Thesis (doctoral)--Faculté de médecine de Paris, 1917.

Diss.--Freie Universität Berlin. / Bibliography: p. 5-18.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1986. / Typescript. Vita. Includes bibliographical references (leaves 305-328).

Introduction: In 2007, the Ministry of Health in Malawi issued a directive banning traditional birth attendants (TBAs) from delivering mothers and ordered all mothers to access skilled birth attendants in health facilities (MoH, 2007b). Anecdotal reports showed that the influx of pregnant mothers to the health facilities resulted in mothers delivering on make shift beds on the floor and sometimes without the assistance of the skilled provider. The badly stretched health care system continues to force mothers to deliver with the assistance of TBAs who have gone underground for fear of being fined. Purpose of the study: The purpose of this study was to explore stakeholders’ perceptions of the changing role of TBAs in order to obtain a greater breadth of understanding of the reasons why home births persist in the rural areas of Central West Zone (CWZ), Malawi. Methods: The study employed a mixed method concurrent triangulation design in which 24 health facilities in the districts of Ntcheu, Dedza, Lilongwe and Mchinji, in CWZ, Malawi were included. A non-probability purposive sampling method was used to select 24 health facilities that provide Basic Emergency Obstetric and Neonatal Care (BEmONC) services in rural areas of CWZ. A randomly selected sample was used to collect quantitative data from mothers, using an interview schedule. These were mothers (n=144) who had come to access maternal and neonatal health care but had previously sought the help of a TBA to deliver. A total of 55 nurse midwives who worked in the 24 health facilities and who were available and willing to participate responded to a structured interview schedule. Quantitative data were analyzed using SPSS version 19. Qualitative data were collected using focus group discussions (FGDs) with TBAs (n=4 FGDs, with 6-7 respondents in each discussion group) who lived in the catchment areas of the selected BEmONC sites. Single in- depth interviews were conducted with TBA trainers (n=10) in the districts and health professionals (n=12) from the Ministry of Health and Nurses and Midwives Council of Malawi. Data were analyzed manually. Findings: The findings showed that the moratorium on TBAs was implemented without consultation with the relevant stakeholders and as a result, many mothers in rural areas continued to seek the services of TBAs. Untrained TBAs took advantage of the opportunity and together with some trained TBAs who were afraid of punishment went underground to practice. Maternal and neonatal health care in BEmONC facilities were deficient as the health care system struggled with challenges such as the lack of adequate and humane accommodation for waiting mothers, critical shortages of staff, drugs and supplies and negative health care worker attitudes. In addition, long distances and the lack of empowerment of rural women prevented mothers from seeking skilled birth attendants. The study concluded that even though the government had issued a moratorium on TBAs, the health care system is not coping. Recommendations: It is recommended that having moved away from the TBAs, there is no need to revert to using them since that would mean perpetuating harmful and substandard care for mothers. In addition, TBA services would undermine the government’s efforts to improve skilled birth attendance. However, the system needs to urgently deal with the challenges that rural mothers encounter in trying to access skilled birth attendance.

Thesis (Ph. D.)--University of Assiut (Egypt), 1985. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (p. 486-506).

Thesis (Ph. D.)--University of Chicago, The Divinity School, Aug. 2003. / Includes bibliographical references (p. 272-292). Also available on the Internet.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2004.

Thesis (Ph. D.)--University of Assiut (Egypt), 1985. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (p. 486-506).

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Estudar o efeito do OECN e do 1.8 cineol, componentes do CrÃton nepetaefolius, planta do Nordeste usada na medicina popular para distÃrbios do trato gastrintestinal (TGI), sobre o comportamento motor do TGI de ratos Wistar. Para tanto,foram utilizados 121 animais machos, pesando entre 200 a 350g, distribuÃdos nos dois seguintes grupos de estudo: i) esvaziamento gÃstrico (EG), trÃnsito gastrintestinal (GI) de lÃquido e pressÃo arterial (PA) em ratos acordados, ii) complacÃncia gÃstrica, PA, pressÃo venosa central (PVC) e freqÃÃncia cardÃaca (FC) de ratos anestesiados. Foram avaliados, em 106 ratos acordados sob jejum e livre acesso à Ãgua por 24h, o efeito da injeÃÃo (0,2mL; e.v.) de OECN (3  g/Kg) e do 1.8 cineol (1, 3, 10 e 30 Âg/Kg) ou veÃculo (salina 0,9%) sobre o EG e o trÃnsito GI de lÃquido, bem como sobre a PA. Mediante gavagem, 1,5mL da refeiÃÃo-teste (vermelho de fenol - 0,5mg/mL em glicose a 5%) foi injetada no estÃmago. Depois de 10min,foram sacrificados os animais e, apÃs laparotomia, obstruÃmos o piloro, o cÃrdia e o Ãleo terminal. Removeu-se e dividiu-se o TGI em: estÃmago e segmentos consecutivos do intestino delgado (40% iniciais; 30% mediais e 30% terminais). A retenÃÃo fracional de vermelho fenol em cada segmento, medida por espectrofotometria à 560nm, permitiu o cÃlculo do EG e trÃnsito GI. Em um grupo separado de animais, a PA foi monitorada continuamente por meio de um sistema digital de aquisiÃÃo de dados durante 20min antes e 30min apÃs o tratamento com 1.8 cineol ou diluente. Comparado ao grupo controle, observou-se aumento da retenÃÃo gÃstrica (p<0,05) de 43,9Â34% (grupo controle salina) para 54,9Â4,7; 61,3Â3,3; 56,2Â1,7 e 55,8Â2,1% nos animais tratados com 1.8 cineol nas doses de 1, 3, 10 e 30  g/Kg, respectivamente sacrificados 10 min apÃs a gavagem. Observou-se tambÃm diminuiÃÃo significativa do trÃnsito gastrintestinal neste grupo de animais. O 1.8 cineol induziu diminuiÃÃo (p<0,05) da PA em relaÃÃo ao perÃodo basal (de 124Â5,2 para 119Â5,2; 100,2Â4,3; 99,8Â0,5 e 88,6Â2,7mmHg) nas doses de 1, 3, 10 e 30 Âg/Kg. Este efeito foi fugaz para a dose de 1 e 3 Âg/Kg em relaÃÃo ao perÃodo basal. Entretanto, nas doses de 10 e 30 Âg/Kg , os animais nÃo apresentaram recuperaÃÃo da PA. O tratamento com OECN aumentou significativamente a retenÃÃo gÃstrica (53,1Â2,4 vs 43,9Â3,4) enquanto diminui o trÃnsito gastrintestinal quando comparamos aos animais que receberam tratamento com salina. O prÃ-tratamento cirÃrgico por vagotomia subdiafragmÃtica, mas nÃo a esplancnotomia, inibiu os efeitos do 1.8 cineol sobre os EG e trÃnsito gastrintestinal de lÃquidos. Os estudos de complacÃncia gÃstrica foram conduzidos em 15 ratos anestesiados, sob jejum de 24h. As variaÃÃes do volume gÃstrico (VG), foram medidas por pletismografia, enquanto a PA, FC e PVC foram monitoradas continuamente por um sistema digital de aquisiÃÃo de dados. Observou-se diminuiÃÃo do VG, o qual foi significativo aos 30, 40, 50 e 60min apÃs o tratamento com 1.8 cineol (3Âg/Kg) quando comparado ao perÃdo basal (2,0Â0,1; 1,9Â0,1; 1,8Â0,1 e 1,7Â0,1mL, vs 2,1Â0,2mL â p<0,05). A PA apresentou queda significativa apÃs a administraÃÃo de 1.8 cineol (3Âg/Kg), mantendo-se assim durante os 60min de monitoraÃÃo (87,9Â7,7; 87,6Â7,1; 87,9Â6,4; 87,8Â5,7; 86,0Â5,5 e 87,7Â6,0mmHg, respectivamente vs 94,4Â6,2; mmHg), bem como a FC (366,3Â13,4; 361,7Â11,5; 357,3Â10,4; 353,0Â10,4; 348,3Â11,1 e 350,4Â13,7bpm respectivamente vs 395,2Â11,1bpm). Jà a PVC nÃo sofreu variaÃÃes significativas durante o tratamento. Em conclusÃo o OECN e o 1.8 cineol diminuem a motilidade gastrintestinal, retardando o EG e o trÃnsito GI de lÃquido em ratos acordados; diminui a complacÃncia gÃstrica em ratos anestesiados alÃm de apresentar efeitos hipotensor e bradicÃrdico; provavelmente por aÃÃo direta sobre a musculatura lisa gastrintestinal e vascular e modulaÃÃo do sistema nervoso parassimpÃtico / It was studied the effect of EOCN and 1,8 cineol, components of the Croton nepetaefolius - plant of North-East of Brasil, used in the popular medicine for riots of the gastrointestinal sistem - on the motor behavior of the gut of Wistar rats. We used 121 male animals, weighing 200-350g, distributed in the two following groups of study: effect of the OECN and the 1,8 cineol on: i) the gastric empyting (GE), the gastrointestinal (GI) transit of liquid and the arterial pressure (AP) in awake rats and ii) the gastric compliance, the AP, the central venous pressure (CVP) and the cardiac frequency (FC) of anaesthetized rats. It was evaluated, in 106 awake rats under starvation for 24h with free access to water, the effect of injection (0,2mL; i.v.) of OECN (3 Âg/Kg) or 1,8 cineol (1, 3, 10 and 30 Âg/Kg) or vehicle (saline 0.9%) on GE and GI transit of liquid, as well as on AP. A test meal (1,5mL of phenol red - 0,5mg/mL in glucose 5%) was injected in the stomach by gavagem. After 10min,it was sacrificed the animals and obstruct the pyloro, cardia and terminal Ãleo. It was removed and divide the gut in: stomach and consecutive segments of small intestine (40% proximal; medial 30% and 30% distal). After homogenization of these visceral portions, it was determined the absorbance of the samples at 560nm. The fracional dye retention in each segment allowed the calculation of the GE and GI transit. In a separate group of animals, the AP was monitored continuously by digital system of acquisition data during 20min before and 30min after the treatment with 1.8 cineol or diluente. Treatment with 1,8 cineol (3 Âg/Kg) was evaluated also in animals after sacrifice 20 or 30min after gavagem. Compared with control, the gastric retention increase (p<0,05) of 43,9Â34% for 54,9Â4,7; 61,3Â3,3; 56,2Â1,7 and 55.8Â2.1% in the treated (1.8 cineol 1, 3, 10 and 30 Âg/Kg, respectively) animals, sacrificed 10 min after gavage.It was also observed significant reduction on the GI transit in this group. The 1,8 cineol (1, 3, 10 and 30 Âg/Kg) induced reduction (p<0,05) of the AP (of 124Â5,2 for 119Â5,2; 100,2Â4,3; 99,8Â0,5 and 88,6Â2,7mmHg, respectivelly). This effect was, however, fugaz, for dose 1 and 3 Âg/Kg, however the doses of 10 and 30 Âg/Kg, the animals had not presented recovery of the AP. Treatment with EOCN also increases gastric retention (53,1Â2,4 versus 43,9Â3,4, p<0,05) while reduces GI transit. The surgical pre-treatment by sub-diafragmatic vagotomy, but not it splancnotomy, inhibited the 1,8 cineol effect on the GE and GI transit of liquid. ii) The effect of 1.8 cineol (1 or 3 Âg/Kg) on gastric compliance had been lead in 15 anaesthetized rats, under jejun of 24h. The variations of the gastric volume (GV), had been measured by plethysmography, while the AP, FC and CVP had been monitored continuously by a digital system of data acquisition. We observe reduction of the GV (p<0.05), which was significant on 30, 40, 50 and 60min after treatment (2,0Â0,1; 1,9Â0,1; 1,8Â0,1 and 1,7Â0,1mL, versus 2,1Â0,2mL) 1 or 3Âg/Kg of 1.8 cineole. The AP presented significant fall after the administration of 1.8 cineol, remaining thus during 60min of monitorization (87,9Â7,7; 87,6Â7,1; 87,9Â6,4; 87,8Â5,7; 86,0Â5,5 and 87,7Â6,0mmHg, respectively versus 94,4Â6,2; mmHg), as well as the FC (366,3Â13,4; 361,7Â11,5; 357,3Â10,4; 353,0Â10,4; 348,3Â11,1 and 350,4Â13,7bpm, respectively versus 395,2Â11,1bpm). The CVP did not suffer significant variations after treatment. In summary, it was observed the OECN and the 1,8 cineol treatments diminish the gut motility, delaying the GE and GI transit of liquid in awake rats; it reduces the gastric complaciance in anaesthetized rats besides presenting effect hipotensor and bradicardic; probably for direct action on the gastrointestinal and vascular smooth muscel and moduling the parassimpatic nervous system

Thesis (PhD (Phytomedicine Programme) (Paravet. Studies))--University of Pretoria, 2008. / Includes bibliographical references. Also available in print format.