AIM AND OBJECTIVES: The aim of this study was to evaluate perceptions on quality of care delivered by service providers to families of children with disabilities, attending the cerebral palsy (CP) clinic at Dr George Mukhari hospital. The objectives of this study were to 1) determine the demographic and socio-economic profile of the caregivers; 2) establish how the caregivers perceive the provision of care as identified by the subscales of the Measure of Processes of Care-South African (MPOC-SA version), by Saloojee (2007); and 3) determine the overall perception of caregivers with regard to their satisfaction from the service they received. METHODS: A correlation study design using structured interviews was used. Purposive sampling technique was used to recruit participants who gave informed consent to participate in the study (n=67). Caregivers completed the demographic and the MPOC-SA version questionnaire through structured interviews conducted by two trained assistants. The researcher completed the Gross Motor Function Classification System (GMFCS) for each child diagnosed with cerebral palsy guideline and eliciting developmental and functional abilities of the child using the Neurodevelopmental therapy (NDT) clinical approach. RESULTS: Ninety-nine percent of caregivers were females, and approximately 45% of them were 30 years old and younger. Just over forty percent of them were married, with 34.33% married to the father of the child. Thirteen percent of caregivers were exposed to tertiary education, and 34.33% of families were receiving less than R500 per average month. Caregivers perceived that the MPOC-SA domains of Respectful and Supportive Care together with Providing Specific Information to have been experienced to a great extent at 5.34 (±0.61) and 5.09 (±0.82) respectively. The weak domains were perceived to be Providing General Information, Enabling and Partnership and 2.34 (±0.95) and 3.26 (±1.10) respectively. Satisfaction with services rendered was at an average of 5.33 (±1.00). There was a positive correlation between Satisfaction and of the all the MPOC-SA domains. CONCLUSION: Service providers need to improve on the interpersonal aspects of service delivery to ensure healthcare provision of high quality with better outcomes and higher satisfaction for users. The identified aspects that need immediate improvement are ‘Providing General Information’ and ‘Enabling and Partnership’ respectively. Providing General Information focuses on activities that meet caregivers’ general information needs such as grant applications, accessing assistive devices, and other resources that may support the family of a child with cerebral palsy such as non-governmental organization. Enabling and Partnership focus on activities where caregivers are involved in decision-making about the appropriate treatment for the child, and in giving input, sharing their concerns and opinions about services they receive.

The study sought to explore and describe the breastfeeding practices of Human Immunodeficiency Virus (HIV) positive postnatal clients’ non-commitment to exclusive breastfeeding in George Mukhari Hospital, South Africa. A non-experimental quantitative design was used. Inferences drawn from the study were that HIV positive clients that opted for exclusive breastfeeding did not commit for fear of transmission of HIV to the baby and exclusive breastfeeding was stopped before the recommended 6 months. Most of the respondents’ partners did not come for counselling. There was lack of emotional support by staff after testing. Health education and emotional support of HIV positive clients has to be intensified. / Health Studies / M. A. (Health Studies)

The study sought to explore and describe the breastfeeding practices of Human Immunodeficiency Virus (HIV) positive postnatal clients’ non-commitment to exclusive breastfeeding in George Mukhari Hospital, South Africa. A non-experimental quantitative design was used. Inferences drawn from the study were that HIV positive clients that opted for exclusive breastfeeding did not commit for fear of transmission of HIV to the baby and exclusive breastfeeding was stopped before the recommended 6 months. Most of the respondents’ partners did not come for counselling. There was lack of emotional support by staff after testing. Health education and emotional support of HIV positive clients has to be intensified. / Health Studies / M. A. (Health Studies)

Background: Group B streptococcus (GBS) is regarded as one of the most important causes of maternal and neonatal morbidity and mortality in many parts of the world. GBS recto-vaginal colonization is important in the health of a mother and her neonate, especially in developing countries. Maternal vaginal colonization with GBS at the time of delivery can cause vertical transmission to the neonate. Multilocus sequence typing (MLST) is a technique used to characterize microbial isolates by means of sequencing internal fragments of housekeeping genes and has the advantage of reproducibility and has been shown to correlate with the other typing techniques and thus has emerged as the standard for delineating the clonal population of GBS. The study aimed to investigate the epidemiology of GBS colonization among pregnant women and their neonates, and to characterize the isolates by multilocus sequence typing technique at Dr George Mukhari Academic Hospital, Pretoria. Methodology: A total of 413 pregnant women who visited the antenatal clinic were recruited and screened. Participants were interviewed using a questionnaire to gather demographic and other relevant information such as history of current pregnancy, previous miscarriages and still births. Samples from maternal rectum and vagina as well as neonate ear and umbilical cord were taken for culture using colistin and nalidixic acid (CNA) blood agar and incubated for 24-48 hours. If negative after 48 hours, Todd-Hewitt broth was subcultured after 18-48 hours onto sheep blood agar. Multilocus sequence typing (MLST) was used to characterize seven group B streptococcus isolates collected at Dr George Mukhari academic hospital. Fragments of seven housekeeping genes were amplified by polymerase chain reaction (PCR) for each strain and sequenced. CLC bio software (Inqaba biotech, South Africa; Pretoria) was used to analyse sequenced loci and UPGMA dendrogram was constructed. Results: The colonization rate for GBS in pregnant women and their neonates was 30.9% and 0%, respectively. A higher proportion of GBS were isolated from the rectum (37.9%) as compared to the vagina (20.6%). Most socio-economic, demographic and obstetric factors analysed were not significantly associated with.GBS colonization. On 128 positive samples, the results of Todd-Hewitt enrichment broth and direct plating method using CNA were compared. A total of 45.3% of colonised were positive on direct selective agar (CNA); an additional 54.7% samples were recovered from Todd-Hewitt broth. Three genes (adhP, glnA and tkt) were sequenced successfully for six samples (1, 2. 4,6,12 and 65). The UPGMA tree with 1000 bootstrap showing the relationship between six samples was drawn.Conclusion: This study revealed that pregnant women of all ages are at risk of group B streptococcus colonization. Group B streptococcus was common among pregnant women at Dr George Mukhari Academic Hospital. No socio-economic risk factor was associated with group B streptococcus colonization. Results confirm that the combination of Todd-Hewitt broth and CNA agar plate is a time saving and sensitive method. The allelic profile, characteristics such as G+C (guanine+cytosine) content and dN/dS ratio were not analysed because of the smaller sample size used in this study, which shows that the MLST method was unsuccessful in this study. The UPGMA tree based on differences in consensus of the isolates showed that all group B streptococcus isolates are clustered and descend from a single node. / Life & Consumer Sciences / Life Sciences / M.Sc. (Life Sciences)

Background: Group B streptococcus (GBS) is regarded as one of the most important causes of maternal and neonatal morbidity and mortality in many parts of the world. GBS recto-vaginal colonization is important in the health of a mother and her neonate, especially in developing countries. Maternal vaginal colonization with GBS at the time of delivery can cause vertical transmission to the neonate. Multilocus sequence typing (MLST) is a technique used to characterize microbial isolates by means of sequencing internal fragments of housekeeping genes and has the advantage of reproducibility and has been shown to correlate with the other typing techniques and thus has emerged as the standard for delineating the clonal population of GBS. The study aimed to investigate the epidemiology of GBS colonization among pregnant women and their neonates, and to characterize the isolates by multilocus sequence typing technique at Dr George Mukhari Academic Hospital, Pretoria. Methodology: A total of 413 pregnant women who visited the antenatal clinic were recruited and screened. Participants were interviewed using a questionnaire to gather demographic and other relevant information such as history of current pregnancy, previous miscarriages and still births. Samples from maternal rectum and vagina as well as neonate ear and umbilical cord were taken for culture using colistin and nalidixic acid (CNA) blood agar and incubated for 24-48 hours. If negative after 48 hours, Todd-Hewitt broth was subcultured after 18-48 hours onto sheep blood agar. Multilocus sequence typing (MLST) was used to characterize seven group B streptococcus isolates collected at Dr George Mukhari academic hospital. Fragments of seven housekeeping genes were amplified by polymerase chain reaction (PCR) for each strain and sequenced. CLC bio software (Inqaba biotech, South Africa; Pretoria) was used to analyse sequenced loci and UPGMA dendrogram was constructed. Results: The colonization rate for GBS in pregnant women and their neonates was 30.9% and 0%, respectively. A higher proportion of GBS were isolated from the rectum (37.9%) as compared to the vagina (20.6%). Most socio-economic, demographic and obstetric factors analysed were not significantly associated with.GBS colonization. On 128 positive samples, the results of Todd-Hewitt enrichment broth and direct plating method using CNA were compared. A total of 45.3% of colonised were positive on direct selective agar (CNA); an additional 54.7% samples were recovered from Todd-Hewitt broth. Three genes (adhP, glnA and tkt) were sequenced successfully for six samples (1, 2. 4,6,12 and 65). The UPGMA tree with 1000 bootstrap showing the relationship between six samples was drawn.Conclusion: This study revealed that pregnant women of all ages are at risk of group B streptococcus colonization. Group B streptococcus was common among pregnant women at Dr George Mukhari Academic Hospital. No socio-economic risk factor was associated with group B streptococcus colonization. Results confirm that the combination of Todd-Hewitt broth and CNA agar plate is a time saving and sensitive method. The allelic profile, characteristics such as G+C (guanine+cytosine) content and dN/dS ratio were not analysed because of the smaller sample size used in this study, which shows that the MLST method was unsuccessful in this study. The UPGMA tree based on differences in consensus of the isolates showed that all group B streptococcus isolates are clustered and descend from a single node. / Life Sciences / M.Sc. (Life Sciences)

Text in English / Previous studies have reported a high prevalence of HIV and AIDS among adolescent girls. It is estimated that there are 5,24 million people living with HIV/AIDS (PLWHA). These estimates would mean that about 2.36 million people living with HIV/AIDS would be young women and girls aged 15-24 years. The latest household survey conducted by the Human Science Research Council (HSRC) revealed that the prevalence of HIV is three to seven fold in girls and young women aged 15-24 than boys and young men (HSRC 2014) This resurgence in HIV incidence is occurring at a time when it is believed the epidemic has reached a plateau following aggressive behavioural, biomedical and structural interventions by the Department of Health, Non-Governmental Organizations (NGO) and civil society in general. A probability sampling method, involving a random selection of elements was used to select 130 young women and girls aged 18-24 presenting at Dr George Mukhari Academic Hospital by simple random sampling. Data were collected by self-administering questionnaires. High unemployment and greater age-disparity in the relationships were found to have a direct correlation with HIV incidence in the population under study. This study also shows that inconsistent condom use, low rate of medical male circumcision of male partners, coupled with lower HIV counselling and testing than the national average, was associated with new HIV infections, in spite of high level of condom availability, knowledge of HIV issues and an exposure to an array of behavioural change communication interventions. / Health Studies / M.A. (Public Health)