According to global statistics more than half of all people living with HIV are women, the majority of whom live in sub-Saharan Africa. South Africa adapted the WHO guidelines on PMTCT to the local situation. In South Africa the prevalence of HIV amongst pregnant women attending public antenatal care is high, although new infections are declining. Studies on missed opportunities in PMTCT have been conducted in other areas of South Africa, but none in the North West Province. Three health institutions deemed to have more patient attendance were chosen for the study from a particular sub-district. The purpose of this study was to identify and describe the missed opportunities in the PMTCT programme in a sub-district of the North West Province, the results of which may assist in the improvement of PMTCT services. A descriptive study design was used to identify and describe the missed opportunities in the PMTCT programme during pregnancy, labour and postnatal period. The sample consisted of 125 the records of pregnant women whose babies were born in January 2010. Entry to the health care facilities was gained through written permissions from the Department of Health and the facilities. Missed opportunities identified were that 0.8% (1/125) of pregnant women whose records were audited, was not tested for HIV infections and 9.6% (12/125) had no information on testing. Of the 35 women who were found to be HIV positive, only 74.3% (26/35) had confirmatory test done while it was not done in 2.9% (1/35). Furthermore, only 57.1% (20/35) had their blood for CD4 cell count taken, for 2.9% (1/35) no blood was taken for CD4 cell count and there was no information for the remaining 40.0% (14/35). Only 2.9% (1/35) HIV positive pregnant women continued with HAART during labour, 62.9% (22/35) received ARVs for PMTCT and for 34.2% (12/35) there was no information recorded. Prophylaxis for prolonged rupture of membranes was not given in 5.7% (2/35) of these women during labour. There were no records of any TB screening for such women and infant feeding counselling were never carried out. Lack of recording was the major problem identified in this study. / MCur, North-West University, Potchefstroom Campus, 2014

According to global statistics more than half of all people living with HIV are women, the majority of whom live in sub-Saharan Africa. South Africa adapted the WHO guidelines on PMTCT to the local situation. In South Africa the prevalence of HIV amongst pregnant women attending public antenatal care is high, although new infections are declining. Studies on missed opportunities in PMTCT have been conducted in other areas of South Africa, but none in the North West Province. Three health institutions deemed to have more patient attendance were chosen for the study from a particular sub-district. The purpose of this study was to identify and describe the missed opportunities in the PMTCT programme in a sub-district of the North West Province, the results of which may assist in the improvement of PMTCT services. A descriptive study design was used to identify and describe the missed opportunities in the PMTCT programme during pregnancy, labour and postnatal period. The sample consisted of 125 the records of pregnant women whose babies were born in January 2010. Entry to the health care facilities was gained through written permissions from the Department of Health and the facilities. Missed opportunities identified were that 0.8% (1/125) of pregnant women whose records were audited, was not tested for HIV infections and 9.6% (12/125) had no information on testing. Of the 35 women who were found to be HIV positive, only 74.3% (26/35) had confirmatory test done while it was not done in 2.9% (1/35). Furthermore, only 57.1% (20/35) had their blood for CD4 cell count taken, for 2.9% (1/35) no blood was taken for CD4 cell count and there was no information for the remaining 40.0% (14/35). Only 2.9% (1/35) HIV positive pregnant women continued with HAART during labour, 62.9% (22/35) received ARVs for PMTCT and for 34.2% (12/35) there was no information recorded. Prophylaxis for prolonged rupture of membranes was not given in 5.7% (2/35) of these women during labour. There were no records of any TB screening for such women and infant feeding counselling were never carried out. Lack of recording was the major problem identified in this study. / MCur, North-West University, Potchefstroom Campus, 2014

Master of Public Health - MPH / Two quantitative studies were carried out in randomly-selected facilities within all nine provinces of South Africa. First, a situational assessment of these randomly selected facilities was undertaken using key informant (health care personnel) interviews and record reviews to ascertain guidelines and procedures for early identification of HIV-exposed infants (HEI), the coverage of early infant diagnosis services, the human resource capacity of the health system, and existing linkage and referral system for antenatal and postnatal PMTCT services. This was followed by the South African national PMTCT survey (SAPMTCTE) which involved a collection of infant blood samples and maternal interview data from mother-infant pairs (infants age 4-8weeks) attending six weeks immunisation service points in the selected facilities. Interviews were conducted with mothers to assess antenatal and peripartum PMTCT services received and maternal intention to request for infant HIV testing at six weeks immunisation visits. Data on gestational age at birth, infant birth weight and HIV status was extracted from the road-to-health-card (RtHC). The HIV status of mothers was determined from maternal report or enzyme immunoassay (EIA) test conducted on infants dried blood spots (DBS). A weighted analysis (weighted for sample size realisation and population live births) was performed to assess uptake of services along the PMTCT cascade. Mothers who either self-reported an HIV-positive status or had an EIA positive infant were classified as HIV-positive mothers. Perinatal ARV regimen coverage was calculated from the total number of HIV-positive mothers who received maternal azidothymidine (AZT) or HAART for any duration during pregnancy plus infant nevirapine (NVP)/AZT received at birth. Descriptive methods were used to analyse national availability of EID services and approaches for identifying HEI at the six weeks immunisation visit. Logistic regression assessed key factors influencing maternal intention to receive EID. Logistic regression was also used to explore individual, health facility and provincial level factors that explain variability in mother-to-child-transmission rates.

This study investigated caregivers' perceptions with regard to vaccine-preventable diseases in terms of six constructs of the Health Belief Model. A qualitative research design that is explorative, descriptive and contextual in nature was employed in order to understand and describe the perceptions influencing access and utilisation of services that lead to missed immunisation opportunities and consequently outbreaks of vaccine-preventable diseases. The data-collection techniques were individual unstructured in-depth interviews, field notes and clinical records. The sample consisted of twenty two (N=22) caregivers who volunteered to be interviewed. The study has highlighted that caregivers' perceptions or cognitive factors play an important role for having children in completing immunisation schedule to protect the public from vaccine-preventable diseases. It is recommended that mass media programmes are needed to address the role of vaccines in reducing high morbidity and mortality rates caused by vaccine preventable diseases and improvement in access to immunisation services. / Health Studies / MPH (Health Studies)

This study investigated caregivers' perceptions with regard to vaccine-preventable diseases in terms of six constructs of the Health Belief Model. A qualitative research design that is explorative, descriptive and contextual in nature was employed in order to understand and describe the perceptions influencing access and utilisation of services that lead to missed immunisation opportunities and consequently outbreaks of vaccine-preventable diseases. The data-collection techniques were individual unstructured in-depth interviews, field notes and clinical records. The sample consisted of twenty two (N=22) caregivers who volunteered to be interviewed. The study has highlighted that caregivers' perceptions or cognitive factors play an important role for having children in completing immunisation schedule to protect the public from vaccine-preventable diseases. It is recommended that mass media programmes are needed to address the role of vaccines in reducing high morbidity and mortality rates caused by vaccine preventable diseases and improvement in access to immunisation services. / Health Studies / MPH (Health Studies)