Made available in DSpace on 2014-09-09T12:22:48Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 69591.pdf: 3878499 bytes, checksum: 34f8bc6b6d59a7f8f16d3a39356fd14f (MD5) Previous issue date: 2014 / Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil. / No Brasil, predomina a assistência obstétrica centrada no médico especialista em obstetrícia e uma excessiva medicalização do trabalho de parto e do parto. .O modelo colaborativo (MC) na assistência obstétrica significa a integração da obstetriz ou enfermeira obstétrica e do médico obstetra na equipe de assistência ao trabalho de parto e parto. Objetivo: Estudar modelos assistenciais, que incorporam a atuação da enfermeira obstétrica para a assistência ao trabalho de parto e parto, e sua associação com intervenções no trabalho de parto e parto e resultados maternos e neonatais. Métodos: Desenho do estudo foi transversal. População do estudo foi mulheres atendidas em hospitais do Município de Belo Horizonte, vinculados ao SUS, que apresentam o modelo colaborativo (equipe composta por médico obstetra e enfermeira obstétrica), modelo tradicional (equipe composto somente por médico obstetra) e um Centro de Parto Normal perihospitalar. O primeiro artigo analisa, por meio de regressão logística multivariada, a associação entre o modelo assistencial e intervenções utilizadas na condução do trabalho de parto. O segundo artigo analisa a associação entre o modelo e o parto vaginal espontâneo conforme um modelo hierarquizado. O terceiro artigo descreve e compara as intervenções, tipo de parto e resultados neonatais entre dois hospitais, que representam o modelo colaborativo e o modelo tradicional, e o Centro de Parto Normal. Resultados: Houve menor utilização da ocitocina, da amniotomia e da episiotomia e maior utilização de métodos não farmacológicos para alívio da dor nos modelos com incorporação da enfermeira obstétrica, sendo as proporções menores no CPN. A associação entre o MC e a redução no uso da ocitocina, da ruptura artificial das membranas e da episiotomia, e do parto vaginal espontâneo se manteve após o ajuste para fatores de confundimento... / In Brazil predominates, even for women of normal risk, physician - centered care and an excessive medicalization of chil dbirth care.The collaborative model (CM) in the obstetric care means midwife or nurse - midwife and obstetrician working together in the team which takes care for women in labor and delivery. Objective: To study care models, with and without incorporating the midwife role for care during labour and delivery, and their association with interventions in childbirth and with maternal and neonatal results. Methods: The study was transversal. The study population were women attended in hospitals from Belo Horizonte, linked to the national public health system (SUS), that represent the collaborative model (team with obstetrician and midwife), traditional model (team composed only by obstetrician) and a alongside birth centre. The first article analyses, by m ultivariate logistic regression, the association between the care model and the interventions used in labour. The second article analyses the association between the model and the spontaneous vaginal delivery according to a hierarchical model. The third ar ticle describes and compares the interventions, birth type and neonatal results between hospitals, th ose represent the collaborative and traditional models, and the birth center care model . Results: There was less use of oxytocin, of amniotomy and episi otomy and more use of non - pharmacological methods to relieve the pain in models incorporating midwives, being the smaller proportions in the birth center. The association between the CM and the reduction of oxytocin use, amniotomy and episiotomy and the in crease of the spontaneous vaginal delivery were kept after the adjustment for confounding factors. The care model was not associated to neonatal complications and use of conduction analgesia. Conclusion: The result suggest that care models incorporating t he midwife can reduce interventions in the labour and delivery care with perinatal similar results, as well as increase the rate of spontaneous vaginal delivery, including women with obstetric - clinic complications, birth induction or pharmacological analge sia. The MC is feasible in the Brazilian context and can be a tool in efforts to change the health care model

Infant feeding in the context of HIV/AIDS poses a challenge among mothers. The implementation of UNICEF guidelines on infant feeding, which state that “when replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended” (WHO, 2003:12) are not easy to meet. In more developed countries, where these criteria are met, almost all HIV-infected mothers have ceased to breast feed. Consequently, infants of mothers in these countries are less likely to be infected with HIV postnatally. In South Africa, more specifically in the Eastern Cape, infant feeding is a challenge as a number of UNICEF criteria cannot be met. The Eastern Cape is one of the poorest Provinces in South Africa, with a number of rural communities. Earlier studies have shown that, if mothers select either exclusive breast feeding or exclusive formula feeding, this reduces mother-to-child transmission of HIV. A limited number of studies on adherence to the method of infant feeding selected before delivery were found in the literature, hence the need for the current study. The purpose of the study was to explore adherence to exclusive breast feeding and exclusive formula feeding among mothers with HIV infection and to determine the problems that mothers may be facing in implementing their pre-selected methods.

MPH / Department of Public Health

This explorative, descriptive quantitative survey attempted to determine whether the reduced number of consultations and admissions of sick children less than five years in Emfuleni sub- district clinics is due to the utilisation of the IMCI strategy or other health services. The research population comprised of all the mothers/caretakers of children less than five years who utilised the clinics and those who consulted the private medical doctor. The convenient sample consisted of 169 candidates. Data was collected by means of a questionnaire and analysed using the SAS/Basic computer statistical software package. Findings of the study revealed a need to address the major concern about the waiting time and operational times in all the three clinics. Recommendations were made that staff allocation procedures and policies be reviewed in order to abate long waiting periods at the clinics where children with childhood illnesses are treated. / Health Studies / M.A. (Health Studies)

Child rights, especially the right to health for children, is a concept of human development. The aim of this qualitative study is to explore the obstacles to gender equality in the right to healthcare for children under five years in East Champaran, Bihar, North India. Ten key informant interviews and nine focus group discussions with mothers, fathers, grandmothers and grandfathers were conducted to research the barriers of guardians to accessing healthcare for their children, including their root beliefs and choices, which causes health inequalities. It was found that a strong patriarchal tradition predominates in these communities in North India, which favour sons and disadvantages daughters in healthcare provision. Despite the existing child rights and human rights policies that have been legislated, in India traditional practices that discriminate against female children remain dominant in the society, and limit development in East Champaran, Bihar, North India. / Development Studies / M.A. (Development Studies)

This explorative, descriptive quantitative survey attempted to determine whether the reduced number of consultations and admissions of sick children less than five years in Emfuleni sub- district clinics is due to the utilisation of the IMCI strategy or other health services. The research population comprised of all the mothers/caretakers of children less than five years who utilised the clinics and those who consulted the private medical doctor. The convenient sample consisted of 169 candidates. Data was collected by means of a questionnaire and analysed using the SAS/Basic computer statistical software package. Findings of the study revealed a need to address the major concern about the waiting time and operational times in all the three clinics. Recommendations were made that staff allocation procedures and policies be reviewed in order to abate long waiting periods at the clinics where children with childhood illnesses are treated. / Health Studies / M.A. (Health Studies)

The collection and utilisation of statistical data is an integral component of rendering primary health care services. This study aimed to assess the utilisation of statistics on certain statistical forms submitted regularly to the Department of Health, by professional nurses at local authority primary health care clinics. Results revealed the following important shortcomings: • Statistics on different forms are viewed in isolation, resulting in a lack of necessary comparisons being made to determine trends. • Several targeted issues in the Reconstruction and Development Programme received insufficient attention, for example, immunisations, teenage pregnancies, tuberculosis treatment, sexually transmitted diseases. • A general managerial inability to analyse, display and utilise collected data by professional nurses. Recommendations centred around increasing the knowledge regarding maternal health care, more focus on prioritised areas of the Reconstruction and Development Programme, appropriate training regarding analysis and utilisation of collected statistics at local primary health care level. / Health Studies / M.A. (Nursing)

The collection and utilisation of statistical data is an integral component of rendering primary health care services. This study aimed to assess the utilisation of statistics on certain statistical forms submitted regularly to the Department of Health, by professional nurses at local authority primary health care clinics. Results revealed the following important shortcomings: • Statistics on different forms are viewed in isolation, resulting in a lack of necessary comparisons being made to determine trends. • Several targeted issues in the Reconstruction and Development Programme received insufficient attention, for example, immunisations, teenage pregnancies, tuberculosis treatment, sexually transmitted diseases. • A general managerial inability to analyse, display and utilise collected data by professional nurses. Recommendations centred around increasing the knowledge regarding maternal health care, more focus on prioritised areas of the Reconstruction and Development Programme, appropriate training regarding analysis and utilisation of collected statistics at local primary health care level. / Health Studies / M.A. (Nursing)

Text in Afrikaans / Die MIV/vigs-pandemie in Suid-Afiika- van die ergste in die wereld- toon geen tekens van afname nie. Miljoene kinders is reeds of wees gelaat of hewig geaffekteer deur die magdom impakte daarvan op gesinne en gemeenskappe. Die epidemie het voortdurend stygende sterftesyfers tot gevolg en die hewige las van die siekte rus swaar op MIV-positiewe sowel as MIV-negatiewe individue. Verder word tradisionele ondersteuningsnetwerke oorbelaai en/of gaan hulle tot niet. Gesinne en gemeenskappe verloor hul ekonomiese, sosiale en kulturele lewensvatbaarheid. Die pandemie hou, veral onder die armes, 'n geweldige bedreiging vir die gesondheid, welstand en regte van babas, kinders en jongmense in. 'n Groot gedeelte van die impak van MIV/vigs hou verband met die feit dat sommige kinders en hul gesinne beperkte toegang tot die elemente van 'n gesonde omgewing en goeie gesondheid het. Regerings, gemeenskappe en gesinne wat deur MIV/vigs geraak word, het minder tyd, energie en finansiële hulpbronne beskikbaar om op voorkomende gesondheidsorg te fokus. Benewens die impak op gesondheidstatus, word kinders se omstandighede ook as gevolg van MIV/vigsverwante probleme bemoeilik. Dit sluit verhoogde gesinsarmoede, 'n hoer risiko van verlating en weeslating, geforseerde migrasie, onterwing, sielkundige trauma, uitsluiting en diskriminasie, en fisiese en seksuele mishandeling in. Die derde vlaag van die epidemie, welke vlaag nou betree word, word gekenmerk deur 'n ontsettende hoe sterftesyfer, 'n ontploffing in die getal sorgbehoewende en weeskinders en 'n verhoging in menslike pyn en lyding. Die reg speel 'n baie belangrike rol in die beperking van hierdie impak van die MIV/vigs-pandemie op die lewens van alle kinders. MIV/vigs-reg is in die proses van evolusie of vorming en reeds bestaande teorieë kan aangewend word ten einde sekere vrae te beantwoord en probleme daaromtrent aan te spreek. Tog is daar 'n dringende behoefte aan MIV/vigs-spesifieke wetgewing en teorieë ten einde die impak van die pandemie op alle vlakke suksesvol te beheer. Verder het die Kinderreg so 'n mate van ontwikkeling bereik dat daar algemeen aanvaar word dat kinders 'n spesiale belangegroep binne die gemeenskap vorm. Die regsreëls met betrekking tot kinders verander gedurig en is ook nie geskik om volgens die tradisionele wyse, as privaat- of publiekreg, geklassifiseer te word nie. In die hieropvolgende proefskrif word die impak van MIV/vigs op sekere publiekregtelike, maar oorwegend privaatregtelike aspekte van die Suid-Afiikaanse kinderreg ondersoek, sowel as enkele metodes waarop die reg moontlik hierdie impak kan absorbeer en hanteer. Daar word ook in aparte hoofstukke na die impak van MIV/vigs op die lewens van kinders. sorgbehoewende kinders, egskeiding en die ouer-kind-verhouding verwys The HIV/aids pandemic in South Africa - one of the worst in the world - does not seem to be decreasing. Millions of children have already been either orphaned or heavily affected by the numerous impacts on families and communities associated with it. The epidemic brings on an ever-increasing mortality rate and the extreme burden thereof weighs down heavily on HIV-positive as well as HIV-negative individuals. Traditional support networks are further being heavily burdened or perish entirely. Families and communities lose their economical, social and cultural viability. The pandemic threatens, especially among the poorest, the health, wellbeing and rights of infants, children and young people. The impact of HIV/aids is to a great extent the result of the fact that some children and their families do not have sufficient access to a healthy environment and good health. Governments, communities and families affected by HIV/aids have less time, energy and financial resources available in order to enable them to focus on preventive healthcare. In addition to the impact on health status, children's circumstances are also being encumbered by HIV/aids-related problems, including family poverty, a higher risk of being abandoned or orphaned, forced migration, disinheritance, psychological trauma, ostracism and discrimination and physical and sexual abuse. The third wave of the epidemic, which wave is presently being experienced, is characterised by a high mortality rate, an increasing amount of children in need of care and orphaned children and an increase in human pain and suffering. The law plays an important role in the limitation of the impact of the HIV/aids pandemic on the lives of children. HIV/aids law is in the process of evolution or forming and existing theories can be used in order to answer certain questions and address certain issues relating to it. However, there is an urgent need for HIV/aids-specific legislation and theories in order to successfully manage the impact of the pandemic on all levels. Child law has also reached such an extent of development that children is now viewed as a special interest group within the community. The legal principles regarding children change constantly and cannot be classified in the traditional way, which is either as private or public law. In this thesis the impact of HIV/aids on certain aspects of the public and private law pertaining to children is examined. Ways in which the impact can be absorbed and managed by the law is also examined. The impact of HIV/aids on divorce, the parent-child relationship, children in need of care, and the impact of HIV/aids on the lives of children is examined in separate chapters. / Jurisprudence / LL. D.

Text in Afrikaans / Die MIV/vigs-pandemie in Suid-Afiika- van die ergste in die wereld- toon geen tekens van afname nie. Miljoene kinders is reeds of wees gelaat of hewig geaffekteer deur die magdom impakte daarvan op gesinne en gemeenskappe. Die epidemie het voortdurend stygende sterftesyfers tot gevolg en die hewige las van die siekte rus swaar op MIV-positiewe sowel as MIV-negatiewe individue. Verder word tradisionele ondersteuningsnetwerke oorbelaai en/of gaan hulle tot niet. Gesinne en gemeenskappe verloor hul ekonomiese, sosiale en kulturele lewensvatbaarheid. Die pandemie hou, veral onder die armes, 'n geweldige bedreiging vir die gesondheid, welstand en regte van babas, kinders en jongmense in. 'n Groot gedeelte van die impak van MIV/vigs hou verband met die feit dat sommige kinders en hul gesinne beperkte toegang tot die elemente van 'n gesonde omgewing en goeie gesondheid het. Regerings, gemeenskappe en gesinne wat deur MIV/vigs geraak word, het minder tyd, energie en finansiële hulpbronne beskikbaar om op voorkomende gesondheidsorg te fokus. Benewens die impak op gesondheidstatus, word kinders se omstandighede ook as gevolg van MIV/vigsverwante probleme bemoeilik. Dit sluit verhoogde gesinsarmoede, 'n hoer risiko van verlating en weeslating, geforseerde migrasie, onterwing, sielkundige trauma, uitsluiting en diskriminasie, en fisiese en seksuele mishandeling in. Die derde vlaag van die epidemie, welke vlaag nou betree word, word gekenmerk deur 'n ontsettende hoe sterftesyfer, 'n ontploffing in die getal sorgbehoewende en weeskinders en 'n verhoging in menslike pyn en lyding. Die reg speel 'n baie belangrike rol in die beperking van hierdie impak van die MIV/vigs-pandemie op die lewens van alle kinders. MIV/vigs-reg is in die proses van evolusie of vorming en reeds bestaande teorieë kan aangewend word ten einde sekere vrae te beantwoord en probleme daaromtrent aan te spreek. Tog is daar 'n dringende behoefte aan MIV/vigs-spesifieke wetgewing en teorieë ten einde die impak van die pandemie op alle vlakke suksesvol te beheer. Verder het die Kinderreg so 'n mate van ontwikkeling bereik dat daar algemeen aanvaar word dat kinders 'n spesiale belangegroep binne die gemeenskap vorm. Die regsreëls met betrekking tot kinders verander gedurig en is ook nie geskik om volgens die tradisionele wyse, as privaat- of publiekreg, geklassifiseer te word nie. In die hieropvolgende proefskrif word die impak van MIV/vigs op sekere publiekregtelike, maar oorwegend privaatregtelike aspekte van die Suid-Afiikaanse kinderreg ondersoek, sowel as enkele metodes waarop die reg moontlik hierdie impak kan absorbeer en hanteer. Daar word ook in aparte hoofstukke na die impak van MIV/vigs op die lewens van kinders. sorgbehoewende kinders, egskeiding en die ouer-kind-verhouding verwys The HIV/aids pandemic in South Africa - one of the worst in the world - does not seem to be decreasing. Millions of children have already been either orphaned or heavily affected by the numerous impacts on families and communities associated with it. The epidemic brings on an ever-increasing mortality rate and the extreme burden thereof weighs down heavily on HIV-positive as well as HIV-negative individuals. Traditional support networks are further being heavily burdened or perish entirely. Families and communities lose their economical, social and cultural viability. The pandemic threatens, especially among the poorest, the health, wellbeing and rights of infants, children and young people. The impact of HIV/aids is to a great extent the result of the fact that some children and their families do not have sufficient access to a healthy environment and good health. Governments, communities and families affected by HIV/aids have less time, energy and financial resources available in order to enable them to focus on preventive healthcare. In addition to the impact on health status, children's circumstances are also being encumbered by HIV/aids-related problems, including family poverty, a higher risk of being abandoned or orphaned, forced migration, disinheritance, psychological trauma, ostracism and discrimination and physical and sexual abuse. The third wave of the epidemic, which wave is presently being experienced, is characterised by a high mortality rate, an increasing amount of children in need of care and orphaned children and an increase in human pain and suffering. The law plays an important role in the limitation of the impact of the HIV/aids pandemic on the lives of children. HIV/aids law is in the process of evolution or forming and existing theories can be used in order to answer certain questions and address certain issues relating to it. However, there is an urgent need for HIV/aids-specific legislation and theories in order to successfully manage the impact of the pandemic on all levels. Child law has also reached such an extent of development that children is now viewed as a special interest group within the community. The legal principles regarding children change constantly and cannot be classified in the traditional way, which is either as private or public law. In this thesis the impact of HIV/aids on certain aspects of the public and private law pertaining to children is examined. Ways in which the impact can be absorbed and managed by the law is also examined. The impact of HIV/aids on divorce, the parent-child relationship, children in need of care, and the impact of HIV/aids on the lives of children is examined in separate chapters. / Jurisprudence / LL. D.