A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand in partial fulfillment of the requirements for the degree of Master of Science in Medicine (Epidemiology and Biostatistics) Johannesburg, May 2014 / Objective: The objective is to estimate the magnitude and determinants of perinatal mortality in Agincourt, and determine whether there is a difference in perinatal mortality rate between South Africans and self-settled Mozambicans. Design: Case-control study of 134 cases and 136 controls using longitudinal data drawn from the Agincourt dataset for the period 1995-2000 Methods: All cases were matched against a random selection of 136 controls. Odds ratios were used to assess risk, with p-values for trend where necessary. Logistic regression was used to determine independent effects of significant risk factors. Limitations of the study: Probable under-reporting of stillbirths and early neonatal deaths. Results: The Agincourt perinatal mortality rate is estimated as 13.4 per 1000 births (95%CI, 11.23- 15.8) with an increasing trend from 1995-2000 (X2 for trend 19.487, p-value <0.001). Delivery by a nurse attendant is a protective factor but not independently so. Multivariate analysis indicates that babies of women who never attended antenatal clinic during the index pregnancy are at higher risk of perinatal death (OR= 7.55; 95%CI, 2.03-28.05) compared to others whose mothers attended antenatal clinic at least four times. Women with history of perinatal death are at a higher risk of experiencing it again, compared with those without (OR =13.68; 95%CI, 1.43-130.82). The difference in perinatal mortality rate for South Africans (13.3) and former Mozambican refugees (11.8) is not statistically significant (p-value = 0.522). Conclusion: Perinatal mortality is rising; key risk factors are non-attendance for antenatal care by mothers, and previous perinatal death. There is no significant difference in perinatal mortality rate between South Africans and self-settled Mozambicans in Agincourt.

A RESEARCH THESIS SUBMITTED TO THE FACULTY OF HUMANITIES, UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG, IN FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE DEGREE OF DOCTOR OF PHILOSOPHY IN DEMOGRAPHY AND POPULATION STUDIES. October 2013. / The burden of disease and mortality in South Africa is a challenge. In the area of HIV/AIDS, an estimated 316,900 new infections to persons aged 15 and older were reported in 2011. For persons below the age of 15 years, 63,600 new infections were detected in this year (Stats SA, 2011). South Africa is also doing poorly with regard to other development indicators. The infant mortality rate for this year was estimated at 37.9 deaths per 100,000 live births and under- five mortality is 54.3 deaths per 100,000. With adolescents in South Africa constituting approximately 20% of the total population, a substantial percentage of adolescents could then be orphans. Adolescents in contemporary South Africa are affected by HIV/AIDS, teen pregnancy, domestic violence and other reproductive health issues (Pettifor et al., 2005; Kaufman et al., 2001; King et al., 2004). They are also faced with poverty and unemployment (Ngoma, 2005). Given the overall optimistic forecast for South Africa’s economic and political growth, based on the end of Apartheid, these grave challenges that youth face persist, making South Africa a very interesting study area to examine the determinants of other-health related and mortality risks for adolescents. The main objective of this study is to identify the levels, causes and determinants of adolescent mortality in South Africa. More specifically the study examines a host of natural, unnatural and broad-underlying causes of death. In addition, individual, household and community, demographic and socioeconomic characteristics are tested as determinants of adolescent mortality. This study is a cross - sectional study using nationally representative data from the South African Census 2001; the Community Survey 2007 and Death Notification Forms as collated by Statistics SA. The Community Survey is nationally representative and collects the same information as the Census. Thus demographic, socioeconomic and mortality questions are similar in both sources and are suitable for a nationally representative study on mortality trends. Death Notification Forms articulate immediate and broad- underlying causes of death, this is useful in identifying specific risks. Adolescents aged 10 to 19 years old are covered in this study. Both adolescent males and females are studied. A total of 41,261 adolescent deaths were recorded in 2001 and 54,046 adolescent deaths were noted for 2007. Demographic and socioeconomic indicators are included for all adolescents represented in the surveys. This study is a quantitative study of adolescent mortality in South Africa. STATA 11(SE) was for the management and analysis of data in this study. The methods of analysis for this study follow the order of the study objectives. To determine levels of adolescent mortality, frequency distributions, age and sex specific mortality rates and proportional mortality ratios were used. In identifying and evaluating prevalent causes of death age- standardized death rates by cause and cause- specific mortality rates are initially used. Then multiple and associated decrement life tables ( in particular, probability of dying, survival function, life expectancy and cause- deleted life expectancy) and Years of Potential Life Lost (YPLL) are calculated. To identify determinants of adolescent mortality logistic regression and multilevel logistic regression is applied. Among other results, the main findings of this study are first the levels of adolescent mortality in South Africa increased from 2001 to 2007 by approximately 1.3%. Second among adolescents, the levels of male mortality (21,686) exceed that of their female (19,575) counterparts in 2001, however the reverse is true of 2007, where female adolescent mortality (28,517) exceeds that of males (25,529). This particular finding is unusual since male mortality during youth (15- 24 years) is generally higher among males. This is due to the increased burden of disease on females in the country, which is now affecting adolescent females too. This is shown in results that the see plight of Tuberculosis- related deaths is more concentrated among females than males. In addition, the probability of adolescent females dying from Tuberculosis increased for 1.45 in 2001 to 1.75 in 2007 in South Africa. In addition, this study shows that for specific causes of adolescent mortality the elimination of causes of death such as Tuberculosis and pneumonia could produce substantial gains in life expectancy. Females have consistently lower odds of adolescent mortality from unnatural causes of death compared to males. Finally, having a few household assets, 6 or more people living in a residence, and high ethnic diversity within the community is associated with increased odds of adolescent mortality in South Africa in 2001. A main conclusion of this study is that with adolescent mortality in the country increasing future economic growth is compromised. Adolescents will soon enter the labour force and contribute to the country’s growth. With fewer adolescent’s surviving to adulthood this means the country’s economic growth with be slow. In addition, increasing adolescent mortality compromises the economic support available to dependent populations. With fewer economically active adults, the country’s dependency ratio will be high, thus increasing the burden placed on government to provide for the elderly and children.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements of the award of the Masters in Science in Epidemiology in the field of Population-based Field Epidemiology April 2012 / Objective: To determine the causes of death and associated risk factors in women of reproductive age in rural South Africa. . Methods: The study population comprised all female members aged 15-49 years of 11 000 households of a rural South African Health and Demographic Surveillance Site from 2000-2009. Deaths and person-years of observation (pyo) were determined for individuals between 01 January 2000 and 31 December 2009. Cause of death was ascertained by verbal autopsy interviews, based on ICD-10 coding; cause of death were broadly categorized as AIDS/TB causes, Non-communicable causes, Communicable/maternal/perinatal/nutrition causes, Injuries and another category of undetermined (unknown) causes of death. Overall and cause specific mortality rates (MR) with 95% confidence intervals (CI) were calculated. Cox proportional hazard regression (HR, 95% CI) was used to determine risk factors associated with overall and cause-specific mortality. Results: 42703 eligible women were included; 3098 deaths were reported for 212607 person-years (pyo) of observation. Overall MR was 14.57 deaths/1000 pyo (CI;14.07-15.09), increasing from 2000-2003 (2003: MR;18.15, CI;16.41-20.08) and subsequently decreasing (2009: MR; 9.59, CI;8.43-10.91) after introduction of antiretroviral treatment (ART) for HIV in public health system facilities in South Africa in 2004. Mortality was highest for AIDS/TB (MR;10.66, CI;10.23-11.11) and the cause of death for 73.1% of all recorded deaths. Maternal mortality was 0.07 (CI; 0.04-0.11). Women aged 30-34 years had the highest MR due to AIDS/TB (MR; 20.34/1000 pyo), women aged 45-49 years due to other causes (MR; 4.29/ 1000 pyo). v In multivariable analyses, external migration status was associated with increased hazards of all cause mortality (HR; 1.87, CI; 1.56-2.26) and other causes of mortality (HR; 1.782, CI; 1.24-2.57). Self reported poor health was significantly associated with increased hazards of all cause mortality (HR; 11.052, CI; 4.24-28.82) but not with mortality due to other causes. Positive HIV status was associated with increased hazards of all cause mortality (HR; 8.53, CI; 6.81-10.67) and other causes of mortality (HR; 2.84, CI; 1.97- 4.09). Conclusion. AIDS was the main cause of death in the current study, with mortality rates declining since introduction of ART for HIV in public health facilities in the surveillance area in 2004. Further ART roll-out, increased community awareness and sensitisation messages are still needed to reduce the spread of HIV and other sexually transmitted diseases.

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Doctor of Philosophy Johannesburg, October 2014 / Introduction Data on the burden of influenza-associated hospitalisation and mortality in relation to other aetiologies of pneumonia as well as risk groups for severe and complicated disease are important to guide influenza prevention policy. Materials and methods We estimated influenza-related deaths as excess mortality above a model baseline during influenza epidemic periods from monthly age-specific mortality data using Serfling regression models. For individuals aged ≥65 years from South Africa and the United States of America (US) we evaluated influenza-related deaths due to all causes, pneumonia and influenza (P&I) and other influenza-associated diagnoses for 1998-2005. For adults with acquired immune deficiency syndrome (AIDS) aged 25-54 years in South Africa (1998-2005) and the US (pre-highly active antiretroviral therapy (HAART) era: 1987-1994; HAART era: 1997-2005) we estimated deaths due to all-causes and P&I. We prospectively enrolled individuals with severe acute respiratory illness (SARI) at six hospitals in four provinces of South Africa from 2009-2012. Using polymerase chain reaction, respiratory samples were tested for ten respiratory viruses and blood for pneumococcal DNA. Cumulative annual SARI incidence was estimated at one site with available population denominators. Results Age-standardised excess mortality rates amongst seniors were higher in South Africa than in the US (545 vs. 133 per 100,000 for all-causes, p<0.001; 63 vs. 21 for P&I, p=0.03). The mean percent of winter deaths attributable to influenza was 16% in South Africa and 6% in the US, p<0.001. For all respiratory causes, cerebrovascular disease and diabetes age-standardised excess death rates were 4- to 8-fold greater in South Africa than in the US, and the percent increase in winter deaths attributable to influenza was 2- to 4-fold higher. In the US pre-HAART, influenza-related mortality rates in adults with AIDS were 150- (95% confidence interval (CI) 49-460) and 208- (95% CI 74-583) times greater than in the general population for all-cause and P&I respectively and 2.5- (95% CI 0.9-7.2) and 4.1- (95% CI 1.4-13) times higher than in seniors. Following HAART introduction, influenza-related mortality in adults with AIDS dropped 3-6 fold but remained elevated compared to the general population (all cause relative risk (RR) 44, 95% CI 16-12); P&I RR 73, 95% CI 47-113). Influenza-related mortality in South African adults with AIDS was similar to that in the US in the pre-HAART era. From 2009-2012 we enrolled 8723 children age <5 years with SARI. The human immunodeficiency virus (HIV) prevalence among tested children was 12% (705/5964). The overall prevalence of respiratory viruses identified was 78% (6517/8393), which included 26% (n=2216) respiratory syncytial virus (RSV) and 7% (n=613) influenza. The annual incidence of SARI hospitalisation in children age <5 years ranged from 2530-3173 per 100,000 and was 1.1-3-fold greater in HIV-infected than HIV-uninfected children. In multivariable analysis, compared to HIV-uninfected children, HIV-infected children were more likely to be hospitalised >7 days (odds ratio (OR) 3.6, 95% CI 2.8-5.0) and had a 4.2-fold (95% CI 2.6-6.8) higher case-fatality ratio. From 2009-2012, we enrolled 7193 individuals aged ≥5 years with SARI. HIV-prevalence was 74% (4663/6334) and 9% (621/7067) tested influenza positive. The annual incidence of SARI hospitalisation in individuals age ≥5 years ranged from 325-617 per 100,000 population and was 13 to 19-fold greater in HIV-infected individuals (p<0.001). On multivariable analysis, compared to HIV-uninfected individuals, HIV-infected individuals were more likely to be receiving tuberculosis treatment (OR 2.1, 95% CI 1.3-3.2), have pneumococcal infection (OR 2.2, 95% CI 1.6-2.9), be hospitalised for longer (>7 days rather than <2 days OR 2.4, 95% CI 1.8-3.2) and had a higher case-fatality ratio (8% vs. 5%; OR 1.6, 95% CI 1.2-2.2), but were less likely to be infected with influenza (OR 0.6, 95% CI 0.5-0.8). Influenza was identified in 9% (1056/11925) of patients of all ages enrolled in SARI surveillance from 2009-2011. Among influenza case-patients, 44% (358/819) were HIV-infected. Age-adjusted influenza-associated SARI incidence was 4-8 times greater in HIV-infected (186-228 per 100,000 population) than HIV-uninfected (26-54 per 100,000 population). On multivariable analysis, compared to HIV-uninfected individuals, HIV-infected individuals with influenza-associated SARI were more likely to have pneumococcal co-infection (OR 2.3, 95% CI 1.0-5.0), influenza type B than type A (OR 1.6, 95% CI 1.0-2.4), be hospitalised for 2-7 days (OR 2.8 95% CI 1.5-5.5) or >7 days (OR 4.5, 95% CI 2.1-9.5) and more likely to die (OR 3.9, 95% CI 1.1-14.1). Discussion and conclusions The mortality impact of seasonal influenza in the South African elderly may be substantially higher in an African setting compared to the US. Adults with AIDS in South Africa and the US experience substantially elevated influenza-associated mortality rates, which although lessened by widespread HAART treatment does not completely abrogate the heightened risk for influenza illness. HIV-infected children and adults also experience substantially elevated incidence of hospitalisation for influenza-associated SARI and have higher case-fatality ratios. Influenza is commonly detected amongst children (7%) and adults (9%) with SARI. Less frequent identification of influenza amongst HIV-infected than -uninfected individuals aged ≥5 years likely reflects increased relative burden and role of other opportunistic pathogens such as pnuemococcus and Pneumocystis jirovecii. Improved access to HAART for HIV-infected individuals and vaccination against influenza virus amongst HIV-infected individuals, young children and the elderly, where the influenza burden is great may reduce the high burden of hospitalisations and mortality associated with influenza.

Division of Forensic Medicine and Pathology, University of the Witwatersrand Submitted in fulfilment of the requirements for the degree of Masters of Science in Medicine In the Health Science Faculty University of Witwatersrand Johannesburg 2014 / Within the field of paediatric pathology dominant universal trends have emerged with child abuse related fatalities and child murders being at the forefront. However, several authors have noted that such trends have not been documented within the South African context. This is due to the lack of data collection and research within South Africa. Patterns of injury and prevalence of paediatric fatalities received at the Johannesburg Forensic Pathology Service (JHB FPS) over three years were observed through a descriptive, retrospective study. Data were collected from FPS case files and Police reports (SAPS180) accompanying the body to the mortuary. The results indicated that the majority of paediatric deaths were due to blunt force injuries, natural disease processes and drowning. Subdural and subarachnoid haematomas, multiple blunt force internal injuries, hyperinflation and consolidation of the lungs and features of dehydration were the dominant patterns of injuries and disease. Additionally, results exhibited a significant difference in age range when correlated to category of death as well as a high risk of mortality within the first year of life. This study highlights the alarming figures of accidental and socio-economic paediatric death cases which are received at the JHB FPS. Keywords: Child mortality, Injury patterns, Forensic Pathology

Infant mortality rates are used as indicators of a group or population's well being. A high rate indicates poor access to social services such as health care provision, and other socioeconomic factors. Sub-Saharan Africa has the highest infant mortality rates in tne world. Compared to the region as a whole, South Africa's rates are lower. However, a sudden increase in rates was noted from early 1990s (Department of Health, Medical Research Council, Macro International, 1998). Since household is the first environment that infants are exposed to, it is thus the environment that strongly influences development and survival chances of this group. The study aims at taking a closer look at several aspects of the structure of the household and how they impact on infant mortality. The study is based on data from the South African Demographic and Health Survey (SADHS) administered by the Department of Health in 1998. Aspects of household structure that are viewed as affecting infant mortality are: sex of the household head, his/her age, number of household members, and number of children under 5 years old in a household. Estimating infant mortality rate and its probability by using ordinary life tables and multiple logistic regression modeling respectively, the study found that sex of the household head does no have an impact as a determinant of infant mortality in South Africa. However, other aspects of the household structure (number of household members and number of younger children under 5 years of age) were found to determine the survival of infants. Larger households are better off in securing infant survival than smaller households. / Thesis (M.A.)-University of Natal, Durban, 2002.

Many countries in the world record annual summary statistics such as economic indicators like Gross Domestic Product (GDP) and vital statistics for example the number of births and deaths. In this thesis we focus on mortality data from various causes including Tuberculosis (TB) and HIV. TB is an infectious disease caused by bacteria called Mycobacterium tuberculosis. It is the main cause of death in the world among all infectious diseases. An additional complexity is that HIV/AIDS acts as a catalyst to the occurrence of TB. Vaidyanathan and Singh revealed that people infected with mycobacterium tuberculosis alone have an approximately 10% life time risk of developing active TB, compared to 60% or more in persons co-infected with HIV and mycobacterium tuberculosis. South Africa was ranked seventh highest by the World Health Organization among the 22 TB high burden countries in the world and fourth highest in Africa. The research work in this thesis uses the 2007 Statistics South Africa (STATSSA) data on TB and HIV as the primary cause of death to build statistical models that can be used to investigate factors associated with death due to TB. Logistic regression, Survey Logistic regression and generalized linear models (GLM) will be used to assess the effect of risk factors or predictors to the probability of deaths associated with TB and HIV. This study will be guided by a theoretical approach to understanding factors associated with TB and HIV deaths. Bayesian modeling using WINBUGS will be used to assess spatial modeling of relative risk and spatial prior distributions for disease mapping models. Of the 615312 deceased, 546917 (89%) died from natural death, 14179 (2%) were stillborn and 54216 (9%) from non-natural death possibly accidents, murder, suicide. Among those who died from natural death and disease, 65052 (12%) died of TB and 13718 (2%) died of HIV. The results of the analysis revealed risk factors associated with TB and HIV mortality. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

Thesis (MA (Psychology))--Stellenbosch University, 2008. / South Africa’s violence and injury death rates pandemic are steadily growing. Global estimates reported by the World Health Organisation (2000) have revealed that there is an increase in worldwide deaths. Approximately 5 million people die as a result of injuries each year and hundreds of thousands more are left physically or psychologically scarred (World Health Organisation, 2000). There are alarmingly high incidences of violence, crime and injury deaths in South Africa and the impact of these injury fatalities is imposing an immense burden on government, communities, families and even individuals. The burden of fatal injury mortalities has not fallen evenly. In South Africa, low socio-economic communities have borne the brunt of this epidemic. This study presents a focus on mortality and injury patterns and emerging problem areas for children and youth in a peri-urban setting. The aim of this study was to provide an overview of the fatal injury mortality and suicide data of children and youth in the Stellenbosch district, in order to develop a comprehensive understanding of the problem areas of injury deaths such as the main causes and consequences and age, sex, race and other pertinent comparisons. The study also aimed to consider the impact and relationship between alcohol abuse and youth injury deaths. Mortuary data were compiled from 591 children and youth cases for the period 2001-2005 in the Stellenbosch district using the National Injury Mortality Surveillance System data form. The present study highlighted several key findings. Transport-related deaths were indicated as a serious cause for concern among both children and youth in peri-urban settings. The importance of specific road safety awareness initiatives within peri-urban areas and among specific age groups were also indicated. Violence-related deaths were determined to be a leading cause of death among the older age groups in the youth category, with sharp force objects being the leading external cause of violent deaths. This highlighted an additional key finding reporting that sharp force objects death are a more serious cause for concern than firearm deaths in peri-urban areas, which challenges previous urban data. vi Burns and drowning were indicated as pertinent cause of unintentional deaths among both children and youth within peri-urban areas. This was suggested to be due to the high use of paraffin enabled heating systems in house in peri-urban areas and the lack of safety surrounding materials such as matches in the home. In addition, suffocation deaths among infants were also identified as a concern. Furthermore, the link between alcohol abuse among the youth age group was indicated by a key finding that alcohol is a prominent risk factor for fatal injury mortalities among youth. However more studies are needed to explore the effects and risks of other substances on youth fatal injury deaths. Several implications of the research findings are identified for health care professionals, policy developers, government departments and non-government organisations to consider in reducing the mortality rates of children and youth. These implications are critical in informing preventative interventions and initiatives aimed at enhancing safety to children and youth living in peri-urban areas within South Africa. vii

PhDH / Department of Advanced Nursing Science / Background: The National Committee for the Confidential Enquiries into Maternal Deaths recommend the implementation of “Saving Mothers’ recommendations” as a measure to reduce maternal deaths. However, this objective has not been achieved because the Maternal Mortality Rate in South Africa was standing at 134.33/100 000 live births and Limpopo Province at 165.16/100 000 live births. The national target for reduction of maternal mortality was 20% for all provinces for 2016. Limpopo Province’s reduction was below 12.5% for 2016. Purpose: The purpose of the study was to develop a strategy to enhance the implementation of the Saving Mothers’ recommendations in the maternity units of Limpopo Province. Methods: The convergent parallel design was used in this study. The study was conducted in phases, namely: Phase 1(a) was a qualitative research approach and a non-experimental, descriptive and exploratory design. The population consisted of district managers who were managing the Maternal Health Services and registered midwives who were working in the maternity units of Limpopo Province. Non-probability purposive sampling was used for both the district managers and the registered midwives. Data were collected using a central question for the managers managing Maternal Health services which was “What support are you giving to facilitate the implementation of the recommendations by the Saving Mothers Report?” and the question for the registered midwives was “What challenges are you experiencing when implementing the Saving Mothers’ recommendations.” Tesch’s open-coding technique was used to analyse qualitative data. Trustworthiness was ensured through credibility, confirmability, dependability, transferability and authenticity. Phase 1(b) was a quantitative and a non-experimental descriptive design. The population comprised of 200 patients who were included in the study. Questionnaires were developed and used to collect ABSTRACT vi data. Data was analysed using the Statistical Package for Social Sciences (SPSS, version 24.0) with the assistance of the statistician. Discussion of data were done in an explanatory sequential way where data from Phase 1a was discussed and supported by data from Phase 1b. Findings: The themes that emerged were: Challenges related to implementation of the recommendations of the Saving Mothers Report in maternity units, Description of existing training programmes and in-service education for health care professionals, Knowledge on implementing recommendations for the Saving Mothers Report when providing care in maternity units and Suggestions related to improvement of adherence to recommendations for the Saving Mothers Report in maternity units. Some of the themes were supported by the quantitative results whilst some not supported. Validity and reliability were ensured by giving the questionnaires to experts on the subject, colleagues and promoters to analyse and determine if items adequately represent content in the correct proportion. Ethical considerations were ensured by obtaining ethical approval from the University of Venda Ethics Committee and permission to access the facilities from the Limpopo Province Department of Health. The participants signed informed written consent. Phase 2 entailed strategy development and validation of the developed strategy. Recommendations: The recommendations included that the Department of Health should employ more staff and put operational managers in permanent positions. Sufficient equipment and supplies essential for maternal health care and maternal health infrastructure should be procured and a good plan for the managing thereof implemented. It is also recommended that health care workers should work hand in hand with the community structures and the ‘mosate’. / NRF

Thesis (MA)--Stellenbosch University, 2010. / ENGLISH ABSTRACT: Hypertensive disorders are one of the leading causes of maternal morbidity and mortality in South Africa. The morbidity and mortality rate can be decreased by early detection and management of hypertensive disorders at primary health care Level. The midwives should therefore be knowledgeable and competent in the assessment and diagnosis of pregnant women who are at risk of developing a hypertensive disorder, and be able to manage the problem. The purpose of the study was to investigate scientifically the knowledge of the registered midwives managing hypertensive disorders in pregnancy working at primary health care level in the Eastern Cape. The objectives set for the study were to investigate the knowledge of the registered midwives in the following areas: • Knowledge about hypertensive disorders • Assessment • Diagnosis • Management A descriptive correlational research design was applied with a quantitative approach to investigate scientifically the knowledge of the registered midwives managing hypertensive disorders in pregnancy. The target population included all the registered midwives working permanently in primary health care clinics in the Buffalo City Local Service Area. A stratified random sample of n=43 (44%) of a population of N=98 clinics both in rural and urban were selected together with a sample of n=101(44%) of N=228 registered midwives working in these clinics. A questionnaire consisting of predominantly closed questions was used for the collection of data, collected personally by the researcher. Ethical approval was obtained from Stellenbosch University, Department of Health and individual informed consent. A pilot study, which did not form part of the study, was conducted to test the questionnaire at the clinics. A 10% (n=10) sample of the registered midwives of 4 clinics participated in the pilot study. The validity and reliability was assured through the pilot study, the use of a statistician, as well as experts in midwifery, nursing and a research methodologist. The data was analysed and presented in tables and histograms. Statistical correlational tests were done to determine any correlations between the variables. Findings obtained show that inadequate knowledge exists among participants with specific reference to knowledge, assessment, diagnosis and management about hypertensive disorders. A statistical correlation was shown between the presence of doctors and the knowledge of the midwives using the Mann-Whitney statistical test (p=0.04). In clinics where there are no doctors’ visits, the knowledge of the staff was higher (0.691), than the total knowledge mean score (0.666). Where doctors are regularly visiting the clinics the mean knowledge score is lower (0.656). These results show that where midwives do not have any additional support as when there are doctors present, individual effort is made to keep up to date as they are practising as independent practitioners. Recommendations are based on the scientific evidence which emphasis further education in advanced midwifery, workshops, conferences, updating their knowledge and weekly in-service training, introduction of a quality assurance and patient education programmes. In conclusion empowering the midwives with the required knowledge about hypertensive disorders will contribute towards decreasing the mortality and morbidity rates. / AFRIKAANSE OPSOMMING: Siektetoestande gekoppel aan hipertensie is een van die vernaamste oorsake van sieklikheid en moedersterftes in Suid-Afrika. Die siektetoestand en sterftekoers kan afneem deur vroeë opsporing en bestuur van hipertensietoestande op primêre gesondheidsorgvlak. Die kraampersoneel behoort dus kundig en bekwaam te wees tydens die assessering en diagnose van swanger vroue wat die risiko loop om ’n toestand van hipertensie te ontwikkel en daartoe in staat te wees om die probleem te kan hanteer. Die doel van die studie is om die kennis van geregistreerde vroedvroue wetenskaplike te ondersoek wat hipertensiewe toestande tydens swangerskap hanteer op Primêre Gesondheidssorgvlak in die Oos-Kaap. Die doelstellings wat uiteengesit is vir die studie, is om die kennis van geregistreerde kraampersoneel in die volgende areas te ondersoek: • Kennis van hipertensiewe toestande • Assessering • Diagnose • Hantering. ’n Beskrywende korrelerende navorsingsontwerp is toegepas met ’n kwantitatiewe benadering om die kennis van die geregistreerde kraampersoneel wat hipertensiewe versteurings in swangerskappe hanteer, wetenskaplik te ondersoek. Die teikengroep het al die geregistreerde kraampersoneel wat permanent in die primêre gesondheidssorgklinieke in die Buffalo City Plaaslike Diensarea werk, ingesluit. ’n Gestratifieerde ewekansige steekproef van n=43 (44%) gekies uit ’n gesamentlike plattelandse en stedelike bevolking van N=98 klinieke met ’n steekproef van n=101 (44%) van N=228 geregistreerde vroedvroue wat in die klinieke werk. ’n Vraelys wat hoofsaaklik uit geslote vrae bestaan, is gebruik vir die insameling van data wat persoonlik deur die navorser ingesamel is. Etiese toestemming is verkry van die Universiteit Stellenbosch, die Departement van Gesondheid asook individuele ingeligte toestemming. ’n Loodsondersoek is uitgevoer om die vraelys te toets by die klinieke wat nie deel van die studie was nie. ’n 10% (n=10), steekproef van die geregistreerde vroedvroue van 4 klinieke het deelgeneem aan die loodsondersoek. Die geldigheid en betroubaarheid is verseker deur die loodsondersoek, die gebruik van ’n statistikus asook kundiges in kraamverpleging en ’n navorsingsmetodoloog. Die data is geanaliseer en weergegee in tabelle en histogramme, statistiese korrelasietoetse is gedoen om korrelasies te bepaal tussen die veranderlikes. Die bevindings, bewys dat ongenoegsame kennis bestaan by deelnemers met spesifieke verwysing na kennis, assessering, diagnose en hantering ten opsigte van aangaande toestande van hipertensiewe toestande. ’n Statistiese korrelasie is getoon tussen die teenwoordigheid van geneeshere en die kennis van vroedvroue deur gebruik te maak van die Mann-Whitney statistiese toets (p=0.04). In klinieke waar daar geen doktersbesoeke is nie, is die personeelkennis beter (0.691) as die totale gemiddelde kennistelling (0.666). Waar geneeshere gereeld die klinieke besoek, is die gemiddelde kennistelling laer (0.656). Hierdie resultate bewys dat waar die vroedvroue geen bykomende ondersteuning deur die teenwoordigheid van geneeshere het nie, het individuele moeite gedoen om op die hoogte te bly, aangesien hulle as onafhanklike praktisyns optree. Aanbevelings is gebaseer op wetenskaplike bewyse wat verdere onderrig beklemtoon in gevorderde kraamverpleging, werkswinkels, konferensies, die bywerk van kennis en weeklikse indiensopleiding, die instel van ’n kwaliteitsversekering en opvoedingsprogramme vir pasiënte. Ten slotte die bemagtiging van vroedvroue wat oor die vereiste kennis beskik van toestande van hipertensiewe toestande, sal bydra tot die afname van sterfte- en siektesyfers.