Master of Public Health - MPH / Access to appropriate health care service during childbirth is a great challenge to many women in Africa and Namibia is no exception. More than 70% of women in Otjozondjupa region experienced some form of delay during childbirth, and while maternal mortality continued to rise over the years in Namibia it is currently at about 265/100 000, which is too high for a middle-income country. Hence, this study aimed to get a deeper understanding of the perceptions of women who experienced any of the three delays in accessing appropriate health care during childbirth in Otjiwarongo hospital.

Magister Curationis - MCur / Perinatal deaths are emotion-laden events not only for the mothers, but also for physicians and midwives. Hence, mothers experiencing the phenomenon need support to overcome the experience. If the loss occurs in a health institution, the responsibility of supporting the woman is borne by healthcare providers, particularly midwives. However, limited information exists on how midwives manage patients who experience perinatal loss in health institutions. Consequently, this study on midwives' experiences of managing patients' perinatal loss at a maternity hospital in the Western Cape, South Africa was conducted. The aim of the study was to explore midwives' management of patients with perinatal loss. The study utilised a qualitative research design and employs a phenomenological approach. Purposive sampling was used to select eight registered midwives to participate in the study. Data was collected by means of in-depth unstructured interviews, which were audio-recorded. It was then analysed by utilising Colaizzi's (1978) steps of phenomenological data analysis. Four themes emerged from the data, namely, knowledge of perinatal loss, challenges when managing patients, managing perinatal loss, and getting emotionally involved. Themes were informed by several subthemes. In addition, implication on practice indicates that improving support to mothers with pregnancy loss requires a multi-disciplinary approach or teamwork from various professionals in order to enhance mutual collaboration between families and healthcare workers. The study concludes that nursing education programmes should be reviewed to ensure that they include midwives' needs in the area of managing clients experiencing a perinatal loss. Hence, student midwives should be given more clinical experience of caring for bereaved couples under supervision, as well as compassionate support, which would assist them to develop these skills before they graduate.

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Purpose: To compare the determinants and distribution of fetal and early neonatal deaths in the Commonwealth of Virginia. Background: Much attention is devoted to reducing the infant mortality rate which was declining up until 2002. The recent rise was parsed and found to stem from an increase in deaths during the early neonatal period. Fetal deaths are not well understood and are not routinely included when evaluating infant mortality. Methods: Using data collected from 2001 to 2006 fetal death and linked infant birth and death certificates by the Virginia Department of Health, crude mortality rates and leading causes of death were calculated for fetal and early neonatal mortality. Rates were calculated for each period of death by locality and mapped to determine if the distribution differed. Logistic regression was also used to evaluate sociodemographic and pregnancy risk factors and chi-square analyses were used to determine if the determinants varied significantly by timing of death outcome. Results: During the study period, the fetal death rate was 5.4 per 1,000 fetal deaths plus live births, the early neonatal death rate was 2.5 deaths per 1,000 live births and perinatal mortality rate was 7.9 deaths per 1,000 fetal deaths plus live births. Trends over time, gestational age specific mortality, geographic distribution, cause of death and many determinants were comparable between both death periods. Extremely low birth weight was the most significant risk factor for early neonatal death (OR = 1747.06). Congenital anomalies of the child were the leading predictor of fetal death (OR = 26.24, 95% CI: 19.62, 35.10) and second highest for early neonatal death (OR = 52.26, 95% CI: 35.21, 77.56). Conclusions: Because of the similarities in geographic distribution, sociodemographic factors, pregnancy risk factors and causes of death, analyzing neonatal and infant mortality rates in isolation from fetal deaths does not accurately depict the burden of adverse pregnancy outcomes.

<p>These studies were undertaken to investigate risks of maternal and perinatal complications in pregnant women with chronic hypertensive disease, and to investigate future risk of preeclampsia in women born small for gestational age (SGA). Population based cohort studies using the Swedish Medical Birth Register from different years were performed.</p><p>The maternal complications mild and severe preeclampsia, gestational diabetes and abruptio placenta were studied in a population of 681 515 women, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics as age, parity, BMI, ethnicity and smoking habits. Chronic hypertensive women wore found to have significantly increased risks of all complications. </p><p>The perinatal complication SGA was studied in a population of 560 188, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the secondary complications mild and severe preeclampsia. Chronic hypertensive women were found to suffer a significantly increased risk of giving birth to an offspring that is SGA. </p><p>The perinatal complication fetal/infant mortality was studied in a population of 1 222 952 with a prevalence of 0,6% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the complications mild and severe preeclampsia, gestational diabetes, abruptio placenta and offspring being SGA In the analysis an effect modification by gender was included. Chronic hypertensive women were found to have a significantly increased risk for stillbirth and neonatal death in male, but not in female, offspring. Thus a clear gender difference in mortality was revealed. The risk of mortality of offspring was mediated by severe preeclampsia, abruptio placenta and offspring being SGA. Mild preeclampsia and gestational diabetes did not affect the risk. No increased risk of post neonatal mortality was found.</p><p>A generation study was performed in 118 634 girls of which 5.8% were born SGA. Their future risk for mild and severe preeclampsia in first pregnancy was analysed. Risk estimates were adjusted for age, smoking, BMI and for preeclampsia in the mothers while pregnant with the study population. Women who were born SGA were shown to have a significantly increased risk for severe preeclampsia, but not for mild preeclampsia. </p>

These studies were undertaken to investigate risks of maternal and perinatal complications in pregnant women with chronic hypertensive disease, and to investigate future risk of preeclampsia in women born small for gestational age (SGA). Population based cohort studies using the Swedish Medical Birth Register from different years were performed. The maternal complications mild and severe preeclampsia, gestational diabetes and abruptio placenta were studied in a population of 681 515 women, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics as age, parity, BMI, ethnicity and smoking habits. Chronic hypertensive women wore found to have significantly increased risks of all complications. The perinatal complication SGA was studied in a population of 560 188, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the secondary complications mild and severe preeclampsia. Chronic hypertensive women were found to suffer a significantly increased risk of giving birth to an offspring that is SGA. The perinatal complication fetal/infant mortality was studied in a population of 1 222 952 with a prevalence of 0,6% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the complications mild and severe preeclampsia, gestational diabetes, abruptio placenta and offspring being SGA In the analysis an effect modification by gender was included. Chronic hypertensive women were found to have a significantly increased risk for stillbirth and neonatal death in male, but not in female, offspring. Thus a clear gender difference in mortality was revealed. The risk of mortality of offspring was mediated by severe preeclampsia, abruptio placenta and offspring being SGA. Mild preeclampsia and gestational diabetes did not affect the risk. No increased risk of post neonatal mortality was found. A generation study was performed in 118 634 girls of which 5.8% were born SGA. Their future risk for mild and severe preeclampsia in first pregnancy was analysed. Risk estimates were adjusted for age, smoking, BMI and for preeclampsia in the mothers while pregnant with the study population. Women who were born SGA were shown to have a significantly increased risk for severe preeclampsia, but not for mild preeclampsia.

Made available in DSpace on 2016-08-19T17:37:06Z (GMT). No. of bitstreams: 1 DISSERTACAO_PATRICIA SAMPAIO DE ASSUNCAO.pdf: 1160971 bytes, checksum: 7b4066a5db9a6b5d3be6e51004379c3a (MD5) Previous issue date: 2015-03-26 / Infant mortality is an indicator of the levels of social and economic development and health of the population. Although the infant mortality rate has decreased in the post-neonatal, neonatal period still has the largest number of deaths. This component is difficult because reduction depends primarily on actions directed to improve care provided in prenatal care and health services that perform deliveries. Thus, understanding how mothers interpret and explain the death of his son in the neonatal period may unveil a face of child mortality not revealed in official documents of death or the socio-demographic indicators. Therefore, we sought to analyze the models to the death of newborns in the perspective of women who have lost infants at birth. We adopted a descriptive and analytical research, qualitative type, with women living in São Luis, who gave birth in maternity hospitals in the capital. Semi-structured interviews for data collection were used. Data were analyzed by thematic analysis technique and Categorization. The results show that women build their own models to the death of their children. Thus the explanations and interpretations given by women show some aspects whose categories are objects of analysis of this study: Realizing the danger, explaining the causes of death and Facing the process of mourning. Accounts, the situations that represent the weakness in the service network and the lack of information during the prenatal monitoring and even at delivery were identified. This is evident both in relation to the monitoring of pregnant women as well as in neonatal mourning situations. The results show a scenario in which the neonatal mourning situations go unnoticed in health team work routine in maternity wards. / A mortalidade infantil é um indicador dos níveis de desenvolvimento social e econômico e de condições de saúde da população. Embora a taxa de mortalidade infantil tenha decrescido no componente pós-neonatal, o período neonatal ainda concentra o maior número de óbitos. Esse componente é de difícil redução porque depende principalmente de ações dirigidas à qualificação da atenção prestada no pré-natal e nos serviços de saúde que realizam partos. Dessa forma, entender como as mães interpretam e explicam a morte do seu filho no período neonatal pode desvendar uma face da mortalidade infantil não revelada nos documentos oficiais de óbito ou nos indicadores sócio demográficos. Sendo assim, buscou-se analisar os modelos explicativos para o óbito de recém-nascidos na perspectiva das mulheres que perderam os filhos no período neonatal. Adotou-se pesquisa descritiva e analítica, do tipo qualitativa, com mulheres residentes no município de São Luís, que tiveram partos nas maternidades da capital. Foram utilizadas entrevistas semiestruturadas para a coleta de dados. Os dados foram analisados pela técnica de Análise Temática e Categorização. Os dados evidenciaram que as mulheres constroem modelos explicativos próprios para a morte de seus filhos. Dessa forma as explicações e interpretações atribuídas pelas mulheres evidenciam alguns aspectos cujas categorias são objetos de análise deste estudo: Percebendo o perigo, Explicando as causas da morte e Encarando o processo de Luto. Dos relatos, foram identificadas as situações que representam a fragilidade na rede de atendimento, bem como a falta de informação durante o acompanhamento de pré- natal e até no momento do parto. Isto se evidencia tanto em relação ao acompanhamento da mulher grávida como também em situações de luto neonatal. Os resultados revelam um cenário em que a situações de luto neonatal passam despercebidas no cotidiano de trabalho da equipe de saúde nas maternidades.

This research study examined mothers’ experiences of gaining access to services following the death of a baby through stillbirth or a neonatal death. An exploratory research design was used to conduct applied research into the said topic through the use of a semi-structured interview schedule. The research sample consisted of fifteen mothers, all having lost a baby within the last five years to stillbirth or neonatal death. These mothers were met in propinquity and the interview schedule was conducted with them. The findings were analysed and presented both quantitatively, by means of percentages and graphs, and qualitatively, by means of themes and sub themes. The research was particularly relevant in that it is estimated that between three and five percent of all pregnant mothers in South Africa will lose their babies to a stillbirth or neonatal death every year. For this reason it is essential that adequate and quality services be offered to these mothers to prevent complications in their grief. The study conducted by the researcher focused on the accessibility of quality hospital, religious, formal and social support services to bereaved mothers following the death of a baby through stillbirth and neonatal death. The researcher then discussed, in detail, the literature informing the study. The discussion of the literature, as outlined by the researcher, was set in a logical progression – beginning with a discussion on grief, the grief process, dysfunctional grief and models of grief, then moving onto a discussion of the grief following the loss of a baby and maternal grief predictors. The theory ended with a discussion on the services, particularly hospital services, religious services and formal services, available to bereaved mothers. The researcher then presented the findings of the study, drawing comparisons between the literature and the empirical findings where relevant. Conclusions and recommendations were then formulated and presented. The researcher firmly believes that the research conducted holds the potential of providing significant practical suggestions to the functioning of the services that are available to bereaved mothers. / Dissertation (MSD (Play Therapy))--University of Pretoria, 2007. / Social Work and Criminology / unrestricted

Made available in DSpace on 2011-11-09T14:45:49Z (GMT). No. of bitstreams: 2 license.txt: 1648 bytes, checksum: e095249ac7cacefbfe39684dfe45e706 (MD5) 000227.pdf: 618359 bytes, checksum: 66377ddbd51c6f2ae1dc1ac99d13c169 (MD5) Previous issue date: 2008 / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ< Brasil / Este estudo objetivou analisar o entendimento das informações fornecidas e as opções reprodutivas de mulheres que passaram pelo aconselhamento genético (AG) no Instituto Fernandes Figueira (IFF)/Fundação Oswaldo Cruz (FIOCRUZ). Muitos artigos mostram que a lembrança dos riscos de recorrência e a interpretação dos riscos de forma correta são fundamentais para o planejamento reprodutivo. Primeiramente foi feito uma análise quantitativa, através de freqüências simples, para o levantamento do perfil das mulheres atendidas durante os anos de 2002 e 2003 (160 mulheres), quanto à idade, escolaridade e estado civil. Avaliamos também o fluxograma do atendimento durante o pré-natal e nas consultas de AG.Posteriormente foi realizada uma pesquisa, através de entrevistas estruturadas (35 perguntas), enviadas pelo correio para as 101 mulheres atendidas no período de 2002 a 2004, que se enquadravam nos critérios de inclusão ( filho natimorto ou neomorto com anomalia congênita e que foi submetido a necrópsia, avaliação genética, ou estudo citogenético). Recebemos 34 respostas ( com termo de consentimento livre e informado assinado), que foram analisadas fazendo-se uso das abordagens quantitativa e qualitativa, para verificar o entendimento das clientes em relação ao diagnóstico, risco de recorrência, interpretação de riscos e suas opções reprodutivas após o AG.Encontramos respostas condizentes com as informações fornecidas em relação à lembrança do risco numérico e à interpretação do risco em torno de 53 por cento e 56 por cento , respectivamente. Percebemos, entretanto, que em nosso estudo o desejo de ter filhos esteve mais fortemente ligado às decisões reprodutivas do que os riscos de recorrência fornecidos. / This study aimed to analyze how the information provided to women through genetic counselling (GC) in Instituto Fernandes Figueira (IFF) / Oswaldo Cruz Foundation (FIOCRUZ) was understood and their reproductive options thereafter. Many authors point out that recalling the recurrence risks and their correct interpretation are extremely important for reproductive planning. A quantitative analysis was performed using simple frequencies to characterize the profile of the women who sought GC in the years 2002 and 2003 (160 women). Data such as age, education level and marital status were collected. The flowchart of care during prenatal and GC consultations was studied. After the profile analysis, a structured interview comprising 35 questions was sent by mail to 101 women who underwent GC in the years 2002 to 2004 and fullfilled the inclusion criteria (whose babies had congenital anomalies and werestillborn or died in the neonatal period and underwent autopsy, genetic evaluation or chromosomal investigation). The 34 responses (with signed informed consent to participate in the study) were received and underwent both quantitative and qualitative analyses, where the clients´ understanding was verified regarding diagnosis,recurrence risks, risk interpretation and their reproductive options after the conclusion of GC. Responses were in accordance to the information provided in GC, regarding remembrance of the numerical recurrence risk and its interpretation in 53% and 56%, respectively. Our study showed, however, that the desire to have children was more strongly related to the reproductive decisions than the informed recurrence risks.

A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M.A. (Health Studies)