Master of Public Health - MPH / PMTCT is an effective strategy in preventing paediatric HIV infection. In Zimbabwe the success of PMTCT is entirely dependent on pregnant women accessing antenatal care services and through that, getting linked to PMTCT. Failure of pregnant women to book for antenatal care through the course of pregnancy presents a missed opportunity for PMTCT and a high risk for maternal HIV transmission. It is therefore important to determine the burden of unbooked women and the factors associated with it, if elimination of maternal HIV transmission is to be achieved in the country.

Master of Public Health - MPH / Background:Theoutcomeofpregnanciesinmanyinstancesislargelypredicatedon availabilityofSkilledBirthAttendants(SBAs).Despitethisphenomenon,illiteracyand financialdisadvantagehavebeenvariouslycitedastwinfactorspromotingtheinterest andpatronageofTraditionalBirthAttendants(TBAs)bywomenfolk.Itistherefore expected thatwomenhavingtertiarylevelofeducationandpossessing adequate economic resources would naturally prefer to use the SBAs.However,these http://etd.uwc.ac.za/ 9 observationshavenotsignificantlyreflected therealityin thechoiceofmaternal healthcareprovidersinNigeriaandthecityofLagosinparticular.Yet,accessto maternalservicesoftheSBAshasbeenwidelyacceptedasoneoftheleadingwaysof loweringmaternalmortality.Therefore,inordertoimprovethepatronageofSBAsand correspondinglylowermaternaldeathrates,itbecomesimperativetounderstandthe rationalebehindthepreferencefortheTBAs’usebywomenwhoarenotordinarily expectedtodosobyvirtueoftheirhighlevelofeducationandgoodfinancialcapacity. Aim:Theaim ofthisstudywastoexploreandunderstandtheexperiences,perception and beliefsystems influencing well-educated,middle income women and their reasoningfortheuseofTraditionalBirthAttendantsratherthanSkilledBirthAttendants fordeliveryservicesinLagos,Nigeria. Methodology:ThisisaqualitativestudyconductedinAlimoshoLocalGovernmentArea ofLagosinNigeria.Tenwomenwithtertiarylevelofeducationandbelongingtomiddle incomeeconomiccategorieswereenrolledasparticipants.Inaddition,itinvolved3 FocusGroupDiscussionscomprising7TraditionalBirthAttendantspergroup. Results:Behaviouraland attitudinalshortcomings by the SBAs;misconceptions regardingsurgicaldeliverybywomen;bureaucraticdelaysandbottlenecksexperienced attheSBAs’centres;thebeliefbythewomenthatpregnancyisasacredandspiritual eventwhichonlytheTBAshaveabilitytomanage;women’sconfidenceintheTBAsas havingbettercapacitytomanagecertaincoexistingmedicalconditionsinpregnancy; andmisinformationonmanagementmodalitiesforcertainconditionslikeinfertilityand fibroidallcombinetoinfluencepreferenceforutilizationofTBAsbywell-educated, middleincomewomeninthestudyarea.

Background: The vertical transmission of HIV from mother to child ranges from 15 to 40%. The preventing mothers to child transmission programme (PMTCT) services have been introduced during the past five years in South Africa; however vertical transmission of HIV remains high. Objectives: The objectives of the study were: 1. To describe the clinical and demographic characteristics of women attending the ANC clinic and delivering at the Germiston Hospital; 2. To determine the proportion of women who were offered voluntary counselling and testing (VCT) in 2004; 3. To determine the proportion of women who subsequently received PMTCT. Methods: This is a cross-sectional study I which a sample of 776 patient files were retrospectively, systematically and randomly sampled from 1, 500 antenatal files for the period 2004 (Jan-Dec), in an urban district hospital in the Gauteng Province. A checklist was used to extract specific information. Data was entered into EpiData and analysed using STATA version 8. Pearson's chi-square test was used to obtain measures of association for all categorical variables. The multiple logistic regression method was used to investigate predictors for missed PMTCT opportunities. Results: The pre_yalence proportion of syphilis was 14.19% {95%CI (11.81-16.85)}; prevalence proportion ofHIV was 33.76% {95% CI (27.53-37.13)}. The mean age ofthe sample population was 26.37 years (min=22, max=30). Forty eight per cent of the sample had registered late in the third trimester of pregnancy. Pregnant women presenting with syphilis were more likely to have a missed PMTCT opportunity {OR=2.2, 95%CI (1.16- 4.20), p=0.02}. Women having made fewer than two ANC visits were more likely to have a missed PMTCT/VCT opportunity than women having made more than two visits {OR=O.Sl, 95%CI (0.30-0.86), p=O.Ol}. Conclusions: The prevalence proportion of HIV is high in this setting (33%) and the prevalence of syphilis is seven times greater than the national prevalence. Every antenatal care visit is an opportunity for the healthcare worker to offer voluntary counselling and testing. All women identified as having syphilis infection are at high risk of acquiring HIV. Therefore every woman identified and treated for syphilis should be counselled and tested for HIV. Women must be offered HIV and AIDS education at every ANC visit. Routine opt-out counselling should be offered at every ANC visit for those who have not been previously tested. Recommendation: In order to increase the uptake of the PMTCT programme healthcare workers should have training and re-orientation on: 1. The need to use every opportunity in antenatal care and maternity wards to offer HIV counselling and testing to mothers; 2. HIV and AIDS in pregnancy, PMTCT, as well as the treatment and care of pregnant women. / Dissertation (MPH)--University of Pretoria, 2006. / School of Health Systems and Public Health (SHSPH) / MPH / Unrestricted

In my thesis I deal with the topic relating to prenatal preparation of women and men in the Thomayer Hospital in Prague. The thesis is divided into theoretical and empirical part. In the theoretical part I deal with education in the prenatal preparation. Importance of education as such is characterized there, thus education not only in the prenatal preparation but also in other branches of medicine. It is one of basic elements to improve quality of health care in the Czech Republic. This part of the thesis also provides possibilities of prenatal preparation in the Czech Republic. It describes several topics of the classes of the "psychoprophylactic preparation". Change management is another topic of my thesis since it is just the change that results in quality improvement. Quality improvement was endeavored for also at innovation of the prenatal preparation in the Thomayer Hospital. Last chapter of the theoretical part is marketing in health care. This chapter describes several definitions, under individual authors. This part deals among others also with marketing of health services and medical supplies, marketing mix and marketing communication. Empirical part provides results of survey via questionnaires, thus results of quantitative research. These will serve for evaluation of satisfaction of...

Effectiveness of services for Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) depends on viable and efficient health systems, adherence to and utilization of services. Despite strategies to provide access to PMTCT of HIV services, utilization of these services remain low in Nigeria thereby increasing child morbidity and mortality from HIV-related causes. Adherence to comprehensive HIV/AIDS care, for both the mother and baby, remain a challenge for HIV positive women. Utilizing the Health Belief Model and Social Support Theory, this qualitative study explores factors influencing utilization and adherence to PMTCT services by mothers living with HIV/AIDS in Rivers State, Nigeria. Purposive sampling procedures were used to select 40 study participants including 20 HIV positive mothers and 20 health care workers as key informants. Findings indicate that high self-perceived susceptibility to HIV influences utilization and adherence to PMTCT services among mothers living with HIV and AIDS in Rivers State. Although utilization and adherence to PMTCT were reported very high among this population, there were however challenges and barriers to optimal utilization of PMTCT. These include unavailability of test kits, antiretroviral medication stock-outs, and inadequate human resources for health. High transport, PMTCT and antenatal care costs were identified as the major socio-economic barriers to PMTCT administration as well as the high financial burden of formula feeding for women that preferred exclusive formula feeding. In addition to increased numbers of health care workers trained in PMTCT service delivery, recommendations for a public health approach to service delivery and a streamlined primary care strategy are proposed. These include social and community activities to address HIV/AIDS stigma, improving awareness of PMTCT facts, addressing gender relations and encouraging male participation. Inter-ministerial collaborations and targeted partnerships are also recommended for expanding coverage and ensuring optimal utilization of PMTCT services.

Magister Public Health - MPH / Sub Saharan Africa (SSA) single-handedly accounted for approximately two thirds (196 000) of the world maternal deaths. High maternal deaths have been attributed to high prevalence of HIV and low uptake of Antenatal Care (ANC). This made World Health Organization (WHO) to recommend integration of Prevention of Mother to Child Transmission of HIV (PMTCT) services into ANC to improve accessibility and utilization. According to Zambia Ministry of Health (MoH), every pregnant woman should have her ANC registration in the first trimester and achieve eight visits by delivery time. With the extra need of PMTCT services in the women living with HIV, early and regular ANC attendance is emphasized. However, in Zambia, there is limited information on ANC uptake and its associated factors among women living with HIV. / 2023

Despite antenatal care presenting opportunities to identify and monitor women at risk, use of recommended antenatal care services remains. Barriers preventing use of antenatal services vary between countries, and limited knowledge exists about the link between geographical settings and antenatal service use. The objective of this cross-sectional quantitative study was to explore geographical variations and investigate how social demographic characteristics affect use of antenatal care for women in Sierra Leone using the Andersen behavioral model. The data used were from the 2016 maternal death surveillance report of the whole counrty (N =706). Logistic regression analysis was used to determine the individual predictor effects on antenatal care, including geographical location, the age of women, marital status, parity, and institution of birth impact. Southern, Northern, and Eastern women had significantly lower odds of attending the recommended antenatal services compared to women in the Western region (OR = .517, p = .019; OR = .497, p = .021; OR = 0.014, p = .041, respectively). The odds of married women attending the recommended antenatal services was 7.3 times more than that of the single women (OR = 7.397). Also, significantly associated with less uptake of recommended antenatal visits was lower education level among women (OR = .517). This study will contribute to positive social change by highlighting inequities in antenatal care use among women, thus allowing for accurate targeting of health promotion programs and ultimately saving lives of mothers and children of Sierra Leone through more inclusive policies.

Masters of Public Health - see Magister Public Health / Introduction: Mother-to-child transmission (MTCT) is the cause of most HIV acquisition among children. Prevention of mother-to-child transmission (PMTCT) of HIV programs aim to enable pregnant women to attain viral suppression so that they are unlikely to pass HIV to the foetus in utero or during birth, and to the neonate during breastfeeding. The Option B+ treatment regimen - initiating pregnant and breastfeeding women, diagnosed with HIV, on lifelong triple antiretroviral therapy (ART) regardless of their WHO clinical stage – was introduced in 2013 in Zambia but to date, no evaluation of this program has been done. Study Aim: The current study described factors associated with adherence and retention in care(RIC) among postnatal women initiated on ART during the antenatal and postnatal period at five PMTCT centres in Lusaka District, Zambia in 2017 and 2018. Methodology: A quantitative, retrospective cohort analysis of 311 postnatal women who were initiated on option B+ regimen at five PMTCT centres in Lusaka District between 1 January 2017 and 30 April 2018 was done. Adherence to treatment was measured by analysing data on patients’ missed clinic appointments and self-reported missed medication doses. Kaplan-Meier survival analysis was used to calculate RIC at 6, 12, 18, and 24 months. Bivariate analysis was conducted to determine the significance of associations between adherence and RIC, and sociodemographic and clinical characteristics, respectively. Results: Retention in care decreased over time, from 92% at the time of delivery to 81%, 77%, 74% and 70% at 6, 12, 18 and 24 months postnatal, respectively. Higher retention in care was observed amongst married women (p=0.012); who stayed within one kilometer from the health facility (p=0.018); whose spouses were on ART (p=0.027); who knew their HIV status before pregnancy (p=0.005); who were commenced on ART in the first trimester (p=<0.001); and the postnatal period (p=<0.001); who were on other medication, in addition to ART (p=0.001); who did not miss a dose of medication in the week before the last appointment (p=<0.001); and who did not miss any clinic appointment since commencing ART (p=<0.001). Half of the study participants (50.2%; n=155) reported optimal adherence (did not miss a scheduled clinic appointment since commencing ART). Optimal adherence to ART was significantly associated with women who lived within 1 km from the health facility (p=0.012) and who had a treatment supporter (p=0.030). Conclusion: Half of the study participants had optimal adherence to their scheduled clinic visits since enrolment into the Option B+ program, and 30% were lost to follow up over the first two years. Staying closer to the health facility where the woman received ART, knowing one’s HIV status before pregnancy or earlier in pregnancy, and initiating ART earlier in pregnancy, increased the likelihood of optimal adherence to ART and RIC at 24 months postnatal. Additionally, having a treatment supporter increased the likelihood of optimal adherence.

Fostrets rörelser kan vara en indikator på den intrauterina miljön, där avtagande fosterrörelser kan tyda på att moderkakan inte fungerar optimalt. När fostret får för lite syre och näring spar fostret energi genom att röra sig mindre. Det finns olika räknemetoder för att registrera fosterrörelser. Metoderna har utvecklats för att identifiera ett foster som är under risk, där förlossningen måste tidigareläggas för att rädda barnets liv. Evidens för räknemetodernas effektivitet diskuteras i en pågående internationell diskurs. Mindfetalness är en ny metod för att observera fostrets rörelser, där fokus är att registrera rörelsernas styrka, kvalité och karaktär utan att räkna varje enskild rörelse.   Syftet var att undersöka barnmorskors upplevelse av att arbeta med Mindfetalness på barnmorskemottagning.   I december 2017 genomfördes en datainsamling, med hjälp av ett webb-baserat frågeformulär, till barnmorskor som arbetar på en mottagning som lottats att dela ut en broschyr till gravida kvinnor. Svaren analyserades med hjälp av en innehållsanalys med induktiv ansats.   Majoriteten av barnmorskorna upplevde att broschyren var lätthanterlig, stödjande och den kompletterade deras muntliga information om fosterrörelser. Barnmorskorna upplevde att kvinnorna var nöjda och kände sig trygga med att få broschyren. I några få fall upplevde barnmorskorna att kvinnorna blev oroliga. Barnmorskorna förmedlade att informationen om Mindfetalness underlättade kvinnornas anknytning till sitt ofödda barn. Att informera om fosterrörelser var enligt barnmorskorna svårt men samtidigt viktigt och betydelsefullt.   Mindfetalness kan vara en lämplig metod för barnmorskor att använda då de informerar och samtalar om fostrets rörelser med gravida kvinnor. Fler studier behövs om metodens effektivitet avseende att identifiera foster under risk. / Fetal movements can be an indicator of the intrauterine environment, where reduced fetal movements may interpret a placenta deficiency. When a shortage of oxygen and nutrition occurs the fetus saves energy by moving less frequently. There are a variety of methods for recording fetal movements. The methods have been created to identify a fetus at risk and the delivery might be put in advance to save the fetus’s life. There is an on-going international discussion whether the counting methods carries enough evidence. Mindfetalness is a new method to observe fetal movements, where the main focus is to record the strength, quality and characteristic of the movements without counting each and every movement.   The purpose was to observe midwives experience working with Mindfetalness at midwifery clinics.   In December 2017 data collection was conducted via a web-based questionnaire including midwives practicing at antenatal clinics, which were randomized to hand out brochures to pregnant women. The responses were analysed based on a content analysis with inductive approaches.   A majority of the midwives experienced the brochure manageable, supporting and complemented the verbal information about fetal movements. The midwives experienced that the women perceived satisfaction and felt secure receiving the brochure. A few women experienced anxiety according to the midwives. The midwives conveyed the information of Mindfetalness facilitate the women’s attachment to their unborn child. To inform about fetal movements was according to the midwives difficult but at same time important and meaningful.   Mindfetalness can be an appropriate method for midwives when informing and talking about fetal movements to pregnant women. Further research focused on the methods efficacy to identify a fetus at risk is necessary.

Thesis (MPH.) -- University of Limpopo, 2021 / Pregnancy and childbearing are most of the crucial milestones in women’s lives as they look forward to becoming mothers. During this time, they have positive expectations while pregnant, however, the physical, hormonal, neurotransmitters and psychosocial changes that occur can make pregnancy to be stressful and overwhelming. The disability associated with depression and its impact on maternal and child health has important implications for public health policy. While the prevalence of postnatal depression is high, there are no prevalence data and associated risk factors on antenatal depression in Helen Franz Hospital of Limpopo Province, South Africa. The purpose of this study was to determine the prevalence and factors associated with depression amongst pregnant women at Helene Franz Hospital. Methodology: A quantitative retrospective design was used in the study and a sample size of 336 was required which was calculated based on the 95% confidence interval, 5% sampling error and 38.5% prevalence of depression amongst pregnant women in KZN. A self-administered questionnaire with close-ended questions which was adopted from the Edinburgh postnatal depression scale was given to the participants to complete. The scoring of the questionnaire was that the maximum score was 30 and the persons who scored 10 or greater were considered depressed according to the Edinburg scale for assessing depression. Data were analysed using SPSS V.21.0 and a p-value of less than 0.05 was considered statistically significant. Results: The participants ranged from 18 to 47 years with the mean age of 27.8±6.9 years. The majority of the pregnant women were in the age groups 20-24 years and 25-29 years. The mean depression score for pregnant women was 7.87±5.2 and ranged from 0 to 23. The prevalence rate of depression symptoms was 31%. Maternal age was not significantly associated with depression and a significantly higher proportion of married pregnant women were depressed as compared to unmarried women at p=0.017. Pregnant women who smoke were significantly more likely to be depressed than those who do not smoke at p=0.002. Pregnant women without financial support from partnerwere significantly likely to be depressed than those who receive financial support at p-=0.002. A significantly greater proportion of pregnant women with partner violent were likely to be depressed than those with non-violent partner at p <0.001. Pregnant women in relationships with unemployed spouses were significantly likely to experience depression than the employed spouse at p=0.035. lastly, pregnant women in relationship with a spouse with lower educational level were significantly likely to be depressed than the other groups at p-.006. Conclusion: The prevalence of depression among pregnant women was high and the main risk factors involved in the onset of antenatal depression have highlighted a complex multifactorial aetiology. These are related to different sources of chronic diseases, psychosocial, environmental, obstetric and pregnancy- related risk factors have been highlighted. Correctly identifying women at risk of suffering from depression would provide an opportunity to target those women who would benefit from preventive and supportive interventions. Therefore, a psychosocial assessment, in the sense of a comprehensive and multidimensional evaluation of a woman's psychosocial circumstances should be common practice for all women during the antenatal period. Key concepts Antenatal care; Pregnancy; Childbearing; Depression; Psychosocial