The South African government promulgated the Choice on Termination of pregnancy Act (CTOP Act, 92 of 1996). This was a dramatic declaration of intent unprecedented in the African continent and globally. This act changed the outlook of the practice of termination of pregnancy by ensuring that services play a critical role in the delivery of the service. This study, which is qualitative in nature, explored the experiences of Termination of Pregnancy service providers working in three designated public health institutions in the Limpopo Province. Interviews were conducted with six service providers to look at how they construct their practice of providing termination of pregnancy services. The information was analyzed and interpreted by means of a thematic analysis method. Major themes that emerged from the participants’ experiences centred on their relationship with family, colleagues, management, clients, and the community reflecting a sense of alienation and lack of adequate infrastructural support. Inadequate support has been found to greatly contribute to the loss of interest in the work around abortion. / Psychology / M. A. (Clinical Psychology)

The registered midwives are engaged in continuous health education lessons In antenatal visits, discouraging antenatal clients from using hannful traditional and cultural practices in an attempt to preserve pregnancy to tenn. Despite the registered midwives' efforts, the clients continue to use hannful cultural methods, which are life-threatening to both the mother and the foetus In utero. The prenatal clients perceive the registered midwives as not being sensitive to their culture. The results of this study revealed that health education in antenatal clinics should be collaborative: that is, the people who have influence over the clients' pregnancy, like me mother-in-law, the traditional practitioners, cUents and their family members, should be involved by the midwives during the preparation of pregnancy lessons and health education lessons on how to preserve pregnancy to term according to· scientifically proven methods. / Health Studies / M.A. (Health Studies)

The purpose of this study was to analyse and describe the factors that influence the choice of site of delivery by pregnant women in Mukono district. By employing quantitative, non experimental research methods, 431 women were interviewed by using structured questionnaires. These women had either delivered at; home, TBA, private or public clinic and 72% had been delivered by skilled attendants. Choice of delivery site was influenced by the attitudes of health workers which were rather poor in public sites, proximity of site, attendance of antenatal clinic at a site, availability of supplies and drugs, plus level of care including emergency obstetric care. / Health Studies / M. A. (Public Health)

The purpose of this study was to identify the need for a training programme and to develop the training programme to meet the needs of traditional birth attendants in the management of pregnancy, labour and puerperium. The study was conducted in the Flagstaff district which is one of the districts of the north eastern region (region E) of the Eastern Cape. The target group consisted of all the traditional birth attendants who availed themselves at the residential clinics of Flagstaff district and the number is not known as not all traditional birth attendants who presented themselves are recognized by their communities as traditional birth attendants. The study was a quantitative descriptive design and the data was collected by means of structured interviews using a questionnaire that was designed by the researcher. According to the findings the traditional birth attendants are functioning without being formally trained before. They lack knowledge and skill in the management of pregnancy, labour and puerperium. Some of their practices are reason for concern, for example cephalic versions and not using protective devices. There is a need for the development of the training programme in the Flagstaff district. This programme was developed from the information obtained from the data-analysis and is given as annexure F / Health Sciences / M.A. (Advanced Nursing Sciences)

This study was carried out as part of efforts to better understand the factors that impinge on childbirth service delivery and to develop guidelines to help improve the quality and safety of childbirth services in Ghana. The objectives were to: assess the factors that influence client-centredness; explore women’s and health professional’s views of and experiences with client-centred childbirth services; and develop guidelines to assist improve client-centred childbirth services in hospitals. The fixed mixed methods design comprising both quantitative and qualitative methods was employed. Structured questionnaire and exit interviews were used to gather data from 754 women who delivered in the hospitals. Furthermore, in-depth interviews were used to examine the experiences of women, doctors and midwives. STATA MP Version 13 was used to analyse the data by generating frequencies, chi-square and binary logistic regression results. Qualitative data analysis was analysed through data reduction, data display and generation of themes and categories. The process of developing the guidelines comprised: drafting based on the findings of the study and additional literature review, and a number of reviews by senior health professionls to build consesnsus on the content. With a response rate of 97.8%, the results indicated average performance. A number of the items examined under demographic characteristics, ante-natal, labour and postnatal care were significantly associated with the experience of excellent client-centred care. These included: number of weeks pregnant before delivery; health professional who assisted with delivery; mode of delivery; labour pain management; and length of stay after delivery. On the whole, the findings of the quantitative study were support by that of the structured interviews. Most of the themes from in-depth interviews with women were had to do with the relationship between health care provider and clients. Issues of support during childbirth; decision-making and informed choice; and continuity were raised. Themes deduced from the doctors’ and midwives’ interviews demonstrated a fair understanding of principles of client-centred care and delineated relational as well as client, health care worker and organisational factors that facilitate or limit effective implementation of client-centred care. The findings of the studies were used to develop guidelines to help improve services. It is recommended that the Ministry of Health, Ghana adopt the guidelines and provide the enabling environment for its effective implementation. / Health Studies / D. Litt. et Phil. (Health Studies)

Este estudo de caso buscou caracterizar a clientela de camadas populares e médias de um serviço de saúde \"alternativo\", com uma proposta de parto ambulatorial realizado fora do hospital, assistido por obstetrizes. Seu objetivo principal foi o de compreender a forma como ambas as clientelas conheceram e passaram a freqüentar esse serviço e os motivos que as levaram a fazerem essa opção, buscando reconhecer semelhanças e diferenças entre elas. O serviço em estudo foi o ambulatório e a Casa de Parto da Associação Comunitária Monte Azul - ACOMA, associação antroposófica que tinha, por objetivo, prestar serviços de saúde, prioritariamente, a moradores de duas favelas e do bairro em que se situa. A análise parte de uma abordagem antropológica, na qual a parturição é vista como uma arena, em que concepções e práticas conflitantes e competitivas se confrontam e se articulam. Foram utilizados métodos e técnicas qualitativos e quantitativos. A realização de entrevistas semi-abertas, visando a apreender as narrativas dos sujeitos acerca de suas vivências de gestação e parto, ao lado da observação participante de consultas de pré-natal e parto foram os principais instrumentos da análise qualitativa empreendida. Foi usada metodologia quantitativa para caracterizar o cenário da investigação, em que se procurou traçar o perfil sócio-epidemiológico de 564 mulheres atendidas nesse serviço, no período entre abril de 1995 e março de 1998, e de seus recém- nascidos, a partir das Declarações de Nascidos Vivos. Os resultados do levantamento sócioepidemiológico indicam que a maioria de sua clientela (77,2%) reside fora da área de abrangência prioritária da ACOMA. Por outro lado, a grande maioria dessas mulheres (93,5%) pertence aos estratos mais pobres da população do Município de São Paulo. As maneiras pelas quais a clientela soube da existência desse serviço e padrões de freqüência ao pré-natal são descritas e analisadas, quantitativa e qualitativamente, apontando para continuidades e descontinuidades entre a clientela \"particular\" e de \"usuárias\". Destaca-se que, para muitas \"usuárias\", a ACOMA era o serviço de prénatal mais freqüentado na gestação, e 44,2% dessas, deram à luz no mesmo serviço. A tendência predominante entre as \"clientes particulares\", por outro lado, era a de realizarem o pré-natal, simultaneamente, nesse e em outro serviço, pois procuravam a ACOMA, com a intenção de evitarem um parto hospitalar e de conferirem a proposta de parto do mesmo. As razões apresentadas e que levaram à escolha desse serviço para realizarem o parto foram múltiplas e complexas e acompanhadas de constrangimentos de ordem sócio-econômica e cultural. Entre elas, destacaram-se, o relacionamento com profissionais de saúde, a percepção de riscos em relação ao parto e a possibilidade de contar com acompanhantes de sua escolha, no momento do parto. Entre as \"usuárias\", o maior temor em relação ao parto hospitalar era o de não ter acesso a um leito, na hora necessária, e, entre as \"clientes particulares\", temia-se a cesárea desnecessária. Questões que se colocaram e que merecem ser aprofundadas referem-se a certas noções e valores em relação à sexualidade e à maternidade e sua associação com noções de \"modernidade\" em relação à família e ao parto, bem como sobre o processo de constituição da autoridade cultural e social de profissionais de saúde. / This study describes some of the characteristics of lower and middle class clients of an \"alternative\" health care center in which midwives were assigned to maternity care in an out clinic. It\'s primary objective was to understand how clients became familiar with the proposal; the patterns of attendance; why they chose this form of maternity care in a context where hospital birth is predominant, and whether there were significant differences in these patterns according to social class. This study was conducted at the Monte Azul Clinic and Birth Center, administrated by the Monte Azul Community Association (ACOMA). The latter is an anthroposophical association, whose basic objective is to attend to demands of the inhabitants of two shanty towns and the surrounding neighborhood. An anthropological approach in which birth is viewed as an arena where conflicting and competitve concepts and pratices are articulated and confront themselves is adopted in analysis. Qualitative and quantitative methods and techniques were employed. Interviews focused on the experiences with respect to pregnancy and birthing among the subjects of this study. Participant observation of pre-natal consultations and of childbirths were also conducted. In order to characterize the context of the field of research, quantitative methodology was employed. A social and epidemiological profile was constructed of the 564 women (as well as their newborns) who gave birth between April 1995 and March 1998, receiving maternity care from midwives working at the Clinic and Birth Center during this period. For this purpose data was collected from the Declaração de Nascidos Vivos - Live Birth Form, a document from the Ministry of Health, filled out at birth by the birth attendant which records data concerning live births. Results indicate that the majority of it\'s clients (77,2%) did not live within the association\'s \"target\" community. On the other hand, data indicates that the majority of women attended (93,5%) belonged to the poorest segments of the population of Sao Paulo City. How clients were informed about the existence of this Clinic and Birth Center as well as patterns of attendance are described and analyzed using quantitative and qualitative approaches. Continuities and discontinuities with respect to these patterns among the Clinic\'s clients and the midwives\' private clients are described and analyzed. Many of the Clinic\'s clients, recurred to this service predominantly for their prenatal checkups and 44,2% of these women recurred to the midwives\' assistance for maternity care. Among the midwives\' private patients, on the other hand, the predominant tendency was to do prenatal checkups simultaneously at the clinic and at other clinics where they were attended by obstetricians. The latter wanted to avoid hospital maternity care and attended prenatal checkups so as to confer and perhaps adhere to the midwives\' proposal of maternity care. Reasons presented with respect to choice of care in childbirth are multiple and complex, involving social, economic and cultural constraints. Among the reasons referred to in the interviews, the most recurrent were the quality of the relationship established with the health professionals; perception of risks with respect to childbirth; and the possibility of having support persons of their choice present during labour and childbirth. Among the clinic\'s clients, the fear of not gaining access to a hospital bed in due time was their major concern with respect to hospital maternity care. Among the midwives\' private patients, the fear of being submitted to a unnecessary cesarean section was a major concern with respect to hospital maternity care. Themes which emerged in this study and require further research include notions of \'modernity\' and their association to concepts and values concerning sexuality and maternity as well as questions related to the construction of cultural and social authority.

Este estudo de caso buscou caracterizar a clientela de camadas populares e médias de um serviço de saúde \"alternativo\", com uma proposta de parto ambulatorial realizado fora do hospital, assistido por obstetrizes. Seu objetivo principal foi o de compreender a forma como ambas as clientelas conheceram e passaram a freqüentar esse serviço e os motivos que as levaram a fazerem essa opção, buscando reconhecer semelhanças e diferenças entre elas. O serviço em estudo foi o ambulatório e a Casa de Parto da Associação Comunitária Monte Azul - ACOMA, associação antroposófica que tinha, por objetivo, prestar serviços de saúde, prioritariamente, a moradores de duas favelas e do bairro em que se situa. A análise parte de uma abordagem antropológica, na qual a parturição é vista como uma arena, em que concepções e práticas conflitantes e competitivas se confrontam e se articulam. Foram utilizados métodos e técnicas qualitativos e quantitativos. A realização de entrevistas semi-abertas, visando a apreender as narrativas dos sujeitos acerca de suas vivências de gestação e parto, ao lado da observação participante de consultas de pré-natal e parto foram os principais instrumentos da análise qualitativa empreendida. Foi usada metodologia quantitativa para caracterizar o cenário da investigação, em que se procurou traçar o perfil sócio-epidemiológico de 564 mulheres atendidas nesse serviço, no período entre abril de 1995 e março de 1998, e de seus recém- nascidos, a partir das Declarações de Nascidos Vivos. Os resultados do levantamento sócioepidemiológico indicam que a maioria de sua clientela (77,2%) reside fora da área de abrangência prioritária da ACOMA. Por outro lado, a grande maioria dessas mulheres (93,5%) pertence aos estratos mais pobres da população do Município de São Paulo. As maneiras pelas quais a clientela soube da existência desse serviço e padrões de freqüência ao pré-natal são descritas e analisadas, quantitativa e qualitativamente, apontando para continuidades e descontinuidades entre a clientela \"particular\" e de \"usuárias\". Destaca-se que, para muitas \"usuárias\", a ACOMA era o serviço de prénatal mais freqüentado na gestação, e 44,2% dessas, deram à luz no mesmo serviço. A tendência predominante entre as \"clientes particulares\", por outro lado, era a de realizarem o pré-natal, simultaneamente, nesse e em outro serviço, pois procuravam a ACOMA, com a intenção de evitarem um parto hospitalar e de conferirem a proposta de parto do mesmo. As razões apresentadas e que levaram à escolha desse serviço para realizarem o parto foram múltiplas e complexas e acompanhadas de constrangimentos de ordem sócio-econômica e cultural. Entre elas, destacaram-se, o relacionamento com profissionais de saúde, a percepção de riscos em relação ao parto e a possibilidade de contar com acompanhantes de sua escolha, no momento do parto. Entre as \"usuárias\", o maior temor em relação ao parto hospitalar era o de não ter acesso a um leito, na hora necessária, e, entre as \"clientes particulares\", temia-se a cesárea desnecessária. Questões que se colocaram e que merecem ser aprofundadas referem-se a certas noções e valores em relação à sexualidade e à maternidade e sua associação com noções de \"modernidade\" em relação à família e ao parto, bem como sobre o processo de constituição da autoridade cultural e social de profissionais de saúde. / This study describes some of the characteristics of lower and middle class clients of an \"alternative\" health care center in which midwives were assigned to maternity care in an out clinic. It\'s primary objective was to understand how clients became familiar with the proposal; the patterns of attendance; why they chose this form of maternity care in a context where hospital birth is predominant, and whether there were significant differences in these patterns according to social class. This study was conducted at the Monte Azul Clinic and Birth Center, administrated by the Monte Azul Community Association (ACOMA). The latter is an anthroposophical association, whose basic objective is to attend to demands of the inhabitants of two shanty towns and the surrounding neighborhood. An anthropological approach in which birth is viewed as an arena where conflicting and competitve concepts and pratices are articulated and confront themselves is adopted in analysis. Qualitative and quantitative methods and techniques were employed. Interviews focused on the experiences with respect to pregnancy and birthing among the subjects of this study. Participant observation of pre-natal consultations and of childbirths were also conducted. In order to characterize the context of the field of research, quantitative methodology was employed. A social and epidemiological profile was constructed of the 564 women (as well as their newborns) who gave birth between April 1995 and March 1998, receiving maternity care from midwives working at the Clinic and Birth Center during this period. For this purpose data was collected from the Declaração de Nascidos Vivos - Live Birth Form, a document from the Ministry of Health, filled out at birth by the birth attendant which records data concerning live births. Results indicate that the majority of it\'s clients (77,2%) did not live within the association\'s \"target\" community. On the other hand, data indicates that the majority of women attended (93,5%) belonged to the poorest segments of the population of Sao Paulo City. How clients were informed about the existence of this Clinic and Birth Center as well as patterns of attendance are described and analyzed using quantitative and qualitative approaches. Continuities and discontinuities with respect to these patterns among the Clinic\'s clients and the midwives\' private clients are described and analyzed. Many of the Clinic\'s clients, recurred to this service predominantly for their prenatal checkups and 44,2% of these women recurred to the midwives\' assistance for maternity care. Among the midwives\' private patients, on the other hand, the predominant tendency was to do prenatal checkups simultaneously at the clinic and at other clinics where they were attended by obstetricians. The latter wanted to avoid hospital maternity care and attended prenatal checkups so as to confer and perhaps adhere to the midwives\' proposal of maternity care. Reasons presented with respect to choice of care in childbirth are multiple and complex, involving social, economic and cultural constraints. Among the reasons referred to in the interviews, the most recurrent were the quality of the relationship established with the health professionals; perception of risks with respect to childbirth; and the possibility of having support persons of their choice present during labour and childbirth. Among the clinic\'s clients, the fear of not gaining access to a hospital bed in due time was their major concern with respect to hospital maternity care. Among the midwives\' private patients, the fear of being submitted to a unnecessary cesarean section was a major concern with respect to hospital maternity care. Themes which emerged in this study and require further research include notions of \'modernity\' and their association to concepts and values concerning sexuality and maternity as well as questions related to the construction of cultural and social authority.

The purpose of the study is to determine the knowledge of midwives on implementing clinical guidelines for the management of pre-eclampsia with the aim of improving midwifery practice and preventing maternal and neonatal death due to pre-eclampsia. A quantitative, descriptive, cross sectional study design was used for the study. Data was collected using a self-administered questionnaire from 100 midwives working in the maternity section of the clinic referring to the regional hospital in UMgungundlovu District. The Statistical Package for Social Sciences (SPSS) version 23 was used for data analysis. The findings show that respondents to the study have a high mean value (3.6) of knowledge but need support in terms of providing training on the new guidelines. The study also showed that there is need to improve on distribution of guidelines. There was no significant association between demographic factors and the knowledge of midwives on clinical guidelines for the management of pre-eclampsia. A clinical audit of maternity records as well as a quality care project can be developed based on the findings / Health Studies / M.A. (Health Studies)

The purpose of this study was to determine factors influencing skilled delivery service utilisation in order to develop strategies to improve utilisation of skilled birth attendance service in North West Ethiopia. The objectives were to explore and describe the perceptions and experiences of the community regarding skilled utilisation of the birth attendance service; explore reasons for non-utilisation of skilled birth attendance service; asses the health system experience of provision of skilled birth attendance service; and formulate strategies to improve utilisation of skilled birth attendance service. The study employed a qualitative, descriptive, and explorative research design to address the research questions formulated by the researcher. The study used focus group discussion guide to obtain information from pregnant women and women who gave birth recently. Furthermore, the study used an interview guide to gather information from health extension workers, midwives, health centre heads, district health office technical experts and heads. It also employed and inductive thematic analysis approach to analyse the qualitative data. The study further used the Atlas ti version 7 for the data analysis. The steps followed for the analysis were data immersion, coding, displaying, reduction, and interpretation. Overall, nine themes emerged from the analysis of the data. Consequently, the researcher used the findings of the study to develop strategies to improve the utilisation of skilled birth attendance service. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to conduct evaluation research on the implementation of the Baby and Mother Friendly Initiative in Namibia in order to identify its successes and failures, as well as to develop guidelines for the strengthening of the programme. An evaluation research design using a sequential mixed-methods approach to collect qualitative and quantitative data was conducted. In phase 1, qualitative data were collected through face-to-face interviews. Participants were the chief health programme officer for nutrition at national level and nurse managers in charge of the baby and mother friendly hospitals. In phase 2, quantitative data were collected from 391 registered and enrolled nurses/midwives working in the baby and mother friendly hospitals through a self-administered questionnaire. Both phases 1 and 2 indicated partial implementation of the Baby and Mother Friendly Initiative programme. Factors influencing the implementation positively or negatively were identified. The integrated findings formed the basis of guidelines to strengthen the programme. Nine guidelines were developed and validated. / Health Studies / D.Litt. et Phil. (Health Studies)