ABSTRACT This abstract provides a brief summary of the research study (Nieswiadomy, 2002). The South African report on confidential enquiries into maternal deaths identified delayed and/or infrequent antenatal care as a significant avoidable factor contributing to maternal mortality in South Africa (SA) (Department of Health (DOH), 2001). There are still women in South Africa whose first antenatal care contact with the midwives obstetrical unit (MOU) is in the third trimester of their pregnancy. The aim of this study was to determine the health seeking practices amongst primigravidae at a level 1 MOU, based in a peri-urban area in Gauteng province, SA. The health seeking practice of concern was antenatal clinic attendance. The research design was qualitative, descriptive, exploratory and contextual. The research method implemented was unstructured individual in-depth interviews. The population consisted of primigravidae who were attending antenatal clinic at a level 1 MOU. The sample consisted of primigravidae who booked at the level 1 MOU’s antenatal clinic in the third trimester of their pregnancy. Maximum variety purposive sampling, with inclusion and exclusion criteria, was used and sampling continued until data were saturated. The sample size consisted of 10 participants whereby 2 of them were the pilot study and eight were the interviews that followed the pilot study. Data were collected by means of individual in-depth interviews. One question was asked: ‘What experiences influenced you to go for your first antenatal visit when you did?’ Interviews were audio taped, transcribed and analyzed by using Tesch’s eight steps of data analysis (Creswell, 1994). Lincoln and Guba’s four strategies for trustworthiness were applied and ethical considerations were implemented. The results were discussed under two themes. Those themes were: needs, and delayed booking. The recommendations were made regarding the recommendations that arose from the study, recommendations for research, nursing practice and nursing education.

Thesis (M Med.(Family Medicine))--University of Limpopo, 2008. / Objective: To determine what proportion of pregnant women attending antenatal care in Mecklenburg Hospital eat soil. Study Design: A cross-sectional descriptive study was conducted at Mecklenburg Hospital. Results: A total 273 pregnant women participated in the study, of which 85% eat soil. The majority (74%) were single, mean age of 26 years. About seventy-eight percent had secondary education. Most of the women were unemployed. The majority of women believed that soil eating gives energy, taste nice, makes women feel strong, and makes stomach feel full. The other reason given by these women is that soil eating protects unborn baby from poison, gives nutrients to unborn baby, prevent prolonged labor, stops morning sickness. Conclusion: We conclude that the majority of pregnant women seen at Mecklenburg Hospital eat soil. There was not direct relationship between education level and nutritional reasons for eating soil. Furthermore, fetal and maternal reasons for eating soil were not associated with education level.

Objective: To describe the levels of ANC adequacy and factors related in 3 provinces of Vietnam: Long an, Ben tre and Quang ngai. Method: Data from three rural provinces of Vietnam collected by the Vietnam Australia Primary Health Care Project were analysed using descriptive and analytical statistical techniques including multivariate regression, multipart analysis and hierarchical techniques. A sample of 1335 eligible women was available for analysis. The Andersen Health Behaviour Model was utilised in analyses of ANC utilisation. The Donabedian Quality of Health Model was used in analyses of ANC content and overall adequacy. Results: ANC was inadequate with only 71% of women having some ANC, 51% having initial visits within the first four months, 41% having three or more visits, 35% having three or more visits with the initial visits within the first four months, 17% of women reported three quarter or more of recommended ANC procedures/advice, 12% of women had enough ANC utilisation and fair ANC content. Factors that existed prior to contact with health care providers such as external environment, predisposing and need were related to whether the women seek any ANC and to pregnancy duration at first visits. However, factors that resulted from initial contact with health care providers, such as satisfaction of women with ANC services and health care provider related characteristics, were important in the models examining total number of ANC visits, overall ANC utilisation, content of ANC reported and overall ANC adequacy. Province of residence related to all aspects of ANC adequacy. Different aspects of ANC adequacy were related to each other. Conclusion: ANC adequacy levels in Vietnam were low. To increase the proportions of women who use ANC services and attend ANC early, promotion of ANC should be targeted at women at risk. However, to improve continuation with ANC, ANC content, and overall ANC adequacy, the quality of services provided needs to be improved. To reduce the gap between provinces, priority should be given to less developed provinces. / PhD Doctorate

No description available.

[Truncated abstract] There is a large body of evidence describing the benefits and risks, to the human fetus, of antenatal glucocorticoid treatment, but no published research on the effects on lactation. The withdrawal of progesterone, in the presence of high levels of endogenous glucocorticoids and prolactin, triggers the onset of copious milk secretion (lactogenesis II) at the end of pregnancy. The alteration of lactogenesis II by exogenous glucocorticoids could potentially have adverse impacts on postnatal nutrition in both term and preterm infants. I aimed to determine the effects of maternal antenatal glucocorticoid treatment on lactogenesis II in both ewes and women. I found profound adverse effects on lactation in ewes, and similar but more subtle effects on lactation in women . . . This thesis represents the first investigation of the effects of antenatal glucocorticoid treatment on lactogenesis II in both ewes and women. I found that, in ewes, antenatal glucocorticoid treatment stimulated premature lactogenesis II, and this was caused by disruptions to hormonal regulation during pregnancy. This event was followed by profound delays in lactogenesis II after term parturition. More subtle effects in women suggest that antenatal glucocorticoid treatment did not have a major, prolonged impact on postnatal lactogenesis II. Very preterm gestational age strongly predicted delays in lactogenesis II stressing the importance of assistance for these mothers when they are establishing lactation.

Background: The prevalence of cases of HIV among children below the ages of 15 years continues to increase and majority of these children acquired the infection through mother-to-child transmission. Methodology: The main objectives of the study were to explore the perceptions of local women regarding the PMTCT program, to evaluate the strength of these perceptions and to make recommendations. A qualitative method was used involving a number of focus group discussions among antenatal clinic attendees in the 27 primary health care clinics in Qwa-Qwa, Free State province of South Africa. Findings: The findings were organised under eight major themes: (1) Knowledge of the program -where the participants expressed high knowledge about the PMTCT program as they knew how MTCT of HIV occurs and how it can be prevented, (2) Perceived concerns about the program- which were mainly fear of resistance to ARVs, fear of stopping the treatment after delivery, potential for high numbers of orphans, depression and suicide when HIV result is positive, the fear of the family neglecting the baby if the mothers dies, the perception that the program cares for only the babies and not their mother, (3)Readiness to do HIV test- where majority of the participants said it was difficult doing the HIV test due to fear of positive result, (4) Ease of taking ARVs- Difficulty in taking the ARVs due to fear of resistance and harmful side effects, (5) Relationship with clinic staff- a majority of the participants were happy with their relationship with the clinic staff, (6) Reactions expected from family members when program advice is followed- more than half of the participants expected negative reactions from family members if the program advice is followed because of the negative attitudes of their male partners and the elders’ of the resistance to change from their cultural beliefs, (7) Advantages of the program- according to the focus group participants, the advantages of the program include the knowledge gained about HIV, modes of MTCT of HIV and how to prevent MTCT of HIV. Other advantages mentioned were prevention of MTCT of HIV, pre-test counselling reducing the fear of doing HIV test, knowing one’s HIV status as well as the potential of the program to have positive change on the cultural beliefs of the people, and lastly (8)How they felt being part of the program- where all the participants said they were excited . Conclusions: The findings were similar to those of other studies in many respects. Recommendations: The recommendations were community and family HIV/AIDS education and their involvement in the PMTCT program in other to reduce misconceptions about the disease, and stigmatization against the women in the program. Other recommendations include: the concept of PMTCT-plus which provides ongoing support and treatment for the mothers, babies and infected family members; integration of innovative health education and culturally appropriate interventions into the program; provision of adequate maternity leaves to women in the PMTCT program as well as full integration of the PMTCT program into the District Health System (DHS) as part of the “horizontal” delivered package.

Psychological distress is common during pregnancy. The objective of this thesis was to evaluate the effectiveness of antenatal cognitive behavioural based treatments in reducing psychological distress in pregnant women. A systematic review was undertaken of randomised controlled studies utilizing antenatal cognitive behavioural based treatment in reducing anxiety and stress compared to treatment as usual. Eleven papers were identified through a systematic search of databases using predefined criteria comparing intervention groups to treatment as usual in pregnant women with anxiety or stress. The systematic review revealed preliminary evidence for the effectiveness of cognitive behavioural based treatment with several studies noting changes over time in anxiety and stress; however, only a few studies reported intervention effects when compared to control. While the systematic review results suggest that a small number of cognitive behavioural based interventions may be effective in reducing anxiety and stress during pregnancy compared to treatment as usual, confidence in these findings is limited due to methodological limitations such as lack of follow-up, high attrition rates and difficulties with generalisability. The evidence base is currently insufficient and further research which utilises a robust methodology is needed before any reliable conclusions can be drawn. An empirical study was conducted to examine the effectiveness of a brief, single-session stress reduction programme introducing cognitive behavioural techniques aimed at reducing general anxiety, other pregnancy related distress and improving general well-being and pregnancy outcomes. Twenty-nine participants with clinically significant levels of anxiety were recruited to the empirical study from the local maternity hospital. Participants completed measures of general anxiety, pregnancy related anxiety, general well-being and childbirth experience. The control was derived from a historical dataset where 37 participants were matched for baseline anxiety levels. The empirical study demonstrated significant reductions in general anxiety; however, similar findings were also observed in the control group. Significant reductions were observed with pregnancy related anxiety and women also reported their childbirth experience similarly regardless of delivery type. Although our findings were not significant when compared to control, our recruitment design resulted in good return rates following birth. Further studies using sophisticated study design with use of robust control group are required.

Magister Public Health - MPH / Introduction: Nigeria operates a three tiered health care delivery system with a large percentage of health care delivery vested at the primary care level. There has been over the years a continued effort by the government to decentralize health care service thereby increasing the range of services provided at the primary care level. Despite all these efforts there is still low utilization of primary health care services. This study therefore seeks to explore the factors that may be responsible for poor utilization of primary health service in Nasarawa State, Nigeria using two primary health clinics in Lafia local government area as case studies. Methodology: The study was carried out using the qualitative research methodology primarily using two data collection methods, the focus group discussions and individual interviews. A total of sixty participants were sampled, these consisted of ten members of staff, twenty non facility users and thirty facility users. Thirty individual interviews were conducted and four focus group discussions held with staff and facility users at the two clinics. Facility users were randomly selected as they attended the clinic on the data collection days and were invited to participate in the study. Every second patient attending the clinic was selected for the focus group discussion and every third person for the interviews. The staff participants were randomly selected based on their availability while non-facility users were selected using snowballing. Data was analyzed using thematic analysis method. Findings: Two major themes emerged following data analysis; these were perception and experiences of facility users and barriers to utilization of health services. Users had a good perception of the services they received and are reasonably satisfied but certain deficiencies in the health care systems compromised the quality of service. Several factors were however hindering the utilization of these services and these include mainly institutional factors such as lack of infrastructure, equipment and staffing constraints; household factors such as cost of service and responsibility of decision making and other factors such as stigmatization and beliefs. Conclusion: Facility users of these clinics seem to have an overall good impression of services at the clinics; however there are certain fundamental deficiencies that need to be urgently addressed to improve the care provided at these clinics as these constitute barriers to utilization. These deficiencies such as the absence of electricity and water, lack of basic work equipment and inappropriate staff composition need to be addressed by the local government health department to ensure utilization and improved quality of service.

The purpose of this study was to investigate the relationship between antenatal care (ANC) adequacy and preterm births. The researcher used the quantitative, descriptive, correlational, retrospective, case control design on a sample size of 40 cases and 80 controls. A checklist was used to collect data at one state hospital in Windhoek. When the Adequacy of Prenatal Care Use (APNCU) index was applied, premature birth was found to be less likely for women in the higher categories of care (OR 0.121; 95% CI 0.124–0.613) as compared to those in the lower categories. Similarly when the Content and Timing of care in Pregnancy (CTP) tool was used; women in the higher categories of care, were less likely (OR 0.114; 95% CI 0.012–1.056) to give birth prematurely as compared to those in the lower categories / Health Studies / M.A. (Health Studies)

The purpose of this study was to investigate the relationship between antenatal care (ANC) adequacy and preterm births. The researcher used the quantitative, descriptive, correlational, retrospective, case control design on a sample size of 40 cases and 80 controls. A checklist was used to collect data at one state hospital in Windhoek. When the Adequacy of Prenatal Care Use (APNCU) index was applied, premature birth was found to be less likely for women in the higher categories of care (OR 0.121; 95% CI 0.124–0.613) as compared to those in the lower categories. Similarly when the Content and Timing of care in Pregnancy (CTP) tool was used; women in the higher categories of care, were less likely (OR 0.114; 95% CI 0.012–1.056) to give birth prematurely as compared to those in the lower categories / Health Studies / M.A. (Health Studies)