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Now showing 1 - 8 of 8
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    Patterns of injury and pathology in paediatric deaths processed at the Johannesburg Forensic Pathology Service over the period 2009 - 2011
    (2015-04-22) Thornton, Roxanne
    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
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    Modelling spatiotemporal patterns of childhood HIV/TB related mortality and malnutrition: applications to Agincourt data in rural South Africa
    (2014-02-18) Musenge, Eustasius
    Background: South Africa accounts for more than a seventh of the global population living with HIV/AIDS and TB, and ranks highest in HIV/TB co-infection worldwide. Consequent high child mortality is exacerbated by child malnutrition, which is an important indicator of health status and is associated with morbidity as well as mortality. Rural areas usually present with the greatest burden of morbidity and mortality, yet the extent of geographical disparities in child mortality, malnutrition and HIV/TB has hardly been explored. This is a reservoir of information useful for effective public health interventions. In this thesis we investigated the factors associated with childhood HIV/TB mortality and malnutrition, how they interrelate and their spatial distribution in the rural Agincourt sub-district located in north-east South Africa close to the border with Mozambique. Rationale: Africa at large lacks data that are routinely and reliably collected then validated, to guide policy and intervention programmes. Causes of deaths and even death counts are often misclassified and underestimated respectively, especially for children. To bridge this gap, a health and socio-demographic surveillance systems located in the rural Agincourt sub-district hosts which annually collects and collates data on vital events including fertility, mortality and migration. These data have been collected since 1992 to-date and now cover 80,000 people living in more than 16,000 households situated in 27 villages; all households are fully geo-coded. These hierarchical data allow us to address several epidemiological questions on how person, place (spatial) and time (temporality) have impacted on mortality and malnutrition patterns in children living in the rural Agincourt sub-district. Objectives: The aims of this thesis were both methodological and applied: Methodological (1) To investigate the presence of spatial autocorrelation in the Agincourt sub-district and model this using geographical and geo-statistical procedures (2) To model large spatial random effects accurately and efficiently (3) To model hierarchical data with zero inflated outcomes Applied (1) To investigate childhood HIV/TB mortality determinants and their geographical distribution using retrospective and cross-sectional data (2) To determine factors associated with malnutrition outcomes adjusting for their multivariate spatial random effects and selection bias for children under five years (3) To model how the associated factors were interrelated as either underlying or proximate factors of child mortality or malnutrition using pathway analysis. Methods: We conducted a secondary data analysis based on retrospective and cross-sectional data collected from 1992 to 2010 from the Agincourt sub-district in rural northeast South Africa. During the period of our study 71,057 children aged 0 to 9 years from 15,703 households were observed. All the data in the thesis were for children aged 1 to under 5 except for the chapter 6 (last paper) who were aged from 0 to 9 years of age. Child HIV/TB death and malnutrition were the outcome measures; mortality was derived from physicianbased verbal autopsy. We investigated presence of spatial autocorrelation using Moran’s and Geary’s coefficients, semi-variograms and estimated the spatial parameters using Bayesianbased univariate and multivariate procedures. Regression modelling that adjusted for spatial random effects was done using linear regression and zero inflated variants for logistic, Poisson and Negative Binomial regression models. Structural equation models were used in modelling the complex relationships between multiple exposures and child HIV/TB mortality and malnutrition portrayed by conceptual frameworks. Risk maps were drawn based on spatial residuals (posteriors) with prediction (kriging) procedures used to estimate for households where no data were observed. Statistical inference on parameter estimation was done using both the frequentist; maximum likelihood estimation and Bayesian; Markov Chain Monte Carlo (MCMC) directly and sometimes aided with Metropolis Hastings or Integrated Nested Laplace Approximations (INLA). Results: The levels of child under-nutrition in this area were: 6.6% wasted, 17.3% stunted and 9.9% underweight. Moran’s (I) and Geary’s (c) coefficients indicated that there was global and local clustering respectively. Estimated severity of spatial variation using the partial-sill-to-sill ratio yielded 12.1%, 4.7% and 16.5%, for weight-for-age, height-for-age and weight-for-height Z-scores measures respectively. Maternal death had the greatest negative impact on child HIV/TB mortality. Other determinants included being a male child and belonging to a household that had experienced multiple deaths. A protective effect was found in households with better socio-economic status and where older children were present. Pathway analyses of these factors showed that HIV had a significant mediator effect and the greatest worsening effect on malnutrition after controlling for low birth-weight selection bias Several spatial hot spots of mortality and malnutrition were observed, with these regions consistently emerging as areas of greater risk, which reinforces geographical differentials in these public health indicators. Conclusion: Modelling that adjusts for spatial random effects, is a potentially useful technique to disclose hidden patterns. These geographical differences are often ignored in epidemiological regression modelling resulting in reporting of biased estimates. Proximate and underlying determinants, notably socioeconomic status and maternal deaths, impacteddirectly and indirectly on child mortality and malnutrition. These factors are highly relevant locally and should be used to formulate interventions to reduce child mortality. Spatial prediction maps can guide policy on where to best target interventions. Child interventions can be more effective if there is a dual focus: treatment and care for those already HIV/TB infected, coupled with prevention in those geographical areas of greatest risk. Public health population-level interventions aimed at reducing child malnutrition are pivotal in lowering morbidity and mortality in remote areas. Keywords: HIV/TB, Child mortality, Child malnutrition, Conceptual framework, Spatial analysis, MCMC, Path analysis, South Africa
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    The effect of distance to formal health facility on chilhood mortality: case of Ifakara DSS in rural Tanzania
    (2010-04-14T07:31:02Z) Kadobera, Daniel
    Background: MDG 4 commits the international community to reducing mortality in children younger than 5 years by two-thirds by 2015.The biggest burden of child mortality lies in Saharan Africa. Objective: To investigate how distance from home to the nearest health facility is associated with infant and child (1-4 years) mortality in a typical rural setting of sub Saharan Africa. Methods: A secondary analysis of 28,823 under five children in Ifakara Health and Demographic surveillance system between 2005 and 2007 was carried out. Both Euclidean and networked distance from the household to the nearest health facility was estimated using geographical information system methods. Cox proportional hazard regression models were used to investigate the effect of distance from home to the nearest health facility on infant and child mortality. Results: Children who lived in homes with networked distance >5KM experienced about 18% increased mortality risk [HR=1.18;95%CI 1.02-1.38 p-value 0.05] compared to those who lived less than 5KM networked distance to the nearest health facility. Death of mother, death of preceding sibling and multiple births were the strongest independent predictors of child mortality. Malaria/AFI and pneumonia/ARI were the leading causes of death in children although there was no evidence to show association of cause specific mortality with networked distance in the study. vi Conclusions: Staying closer to the health facility improved the survival probability of the children. This effect was similar to that reported elsewhere in other studies which re-emphasize the usefulness of having fully functional health facilities closer to the populations that need them. The inconsistency of the Euclidean distance in the study further suggests that the networked distance is a better estimator of geographical accessibility and should be the preferred proxy distance measurement option in public health research. 1 Faculty of Health Sciences, University of the Witwatersrand; South Africa. 2 Ifakara Health & Demographic Surveillance System; Tanzania. 3 Iganga/Mayuge Health & Demographic Surveillance System; Uganda
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    A comparative study of under-five child mortality in different housing settlements in Soweto, South Africa 2002
    (2009-03-25T11:38:44Z) Kutto, Ezekiel Sitienei
    Background: The study examines the differentials in child mortality existing in the different settlements in Soweto Townships as at May 2002. It attempts to establish the association existing between housing settlement and under-five mortality and as well examine how household characteristics such as building materials, source of drinking water, sanitation facilities and source of energy is associated with under-five mortality. Methods: The research comprises secondary data analysis of a household survey conducted in Soweto in May 2002 by Perinatal HIV Research Unit. The aim of the study is to describe child mortality and explore its relationship to five different housing settlements in Soweto Townships. Kaplan Meier curves were fitted to examine differentials in child mortality in the different housing settlements and Log rank test was used to compare the survival curves. Logistic regression models were fitted to establish factors that were associated with under-five mortality in Soweto Townships as a whole. Results: A total of 2741under-five surviving children and 84 under-five deaths were studied. Informal settlements recorded the highest overall under-five mortality rate (15.9 per 10000 child years) while private sector housing settlement recorded the least (3.3 per 10000 child years) of all the housing settlements. The overall under-five mortality in Soweto Townships was 10.4 per 10000 child years. After controlling for other household characteristics settlement was significantly associated with high under-five mortality (Council settlement OR 3.3, P=0.032, 95 CI; 1.113, 10.24, Informal settlement OR 5.10, P=0.005, 95% CI; 1.633, 15.99 and Hostel settlement OR 4.09, P=0.012, 95% CI; 1.357, 12.35). Use of paraffin and candles were also significantly associated with high under-five mortality (OR 3.4, P-value<0.001, 95% CI; 2.416, 19.15 and OR 7.2 P-value=0.014, 95% CI; 1.25, 8.88 respectively). Conclusions: Private sector housing settlements reported lower under-five mortality rates in Soweto Townships (3.3 per 10,000 child years) and was less associated with high mortality in comparison to the other housing settlements (Informal, council and hostel housing settlements) in Soweto Townships. Use of paraffin and candles for lighting in households were mainly associated with high under-five mortality in Soweto Townships in comparison to those households that used of electricity.
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    The association between household food security and mortality in children under-five years of age in Agincourt, Limpopo Province, in 2004
    (2008-10-24T09:05:56Z) Crowther, Penny
    Background: When children experience food insecurity, in addition to poverty, their resultant inadequate food intake and disease often leads to the development of proteinenergy malnutrition and ultimately to death. In South Africa, where three out of every four children live in poverty, food insecurity and its multiple negative effects are consequently among the most urgent social issues affecting households and their children. Since household food insecurity is thought to be associated with increased child mortality, it is important to study any such associations amongst South African children to determine additional risk factors for child mortality. Objectives: The main objective of this study was to establish the relationship between household food security and mortality in children under the age of five years in the Agincourt field site, Limpopo Province, in 2004. Methods: An analytical cross-sectional study of secondary data obtained from the 2004 census questionnaire and food security module of the Agincourt Health and Demographic Surveillance System in rural Limpopo Province was conducted, involving a total of 7,790 black children under the age of five years. Certain exposure variables were selected for use as indicators of food security and these were analysed with respect to child mortality using univariate and multivariate logistic regression. Results: Based on the outcome indicators of food consumption, 37% of the study population were found to have experienced household food insecurity in 2004, reporting insufficient food for the entire household in the previous month and year. The limited dietary diversity and insufficient quantities of food experienced by the majority of the population were supplemented by the local growth of food crops and the gathering of food from the bush. Of the 79 children (1%) under the age of five years who died in 2004, the majority (24%) died of HIV-related diseases, in addition to deaths caused by diarrhoea, respiratory infections, and malnutrition. Child mortality was found to be associated with the reporting of “unknown” for several indicators of food security. Additionally, expecting the food availability of the household in the coming year to be less than that of the current year (that is, the prediction of future household food insecurity) was significantly associated with an increased risk of under-five child mortality compared to the expectation of the same amount of food the following year (adjusted odds ratio (OR) 2.0), and with a greatly increased risk of mortality compared to the prediction of more food (future household food security) (adjusted OR 4.4). The latter association was age-specific to infants under the age of one year (adjusted OR 5.6) and cause-specific to HIV deaths (adjusted OR 5.9). Conclusions: Following a significant trend in this study in the rural north-east of South Africa, future household food security was inversely related to, and hence protective over, childhood mortality in 2004, even after controlling for confounding factors. Further research on the associations between household food security and under-five child mortality, conducted following the development of a standard nation-wide food security measurement tool specific to South African household conditions, would confirm household food insecurity as a significant risk factor for under-five child mortality and, consequently, as a target for future policies in the reduction of child mortality in this country.
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    Health impacts of social transistion: A study of female temporary migration and its impact on child mortality in rural South Africa
    (2008-05-15T06:40:58Z) Collinson, Mark Andrew
    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.