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)

Basic Antenatal Care (BANC) is a way of training or upgrading the knowledge and skills of all nurses, midwives and doctors involved in antenatal care at the primary health care level so that the minimum care can be provided effectively. This study was conducted to investigate the implementation of the BANC program by midwives in the Mdantsane clinics during February 2009. Methods: A descriptive study design was undertaken targeting midwives providing antenatal care to pregnant women, in 14 clinics of Mdantsane. Data was collected from 25 midwives in the clinics, and from 140 ANC cards of women attending ANC on the day of their visit to the clinic. Results: The majority of midwives providing BANC in Mdantsane clinics were not trained in BANC. There were 10 trained midwives and 15 not yet trained. A total of twenty five midwives were involved in the study. The number of visits according to the BANC schedule was well known by the midwives in the study. The content of the visits was well known for the first visit, but for subsequent visits, the participating midwives could not state exactly what they do on these visits. They perceived BANC as something beneficial for both midwives and pregnant women with 24 of the participating midwives rating BANC as advantageous. In completing an ANC card, the midwives scored between 48 percent and 100 percent. Under examination, they scored between 52 percent and 100 percent. Lastly on interpretation and decision making, they scored between 0 percent and 92 percent. This could have troubling consequences for the health status of the mother and baby. Weaknesses in providing antenatal care identified in the study included participating midwives failing to fill in the last normal menstrual period (LNMP) and the estimated date of delivery (EDD), which was a worrying observation. Plotting of the gestational age at first visit was also not carried out well as only 47 percent of the midwives in the study did this, meaning that there would be a miscalculation of the gestational age thereafter throughout the pregnancies. The body mass index (BMI) was not calculated as the maternal height and weight were not written on the ANC card. This should be completed in order to check the nutritional status of the pregnant woman to help supplement, if malnourished, and educate on diet, if overweight. Only 17 percent of the midwives in the study plotted the foetal presentation. Failure to plot foetal presentation could lead to complications during delivery because women with abnormal presentations could end up delivering in a clinic instead of the hospital.Conclusion: This study showed that even though midwives are implementing BANC among pregnant women, it is not being carried out correctly. Therefore the programme will not be as beneficial as it would be if put into practice correctly. This is highlighted by the lack of knowledge from the untrained midwives regarding the content of care on subsequent visits. Thus there is an urgent need for BANC training to be conducted and monitored at various sites.

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

The purpose of the study was to determine the reasons for student midwives’ absenteeism during midwifery classroom facilitation and clinical placement, and the effects of such absenteeism. A quantitative, descriptive, correlational design was adopted to examine the relationship between absenteeism (independent variable) and student midwives’ performance (dependent variable). Data were collected by means of a three-part questionnaire related to respondents’ demographic data, theory facilitation and clinical placement. Data analysis was done using Statistical Package Microsoft Excell 365 Pro Plus, Version 2019. The study revealed that despite the shortage of staff, the most related factor to absenteeism was the negative staff attitude and lack of clinical accompaniment. These discouraged regular attendance, thus affecting the performance of student midwives. With regards to college resources (classroom facilitation), the study revealed that irrespective of how many days a student midwife missed lectures, academic performance declined. Also, the unavailability of study areas and libraries (after 4 pm), Wi-Fi and internet facilities both in the college grounds and clinical areas contributed to absenteeism. Moreover, health issues, social issues and inadequate transport also contributed to absenteeism to some extent. / Health Studies / M.A. (Health Studies)

Adolescent pregnancies are high risks obstetric occurrences. Antenatal care (ANC) provides opportunities to recognise and treat obstetric complications, enhancing the pregnancy outcomes for mothers and babies. This study investigated factors influencing pregnant adolescents' utilisation of ANC services in Bulawayo, using the Health Belief Model's major tenets. A quantitative descriptive design was used in four phases: 80 adolescents' ANC records were audited; structured interviews were conducted with 200 adolescents attending ANC and with 80 adolescents who had delivered their babies without attending ANC; and 52 midwives completed questionnaires portraying their perceptions on adolescents' utilisation of ANC services in Bulawayo. Documentation of ANC services provided to adolescents did not meet the expected standards. Poor or non utilisation of ANC services was influenced by socio demographic factors, individual perceptions of adolescents about antenatal care, perceived benefits of and perceived barriers to the utilisation of ANC. Most pregnant adolescents could not access these services because they could not pay the ANC and/or delivery fees charged at government clinics/hospitals. Midwives required more training in providing and recording adequate ANC services. Free ANC and delivery services could enhance adolescents' pregnancy outcomes in Zimbabawe. An information brochure on the importance of ANC attendance for adolescents has been compiled, based on the research results (see Annexure J). / Health Studies / D.Litt. et Phil. (Health Studies)

Adolescent pregnancies are high risks obstetric occurrences. Antenatal care (ANC) provides opportunities to recognise and treat obstetric complications, enhancing the pregnancy outcomes for mothers and babies. This study investigated factors influencing pregnant adolescents' utilisation of ANC services in Bulawayo, using the Health Belief Model's major tenets. A quantitative descriptive design was used in four phases: 80 adolescents' ANC records were audited; structured interviews were conducted with 200 adolescents attending ANC and with 80 adolescents who had delivered their babies without attending ANC; and 52 midwives completed questionnaires portraying their perceptions on adolescents' utilisation of ANC services in Bulawayo. Documentation of ANC services provided to adolescents did not meet the expected standards. Poor or non utilisation of ANC services was influenced by socio demographic factors, individual perceptions of adolescents about antenatal care, perceived benefits of and perceived barriers to the utilisation of ANC. Most pregnant adolescents could not access these services because they could not pay the ANC and/or delivery fees charged at government clinics/hospitals. Midwives required more training in providing and recording adequate ANC services. Free ANC and delivery services could enhance adolescents' pregnancy outcomes in Zimbabawe. An information brochure on the importance of ANC attendance for adolescents has been compiled, based on the research results (see Annexure J). / Health Studies / D.Litt. et Phil. (Health Studies)