Background: South Africa has a high Maternal Mortality Ratio (MMR) and is not on track to meet Millennium Development Goal (MDG) 5, target 5A (to reduce by three quarters between 1990 and 2015 the MMR). Along with gathering crucial information about maternal deaths, it is also important to understand the experiences and opinions of those who have almost died during their pregnancy or delivery - termed near-misses in maternal health services - to recommend relevant interventions aimed at bringing down South Africa's MMR. Aim: The overall aim of the study was to explore patient experiences and perspectives of maternal near-misses and their opinions of how these could have been prevented. Methods: Using a case study design, where the case was women who had experienced severe acute maternal morbidity (a near-miss event), in-depth interviews were conducted with nearmisses until a point of saturation was reached after the ninth woman. Each woman was interviewed twice on two separate occasions between 1st April and 30th September 2009 about their experiences and opinions of the near-miss event, and access to reproductive health services and the health system more broadly. Their social and economic circumstances were also explored.MAXqda was used for data management and a thematic analysis was carried out on the interview data. Results: Bureaucracy in accessing reproductive health services, lengthy referral processes, lack of transport and resources in clinics were seen as major health system barriers that contributed in women being near-misses. Inadequate knowledge about reproductive health and warning signs of serious morbidity; although seen as patient factors, were also be attributed to health system factors. The desire to or not to fall pregnant was not the only factor that influenced contraceptive use. Power relations between women and their partners affected most women who were in lower positions of power. Cessation of menstruation as a side effect of contraception resulted in failure to recognize absence of menstruation during pregnancy. Lack of service integration affected women irrespective of their demographic characteristics. Patients are at risk of abuse in health facilities although this is not the norm. Little attention was given to postnatal care of women. Conclusion: Health systems' issue which according to the AAAQ framework were not satisfactory contributed in women being near-misses. Women's limited knowledge on reproductive health issues which might be as a result of inadequate information offered at the clinic affected use of reproductive health services. Educating women and their families about obstetric emergencies may result in early recognition of warning signs of obstetric emergencies and prevention of near-misses.

This investigation aimed to determine factors that influence women's utilisation of maternal health services, with specific focus on the quality of care and services available to disadvantaged communities in South Africa. It used the women's perspectives to assess the quality of maternal healthcare services in peri-urban commercial farming and rural areas with the purpose of understanding why women utilise maternal services the way they do.

This investigation aimed to determine factors that influence women's utilisation of maternal health services, with specific focus on the quality of care and services available to disadvantaged communities in South Africa. It used the women's perspectives to assess the quality of maternal healthcare services in peri-urban commercial farming and rural areas with the purpose of understanding why women utilise maternal services the way they do.

The issue of adolescent health has steadily grown momentum with people realizing the vulnerability ofthis sector ofthe world's population. Within the South African context, the tide had also turned. However, most initiatives aimed at the prevention of problems, one of which was adolescent pregnancy. Extant literature revealed that despite efforts to reduce adolescent pregnancy, adolescent fertility rate in SubSaharan Africa remained on the rise. As such, the need for appropriate maternity services for this group became a concern, as extant literature also revealed the costly long term effects to pregnant and parenting adolescents, as well as society as a whole. Within KwaZulu-Natal pregnant and parenting adolescents use the same maternity services as their adult counterparts. It was not clear if these services were appropriate to the needs of these clients. As such, a Glaser Grounded Theory approach was used to explore the maternity services from the points of view of the various stakeholder groups. Data was collected, using theoretical sampling, by means of semi-structured interviews and focus group interviews. Constructs of adolescent-friendly maternity care were identified from the findings. The components of the constructs included aspects of (1) Structures and Resources, (2) Attitudes to AMCs, and (3) Services. The resources or structures that either need to exist and/or be improved included policies, the quality and quantity of HCps, formalized support for AMCs, a sensitized administration, community involvement and the educational preparation of HCps. The attitudes that service providers were expected to demonstrate in their interaction with AMCs included those of equality, empathy and respect. They were also expected to show understanding towards AMCs and provide them with reassurance and support. The third component identified specific services to be provided to AMCs during the antenatal, labour and delivery, and postnatal period. These constructs can be used by health care planners and providers to strengthen and improve service provision to and utilization by pregnant and parenting adolescents and form the foundation on which a theory of adolescent-friendly maternity care can be based. Recommendations were made with regards to future service and research endeavours. / Thesis (Ph.D.)-University of KwaZulu-Natal, 2005.

The general health status of pregnant women depends largely on the quality of the antenatal services available to them. The provision of good antenatal services ensures early detection and prompt management of any complication or disease that may adversely affect pregnancy outcome. In order to ensure high quality care, antenatal services need to be evaluated at regular intervals, both from provider and client perspective, to ensure their effectiveness in improving the health status of pregnant women. The midwife, as the first contact person for most pregnant women attending antenatal clinics in South Africa, has the potential to play a major role in improving the health status of these women. However, for the midwife to be effective in achieving this, antenatal services need to be effectively utilized by women. One of the factors that affect utilization of any service is client satisfaction with the service being rendered. This study, therefore, explores the perceptions that pregnant women have of the care that they receive from midwives at the selected antenatal clinics. The objectives of the study are to: {u100083} Explore and describe the perceptions and experiences of pregnant women attending antenatal clinic regarding the care they receive from midwives. {u100083} Make recommendations to assist registered midwives in optimizing the accompaniment of women during the antenatal period. A qualitative, descriptive, exploratory and contextual design was used for the study. The sample was chosen from the target population by means of purposive sampling and data was collected through unstructured interviews with the participants. Before data collection, permission was obtained from the Eastern Cape Department of Health and the Nursing Service Manager of the Gateway clinic, in the district hospital where the research was conducted. The Nursing Service Manager was acting as a Medical Superintendent at the time of the study. Written, informed consent was obtained from all participants before conducting interviews. Trustworthiness was ensured by means of Guba’s model throughout the study, and the aspects of truth value, applicability, consistency and neutrality were considered. Tesch’s eight steps of data analysis were used to analyze the data collected, and four main themes were identified namely: • Women perceive midwives as considerate and knowledgeable • Women perceive midwives as lazy and rude • Women experience mixed emotions about the care they receive from midwives • Though their experiences, women identified certain needs in the services and care they received at the clinic. Conclusions were drawn and recommendations for midwifery practice made based on the results of the study, with the aim of improving antenatal services rendered to pregnant women.

Thesis (M. A. (Nursing Science)) -- University of Limpopo, 2016. / Perinatal morbidity is a public health indicator of the level of equality in a country. Its prevention has major medical, social and economic costs. The aim of this study was to describe factors contributing to high perinatal morbidity rates in Mankweng-Polokwane Complex of the Capricorn district, Limpopo Province, South Africa. A quantitative, descriptive cross-sectional research method was used to describe factors contributing to high perinatal morbidity. The study population comprised 80 registered midwives. Simple random sampling was used to select the 66 respondents. Data were collected using a self-developed questionnaire. Questionnaires were completed and returned, and only one questionnaire was not returned, and two were spoiled as they were incomplete, then 63 questionnaires were analysed. Ethical clearance was obtained from Medunsa Research and Ethics Committee, Limpopo Province Department of Health Ethics Committee and Hospital management. The Statistical Package for Social Sciences (SPSS, version 22) was used for data analysis. Descriptive statistics were used to analyse and describe and summarise data whereby the findings were presented in the form of distribution tables and graphs. Inferential statistics were used based on probability and allowed judgement to be made about the variables. The study revealed that shortage of staff, absenteeism, resignation, bad staff-patient ratio and overcrowding of patients, long waiting periods for caesarean sections, long waiting period for babies operation, work overload of staff, lack of equipment and supplies, congenital anomalies, perinatal asphyxia, prematurity and neonatal sepsis were contributory factors to high perinatal morbidity rates. The study recommended that all staff should be able to resuscitate newborn babies, be able to use Partograph effectively, further research on factors contributing to high perinatal morbidity and education training on speciality qualifications. Key-words: Factors, High, Perinatal, Morbidity rates

The purpose of this study was to describe and evaluate the strategies used to reduce maternal mortality of the Fezile Dabi District in the Free State Province, South Africa. A quantitative descriptive study was conducted at three hospitals to describe and evaluate the strategies. Data collection was done by using the Maternal and Neonatal Programme Effort Index (MNPI) self-administered questionnaire. The study population comprised of 71 (midwives (52), doctors (13), management-operational managers (6). The overall response rate for the three hospitals was (43.5%). The study indicated that programme efforts for maternal health are similar across the three hospitals, however, there are particular areas in each hospital that need more attention. The ratings of all the strategies generally showed weak to partial effort. The findings revealed general poor performance under the following strategies: postpartum care, training arrangements, information, education, communication and hospital protocols. Based on the study results, the quality of maternal health care need to be improved / Health Studies / M.A. (Public Health)

Submitted in fulfilment of the requirements of the Degree of Master of Technology: Biomedical Technology, Durban University of Technology, 2013. / The purpose of the study was to evaluate knowledge and effects of Haemolytic Disease of the Newborn (HDN) in postnatal women from the Umgungundlovu District. Although the prevalence of HDN has declined because of prophylaxis from 45 cases per 10,000 births to 10.2 cases per 10,000 births but it is still a cause of infant and neonatal morbidity and mortality. The effects of the disease range from jaundice, kernicterus and in severe cases death. Methodology : An interviewer-administered questionnaire was used to obtain information about the knowledge and effects of HDN amongst postnatal women. The incidence rate was calculated using the number of cases that were found divided by the total number of deliveries during the study period. A total of 300 women were interviewed. SPSS version 19.0 was used to analyse data. Findings : Fifteen (15) of the 300 women had babies with confirmed HDN and only four of the 15 (26%) women had knowledge of HDN. Two hundred and eighty five women had babies with jaundice but were not affected by HDN and, of these women, 12 (4.2%) of them knew what HDN was. Overall, only 16 (5.3%) knew what HDN was. All 15 women who had babies with HDN indicated financial and emotional effects because of HDN. The total incidence was 0.09% for the first 12 months of the study period. Conclusion : Postnatal women with jaundiced babies lack knowledge of HDN and HDN has financial and emotional effects on these women. Although the incidence rate of HDN was found to be even smaller than previously reported, it still exists and threatens the lives of infants and neonates.

Submitted in fulfillment of the requirements for the Degree of Master of Technology in Nursing, Durban University of Technology, 2014. / Brief background to the study The national guidelines for maternity care in South Africa recommend that a standardised maternity case record be used by all facilities at all levels of care in order to improve the quality of care for pregnant women. According to the National Department of Health, this will facilitate continuity and quality of care for women during pregnancy, labour and post-partum. Aim of the study The aim of the study was to assess whether the implementation of the new maternity case record has improved the quality of care for pregnant women. Methodology An exploratory, descriptive study using both quantitative and qualitative design was used to conduct the study. Data was collected through a retrospective record review using a checklist for the quantitative strand, and from midwives using unstructured interviews for the qualitative strand. The quantitative data set was analysed using the Statistical Package for the Social Sciences version 21.0 and the qualitative strand was analysed using the Tesch’s method of data analysis. Results The results of the record review revealed that although the recording was done fairly well, there were a number of activities and interventions that were recorded poorly or not recorded at all in some primary health care clinic. The midwives verbalised that many mistakes and mismanagement of ante-natal care clients emanated from the structure and the design of the new maternity case record. Recommendations Recommendations include the following: communication of policies and protocols to the midwives should be done timeously, provision of in-service education and/or updates on new developments, strengthening of supportive supervision, the Nursing colleges be kept up-to-date with new developments in nursing practice and that a broader study involving other districts and provinces be conducted.

Submitted in fulfillment of the requirements for the degree of Master of Technology: Environmental Health, Durban University of Technology, Durban, South Africa, 2016. / South Africa, like many other developed countries, is challenged by the under attendance and delay in initiation of antenatal care (ANC) services among pregnant adolescents. Adolescents are more vulnerable to pregnancy related complications, which may contribute to maternal and child mortality and morbidity. This study aimed at evaluating the under attendance and/or delay in initiation of ANC services among young pregnant adolescents (13-16 years old) as a risk for adverse maternal and birth outcomes. The research was based at a district hospital on the North Coast of Kwazulu-Natal. A retrospective review of all young adolescent (13-16 years old) maternity case records for the period from 2011-2013 was conducted. Data collected included ANC trends in attendance, obstetric and perinatal outcomes. A total of 314 pregnancies were recorded among young adolescents at this single hospital over a period of 3 years. Adolescent pregnancy was associated with a risk of late ANC booking and reduced ANC visits. The prevalence of anaemia (32%) was relatively high among the girls. Fifty percent of all adolescents received episiotomies while, 45(14%) experienced perineal tears. Logistic regression models found that the condition of perineum was significantly associated with HIV status (OR= 0.36; 95% CI=0.16; 0.84; p<0.05). HIV positive mothers were more likely to have an intact perineum post-delivery. However, HIV positive adolescents were twice as likely to be diagnosed with anaemia compared HIV negative mothers (results not significant). Underutilisation of ANC (i.e less than 4 visits) was significantly associated with lower gestational age (< 37 weeks) (OR=2.64; 95% CI=1.04; 6.74; p<0.05). Fifteen percent of young mothers delivered early (< 37 weeks), 10% delivered babies with a low birth weight (< 2500g) and 15% of the neonates suffered fetal distress. Low birth weight, low Apgar scores as well as the incidence of maternal anaemia and Pregnancy Induced Hypertension (PIH) were found to be related to late ANC booking. Qualitative findings highlighted the perceived barriers of ANC by pregnant adolescents. Interviews identified the following as factors that hindered access of care; financial barriers, attitudes of Health Care Workers (HCW), system barriers and fear of HIV testing. Urgent population based strategies are required to encourage timeous initiation of ANC among adolescents. Strengthening of health education programs on the benefits of ANC attendance among adolescents can be utilized as part of an approach to address the current public health concern. / M