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.

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

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.

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

Bakgrund: Flera studier visar att sjuksköterskor inte tillgodoser patientgruppers behov av att tala om sexualitet och sexuell hälsa. Barnmorskors samtal om sexualitet är ett nästan helt outforskat område. Syfte: Syftet är att undersöka barnmorskors syn på och erfarenhet av samtal om sexualitet på barnmorskemottagningen. Metod: Semistrukturerade intervjuer utfördes med nio barnmorskor på sju olika mottagningar i Skåne. Intervjuerna analyserades med en kvalitativ innehållsanalys genom identifiering av kodord, kategorier och teman. Resultat och analys: Skriptteorin har använts för att analysera och förstå hur barnmorskorna agerar och samtalar i relation till sexualitet. Analysen utmynnade i ett övergripande tema: Sexualitet är betydelsefullt men lätt att tappa bort. Barnmorskorna ser sexualitet som ett angeläget ämne men svårt att adressera i möten. Svårigheter att kommunicera sexualitet beror på tids- och kunskapsbrist samt brist på uppmuntran från ledningen och/eller avsaknad av samtalsverktyg samt ytterligare osäkerhet då patienten avviker från heteronormen eller har en annan kulturell bakgrund. Konklusion: Utbildning i sexologi efterfrågas av barnmorskorna för att kommunicera sexualitet och kunna ge den holistiska vård patienter har rätt till oavsett sexuell orientering eller kulturell bakgrund. Men resultatet antyder att tydliga förväntningar och riktlinjer kring att och hur samtal tas upp är viktigare än fördjupad kunskap. Så länge det finns ett kulturellt och interpersonellt skript på arbetsplatsen i vilket sexualitet inte förväntas adresseras kommer inte utbildning förändra förhållningssättet. Stöd från ledningen och/eller organisationen och möjligheter till handledning/reflektion som rör sexuella frågor kan stötta och uppmuntra barnmorskor att initiera frågor om sexualitet och förändra skripten. Vidare studier behöver göras för att till fullo förstå vilka mekanismer som ligger bakom svårigheten att adressera sexualitet på barnmorskemottagningen. / Background: Several studies show that nurses don’t meet the need from groups of patients to talk about sexuality and sexual health. There are almost no studies on midwives’ view on sexuality counselling. Aim: The aim of this study is to explore midwives’ views and experiences on sexuality counselling at the antenatal care. Method: Semi-structured interviews were conducted with nine midwives’ at seven different antenatal care centers in Skåne. The interviews were then analyzed with a qualitative content analysis through identification of codes, categories and themes. Results and analysis: The study utilizes scripting theory to analyze and understand how midwives act and counsel patients in relation to sexuality. One main theme emerged: Sexuality is important but easy to lose. The midwives’ consider sexuality as important but sometimes hard to address. The reasons for this is said to be lack of time, lack of knowledge, lack of encouragement from the managerial level and/or lack of counseling tools, and, added to that, even more uncertainty when the patient deviates from the heterosexual norm or has another cultural background. Conclusion: Midwives’ ask for education to communicate around sexuality and to be able to provide the holistic care that the patients are entitled to. The result, however, suggest that clear expectations and guidelines about when and how to address sexuality is more important than deepened knowledge. As long as there is cultural and interpersonal scripts in the workplace in which sexuality is not expected to be addressed, additional education won’t help to change addressing patients’ sexuality. Organizational and managerial support along with opportunities for reflection concerning dialogue regarding sexual issues might evoke the interest and intent of midwives’ to approach sexuality and change the cultural and interpersonal scripts. Further studies are needed to understand fully what mechanisms underline the barriers that prevent midwives’ from addressing patients’ sexuality.

Yes / A Delivery Suite Assessment Unit (DSAU) has been established at a large Northern teaching hospital. This was as a recommendation of ASQUAM (achieving sustainable quality in maternity) to reduce antenatal admissions to delivery suite and provide a more appropriate environment for women attending for antenatal or labour assessment. The DSAU has also provided an effective teaching environment where skills such as effective telephone triage, diagnosis of labour and care of women with pre-labour spontaneous rupture of membranes (SROM) have been developed by junior staff. The first twelve months' audit results indicate that the establishment of the DSAU has been successful in reducing antenatal admissions to delivery suite by increasing the transfers of clients home, rather than to the antenatal wards. This may reflect the confidence of the highly skilled midwives working in this environment and the confidence women feel about their ability to obtain prompt and accurate advice over the telephone.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.

In Sweden, there is currently no consensus addressing the screening, diagnostics and treatment of gestational diabetes mellitus (GDM). In addition, there is little knowledge on the impact of GDM on the daily life of pregnant women and the experiences of health care professionals providing maternal health care to women with GDM. Using different perspectives, this thesis examines the experiences of GDM and the performance of screening for GDM in a regional context in Sweden. The studies used qualitative and quantitative methods. In the qualitative studies, grounded theory was applied in two studies and qualitative content analysis in one study. In the quantitative study, a combination of questionnaire data and data from medical records of pregnancy and birth were processed. Surprisingly, screening for GDM was reduced despite local clinical guidelines stipulating the risk factors indicating an OGTT. Furthermore, the prevalence of the risk factors for GDM in the population investigated was almost doubled compared to previous Swedish studies. Pregnant women developing risk factors for GDM during pregnancy were found to be at substantially increased risk of giving birth to an infant with macrosomia. The experiences of pregnant women with GDM revealed that being diagnosed with and living with GDM during pregnancy might be understood as a process ‘from stun to gradual balance’. The experience comprised both negative and positive dimensions. Despite the challenges, the inconveniences and the changes involved, gradually adapting to an altered lifestyle and finding their balance in daily life was ‘the prize’ the women ‘were willing to pay’ to secure optimal maternal and foetal health. The experiences of midwives comprised managing conflicting demands providing antenatal care to pregnant women diagnosed with GDM. Most midwives felt the obligation to control and monitor the complicated pregnancy, to initiate and motivate the recommended changes in life style together with providing an empowering and caring relation with the women. These assignments disclosed complex conflicting situations and the midwives appeared to choose strategy for managing the situation depending on their perception of the circumstances. The experiences of the obstetricians were understood as ‘dealing with ambiguity’. The ambiguity permeated all aspects of working as an obstetrician within the maternal health care counselling women with GDM: the role of the obstetrician, the context of the organization, balancing the multifaceted interests of the maternal and foetal conditions and the lack of consensus, recommendations and evidence-based knowledge.   The studies revealed the complexity of the situation for the affected pregnant women as well as for the health care professionals providing antenatal care to women diagnosed with GDM. Furthermore, the performance of screening of GDM in pregnant women with risk factors for GDM was insufficient in the investigated region. The findings in this thesis may be useful to increase knowledge of the experiences of pregnant women living with or managing GDM. The findings may also be useful when planning for improvements of maternal health care directed to pregnant women diagnosed with GDM during pregnancy.