The SA National Department of Health made maternal deaths notifiable in 1997. It also commissioned a National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) to confidentially investigate all maternal deaths, to write the "Saving Mothers Report" and to make recommendations based on the findings of the study. The Department of Health in 2003 commissioned an evaluation of the extent to which the 10 recommendations contained in the first "Saving Mother's Report" had been implemented. This rapid appraisal was carried out by Centre for Health and Social Studies (CHESS), University of Natal. A report 'The Progress with the Implementation of the Key Recommendations of the 1998 "Saving Mothers Report" on the Confidential Enquiry into Maternal Deaths in South Africa - A Rapid Appraisal," was published in 2003. The data collected on Recommendation 5 on the use of the obstetric partogram in 46 selected provincial hospitals in all the 9 provinces was only partially analysed in this report. This study reports on a secondary analysis of the 942 questionnaires that were completed on the use and application of the partogram in hospitals in South Africa. In the rapid appraisal experienced field workers evaluated the use of the partogram using a 36-point checklist. Provincial and national averages for each of these variables were calculated and hospitals were evaluated into how they performed according to these averages using Lot Quality Assurance Sampling methodologies. Using national and provincial averages, the hospitals in each province are compared with one another provincially and nationally. In addition, the application and use of partograms in areas and levels of hospitals are described. An attempt is made to show if there is relation between the number of deliveries and the recording of the partogram. The main findings were that, of all the provinces KwaZulu-Natal had the lowest number variables below the national average from the 36 variables used as a checklist. Eastern Cape and Limpopo had the highest number of variables below the national average. The hospital with the highest number below the national average is in the Eastern Cape. In the recording of the chart rural and level one hospitals are low in comparison with urban and level three hospitals. There was no relation in the recording of the chart and the number of deliveries. / Thesis (M.PH.)-University of KwaZulu-Natal, 2004.

BACKGROUND: Maternal mortality remains a persistent public health concern in Sub-Saharan African countries such as Ethiopia. The Ethiopian Ministry of Health has made it a priority to improve maternal health outcomes within the country. Health information technology (HIT) solutions are a flexible and low-cost method for improving health outcomes and have been proven beneficial in low-to-middle income countries, like Ethiopia. The aims of this dissertation were: (a) to characterize the use of HIT usability evaluations in Africa; (b) to quantify facility clinical readiness for obstetric emergencies; (c) to explore the obstetric emergency supply chain dynamics and information flow; (d) to create a visualization dashboard to monitor obstetric emergency readiness; and (e) to evaluate the usability of the dashboard. METHODS: This dissertation comprised six studies with a variety of quantitative and qualitative methods: (1) a scoping review of the literature to identify the types and timing of HIT evaluations occurring in Africa; (2) a prospective, cross-sectional, facility-level comparison of obstetric emergency clinical readiness in Amhara, Ethiopia as measured by the Signal Functions and Clinical Cascades methods; (3) qualitative semi-structured interviews to gain an understanding of the current supply chain in the region, communication flow, and the current barriers and facilitators to success; (4) a case study summarizing the process for the development of the dashboard prototype through integrating existing technology, current literature, and qualitative interview findings; (5) user-centered design sessions with individuals who interact with the obstetric emergency supply chain to create an electronic dashboard prototype to monitor facility readiness to manage obstetric emergencies; and (6) expert review of the dashboard including sessions with a domain expert and information visualization experts and a heuristic usability evaluation with human-computer interaction experts to evaluate and improve the ease of use and usefulness of the prototype. RESULTS: The scoping review found that many usability evaluations in Africa lacked theoretical frameworks to support their work, and that most studies occurred later in the development process when the HIT was close to implementation in practice. The quantitative analysis of facility readiness found that many facilities were missing critical supplies for managing obstetric emergencies and identified a 29.6% discrepancy between the Signal Function tracer items and the Clinical Cascades readiness classifications indicating that the former, which is recommended by the World Health Organization, overestimates facility readiness. The qualitative interviews identified several locations within the current obstetric emergency supply chain where barriers such as bridging the gap of data availability between facilities and regional hubs could be addressed to improve overall facility-level readiness and pointed towards a dashboard as a potential solution. Once a prototype dashboard was developed, user-centered design sessions refined the terminology and colors that should be used throughout the dashboard screens and identified critical graphics and data elements that users believed should be included. Following domain and visualization expert review and iterative refinement of the dashboard, human-computer interaction experts rated the dashboards highly usable. CONCLUSIONS: Dashboards are a novel method for promoting facility-level readiness to manage obstetric emergencies. By exploring the existing supply chain and including targeted end-users and experts in the design process the author was able to tailor the dashboard to meet user needs, fit into the existing integrated pharmaceutical logistics system, and ensure that it follows best practices. Consequently, these studies contribute to strategies to address maternal mortality in Ethiopia.

Doctorat en Sciences de la santé publique / info:eu-repo/semantics/nonPublished

Delayed access to antenatal care (ANC) has been linked to maternal and foetal mortality and morbidity. Early and regular attendance of antenatal care by pregnant women is very important as it could identify birthing complications and includes amongst others, measuring of blood pressure to exclude pregnancy induced hypertension and measuring of weight to exclude intrauterine growth restriction. The purpose of the study was to explore the factors contributing to late antenatal booking around Thulamahashe local area so that interventions can be done to ensure that all pregnant women start antenatal care as soon as they miss a period, at twelve weeks at the most or before 20 weeks of gestation. The study was conducted at Thulamahashe local area which consists of 4 eight hour clinics and 1 twenty- four hours community health centre, at Bushbuckridge sub district, Ehlanzeni district, Mpumalanga province in South Africa. Data was collected using a researcher designed questionnaire which is a list of questions which were asked from respondents and which gave indirect measures of the variables under investigation. The structured questionnaire consisted of both open and close ended questions, which were used to collect information directly from pregnant women. The population of the study was pregnant women who had started antenatal care after 20 weeks of gestation, who were 18 years and above. The sample size consisted of 25 pregnant women who had booked late for antenatal care who were drawn from each facility by simple random sampling method and the total sample size was 127 respondents. The results indicated that most women initiated ANC later than the recommendations by World Health Organization (WHO) which is less than twelve weeks of gestation. Factors that were identified as associated with late antenatal booking were midwives’ attitude distance to the clinic, poor infrastructure, unplanned pregnancy, lack of education and unemployment. / Health Studies / M.A. (Health Studies)