Thesis (M.Cur.) --University of Limpopo, 2011 / Introduction and aim: Globally it is of paramount importance that all pregnant women in labour are monitored by midwives utilizing a partograph so that a live baby is delivered. Midwives seemed not to utilize the partograph correctly when monitoring women in labour. The purpose of this study was to determine the utilization of the partograph by midwives in the labour wards of Lebowakgomo and Zebediela level 1 hospitals in the Capricorn District of the Limpopo Province, South Africa. The research question was, “What skills and knowledge do midwives have on the utilization of the partograph for monitoring pregnant women in labour”. The objectives of this study were to explore and describe the utilization of the partograph by midwives in Lebowakgomo and Zebediela level 1 hospitals in the Capricorn District of the Limpopo Province, and to develop guidelines that would assist midwives to effectively utilize the partograph hence provision of quality midwifery care. Research Design and method: The research design was qualitative, descriptive, explorative and contextual in nature. The population comprised all midwives registered with the South African Nursing Council and practicing as such in Lebowakgomo and Zebediela level 1 hospitals. A purposive sampling technique was used to select 15 participants. Data were collected using semi-structured in–depth interviews with a guide. The semi-structured in-depth interviews were conducted until data were saturated. Trustworthiness was ensured by credibility, dependability, transferability and confirmability. Ethical clearance to conduct the study was obtained from the University of Limpopo and from the Department Health and Social Development. The principles of informed consent, confidentiality and anonymity were observed during the study. Data were analyzed using the Tesch’s approach as described by Creswell (1994) cited in de Vos (2005:333). Conclusions: The following themes emerged during data analysis: monitoring of foetal status during intrapartum, monitoring of the progress of labour during intrapartum, monitoring of the maternal status during intrapartum, and shortage of staff in the labour wards. Guidelines which aimed at improving midwifery care were formulated.

Background: Concerns have been well documented about women either dying or developing severe morbidities from prolonged and obstructed labour. These concerns have noted that maternity care during labour has not been of a sufficient standard to improve the outcome for women giving birth in Malawi. This ‘failure to save’ women remains, despite assertions that obstructed and prolonged labour can be prevented through appropriate decision making during the progress and management of labour. Midwives in Malawi form the majority of maternity healthcare workers and an important aspect of their decision-making role is to assess the progress of labour when caring for women in labour. To date, there has been limited exploration of either midwifery decision making during labour or the contextual factors that influence midwives’ decision making. The aim of this study was to explore how Malawian midwives make decisions during the first stage of labour in a hospital setting and to identify the contextual factors that influence their decision making. Design and Method: Using a qualitative ethnographic research approach, 27 participant observations, 26 follow-up interviews and document reviews comprised the data collection. Nine Malawian nurse-midwives who worked at a tertiary (n=5) and a secondary referral hospital (n=4), with a mixture of qualifications and experiences, participated. Each nurse midwife was observed three times with subsequent follow-up interviews. Interviews were conducted in a vernacular language, audio-taped, transcribed, translated into English and back translated into vernacular language. Qualitative data analysis software, NVivo 10, was used to assist with data management for the analysis. All data was analysed using the principle of theme and category formation. Findings: Three major themes were identified - contextual factors influencing midwifery decision making - the role of cue acquisition - the role of the partograph during care of women in the first stage of labour. Integration of the themes has led to the development of a proposed conceptual model of ‘supporting normality’ during the first stage of labour, which suggests that the midwives strived to make decisions during the care of women in labour with the aim of supporting the normal physiological processes of labour. The first theme illustrates that for Malawian midwives, decision making is a complex and contextually dependent undertaking. In everyday practice, decision making was influenced by multiple and competing factors but the midwives developed strategies to manage and control the context of their practice and facilitate decision making. The role of cue acquisition comprised a six-stage subprocess illustrating the ways in which midwives utilise assessment data to reason and make decisions during the care of women in labour. These processes involved the midwives building a case for each woman’s labour progression by piecing together segments of information they obtained. This process was striking when there was uncertainty in a woman’s progress of labour as they used deductive thinking by cross-checking data obtained across the labour progression span. There was a constant forward and backward moving of thought processes supported by actions that uncovered real case-building evidence for informing decisions about whether to intervene or not. The model further indicates the role of the partograph, which alerted midwives to the presence of progress or non-progress of labour. Although the partograph acted as an adjunct to the midwives’ decision making that could indicate opportunities for early intervention in labour if labour appeared not to be progressing, the midwives were sometimes cautious about its interpretation. This thesis has expanded on current theoretical knowledge of decision making by elaborating on the processes midwives employ to make decisions as they care for women in labour. It also illuminates the impact of contextual factors on decision making, and elucidates various strategies midwives use to advance their professional role. The emerging conceptual model provides implications for future midwifery practice, education and policy both in Malawi and worldwide.

A constante evolução da tecnologia em saúde permite diagnósticos clínicos cada vez mais rápidos e precisos, porém eles não são isentos de danos. Conhecer e calcular a capacidade preditiva de classificadores de risco é um passo fundamental no desenvolvimento de políticas de saúde e na criação de protocolos clínicos. O processo de avaliação de um teste diagnóstico normalmente tem início com o preenchimento da tabela de contingência. Testes diagnósticos com elevado número de falso positivos geram ansiedade, exames adicionais e tratamentos desnecessários. Testes diagnósticos com elevado número de falso negativos podem contribuir para demoras desnecessárias no tratamento de uma possível doença, podendo dificultar sua cura. A partir da experiência adquirida com a análise da capacidade preditiva do partograma da OMS, esta tese apresenta o desenvolvimento de um novo indicador de capacidade preditiva e diagnóstica de testes. Justifica-se este novo desenvolvimento pela necessidade de simplificar, integralizar e exibir de forma conjunta os principais parâmetros necessários à avaliação da capacidade preditiva e diagnóstica de testes. A avalição dos partogramas de 9.995 mulheres da Nigéria e Uganda mostrou que a linha de alerta deste instrumento possui uma baixa capacidade diagnóstica como preditor para desfechos adversos graves no trabalho de parto. A partir desses e outros resultados, em fevereiro de 2018 a OMS recomendou mudanças no partograma. Com isso, foi explorado o uso do gráfico-radar como uma ferramenta para facilitar a comunicação dos parâmetros já existentes utilizados na avaliação da capacidade diagnóstica dos testes. Sete documentos com diretrizes em saúde materna publicados pela OMS entre os anos de 2016 a 2018 foram utilizados nesse processo. Utilizando o cálculo da área inscrita do gráfico-radar apresenta-se também um novo indicador integrativo para avaliação da capacidade preditiva de testes diagnósticos, o Índice de Máxima Acurácia (IMA) / The constant evolution of health technology allows for faster and more accurate clinical diagnoses, but they are not harmless. Knowing and calculating the predictive capacity of risk classifiers is a fundamental step in the development of health policies and in the creation of clinical protocols. The process of evaluating a diagnostic test usually begins with the completion of the contingency table. Diagnostic tests with high false positives generate avoidable distress, additional tests and unnecessary treatments. Diagnostic tests with high false negatives may contribute to unnecessary delays in the treatment of a possible disease. Based on the experience gained with the analysis of predictive capacity of the WHO partograph, this thesis presents the development of a new indicator of predictive and diagnostic capacity of tests. This new development is justified by the need to simplify, integrate and display together the main parameters necessary for the evaluation of the predictive and diagnostic capacity of tests. The assessment of the partographs of 9,995 women from Nigeria and Uganda showed that the alert line of this instrument has a low diagnostic capacity as a predictor for serious adverse outcomes in labor. From these and other results, in February 2018 the WHO recommended changes in the partograph. The use of the radar chart was explored as a tool to facilitate the communication of the existing parameters used in the evaluation of the diagnostic capacity of the tests. Seven documents with guidelines on maternal health published by WHO between 2016 and 2018 were used in this process. Using the calculated area of the radar chart, a new integrative indicator for the predictive capacity of diagnostic tests, the Index of Maximum Accuracy (IMA), is also presented

Magister Curationis - MCur / The present study examined the extent of utilization of partogram among nurses and midwives in Rwamagana health facilities located in the eastern province of Rwanda. The study specifically sought to; assess knowledge and use of partogram among nurses and midwives in Rwamagana health facilities, to identify the challenges facing nurses and midwives with regards to the utilization of partogram in the health facilities and to determine factors influencing the use of partogram among nurses and midwives in Rwamagana health facilities. Patricia Benner’s model of nursing practice was used to guide this study

This study aimed to assess the magnitude, trends and determinants of intrapartum stillbirths in the public health facilities in Addis Ababa. A case-control study design was used along with quantitative data collection methods. Obstetric care data on key variables were collected from medical records of 728 cases and 1551 controls in the public health facilities during July 1, 2010 and June 30, 2015. Data were analysed using SPSS version 24 to determine associations and risk factors against intrapartum stillbirth. HMIS data from different sources were further analysed for the same period to determine trends of stillbirth in the public health facilities of Addis Ababa. Findings from this study showed a staggering high prevalence of stillbirth at an average rate of 28 per 1000 births during the period 2010-2015. This figure was comparable with the population level prevalence of prenatal death in Addis Ababa which was 30 per 1000 birth (Central Statistical Agency 2011:115). No statistically significant associations were revealed against the effects of maternal medical conditions including diabetes, hypertension, cardiac and renal diseases and key socio-demographic variables including age, parity and marital status, and intrapartum stillbirth. On the contrary, HIV and syphilis infections, foetal presentations, multiple pregnancy and the frequency of ANC visits during the index pregnancy had statistically significant associations with intrapartum stillbirth. Furthermore, low FHR, non-vertex foetal presentations and ruptured cervical membrane on admission to labour were among risk factors for intrapartum stillbirth. Similarly, women in the stillbirth group received substandard care regarding the timely assessment of foetal decent, cervical dilatation, labour induction, and episiotomy care compared to women in the livebirth group. Obstetrical complications including obstructed labour, eclampsia and preeclampsia were more common among women in the intrapartum stillbirth group indicating that the above variables were key determinant of intrapartum stillbirth. These findings suggest that poor quality of obstetric care during labour and childbirth were the underlying risk factors for intrapartum stillbirth. In conclusion, strategies to overhaul the obstetric care practices in the public health facilities through skills building, accurate use of labour monitoring tools, close supervisions, accurate classification of stillbirth, proper documentation, and ongoing research efforts. / Health Studies / D. Litt. et Phil. (Health Studies)

Text in English with abstracts in English, Northern Sotho, Tshivenda and Xitsonga / The purpose of this study was to determine the self-reported competence of newly qualified professional nurses on the critical midwifery skills. The study was conducted in the four public hospitals designated for community service in Gauteng Province. A quantitative descriptive design was used with a structured self-report questionnaire as data collection instrument. Non-probability convenience sampling was used for the study. The sample size was eighty-four newly qualified professional nurses. The Stata 15 software was used for statistical analyses. The researcher used descriptive statistics to describe and synthesize the collected data. The findings revealed that most newly qualified professional nurses had no knowledge in identifying different types of decelerations, management of late and variable decelerations, but had knowledge in most of the skills related to management of third stage of labour. / Maikemišetšo a dinyakišišo tše e be e le go hwetša bokgoni bja go ipega ka nnoši bja baoki bao ba ithutetšego profešene ya booki ka go bokgoni bjo bohlokwa bja pelegišo. Dinyakišišo di dirilwe dipetleleng tše nne tša bohle tšeo di kgethetšwego tirelo ya setšhaba ka Profenseng ya Gauteng. Khwanthitheitif diskriptif disaene ‘Quantitative descriptive design’ e dirišitšwe gammogo le lenaneopotšišo leo le beakantšwego la go ipega ka nnoši ‘structured self-report questionnaire’ bjalo ka sedirišwa sa go kgoboketša bohlatsi. “Non-probability convenience sampling” e dirišitšwe mo go kgetheng banyakišišwa. Bogolo bja sešupo e be e le baoki ba masomeseswai-nne ba baswa bao ba ithutetšego profešene ya booki. “Stata 15 software” e dirišitšwe tshekatshekong ya dipalopalo. Monyakišiši o dirišitše dipalopalo tša tlhalošo ‘descriptive statistics’ go hlaloša le go kopanya ‘data’ yeo e kgobokeditšwego. Ditšweletšo di utollotše gore bontši ba baoki ba baswa bao ba ithutetšego profešene ya booki ga ba na le tsebo ya go hlatha mehuta yeo e fapanego ya diphokotšo, taolo ya diphokotšo tša morago le tša go fetoga, efela ba na le tsebo ka go bokgoni bjo bontši bjoo bo amanago le taolo ya kgato ya boraro ya lešoko. / Ndivho ya ngudo iyi yo vha u wanulusa nḓivho ya vhukoni ha iwe muṋe ya vhaongi vhaswa vha kha ḓi bvaho u phasa vhuongi uri vha na zwikili zwa ndeme zwa vhuongi vhubebisi u swika ngafhi. Ngudo iyi yo itwa kha zwibadela zwiṋa zwa muvhuso zwo ṋewaho u isa tshumelo zwitshavhani kha vunḓu ḽa Gauteng. Kha u kuvhanganya mafhungo muṱoḓisi o shumisa ngona ya u ṱalutshedza ya khwanthithethivi ho ṱanganyiswa na mbudziso dzo dzudzanyiwaho dzi bviselaho khagala kha iwe muṋe (structured self-report questionnaire). Vhunanguludzi ho shumiswaho kha ngudo iyi ho vha “Non-probability convenience”. Tshivhalo tsha vhashelamulenzhe vho nanguludzwaho tsho vha vhaongi vhaswa vha kha ḓibvaho u phasa vha fumalo ina. “The Stata 15 software” ndi tshishumiswa tsho shumiswaho kha u sengulusa mafhungo o kuvhanganywaho. Muṱoḓisisi o shumisa zwisiṱatisitika zwa u ṱalutshedza kha u ṱalutshedza na u dzudzanya mafhungo o kuvhanganyiwaho. Ngudo iyi yo bvisela khagala uri vhunzhi ha vhaongi vhaswa vha kha ḓi bvaho u phasa a vha na nḓivho ya u vhona tshaka dzo fhambanaho dza kurwele kwa mbilu ya ṅwana na u langa u lenga ha u rwa ha mbilu ya ṅwana zwo katela na u sa dzudzanyea fhethu huthihi ha kurwele kwa mbilu ya ṅwana, honeha vha na nḓivho ya zwikili zwi yelanaho na vhulanguli ha tshipiḓa tsha vhuraru tsha u beba. / Xikongomelo xa ndzavisiso lowu i ku kuma vuswikoti lebyi munhu a byi twisisaka hi vaongori lava ha ku thwaselaka tidyondzo ta vuongori eka swikili swa nkoka hi vusungukati. Ndzavisiso lowu wu endliwile eka swibedlhele swa mune swa mani na mani leswi yisaka vukorhokeri evanhwini eka Phurovhinsi ya Gauteng, laha ku tirhisiweke maendlelo ya tinhlayo lama hambanaka na swivutiso ku hlengeleta timhaka. Ku tirhisiwile xiphemu xo karhi xa vanhu ku kuma vuxokoxoko hi mayelano na vona hinkwavo. Xiphemu lexi tirhisiweke i xa nhlayo ya vaongori vo ringana makumenhungu-mune wa vaongori lawa ha ku thwaselaka tidyondzo ta vuongori. Ku tirhisiwile “stata software” ku hlela tinhlayo leti tirhisiweke. Mulavisisi u tirhisile tinhlayo, tinhlayonhlamuselo ku hlamusela no katsakanya mahungu lama a ma hlengeleteke. Leswi kumiweke swi paluxa leswaku vunyingi bya vaongori lava ha ku thwaselaka tidyondzo ta vuongori va hava vutivi byo hambanisa mabelo ya mbilu, ku hlawula ku hlwela no hambana ka mabelo ya mbilu, kambe va na vutivi eka swikili mayelana no lawula xiyimo xa vunharhu xo lumiwa. / Health Studies / M.A. (Nursing)