Magister Public Health - MPH / Objective: The study aim was to measure the operational effectiveness of a single dose Nevirapine for PMTCT programme among infants aged six weeks in Khomas region of Namibia.Methods: This was a retrospective record review quantitative study based on a descriptive approach. The record review aimed at measuring operational effectiveness through the distribution of certain variables among HIV exposed infants including the socio economic variables such as age, sex and the breast feeding practices of their mothers. A total of 451 HIV positive mothers and their infant pairs` record registers were reviewed in two hospitals of Khomas region, Namibia.Results: A total of 451 PMTCT mothers’ records for the year 2007 (median age 29 years) were reviewed in the Katutura and Windhoek Central hospitals of Namibia.. The HIV prevalence among infants aged six weeks or more out of the total 167 tested was 5% (95%CI, 0.9 -3.7). Conclusion: The findings from this study shows that although the rate of PMTCT in tested infants was low, registers for maternity and infant follow up are extremely poorly completed with the vast amounts of missing information making it difficult to assess programme effectiveness and monitor programme outcomes. PMTCT programme registers and routine monitoring and evaluation data need to be strengthened.

An estimated 33.0 million people are currently living with HIV/AIDS worldwide. Of these, 15.5 million are women, and 2.2 million children under the age of 5 years who have mainly been infected through mother-to-child transmission. Mothers and babies are increasingly infected and about 90% of these are in sub-Saharan Africa. The same trend can be identified in South Africa, which has one of the highest incidences and prevalence rates of HIV/AIDS in the world with 5-6 million people living with HIV/AIDS. Women of childbearing age constitute 55% of all HIV positive adults and a quarter of pregnant women (28%) in South Africa are HIV positive. The HIV/AIDS epidemic is overburdening hospital systems and it will continue to grow within the context of already massively overstretched public resources. This increase also impacts on health services in the North West Province which are facing an alarming increase in mothers and babies living with HIV/AIDS. One of the strategies that are implemented to reduce maternal deaths is the Prevention-of-Mother-to-Child Transmission (PMTCT) Programme and massive roll out of Antiretrovirals during puerperium. One of the goals of the PMTCT programme is to prevent transmission of HIV/AIDS from mothers to babies and reduce child, perinatal and neonatal morbidity and mortality. This strategy is integrated with Non-Governmental Organizations (NGOs) and community-based organizations (CBOs) in care of mothers and babies living with HIV/AIDS during puerperium. Successful implementation of this programme requires social support and community involvement because of short hospitalization during the postnatal period. Caregivers are trained to perform various tasks and fulfil certain roles due to lack of human resources. Caregivers implementing the PMTCT programme experience problems which lead to stress and one of the causes of this stress manifests in feelings of inadequacy and isolation. They are faced with problems pertaining to mothers not adhering to treatment, and poverty is an additional source of stress as it negatively affects the quality of the PMTCT services they need to provide. This research was conducted in the Bojanala region, Rustenburg Sub-District of the North West Province in South Africa. A descriptive, exploratory, qualitative research design was utilized to explore and describe the lived experiences of caregivers while implementing the PMTCT programme as well as perceptions of health workers coordinating the PMTCT programme in order to gain a more thorough understanding of the support needed by caregivers during puerperium. Two populations were used. In population one, purposive sampling was used to select caregivers. In population two inclusive sampling was used to select health workers. In-depth interviews were conducted with both populations with the aim to collect data. From the research findings similarities were identified between the two populations regarding support, namely: (a) Caregivers need personal support in the form of counselling as well as support networks to enable them to deal with the problems they are faced with. (b) Caregivers need financial support to afford basic essentials and better remuneration to meet their financial needs. (c) Caregivers need to be trained in areas in which they lack knowledge -continued development and empowerment is essential. They also need to be trained specifically in PMTCT and they need a PMTCT consultant to always be available to support them. (d) Improvement of the PMTCT services by providing transport to follow up mothers, protective resources to protect themselves against infections as they are at risk of infections, water is essential as a basic human right, provision with food parcels to mothers who are poverty stricken and the PMTCT health services to be intensified from the antenatal period. (e) Management to establish a caring environment by displaying a caring attitude, respecting them and providing them with rewards to improve morale and performance. Recommendations were made for the fields of nursing education, nursing research and community health practice with recommendations to establish a structure of support for caregivers to enhance the PMTCT programme during puerperium. These recommendations were discussed under the five themes presented above. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2010.

An estimated 33.0 million people are currently living with HIV/AIDS worldwide. Of these, 15.5 million are women, and 2.2 million children under the age of 5 years who have mainly been infected through mother-to-child transmission. Mothers and babies are increasingly infected and about 90% of these are in sub-Saharan Africa. The same trend can be identified in South Africa, which has one of the highest incidences and prevalence rates of HIV/AIDS in the world with 5-6 million people living with HIV/AIDS. Women of childbearing age constitute 55% of all HIV positive adults and a quarter of pregnant women (28%) in South Africa are HIV positive. The HIV/AIDS epidemic is overburdening hospital systems and it will continue to grow within the context of already massively overstretched public resources. This increase also impacts on health services in the North West Province which are facing an alarming increase in mothers and babies living with HIV/AIDS. One of the strategies that are implemented to reduce maternal deaths is the Prevention-of-Mother-to-Child Transmission (PMTCT) Programme and massive roll out of Antiretrovirals during puerperium. One of the goals of the PMTCT programme is to prevent transmission of HIV/AIDS from mothers to babies and reduce child, perinatal and neonatal morbidity and mortality. This strategy is integrated with Non-Governmental Organizations (NGOs) and community-based organizations (CBOs) in care of mothers and babies living with HIV/AIDS during puerperium. Successful implementation of this programme requires social support and community involvement because of short hospitalization during the postnatal period. Caregivers are trained to perform various tasks and fulfil certain roles due to lack of human resources. Caregivers implementing the PMTCT programme experience problems which lead to stress and one of the causes of this stress manifests in feelings of inadequacy and isolation. They are faced with problems pertaining to mothers not adhering to treatment, and poverty is an additional source of stress as it negatively affects the quality of the PMTCT services they need to provide. This research was conducted in the Bojanala region, Rustenburg Sub-District of the North West Province in South Africa. A descriptive, exploratory, qualitative research design was utilized to explore and describe the lived experiences of caregivers while implementing the PMTCT programme as well as perceptions of health workers coordinating the PMTCT programme in order to gain a more thorough understanding of the support needed by caregivers during puerperium. Two populations were used. In population one, purposive sampling was used to select caregivers. In population two inclusive sampling was used to select health workers. In-depth interviews were conducted with both populations with the aim to collect data. From the research findings similarities were identified between the two populations regarding support, namely: (a) Caregivers need personal support in the form of counselling as well as support networks to enable them to deal with the problems they are faced with. (b) Caregivers need financial support to afford basic essentials and better remuneration to meet their financial needs. (c) Caregivers need to be trained in areas in which they lack knowledge -continued development and empowerment is essential. They also need to be trained specifically in PMTCT and they need a PMTCT consultant to always be available to support them. (d) Improvement of the PMTCT services by providing transport to follow up mothers, protective resources to protect themselves against infections as they are at risk of infections, water is essential as a basic human right, provision with food parcels to mothers who are poverty stricken and the PMTCT health services to be intensified from the antenatal period. (e) Management to establish a caring environment by displaying a caring attitude, respecting them and providing them with rewards to improve morale and performance. Recommendations were made for the fields of nursing education, nursing research and community health practice with recommendations to establish a structure of support for caregivers to enhance the PMTCT programme during puerperium. These recommendations were discussed under the five themes presented above. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2010.

225 leaves printed on single pages, preliminary pages i- xxiii and numbered pages 1-203. Includes bibliography, list of abbreviations, list of definitions, list of tables and figures and list of appendices. / Digitized at 330 dpi color PDF format (OCR), using KODAK i 1220 PLUS scanner. / Thesis (MNutr (Interdisciplinary Health Sciences))--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: "A comprehensive package of care for the Prevention of Mother- To-Child Transmission (PMTCT) of HIV" states that all mothers participating in the PMTCT Programme should receive education that will enable them to make informed decisions about infant feeding options. Rapid, same-day HIV testing and results that are available immediately, enable health care workers to be responsible for providing pre- and post-test counselling (which includes infant feeding options) on the same day. This could place a tremendous workload and time pressure on the health care workers. The aim of this study was to determine how "informed" is the literate mother's decision regarding infant feeding options, who participated in the PMTCT Programme, in the Gert Sibande District, Mpumalanga, South Africa. Method: Data was collected from health care workers and mothers on the PMTCT Programme at 23 PMTCT sites in the Gert Sibande District, with the help of 6 field workers and the PMTCT site manager at each PMTCT site, by means of once-off, self-administered questionnaires, which had been previously tested and validated. Results: Health care workers' attitude towards the PMTCT Programme was positive, although some (14%) indicated that what was expected of them was not achievable in their working environment. The most prominent change relating to the personal preferences of health care workers regarding infant feeding options for HIV-infected mothers, after attending the 5-day PMTCT course, was from formula-feeding to breast-feeding. Most (65%) indicated it was possible to stay neutral in a counselling session regardless of personal preference for infant feeding and 60% of those who could not stay neutral, still thought it was in the mother's best interest to be counselled by them. Most (98%) agreed mothers had the right to make informed decisions and 80% agreed mothers were able to make such a decision. Most (67%) health care workers indicated that not enough staff was stationed at PMTCT sites, only 53% used the feeding option cards when counselling mothers and indicated that more educational material was needed. Sixty one percent of the health care workers demonstrated the preparation of the formula to the mothers and allowed the mothers to demonstrate back to them. Between 49-82% and 37-56% of the health care workers knew the correct answers to knowledge questions relating to breastfeeding and formula-feeding, respectively. Not one health care worker, nor mother, knew all the steps in preparing a formula feed. Most (80%) mothers made decisions based on information provided to them by health care workers and only a small (13%) percentage were influenced by the community to practise a different feeding option than what they had chosen. Conclusions: The attitude, personal preferences, knowledge of and resources available to health care workers, influenced the decision made by mothers regarding infant feeding options and seeing that most mothers made their decision, based on information provided by health care workers, it is concluded that mothers can only make an informed decision about infant feeding options if they are advised appropriately by well trained, equipped and informed health care workers. / AFRIKAANSE OPSOMMING: "A comprehensive package of care for the Prevention of Mother-To-Child Transmission of HIV", vermeld dat moeders, wat deelneem aan die Voorkoming van Moeder-Tot-Kind Oordrag (VMTKO) progam, voorligting behoort te ontvang ten opsigte van voedingsopsies vir hul babas, sodat hulle in staat sal wees om 'n ingeligte keuse te maak. Gesondheidswerkers is verantwoordelik om voorligting voor en na die HIV toets te gee, wat die voedingsopsies vir babas insluit, op dieselfde dag. Dit kan 'n ontsaglike werkslading op die gesondheidswerkers plaas. Die doel van die studie was om te bepaal hoe "ingelig" is die geletterde moeder se keuse ten opsigte van voedingsopsies, wat deelneem aan die VMTKO program, in die Gert Sibande distrik, Mpumalanga, Suid-Afrika. Metode: Die data is ingesamel by 23 VMTKO-klinieke en -hospitale in die Gert Sibande distrik onder gesondheidswerkers en moeders op die VMTKO-program, met behulp van 6 veldwerkers en VMTKO-bestuurders, deur middel van eenmalige, selfvoltooide vraelyste, wat van tevore getoets en gevalideer was. Resultate: Die gesondheidswerkers se houding teenoor die VMTKO-program was positief, alhoewel 14% aangedui het dat wat van hulle verwag word nie prakties of moontlik is in hul werksomgewing nie. Die prominentste verandering rakende die persoonlike voorkeure van die gesonheidswerkers teenoor voedingsopsies vir HIV -geinfekteerde moeders, na die 5-dag VMTKO kursus, was van formulevoeding na borsvoeding. Meeste (65%) het aangedui dit is moontlik om neutraal te bly gedurende 'n voorligtingssessie, ten spyte van persoonlike voorkeure vir voedingsopsies en 60% van die wat nie neutraal kon bly nie, het steeds gedink dit is in die beste belang van die moeder om deur hulle voorgelig te word. Meeste (98%) het saamgestem dat dit die moeder se reg is om 'n ingeligte keuse te maak en 80% het saamgestem dat die moeder wel in staat is om so 'n besluit te neem. Meeste (67%) gesondheidswerkers het aangedui dat personeel tekorte bestaan by die VMTKO klinieke en hospitale. Slegs 53% gebruik die voedingsopsie kaarte gedurende 'n voorligtingsessie met die moeder en het aangedui dat meer voorligtingsmateriaal benodig word. Een en sestig persent van die gesondheidswerkers het die voorbereiding van die formulevoeding aan die moeders gedemonstreer en het moeders toegelaat om ook die demonstrasie te doen. Nege en veertig tot twee en tagtig persent en 37-56% van die gesondheidswerkers kon die korrekte antwoorde verskaf vir vrae oor borsvoeding en formulevoeding, afsonderlik. Nie een gesondheidswerker of moeder kon al die stappe vir die voorbereiding van die formulevoeding noem nie. Meeste (80%) moeders maak keuses gebaseer op inligting wat aan hulle verskaf word deur die gesondheidswerkers en slegs 'n klein persentasie (13%) word beinvloed deur familielede om die teenoorgestelde voedingsopsie te praktiseer as wat hulle gekies het. Gevolgtrekking: Die houding, persoonlike voorkeure, kennis van en hulpbronne beskikbaar aan die gesongheidswerkers, beinvloed die besluit wat moeders neem ten op sigte van voedingsopsies en aangesien die moeders hulle besluit baseer op inligting wat deur die gesondheidswerkers aan hulle gegee word, word die gevolgtrekking gemaak dat moeders slegs 'n ingeligte keuse aangaande voedingsopsies kan maak indien hulle voorligting ontvang deur goed opgeleide en ingeligte gesondheidswerkers.