Thesis (MFamMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background: The number of adults affected by diabetes mellitus in developing countries, such as South Africa, is projected to grow by 170%, from 84 to 228 million people between 1995 and 2025 .This high and increasing prevalence of diabetes worldwide, and the economic burden of diabetes on developing countries like South Africa emphasizes the importance of ensuring good glycemic control so as to slow down the rate of disease progression and prevent complications. The district health care facilities are the foundation of the health care system of South Africa. The current practice is that diabetics have a point of care random blood glucose (RBG) done on the morning of their clinic appointment and this is used as a form of assessment of glycemic control during the consultation. For further clinical decision making a HbA1c is done once a year as a benchmark of glycemic control. The practical clinical question that arises is whether the assumptions underlying local clinical decision making using the RBG are valid and to what extent RBG can be used to guide clinical management. Aim and Objectives: The aim of this study was to assess the strength of the correlation between RBG and HbA1c and to make recommendations for the interpretation of RBG results in adult patients with Type 2 Diabetes taken at Karl Bremer District Hospital out-patient department. The objectives were: To determine glycaemic control in the study population and compare differences between age, sex and racial groups , and determine the RBG cut-off with the best sensitivity and specificity for predicting poor glycaemic control (HbA1c>7.0% ) as well as the predictive value, likelihood ratio and pre/post-test odds and probability at this cut off. Methods: A retrospective analysis of existing hospital data and the HbA1c tests requested from the NHLS by Karl Bremer Hospital over the 2011 year period. The data was analysed by means of a receiver operating characteristic (ROC) curve analysis to determine the value of RBG with the best combination of sensitivity and specificity to predict poor control of diabetes. A p-value of < 0.05 was assumed to represent statistical significance and 95% confidence intervals were used to describe the estimation of unknown parameters. HbA1c level of < = 7% was taken as representing good control and > 7% poor control. Results: Data was obtained on 349 diabetic patients of whom 203 (58.2%) were female and 146 (41.8%) male. This study population had a mean age of 54.7 years, mean RBG of 13.0mmol/l and mean HBA1c of 9.4%. The total number of black patients was 79 (23%), coloured patients 147 (42%) and white patients 122 (35) % and their mean RBG were 15.4 mmol/l, 12.8 mmol/l and 11.9 mol/l respectively. There was a statistically significant correlation between increasing RBG and increasing HbA1c (p< 0.01). The best value obtained on the ROC curve was an RBG of 9.8 mmol/l, which had a sensitivity of 77% and a specificity of 75%, positive predictive value of 0.88, positive likelihood ratio 3.08 and post-test probability of 88.2% for predicting an HbA1c above 7%. Conclusion: It was concluded that a moderate correlation exists between RBG and HbA1c in this population of diabetic patients. .The best RBG for determining poor control, defined as a HbA1c>7.0%, was found to be 9.8mmol/l and this RBG had a sensitivity of 77% , specificity of 75% and positive predictive value of 88%. Significant differences were found in pre- and post -test probability for different racial groups. Point of care testing using this level of RBG for clinical decision making will inappropriately categorise 23% of patients in this population and therefore introducing point of care testing for HbA1c is recommended.

Thesis (MFamMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction This cross-sectional study assessed factors affecting access to antiretroviral therapy (ART) among HIV patients. The aim of this study was to explore factors that delay patients from accessing antiretroviral treatment at an East London Hospital Complex clinic and to determine the pathway that people from communities in the surrounding area take in order to access antiretroviral treatment at the referral hospital ART clinic Methods The study design was a descriptive cross-sectional survey using both open and closed questions to generate qualitative and quantitative data. The survey used a questionnaire administered via a face to face interview. 200 Adult patients (>18years old) from the local population with a CD4 count of ≤100/mm3 referred to the ART clinic at East London Hospital Complex for the first time during May to October 2011 were interviewed. Results With the health system, some issues were structural (staffing, availability of CD4 counts) and most were process related and reflected a poor patient experience and lack of trust in the quality of care. Contextual related issues were mainly geographic accessibility (cost and lack of transport, distance to health care facility), stigma and discrimination about HIV. Patients related factors included misperceptions and false beliefs about HIV, low level of education, socioeconomic factors, lack of family and social support such as unavailability of treatment supporter and status of patient’s general health discouraged people from seeking ART. Coping strategies such as denial of results and reluctant to disclose results to other people came out as a distrust of patients in community. Conclusions This study gives evidence that people living with HIV experience health system, patient and contextual related barriers to access HIV treatment. The majority accessed care via their local primary care clinic and traditional or alternative practitioners did not appear to play a major role. The distance from and cost of transport to the referral hospital ART service was a major issue compounded by the difficulty of travelling when acutely sick. The expectation of long waiting times and sometimes negative staff attitudes reduced motivation. A number of other factors related to the patient, the health service and the community context were also identified. Many of these factors that reduce access to ART are amenable to change.

Thesis (MFamMed) Stellenbosch University, 2011. / ABSTRACT: Background: The initiation of antenatal care (“booking”) is universally recommended in the first trimester. While working in the Michael Mapongwana antenatal clinic (ANC) in Khayelitsha, the researcher noticed that late booking was prevalent, with consequent impaired antenatal care and increased potential for adverse outcomes. The objective of this qualitative study was to understand why women book late at this specific ANC. Methods: Twenty-three in-depth, open-ended interviews were conducted with 23 late bookers (i.e. who booked after 18 weeks) who attended the ANC between June and October in 2009. The interviews were recorded, transcribed, and analysed according to the “Framework” model. Results: The mean gestational age at booking was 26,4 weeks (range: 20 to 34 weeks). The majority were multigravid, unmarried and unemployed. A high incidence of previous or current obstetric problems was noted. Important personal barriers included ignorance of purpose of antenatal care, ignorance of ideal booking time, and denial or late recognition of an unplanned pregnancy. Provider barriers appeared to be significant, especially the cumbersome booking system, absence of an ultrasound service, and perceived poor quality of care. Conclusion: A combination of personal and provider barriers contributed to late booking at this clinic - it seems that the perceived effort of attending this antenatal service outweighed the perceived value thereof. Provider barriers should be addressed by accommodating patients’ needs, optimising nurse-patient interaction, provision of an ultrasound service and improvement of the booking system. Public awareness of early booking and the holistic value of antenatal care should also be enhanced.

Thesis (PhD)--Stellenbosch University, 2002.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Rationale: Critical questions have been raised about the overcrowding of primary care services, such as community health centres (CHCs) and clinics in predominantly Xhosa-occupied areas in the Western and Eastern Cape, with clients who present with minor health ailments. Suggestions have been made about the integration and the use of the indigenous health knowledge (IHK) carried by older Xhosa women in the services as a strategy for managing minor health ailments, and as a way of encouraging appropriate health-seeking behaviour. Preliminary studies have reinforced the need for the revival of the IHK that currently is lying dormant within communities. The studies affirm that such knowledge could be an asset if integrated into, and valued by, the Western biomedical model, and could play a major role in contributing towards alleviating the problem of overcrowding in primary care (PC) services. Aim: This study primarily explored and described the IHK carried by older Xhosa women and used in the management of health problems in their home situation. Secondary recommendations were made to key stakeholders regarding the use, retainment and integration of the IHK into PC services. Method: This ethnographic, feminist and emancipatory study used qualitative methods of data collection. Thirty-six (36) older Xhosa women were purposefully selected to participate in four FGDs, to explore the IHK that they used for managing health problems in their home situation. Sixteen (16) in-depth interviews were conducted with the elite older Xhosa women and their family members to validate the findings from the four FGDs. The process of analysis and interpretation was informed by an inductive process of a combination of narrative analysis and the analysis of narratives strategies. Findings: The findings showed that the older Xhosa women possess IHK regarding the management of minor health problems within the home situation. Assessment, treatment strategies and medications were identified. Functionality and observation are mainly used to diagnose and manage illness. This approach also includes monitoring the progress, severity and recovery from illness in the patient. The findings further demonstrated that older Xhosa women were also managing illnesses that could be classified as major. They could clearly distinguish between what was health and what was illness in their village. Distance from health care services had an impact on the health-seeking behaviour of the older Xhosa women, with those closer to health care services wanting all illnesses, even those that could be classified as minor health ailments, to be managed by the health service, and those who were farther away from the hospital appearing to manage complex illnesses, and only referring clients with those illnesses to external health care services quite late. The findings further showed communication and attitudinal problems that existed between the clients and health care providers. Conclusion: Many studies have already challenged the manner in which PHC was implemented in developing countries, as it appeared to focus on the curative approach to disease and left out disease prevention and health promotion. It is within this area that the older Xhosa women appear to express the greatest concern for the health of their homes and villages. The older Xhosa women in the Eastern Cape appear to be struggling with problems of broken family units, and are left behind to struggle to keep the home together, as they lack the necessary resources to do the hard work involved with producing food and building the home and village. In the light of the promise of National Health Insurance and the revitalisation of PHC, the study proposes that the two major national health policies should take cognisance of the IHK utilised by the older Xhosa women, and that there should be a clear plan as to how the knowledge can be supported within a health care systems approach. A rural health model is proposed by the study to do this. / AFRIKAANSE OPSOMMING: Rasionaal: Daar word kritiese vrae gestel oor die toeloop van mense met geringe ongesteldhede by primêre-sorg(PS)-dienste, soos gemeenskapgesondheidsentrums (GGS) en klinieke, hoofsaaklik in Xhosa-woongebiede in die Wes- en Oos-Kaap. Voorstelle is geopper dat ouer Xhosa-vroue se inheemse gesondheidskennis (IGK) by die dienste geïntegreer en benut moet word as ’n strategie om minder ernstige gesondheidsprobleme te bestuur en om mense aan te moedig om toepaslike keuses oor gesondheidshulp te maak. Voorlopige navorsing het die nodigheid bevestig dat die kundigheid wat tans onbenut in gemeenskappe lê, herontgin behoort te word. Die navorsing bevestig dat sulke kennis ’n bate kan wees indien dit as ’n gewaardeerde element by die Westerse biomediese model ingeskakel word en dat dit ’n groot rol kan speel om die druk op PS-sentrums te verlig. Doelstelling:Hierdie navorsing ondersoek en beskryf hoofsaaklik die IGK waaroor ouer Xhosa-vroue beskik en wat in die hantering van gesondheidsprobleme in hul tuisomgewing aangewend word. Aanvullende aanbevelings rakende die gebruik, behoud en integrasie van IGK by PS-dienste is aan bepalende belanghebbers voorgelê. Metode: Kwalitatiewe data-insamelingsmetodes is in hierdie etnografiese, feministiese en bevrydingsgerigte navorsing gebruik. Ses-en-dertig ouer Xhosa-vroue is spesifiek uitgesoek vir deelname aan vier fokusgroepbesprekings (FGB’s) om hul hantering van gesondheidsprobleme in hul tuisomgewing aan die hand van hul IGK te ondersoek. Sestien indringende onderhoude is met die elite- ouer Xhosa-vroue en hul gesinslede gevoer om die bevindings van die vier besprekings te bevestig. Die proses van ontleding en vertolking is gerig deur ’n induktiewe proses wat ’n kombinasie van narratiewe ontleding en die ontleding van narratiewe strategieë behels het. Bevindings: Die bevindings wys dat ouer Xhosa-vroue IGK het rakende die hantering van minder ernstige gesondheidsprobleme in die tuisomgewing. Evalueringsmetodes, behandelingstrategieë en medikasie is uitgewys. Kwale word hoofsaaklik volgens funksionaliteit en waarneming gediagnoseer en hanteer. Die werkwyse sluit in dat pasiënte se vordering, die erns van hul siekte en hul herstel gemoniteer word. Die bevindings wys verder dat ouer Xhosa-vroue ook siektetoestande hanteer wat as ernstig geklassifiseer kan word. Hulle kan duidelik tussen gesondheid en siekte in hul gemeenskap onderskei. Die afstand vanaf gesondheidsorgdienste speel ’n rol in die gedrag van ouer Xhosa-vroue wat keuses oor gesondheidshulp betref; diegene wat na aan ʼn gesondheidsorgsentrum woon, verkies dat die gesondheidsdienste alle siektes - selfs dié wat as minder ernstige gesondheidskwale geklassifiseer kan word - moet hanteer, terwyl diegene wat verder van ’n hospitaal woon, klaarblyklik self komplekse siektetoestande behandel en eers op ’n gevorderde stadium sulke kliënte na eksterne gesondheidsorgdienste verwys. Die bevindings het ook probleme rakende kommunikasie en houdingsingesteldheid tussen kliënte en gesondheidsdiensverskaffers uitgewys. Gevolgtrekking: Verskeie ondersoeke het al die manier waarop PG-sorg in ontwikkelende lande toegepas word, bevraagteken, aangesien die benadering oënskynlik op genesing fokus terwyl dit siektevoorkoming en gesondheidsvoorligting verontagsaam. Dis oor hierdie aspek dat die ouer Xhosa-vroue skynbaar die grootste kommer oor die welstand van hul huishoudings en gemeenskappe het. Die ouer Xhosa-vroue in die Oos-Kaap het klaarblyklik met dieselfde probleme van gebroke gesinne as dié in die Wes-Kaap te kampe, en word dikwels alleen agtergelaat om die huishouding te laat oorleef. Hulle kry swaar om sonder die nodige hulpbronne die harde werk te doen om voedsel te produseer en om huishoudings en die gemeenskap op te bou. In die lig van die vooruitsigte wat nasionale gesondheidsversekering en vernuwing van die PGS inhou, stel hierdie navorsingsprojek voor dat bogenoemde twee hoofelemente van die nasionale gesondheidsorgbeleid aandag skenk aan die IGK wat ouer Xhosa-vroue toepas, asook dat ’n duidelike plan uitgewerk word oor hoe hierdie kennis binne die benadering tot gesondheidsorg ondersteun kan word. Die navorsings stel ’n model vir plattelandse gesondheidsorg voor om dié doelstellings te verwesenlik.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: A portfolio of learning is one way of showing evidence of performance over a period of time. Worldwide, the need for social accountability and health services reforms has led to an increased interest in competency-based medical education with specific outcomes. Postgraduate training increasingly focuses on life-long adult learning, placing emphasis on close supervision with feedback and workplace-based assessment. South Africa, although better resourced, faces many similar socio-political and health services challenges as the rest of Africa. The democracy is less than 20 years old, with 80% of the previously disadvantaged population now having access to health services. In this new era medical schools have aligned their curricula to focus on patient-centred primary health care. The huge demand for appropriately trained family physicians has become a national priority. Subsequently, the College of Family Physicians of the Colleges of Medicine of South Africa developed a national exit examination for postgraduate family medicine training. One component of the examination is the submission of a satisfactory portfolio of learning. The aim of this thesis was to develop a national portfolio for postgraduate family medicine education in South Africa. It needed to be valid, acceptable, useful for learning, and be assessed in a reliable way. The research process involved a collaboration with registrars, supervisors and programme managers from all eight medical schools in the country over four years and culminated in the first national portfolio for family medicine in the country. The thesis was done by way of publication, which involved four articles being published in international journals, outlining the development, implementation and assessment of our portfolio. Content and construct validity of the draft portfolio was established through a Delphi process. Subsequently, the portfolio was implemented at all eight medical schools. Workshops over two years at all the universities facilitated implementation and provided feedback on the use of the portfolio across the country. After implementation of this initial portfolio, the acceptability, educational impact, and usefulness for assessment were evaluated through a national survey and in-depth interviews. A portfolio assessment tool was developed and its reliability was established for the overall score. The assessment tool has also been implemented nationally. The portfolio’s requirements have made the expectations and challenges of workplace-based learning and assessment more visible, with supervision, safe learning environments and more user-friendly learning and assessment tools needing further research. / AFRIKAANSE OPSOMMING: ‘n Portefeulje met bewyse van opleiding is een manier om bevoegdheid en prestasie oor ‘n periode van tyd te demonstreer. Sosiale verantwoordelikheid en hervormings in gesondheidsdienste wêreldwyd het gelei tot vaardigheids-gebaseerde mediese opvoeding met spesiefieke uitkomste. Nagraadse opleiding fokus toenemend op lewenslange volwasse leermetodes met ‘n groot klem op nabye toesig, terugvoer en werksgebaseerde evaluasies. Alhoewel Suid-Afrika beter toegerus is as meeste lande in Afrika, staar die land baie soortgelyke sosiaal-politiese en gesondheids uitdagings in die gesig. Met die jong demokrasie van 20 jaar het 80% van mense wat voorheen nie toegang gehad het tot goeie gesondheidsdienste nie nou wel toegang. Mediese skole het hul kurrikulums aangepas om te konsentreer op pasient-gefokusde primêre gesondheidsorg. Die Kollege van Huisartse van die Kolleges van Geneeskunde van Suid-Afrika het ‘n nasionale eksamen vir nagraadse opleiding in huisartskunde in die land geimplementeer. Een van die komponente van die eksamen behels die inhandiging van ‘n bevredigende opleidingsportefeulje. Die doel van hierdie tesis was om ‘n nasionale portefeulje vir nagraadse opleiding in huisartskunde in Suid-Afrika te ontwikkel. Die portefeulje moes geldig en aanvaarbaar wees, asook nuttig vir leer en ook op ‘n betroubare manier evalueer kon word. ‘n Proses van samewerking tussen kliniese assistente, toesighouers en programbestuurders van al agt mediese skole in die land oor ‘n periode van vier jaar het die eerste nasionale opleidingsportefeulje vir huisartskunde in Suid-Afrika die lig laat sien. Hierdie is ‘n tesis by wyse van publikasie deur vier artikels wat in internasional journale verskyn het, wat die ontwikkeling, implementering, en evaluering van die portefeulje beskryf. Die geldigheid van die inhoud en samestelling van die portefeulje was ontwikkel deur ‘n Delphi proses. Nadat die portefeulje geimplementeer was, was die aanvaarding, leerimpak en nuttigheid vir evaluering ondersoek deur ‘n nasionale opname en in-diepte onderhoude. Werkswinkels by al die universiteite het die geldigheid en implemetering van die portefeulje verder versterk. ‘n Instrument om die portefeulje te evalueer was ontwikkel en in gebruik geneem landwyd, en betroubaarheid van die totale telling was bewerkstellig. Die behoeftes van die portefeulje het die verwagtinge en uitdagings van werksgebaseerde opleiding en evaluering meer sigbaar gemaak, met toesighouding, veilige leeromgewings en meer gebruiksvriendelike leer- en evalueringsinstrumente as areas identifiseer wat aangaande navorsing benodig.

Thesis (MMed) -- Stellenbosch University, 2010. / Bibliography / Chronic wounds afflict millions worldwide, incurring significant health care costs and chronic suffering. Clinicians are often unsure about treatment, resulting in poor outcomes. Objective To determine the scope of knowledge possessed by fifth year medical students, general practitioners (GP’s) and surgical registrars, concerning chronic wound management. Design Cross sectional study Methods Deans of eight South African medical schools received letters requesting information regarding time devoted to wound-care training. Knowledge-based questionnaires were distributed to final-year students at two universities, surgical registrars at three universities and general practitioners attending refresher courses. Result. Four medical schools replied, of whom only two offered formal teaching. 162 medical students, 45 GP’s and 47 surgical registrars completed questionnaires. The overall median (25th–75th percentiles) knowledge scores for registrars, GP’s and students were 65%;(55%–70%), 55%;(45%–65%) and 45%;(35%–50%) respectively. Whereas the scores of registrars and GP’s did not differ, the student scores were significantly less. Only 32% of registrars and 18% of GP’s attained scores of 70% or more. 96% considered training to be inadequate. Interest in wound-care was only mild to moderate, with more GP’s than registrars requesting literature. Conclusions Very little, if any training on chronic wounds is offered in South Africa. The levels of knowledge cannot be considered adequate for successful treatment, nor for teaching to undergraduates. This preliminary study cannot reflect the attitudes and knowledge throughout the country; however it is clear that there is a need for improved education about these conditions that have huge clinical and economic consequences.

Thesis (MMed) -- Stellenbosch University, 2010. / Bibliography / Objective: The objective of this retrospective cohort study is to assess whether demographic and anthropometric parameters, laboratory tests, co-morbidity, co-infection, treatment regimen, IRIS and adherence to treatment predict the expected response to HAART and differences if any, in the pattern of response as measured by CD4 count, weight gain and haemoglobin levels in two cohorts of patients in Roma, The Kingdom of Lesotho. Method: Data were collected randomly from a computerised database of the Antiretroviral Centre of the hospital and two cohorts of 151 subjects in each of the two arms of the study were identified from hospital records from January 2008. Each of these subjects was followed up over a period of 12 months with data obtained for at least 2 visits within the 12 month span. Data were obtained at baseline, 3 months and also at 6 and 12 months marks. Data on characteristics were compared between the two arms. Variables that may be potential confounders were identified and univariate and multivariate logistic regression analyses were carried out to establish differences independent of confounding factors for the combined endpoints as well as for each endpoint separately. Results: In all 302 patients had their records analysed and comparison of clinical and immunological response patterns in patients taking AZT and TDF-containing ART regimens and the possible prediction of which the regimen would be better and within which population. Despite the perceived mismatch between two NRTIs it can be concluded from the results of this study that, overall, the inclusion of AZT in treatment regimen showed a modest protective effect over the TDF counterpart as measured by the endpoints of the discriminative powers of the Receiver Operating Curves of the explanatory variables being 66% , 77% and 66% for CD4, Haemoglobin and Weight respectively, and 63%, 70% and 65% for the same variables in the AZT and TDF arms of the study respectively. Conclusion: In a population of HIV patients on treatment in resource-limited settings AZT-containing regimens appear to show a slight improvement over the TDF-containing ones.

Thesis (MMed) -- Stellenbosch University, 2010. / Bibliography / Background: Evidence-based medicine (EBM) involves the care of patients using the best available evidence from the results of good quality clinical research to guide clinical decision making 1 – 3. By incorporating the principles of Evidence-based Medicine (EBM), the family practitioner would be able to treat a patient according to the best clinical research available. This principle is implemented widely in the USA, Canada, the United Kingdom and Europe. In South Africa, however, EBM is not yet as widely incorporated into family practice. This is so despite the plethora of websites available to practitioners and the relative ease with which applicable research evidence can be found. Very few published studies are available regarding EBM or Evidence–based Practice (EBP) in the South African context. The findings of this study would thus highlight reasons and/ or barriers preventing family practitioners from implementing EBM in their respective practices. This could also lead to further research into possible methods of implementation of EBM into South African family practices. Aim: The aim of the study was to describe the perceptions, knowledge and attitudes of private practitioners regarding evidence based practice and to identify the barriers encountered in evidence based practice. Methods A questionnaire survey of general practitioners in Gauteng, South Africa, was conducted. Questionnaires were distributed to a random sample of practitioners in the Gauteng region. Two hundred and twenty one (221) practitioners participated in the survey and responded to questionnaires mailed to them. The questionnaire was mailed, faxed or e-mailed to the practitioners, which they then completed and returned for statistical analysis. Study design The study design is that of quantitative, statistical analysis (descriptive cross-sectional survey). Setting General practitioners were randomly selected from a list of practitioners in the Gauteng Province. Doing a nationwide survey would have been a mammoth undertaking. It was therefore decided to limit the research to one province and therefore it was only concentrated on practitioners practicing in the Gauteng area. Results It is interesting to note that of the two hundred and twenty one participants in this study; only 10% of the practitioners were against using EBM in their practices. This, however, stands in stark contrast to the 56% of practitioners who do not implement EBM in their practices or make use of the EBM principle at all. The major barriers preventing practitioners from implementing EBM is depicted in the following graph: Lack of time and the training in aspects of Evidence-based medicine were the main barriers preventing the full scale implementation of EBM in family practices in Gauteng. Conclusion Participating Gauteng doctors were in principle, very positive towards the implementation of EBM in their respective practices. Most of the participants agreed that EBM would benefit their patients’ care and treatment. Very few of the participants, however, make use of EBM in practice. A lack of training and time constraints were the main barriers with regards to the implementation of EBM. Proper training of medical students at undergraduate level at faculties of health sciences, would go a long way assisting prospective doctors in mastering the concept of EBM and increasing their overall awareness of EBM. Further definitive research would assist in establishing whether such awareness would be associated with improved implementation of evidence in the form of evidence based guidelines in practice.

Research report (MMed) -- Stellenbosch University, 2010. / Bibliography / ENGLISH ABSTRACT: BACKGROUND: Hypertension and its complications is responsible for a significant proportion of maternal and neonatal morbidity and mortality worldwide. In Dora Nginza Hospital, clinical experience has shown that hypertension and its complications are common but despite this assumption, the overall prevalence of complications, social and demographic characteristics and various forms of presentations of hypertension in pregnancy is still largely unknown. OBJECTIVES: To determine the prevalence of complications, risk factors, social and demographic characteristics of hypertensive complications of pregnancy in Dora Nginza Hospital. STUDY DESIGN: The study is a retrospective descriptive study performed on medical records. The study was carried out by looking at records of patients admitted with hypertension in pregnancy over a 2 year period (2007-2008). MS Excel was used to capture the data and STATISTICA version 9 was used for data analysis. SETTING: Dora Nginza hospital, Port Elizabeth Hospitals Complex. MAIN OUTCOME MEASURES: The incidence, risk factors, maternal complications, perinatal outcome. RESULTS: A total of 22,711 deliveries were recorded in Dora Nginza hospital over the two year period (2007-2008). 1520 cases were complicated by hypertension giving an incidence of hypertension as 6.69% (66.9 per 1000 deliveries). The incidence of pre eclampsia is 35.40% and chronic hypertension 2.80%. Maternal complications occurred in 40.29% of the hypertensive women. Maternal deaths occurred in 0.79% (790 per 100000 deliveries) accounting for 38.71% of the total maternal deaths in the facility. Poor neonatal outcome was recorded in 5.90% of these women. The 2.30% stillbirths represent 3.30% of all fetal deaths in the facility for the study period. Prominent risk factors are age, race, low socioeconomic status, smoking and BMI CONCLUSION: Hypertensive disorders of pregnancy in Dora Nginza hospital is common and is an important cause of maternal and perinatal morbidity and mortality. Improved socioeconomic status, quality obstetric services which include early booking, proper antenatal care, early referral and proper documentation can minimise the effect of hypertension on pregnancy. / AFRIKAANSE OPSOMMING: geen opsomming