Thesis (Ph. D.)--Michigan State University, 2005. / Includes bibliographical references. Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (Ph. D.)--Michigan State University, 2005. / Includes bibliographical references.

Summaries in English and Sesotho / This qualitative, exploratory, descriptive study explored culturally sensitive health information about the use of herbal medicine by pregnant women in Lesotho, in order to provide culturally sensitive health advice to pregnant women. Pregnant women used herbal medicine and remedies during pregnancy resulted in still births and complications during labour. Data on the beliefs and practices of fifteen purposively and conveniently sampled pregnant women attending a rural antenatal clinic was collected through semistructured interviews and analysed using Colaizzi’s seven-step method. Ethical principles and strategies to ensure trustworthiness were applied. One central theme emerged: ‘Women believe that the use of herbal medicine and remedies is a traditional practice that pregnant women need to follow due to culture’. The cultural beliefs and practices of the women were deeply rooted in Basotho culture, which guided the use of herbal medicine. However, some considered herbal medicines to be harmful, as the dosage and content of these medicines vary. Nurses are therefore key to providing culturally sensitive health care advise on using herbal medicine during pregnancy. / Boithuto bona ba boleng bo botle, bo hlalosang le ho fumaneng tlhaiso-leseling e mabapi le bophelo bo botle mabapi le ts’ebeliso ea meriana ea litlama ke basali ba baimana Lesotho, ele ho fana ka likeletso tsa bophelo bo botle ba setso. Lintlha tse mabapi le litumelo le litloaelo tsa basali ba baimana ba leshome le metso e mehlano ka boomo le ka mokhoa o fumanehang li ile tsa bokelloa ka lipuisano tse hlophisitsoeng le ho hlahlojoa ho sebelisoa mekhoa e supileng ea Colaizzi. Melao-motheo ea boits’oaro le maano a ho netefatsa hore a ts’epahetse a sebelisitsoe. Ho ile hoa hlaha sehlooho se le seng se bohareng: ‘Basali ba lumela hore ts’ebeliso ea litlama ke tloaelo eo basali ba baimana ba lokelang ho e latela ka lebaka la moetlo’. Litumelo le litloaelo tsa basali li ne li metse ka metso moetlong oa Basotho, o neng o tataisa ts’ebeliso ea meriana ea litlama. Leha ho le joalo, ba bang ba ne ba nka meriana ea litlama e le kotsi, hobane litekanyetso le litlhare tsa meriana ena li ea fapana. Ka hona baoki ke senotlolo sa ho fana ka thuto ea bophelo bo botle ba setso mabapi le ho sebelisa litlama nakong ea boimana. Mehopolo ea bohlokoa Meriana ea litlama, litumelo le litloaelo tsa moetlo, basali ba baimana, thuto ea bophelo bo botle / Health Studies / M.A. (Public Health)

No description available.

Increased levels of oestrogen and progesterone during pregnancy may lead to periodontal disease. The anaerobic Gram-negative bacteria called red complex (Porphyromonas gingivalis, Tannerella forsythensis and Treponema denticola) are frequently associated with periodontal disease. Periodontopathogens produce toxins and enzymes which can enter the bloodstream and cross the placenta to harm the foetus. The response of the mother&rsquo / s immune system to infection by these periodontopathogens, brings about the release of inflammatory mediators which may trigger preterm labour or result in low birth-weight infants. The purpose of this study was to examine the prevalence of red complex, using BANA and PCR in subginginval plaque samples from pregnant women. Subgingival plaque samples were obtained from pregnant women between the ages of 17 to 45 years attending a Mitchells Plain ante-natal clinic. Plaque samples were analyzed by the enzymatic BANA-test for detection of the presence of red complex and DNA was extracted and analyzed using 16 rDNA-Polymerase Chain Reaction (PCR).<br /> <br /> Seventy-nine percent of pregnant women showed gingival index scores of &ge / 1 of which 74.24% harboured by at least one of the members of the red complex. P.gingivalis was the most prevalent of the three members of the red complex. Findings of this study confirmed a need for dental preventive measures in pregnant women and microbial monitoring of suspected periodontopathogenes. This could be achieved by joint cooperation between Maternity Obstetric Units (MOU), Dentistry and oral microbiology departments. The results of this study revealed that although PCR is more sensitive than BANA in detecting members of the red complex, BANA showed a better association with the indices used to diagnose periodontal disease.

Background:  Betel nut (BN) or Areca nut (AN) chewing habits on its own or with other ingredients including chewing tobacco are highly prevalent in many South East Asian countries as well as among the migrants from these countries residing around the world. The major alcaloid arecoline in betel nut has been found to carcinogenic and to be associated with a range of health risks, including negative effects on pregnancy outcomes.  It is also reportedly associated with nutritional deficiencies including lower folate status among men and women. Pregnancy imposes stress on folate stores because of increased requirements for growth of maternal tissues, the fetus and the placenta.  Folate deficiency during pregnancy is a major public health concern as it is associated with many adverse health outcomes including neural tube defects, low birth weight, preterm birth, delayed maturation of the nervous system, growth retardation and megaloblastic anemia. Aim: To evaluate the association between betel nut use and folate status among pregnant women in Matlab, Bangladesh. Design: A secondary analysis of data from the Maternal and Infant Nutrition Intervention in Matlab (MINIMat) trial.  A sub sample of pregnant women aged 14-50 years and living in the study area Matlab with available serum folate measurements (N= 730) was included in this study. Outcome variable was folate level and folate deficiency and the independent variable was betel nut consumption.  Logistic regression analysis and analyses of covariance (ANCOVA) were done. Results were adjusted for potential confounders. Results: Two-thirds (63%) of the women consumed betel nut and 17% had folate deficiency. Women who consumed betel nut combined with  chewing  tobacco were 2.57 times more likely to have folate deficiency (OR = 2.57; 95% CI = 1.23-5.36; p =0.012;) and  betel nut consumption 2-3 times/day was significantly associated with folate deficiency among users (OR = 2.51; 95% CI = 1.07–5.92; p =0.035). Mean serum folate levels were significantly lower among betel nut users as compared to non-users. Conclusion: Betel nut consumption combined with chewing tobacco is associated with lower serum folate level or folate deficiency among pregnant women in Matlab in Bangladesh. Strategies are needed for prevention and control of betel nut consumption in order to prevent adverse health outcomes. There is a need of more knowledge regarding betel nut use and other combined substances to distinguish their individual effects on folate deficiency.

The aim of this doctoral research was to explore CAM use in pregnancy from the perspectives of pregnant women and health professionals. The research was conducted in four phases: a systematic review of the published literature from 2008-2012; cross sectional surveys of two cohorts of women during the first and last trimester; and a cross sectional survey of health professionals (midwives, obstetricians, anaesthetists) at Aberdeen Maternity Hospital. The systematic review reported a significant proportion of women used CAM during pregnancy with prevalence rates ranging from 5.8% to 74.2%. The study of health professionals identified that more than 30% of respondents have prescribed, referred or advised the use of CAM to pregnant women. The main associated factor for CAM use was, 'personal use of CAM', with an odds ratio of 8.26 (95% CI 3.09–22.05; P < 0.001). Two thirds of women (63%) reported using CAM, excluding vitamins and minerals, during early pregnancy. The independent predictors of CAM use identified were: use by family and friends (OR 4.1, 95% CI 2.3–7.3, p < 0.001); ethnicity (non-white British) (OR 3.4, 95% CI 1.8–6.8, p < 0.001); and use prior to pregnancy (OR 2.4, 95% CI 1.2–4.8, p = 0.014). Two thirds of women (61.4%) reported using CAM, excluding vitamins and minerals, during the third trimester. The independent associated factors for CAM medicine use identified were: CAM use before pregnancy (odds ratio [OR] 4.36, 95% confidence interval [CI] 2.39–7.95, P<0.001); a university education (OR 2.41, 95% CI 1.46–4.0, P<0.001), and CAM use by family or friends (OR 2.36, 95% CI 1.61–3.47,P<0.001). The lack of an evidence based approach together with the reliance on the advice of family and friends is of concern given the lack of robust data of efficacy and safety. To date, four peer reviewed papers from this doctoral research have been published.

ABSTRACT Introduction The aim of this study was to determine the current RPR positive prevalence rate at the Johannesburg Hospital and to determine whether there has been a significant decrease in the prevalence rate of RPR positive tests. Patients and Methods A retrospective analysis of all RPR results within labour ward registers was performed. A sample from 01/08/02 to 31/01/03 was used to determine the current RPR positive prevalence rate. The results from the current period were then compared to the results from a similar study in 1996. Results of two months, six months apart, of each year between these periods were also analyzed in order to determine the trend of RPR positive prevalence rates. Results The RPR prevalence rate was 4.4% compared to 19.5% in 1995/96 (p < 0.0001). Results obtained from the intervening years showed a statistically significant decrease. Conclusion RPR positive prevalence rates at Johannesburg Hospital have decreased significantly in recent years.

MSc (Med), Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, 2009 / Context Prevention of mother to child transmission (PMTCT) of HIV relies on identification of HIV-positive pregnant women at the first antenatal visit and at time points thereafter. As not all women who attend antenatal care initially agree to test or maintain an HIV-negative status the lack of re-establishing HIV prevalence at delivery may result in missed prevention opportunities and a false impression of PMTCT coverage. Objectives To assess whether a routine peri-partum HIV counseling and testing service improves access to HIV prevention, testing and care of infants by identifying additional HIV-positive women at the time of delivery. To assess the effect on the PMTCT coverage indicator when HIV prevalence is reestablished in the delivery population. Design and Patients All women 18 years or older with live births in the labour and postnatal wards of the Rahima Moosa Mother and Child Hospital (RMMCH) were interviewed and invited to enrol irrespective of their need to retest/test for HIV or their potential refusal of an HIV test. Rapid HIV antibody tests were offered to women who had no HIV result, reported an HIV-negative result performed more than six weeks prior to delivery or reported an HIV result discrepant with her documented result. vi Test acceptance and HIV prevalence were calculated for the enrolled population. The rate of return and results for early infant diagnosis in HIV-exposed infants and the follow-up of infected infants were documented. HIV polymerase chain reaction (PCR) results for infants not returning to the facility were retrieved from the National Health Laboratory Services database. Results Between 9th April 2008 and the 23rd of September 2008 there were 5169 women with live births. A total of 3684 (71.3%) of the 5169 women delivering were interviewed and 2419 (46.8%) were enrolled. Of the women enrolled, 2140 (88.5%) reported a known HIV status and 490 (22.9%) of these were HIV-positive. After counseling and testing, an additional 101 HIV-positive women were identified increasing the number of HIV-positive women by 20.6%. An additional 177 women were identified as being HIV-negative. The true infant PMTCT coverage increased by 17% as a result of newly identified HIV-positive women. Of 591 HIV-exposed infants identified, 284 (48.0%) underwent PCR testing at RMMCH or surrounding facilities and 16 (5.6%) tested PCR-positive. Of the infants expected to return to RMMCH for PCR testing 155/203 (76.4%) antenataly diagnosed versus 12/83 (14.5%) newly diagnosed women returned with their infants (p<0.001). Ten HIVinfected infants were diagnosed at RMMCH of which nine were in care with six initiated on antiretrovirals.

A Dissertation that is being submitted for an MMed in Obstetrics and Gynaecology in partial fulfilment of the FCOG (SA) Part II 07 April 2015 / Objectives: The main objective of this study was to characterise women who presented at Chris Hani Baragwanath Academic Hospital (CHBAH) between 12 and 20 weeks for termination of pregnancy (TOP). Secondary objectives were to determine time to abortion, compare sonar gestational age to gestational age by dates and reasons for late presentation. Method: This was a prospective cohort study of women over the age of 18 who were referred to CHBAH for second trimester TOP between August 2012 and May 2013. The exclusion criteria were pregnancies more advanced than 20 weeks gestation. Data was collected from the medical file and by interview. Demographics and reasons to terminate were extracted from the files. Outcome variables included bleeding, pain, and time to abortion. Results: One hundred and ninety one women (91.39%) aborted. The median age of women was 25.00 (IQR=21.00-31.00), range (18-43). Women older than 25 years were 33% less likely to abort than women less than 25 years of age. Ninety nine women (47.14%) bled severely. One woman had a uterine perforation following evacuation of the uterus. The median gestational age by sonar was14.71 (IQR=13.86-16.14), range (13.00-20.00). The median gestational age by dates was13.57 (IQR=12.29-15.00), range (4.14-26.28). One hundred and thirty five women (63.98%) had an MVA for RPOC using analgesia following medical induction. Two women (0.95%) needed hysterotomy following failed TOP. The median time to abortion was 11.50(IQR=8.67-17.92), range (3.50-69.33) and incidence rate of 0.5 per hour or 1 per 2hours. Conclusion: The majority of women (91%) aborted within 72 hours following medical induction with less complication rate and short induction to abortion time. This affirm misoprostol efficacy as the suitable drug for conducting second trimester medical TOP. / MT2016