Dissertationen zum Thema „Mortality South Australia Statistics“

This thesis examines mortality rates among adults who experienced full-time imprisonment in New South Wales between January 1988 and December 2002, by record linkage to the Australian National Death Index. The cohort included 76383 men and 8820 women. Over a mean follow-up of 7.7 years, 5137 deaths (4724 men, 423 women) were identified. Three hundred and three deaths (295 men, eight women) occurred in custody. The median age at death was 36.6 years for men and 32.7 years for women. The prominent causes of death were drug overdose, suicide, accidental and cardiovascular disease. The crude mortality rate was 797 per 100000 person-years for men and 685 per 100000 person-years for women. Risk of mortality was 3.7 times greater in male and 7.8 times greater in female prisoners than the standard population. The excess mortality was substantially raised following release from prison in both men (standardised mortality ratio 4.0 vs 1.7) and women (standardised mortality ratio 8.2 vs 2.1). The period of highest risk of death was the first two weeks after release. Drug overdose was the main cause of death, responsible for 68% of the deaths in the first two weeks for men and for 90% of the deaths in this period for women. In men, there was also a clustering of suicide directly after release. Prisoners admitted to prison psychiatric hospital, repeat offenders and those in the early stage of followup were at increased risk of mortality. Violent offenders were overrepresented in suicide figures and property offenders in death from overdose. Minority groups, in particular men, had a lower risk of death than white people. The above findings reinforce how disadvantaged prisoners are, measured by mortality as the most fundamental scale of human wellbeing. Prison represents a potential opportunity for treatment and public health intervention to address some of the health problems underlying the high mortality found in this study. The key challenge is, however, to provide a continuum of care between the prison and community.

Thesis (M.Sc.)--University of Adelaide, School of Applied Mathematics, 2003.
Accompanying CD-ROM is part of the appendix. It includes computer programs, data files and output tables. Bibliography: leaves 166-170. Also available in an electronic version via the Internet (ADT).

[Truncated abstract. Please see pdf format for complete text.] Background : The excess burden of mortality born by young Indigenous Australians and the disparity in infant and childhood mortality between Indigenous and non-Indigenous Australians have been well documented. The accuracy and completeness of national data describing the health of Indigenous Australians is inconsistent. The Western Australia (WA) Maternal and Child Health Research Database (MCHRDB), is a linked total population database that includes perinatal maternal and infant data, and infant and childhood morbidity and mortality data. Overall, these data are more than 99% complete, with a similar high level of completeness and validity for Indigenous Western Australians. Aim : The aim of this thesis is to measure Indigenous infant (0 to <1 year) and childhood (>=1 to <19 years) mortality and the disparity between Indigenous and non-Indigenous infants and children in WA for birth cohorts from 1980 to 1997 inclusive. To achieve this aim a number of secondary aims were identified, including the measurement of certain maternal and infant variables, and the age-specific, all-cause and cause-specific mortality for WA infants and children. Method : The study comprises a longitudinal birth cohort study, the primary data source being the MCHRDB. Data included on the MCHRDB are complete for all births in WA from 1980 onwards, with new birth cohorts linked on an annual basis. Maternal and infant variables and the geographical location of the residence and the time of birth and death were included in the descriptive and multivariate analyses. Each infant and childhood death was coded using a three-digit code developed primarily for research purposes. The descriptive analyses of mortality referred to the probability of dying in infancy and in childhood as the cumulative mortality risk (CMR), for various diseases and various population subgroups. Age-specific childhood rates were also calculated. The results of multivariate analyses included the fitting of Cox and Poisson regression models, and estimates of effect were represented as hazard ratios (Cox regression) and relative rates (Poisson regression). Results : Between 1980 and 1997, births to Indigenous mothers accounted for 6% of total WA births. Approximately 46% of Indigenous births were to mothers living in a remote location compared to 9% of non-Indigenous births. Indigenous mothers gave birth at an earlier age (30% of births were to teenage mothers compared to 6% of non-Indigenous births), and were more likely to be single than non-Indigenous mothers (40% Indigenous, 9% non-Indigenous). Indigenous infants had more siblings, were born at an earlier gestation and with a lower birth weight and percentage of expected birth weight. The CMR for Indigenous infants was 22 per 1000 live births compared with 6.7 for non- Indigenous infants, a relative risk (RR) of 3.3 (95%CI 3.0, 3.6). While there was a decrease in the CMR over the birth year groups for both populations, the disparity between the rate of Indigenous and non-Indigenous infant mortality increased. The Indigenous postneonatal (>28 to 365 days) mortality rate (11.7 per 1,000 neonatal survivors) was higher than the neonatal (0 to 28 days) mortality rate (10.3 per 1,000 live births). This profile differed from that for non-Indigenous infants, where the neonatal mortality rate (4.3 per 1,000 live births) was nearly twice that of the postneonatal mortality rate (2.4 per 1,000 neonatal survivors). The main causes of infant mortality among Indigenous infants were potentially preventable. These causes were infection followed by Sudden Infant Death Syndrome (SIDS), which differed from the main causes for non-Indigenous infants, sequelae of prematurity and birth defects. The CMR attributable to SIDS increased over the years amongst Indigenous infants and decreased significantly over the years in the non-Indigenous population. Furthermore, the disparity in mortality between the two populations increased and, in 1995 to 1997, was over seven times higher amongst Indigenous infants. The CMR was highest amongst infants living in remote locations for all causes of death except for Indigenous deaths attributable to SIDS, where the risk of death was highest amongst infants living in metropolitan locations. With the exception of infection, there was no difference in cause-specific mortality amongst Indigenous infants according to geographical location. Indigenous infants living in a remote location were at a significantly increased risk of death due to infection compared with their peers living in a rural or metropolitan location. The risk of death for Indigenous children was more than three times higher than for non-Indigenous children. This risk was significantly increased when most of the perinatal maternal and infant variables were considered.

The purpose of the study was to explore and compare key classroom level factors affecting mathematics learner achievement for South Africa and Australia. The study focused in the classroom where teaching and learning takes place. This is a secondary analysis of classroom level factors influencing Grade 8 mathematics learner achievement using the Trends in International Mathematics and Science Study (TIMSS) 2003. TIMSS 2003 was chosen because it was the latest international study available to measure trends in mathematics learner achievement, where South Africa had participated. Quantitative research approach was employed and a survey research method was used which seeks, among others, to explore relationships and patterns. Survey research method was suitable to provide data that responded to the research questions. The data collection in South Africa and Australia was conducted in October-December 2002 as both countries are located in the Southern Hemisphere. The sample for South Africa consisted of 255 schools with 100% coverage and stratification done by a total of nine provinces, and language. This resulted in 8952 learners tested across the provinces (Joncas, 2004, p. 212). For Australia, the sample consisted of 207 schools with 100% coverage and stratification done by a total of 8 States and Territories and school type. This resulted in 4791 learners participating in the study. The sample included teachers of learners who were selected to participate in the TIMSS 2003 study for South Africa and Australia. The intended target was teachers of all learners at the end of their eight year of schooling. For each participating school, a single mathematics class was sampled and the mathematics teacher of the selected class was asked to complete a mathematics questionnaire. Mathematics teachers of sampled learners responded to questions about teaching emphasis on the topics in the curriculum frameworks, instructional practices, professional training and education and their views on mathematics. The mathematics teacher questionnaire was designed to take about 45 minutes to complete The main question for this study was “What are the key classroom factors that influence learner performance in mathematics?” The three sub questions for the study were: What key variables on classroom level are related to learner achievement in mathematics for South Africa? What key variables on classroom level are related to learner achievement in mathematics for Australia? How do the classroom level factors in mathematics performance of South Africa compare with classroom level factors in Australia? The conceptual framework for the study stressed classroom level factors including instructional quality, which includes teacher background factors, classroom climate, teaching requirements and mathematics curriculum. The framework describes the factors related to classroom interactions within the comprehensive education system, with regard to inputs – process – outputs – outcomes. The selection of variables for the inclusion in the models was guided by the conceptual framework and extensive preliminary analyses. Preliminary statistical analyses included exploring descriptive statistics, Varimax factor analysis, reliability, correlation analysis and stepwise multiple regression analysis. The results of the study indicate that several specific classroom level factors were associated with the higher levels of mathematics achievement of South Africa and Australia. The results for the final South African model were: age of teacher; years been teaching; outside school day grading tests; outside school day other; and computer shortage were identified to predict learner achievement. For Australia ten classroom factors, namely, teacher perception of school climate; teacher perception of school safety; teacher emphasis on mathematics homework; teacher repeat mathematics limiting factors; homework contribute towards learning; work conditions; unhappy learners; shortage of instructional equipment; geometric shapes; and algebraic functions were identified to predict learner achievement. South Africa has factors like teacher background and outside school activities by the teacher. Australia has factors like classroom climate, work conditions and curriculum quality. In the light of schools effectiveness research and school improvement research, a comparative study like this one would require more than one level (classroom level), two or three levels would have been ideal to draw other variables and enrich the analysis, especially the learner level and school level. School effectiveness places an emphasis on the ability and social background of the learners as factors that shape academic performance
Dissertation (MEd)--University of Pretoria, 2011.
Science, Mathematics and Technology Education
unrestricted

[Truncated abstract] Managed Aquifer Recharge (MAR) is a technique that can be used to capture and store water in aquifers for later reuse. This method recycles water that would normally be lost or discarded to the environment. MAR has been observed to have the potential for improving the quality of recharged water through a combination of physical, chemical and biological processes. The aim of this study was to investigate the changes in groundwater microbial population structure during MAR and the major influences that drive these population changes. Biogeochemical MAR studies have the potential to assist in the improved prediction of the removal of contaminants such as nutrients, pathogens and trace organics from the recharged water. Biological clogging during recharge also has the potential to overwhelm an aquifers ability to process wastewater thus reducing the hydraulic conductivity of the aquifer. Therefore further research into the spatial and temporal biogeochemical processes that occur during MAR is required. The geochemical and microbial population dynamics of two contrasting MAR techniques were investigated at two different geographical locations (Perth, Western Australia and Adelaide, South Australia). These MAR sites contained aquifers of dissimilar properties that were recharged with wastewater that contrasted in water quality. The Perth MAR site received secondary treated effluent which continuously infiltrated the unsaturated zone into an unconfined aquifer aided by infiltration galleries. Reclaimed water was extracted from a well at distance from the infiltration gallery. ... Notably the background and recovered water was most dissimilar in microbial and chemical population structure to that described for the infiltration gallery and injection well. Microbial and chemical evidence suggested that the background and extraction well groundwater were unaffected by plume migration. These results suggested that extraction well groundwater was similar in quality to that of ambient groundwater. Significant geochemical and microbial changes of secondary treated effluent during infiltration and lateral movement through aquifer were implicated in addition to the forced hydraulic gradient created from extracting fives time the volume of infiltrating wastewater. This study demonstrated that microbial populations and the geochemical processes associated with MAR can be studied and compared. Multivariate statistical methodology greatly simplified a vast array of dynamic biogeochemical information that could be dissected for meaningful interpretation over distance and time. The study evaluated the major biogeochemical influences which resulted in microbial and geochemical changes where it was noted that microbial populations were more dynamic than geochemical variation over time. Additionally biogeochemical comparative analysis indicated that microbial populations could change in population structure before a shift in aquifer geochemistry was detected. It is anticipated that the results from this study will benefit further research into the biogeochemical processes involved in water quality changes (e.g. nutrient removal, pathogen decay and biodegradation of trace organics) as well as controlling biological clogging of MAR schemes.

Assessment of trophic interactions between increasing populations of New Zealand fur seals (Arctocephalus forsteri) and fisheries in southern Australia is limited due to a lack of species specific demographic data and an understanding of the factors influencing population growth. To establish species specific demographic parameters a cross-sectional sample of New Zealand fur seal females (330) and males (100) were caught and individually-marked on Kangaroo Island, South Australia between 2000 and 2003. The seals were aged through examination of a postcanine tooth, which was removed from each animal to investigate age-specific life-history parameters. Annual formation of cementum layers was confirmed and accuracy in age estimation was determined by examination of teeth removed from individuals of known-age. Indirect methods of assessing reproductive maturity based on mammary teat characteristics indicated that females first gave birth between 4-8 years of age, with an average age at reproductive maturity of 5 years. Among reproductively mature females, age-specific reproductive rates increased rapidly between 4-7 years of age, reaching maximum rates of 70-81% between 8-13 years, and gradually decreased in older females. No females older than 22 years were recorded to pup. Age of first territory tenure in males ranged from 8-10 years. The oldest female and male were 25 and 19 years old, respectively. Post-weaning growth in females was monophasic, characterised by high growth rates in length and mass during the juvenile growth stage, followed by a gradual decline in growth rates after reproductive maturity. In contrast, growth in males was biphasic and displayed a secondary growth spurt in both length and mass, which coincided with sexual and social maturation, followed by a rapid decline in growth rates. Age-specific survival rates were high (0.823-0.953) among prime-age females (8-13 yrs of age) and declined in older females. Relative change in annual pup production was strongly correlated with reproductive rates of prime-age females and adult female survival between breeding seasons.

Accompanying CD-ROM is part of the appendix. It includes computer programs, data files and output tables. Bibliography: leaves 166-170. The average length of life from birth until death in a human population is a single statistic that is often used to characterise the prevailing health status of the population. It is one of many statistics calculated from an analysis that, for each age, combines the number of deaths with the size of the population in which these deaths occur. This analysis is generally known as life table analysis. Life tables have only occasionally been produced specifically for South Australia, although the necessary data has been routinely collected since 1842. In this thesis, the mortality pattern of South Australia over the period of 150 years of European settlement is quantified by using life table analyses and estimates of average length of life. System requirements for accompanying CD-ROM: IBM compatible computer. Other requirements: Winzip. Adobe Acrobat Reader is required to view or print the PDF files.

Ph.D., Faculty of Health Sciences, University of the Witwatersrand, 2011
Background to and purpose of the study An adverse outcome during the administration of an anaesthetic may result in morbidity or mortality, the latter providing us with the most fundamental measure of the safety of anaesthesia for our patients. Peri-operative deaths due to anaesthesia have not been documented in the province of Gauteng, South Africa, since 1955. The purpose of this study was to document these deaths and compare the findings with previous South African studies, as well as some studies performed overseas. Aims and objectives This study aimed to investigate and determine the prevalence of anaesthesia associated deaths, particularly those that occurred as a direct result of anaesthesia (ACD), both general and regional in two major academic hospitals in the Johannesburg area. These were the Charlotte Maxeke Johannesburg Academic Hospital and the Chris Hani Baragwanath Maternity Hospital. The objectives included examining current legislation and the interpretation thereof with recommendations, as well as the causes or possible risk factors involved in the peri-operative deaths that were studied. vii Research methods and procedures This was a retrospective longitudinal descriptive study, in the form of a clinical audit. All peri-operative deaths during the period 2000 to 2004 were studied at both sites. Numerous data were collected from each death, and descriptive and analytical statistics performed using SAS for Windows to provide frequencies for all of the variables recorded, with subsequent categorical analysis. Results The Anaesthetic Contributory Death (ACD) rate at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) was 0.4 per 10,000, which is an improvement from the pilot study that was conducted in that hospital during 1999, but it is still higher per 10,000 than the figures from the United Kingdom. The Anaesthetic Contributory Maternal Death (ACDM) rate at the Chris Hani Baragwanath Hospital was similar to the ACD rate at the CMJAH, and similar to the rate in the United Kingdom. Conclusions The ACD rate in these two hospitals is low, and may well not improve any further, as human error cannot totally be eliminated from anaesthetic practice. The South African law does not specify a time period from the start of the anaesthetic during which a peri-operative death is classified as an ACD. This is poorly understood by the medical fraternity and general public.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements of the award of the Masters in Science in Epidemiology in the field of Population-based Field Epidemiology April 2012
Objective: To determine the causes of death and associated risk factors in women of reproductive age in rural South Africa. . Methods: The study population comprised all female members aged 15-49 years of 11 000 households of a rural South African Health and Demographic Surveillance Site from 2000-2009. Deaths and person-years of observation (pyo) were determined for individuals between 01 January 2000 and 31 December 2009. Cause of death was ascertained by verbal autopsy interviews, based on ICD-10 coding; cause of death were broadly categorized as AIDS/TB causes, Non-communicable causes, Communicable/maternal/perinatal/nutrition causes, Injuries and another category of undetermined (unknown) causes of death. Overall and cause specific mortality rates (MR) with 95% confidence intervals (CI) were calculated. Cox proportional hazard regression (HR, 95% CI) was used to determine risk factors associated with overall and cause-specific mortality. Results: 42703 eligible women were included; 3098 deaths were reported for 212607 person-years (pyo) of observation. Overall MR was 14.57 deaths/1000 pyo (CI;14.07-15.09), increasing from 2000-2003 (2003: MR;18.15, CI;16.41-20.08) and subsequently decreasing (2009: MR; 9.59, CI;8.43-10.91) after introduction of antiretroviral treatment (ART) for HIV in public health system facilities in South Africa in 2004. Mortality was highest for AIDS/TB (MR;10.66, CI;10.23-11.11) and the cause of death for 73.1% of all recorded deaths. Maternal mortality was 0.07 (CI; 0.04-0.11). Women aged 30-34 years had the highest MR due to AIDS/TB (MR; 20.34/1000 pyo), women aged 45-49 years due to other causes (MR; 4.29/ 1000 pyo). v In multivariable analyses, external migration status was associated with increased hazards of all cause mortality (HR; 1.87, CI; 1.56-2.26) and other causes of mortality (HR; 1.782, CI; 1.24-2.57). Self reported poor health was significantly associated with increased hazards of all cause mortality (HR; 11.052, CI; 4.24-28.82) but not with mortality due to other causes. Positive HIV status was associated with increased hazards of all cause mortality (HR; 8.53, CI; 6.81-10.67) and other causes of mortality (HR; 2.84, CI; 1.97- 4.09). Conclusion. AIDS was the main cause of death in the current study, with mortality rates declining since introduction of ART for HIV in public health facilities in the surveillance area in 2004. Further ART roll-out, increased community awareness and sensitisation messages are still needed to reduce the spread of HIV and other sexually transmitted diseases.

Many countries in the world record annual summary statistics such as economic indicators like Gross Domestic Product (GDP) and vital statistics for example the number of births and deaths. In this thesis we focus on mortality data from various causes including Tuberculosis (TB) and HIV. TB is an infectious disease caused by bacteria called Mycobacterium tuberculosis. It is the main cause of death in the world among all infectious diseases. An additional complexity is that HIV/AIDS acts as a catalyst to the occurrence of TB. Vaidyanathan and Singh revealed that people infected with mycobacterium tuberculosis alone have an approximately 10% life time risk of developing active TB, compared to 60% or more in persons co-infected with HIV and mycobacterium tuberculosis. South Africa was ranked seventh highest by the World Health Organization among the 22 TB high burden countries in the world and fourth highest in Africa. The research work in this thesis uses the 2007 Statistics South Africa (STATSSA) data on TB and HIV as the primary cause of death to build statistical models that can be used to investigate factors associated with death due to TB. Logistic regression, Survey Logistic regression and generalized linear models (GLM) will be used to assess the effect of risk factors or predictors to the probability of deaths associated with TB and HIV. This study will be guided by a theoretical approach to understanding factors associated with TB and HIV deaths. Bayesian modeling using WINBUGS will be used to assess spatial modeling of relative risk and spatial prior distributions for disease mapping models. Of the 615312 deceased, 546917 (89%) died from natural death, 14179 (2%) were stillborn and 54216 (9%) from non-natural death possibly accidents, murder, suicide. Among those who died from natural death and disease, 65052 (12%) died of TB and 13718 (2%) died of HIV. The results of the analysis revealed risk factors associated with TB and HIV mortality.
Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

In the past the identification and explanation of spatial variations in fertility was seen as an important contribution to the field of population geography. By the 1980s with the substantial declines in fertility and the ' end ' of the demographic transition came the belief low fertility equated with little variation between groups and across space. Recent evidence however suggests the interaction of various factors including place - specific factors has led to spatio - temporal changes in fertility that have not been expected based on theoretical and national patterns of fertility. The objective of this thesis was to investigate if spatial differentials in fertility still exist, and have relevance in a low fertility setting. The study examines the geography of fertility in the State of South Australia from the mid 1970s to the mid 1990s using unpublished issue data from the 1976, 1981, 1986 and 1996 Australian Censuses for women aged 45 - 49 years and 15 - 44 years. In addition to identifying the patterns trends towards convergence or divergence in the patterns over time and the reasons for the patterns were also identified. The findings of this study indicate strong spatial variations in fertility still exist, have persisted over time and there are localised conditions which temper overall expectations from theory. While it is assumed declines in fertility equate with a convergence in differentials, the statistical parameters used in this study showed trends towards convergence or divergence varied by geographical scale and age group. Despite the limited attention socio - economic factors have received in the examination of population issues in Australia, they remain central to explaining the fertility patterns and trends found in this study. In fact in metropolitan Adelaide fertility may be a significant contributor and influence on social polarisation.
Thesis (Ph.D.)--School of Social Sciences, 2005.

The HIV and AIDS epidemic has remained one of the leading causes of death in the world and has been destructive in Africa with Sub-Saharan Africa remaining the epidemiological locus of the epidemic. HIV and AIDS hinders development by erasing decades of health, economic and social progress, reducing life expectancy by years and deepening poverty [57].The most urgent public-health problem globally is to devise effective strategies to minimize the destruction caused by the HIV and AIDS epidemic. Due to the problems caused by HIV and AIDS, well defined endpoints to evaluate treatment benefits are needed. The surrogate and true endpoints for a disease need to be specified. The purpose of a surrogate endpoint is to draw conclusions about the effect of intervention on true endpoint without having to observe the true endpoint. It is of great importance to understand the surrogate validation methods. At present the question remains as to whether CD4 count and viral load are good surrogate markers for death in HIV or there are some better surrogate markers. This dissertation was undertaken to obtain some clarity on this question by adopting a mathematical model for HIV at immune system level and the impact of treatment in the form of reverse transcriptase inhibitors (RTIs). For an understanding of HIV, the dissertation begins with the description of the human immune system, HIV virion structure, HIV disease progression and HIV drugs. Then a review of an existing mathematical model follows, analyses and simulations of this model are done. These gave an insight into the dynamics of the CD4 count, viral load and HIV therapy. Thereafter surrogate marker validation methods followed. Finally generalized estimating equations (GEEs) approach was used to analyse real data for HIV positive individuals, from the Centre for the AIDS Programme of Research in South Africa (CAPRISA). Numerical simulations for the HIV dynamic model with treatment suggest that the higher the treatment efficacy, the lower the infected cells are left in the body. The infected cells are suppressed to a lower threshold value but they do not completely disappear, as long as the treatment is not 100% efficacious. Further numerical simulations suggest that it is advantageous to have a low proportion of infectious virions (ω) at an individual level because the individual would produce few infectious virions to infect healthy cells. Statistical analysis model using GEEs suggest that CD4 count< 200 and viral load are highly associated with death, meaning that they are good surrogate markers for death. An interesting finding from the analysis of this particular data from CAPRISA was that low CD4 count and high viral loads as surrogates for HIV survival act independently/additively. The interaction effect was found to be insignificant. Individual characteristics or factors that were found to be significantly associated with HIV related death are weight, CD4 count< 200 and viral load.
Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

"October 2004"
Includes bibliographical references (leaves 313-337)
x, 337 leaves : ill. (col.), maps (col.) ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2004

The effect of anti-retroviral therapy (ART) rollout can be measured in a number of ways including treatment coverage, behaviour change and the emergence of resistance. However, changes in population mortality are undoubtedly the most important measurable effect. Objectives: To describe trends in child and adult all-cause mortality versus HIV/AIDS related mortality before and after ART rollout; and to identify significant clusters of child and adult all-cause mortality versus HIV/AIDS related mortality in space-time, during pre and post ART rollout eras at Agincourt and Dikgale health and demographic surveillance systems (HDSSs) in South Africa. Design: Mortality data were extracted from both the Agincourt and Dikgale HDSSs for the period 1996–2010. Mortality rates by age group, year and village were calculated assuming a Poisson distribution and using precise person-years as the denominator. The Kulldorff spatial scan statistic was used to test for clusters of age group all-cause and HIV-related mortality both in space and time. Clusters were mapped using Quantum geographic information systems (GIS) software. Results: Both HIV-related and all-cause mortality decreased gradually over the years after the introduction of ART in 2007 for the two HDSS sites. Several statistically significant clusters of higher all-cause and HIV-related mortality were identified both in space and time. In the Agincourt HDSS, specific areas were consistently identified as high risk areas; namely, the east/south-east corner and upper central to west regions, pre ART. In the Dikgale HDSS, no significant clusters were identified using the spatial only analysis but one significant cluster, located towards the north of the Dikgale HDSS site, was identified using the space-time scanning, post ART. In Agincourt, no significant clusters of mortality were detected after the introduction of ART whereas in Dikgale, a significant cluster for all-cause mortality in the under-five age group was detected for the years after the introduction of ART. Conclusion: This work revealed the existence of spatio-temporal clusters of both child and adult mortality at the Agincourt and Dikgale HDSSs and that the introduction of ART had a substantial influence in reducing both HIV-related and all-cause mortality in rural South Africa. There is need though to take into account socio-demographic characteristics so as to determine fundamental risk factors influencing these spatio-temporal HIV-related and all-cause mortality patterns.

Child pedestrian injury and mortality is an issue of significant public health concern in the city of Johannesburg, Gauteng, in South Africa. Since there is a paucity of studies in the last decade or more on fatal childhood traffic and non-traffic injuries in Johannesburg, this study aspires to address the disproportion in this domain of research, and provide more recent, and comprehensive empirical evidence over a ten-year period. The overarching aim of this study was to describe and examine the magnitude, circumstances, and neighbourhood characteristics of fatal pedestrian injuries among children (0-14 years) in Johannesburg for the period from 2001 to 2010. More specifically, the objectives of the study were: firstly, to provide a comprehensive epidemiological description of the magnitude, trends and occurrence of pedestrian mortality among children; secondly, to describe and examine the epidemiology of child pedestrian mortality in relation to children as motor vehicle passengers; thirdly, to describe and examine child pedestrian mortality in relation to non-traffic injuries, in particular, burns and drowning; and fourthly, to assess the influence of neighbourhood characteristics on child pedestrian mortality. The study conceptualised pedestrian road safety within an ecological systems framework. The study used quantitative descriptive, and multivariate logistic regression methods of analysis to examine child pedestrian mortality data. The study drew on data from the National Injury Mortality Surveillance System (NIMSS) and the Census 2001. The main findings indicated that black, male children aged 5 to 9 years (11.02/100 000) are the most vulnerable, and that mortality occurred predominantly during the afternoons and early evenings (12h00-16h00 and 16h00-21h00), over weekends, during school holidays, and to a lesser extent, during non-holiday months. In addition, neighbourhood characteristics that reflected concentrations of disadvantage, single female-headed households and residentially stable areas were associated with child pedestrian mortality. The study findings highlight the need for critical action in terms of investment in child pedestrian safety research, and appropriate prevention initiatives guided by stringent evidenced-based studies, and the design of safe pedestrian, vehicular and urban environments.
Psychology
D. Phil. (Psychology)

Thesis (Ph. D. (Science)) -- University of Limpopo, 2015
The objectives of the study were to examine the demographic profile and causes of death of people dying in a hospital and community; and to determine mortality rates, specifically age- and gender-specific mortality rates in a community. The study also compared causes of death assigned to hospital records with causes of death obtained from verbal autopsy reports. Methodology The data used in this thesis were collected in two phases. The first phase involved a retrospective review of all deaths that occurred in the Pietersburg/Mankweng Hospital Complex from 1st January, 2011 to 31st December, 2012. The second phase involved a community-based study using a verbal autopsyto determine cause of death in Dikgale HDSS for the same period. Results A total of 5402 deaths were reported in the hospital and 625 in the community. The majority of deaths in the hospital involved adults in the 15 to 49 year old age group, while in the community more deaths were recorded amongst adults aged 15 to 49 years of age and those in the 65+ year old age group. There were more male deaths in the hospital, while in the community a higher proportion of deaths occurred amongst females. v In children less than1 year old, the cause of death in the hospital was predominantly due to perinatal conditions, particularly preterm birth, low birth weight and birth asphyxia; while in the community, of the 5 deaths in this age group, infectious diseases were recorded as the main cause of death. Amongst children in the 1 to 4 year old age groups causes of hospital deaths were dominated by infectious diseases, injuries and malnutrition; while in the community infectious diseases were the main cause of death. Stillbirths were noted in the hospital with a stillbirth rate of 29.1/1000 deliveries. In the community no stillbirths were reported. More than half of the stillbirths were caused by unexplained intrauterine foetal causes followed by maternal hypertension in pregnancy and placenta abruption. For adults in the 15 to 49 year old age groups infectious diseases, such as HIV/AIDS and tuberculosis, were the leading causes of death in both the hospital and in the community. The proportion of deaths due to HIV/AIDS and tuberculosis was significantly greater in the community than in the hospital. Amongst adults in the 50+year old age group non-communicable diseases, particularly cardiovascular diseases and cancers were the most common causes of death. In this age group, the hospital recorded more cancer deaths than did the community; while the community recorded more cardiovascular deaths than did the hospital. vi The overall mortality rate in the community was 8.4 deaths per 1000 person-year, with more deaths occurring amongst males (8.9 deaths per 1000 person-year). The mortality rate was high amongst adults in the 65+ year old age group (48.9 deaths per 1000 person-year). When comparing cause-specific mortality between hospital cause of death notification forms and cause of death determined by verbal autopsy reviews, the same top five underlying causes of death were observed, namely: cardiovascular diseases, infectious diseases, diabetes mellitus, malignant neoplasms and respiratory infections. The agreement between causes of death reported on cause of death notification forms and cause of death as a result of a verbal autopsywas 48%. For individual causes, agreement of more than 80% was achieved between cause of death recorded on cause of death notification forms and from verbal autopsy reviews for respiratory infections, diabetes, malignancies and injuries. Infectious diseases (68.5%) and cardiovascular diseases (74.1%) achieved the lowest agreement. In other words, in only 68.5% and 74.1% respectively was the cause of death as recorded on the “cause of death notification” forms the same as the cause of death when reviewed verbally. Furthermore, 13 deaths were recorded as being due to cardiovascular diseases on the “cause of death notification” forms, however, in only 5 of these cases was the cause of death recorded as the same in the verbal autopsy report. In 21 cases cause of death was attributed to infectious diseases on the cause of death notification form, vii while in only 13 of these cases was the cause of death similarly ascribed after verbal autopsy review. Conclusion This study showed that the verbal autopsy instrument has the potential to identify causes of death in a population where deaths occur outside of health facilities. Procedures for death certification and coding of underlying causes of death need to be streamlined in order to improve the reliability of registration data. This will be achieved if medical students and trainee specialists are trained in the completion of cause of death notification forms. Foetal autopsies should be introduced at tertiary hospitals to determine the causes of stillbirths.Antenatal care education for pregnant women should be encouraged because the level of antenatal care has an influence on the health of mothers and their newborns. The government should continue to focus on improving the socio-economic status of the population, while adequate foetal monitoring by health workers may reduce neonatal deaths resulting from preterm births, low birth weight and birth asphyxia. Innovative injury prevention strategies, interventions to control infectious diseases, cancer screening and lifestyle program may reduce adult mortality.

The purpose of the research was to determine the underlying contributory factors in an obstetric unit at the district hospital in Mpumalanga province, South Africa, regarding neonatal deaths and to propose strategies for midwifery practice. Quantitative, nonexperimental, descriptive, exploratory and retrospective (ex-post facto) design was used to explore and describe the factors contributing to neonatal deaths. Data collection was done using an audit tool. The conclusions drawn from this study supported the assumptions that there are factors related to antenatal, intrapartum, postnatal and neonatal care that contribute to neonatal deaths, thus emphasizing the urgency of improving the care of pregnant mothers and their babies through effective implementation of programmes and protocols
Health Studies
M.A. (Health Studies)