Wednesday 10 September 2003, 4pm, Chapel
Determinants of childhood morbidity in sub-Saharan Africa: implications for child survival
Kandala Ngianga-Bakwin, University of Southampton
In sub-Saharan Africa, diarrhoea, fever, and cough diseases are the most frequent causes of illness and are major contributors to mortality among children under five years of age (World Health Organisation (WHO), 1998). This paper explores the health effect of these three ailments in the high-risk group of under-five year olds. As an indicator for development, childhood morbidity provides an indication of potential health effects associated with the important issues of air pollution (especially indoor pollution), breastfeeding (especially for children from HIV/ AIDS mothers) and other environmental issues such as crowding and socio-economic status.
By providing determinants of morbidity in the sensitive group of under-five year olds, this study also provides an indirect indication of potential health effects in children from mothers living with AIDS.
As an exploration of cause-specific morbidity, this study can serve several purposes:
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To establish the relative public health importance of diarrhoea, fever, and cough illnesses as causes of death
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To monitor changes over time and provide an early warning of the need for intervention
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To map variations in diarrhoea, fever, and cough illnesses as a basis for identifying areas requiring special interventions
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To monitor the effectiveness of policies and other interventions aimed at reducing diarrhoea, fever, and cough mortality
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To help investigate associations between environmental pollution or other risk factors and mortality due to diarrhoea, fever, and cough illnesses
The Demographic and Health Survey data of Malawi and Zambia (DHS 1992) are used. The results show that district-level socio-economic characteristics are important determinants of child morbidity. Independent of other factors, a separate spatial process produces district clustering of high child morbidity.
Email: nbk3@socsci.soton.ac.uk
Impact on mortality of the AIDS epidemic in northern Namibia assessed using parish registers
Veijo Notkola, Rehabilitation Foundation, Finland, Ian M Timæus, London School of Hygiene and Tropical Medicine, and Harri Siiskonen, Univeristy of Joensuu
HIV spread rapidly in Namibia in the 1990s. As in most of Africa, however, few data exist to document the impact on mortality of AIDS. Such data can contribute to knowledge of the epidemiology of HIV infection and inform the development of programmes to mitigate the impact of the AIDS epidemic.
The study analyses death records from the registers of eight Evangelical Lutheran parishes in northern Namibia. The dataset covers the experience between 1980 and 2000 of 4,680 couples marrying between 1956 and 1995 and their children. We examine trends in post-neonatal and 1-4 years mortality and the age-standardised death rates at 20-64 of both men and women. Poisson regression for rates is used to smooth the data and test for statistically significant discontinuities in the trend. The detailed age patterns of mortality in 1980-93 and 1994-2000 are contrasted.
Post-neonatal mortality rose more than sixfold and 1-4 mortality more than threefold between 1991 and 2000. By 2000, adult mortality for women was 3.5 times, and for men 2.5 times, its 1993 level. The rise in adult mortality was concentrated at ages 30-54 for men and ages 25-49 for women. This pattern of mortality increase by age is consistent with the hypothesis that it is entirely due to AIDS. While not widely available, parish registers exist elsewhere in Africa and are potentially a low-cost source of data for study of the impact of AIDS on mortality and demographic trends more generally.
Email: veijo.notkola@kuntoutussaatio.fi
Email: ian.timaeus@lshtm.ac.uk
The development of an institutional audit into maternal mortality in Yemeni hospitals
Jane Diamond and Will Stones (University of Southampton), Abdullah Wali Nasher (International Bank of Yemen) and Nagiba Abdul Ghani (Ministry of Public Health, Yemen)
Maternal mortality in the Yemen is one of the highest in the world and it has been suggested that this could be reduced if there were significant increases in hospital births, particularly by those women who may have a particular risk. However, this can only work if the risks of hospital delivery are minimised.
This paper describes research into the development of an institutional audit at a number of Yemeni hospitals. The paper first describes a number of processual issues in initiating an institutional audit in Yemen. It then reports the development of a set of protocols to give best practice, in the Yemeni context, for the management of major maternal morbidities and describes a number of issues associated with taking the research into practice throughout Yemen. Finally the paper describes focus group and key informant research in the sending communities to identify attitudes to hospital delivery and barriers to effective development.
Email address: jdiamond@socsci.soton.ac.uk
Child feeding practices and morbidity: analysis from the Botswana Family Health Survey
Banyana C Madi, NJ Madise and RW Stones, Division of Social Sciences, University of Southampton
The HIV/ AIDS scourge has resulted in major declines in breastfeeding in the world at large. However, in most parts of Africa, breastfeeding remains the cultural norm, and mothers who do not breast feed are considered aberrant. Botswana, like some of its southern African neighbours, has the cultural practice of breastfeeding and is severely affected by HIV/ AIDS. One of the main ways the government has chosen to reduce transmission of HIV from mothers to their children is to discourage breastfeeding completely for women who are affected, and instead offer free formula together with antiretroviral drugs.
Botswana Family Health Survey data was analysed to assess feeding practices (exclusive breastfeeding, mixed feeding and never breastfed) and any associations with child morbidity from diarrhoea, severe cough or difficulty in breathing, fever and ear infections during the first five years before the initiative to discourage breastfeeding.
Results showed that 94.5 per cent of women initiate breastfeeding, and only 11 per cent practice exclusive breastfeeding. Morbidity was generally low, 6 per cent reported ear pain/ discharge, 11 per cent reported diarrhoea in the last two weeks and 13.5 per cent reported fever in the last four weeks. A slightly higher proportion (24 per cent) reported severe cough or difficulty in breathing. The type of feeding did not have a statistically significant effect on the incidence of diarrhoea, cough, or fever. However, the majority of children (76 per cent) were mixed fed, making it difficult to estimate the effects of exclusive breastfeeding and no breastfeeding on morbidity.
The results may have important implications for prevention of mother to child transmission of HIV through breastfeeding. Mixed feeding has been identified as the main vector for transmission of HIV from mother to child. Formula feeding is one of the effective ways of avoiding transmission but it challenges traditional beliefs and practices and may fuel stigma against mothers of young children who might be labelled as having AIDS and ostracised by their communities.
Email: bcm@socsci.soton.ac.uk