Thesis (M.S.)--Virginia Polytechnic Institute and State University, 1990. / Vita. Abstract. Includes bibliographical references (leaves 28-31. cm). Also available via the Internet.

Thesis (Ph. D.)--University of Texas at Austin, 2005. / Supervisor: Deborah Jacobvitz. Vita. Includes bibliographical references.

Thesis (D. Min.)--Reformed Theological Seminary, Charlotte, NC, 2007. / Description based on Print version record. Includes bibliographical references.

Thesis (M.A.)--University of Hong Kong, 1997. / Includes bibliographical references (leaf 36-37).

Thesis (M.A.)--University of Hong Kong, 1997. / Includes bibliographical references (leaf 36-37). Also available in print.

No description available.

Neonatal pain management has received increasing attention over the past four decades, along with the technological advances made in neonatal care which have increased the survival of neonatal patients. Empirical evidence confirms and acknowledges that the life-saving or life supporting procedures neonates are subjected to, during their admission into neonatal intensive care or high care facilities, are often painful. Research into the effects of neonatal pain emphasises the professional, ethical and moral, obligations by neonatal staff to manage neonatal pain effectively, in order to obtain positive patient outcomes both in the short and long term. This study used a non-experimental, prospective quantitative survey to investigate the knowledge, attitudes and beliefs of nurses and doctors concerning neonatal pain and its management. To answer the research question posed fully a third objective was included to explore current practice on this topic. The entire population (N=150) of neonatal staff working in neonatal wards of two tertiary hospitals in Gauteng, were invited to participate in the study. The data was collected using self administration of the Infant Pain Questionnaire. The response rate of this study was 35.33% (n=53).Data was analysed using “STATA” 12. Descriptive findings showed that, the majority of the respondents were female, from the professional nurse category, working in neonatal intensive care units with between 0 – 5 years experience in neonatal care. A significant finding was the unavailability of a pain management guideline in the neonatal units as reported on by 64% of the respondents. Despite this pain neonatal pain is recognised and treated. The main concern raised by this is the accuracy of assessment and adequacy of pain management interventions. The neonatal staff acknowledges and empathise with neonates’ pain experience. Results from comparative analysis using a Fischer’s exact test, showed a statistically significant (p<0.05) association between procedural pain ratings and the beliefs held by the participants about the increased frequency of pharmacological intervention implementation on five clinical procedures. This positive attitude towards neonatal pain management is important in ensuring consistent and adequate implementation of guidelines, hence adequate treatment of neonatal pain. A review of the pain management interventions used in the study setting showed preference for pharmacological pain management interventions for moderate to severe pain. This requires collaboration between the nurse and doctor. This finding was found to be consistent with international pain management standards. The nurses in the study also reported inadequate implementation of non-pharmacological interventions. This method of intervention use can be enhanced with empirical evidence. The small sample size and composition of respondents are noteworthy limitations, along with the exclusion of record review as part of this study. The main recommendation is to increase research neonatal pain management utilising existing structures in the practice, education and international resources.

Therapeutic intervention should take humans‟ daily routines into account or it is unlikely to be assimilated into everyday practice. This is particularly true for the mothers of young children. The purpose of this study was to examine the effect of a prone postural control programme, by inserting infant stimulation activities in to the activities of daily living of mothers. 30 mother-infant dyads were randomly assigned at eight weeks postpartum, to an intervention or usual care group. Following a four month period in which the intervention group followed a prone activity programme developed by the researcher, the infants were reassessed. The Peabody Developmental Motor Scales (2nd Ed) were used to evaluate the programme‟s efficacy and the results demonstrate a significant difference (p≤0.00) in the total motor development between the two groups post intervention. Thus a „prone playing‟ programme given to mitigate developmental delay associated with supine sleeping, was successful when embedded into the mother‟s daily routine.

Introduction: KwaZulu-Natal is one of the provinces most affected by HIV/AIDS in South Africa. The estimated HIV prevalence among pregnant women attending ante-natal clinic at LUDWMH in Empangeni is high (40%). Infant feeding practices by these mothers are critical to reducing MTCT of HIV. The objectives of the study are: to describe the ante-natal infant feeding choices of a group of HIV-positive women attending the PMTCT clinic at LUDWMH; to determine the infant feeding practices of these women during the six weeks post-natal period; to determine the correlation between these mothers‟ infant feeding choices and their actual infant feeding practices six weeks after childbirth; to describe these women‟s socio-environmental conditions; and to determine the compliance of their infant feeding practices to safe infant feeding guidelines. Materials and methods: A descriptive cross-sectional study design was used. The mothers were from the predominantly poor-rural communities in Area 3 of northern KwaZulu-Natal. Data were obtained by the use of structured questionnaires which were directly administered to 395 mothers attending the PMTCT clinic six weeks after childbirth. Their ante-natal clinic records were also reviewed. Data entry was done with Microsoft Access. The data were analysed using Epi Info and Microsoft Excel. Results: The commonest ante-natal infant feeding choice was exclusive breastfeeding (78.2%) which was more than the combined number of women who chose replacement feeding (19.2%) and mixed feeding (2.5%). Majority of the mothers practiced their infant feeding choices in the six weeks post-natal period (p-value = 0.000). Expectedly, access to regular maternal income was low (36.7%; 95% CI 32.0 – 41.7). However, access to the other three individual socio-environmental resources was high [safe water (66.8%; CI 61.9 – 71.4); fuel (83%; CI 79.0 – 86.6); fridge/freezer (82.5%; CI 78.4 – 86.1)]. Approximately 61% of women had access to all three of these resources (cumulatively). Discussion and conclusions The study demonstrated that exclusive breastfeeding is the predominant infant feeding choice and practice amongst women attending LUDWMH, Empangeni in KwaZulu-Natal province. The high uptake of exclusive breastfeeding (77.7%) in the six weeks post-natal period is encouraging given the heavy burden of diarrhoeal diseases and protein-energy malnutrition with associated high mortality rates in this setting. Another encouraging finding that may help to improve prevention of MTCT of HIV was that mixed feeding was uncommon in these women. The finding that almost two-thirds of mothers who practiced replacement feeding complied with WHO/National guidelines for safe replacement feeding in this largely poor-rural setting is commendable.

BACKGROUND: Globally, perinatal mortality accounts for a large proportion of child deaths. Perinatal mortality rate (PNMR) is taken as an index of efficient obstetric care, and also serves as an indicator for the Millennium Development Goals (MDGs) 4 and 5, that is related to infant mortality rate and improving maternal health (Day, Monticelli, Barron, et al., 2010). In developed countries, perinatal mortality rate has shown a marked decrease over the past few years. This is mostly due to the changing patterns in reproductive health, improved socio-economic factors and quality of maternal and child care (World Health Organization, 2006). However, developing countries are still struggling to curb perinatal deaths. In South Africa, there has been a gradual decline in the PNMR in public health facilities from 38.6 in 2003/2004 to 31.0 per 1000 live births in 2008/2009. However, there has been a slight increase to 32.8 per 1000 live births in 2010/2011 (Day, Barron, Massyn, et al., 2012). In the Mpumalanga province, the PNMR has decreased slightly from 34.9 per 1000 live births in 2008/2009 to 33.2 per 1000 live births in 2010/2011. Carolina Hospital itself has a PNMR which is far too high at 43 per 1000 live births from January to June in 2008/2009. It is assumed that because the sub-district is underserved with primary health care facilities as well as having a poor attendance of antenatal care services by pregnant women, this has subsequently had a negative effect on perinatal care. However, this has never been formally assessed. AIM: The aim of the study was to describe the perinatal mortality and morbidity, and to identify the causes and avoidable factors of perinatal mortality and morbidity at Carolina Hospital for the period 1st April 2009 to 31st March 2011. METHODOLOGY: The setting for the study was the maternity unit of Carolina Hospital, a district hospital in the Gert Sibande district, Mpumalanga. It comprised of a retrospective record review of data from the maternity registers and the Perinatal Problem Identification Programme (PPIP); from the 1st April 2009 to the 31st March 2011. All the records of perinatal deaths (N=94) and admissions (N=35) of babies 7 days old and younger during the study period were included in the study and no sampling was done for these two groups of patients. For all other delivery records, systematic sampling was utilized by choosing every tenth record listed on the sampling frame. Data was extracted from the PPIP and maternity registers using data extraction sheets. Data was captured onto a Microsoft excel based spreadsheet, imported into and analyzed with EPI-Info software version 3.5.1 using descriptive and analytic statistics. Data was collected the number of perinatal deaths, admissions, total number of deliveries, neonatal and maternal profile, causes of perinatal mortality and morbidity and factors associated with perinatal mortality and morbidity RESULTS: During the period of the study there was a total of 1 604 deliveries with 94 perinatal deaths and 35 perinatal admissions. The perinatal mortality rate was 61.4 per 1000 live births with a stillbirth rate of 47 per live births; and an early neonatal death rate of 14.4 per 1000 live birth. Nine percent of the mothers were unbooked, and this accounted for 11.4% of perinatal morbidity and 17% of the mortality which occurred during the study period. Over a third (34%) of the perinates who died were born from HIV positive mothers; whilst more than halve (54.3%) of those perinates who were admitted during the perinatal period were born from HIV positive mothers. Over two thirds (63.2%) of the perinatal deaths were below 2500g while half (45.7%) of admissions were below this birth weight. Intrauterine death (40.4%) was the leading cause of perinatal mortality at Carolina Hospital for the two years of study. Over the two year study period, patient related factors were the highest avoidable factors given, accounting to 72.9% of the total while health care related avoidable factors accounted to 39.5% of the perinatal mortalities and morbidities. CONCLUSION: The study found that there was a high PNMR and high still birth rate at Carolina Hospital. The majority of the avoidable factors were patient related. The reasons for this included late booking, delay in seeking medical attention during labour, never initiating antenatal care, infrequent visits to the clinic, and inappropriate response to poor fetal movement. In order to achieve the Millennium Development Goal 4 more attention should be given to reducing perinatal deaths. These indicate a need to strengthen the quality of ANC rendered, especially in the primary health care facilities. RECOMMENDATIONS: There is a need to strengthen maternal and child health services in the maternity unit of Carolina Hospital, and in the surrounding clinics within the Albert Luthuli sub-district. Clinical governance should be strengthened within Carolina Hospital. There is also a need for maternal and child health specialist outreach services within the Gert Sibande district health as a whole.