Ethiopia is one of the five nations that bear the global burden of nearly 50% maternal mortalities and newborn deaths. Cause-specific maternal mortality and newborn death information are vitally important for prevention, but little is known about the causes of deaths. Many maternal mortalities and newborn deaths occur at home, outside the formal health sector, and few are attended by qualified medical professionals. Despite the fact that, non-medical factors are often more important in determining whether a woman/newborn lives or dies than the medical cause of death itself. This study determines and explores factors contributing to maternal mortalities and newborn deaths in Ethiopia with the aim of developing a community-based model for averting maternal mortalities and newborn deaths in Ethiopia. The study was organised in three phases. In Phase 1, a community-based-retrospective approach using explorative, descriptive and contextual study design, combining both qualitative and quantitative methods (mixed methods) were used to make an in-depth investigation and analysis of the circumstances and events surrounding individual cases of maternal mortality and newborn deaths. The result of the study revealed various direct and indirect as well as possible contributing factors to maternal mortalities and newborn deaths which outlined bases for forwarding Phase 2 of the study called concept analysis. In Phase 3, a prototype model was developed according to Chinn and Kramer’s approach to theory generation: initially, based on the empirical perspectives of the study, concept analysis was conducted. The structure and process of a model to avert maternal mortality and newborn death were described; and, six survey list; namely, agent, recipient, context, procedure, dynamic and terminus of Dickoff, James and Wiedenbach (1968) form the basis for development and description of a model for averting maternal mortality and newborn deaths in Ethiopia. Impediment in receiving prompt, adequate and appropriate care were common problems encountered even after reaching an appropriate medical facility. For any attempt to attain a significant reduction in maternal mortality and newborn death, the health care system in Ethiopia must assume its tasks to institute critical changes in both the structure and process of health care delivery services. / Health Studies / D. Litt. et Phil. (Health Studies)

The demands on health and social care organisations require professions to work more collaboratively. During pre-registration training, health care and social work students learn within practice settings, supported by practice mentors. These settings are rich learning environments to experience interprofessional working (IPW) and for students to learn together through interprofessional practice learning (IPPL). There is, however, evidence that students' experiences of both are varied or limited. The value placed on IPW, and IPPL, is therefore of interest. This thesis will investigate practice mentors' attitudes to IPW and IPPL, and explore their perspectives of the enablers and barriers to these occurring in practice settings. A mixed-methods case study approach was used to measure the attitudes of practice mentors from health and social work, and to identify enablers and barriers to IPW, and IPPL for students. Online surveys and semi-structured face to face interviews were carried out with a range of professions within one Scottish health board and associated local authority. Results showed that attitudes to IPW, and IPPL for students were generally positive. Attitudes were not significantly affected by governing body, gender, area of work, years of experience, or prior experience of IPE. IPW was perceived to be enabled by shared processes and policies, IPPL for staff, effective communication, established teams, and shared processes and policies. Proximity to other professions and shared spaces encouraged informal communication and positive interprofessional relationships. Regular structured IPPL opportunities for students were limited. However, where opportunities did occur, this was linked to areas where practice mentors perceived that there was a strong interprofessional team identity. Although attitudes to IPW, and IPPL for students are positive, further work is needed to identify systems for improving IPW, to strengthen professions' identity as interprofessional teams, and to increase IPPL opportunities for students.

La transition du patient entre les secteurs de soins est une période à haut risque de discontinuité de la prise en charge médicamenteuse. Les problèmes liés aux médicaments spécifiquement rencontrés résultent principalement de différences non expliquées entre les traitements médicamenteux documentés aux niveaux des différents sites de soins et/ou des différents professionnels de la santé, également appelés discordances médicamenteuses médicalement non justifiées. Leur survenue peut entrainer des préjudices pour le patient mais aussi une utilisation accrue des services de soins de santé et par conséquent une augmentation des coûts. <p><p>Dans ce contexte, la première partie de ce travail est consacrée à la mise au point d’un instrument valide et fiable permettant de caractériser les discordances médicamenteuses médicalement non justifiées lors de la sortie de l’hôpital. Il s’avère particulièrement bien approprié pour la recherche ou pour la familiarisation à la problématique. La deuxième partie de ce travail a permis de mettre en œuvre cet outil dans une situation clinique réelle. Une étude prospective d’observation incluant des patients recevant les soins usuels (groupe contrôle) et des patients pris en charge par des pharmaciens cliniciens (groupe intervention) a été réalisée. L’intervention des pharmaciens cliniciens comportait la réalisation d’une conciliation médicamenteuse à l’admission et à la sortie de l’hôpital. La conciliation médicamenteuse est un processus structuré pendant lequel le professionnel de santé collabore avec le patient, la famille et les proches pour s’assurer qu’une information correcte et exhaustive sur les médicaments est communiquée lors de la transition du patient entre les secteurs de soins. Elle consiste en la vérification (collecte d’un historique médicamenteux correct et l’identification des discordances médicamenteuses), la clarification (s’assurer que les médicaments et la posologie sont appropriés), la conciliation (documentation de chaque changement de médicament et éducation du patient à ce sujet) et finalement le transfert d’information aux autres professionnels de santé. Les résultats montrent que l’intervention des pharmaciens cliniciens diminue le risque de discordances médicamenteuses médicalement non justifiées après la sortie de l’hôpital. De plus, la satisfaction des patients vis à vis de l’information sur les médicaments prescrits à la sortie est significativement plus élevée dans le groupe pris en charge par le pharmacien clinicien. Cependant, aucun impact n’a été montré sur l’utilisation des services de soins (visites aux urgences et réadmission à l’hôpital) dans le mois après la sortie. Finalement, la dernière partie de ce travail a permis de développer une information sur les médicaments destinée aux pharmaciens d’officine à la sortie de l’hôpital du patient. Une étude prospective a évalué l’effet de la remise de cette information, dénommée feuille de transfert, par le pharmacien clinicien au patient. Une enquête en ligne ouverte à tous les pharmaciens d’officine a par ailleurs évalué leurs besoins en information. Il a été observé que la communication d’une feuille de transfert contenant des informations sur le traitement médicamenteux à la sortie de l’hôpital présente un réel intérêt pour le pharmacien d’officine. Ces informations vont en effet au-delà des informations retrouvées sur une prescription médicale. Néanmoins, la feuille de transfert devrait inclure davantage d'informations nécessaires pour la réalisation des soins pharmaceutiques. <p><p>En conclusion, ce travail a permis de développer, d’une part, un nouvel outil de détection et de classification des discordances médicamenteuses médicalement non justifiées et d’autre part, un modèle de pratique qui a montré son efficacité sur la continuité des traitements médicamenteux lors de la sortie des patients de l’hôpital à leur domicile, en maison de repos et en revalidation. Toutefois, des perspectives d’amélioration de ce modèle ont été mises en évidence et mériteraient une attention particulière dans le futur. / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished

The aim of this research was to explore the challenges faced by women providing home-based care to those infected and affected by HIV and AIDS. The specific objectives of the study were to explore the gender-related, sociocultural and socioeconomic challenges faced by these women; and to investigate best practices in home- based care. An exploration of the challenges women experience in their communities as they provide care for the HIV and AIDS infected and affected is located within a gender and power framework. Feminist theories are also used to try and explain the reasons behind the differences and inequalities that exist in the community, particularly as regards the women who provide home-based care. A qualitative study, which used both qualitative and participatory methods of data gathering, was undertaken in 2014 in Mzimba, Malawi. Data was collected from 26 women participants by means of Critical Incident Narrative interviews (5), Individual In-Depth Interviews (5), and two Focus Group Discussions (6 and 10 participants respectively). Three Key Informant Interviews were conducted with a Ministry of Local Government official, another with a Nursing sister at the Mzimba District Hospital Tuberculosis Ward, and the Mzimba District Hospital Home-based care Coordinator. Purposive and snowballing sampling techniques were used to recruit the research participants. A topic guide was used in critical incident narrative interviews. An interview schedule consisting open-ended questions and face interviews were used for the Individual In-depth Interviews. A topic guide was used for the Focus Group Discussions. All the data collection instruments were guided by the themes of social, economic, cultural, psychological challenges; food security, and coping mechanisms. An interview schedule consisting of open-ended questions were used for the Key Informant Interviews. A Check List of WHO minimum package for home-based care programmes was used to assess the actual program best practices. The methodology of this study was guided by the WHO framework on home-based care. In this framework, the home-based care programme includes the following elements which make up the minimum package of care: provision of care, continuum of care, education, supplies and equipment, staffing, finance and sustainability, and monitoring and evaluation. Very few studies have been concluded to understand the sociological issues that affect women who provide care to the HIV and AIDS infected and affected in households and communities. It is hoped that this study will in some way address this gap, and that the information and recommendations contained in this thesis will guide policy recommendations in Malawi that will incorporate the lived experiences of those who provide this care. The study revealed that women providing home-based care to the HIV and AIDS infected and affected experience harsh challenges. Women carry the burden of care as traditionally men do not provide care. Women experience extreme deprivation which manifests itself through a number of socio-economic difficulties and these include been shown in their inability to provide for their basic necessities such as food, and other household needs. For most of the women carers, the deprivation is a direct consequence of their low levels of education which rendered them unable to find employment of engage in successful business ownership. The women carers also lack social security in the sense that they do not have access to land for example which could ensure that they have some level of food security. When the main income earner died the women carers and their dependants were left to fend for themselves. Women carers also experienced various psychological problems and these included nightmares, insomnia, depression and these affected their physical health such a few reported lack of appetite for food as a major issue. Women carers and in particular the young women reported that they had to elements which make up the minimum package of care: provision of care, continuum of care, education, supplies and equipment, staffing, finance and sustainability, and monitoring and evaluation. Very few studies have been concluded to understand the sociological issues that affect women who provide care to the HIV and AIDS infected and affected in households and communities. It is hoped that this study will in some way address this gap, and that the information and recommendations contained in this thesis will guide policy recommendations in Malawi that will incorporate the lived experiences of those who provide this care. The study revealed that women providing home-based care to the HIV and AIDS infected and affected experience harsh challenges. Women carry the burden of care as traditionally men do not provide care. Women experience extreme deprivation which manifests itself through a number of socio-economic difficulties and these include been shown in their inability to provide for their basic necessities such as food, and other household needs. For most of the women carers, the deprivation is a direct consequence of their low levels of education which rendered them unable to find employment of engage in successful business ownership. The women carers also lack social security in the sense that they do not have access to land for example which could ensure that they have some level of food security. When the main income earner died the women carers and their dependants were left to fend for themselves. Women carers also experienced various psychological problems and these included nightmares, insomnia, depression and these affected their physical health such a few reported lack of appetite for food as a major issue. Women carers and in particular the young women reported that they had to drop of school to marry when their parents or guardians died. The other dimension to this issue was that the older women carers reported that during their young years, it was common place to find girls who did not attend school or were pressurised to get married because their parents did not believe in educating girls. The background is currently affecting the women carers as they find that they cannot get involved in profitable business or even look for employment. They lack the basic literacy levels that would allow them to be become more productive and ensure financial security. Women carers experienced a number of gender related challenges as they provided care and these included the burden of care being almost solely borne by the women. Women revealed that they have had to use various coping strategies in the face of the overwhelming challenges that they continue to experience. Elderly women have found ways to cope by selling the property such as land and household goods, conducting small scale informal business, and sending the children away to relatives to be fostered. The young women on the other hand have sometimes reverted to some dangerous strategies for coping such as getting a boyfriend to provide for their financial needs, engaged in transactional sex, and some got married very early. The other coping strategies that the young women employed were to conduct small businesses, depended on family and relatives to provide for their various needs. The women volunteers revealed that they used their group as a therapy group, they shared the work, and that they were involved in small scale businesses. The study has also revealed that there is a home-based care programme that is functioning fairly well. However, there are indications that as much as the various players are trying to assist those who are infected and affected by HIV and AIDS, there are severe gaps in the effectiveness of the programme. There is need for a review of the programme so that it answers to the needs of those who are caring for those who are on home-based care i.e. a more rigorous implementation of HBC programme is required. The overall findings of the study indicate that the poverty trap in which the women are caught impacts on every aspect of their existence, with little hope of them ever improving their conditions. There is need for the Malawi government to come up with strategic interventions that would alleviate of women in general but in particular those who are left to provide care at home. Such interventions could include poverty alleviation strategies for women who are providing care to ensure that their situation does not deteriorate once they begin to provide care. Since Malawi is a signatory to the UN Millennium Development Goals, it is important that the plight of women is revisited and find lasting solutions to the challenges that they experience. Women are still lagging behind in education for example. There is need to improve girls and women access to education. The health of women has been affected by HIV and AIDS. The Government of Malawi also needs to review the policies that are in place which address women’s health. Essentially the status of women is need of a major change in order for the country to achieve some level of development which is at par with other countries in the sub-Saharan African region. / Sociology / D. Phil. (Sociology)

In South Africa, substance use, abuse and dependency is twice the world norm. To address this trend, the continuum of care guides legislative prescriptions for the treatment of a substance use disorder. This study aimed to address the lack of a description of the utilisation thereof in literature and recent research findings. A qualitative approach was followed and purposive sampling was employed to collect data from both service providers and users of services. Tesch’s framework for qualitative data analysis (Creswell, 2014:218) was used to identify themes, sub-themes and categories, while the data was compared with existing literature on the identified themes. The trustworthiness of the findings was enhanced by the verification of the data through aspects of credibility/authenticity, transformability, dependability and conformability (Schurink, Fouché and de Vos, 2011:397). Informed consent, confidentiality , non-compensation, debriefing of participants, and the management of information were considered to ensure ethical practice. / Social Work / M.A.(S.S.)

The aim of this research was to explore the challenges faced by women providing home-based care to those infected and affected by HIV and AIDS. The specific objectives of the study were to explore the gender-related, sociocultural and socioeconomic challenges faced by these women; and to investigate best practices in home- based care. An exploration of the challenges women experience in their communities as they provide care for the HIV and AIDS infected and affected is located within a gender and power framework. Feminist theories are also used to try and explain the reasons behind the differences and inequalities that exist in the community, particularly as regards the women who provide home-based care. A qualitative study, which used both qualitative and participatory methods of data gathering, was undertaken in 2014 in Mzimba, Malawi. Data was collected from 26 women participants by means of Critical Incident Narrative interviews (5), Individual In-Depth Interviews (5), and two Focus Group Discussions (6 and 10 participants respectively). Three Key Informant Interviews were conducted with a Ministry of Local Government official, another with a Nursing sister at the Mzimba District Hospital Tuberculosis Ward, and the Mzimba District Hospital Home-based care Coordinator. Purposive and snowballing sampling techniques were used to recruit the research participants. A topic guide was used in critical incident narrative interviews. An interview schedule consisting open-ended questions and face interviews were used for the Individual In-depth Interviews. A topic guide was used for the Focus Group Discussions. All the data collection instruments were guided by the themes of social, economic, cultural, psychological challenges; food security, and coping mechanisms. An interview schedule consisting of open-ended questions were used for the Key Informant Interviews. A Check List of WHO minimum package for home-based care programmes was used to assess the actual program best practices. The methodology of this study was guided by the WHO framework on home-based care. In this framework, the home-based care programme includes the following elements which make up the minimum package of care: provision of care, continuum of care, education, supplies and equipment, staffing, finance and sustainability, and monitoring and evaluation. Very few studies have been concluded to understand the sociological issues that affect women who provide care to the HIV and AIDS infected and affected in households and communities. It is hoped that this study will in some way address this gap, and that the information and recommendations contained in this thesis will guide policy recommendations in Malawi that will incorporate the lived experiences of those who provide this care. The study revealed that women providing home-based care to the HIV and AIDS infected and affected experience harsh challenges. Women carry the burden of care as traditionally men do not provide care. Women experience extreme deprivation which manifests itself through a number of socio-economic difficulties and these include been shown in their inability to provide for their basic necessities such as food, and other household needs. For most of the women carers, the deprivation is a direct consequence of their low levels of education which rendered them unable to find employment of engage in successful business ownership. The women carers also lack social security in the sense that they do not have access to land for example which could ensure that they have some level of food security. When the main income earner died the women carers and their dependants were left to fend for themselves. Women carers also experienced various psychological problems and these included nightmares, insomnia, depression and these affected their physical health such a few reported lack of appetite for food as a major issue. Women carers and in particular the young women reported that they had to elements which make up the minimum package of care: provision of care, continuum of care, education, supplies and equipment, staffing, finance and sustainability, and monitoring and evaluation. Very few studies have been concluded to understand the sociological issues that affect women who provide care to the HIV and AIDS infected and affected in households and communities. It is hoped that this study will in some way address this gap, and that the information and recommendations contained in this thesis will guide policy recommendations in Malawi that will incorporate the lived experiences of those who provide this care. The study revealed that women providing home-based care to the HIV and AIDS infected and affected experience harsh challenges. Women carry the burden of care as traditionally men do not provide care. Women experience extreme deprivation which manifests itself through a number of socio-economic difficulties and these include been shown in their inability to provide for their basic necessities such as food, and other household needs. For most of the women carers, the deprivation is a direct consequence of their low levels of education which rendered them unable to find employment of engage in successful business ownership. The women carers also lack social security in the sense that they do not have access to land for example which could ensure that they have some level of food security. When the main income earner died the women carers and their dependants were left to fend for themselves. Women carers also experienced various psychological problems and these included nightmares, insomnia, depression and these affected their physical health such a few reported lack of appetite for food as a major issue. Women carers and in particular the young women reported that they had to drop of school to marry when their parents or guardians died. The other dimension to this issue was that the older women carers reported that during their young years, it was common place to find girls who did not attend school or were pressurised to get married because their parents did not believe in educating girls. The background is currently affecting the women carers as they find that they cannot get involved in profitable business or even look for employment. They lack the basic literacy levels that would allow them to be become more productive and ensure financial security. Women carers experienced a number of gender related challenges as they provided care and these included the burden of care being almost solely borne by the women. Women revealed that they have had to use various coping strategies in the face of the overwhelming challenges that they continue to experience. Elderly women have found ways to cope by selling the property such as land and household goods, conducting small scale informal business, and sending the children away to relatives to be fostered. The young women on the other hand have sometimes reverted to some dangerous strategies for coping such as getting a boyfriend to provide for their financial needs, engaged in transactional sex, and some got married very early. The other coping strategies that the young women employed were to conduct small businesses, depended on family and relatives to provide for their various needs. The women volunteers revealed that they used their group as a therapy group, they shared the work, and that they were involved in small scale businesses. The study has also revealed that there is a home-based care programme that is functioning fairly well. However, there are indications that as much as the various players are trying to assist those who are infected and affected by HIV and AIDS, there are severe gaps in the effectiveness of the programme. There is need for a review of the programme so that it answers to the needs of those who are caring for those who are on home-based care i.e. a more rigorous implementation of HBC programme is required. The overall findings of the study indicate that the poverty trap in which the women are caught impacts on every aspect of their existence, with little hope of them ever improving their conditions. There is need for the Malawi government to come up with strategic interventions that would alleviate of women in general but in particular those who are left to provide care at home. Such interventions could include poverty alleviation strategies for women who are providing care to ensure that their situation does not deteriorate once they begin to provide care. Since Malawi is a signatory to the UN Millennium Development Goals, it is important that the plight of women is revisited and find lasting solutions to the challenges that they experience. Women are still lagging behind in education for example. There is need to improve girls and women access to education. The health of women has been affected by HIV and AIDS. The Government of Malawi also needs to review the policies that are in place which address women’s health. Essentially the status of women is need of a major change in order for the country to achieve some level of development which is at par with other countries in the sub-Saharan African region. / Sociology / D. Phil. (Sociology)