It is only within the last 2 decades that much attention has been focused on foetal mortality, what with the spectacular fall in the maternal morbidity consequent on the vast improvements in antenatal care, the consequences of the discovery of the antibiotics, and the liberal transfusions.

No description available.

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).

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Public Health (Hospital Management) Johannesburg, August 2014 / Background Tuberculosis (TB) remains a major cause of disease and death worldwide. In 2008, South Africa ranked third in the world in terms of the total numbers of new TB cases. Little is known about the profile of TB deaths at individual hospital level. Hence, the aim of the study was to describe the profile of TB deaths in Charles Hurwitz TB Hospital for the period January to December 2007. Methods A descriptive study was done, based on retrospective record review of all patients who died between January and December 2007 at Charles Hurwitz TB Hospital, irrespective of the date of admission. The data was analysed using Microsoft Excel. Findings The mean age at death was 41 years (standard deviation =10.9 years). Less than half of deceased individuals were employed (43.4%), more than one third had a history of smoking (42%) and the majority had a history of alcohol consumption (60.5%). Almost three quarters of the patients (75.3%) were being treated for the first time. The majority (85.1%) of deceased patients tested for HIV were HIV positive, but only 23.3% of those referred for treatment were actually on ART, indicating missed opportunities in treatment and care at the hospital. Conclusion There is need for ongoing vigilance and training to ensure that TB hospitals and individual health care providers comply with the national quality of care and TB management standards, and that missed opportunities are eliminated to reduce avoidable TB deaths.

Thesis (Ph. D.)--University of Hong Kong, 2008. / Includes bibliographical references (leaf 156-187) Also available in print.

Thesis (Ph. D.)--University of Hong Kong, 2008. / Includes bibliographical references (leaf 156-187) Also available online.

Thesis (doctoral)--Ludwig Maximilians-Universität zu München, 1979. / Vita. Includes bibliographical references (p. 6-7).

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.

Introduction Worldwide, 99% of deaths of women in their reproductive ages are due to childbirth and pregnancy complications. Maternal mortality is the subject of the fifth United Nations’ millennium development goal: the aim is to reduce the maternal mortality ratio by three quarters from 1990 to 2015. Although much research has been conducted in recent years, knowing the spatial pattern of maternal mortality in developing countries will help target scarce resources and intervention programs to high risk areas for the greatest impact, since nationwide interventions are costly. Objective This study assessed the spatial patterns and trends of, and causes and risk factors associated with, maternal mortality in the Ifakara Health and Demographic Surveillance Site (IHDSS) in Tanzania, from 2006 to 2010, with a view to providing information that may help reduce maternal mortality in this country. Method A secondary data analysis of a longitudinal study using data from the IHDSS was conducted. Inverse distance weighted (IDW) method of interpolation in ArcGIS was used to assess spatial patterns. Cox proportional hazards regression was used to identify and quantify risk factors associated with maternal mortality. Results A total of 36 792 women aged 15 to 49 were included in the study of which 77 died due to childbirth or pregnancy related complications. The overall maternal mortality rate for the five years was 0.79 per 1000 person years. The trend declined from 90.42 per 1000 person years in 2006 to 57.42 per person years in 2010. There were marked geographical differences in maternal mortality patterns with high levels of mortality occurring in areas with close proximity to health facilities in some instances. The main causes of maternal death were eclampsia (23%), haemorrhage (22%) and abortion-related complications (10%). Maternal age, marital status and socioeconomic status were found to be risk factors. There was a reduced risk of 82% (HR: 0.18, 95% CI: 0.05-0.74) and 78% (HR: 0.22, 95% CI: 0.05 – 0.92) for women aged 20-29 and 30-39 years, respectively, compared with those younger than 20 years. While being married had a protective effect of 94% (HR: 0.06, 95% CI: 0.01 - 0.51) compared to being single, women who were widowed had an increased risk of 813% (HR: 9.13, 95% CI: (1.017 – 81.942). Higher socioeconomic status had a protective effect on maternal mortality: women who were in the poorer and least poor socioeconomic groups were 70% (HR: 0.30, 95% CI: 0.11 – 0.81) and 75% (HR: 0.25, 95% CI: 0.06 - 1.09) less likely to die from maternal causes, respectively, compared to those in the poorest category. Conclusion There has been a decline in maternal mortality in rural southern Tanzania, with geographical differences in patterns of death. Eclampsia, haemorrhage and abortion-related complication are the three leading causes of maternal death in rural southern Tanzania, with risk factors being maternal age less than 20 years, marital status (single, widowed), and lower socioeconomic status. Keywords: maternal mortality, risk factors, spatial pattern, maternal mortality rate, verbal autopsy

BACKGROUND: Globally, perinatal mortality accounts for a large proportion of child deaths. Perinatal mortality rate (PNMR) is taken as an index of efficient obstetric care, and also serves as an indicator for the Millennium Development Goals (MDGs) 4 and 5, that is related to infant mortality rate and improving maternal health (Day, Monticelli, Barron, et al., 2010). In developed countries, perinatal mortality rate has shown a marked decrease over the past few years. This is mostly due to the changing patterns in reproductive health, improved socio-economic factors and quality of maternal and child care (World Health Organization, 2006). However, developing countries are still struggling to curb perinatal deaths. In South Africa, there has been a gradual decline in the PNMR in public health facilities from 38.6 in 2003/2004 to 31.0 per 1000 live births in 2008/2009. However, there has been a slight increase to 32.8 per 1000 live births in 2010/2011 (Day, Barron, Massyn, et al., 2012). In the Mpumalanga province, the PNMR has decreased slightly from 34.9 per 1000 live births in 2008/2009 to 33.2 per 1000 live births in 2010/2011. Carolina Hospital itself has a PNMR which is far too high at 43 per 1000 live births from January to June in 2008/2009. It is assumed that because the sub-district is underserved with primary health care facilities as well as having a poor attendance of antenatal care services by pregnant women, this has subsequently had a negative effect on perinatal care. However, this has never been formally assessed. AIM: The aim of the study was to describe the perinatal mortality and morbidity, and to identify the causes and avoidable factors of perinatal mortality and morbidity at Carolina Hospital for the period 1st April 2009 to 31st March 2011. METHODOLOGY: The setting for the study was the maternity unit of Carolina Hospital, a district hospital in the Gert Sibande district, Mpumalanga. It comprised of a retrospective record review of data from the maternity registers and the Perinatal Problem Identification Programme (PPIP); from the 1st April 2009 to the 31st March 2011. All the records of perinatal deaths (N=94) and admissions (N=35) of babies 7 days old and younger during the study period were included in the study and no sampling was done for these two groups of patients. For all other delivery records, systematic sampling was utilized by choosing every tenth record listed on the sampling frame. Data was extracted from the PPIP and maternity registers using data extraction sheets. Data was captured onto a Microsoft excel based spreadsheet, imported into and analyzed with EPI-Info software version 3.5.1 using descriptive and analytic statistics. Data was collected the number of perinatal deaths, admissions, total number of deliveries, neonatal and maternal profile, causes of perinatal mortality and morbidity and factors associated with perinatal mortality and morbidity RESULTS: During the period of the study there was a total of 1 604 deliveries with 94 perinatal deaths and 35 perinatal admissions. The perinatal mortality rate was 61.4 per 1000 live births with a stillbirth rate of 47 per live births; and an early neonatal death rate of 14.4 per 1000 live birth. Nine percent of the mothers were unbooked, and this accounted for 11.4% of perinatal morbidity and 17% of the mortality which occurred during the study period. Over a third (34%) of the perinates who died were born from HIV positive mothers; whilst more than halve (54.3%) of those perinates who were admitted during the perinatal period were born from HIV positive mothers. Over two thirds (63.2%) of the perinatal deaths were below 2500g while half (45.7%) of admissions were below this birth weight. Intrauterine death (40.4%) was the leading cause of perinatal mortality at Carolina Hospital for the two years of study. Over the two year study period, patient related factors were the highest avoidable factors given, accounting to 72.9% of the total while health care related avoidable factors accounted to 39.5% of the perinatal mortalities and morbidities. CONCLUSION: The study found that there was a high PNMR and high still birth rate at Carolina Hospital. The majority of the avoidable factors were patient related. The reasons for this included late booking, delay in seeking medical attention during labour, never initiating antenatal care, infrequent visits to the clinic, and inappropriate response to poor fetal movement. In order to achieve the Millennium Development Goal 4 more attention should be given to reducing perinatal deaths. These indicate a need to strengthen the quality of ANC rendered, especially in the primary health care facilities. RECOMMENDATIONS: There is a need to strengthen maternal and child health services in the maternity unit of Carolina Hospital, and in the surrounding clinics within the Albert Luthuli sub-district. Clinical governance should be strengthened within Carolina Hospital. There is also a need for maternal and child health specialist outreach services within the Gert Sibande district health as a whole.