Thesis (M.P.H.)--University of Hong Kong, 2006.

Thesis (M.S.)--University of Michigan, 1991.

Thesis (M.S.)--University of Michigan, 1981.

ABSTRACT BACKGROUND: Breastfeeding is important to children’s health and development in early years. It may also have implications for health in later life as it has been associated with some chronic non-communicable diseases including hypertension, obesity, diabetes, hypercholesterolemia, and cardiovascular diseases. The prevalence of exclusive breastfeeding in the United States is estimated to be approximately 44% for a 3-month period and 24% for a 6-month period (CDC, 2008). There are many factors that influence whether or not a mother will be successful in exclusive breastfeeding, and one factor that has been identified with the success of this is delivery method. OBJECTIVE: The purpose of this study was to determine whether or not infant delivery method is associated with exclusive breastfeeding. Additionally, other environmental and personal factors examined included: intent, infant-to-breast within two hours of birth, as well as maternal race, parity, and age. METHODOLOGY: Data were obtained from the Wellstar Kennestone Hospital Lactation Department through an agreement. The information was extracted from the patients’ medical charts between March, 2011 and March, 2013 by nurses in the lactation department. Descriptive statistical tests and univariate and multivariate logistic regression analyses were conducted to examine associations between delivery method and exclusive breastfeeding with analytic consideration given to significant environmental and personal maternal characteristics. RESULTS: There was a statistically significant association between delivery method and exclusive breastfeeding (OR= .510, 95% CI= .375-.695) after adjusting for intent, whether or not baby was put to the breast within two hours of birth, maternal race, parity, and maternal age. Mothers who delivered via cesarean section were .510 times as likely to be exclusively breastfeeding at the time of hospital discharge when compared to mothers who delivered vaginally. CONCLUSION: The results of this study indicate that there is a significant association between delivery method and exclusive breastfeeding, in that vaginally delivered babies were more likely to be exclusively breastfeeding compared to babies delivered via cesarean section. This result is consistent with other research, and it further supports recommendations for healthcare professionals to promote breastfeeding for the first six months of life. As aligned with the Baby-Friendly Hospital Initiative and WHO goals, exclusive breastfeeding should be thoroughly encouraged in addition to promoting natural (vaginal) birth options whenever possible. Further research regarding post-partum factors for both types of delivery that can lead to higher rates of exclusive breastfeeding is warranted.

published_or_final_version / Community Medicine / Master / Master of Public Health

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 Medicine in the branch of Anaesthesiology April 2017 / Background: More than 166 000 women die annually from obstetric haemorrhage, with uterine atony being the most common causative factor (3). More than 50% of these deaths occur in Sub-Saharan Africa (4, 5). Synthetic oxytocin is integral in the prevention and management of postoperative post partum haemorrhage (PPH) and therefore it is essential for anaesthesiologists to have an adequate knowledge of this drug. Aim: The aim of the study was to describe the current knowledge and practise of the anaesthetists in the department of Anaesthesiology at the University of Witwatersrand (Wits), regarding Syntocinon® during caesarean section under spinal anaesthesia. Method: A validated questionnaire was distributed to anaesthetists working at Wits during departmental academic meetings in April 2015. Results: The results of the study showed that 60% of the participating anaesthetists had inadequate knowledge of IV Syntocinon® and that practice varied widely and was based on individual participants’ preference and was not consistent with international guidelines or protocols. Conclusion: Urgent staff education and implementation of a standardised practice guideline and protocol regarding usage and dosing of IV Syntocinon® is needed to prevent poor maternal outcomes and poor service delivery. / MT2017

Thesis (M.P.H.)--University of the Witwatersrand, Faculty of Health Sciences, 2013. / BACKGROUND – District hospitals provides level of care services that are part of the basic service package for district hospitals. Services applicable to district hospitals’ operating theatres include performance of elective and emergency surgical procedures. A study was conducted at Sekororo district hospital to evaluate the functioning of the operating theatre system. AIM: To describe the profile of patients, theatre down time and theatre throughput efficiencies at the district hospital for the period 1 April 2009 – 31 March 2011. METHODOLOGY: This was a cross sectional study based on a retrospective record review. The study setting was Sekororo District Hospital Operating Theatre. The population included records of all operations performed in the theatre during the study period. Theatre utilization was calculated as well as patient throughput to assess the internal operational efficiencies. The throughput of elective and emergency cases were compared. RESULTS: A total of 702 cases were performed during the study period. The majority of cases performed in the operating theatre were maternity cases (caesarean sections). Maternity cases accounted for 602 cases. The most common indication for caesarean sections (CS) is Cephalo-pelvic Disproportion (CPD) (49.2%). For the maternity cases, the majority were emergency cases (84.33%), and 15.67% elective cases. Theatre utilization for this period was 3% (3.6% for 2009/10 and 3.2% for 2010/11). There was a statistically significant difference (p<0.01) between the average throughput for emergency and elective cases – 25 minutes for emergency cases (confidence interval 20-35 minutes) versus 62.5 minutes for elective cases (confidence interval 38.75 – 78.75 minutes). CONCLUSION: The theatre utilization rate is extremely low for this study period. Patient throughput is much more efficient for emergency cases. Further studies are required to determine resource allocation to the operating theatre that resulted in the low theatre utilization.

INTRODUCTION: In sub-Saharan Africa, access to care during pregnancy and child birth is an abiding challenge for many women. Many women face socioeconomic, cultural, and physical barriers while attempting to access healthcare facilities during pregnancy. These barriers often result in women accessing healthcare facilities after life-threatening complications develop, ultimately leading to high rates of maternal mortality. In Nigeria, several locally endemic diseases, such as malaria and HIV, impinge on population health. Having access to care during pregnancy provides an opportunity for prompt diagnosis, treatment, and prevention of common endemic disease. This dissertation focused on access to care during pregnancy in Nigeria by using two indicators: malaria parasitemia and Cesarean-section (CS). Therefore, this dissertation had two overarching goals. The first was to estimate the prevalence of malaria parasitemia during pregnancy and to determine maternal risk factors associated with high malaria parasitemia in Enugu State, Nigeria. The second was to establish the incidence of CS and to determine the socioeconomic and medical risk factors that are associated with having a CS among women in Enugu State, as well as in Nigeria as a whole. METHODS: Secondary analyses of two unique datasets––Healthy Beginnings Initiative (HBI) and the Nigerian Demographic and Health Survey (DHS)––were conducted. The HBI cohort study took place in Enugu State, Nigeria. The prevalence of peripheral malaria parasitemia in Enugu State was established within the context of HBI. Malaria parasitemia was scored according to the Malaria Plus System (0 to ++++). For this dissertation those in the 0 and + group were classified as low having parasitemia; while those in the ++ and +++ groups were classified as having high parasitemia. Person-level maternal risk factors that were associated with high malaria parasitemia were estimated using crude and adjusted logistic regression modeling with malaria parasitemia as the main outcome. The incidence of CS in Enugu State was also estimated within context of the HBI cohort. Socioeconomic and medical risk factors associated with having a CS in Enugu State, Nigeria were estimated. To investigate the extent to which the findings from the HBI represent the rates of CS in Nigeria as a whole, the Nigerian DHS was utilized. The Nigerian DHS was a cross-sectional study that was conducted throughout Nigeria. The incidence of CS in all of Nigeria was estimated. Socioeconomic and medical risk factors associated with having a CS were also investigated. Crude and adjusted logistic regression models with CS as the main outcome are presented. Weights were applied to all analyses conducted with the DHS to make the data representative at the county level. RESULTS: Over 99% of women in the HBI study tested positive for peripheral malaria parasitemia. For each additional person in the household, a 6% lower odds of high malaria parasitemia was found (p<0.05). Regarding CS, analyses of both datasets indicated that Nigeria has relatively low rates of CS compared to the World Health Organization's recommendations. In the HBI, 7.2% of women in Enugu State, Nigeria had a CS. Significantly lower odds of having a CS were observed among women who live in a rural setting compared to those who reside in an urban setting (p<0.05). Percentages of CS increased significantly as maternal age and/or education increased. HBI results demonstrated 53% higher odds of having a CS if participants had high malaria parasitemia compared to those with lower malaria parasitemia (p<0.05). Results of the DHS yielded even lower rates of CS with only 2.3% of women in Nigeria overall having had a CS during their last delivery. Consistent with analysis for Enugu State, in the DHS women living in rural areas had significantly lower odds of having a CS than those living in urban areas (p<0.05). Likewise, religion was significantly associated with having had a CS; Muslim women had 54% lower odds of having a CS compared to Catholics (p<0.05). Women who had health insurance and women who received prenatal care from a skilled birth attendant had increased odds of having a CS compared to women who did not have insurance and received no prenatal care (adjusted OR [aOR] 1.78: 95%CI 1.18-2.67, p<0.05; aOR 3.00: 1.51-5.96, p<0.05). DISCUSSION: Based on the high prevalence of malaria among women in the HBI study, education on best practices to prevent malaria during pregnancy, and resources in support of these practices are urgently needed. Likewise, low rates of CS in both Enugu State and across Nigeria indicate that Nigerian women may not have adequate access to obstetric care during delivery. Results from this dissertation also indicate that Nigerian women face barriers in obtaining adequate perinatal healthcare, ultimately perpetuating the cycle of high maternal mortality and gross health deficiencies that are common to Nigerian women.

Thesis (M. P. H.)--University of Hong Kong, 2005. / Also available in print.

Thesis (MHSc--Health Science) -- Auckland University of Technology, 2003. / Appendices D, E, F and G not included in e-thesis. Also held in print (87 leaves, 30cm.) in Akoranga Theses Collection (T 618.86 ART)