PhD (Health Sciences) / Department of Advanced Nursing Science / Preterm birth is an unresolved health issue; globally it is the largest contributor to mortality among children under 5 years of age. Worldwide, approximately 9.6% of all births are preterm which the World Health Organization (WHO) recognizes as one of the top ten causes of neonatal deaths. The alarming rates of preterm births and deaths may be directly linked to the shortage of resources and an inadequate database of midwifery care guidelines for midwives in South Africa resulting in poor maternal care in public health. This study sought to develop midwifery practice guidelines to promote quality care of preterm babies in resource-limited obstetric units of the Limpopo Province of South Africa. The convergent parallel mixed method was used, explorative, descriptive and contextual qualitative design were run concurrently with the descriptive quantitative approach. For the qualitative design, non-probability purposive sampling was used to select midwives and managers from Limpopo Province. In-depth one-to-one interviews were conducted with 11 midwives and 4 managers. Tesch’s eight steps of open-coding was used to analyze qualitative data. Trustworthiness was ensured through credibility, confirmability, dependability and transferability. For the quantitative approach, 31 midwives and 24 managers completed the Likert scale questionnaire. The non-probability method was employed to select midwives and managers to make up a sample size of 55 participants. Reliability and validity of the instrument was ensured through extensive literature review and a pilot study. Data were analyzed with the IBM Statistical Package for the Social Sciences (SPSS) version 23.0. Both quantitative and qualitative data analysis yielded three themes as follows: the role of midwives in reduction of preterm births and deaths in obstetric units; challenges faced by midwives whilst executing their role during preconception, antenatal, labour and v puerperium period; support needed by midwives during provision of maternal and neonatal care to reduce preterm births and deaths. In the discussion of the findings, qualitative findings were supported by quantitative findings. The WHO model (PICOS & GRADES) was adapted in the development of the guidelines. The group then validated the guidelines using a closed-ended checklist to verify whether the guidelines were congruent with practice. The results were analyzed through simple descriptive statistics where the data were summarized using frequency / NRF

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

PhDH / Department of Advanced Nursing Science / Background: The National Committee for the Confidential Enquiries into Maternal Deaths recommend the implementation of “Saving Mothers’ recommendations” as a measure to reduce maternal deaths. However, this objective has not been achieved because the Maternal Mortality Rate in South Africa was standing at 134.33/100 000 live births and Limpopo Province at 165.16/100 000 live births. The national target for reduction of maternal mortality was 20% for all provinces for 2016. Limpopo Province’s reduction was below 12.5% for 2016. Purpose: The purpose of the study was to develop a strategy to enhance the implementation of the Saving Mothers’ recommendations in the maternity units of Limpopo Province. Methods: The convergent parallel design was used in this study. The study was conducted in phases, namely: Phase 1(a) was a qualitative research approach and a non-experimental, descriptive and exploratory design. The population consisted of district managers who were managing the Maternal Health Services and registered midwives who were working in the maternity units of Limpopo Province. Non-probability purposive sampling was used for both the district managers and the registered midwives. Data were collected using a central question for the managers managing Maternal Health services which was “What support are you giving to facilitate the implementation of the recommendations by the Saving Mothers Report?” and the question for the registered midwives was “What challenges are you experiencing when implementing the Saving Mothers’ recommendations.” Tesch’s open-coding technique was used to analyse qualitative data. Trustworthiness was ensured through credibility, confirmability, dependability, transferability and authenticity. Phase 1(b) was a quantitative and a non-experimental descriptive design. The population comprised of 200 patients who were included in the study. Questionnaires were developed and used to collect ABSTRACT vi data. Data was analysed using the Statistical Package for Social Sciences (SPSS, version 24.0) with the assistance of the statistician. Discussion of data were done in an explanatory sequential way where data from Phase 1a was discussed and supported by data from Phase 1b. Findings: The themes that emerged were: Challenges related to implementation of the recommendations of the Saving Mothers Report in maternity units, Description of existing training programmes and in-service education for health care professionals, Knowledge on implementing recommendations for the Saving Mothers Report when providing care in maternity units and Suggestions related to improvement of adherence to recommendations for the Saving Mothers Report in maternity units. Some of the themes were supported by the quantitative results whilst some not supported. Validity and reliability were ensured by giving the questionnaires to experts on the subject, colleagues and promoters to analyse and determine if items adequately represent content in the correct proportion. Ethical considerations were ensured by obtaining ethical approval from the University of Venda Ethics Committee and permission to access the facilities from the Limpopo Province Department of Health. The participants signed informed written consent. Phase 2 entailed strategy development and validation of the developed strategy. Recommendations: The recommendations included that the Department of Health should employ more staff and put operational managers in permanent positions. Sufficient equipment and supplies essential for maternal health care and maternal health infrastructure should be procured and a good plan for the managing thereof implemented. It is also recommended that health care workers should work hand in hand with the community structures and the ‘mosate’. / NRF

Recent experimental approaches attribute value to events occurring during intrauterine life as crucial in the onset of several diseases during postnatal life. Thyroid hormones (TH) are critical to the physiology of metabolism and body development. The aim of this study was to investigate the repercussions of lack of TH during pregnancy on body mass gain, metabolic profile, ingestive behavior of food, sodium (0.3M NaCl) and water in rat offspring at different postnatal ages. The experimental gestational hypothyroidism (EGH) was induced by the administration of 0.02% methimazole (MMI) in ad libitum drinking water from day 9 of gestation until delivery. Offspring (males and females) from MMI-treated dams (OMTD) were compared to their corresponding control offspring (i.e. male and female offspring from water-treated dams; OWTD). Insulin tolerance test (ITT) and glucose tolerance test (GTT) were also performed. Two- or three-way ANOVA followed by Bonferroni post-test were performed when necessary. OMTD showed lower body weight on PND 23 and 30 (p<0.0001). Similar profile was observed when the offspring were separated by gender, at least during the experimental period (PND 60, 90 and 120; p<0.0001 for both genders). However, there was no difference in the amount of food intake when males of OMTD (m-OMTD) were compared to OWTD (m-OWTD). Female of OMTD (f-OMTD) had lower ability to reduce glucose plasma level at ITT (p = 0.0224), otherwise, no change in GTT (p = 0.1313) was observed. At PND 60, glucose plasma level was higher in f-OMTD than in f-OWTD (p = 0.013). In m-OMTD, plasma cholesterol was higher in PND 60 and lower on PND 120 (p <0.0001), when compared to m-OWTD. In f-OMTD, cholesterol was lower only at PND 120 (p = 0.035). The high density lipoprotein (HDL) cholesterol was lower in OMTD on PND 15 and 30 (p = 0.04) and remained lower only in f-OMTD on PND 120 (p = 0.024). Moreover, EGH induced an increased in plasma triglycerides (TGL), as well as, in serum level of very low density lipoprotein (VLDL) cholesterol in offspring at DPN 15 (p = 0.039) and also after puberty (at DPN 60), but only the m-OMTD (p < 0.0001). The serum urea was lower in OMTD on PND 15 and 30. Interestingly, serum urea was inverted at DPN 60 in both, m- and f-OMTD (p = 0.006, and p = 0.003, respectively), when compared to their respective control groups. At PND 120, retroperitoneal fat weight was lower both in m- (p = 0.05) and f-OMTD (p = 0.009). Additionally, at all studied ages, relative kidney and liver mass was lower in m- (p = 0.001) and f-OMTD (p = 0.008). In conclusion, we demonstrated, for the first time, that maternal TH are critical to the ontogenetic development of systems that regulate energy metabolism throughout the life of the offspring, resulting in a reduction in body mass, biochemical instability throughout the life, lower sensitivity to insulin in females, and, a delay in the development of critical organs for the metabolism of macronutrients. / Recentes abordagens experimentais têm imputado valor aos eventos ocorridos durante a vida intrauterina como cruciais no aparecimento de doenças na vida pós-natal. Os hormônios tireoidianos (HTs) são críticos para fisiologia do metabolismo e desenvolvimento corporal. O objetivo do presente estudo foi investigar as repercussões da carência dos HTs em ratas prenhes na evolução ponderal da massa corporal, perfil bioquímico, comportamento ingestivo de ração, água e sódio (NaCl 0,3M) da prole em diferentes idades pós-natais. O hipotireoidismo gestacional experimental (HGE) foi induzido através da adicão de metimazol 0,02% na água de beber a partir do dia 9 de gestação até o parto. O grupo de prole (machos e fêmeas) de mães hipotireoideanas (PMH) foi comparado ao grupo controle de mães eutireoideanas (PME). Realizou-se o teste de tolerância à insulina (TTI) e o teste de tolerância à glicose (TTG). Os dados foram submetidos ao teste de ANOVA de duas ou três vias, quando necessário, seguidos do pós-teste de Bonferroni. De acordo com os resultados obtidos, observou-se que a PMH apresentou massa corporal menor aos 23 e 30 dias pós-natal (DPN) (p<0,0001). Padrão similar foi encontrado quando as proles foram separadas por gênero, aos 60, 90 e 120 DPN (p<0,0001, para ambos os gêneros). No entanto, não houve diferença significativa na ingestão de ração entre os machos PMH e PME. As fêmeas da prole de mães hipotireoideanas (f-PMH) apresentaram menor capacidade de reduzir a glicemia no TTI (p=0,0224) sem alteração no TTG. Aos 60 DPN, a concentração sérica de glicose foi maior nas f-PMH (p = 0,013) que nas f-PME. Nos machos prole de mães hipotireoideanas (m-PMH) o colesterol plasmático foi elevado aos 60 DPN e reduziu aos 120 DPN (p<0,0001), quando comparado aos machos prole de mães eutireoideanas (m-PME). Nas f-PMH o colesterol sérico foi menor somente aos 120 DPN (p=0,035). O HDL sérico foi menor na PMH aos 15 e 30 DPN (p=0,04), e continuou menor nas f-PMH aos 60, 90 e 120 DPN (p=0,024). Entretanto, o HGE elevou as concentrações séricas de TGL, bem como de VLDL, na PMH aos 15 DPN, e após a puberdade (aos 60 DPN), somente nos m-PMH (p<0,0001). A concentração sérica de ureia foi menor na PMH aos 15 e 30 DPN. Interessantemente, a ureia sérica foi invertida aos 60 DPN, se apresentando elevada tanto em m- (p=0,006) como em f-PMH (p=0,003), quando comparados aos respectivos grupos controle. Aos 120 DPN, a massa da gordura retroperitoneal foi menor tanto em m- (p=0,05) como em f-PMH (p=0,009). Adicionalmente, em todas idades estudadas, as massas relativas dos rins e do fígado foram menores tanto em m- (p=0,001) como em f- da PMH (p=0,008). Em conclusão, demonstrou-se, pela primeira vez, que os HTs maternos são críticos para o desenvolvimento ontogênico de sistemas que regulam o metabolismo de energia ao longo da vida da prole, resultando numa redução da massa corporal, instabilidade bioquímica ao longo da vida, menor sensibilidade à insulina em fêmeas, e um atraso no desenvolvimento de órgãos críticos para o metabolismo de macronutrientes.