Malnutrition among rural and urban children in Lesotho: related hazard and survival probabilities.ABSTRACT
The relationship between the survival time of children and several variables that affect the survival and nutritional status nutritional status,
n the assessment of the state of nourishment of a patient or subject. of children under the age of five years in the Maseru District of Lesotho was investigated. Kaplan-Meier survival probabilities, lifetables and the extended Cox proportional hazards model were used to identify factors that strongly affect malnutrition malnutrition, insufficiency of one or more nutritional elements necessary for health and well-being. Primary malnutrition is caused by the lack of essential foodstuffs—usually vitamins, minerals, or proteins—in the diet. among children and survival up to the age of five. The predictor variables Noun 1. predictor variable - a variable that can be used to predict the value of another variable (as in statistical regression)
variable quantity, variable - a quantity that can assume any of a set of values used for data analysis were: residential area, the literacy status of the mother, the income status of the mother, the immunisation status of the child, acute respiratory infectious diseases infectious diseases: see communicable diseases. , diarrhoeal diseases, tuberculosis tuberculosis (TB), contagious, wasting disease caused by any of several mycobacteria. The most common form of the disease is tuberculosis of the lungs (pulmonary consumption, or phthisis), but the intestines, bones and joints, the skin, and the genitourinary, , the extent of malnutrition suffered by the child, height, weight, height for age, weight for height, weight for age and the overall health condition of the child. Results from the study showed that the extent of malnutrition was strongly related to the residential area, the literacy status of the mother and monthly household income.
Keywords: survival probability; malnutrition; lifetable; Kaplan-Meier estimation estimation
In mathematics, use of a function or formula to derive a solution or make a prediction. Unlike approximation, it has precise connotations. In statistics, for example, it connotes the careful selection and testing of a function called an estimator. ; the extended Cox proportional hazards model
Die verhouding tussen die oorlewingstyd van kinders en verskeie veranderlikes wat die oorlewings- en voedingstatus van kinders onder die ouderdom van vyf jaar affekteer is in die Maseru-distrik in Lesotho nagevors. Kaplan-Meier oorlewingswaarskynlikhede, lewenstabelle en die uitgebreide Cox proporsionele risikomodel is gebruik om die faktore te identifiseer wat wanvoeding en die oorlewing van kinders tot die ouderdom van vyf jaar die meeste beinvloed. Die voorspellingsveranderlikes wat gebruik is vir data-analises is: die woongebied, die geletterdheid van die moeder, die inkomstestatus van die moeder, die immuniseringstatus van die kind, akute aansteeklike asemhalingsiektes, diarreeverwante siektes, tuberkulose, die graad van wanvoeding van die kind, lengte in verhouding tot ouderdom, gewig in verhouding tot lengte, gewig in verhouding tot ouderdom en die algehele gesondheidstand van die kind. Resultate van die studie toon aan dat die omvang van wanvoeding grotendeels geaffekteer word deur die woongebied, die geletterdheid van die moeder en die maandelikse huishoudelike inkomste.
The Kingdom of Lesotho is a small Southern African country with a total population of 2 million people. The total surface area of Lesotho is 30 355 square kilometres Square kilometre (U.S. spelling: square kilometer), symbol km², is a decimal multiple of the SI unit of surface area, the square metre, one of the SI derived units. 1 km² is equal to:
BACKGROUND TO THE STUDY
Rural children in Lesotho are disadvantaged with respect to basic health services such as immunisation, nutrition, education and income (Lesotho Ministry of Health and Social Welfare, 1997:1-38). Although several studies have indicated this fact, not enough has been done to address malnutrition and poverty among rural children in Lesotho. Rural children in Lesotho are mostly brought up and fed by their mothers as almost half of the male work force between the ages of 20 and 44 immigrates to South African mines in search of jobs in the mining industry (Maw & Letsie, 1999:124). As a result, the burden of feeding children, working on farms, fetching fetch·ing
Very attractive; charming: a fetching new hairstyle.
fetching·ly adv. water and firewood, and looking after the cattle becomes the responsibility of the mother alone (Lesotho Population and Manpower Division, 1993:Tables A to G). This, coupled with the fact that the Ministry of Health and Social Services social services
welfare services provided by local authorities or a state agency for people with particular social needs
social services npl → servicios mpl sociales of Lesotho has not done enough to address problems relating to relating to relate prep → concernant
relating to relate prep → bezüglich +gen, mit Bezug auf +acc the delivery of primary health care services to the rural population of Lesotho, has left rural children much more vulnerable than their urban counterparts.
This study was thus conducted primarily to obtain baseline data on the health condition of rural and urban children who lived in the Maseru District of Lesotho with a view to produce a coherent plan of action for government policy and intervention programmes conducted by the Lesotho UNICEF Country Office. It should be noted that this study has been planned to gather facts about, and not to address problems of malnutrition. However, following the completion of this study, an evaluative action research of existing feeding programmes has been conducted by UNICEF and the Ministry of Health and Social Welfare of Lesotho.
The absence of reliable statistical information and baseline data on basic health coverage rates and the severity of malnutrition among rural children under the age of five years has been a major obstacle to efforts made by the Ministry of Health and Social Welfare of Lesotho, the UNICEF and the WHO to produce integrated feeding programmes in various parts of rural and urban Lesotho. The few studies done in these areas prior to this study were essentially cross-sectional and descriptive, and were based on small samples that were not representative of the broader population. Based on indirect estimation and projections, it was reported that malnutrition and under-five mortality and morbidity morbidity /mor·bid·i·ty/ (mor-bid´it-e)
1. a diseased condition or state.
2. the incidence or prevalence of a disease or of all diseases in a population.
n. are much higher among rural children than among urban children in Lesotho. Based on reports from the Lesotho Bureau of Statistics and the World Bank, it was assumed that urban children under the age of five years in Lesotho have better access to basic health, economic and education services than rural children. However, there was no direct proof to the above claims until the present study was conducted on a large representative sample and sound statistical techniques of estimation (Worku, 2001:8794).
REVIEW OF THE LITERATURE
The nutritional status of children is often defined by clinical, anthropometric an·thro·pom·e·try
The study of human body measurement for use in anthropological classification and comparison.
an and biological indicators. Several researchers have demonstrated that anthropometric indicators are easy to measure in the field, and convenient and fairly reliable to assess the nutritional status of children (Teka, Faruque & Fuchs, 1996:1070-1075) in rural African communities. Waterlow (1972:566-669) classified and defined various categories of protein-calorie malnutrition that are being used today by nutritionists to assess the severity of malnutrition among children under the age of five. In most developing countries in Africa, protein-energy malnutrition Protein-Energy Malnutrition Definition
Protein-energy malnutrition (PEM) is a potentially fatal body-depletion disorder. It is the leading cause of death in children in developing countries. is a major factor in childhood illness (Bern, Zucker & Perkins, 1997:8796).
Several sources such as the Lesotho Ministry of Health and Social Welfare, (1997), Worku, (2001:87-94), Maw and Letsie (1999:1-24), Motlomelo and Sebatane (1999:1-26) and Tolboom, Ralitapole-Maruping and Kabir (1986:351-358) have consistently indicated that rural children in Lesotho are disadvantaged with regard to basic health services and economic opportunities. Protein-energy malnutrition (PEM (Privacy Enhanced Mail) A standard for secure e-mail on the Internet. It supports encryption, digital signatures and digital certificates as well as both private and public key methods. Not widely used, work on PEM later evolved into S/MIME. See MIME. ) remains a major public health problem in Lesotho. In the study by Tolboom et al. (1986:351-358) a quarter of observed deaths occurred among severely malnourished mal·nour·ished
Affected by improper nutrition or an insufficient diet. children.
In 1986, the infant mortality rate infant mortality rate
The ratio of the number of deaths in the first year of life to the number of live births occurring in the same population during the same period of time. in urban areas of Lesotho was 71 per thousand live births, and 86 per thousand live births in rural areas (Lesotho Bureau of Statistics, 1986:1.5-3.24). In 1996 the under-five mortality rate in the entire Maseru District of Lesotho (rural and urban) was estimated at 98 per thousand live births (Worku & Makatjane, 1996:54-71). The same study showed that basic health services were better delivered by the Lesotho Health Ministry in urban areas than in rural areas, and that rural children under the age of five years were particularly vulnerable. De Waal
The Ministry of Health and Social Welfare of Lesotho carried out a survey in October 1993 to evaluate the overall health coverage rate of the nation. According to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. this study the coverage rate of the expanded programme of immunisation (EPI EPI
exocrine pancreatic insufficiency. ) was 71 percent. The study showed that 63% of rural mothers were illiterate ILLITERATE. This term is applied to one unacquainted with letters.
2. When an ignorant man, unable to read, signs a deed or agreement, or makes his mark instead of a signature, and he alleges, and can provide that it was falsely read to him, he is not bound by , 69% of rural mothers earned less than R1 000 per month and 59% of them had little or no access to basic health services. Rural children under the age of five years were more malnourished (Worku & Makatjane, 1996:54-71). The study revealed that the major reasons for not achieving a higher coverage rate of immunisation were management problems and lack of accurate information within the health system. The study also showed that 45% of all women in the study attended postnatal postnatal /post·na·tal/ (-na´t'l) occurring after birth, with reference to the newborn.
Of or occurring after birth, especially in the period immediately after birth. health care services, and that 68% of them were willing to practice family planning family planning
Use of measures designed to regulate the number and spacing of children within a family, largely to curb population growth and ensure each family’s access to limited resources. methods, but did not have the money to pay for such services. It was also noted that most rural mothers in the study were not even aware of the availability of family planning methods (Lesotho Ministry of Health and Social Welfare, 1993:1-43).
Malnutrition continues to be a problem even though the number of children hospitalised for this reason shows a decrease, which probably does not match with reality. Following the death of their parents, most of the malnourished children are staying with their grandparents grandparents npl → abuelos mpl
grandparents grand npl → grands-parents mpl
grandparents grand npl or other members of the family, which frequently leads to inadequate feeding. Due to the spread of the HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. pandemic pandemic /pan·dem·ic/ (pan-dem´ik)
1. a widespread epidemic of a disease.
2. widely epidemic.
Epidemic over a wide geographic area.
n. , the number of malnourished children is likely to increase during the coming years. It must be noted that more and more malnourished children are found to be HIV positive. The statistics indicate that Lesotho like many other sub-Saharan countries has suffered great human loss because of the AIDS pandemic Acquired Immune Deficiency Syndrome (AIDS) has led to the deaths of more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. (UNAIDS UNAIDS Joint United Nations Programme on HIV/AIDS , 2001:1247). A recent study conducted by Maw and Letsie (1999:1-24) on behalf of the Ministry of Health and Social Welfare of Lesotho shows that there is a direct link between the spread of HIV/AIDS HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and an increase in the number of orphaned or·phan
a. A child whose parents are dead.
b. A child who has been deprived of parental care and has not been adopted.
2. A young animal without a mother.
3. and malnourished children under the age of five years.
AIM OF THE STUDY
This article is based on data collected from 4 001 children under the age of five and their mothers in the Maseru District of Lesotho. The aim of the study was to compare urban and rural children with regard to the prevalence of malnutrition as well as survival and hazard probabilities using statistical tools such as life tables, Kaplan-Meier survival probabilities, hazard probabilities and the Cox proportional hazards function (Kleinbaum, 1996:56-114). The study shows that rural children fare worse on all these measurements than their urban counterparts. The study was carried out in the Maseru District, the largest of the 10 districts in Lesotho, which includes the capital city of Lesotho--Maseru. It can thus be argued that the sample is fairly representative of the total population of Lesotho.
The objectives of the study were:
* to identify factors that strongly affect malnutrition; and
* to compare rural and urban children in the study with respect to malnutrition, survival and hazard probabilities.
This is a descriptive five-year follow-up study involving two cohorts of children (rural and urban) who were born in the Maseru District of Lesotho between September 1989 and September 1994. The sample size of the study was 4 001 children under the age of five. The District of Maseru was divided into two strata: rural (70% of sample) and urban (30% of sample). Each stratum stratum /stra·tum/ (strat´um) (stra´tum) pl. stra´ta [L.] a layer or lamina.
stratum basa´le was subsequently split into several zones. At each zone the number of eligible households was determined using techniques of proportional allocation with respect to size. Rural and urban zones and households were identified on the basis of criteria used by the Lesotho Bureau of Statistics. A sampling frame was prepared, and eligible households, children and their mothers in the study were selected using systematic random sampling.
Life tables, Kaplan-Meier survival probabilities, hazard probabilities and the Cox proportional hazards model (Kleinbaum, 1996:56-114) were used to compare urban and rural children with respect to malnutrition and chances of survival.
Mothers and caretakers who took part in the study were chosen voluntarily and signed a consent form voluntarily. Each study participant was given a full explanation of the study, and was interviewed in private. Results of interviews and records were kept in confidence. Each participant in the study was assigned a unique study number to ensure anonymity and confidentiality. Where necessary, questions were asked in Sesotho (the official language in Lesotho).
All health-related, clinical and anthropometric measurements anthropometric measurements (anˈ·thrō·p were taken by health professionals employed by the Ministry of Health and Social Welfare of Lesotho. Statistical records and questionnaires were filled in and verified by fourth year students of statistics and demography demography (dĭmŏg`rəfē), science of human population. Demography represents a fundamental approach to the understanding of human society. from the National University of Lesotho The National University of Lesotho is situated at Roma (pop.8,000) some 34 kilometers south-east of Maseru, the capital of Lesotho. The Roma valley is broad and is surrounded by a barrier of rugged mountains which provides magnificent scenery. who were trained for the study by the Ministry of Health and Social Welfare of Lesotho and the UNICEF country office in Lesotho. In most cases, questions were asked in Sesotho as the majority of mothers in the study spoke Sesotho as their first language. Records were kept for each child in the study during the period of the study.
The list of variables and their levels
Data were collected from each of the children selected for the study and their mothers in order to identify factors that affect malnutrition and survival. The variables of interest were a combination of anthropometric, demographic, socio-economic, health-related and sanitary sanitary /san·i·tary/ (san´i-tar?e) promoting or pertaining to health.
1. Of or relating to health.
2. factors that affect malnutrition and survival.
The extent of malnutrition in each child was assessed utilising commonly employed anthropometric variables, as recommended by the WHO. Anthropometric variables used were height for age (HAZ HAZ Heat Affected Zone
HAZ Hazardous Cargo
HAZ HAWK Assignment Zone ), weight for height (WHZ WHZ Westsaechsische Hochschule Zwickau (German university: West Saxon University of Applied Sciences) ), weight for age (WAZ WAZ Westdeutsche Allgemeine Zeitung (German newspaper)
WAZ Wireless Access Zone ) and mid-upper arm circumference (MUAC MUAC Mid-upper arm circumference. See Triceps skin fold. ). Anthropometric measurements were compared with WHO international growth references (Jeliffe, 1966:2-11), and were expressed as weight for age (WAZ), height for age (HAZ) and weight for height (WHZ) Z scores. The rate of growth of children in the study was assessed by growth monitoring charts of the American National Center for Health Statistics National Center for Health Statistics (NCHS) is part of the Centers for Disease Control and Prevention (CDC), which is part of the United States Department of Health and Human Services.
NCHS is the United States' principal health statistics agency. (National Center for Health Statistics, 1977:78-1650). Height was measured in centimetres, age in months, and weight in kilogram kilogram, abbr. kg, fundamental unit of mass in the metric system, defined as the mass of the International Prototype Kilogram, a platinum-iridium cylinder kept at Sèvres, France, near Paris. . Salter salt·er
1. One that manufactures or sells salt.
2. One that treats meat, fish, or other foods with salt.
Noun 1. scales were used to measure weight. For children under the age of two years, the Years, The
the seven decades of Eleanor Pargiter’s life. [Br. Lit.: Benét, 1109]
See : Time recumbent recumbent /re·cum·bent/ (re-kum´bent) lying down.
Lying down, especially in a position of comfort; reclining. length was measured by the use of calibrated cal·i·brate
tr.v. cal·i·brat·ed, cal·i·brat·ing, cal·i·brates
1. To check, adjust, or determine by comparison with a standard (the graduations of a quantitative measuring instrument): measuring boards. For older children, standing height was measured using stadio meters. Stunting was measured using Z-scores from height for age (HAZ). Wasting was measured using Z-scores from weight for height (WHZ). The degree of malnutrition was measured using Z-scores from weight for age (WAZ). Using the NCHS NCHS National Center for Health Statistics
NCHS Naperville Central High School (Illinois)
NCHS North Central High School
NCHS Natrona County High School (Wyoming)
NCHS National Center for Health Services reference height for age chart, the height of a child was compared to the
height corresponding to a perfectly healthy child of the same age and sex on the NCHS chart. A child is said to be stunted stunt 1
tr.v. stunt·ed, stunt·ing, stunts
To check the growth or development of.
1. One that stunts.
2. One that is stunted.
3. if his/her height is less than the corresponding median height on the NCHS chart by two standard deviations In statistics, the average amount a number varies from the average number in a series of numbers.
(statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. . Weight for age (WAZ) was used as a measure of the degree of under-nutrition. Using the NCHS reference weight for age chart, the weight of a child was compared to the weight corresponding to a perfectly healthy child of the same age and sex on the NCHS chart. The child is said to be malnourished if his/her weight is less than the corresponding median weight on the NCHS chart by two standard deviations. Weight for height (WHZ) was used as a measure of wasting. Using the NCHS reference weight for height chart, the weight of a child was compared to the weight corresponding to a perfectly healthy child of the same height and sex on the NCHS chart. A child is said to be wasted if his/her weight is less than the corresponding median weight on the NCHS chart by two standard deviations.
In addition to anthropometric variables, data were collected from each child in the study on demographic and socio-economic factors that affect survival, as indicated in Table 1.
Monthly household income is said to be low if the average monthly income of the household is less than R 2 000. Monthly household income is said to be moderate or better if the average monthly income of the household is greater than or equal to R 2 000.
A child is said to be malnourished if the weight of child is less than the corresponding median weight of a perfectly healthy child on the NCHS chart by two standard deviations or more. A child is said to be not-mal nourished nour·ish
tr.v. nour·ished, nour·ish·ing, nour·ish·es
1. To provide with food or other substances necessary for life and growth; feed.
2. if the weight of child lies within two standard deviations of the corresponding median weight of a perfectly healthy child on the NCHS chart.
First of all, a comparison was made between the 393 non-survivors and the 3 608 survivors in the study with regards to variables relating to both categories of children (Tables 2 and 3). Secondly, a similar comparison was done between the surviving 2 544 rural and 1 064 urban children (Table 4). Thirdly, a summary of anthropometric measures was obtained for the 3 608 survivors in the study (Table 5). Fourthly Fourth´ly
adv. 1. In the fourth place.
Adv. 1. fourthly - in the fourth place; "fourthly, you must pay the rent on the first of the month"
fourth , life tables and Kaplan-Meier survival probabilities were obtained for urban (Table 6) and rural (Table 7) children in the study with age intervals of 12 months. Next, the extended proportional Cox Hazards model (Table 8) was used to identify predictor variables that strongly affect survival time on the basis of hazard ratios The hazard ratio in survival analysis is the effect of an explanatory variable on the hazard or risk of an event. For a less technical definition than is provided here, consider hazard ratio to be an estimate of relative risk and see the explanation on that page. . Lastly, Kaplan-Meier survival probabilities were used to compare the relative probabilities of survival of rural and urban children graphically (Figure 1). The statistical package STATA Stata (Statistics/Data Analysis) is a statistical program created in 1985 by Statacorp that is used by many businesses and academic institutions around the world. Most of its users work in research, especially in the fields of economics, sociology, political science, and version 7 was used for data analysis.
RESULTS OF STUDY
Using the reference curves in the NCHS growth monitoring charts as a guideline guideline Medtalk A series of recommendations by a body of experts in a particular discipline. See Cancer screening guidelines, Cardiac profile guidelines, Gatekeeper guidelines, Harvard guidelines, Transfusion guidelines. , 54.99% of the 3 608 survivors in the study were stunted, 49.67% of them were wasted, and 16.63% of them were malnourished. For the 3 608 survivors in the study, the average height for age ratio (HAZ) was 4.56, the average weight for height ratio (WHZ) was 0.13, and the average weight for age ratio (WAZ) was 0.56. Although NCHS standards are not ideally suited for Southern African children, comparison of HAZ, WHZ and WAZ figures in this study with the reference figures for perfectly healthy children in the NCHS reference charts indicates that the nutritional status of the 3 608 survivors in the study is generally poor by North American North American
named after North America.
North American blastomycosis
see North American blastomycosis.
North American cattle tick
see boophilusannulatus. standards.
Table 2 gives comparative proportions for children who were alive at the end of the five-year follow-up period and those children who died. It can be deduced from Table 2 that children who died were mostly rural children, had generally poor health conditions, belonged to illiterate mothers, were malnourished and came from low-income households. All in all, 393 of the 4 001 children in the study died before the age of five years. This represents 9.8% of the entire sample (N = 4001). The table also shows that 297 of the 393 children who died before the age of five (76%) were rural children, whereas 96 of the 393 children who died before the age of five (24%) were urban children.
Alternatively, Table 3 indicates that for the sample as a whole (N = 4001 representative of the general public), 10.46% (n = 297) of rural children (N = 2841) in the sample died before the age of five years while only 8.3% (n = 96) of the sample from the urban area (N = 1164) died.
Table 4 gives a comparison between live rural and urban children with regards to key health indicators. The table shows that rural children are clearly disadvantaged in comparison with urban children.
Table 5 gives a summary of anthropometric variables such as height for age (HAZ), weight for height (WHZ) and weight for age (WAZ) for the 3 608 children who were alive at the end of the follow-up period. Table 3 also shows that the mean age of children who were alive at the end of the study period is 24.17 months. (The corresponding figure for the 393 children who died is only 10.53 months).
Tables 6 and 7 give the number of deaths and survival probabilities for urban and rural children respectively. A comparison of the corresponding figures in the "Deaths" columns of Tables 6 and 7 shows that the number of deaths per age interval for rural children is much higher than the corresponding number of deaths per age interval for urban children. A comparison of corresponding figures in the "Survival probability" columns of Tables 6 and 7 shows that survival probabilities per age interval of rural children are smaller than corresponding survival probabilities for urban children.
Figure 1 shows Kaplan-Meier survival curves for urban and rural children on the same plane. It can be seen from Figure 1 that the survival probability curve of rural children lies lower than the survival probability curve of urban children over the duration of analysis. The log-rank test was performed to compare the significance of the above finding. At the = 0.01 level of significance, the difference between the two groups of children was highly significant (p=0.0006). Five of the nine dichotomous di·chot·o·mous
1. Divided or dividing into two parts or classifications.
2. Characterized by dichotomy.
di·chot predictor variables (residential area, literacy status, income, diarrhoea diarrhoea
see diarrhea. and malnutrition) proved to be time-varying covariates A time-varying covariate is a term used in statistics, particularly in survival analyses. It reflects the phenomenon that a covariate is not necessarily fixed. For instance, if one wishes to examine the link between area of residence and cancer, this would be complicated by the . Hence, analysis was done using the extended Cox proportional hazards model. Table 8 shows estimates obtained from the extended Cox proportional model.
The theoretical reliability of the estimated Cox regression model was confirmed using the likelihood ratio chi-square test chi-square test: see statistics. with nine degrees of freedom, an observed chi-square value of 1766.41 and a p-value of 0.0000. Table 8 also shows that all standard errors of estimation are small. This indicates that the predictor variables used for analysis are jointly useful in accounting for the survival of children.
[FIGURE 1 OMITTED]
The goal of survival analysis is to determine the hazard ratios of the predictor variables in the model. If the hazard ratios are greater than 1, the odds of death are increased. If the hazard ratios are less than 1, the odds of death are decreased. If the odd ratios are equal to 1, the predictor variable in charge has no influence on survival at all.
The hazard ratio column in Table 8 shows that survival time is strongly affected by malnutrition, literacy status of mother, residential area, TB, income status, immunisation, acute respiratory infectious diseases, diarrhoea and health condition, in a decreasing order of strength. In each case, p = 0.000, and the hazard ratios are greater than 1.
The estimated hazard ratios are interpreted as follows: The hazard ratio for the malnutrition variable is 2.36. This shows that malnourished children are 2.36 times more vulnerable to death than children who are not malnourished. The hazard ratio for the literacy variable is 2.21. This shows that children whose mothers are illiterate are 2.21 times more vulnerable. The same applies to the residence variable (2.19), the tuberculosis variable (1.96), the monthly income variable (1.86), the immunisation variable (1.76), acute respiratory infectious diseases (1.58), diarrhoeal diseases (1.55) and overall health condition (1.46).
The study shows that survival time is strongly affected by malnutrition, the literacy status of the mother, residential area, tuberculosis, monthly income of household, immunisation, acute respiratory infectious diseases, diarrhoeal diseases and overall health condition of the child, in a decreasing order of strength. All in all, 393 of the 4 001 live births (9.822%) followed up from September 1989 to September 1994 ended in death. Out of the 4 001 live births under five years of age selected at random for this study, 281 (7.0233%) were infant deaths Noun 1. infant death - sudden and unexpected death of an apparently healthy infant during sleep
cot death, crib death, SIDS, sudden infant death syndrome . The remaining 112 deaths were of children between one and five years. Of the infants who died, 217 (77.24%) of them lived in rural parts of Maseru. In total, 297 of the 393 or 77% of the deaths were of children in the rural parts of Maseru, whereas only 96 of the 393 deaths (23%) were of urban children.
The study also gives the following four major prevalence rates. Of the 4 001 children in this study, 34% have suffered from diarrhoeal diseases, 22% have suffered from acute respiratory infectious diseases, 26% have suffered from chronic malnutrition, and 17% have suffered from tuberculosis.
The following recommendations, based on findings of the study, are made to further reduce child mortality and morbidity in the Maseru District of Lesotho:
The issue of chronic malnutrition and famine famine
Extreme and protracted shortage of food, resulting in widespread hunger and a substantial increase in the death rate. General famines affect all classes or groups in the region of food shortage; class famines affect some classes or groups much more severely than , particularly in the rural parts of the district, has to be addressed by all government ministries and organisations concerned. The Ministry of Health and Social Welfare must pay particular attention to the rural parts of the Maseru District as most of the victims of the study lived there. Integrated feeding programmes as well as improved health services and infrastructure should be made available to the rural population of the District. If resources are available, similar feeding and health services should be extended to other rural parts of Lesotho where communities experience poverty and drought. The various health services and feeding programmes that are often provided to the rural communities of Lesotho by non-governmental organisations such as the Christian Health Association of Lesotho (CHAL CHAL Challenge
CHAL Christian Health Association of Liberia ) and international agencies such as the UNICEF should be integrated with services provided by the Ministry of Health and Social Welfare of Lesotho. Doing so will enable the Ministry of Health and Social Welfare of Lesotho to monitor feeding and health service programmes and evaluate their efficiency.
The study has shown that 81% of all households in the study have not been visited by community health workers between September 1993 and September 1994. The study has also shown that the majority of rural mothers (58%) included in the study did not know enough about how HIV/AIDS spreads. Awareness about personal hygiene personal hygiene person n → Körperhygiene f , use of safe water and protected toilets was low among rural mothers. For this reason, there is a need to promote existing community-based health-related programmes and activities throughout Lesotho, with emphasis to rural communities. This task can best be done using a community-based approach and primary health care principles, as is often suggested by the World Health Organization. Such an effort will help reduce malnutrition, mortality and morbidity among rural children in Lesotho who are often inconvenienced due to lack of nearby health facilities and the provision of basic health services.
The findings of the study on which the article reports support those of several other studies. These indicate that in Lesotho, rural children are more disadvantaged than urban children with regard to basic health services and economic opportunities. This manifests in higher hazard and lower survival probabilities among rural children in relation to nutrition and malnutrition. For this reason, the Government of Lesotho has several feeding programmes in place. These are monitored for their effectiveness through evaluative action research conducted by UNICEF and the Ministry of Health and Social Welfare of Lesotho.
My profound thanks go to the United Nations Children's Fund United Nations Children's Fund (UNICEF), an affiliated agency of the United Nations. It was established in 1946 as the United Nations International Children's Emergency Fund. (UNICEF) Country Office of Lesotho for covering 70% of the data collection cost of this study, the National University of Lesotho for covering 30% of the data collection cost of the study, the World Health Organization (WHO) Country Office of Lesotho for providing technical assistance and the Ministry of Health and Social Welfare of the Government of Lesotho for providing supervisors.
BIBLIOGRAPHY bibliography. The listing of books is of ancient origin. Lists of clay tablets have been found at Nineveh and elsewhere; the library at Alexandria had subject lists of its books.
Bern, C; Zucker, JR & Perkins, BA 1997: Assessment of potential indicators for protein-energy malnutrition in the algorithm for integrated management of childhood illness Integrated Management of Childhood Illness of IMCI is a systematic approach to children's health which focuses on the whole child. This means not only focusing on curative care but also on prevention of disease. . Bulletin of the World Health Organization, 75(supplement):8796.
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2. (communications) PCN - Personal Communication Network. 1998: The effect of the duration of breastfeeding on the lifetime of children in Lesotho. South African Statistical Journal, 32(1):67-82.
Jeliffe, DB 1966: The assessment of the nutritional status in the community. WHO Monograph Series no 53. Geneva Geneva, canton and city, Switzerland
Geneva (jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. : World Health Organization:2-11.
Kleinbaum, DG 1996: Survival analysis: A self-learning text. New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : Springer-Verlag.
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CDD Community Development Department
CDD Cooling Degree Days (weather derivatives / insurance index converting temperature into prices) , EPI and MCH/ FP. Lesotho Ministry of Health and Social Welfare, pp. 1-43.
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Please help [ improve the introduction] to meet Wikipedia's layout standards. You can discuss the issue on the talk page. . Institute of Education, National University of Lesotho, pp.1-26.
National Center for Health Statistics (NCHS) 1977: NCHS growth curves for children birth--18 years. US Department of Health, Education and Welfare, Vital and health statistics: series 11,
publication number (PHS (Personal Handyphone System) A TDMA-based cellular phone system introduced in Japan in mid-1995. Operating in the 1880-1930 MHz band, PHS uses microcells that cover an area only 100 to 500 meters in diameter, resulting in lower equipment costs but requiring more base ), pp.78-1650. Teka, T; Faruque, ASG ASG Assign
ASG Allen Systems Group (Naples, FL)
ASG Abu Sayyaf Group (terrorist group)
ASG Associated Student Government
ASG Area Support Group
ASG Adaptive Services Grid
ASG Assistant Secretary General & Fuchs, GJ 1996: Risk factors for deaths in under-age-five children attending a diarrhoea treatment center. Acta Paediatricia, 85(1):1070-1075.
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Worku, ZB & Makatjane, TJ 1996: The impact of a short duration of breast feeding breast feeding Pediatrics The provision of a neonate and infant with liquified lacteal products 'on tap'; lactation and BF–≥ 6 months before age 20 is associated with a relative risk of 0. on child survival on the Maseru District. Review of Southern African Studies African studies (also known as Africana studies) is the study of Africa, and can encompass such fields as social and economic development, politics, history, culture, sociology, anthropology or linguistics. A specialist in African studies is referred to as an Africanist. , 1(2):54-71.
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Senior lecturer senior lecturer
n. Chiefly British
A university teacher, especially one ranking next below a reader. of biostatistics biostatistics /bio·sta·tis·tics/ (-stah-tis´tiks) biometry.
The science of statistics applied to the analysis of biological or medical data. , School of Health Systems and Public Health, University of Pretoria
Corresponding author: firstname.lastname@example.org
Table 1: List of variables of study and their levels Variable of study Level 1 Level 2 Survival status of child Dead Alive Residential area Rural Urban Literacy status of mother Illiterate Literate Monthly household income Low Moderate or better Immunisation status of child Not fully immunised Fully immunised Acute respiratory infections in Yes No child Diarrhoea in child Yes No TB in child Yes No Malnutrition in child Yes No Height of child in cms Weight of child in kgs Height for age of child Weight for height of child Weight for age of child General health condition of Poor Moderately good child or better Age of child in months Table 2: Group proportions for non-survivors and survivors Variable Non-survivors (n=393) Survivors (n=3608) Survival status of Dead: 393/4001 = 9.8% Alive: 3608/4001 = 90.2% child Residential area Rural: 297 = 76% Rural: 2544 = 71% Urban: 96 = 24% Urban: 1064 = 29% Literacy status of Illiterate: 304 = 77.4% Illiterate: 321 = 8.9% mothers Literate: 89 = 22.6% Literate: 3287 = 91.1% Monthly household Low: 318 = 80.9% Low: 758 = 21.0% income Otherwise: 75 = 19.1% Otherwise: 2850 = 79.0% Immunisation No: 240 = 61.1% No: 913 = 25.3% status of children Yes: 153 = 38.9% Yes: 2695 = 74.7% Acute respiratory Yes: 325 = 82.7% Yes: 372 = 10.3% infections in No: 68 = 17.3% No: 3236 = 89.7% children Diarrhoea in Yes: 263 = 67.0% Yes: 1082 = 30% children No: 130 = 33% No: 2526 = 70% TB in children Yes: 153 = 39.0% Yes: 487 = 13.5% No: 240 = 61.0% No: 3121 = 86.5% Malnutrition among Yes: Not recorded Yes: 600 = 16.6% children No: Not recorded No: 3008 = 83.4% General health Poor: 393 = 100% Poor: 325 = 9% condition of Good: 0 = 0% Good: 3283 = 91% children Table 3: Differential survival/non-survival for rural and urban children Rural Urban n % n % Non-survivors 297 10.46% 96 8.30% Survivors 2544 89.54% 1064 91.70% TOTAL 2841 100% 1160 100% Table 4: Comparison between 3608 live rural and urban children Variables Rural children Urban children (alive) (alive) N=2544 (71%) N=1064 -29% N % n % Illiterate mothers 1333 52.4% 213 20.0% Mothers with TB 211 8.3% 79 7.4% Deliveries not attended by health 366 14.4% 117 11% worker Mothers not given antenatal 631 24.8% 213 20% health care Mothers not given postnatal 481 18.9% 177 16.6% health care Children not fully immunised 829 32.6% 207 19.5% Children with acute respiratory 738 29.0% 189 17.2% infections Children with diarrhoeal diseases 913 35.9% 348 32.7% Malnourished children 481 18.9% 118 11.1% Children with poor health 501 19.7% 183 17.2% condition Children with TB 451 17.7% 124 11.7% Weight for age ratio (WAZ) 4.879 3.8119 Table 5: Summary of anthropometric measures for the 3608 survivors Std. Variable Mean Dev. Min Max Height in cms 69.80 7.41 35 115 Weight in kgs 9.49 1.08 3 24 Height for age (HAZ) 4.56 3.18 1.08 16.67 Weight for height 0.13 0.03 0.06 0.23 (WHZ) Weight for age (WAZ) 0.56 0.33 0.1 2.08 Age in months 24.17 2.16 3 60 Table 6: Lifetable for urban children with age intervals of 12 months Age interval Children Deaths Survival Std. in months at risk probability Error 0 to 12 1160 64 0.9403 0.0072 12 to 24 920 24 0.9130 0.0089 24 to 36 712 8 0.9010 0.0098 36 to 48 488 0 0.9010 0.0098 48 to 60 320 0 0.9010 0.0098 60 to 72 112 0 0.9010 0.0099 Total 96 Age interval 95% C. I. in months 0 to 12 [0.9244, 0.9530] 12 to 24 [0.8938, 0.9289] 24 to 36 [0.8800, 0.9184] 36 to 48 [0.8800, 0.9184] 48 to 60 [0.8800, 0.9184] 60 to 72 [0.8800, 0.9184] Total Table 7: Lifetable for rural children with age intervals of 12 months Age interval Children Deaths Survival Standard in months at risk probability Error 0 to 12 2841 216 0.9139 0.0056 12 to 24 1961 25 0.8997 0.0062 24 to 36 1240 32 0.8705 0.0079 36 to 48 696 16 0.8445 0.0100 48 to 60 360 8 0.8138 0.0143 60 to 72 72 0 0.8138 0.0143 Total 297 Age interval 95% C. I. in months 0 to 12 [0.9022, 0.9242] 12 to 24 [0.8869, 0.9112] 24 to 36 [0.8542, 0.8851] 36 to 48 [0.8239, 0.8629] 48 to 60 [0.7838, 0.8401] 60 to 72 [0.7838, 0.8401] Total Table 8: Table of estimated hazard ratios from Cox regression Variable Hazard Ratio Standard Error p-value Immunisation 1.757852 0.0192782 0.000 ARI 1.578531 0.0718337 0.000 TB 1.961472 0.0205485 0.000 Health 1.458463 0.0327241 0.000 Residence 2.195696 0.0110085 0.000 Literacy 2.210318 0.0098347 0.000 Income 1.859638 0.0117941 0.000 Diarrhoea 1.54774 0.0080260 0.000 Malnutrition 2.36407 0.0086084 0.000 Variable 95% C. I. for HR Immunisation [1.377054, 2.138650] ARI [1.246078, 1.910984] TB [1.549623, 2.373322] Health [1.014569, 1.902358] Residence [1.743497, 2.647896] Literacy [1.966041, 2.454595] Income [1.584582, 2.134694] Diarrhoea [1.130926, 1.964554] Malnutrition [1.897197, 2.830943]