldades e limitantes da qualidade das informações encontradas durante a coleta de dados, buscou-se valorizar as existentes e que foram analisa das neste trabalho. Conclusões: Os resultados obtidos indicam que em Cabinda, melhorias na qualidade de assistência pré-natal, ao parto e ao recém-nascido de risco, poderiam reduzir ainda que parcialmente a Mortalidade Infantil. Fatores como condições inadequadas de abastecimento de água, falta de saneamento básico, dentre outros, revelaram ter papel importante como condicionantes da elevada Mortalidade Infantil observada em Cabinda. Apesar de ser atraente priorizar investimentos dos recursos em ações curativas, este trabalho reforça a perspectiva revisitar as políticas locais de Saúde e priorizar as atividades preventivas nos municípios da grande Cabinda. Assim, sugere-se a implantação de uma rede primária de assistência à saúde e um investimento permanente na melhoria da qualidade das informações de Saúde / Objective: To critically discuss, describe and analyze the infant deaths data available for public services in the province of Cabinda-Angola. Method: A total of live births in hospitals in the province of Cabinda, and deaths of children under one year of age, in years 2007 and 2008. The data source were used those recorded on the records of municipal hospitals, the provincial hospital and the provincial office of WHO in Cabinda. The data are contextualized by the author\'s experience as an inhabitant of the region. Results: The results of this study suggested that in 2008 more children died in the first days of life (109) than in the remaining 11 months (97). However, it is clear that 200 deaths (54.64 per cent ) occurred in children younger than 28 day- old in 2007 while for the same period in 2008 died 178 children. As the root causes of child deaths, malaria is highlighted as the main cause. Malaria alone accounts for approximately one death every three children who die. Among the vaccinepreventable diseases, tetanus accounts for about 5 per cent of deaths. Among the diseases controlled by sanitation, diarrhea, occupy a prominent position in 2007, 9.83 per cent and 3.27 per cent in 2008. The reduction from 65 to 40 deaths from pneumonia among children falls as the second or third most important cause of death among children Cabinda, sharing space with neonatal asphyxia (17.75 per cent in 2007 and 26.90 per cent in 2008). Despite the difficulties, limiting the quality of information found during the data collection, we sought to enhance existing ones, which were analyzed in this work. Conclusions: The results indicate that in Cabinda, improvements in quality of prenatal care, childbirth and the newborn at risk, even partially could reduce infant mortality. Factors such as inadequate water supply, poor sanitation, among others, were found to have important role as determinants of high infant mortality observed in Cabinda. Despite being attractive investments prioritize resources on curative actions, this work reinforces the perspective of revisit policies and prioritize local health preventive activities in the great area of Cabinda. Thus, we suggest the establishment of a network of primary health care and an ongoing investment to improve the quality of information on Health