3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Risk factors and causes of adult deaths in the Ifakara health and demographic surveillance system population, 2003-2007(2011-03-25) Narh-Bana, Solomon AyerteyIntroduction: The achievements of the United Nations’ millennium development goals (MDGs) are not possible in isolation. Adult health and mortality with the exception of maternal health is one of the health issues that were openly missing among the list of MDGs. But eradicating extreme poverty and hunger would not be possible if the economically active population is not supported to be healthy and to live longer. Little has been done on adult health, especially to reduce mortality as compared to child health. Adult mortality is expected to equal or exceed child mortality in sub-Saharan Africa if nothing is done. There are varying factors associated with specific-causes of adult deaths within and among different settings. Obtaining more and better data on adult deaths and understanding issues relating to adult deaths in Africa are crucial for long life and development. Objectives: The study seeks to (i) describe causes of adult mortality, (ii) estimate adult cause-specific mortality rates and trends and (iii) identify risk factors of cause-specific mortality in the Ifakara Health and Demographic Surveillance System (IHDSS) population from 2003 – 2007 among adults aged 15 – 59 years. Methodology: The data for the study was extracted from the database of the Ifakara Health and Demographic Surveillance System (IHDSS) in Tanzania from 2003-2007. It was an open cohort study. The cohort was selected based on age (15-59years) and active residency from 1st January 2003 to 31st December 2007. Survival estimates were computed using Kaplan-Meier survival technique and adult mortality rates were estimated expressed per 1000 person years observed (PYO). Verbal autopsy method was used to ascertain causes of deaths. Cox proportional hazards method was used to identify socio-demographic factors associated with specific-causes of adult deaths. v Findings: A total 65,548 adults were identified and followed up, yielding a total of 184,000 person years. A total of 1,352 deaths occurred during the follow-up. The crude adult mortality rate (AMR) estimated over the period was 7.3/1000PYO. There was an insignificant steady increase in annual AMR over the period. The AMR in 2007 increased by 11% over year 2003. Most people died from HIV/AIDS (20.4%) followed by Malaria (13.2%). The AMR for the period was 2.49 per 1000PYO for communicable disease (CD) causes, 1.21 per 1000PYO for non communicable disease (NCD) causes and 0.53 per 1000PYO for causes related to accidents/injuries. Over the study period, deaths resulting from NCDs increased significantly by 50%. The proportion of deaths due to NCDs in 2003 was 16% increasing to 24% in year 2007. Adult deaths from Accidents/Injuries were significantly higher among men (hazard ratio (HR) = 2.2) after adjusting for socioeconomic status (SES), level of education and household size. For communicable and NCDs, most people died at home while for Accidents/Injuries most people died elsewhere (neither home nor health facility). The risk factors that were found to be associated with adult deaths due to NCDs were age and level of education. An improvement in level of education saw a reduction in the risk of dying from NCDs ((HR(Primary)=0.67, 95%CI:0.49, 0.92) and (HR(beyond Primary)=0.11, 95%CI:0.02, 0.40) after adjusting for age and sex. Age, SES and “entry type” were the factors found to be associated with dying from communicable diseases among the adults. In-migrants were 1.7 times more likely to die from communicable disease causes than residents having adjusted for age, household size, educational level, employment status of the head of household and SES. Conclusion: HIV/AIDS is the leading cause of adult deaths in IHDSS area followed by malaria. Most adult deaths occurred outside health facility in rural areas. This could probably be explained by the health seeking behavior and or health care accessibility in vi the rural area of sub-Saharan Africa. NCDs are increasing as a result of demographic and epidemiological transitions taking place in most African countries including Tanzania. Without preventions the rural community in Tanzania will soon face increased triple disease burden; (CD), NCD and Accident/Injuries. Policies on accident/injury preventions in developing countries will be effective if based on local evidence and research.Item Experiences of pregnant adolescent girls(2008-03-10T14:39:25Z) Maseko, VellaABSTRACT This study sought to explore the experiences of pregnant adolescent learners. It solicited information around challenges faced by pregnant adolescent girls, the impact of pregnancy on interpersonal relationships and psychological functioning, the support system that pregnant learners have, as well as their current feelings and perceptions about their experience. It is a qualitative study, and it employed thematic content analysis to analyse the results. The sample, comprising of five adolescent girls, was drawn purposively from Soweto High Schools. Adolescent pregnancy is generally perceived as a social problem because of the negative consequences often associated with it. Literature also suggests that low socio-economic circumstances and developmental factors predispose adolescents to a higher risk for unplanned pregnancy. The results of this study indicate that an experience of pregnancy during adolescence often results in challenges that may have a negative impact on normative development. Another finding is that most adolescent mothers receive very little or no financial and emotional support from families, partners or formal structures.Item “Land Tenure Problems and the Rural Youth of Rwanda” The Case of the District of Kamonyi(2007-02-16T11:24:46Z) Dushimimana, Jean de DieuThis study aimed to investigate land tenure problems experienced by the youth of the rural areas of Rwanda. The study targeted the young men and women who have experienced several land problems in terms of land access and ownership, in the district of Kamonyi. The youth’s land tenure problems, their nature, their causes and their effects on youth’s lives were collected and analysed. The study also aimed to analyse the National Land Policy document of 2004 by looking at three aspects namely the land redistribution, group settlement, and the participation of other different government departments, civil society and youth in particular in the policy process in order to see how it deals with land tenure problems facing the rural youth. In order to collect and analyse data, this study used a qualitative method. The use of this method was motivated by its quality of providing information that one can not get with a questionnaire. Moreover, the qualitative method enables to collect and analyse in-depth information on a smaller group of respondents and enables the researcher to participate in data collection. Documentary analysis, observation, in-depth interviews and the focus group discussion were the techniques used to gather data. The study population was made of 20 young people who have experienced the land problems and 10 key informants. The concept of participation, the human needs, and the resource scarcity and conflict theories framed this work. Participation means that all the beneficiaries of a project must be involved in the decision-making, implementation and control process of the programme. As the concept of participation highlights that, problems of poverty among people, specifically young people, are solved when they are involved in planning and implementation of projects that affect their lives, the same concept was used in the current study to investigate whether rural young people have been involved in the land reform process. Youth participation should be taken into account for achieving positive development. When youth are involved in decision-making, they experience social justice as full citizens and their problems are quickly solved. Participation should be achieved from below whereby all members of the community participate in the decision-making on the projects that affect their lives. In other words, developmental projects must take into account the needs and views of beneficiaries and the latter must be empowered in order to achieve effective results. Many development policies fail in Africa and in Rwanda due to the lack of involving beneficiaries or taking into account their views. In addition, the natural resources must be equally shared by all the citizens without any social inequality, in order to avoid intractable-conflicts. People’s basic needs should be met because where some basic needs such as water, land, education, healthcare, shelter are not given, conflicts arise. Where resources are not sufficient to fit with all people in need, the properties’ ownership should be collective rather than individual. The key findings of the study show that the ways of land access and ownership in Kamonyi are mainly, land acquisition through inheritance, through land purchase through land gifted, and through land allocation by the government. Youth experience mainly the problem of landlessness due to the family land scarcity, inequalities between the elites and the poor in terms of land ownership, the increasing number of heirs since women have been included among heirs, the problem of polygamy and the lack of a known father. Many households have no title-deeds, some male children and their fathers become reluctant to recognise women’s inheritance rights, conflicts around land boundaries between neighbours and conflicts between children and their parents due to the lack of inheritance become endless. The national Land Policy of 2004 that intends to solve all the above land tenure problems bears contradictions related to its aim of achieving equity and equality and productivity at the same time. While the policy intends to establish a land tenure system that guarantees tenure security for all Rwandans, it also states that not every Rwandan will possess a plot of land of his own. In addition, it states that former refugees, professionals pastoralists and farmers, and those who will be able to apply for land showing interest in land development will be given land through the redistribution programme, which means that those who are not able to make a consistent application for land or do not belong to former refugees families will not acquire land. In addition the policy process has not been participative at large; rather it has been limited in the hands of elites, rural dwellers especially youth have not been consulted while they are familiar with land related problems. The group settlement is a good alternative but it bears ambiguity because it is silent on the youth’s lives and on who is accountable to build houses in villages.Item Causes of and trends in childhood mortality in a rural South African sub-district(2006-10-31T13:53:45Z) Ansong, DanielBackground: Studies into childhood mortality present the opportunity to identify the leading and common causes of childhood mortality in different populations. Objectives: To study the trends in all-cause mortality, and patterns of cause-specific mortality, in children 0-14 years living in the Agincourt sub-district of South Africa over the period 1992-2000. Methods: Secondary data analysis based on the longitudinal database from the Agincourt Demographic and Health Surveillance System was used to study trends in childhood mortality between 1992 and 2000, and a comparison was made between the earlier period (1992-96) and the later period (1997-2000). Results: Seven hundred and twenty four deaths occurred over the 9 year period, 1992 to 2000, in children aged 0-14 years in the Agincourt sub-district of South Africa. Over 80% of the deaths occurred in children under-five years of age. Death rates in children under one year in the periods 1992-1996 and 1997-2000 were 8.9/1000 live births and 18.0/1000 live births respectively. Children under five years between 1992-1996 and 1997-2000 had death rates of 18.0/1000 live births and 35.0/1000 live births respectively. There was a statistically significant difference in death rate in infants, and in children less than five years, in those who died over the period 1992-1996 and those who died during the later period 1997-2000, with mortality showing an increasing trend (p-values <0.0001 for infants and for children under five years). Overall mortality rates in all children under 14 years between 1992-1996 and 1997-2000 were 26.4/10000 person-years and 37.7/10000 person-years respectively. There was no significant statistical difference in the overall mortality trend among children aged 0-14 years between the two periods of time (p-value 0.614). Infectious and communicable diseases were the leading causes of death with diarrhoeal deaths accounting for 15.2%, HIV/AIDS 9.7% and malnutrition 7.6%. Deaths from diarrhoeal disease between 1992-1996 and 1997-2000 were 481/million and 449/million person-years respectively. Deaths from HIV/AIDS within the same time periods were 107/million and 607/million person-years respectively. HIV/AIDS showed a statistically significant difference over the two periods with an increased risk ratio of 5.59 (95% confidence interval of 4.6 to 70). Conclusion: This analysis reinforced previous findings pointing to the fact that infectious and communicable diseases are the leading causes of childhood mortality in South Africa and other developing countries. HIV/AIDS and diarrhoeal diseases have emerged as major causes of mortality in this analysis. Efforts to control the HIV epidemic and prevent the spread of HIV/AIDS must be accelerated in the Agincourt sub-district.