Thesis (M. A. (Nursing Science)) -- University of Limpopo, 2016. / Perinatal morbidity is a public health indicator of the level of equality in a country. Its prevention has major medical, social and economic costs. The aim of this study was to describe factors contributing to high perinatal morbidity rates in Mankweng-Polokwane Complex of the Capricorn district, Limpopo Province, South Africa. A quantitative, descriptive cross-sectional research method was used to describe factors contributing to high perinatal morbidity. The study population comprised 80 registered midwives. Simple random sampling was used to select the 66 respondents. Data were collected using a self-developed questionnaire. Questionnaires were completed and returned, and only one questionnaire was not returned, and two were spoiled as they were incomplete, then 63 questionnaires were analysed. Ethical clearance was obtained from Medunsa Research and Ethics Committee, Limpopo Province Department of Health Ethics Committee and Hospital management. The Statistical Package for Social Sciences (SPSS, version 22) was used for data analysis. Descriptive statistics were used to analyse and describe and summarise data whereby the findings were presented in the form of distribution tables and graphs. Inferential statistics were used based on probability and allowed judgement to be made about the variables. The study revealed that shortage of staff, absenteeism, resignation, bad staff-patient ratio and overcrowding of patients, long waiting periods for caesarean sections, long waiting period for babies operation, work overload of staff, lack of equipment and supplies, congenital anomalies, perinatal asphyxia, prematurity and neonatal sepsis were contributory factors to high perinatal morbidity rates. The study recommended that all staff should be able to resuscitate newborn babies, be able to use Partograph effectively, further research on factors contributing to high perinatal morbidity and education training on speciality qualifications. Key-words: Factors, High, Perinatal, Morbidity rates

MCur / Department of Advanced Nursing Science / See the attached abstract below

The purpose of the study was to determine the causes, of the increased perinatal mortality, identify and describe other factors contributing to the increased perinatal mortality rate in a rural healthcare facility situated in Sekhukhune district in Limpopo province, and to formulate the recommendations that will reduce the perinatal mortality rate based on the results. A quantitative, descriptive, cross-sectional and retrospective design was conducted. The study population was one hundred and sixty two (162) records of babies who died in the perinatal facility from the 1st January 2015 to the 31st December 2015 with a gestational age of about 28 weeks or more. No sampling was done, but a census was used. The sample comprised of one hundred and sixty two (162) of all the records related to perinatal mortality. Data were collected from patients’ records by using a checklist. Analysis of the data was performed by the IBM Statistical Package for Social Sciences (SPSS) version 14 computer software. Frequency tables and pie graphs were used to present the data. The results indicated that 75.3% (n=122) of the records were associated with health personnel as a factor contributing to perinatal mortality. Furthermore, preterm cases accounted for 45.1% (n=73) and prematurity accounted for 37.0% (n=60) of the cases of perinatal mortality. Therefore, preterm births and prematurity are risk factors that should be managed immediately after birth, and all babies should be managed prior to being transferred to the other healthcare institutions. The recommendations are that the education of patients about early antenatal visit, signs of labour and danger signs during pregnancy and training of healthcare workers on record-keeping have to be done on a continuous basis. Managers should conduct quality improvement programmes, benchmarking and implement maternal and neonatal guidelines in the clinical area throughout pregnancy. / Health Studies / M. P. H. (Health Studies)

A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M.A. (Health Studies)

A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M. A. (Health Studies)

MA (Tshivenda) / Senthara ya M. E.R. Mathivha ya Nyambo dza Afrika, Vhutsila na Mvelele / See the attached abstract below

MCur / Department of Advanced Nursing Science / Each year, an estimated 3.6 million infants die worldwide in the first four weeks of life due to complications of premature birth. One-third of Low Birth Weight (LBW) babies die within the first 12 hours after delivery. The main reasons premature babies are at greater risk of illness and death is that they lack the ability to control their body temperature meaning that they get cold or hypothermic very quickly. Kangaroo Mother Care reduces mortality and if widely applied it could reduce deaths in premature newborn babies. The purpose of this study is to explore and describe the lived experiences of mothers when providing Kangaroo Mother Care at the hospitals in Vhembe District of Limpopo province. Qualitative approach with explorative descriptive, contextual and phenomenological designs were employed to explore the experiences of mothers when providing Kangaroo Mother Care. The study population consisted of all mothers who were providing Kangaroo Mother Care. A non-probability convenience sampling method was used to determine the sample of the study. The size of the sample was determined by data saturation. In-depth individual interviews were conducted using a central question. The Tesch’s eight steps of open-coding model guided the process to analyse data. Trustworthiness was ensured throughout by employing the principles of credibility, dependability, conformability, and transferability. Ethical considerations were followed to protect the participants. Recommendations were made based on the research findings. The findings of the study revealed that mothers who provide Kangaroo Mother Care experience challenges. They received inconsistent information about the practice of Kangaroo Mother Care from nurses. The relationship between mothers and nurses was good. Recomendations were made based on the findings and relevant structures in order to ensure that mothers challenges are addressed. The study revealed ineffective support provided to mothers by nurses and family members. / NRF

The research is concerned with how the post-mortem report can be used as a source of information in the investigation of murder cases to identify crime, individual crimes and trace suspects, etc. The understanding of the post-mortem report, and the information which can be obtained from it, will assist the police investigators to handle murder cases in a professional way. The purpose of this research was to evaluate the existing manner in which police investigators use post-mortem reports in their investigations, with the intention of determining its strengths and weaknesses, and considering how the usage can be improved. Secondly, the researcher wanted to explore how investigators use postmortem reports as a source of information in their investigations. To accomplish this, the researcher perused international and national literature in an attempt to explore the field. The researcher wanted to apply the new research knowledge in order to develop good practice in the field. This has been done by recommending new procedures to enhance performance and to improve the conviction rate in court cases. / Police Practice / M.Tech. (Forensic Investigation)

The research is concerned with how the post-mortem report can be used as a source of information in the investigation of murder cases to identify crime, individual crimes and trace suspects, etc. The understanding of the post-mortem report, and the information which can be obtained from it, will assist the police investigators to handle murder cases in a professional way. The purpose of this research was to evaluate the existing manner in which police investigators use post-mortem reports in their investigations, with the intention of determining its strengths and weaknesses, and considering how the usage can be improved. Secondly, the researcher wanted to explore how investigators use postmortem reports as a source of information in their investigations. To accomplish this, the researcher perused international and national literature in an attempt to explore the field. The researcher wanted to apply the new research knowledge in order to develop good practice in the field. This has been done by recommending new procedures to enhance performance and to improve the conviction rate in court cases. / Police Practice / M.Tech. (Forensic Investigation)

PhD (Microbiology) / Department of Microbiology / Globally, one in ten child deaths before the age of 5 years is due to diarrheal disease, causing almost 800,000 mortalities worldwide, which mostly occur in Sub-Saharan Africa and South Asia. Eighty-eight percent (88%) of diarrheal deaths worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene. Unsanitary environments and poor hygiene practices allow diarrhea causing pathogens including viruses, bacteria and parasites to spread more easily. Norovirus (NoV) are now considered the most common cause of outbreaks of nonbacterial gastroenteritis. However, the factors which control the genetic diversity, the sources of sporadic NoV infections, the transmission and persistence of infection are poorly understood. Limited data are available for NoVs strains in South Africa, especially in rural and peri-urban areas. Despite the excessive burden of diarrhea disease in developing countries, NoVs outbreaks have been to date mostly reported in developed countries. Given that the contribution of the various pathogens to diarrhea may differ substantially between regions depending on local meteorological, geographic, and socio-economic conditions, there is a need to investigate intensively the role of viral agents associated with diarrhea in different settings in Africa continent. How would poor living conditions in rural setting impact the prevalence and genetic characteristics of Norovirus strains circulating Limpopo province is the research question of this study. ix To determine the prevalence and genetic diversity of NoVs strains circulating in the rural communities in the Limpopo Province, South Africa and investigate the genetic relationship between NoVs strains, a cross-sectional study was performed on human stools collected from rural communities. We used qualitative variables of poor living environmental conditions including type of water used at the household of child’s parent or guardian, use of toilet seat, presence of livestock at the household and parent employment status to assess possible environmental risk factors of NoV infection within the study area. Prior to this prospective study, we conducted a systematic review of the PubMed and EMBASE databases for published articles of Human NoVs in Africa between 1990 and 2013 in order to assess the contribution of Human NoVs to diarrhoeal diseases in Africa. This review provides a picture of Human NoVs studies in Africa and reveals that unreported sporadic gastroenteritis cases of Human NoVs are common in Africa. Most are community-associated infections reported from urban settings. Possible environmental transmission routes have been documented. Combined environmental and clinical studies are required for targeted actions to control transmission of Human NoVs in Africa. Between July 2014 and April 2015, outpatient children under 5 years of age from rural communities of Vhembe district, South Africa, were enrolled for the study. A total of 303 stool specimens were collected from those with diarrhea (n=253) and without (n=50) diarrhea. NoVs were identified using real-time one-step RT-PCR. Nucleotide sequencing methods were performed to genotype the strains. Phylogenetic analyses x were performed to compare identified NoVs genotypes to the worldwide circulating strains. One hundred and four (41.1%) NoVs were detected. NoV detection rates in symptomatic and asymptomatic children (OR = 1.24; 95% CI 0.66 – 2.33) were not significantly different. Comparison of the median CT values for NoV in symptomatic and asymptomatic children revealed significant statistical difference of estimated GII viral load from both groups, with a much higher viral burden in symptomatic children to our knowledge this is the first study reporting on the differences in estimated viral load of GII and GI NoV positive cases and controls. The study findings may have implications for the diagnosis of NoV disease and future vaccine development, which may only need to consider GII as the genogroup associated with diarrhea in the South African population. Sequence analyses demonstrated multiple NoV genotypes identified in rural communities of Vhembe district. The most prevalent NoV genotypes were GII.4 Sydney 2012 variants (n=7) among the capsid genotypes, GII.Pe (n=9) among the polymerase genotypes and GII.Pe/GII.4 Sydney 2012 (n=8) putative recombinants among the RdRp/Capsid genotypes. Two unassigned GII.4 variants and an unusual RdRp genotype GII.P15 were found. With note, the rare GII.P15 identified in this study, has a common ancestor with GII.P15 strain from Japan previously reported as GII / untypeable recombinant strain implicated in a gastroenteritis outbreak. To our knowledge this is the first report of this unusual genotype in the African continent. Though not proven predictive of diarrhea disease in this study, the high detection rate of NoV reflects the substantial exposure of children from rural communities to enteric xi pathogens possibly. However in this study no risk factor has been found between NoV positive and qualitative environmental variables of poor living conditions in rural setting. The results also suggest that the difference between asymptomatic and symptomatic children with NoV may be at the level of the viral load of NoV genogroups involved. The findings highlighted NoV genetic diversity and revealed continuous pandemic spread and predominance of GII.Pe/GII.4 Sydney 2012, indicative of increased NoV activity. An unusual RdRp genotype GII.P15 and two unassigned GII.4 variants were also identified from rural settings of the Vhembe district/South Africa. NoV surveillance / NRF