Exclusive breastfeeding is one of the infant feeding methods recommended by the World Health Organisation (WHO) in the prevention of mother-to-child transmission of Human Immunodeficiency Virus (HIV), especially to HIV positive women of low socio economic status. The purpose of the study was to determine and describe the HIV positive mothers’ perceptions towards exclusive breastfeeding in postnatal ward at a particular hospital in Limpopo Province, South Africa. Qualitative exploratory research design was used to explore and describe the HIV positive mothers’ perceptions towards exclusive breastfeeding. A grand tour question in an unstructured interview was used to collect data, followed by probing questions according to participants’ responses. Data were collected from 15 HIV positive mothers aged 18 years and above. They opted for exclusive breastfeeding, and voice recorder and field notes were used to capture data. The seven steps of data analysis, adapted from Colaizzi were used. The findings: Although the benefits of exclusive breastfeeding was known by mothers, some participants had limited knowledge on the importance of exclusive breastfeeding. Some health care providers lack up-to-date information on exclusive breastfeeding. Religious and cultural practices interfere with exclusive breastfeeding. Coping strategies with the feeding options emerged as well. / Health Studies / M.A. (Nursing Science)

The study sought to determine the meaning and interpretation by facility managers and nurses on utilisation of expanded programme on immunisation and integrated management of childhood illnesses (EPI and IMCI) programmes for follow-up and antibody testing of HIV-exposed infants (HEI) at 18 months. Also to understand the factors within the health systems that influence the follow-up and antibody testing. The study setting selected was six facilities in Steve Tshwete subdistrict in Nkangala district of Mpumalanga province in South Africa. The study used a hermeneutic phenomenology using in-depth interviews for collecting data from 4 facility managers and 12 nurses. The major themes that emerged from the interviews were referral, defaulting, integration, stigma, and off-site ART initiation within the health system. These were found to influence the utilisation of HEI and IMCI services for follow-up and management of HEI. It was also found that the importance of integrating the management of HEI into the EPI and IMCI cannot be overemphasised. It was concluded that the Health Department needs to be vigilant and use all available resources to manage HEI to meet the MDG 4 of prevention of infant mortality / Health Studies / M.A. (Nursing Science)

Maternal HIV-disclosure to an adolescent is a controversial issue especially when considering the suitable time and context in which disclosure should take place. Furthermore there have been other considerations such as the adolescent’s emotional maturity as well as gender issues which have played a role in regards to determining whether the adolescent would be able to understand and cope effectively post-disclosure. These considerations formed the basis of this study’s aim and objectives which primarily focused on taking into account the developmental aspects apparent in the adolescent phase. These include adolescent’s relations with their mother, their peers and the meaning attached to having an education and career in their lives. For purposes of this study it was deemed important to actually explore with the adolescent’s the meaning they uphold pertaining to maternal HIVdisclosure. This differs from previous research which has focused predominantly on accessing adolescent’s experiences via their parents and in particular, their mothers. Data of only three participants was included following in-depth interviews being conducted. Data was analysed via Interpretive Phenomenological Analysis (IPA) which enabled an enhanced understanding and meaningful interpretation of the adolescent’s experiences following maternal HIV-disclosure. From the findings it became apparent that most concerns had already been addressed and were similar when compared to previous research that had been conducted. However one notable different finding was that instead of adolescent’s acting in ways that would lead to them self-sabotaging their lives they instead portrayed themselves to be living in a responsible manner. It became apparent rather that it was the adolescent’s mother rather that became more inclined to engage in self-sabotaging behaviours.

No description available.

Thesis (PhD)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The prevention of mother-to-child transmission (PMTCT) of HIV is a key maternal and child health intervention in the context of the HIV/AIDS pandemic in South Africa. Accordingly, the PMTCT programme has been incorporated in the District Health Management Information System (DHMIS) that collects monthly facility-based data to support the management of public health services. To date, there has not been a comprehensive evaluation of the PMTCT information system. By comparing the experiences in two health districts, using the Performance of Routine Information System Management (PRISM) framework and tools, this study seeks to evaluate the availability, quality and use of process and output indicators for monitoring PMTCT interventions. A comparative analytical and observational study was undertaken using a multi-method approach which included: a self-administered survey of health information personnel to assess confidence and competence levels for routine health information system (RHIS) tasks, an assessment of the routine PMTCT data for quality, completeness, accuracy, and data use; and a facility survey of RHIS processes and resources. In addition, in-depth interviews with 22 key informants and observations in health facilities were conducted. Data were collected from 57 health facilities in a convenience sample of two health districts, and also from 182 health information personnel in the 57 health facilities, three sub-districts, and two district offices. Descriptive statistics, χ2-test, correlation and multiple regression analyses were conducted using STATA® Version 13. A general inductive approach was also used to analyse the qualitative data, which was used for triangulation. The study revealed considerable data quality concerns for the PMTCT information with an average accuracy between the register and routine monthly report of 51% and between the routine monthly reports and DHMIS database of 84% suggesting that the primary point of departure for accurate transfer of data is during the collation process. The importance of human factors was emphasised by the observation that the average confidence level for performing RHIS-related tasks (69%) was not commensurate with the average competence levels (30%). Education was found to be associated with competence, implying that levels of education may be associated with the level at which RHIS competencies are acquired; and that three years or more of post-matriculation education is necessary. Motivation, on the other hand was not associated Stellenbosch University https://scholar.sun.ac.za iv with competence. The study observed the absence of processes such as data-quality checks and data-analysis in place in facilities. There was a general absence of a culture of information use, as a result of lack of trust in the data, and the inability of programme and facility managers to analyse, interpret and use information. We observed differences in the data accuracy by organisational authority, and multivariate analysis and qualitative information suggested that feedback may be an essential process to ensure quality. Although the PRISM framework has been developed from a multi-disciplinary evidence base, this study has been able to validate some of the internal assumptions but has also found some aspects that were not supported such as motivation and data display. Data collected from a larger number of facilities will be required to investigate this further. Institutional capacity to improve RHIS processes, ensure core competencies for RHIS-related tasks are needed, and in the longer term, measures to tackle problems associated with low pass rates in numeracy subjects among high school learners are needed. Further exploration of the possible factors that may influence data accuracy, such as supervision, training and leadership are needed as well as investigating the relationships between human and institutional agency-related aspects, in particular, how individual actions can bring about changes in institutional routines. Further study is needed to determine how decision for planning and evaluating key programmes such as PMTCT are made, and what informs such decisions if not routine data. / AFRIKAANSE OPSOMMING: In die lig van Suid Afrika se MIV/VIGS-pandemie kan ’n ingryping op gesondheidsvlak ’n belangrike rol speel om moeder-na-kind-oordrag (beter bekend as PMTCT) van MIV te voorkom. ’n Inligtingstelsel vir distriksgesondheidsbestuur – die DHMIS – was ontwerp vir die invordering van maandelikse fasiliteitsdata, wat gebruik kan word om die bestuur van openbare gesondheidsdienste en -programme te ondersteun. Die inligtingstelsel self was nog nie omvattend evalueer nie. Hierdie studie het die ervarings van twee gesondheidsdistrikte vergelyk met behulp van die PRISM- (Performance of Routine Information System) raamwerk en -instrumente. Derhalwe het hierdie studie die beskikbaarheid, gehalte en gebruik van proses- en uitsetaanwysers probeer bepaal om die PMTCT-ingrypings te monitor. ’n Vergelykende analitiese en waarnemingstudie is onderneem met behulp van ’n veelvuldige benadering. Die verskillende metodes het ’n selfopname onder gesondheidsinligtingspersoneel ingesluit om hul selfvertroue en bevoegdheid in roetinegesondheidsinligtingstelsel (RHIS)-take te evalueer. Daar was ook ’n assessering van die PMTCT-roetinedata om datagehalte, -volledigheid, -akkuraatheid en -gebruik te beoordeel.’n Fasiliteitsopname oor RHIS-prosesse en –hulpbronne was ook gedoen. Ander navorsingsmetodes het diepte-onderhoude met 22 sleutelpersone ingesluit, sowel as waarnemings in gesondheidsfasiliteite. Data is van 182 gesondheidsinligtingpersoneel van die 57 gesondheidsfasiliteite in ’n geriefsteekproef van twee gesondheidsdistrikte ingesamel. Deskriptiewe statistiek, χ2-toetsing, korrelasie en veelvoudige regressie is met behulp van STATA® weergawe 13 ontleed. ʼn Algemene induktiewe benadering is ook gevolg om die kwalitatiewe data te ontleed. Die studie toon dat menslike faktore ’n impak op datagehalte en -inligting kan hê, met ’n gemiddelde akkuraatheidsyfer van 51% van beide die register en roetine maandelikse verslae. Die akkuraatheid van die maandelikse verslae en RHIS databasis is 84%, wat aandui dat akkuraatheid slegs toegepas word indien inligting uit die staanspoor korrek aangeteken word. Die impak van menslike hulpbronafaktore was beklemtoon toe daar bevind was dat hoewel 69% van RHIS-dataverwerkers vertroue getoon het in die gebruik van RHIS-verwante take, slegs 30% wel bevoeg was om die werk te doen. Opvoeding was grootliks geassosieer met bevoegdheid, wat moontlik voorstel dat sekere vlakke van opvoeding benodig word vir spesifieke RHIS-bevoegdhede. Minsten drie jaar tersiêre opleiding word aanbebeel. Motivering was nie met Stellenbosch University https://scholar.sun.ac.za vi bevoegdheid geklassifeer nie. Die studie het bevind dat daar te min aandag aan datagehalte en –analise gegee word in fasiliteite. Oor die algemeen was daar nie ’n ordentlike kultuur van inligtinggebruik nie, a.g.v. die feit dat daar nie vertroue in die data was nie. Terselftertyd was program- en fasiliteitbestuurders nie bevoeg om inligting te analiseer en ontleed nie. Ons het verskille in die akkuraatheid van data opgetel wat deur organisasie-hoofde gedoen was. Meervoudige analise en kwalitatiewe informasie stel voor dat terugvoering ’n belangrike deel van die proses moet wees om kwaliteit te verseker. Hoewel die PRISM-raamwerk saamgestel was uit ’n multi-dissiplinêre bewyslewering, kon hierdie studie sommige van die interne voorneme valideer, maar daar was aspekte wat nie gestaaf kon word nie. Inligting van ’n groter aantal fasiliteite sal benodig word om verder hierna ondersoek in te stel. Institusionele kapasiteit word benodig om RHIS-prosesses te verbeter en basiese vaardighede vir RHIS-verwante take te verseker. Op langtermynvlak moet daar ook gekyk word na probleme wat lei tot laë slaagsyfers in syfervaardighede in hoërskoolleerders. Verdere ondersoek moet ingestel word om vas te stel watter faktore moontlik akkurate data teweeg kan bring. Dit sluit toesig, opleiding en leierskap, asook die verhoudings tussen menslike en agentskap-verwante aspekte in. Die feit dat optrede op individuele vlak veranderings in institusionele roetines kan aanbring, moet spesifiek na gekyk word. Verdere studies kan help om vas te stel hoe besluite vir beplanning en evaluaring vir hoofprogramme soos PMTCT gemaak word – asook hoe die besluite gemaak word indien hulle nie roetine voorafgaan nie.

The purpose of this study was to evaluate care rendered to HIV positive women and their infants during the first six weeks of postpartum. Quantitative, descriptive, cross sectional and analytic study was conducted to investigate postnatal care services provided to HIV positive mothers. Data collection was done using structured questionnaires. 372 respondents participated in the study. Descriptive data analysis was used; Epi info version 3.5.2 software was used. The study highlighted that the quality of PNC was compromised, in all levels including the critical immediate postnatal care, 3-14 days and 6 weeks postnatal care services. All health facilities that were involved in the study had the basic resources to render quality postnatal care. Negative attitudes of staff and long waiting time (16.7%), were the most deterrents to postnatal care. / Health Studies / M.A. (Health Studies)

Thesis (MMed (Medical Microbiology))--University of Stellenbosch, 2006. / One of the major routes of transmission of human immunodeficiency virus (HIV) in the developing world is vertical transmission from mother to infant – pre-, intra-, or post-partum. In the Western Cape, HIV-1 subtype C is the predominant subtype in the heterosexual population, and this trend was expected to be seen amongst cases of mother-to-child transmission of HIV. The aim of this study was to perform genetic characterisation and phylogenetic analysis of the HIV-1 genome in positive serum/plasma samples obtained from children (age 0 to 18 months) from 2000-2002, and temporally related specimens from their mothers. We obtained 27 suitable pairs of samples taken within 6 months of delivery. From this pool, we obtained 21 infant DNA sequences and 17 maternal sequences, resulting in 16 mother-infant pairs. All patient sequences were identified as HIV-1 subtype C, and, as expected, mother and infant viral sequences clustered together. In some cases where a mother was suspected to have two dominant quasispecies based on the electropherogram, only one sequence was detectable in the infant. Single or multiple amino acid deletions were consistent between mothers and infants, and some pairs showed the same amino acid deletions seen in other pairs.

First eleven leaves not numbered / The purpose of this study was to identify, explore and describe the potential contributing factors of the upsurge of HIV among children aged three to eighteen months in the Mangaung Metropolitan area of the Free State Province in South Africa. The study was conducted at five primary healthcare facilities and one hospital in the Mangaung metropolitan municipality of the Free State Province with sixty randomly selected mothers of children testing HIV-positive for the first time between the ages of three and eighteen months. The convergent mixed-methods research design was opted for, according to which both qualitative and quantitative data were collected at the same health facilities selected by means of cluster sampling. The review of medical records, unstructured interviews, and structured questionnaires were used for qualitative and quantitative data collection, while random cluster sampling was used for participant selection. Thematic data analysis was applied for the interpretation of recurrent patterns of qualitative and quantitative data. The study results revealed that mothers were well-informed about the prevention of mother-to-child-transmission. The main factors that contributed to more children testing HIV positive after the routine tests were conducted at ten weeks included non-adherence factors to PMTCT prescripts mainly by mothers, such as: babies were not brought to the clinics for testing and immunisations at ten weeks, and that mothers acquired HIV infection during the breastfeeding period. Some other potential contributing factors were late antenatal booking which lead to the delay in initiation of antiretroviral treatment, nonadherence to antiretroviral therapy during pregnancy, and mixed feeding. The themes that emerged from the qualitative data were psychological factors, emotional factors, socioeconomic factors, missed opportunities, risky behaviour, as well as women disempowerment; while some mothers were left with unanswered questions. The results of the qualitative part complemented the quantitative findings as they uncovered the factors that led to the deviation from the PMTCT prescripts by the mothers. The study’s recommendations include PMTCT psychological assessment and counselling; partner and community involvement; women empowerment; and that couple testing at antenatal and postnatal clinics should be a national policy subjected to protracted monitoring and evaluation processes. / Health Studies / D. Litt. et Phil. (Health Studies)

Com a finalidade de estudar a soroprevalência do Vírus da Imunodeficiência Humana, HIV, e infecções com transmissão relacionadas, entrevistamos e colhemos sangue de 197 usuários de drogas injetáveis, UDIs, amostrados através da metodologia de \"bola de neve\" (snow-balling), da cidade de Santos, São Paulo, Brasil. Nesta cidade a estimativa de UDIs, 10.000 indivíduos, compreende cerca de 2% de sua população. Soroprevalências de HIV, hepatites B e C, sífilis e HTLV (1 ou 2) foram obtidas e comparadas com 197 doadores de sangue pareados por idade e sexo. As soroprevalências encontradas foram de 62% para HIV, 75% para HCV, 75% para HBV, 34% para sífilis, e 25% para o HTLV (1 e 2) entre os UDIs, comparado com 0%; 2%; 23%; 12% e 1% entre os doadores do banco de sangue, respectivamente. Os fatores de risco para transmissões parenterais nesta comunidade de UDIs são mais importantes que para transmissão sexual, embora a última deva ser considerada quando se planejar estratégias de controle. Além disso, estimamos a Razão de Reprodutibilidade Basal, R0, para o HIV entre os UDIs. Usando um modelo clássico para infecções transmitidas por vetores de Macdonald adaptado para \"agulhas\", o valor de R0 foi estimado em 28 e 98, considerando uma distribuição dos inóculos infectantes como homogênea ou heterogênea respectivamente . Esta estimativa foi baseada somente em parâmetros de transmissão parenteral nesta comunidade de UDIs. Usando este modelo a estimativa da soroprevalência do HIV no equilíbrio (0,67) é bem próxima à soroprevalência observada (0,62). / In order to study the seroprevalence of HIV and infections with related transmission patterns, as hepatitis B and C, syphilis and HTLV (1 and 2), we interviewed and bled 197 IDUs, sampled by snow-balling and compared with 197 blood donors matched for age and sex, both groups from the city of Santos, Sao Paulo, Brazil. Seroprevalences found were 62% for HIV, 75% for HCV, 75% for HBV, 34% for syphilis and 25% for HTLV (1 or 2) among IDUs, which compare with 0.0%, 2%, 23%, 12%, and 1% for blood donors, respectively. The risk for parenterally transmitted infections in this IDUs community is higher than that for sexually transmitted one. We also estimated the Basic Reproduction Ratio, R0, for HIV among IDUs. Using a model adapted from the classical Macdonald\'s model for vector-born infection, the R0 resulted in 28 and 98, assuming an homogeneous or heterogeneous distribution of infective inoculae, respectively. This estimation was based only on parenteral transmission. Using this model the expected equilibrium for HIV seroprevalence (0.67) is close to the observed seroprevalence (0.62)

Com a finalidade de estudar a soroprevalência do Vírus da Imunodeficiência Humana, HIV, e infecções com transmissão relacionadas, entrevistamos e colhemos sangue de 197 usuários de drogas injetáveis, UDIs, amostrados através da metodologia de \"bola de neve\" (snow-balling), da cidade de Santos, São Paulo, Brasil. Nesta cidade a estimativa de UDIs, 10.000 indivíduos, compreende cerca de 2% de sua população. Soroprevalências de HIV, hepatites B e C, sífilis e HTLV (1 ou 2) foram obtidas e comparadas com 197 doadores de sangue pareados por idade e sexo. As soroprevalências encontradas foram de 62% para HIV, 75% para HCV, 75% para HBV, 34% para sífilis, e 25% para o HTLV (1 e 2) entre os UDIs, comparado com 0%; 2%; 23%; 12% e 1% entre os doadores do banco de sangue, respectivamente. Os fatores de risco para transmissões parenterais nesta comunidade de UDIs são mais importantes que para transmissão sexual, embora a última deva ser considerada quando se planejar estratégias de controle. Além disso, estimamos a Razão de Reprodutibilidade Basal, R0, para o HIV entre os UDIs. Usando um modelo clássico para infecções transmitidas por vetores de Macdonald adaptado para \"agulhas\", o valor de R0 foi estimado em 28 e 98, considerando uma distribuição dos inóculos infectantes como homogênea ou heterogênea respectivamente . Esta estimativa foi baseada somente em parâmetros de transmissão parenteral nesta comunidade de UDIs. Usando este modelo a estimativa da soroprevalência do HIV no equilíbrio (0,67) é bem próxima à soroprevalência observada (0,62). / In order to study the seroprevalence of HIV and infections with related transmission patterns, as hepatitis B and C, syphilis and HTLV (1 and 2), we interviewed and bled 197 IDUs, sampled by snow-balling and compared with 197 blood donors matched for age and sex, both groups from the city of Santos, Sao Paulo, Brazil. Seroprevalences found were 62% for HIV, 75% for HCV, 75% for HBV, 34% for syphilis and 25% for HTLV (1 or 2) among IDUs, which compare with 0.0%, 2%, 23%, 12%, and 1% for blood donors, respectively. The risk for parenterally transmitted infections in this IDUs community is higher than that for sexually transmitted one. We also estimated the Basic Reproduction Ratio, R0, for HIV among IDUs. Using a model adapted from the classical Macdonald\'s model for vector-born infection, the R0 resulted in 28 and 98, assuming an homogeneous or heterogeneous distribution of infective inoculae, respectively. This estimation was based only on parenteral transmission. Using this model the expected equilibrium for HIV seroprevalence (0.67) is close to the observed seroprevalence (0.62)