The purpose of this study was to review the evidence linking maternal and paternal lifestyle habits in the preconception and prenatal period to adverse reproductive outcomes; to determine either the proportion of reproductive casualties which could be attributed to lifestyle risk, thus be amenable to prevention, or the information required to estimate the preventable portion of lifestyle-related reproductive casualties; and to examine a method for surveillance of reproductive health in the community which would provide the basis for a comprehensive information system suited to the needs of the research, planning, preventive medicine and health promotion communities. As a means of managing the size of the study report, only a representative set of lifestyles (smoking, alcohol consumption and nutrition) and research literature (major cohort and case-control studies in human populations) was reported in detail. A method was developed to review and describe the degree to which the evidence meets established criteria for causal association. The most recently available prevalence data for determining smoking, alcohol and nutritional risk, and incidence data for seven reproductive outcomes (infertility, spontaneous abortion, stillbirth, infant mortality, congenital anomalies, fetal growth and morbidity) in the British Columbia population were used to calculate the preventable portion of reproductive casualties in this community. A review of the variables required, compared with the data available, provided the basis for recommendations regarding a reproductive health information system to support community surveillance, evaluation and research. The study supports the conclusion that there is evidence of a causal link between exposure to lifestyle risks and the majority of adverse reproductive outcomes selected as indicators of reproductive health. The calculation of the preventable portion (etiologic fraction) of lifestyle-related reproductive casualties in British Columbia suggests the preventable portion associated with single lifestyle risk variables may be in the range of 10-50 percent. A more extensive and up-to-date set of population data for British Columbia is required to determine an accurate estimate. The benefits to be derived from an improved information system were detailed in the study. Reproductive health data collected for British Columbia is primarily outcome oriented with very little input data on which to base rational planning decisions for the improvement of reproductive health outcomes. The study recommends that a more comprehensive reproductive health information system, with an integrated, linked data base, be considered a high priority by government and all institutions, agencies and individuals working to improve reproductive health outcomes in British Columbia. The potential to improve reproductive health is significant enough to warrant action at the clinical and community level, but additional data are required to plan cost-effective intervention strategies, to monitor improvements in reproductive health, and to support applied research initiatives. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Tong, Yan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 66-78). / Abstracts in English and Chinese; includes Chinese. / Acknowledgements --- p.i / Conferences & Academic Awards --- p.ii / Table of contents --- p.iii / List of figures --- p.vii / List of tables --- p.viii / List of abbreviations --- p.ix / Abstract --- p.x / Abstract (Chinese) / Chapter Chapter I --- Background of diabetes mellitus and DM complicating pregnancy …… --- p.1 / Chapter 1.1 --- Definitions and clinical manifestations of Diabetes Mellitus --- p.1 / Chapter 1.2 --- Diagnostic criteria of DM --- p.1 / Chapter 1.3 --- Classification of DM --- p.1 / Chapter 1.4 --- Prevalence of DM --- p.2 / Chapter 1.5 --- Aetiology and Pathogenesis of DM --- p.3 / Chapter 1.6 --- Treatment of DM --- p.3 / Chapter 1.7 --- Complications of DM --- p.4 / Chapter 1.8 --- DM complicating pregnancy --- p.4 / Chapter 1.8.1 --- Implications of DM complicating pregnancy --- p.4 / Chapter 1.8.2 --- Diabetic Embryopathy --- p.5 / Chapter 1.8.3 --- Incidences of the major congenital anomalies --- p.5 / Chapter 1.8.4 --- Possible pathogenesis of congenital anomalies in DM complicating pregnancy --- p.6 / Chapter 1.8.4.1 --- Apoptosis --- p.6 / Chapter 1.8.4.2 --- Oxidative stress --- p.7 / Chapter 1.8.4.3 --- Arachidonic acid and PGE2 --- p.7 / Chapter 1.8.5 --- Clinical management of DM complicating pregnancy --- p.8 / Chapter 1.8.5.1 --- Pre-pregnancy care --- p.8 / Chapter 1.8.5.2 --- Antenatal management of DM complicating pregnancy --- p.9 / Chapter Chapter II --- Background of Traditional Chinese Medicine in treatment of DM --- p.10 / Chapter 2.1 --- Definition and manifestations of DM in TCM theory --- p.10 / Chapter 2.2 --- Historical context of DM in TCM --- p.10 / Chapter 2.2.1 --- "Spring and Autumn Period and Warring States Period (770 B.C.一8 A.D.): The first nomenclature of ""Wasting Thirst""" --- p.10 / Chapter 2.2.2 --- "Han Dynasty (9 A.D.-280 A.D.)： monograph on ""Wasting Thirst""" --- p.11 / Chapter 2.2.3 --- "Sui and Tang Dynasty (581 A.D.-960 A.D.)： the diagnosing marker of ""Wasting Thirst""" --- p.11 / Chapter 2.2.4 --- Song Dynasty (960 A.D.-1270 A.D.): the Golden Time of developing the treatment on DM --- p.12 / Chapter 2.2.5 --- Ming and Qing Dynasty (1270 A.D. - 1911 A.D.): the integration period of TCM theory on DM --- p.15 / Chapter 2.3 --- Aetiology of DM in TCM theory --- p.15 / Chapter 2.3.1 --- Congenital weakness --- p.16 / Chapter 2.3.2 --- Improper diet --- p.16 / Chapter 2.3.3 --- Emotional disorders and overstrain --- p.17 / Chapter 2.3.4 --- Excessive sexual activities --- p.17 / Chapter 2.4 --- Pathogenesis of DM in TCM theory --- p.17 / Chapter 2.5 --- Prognosis of DM in TCM theory --- p.19 / Chapter 2.5.1 --- """Dual Qi-Yin Deficiency"" and ""Dual Yin-Yang Deficiency""" --- p.19 / Chapter 2.5.2 --- "Multi-systemic malfunction of ""Zang Fu""" --- p.19 / Chapter 2.6 --- Principle of treatment --- p.20 / Chapter 2.7 --- Commonly used herbal remedies and recent experimental studies --- p.20 / Chapter 2.8 --- TCM on relieving DM complications --- p.21 / Chapter 2.9 --- "Dwarf Lilyturf Tuber (Ophiopogonis Radix, Mai Dong,麥冬）" --- p.21 / Chapter 2.10 --- Objectives and hypothesis --- p.22 / Chapter 2.10.1 --- Objectives --- p.22 / Chapter 2.10.2 --- Hypotheses --- p.23 / Chapter Chapter III --- Methodology and Results --- p.24 / Chapter 3.1 --- Set up of mouse embryos --- p.24 / Chapter 3.1.1 --- Mouse strain --- p.24 / Chapter 3.1.2 --- Research animal ethnics and care guidelines --- p.24 / Chapter 3.1.3 --- Mouse sacrifice and embryo dissection --- p.24 / Chapter 3.1.4 --- Grouping of embryos --- p.25 / Chapter 3.2 --- Preparations of D-glucose --- p.25 / Chapter 3.3 --- Chinese medicine quality controls and preparations --- p.25 / Chapter 3.4 --- Whole mouse embryo culture --- p.26 / Chapter 3.5 --- Morphological scoring on mouse embryos and statistical analysis --- p.27 / Chapter 3.6 --- Establishment of cranial NTD by D-glucose --- p.28 / Chapter 3.6.1 --- Dosage of D-glucose to induce cranial NTD --- p.29 / Chapter 3.6.2 --- Result --- p.30 / Chapter 3.7 --- Experimental designs --- p.31 / Chapter 3.8 --- Part I: Efficacy and dose-response effects of Maidong extract --- p.32 / Chapter 3.8.1 --- Safety dose of Maidong extract on non-diabetic mouse embryos --- p.32 / Chapter 3.8.1.1 --- Dosage --- p.32 / Chapter 3.8.1.2 --- Result --- p.35 / Chapter 3.8.2 --- Efficacy and dose-effect response of Maidong extract on non-diabetic mouse embryos --- p.36 / Chapter 3.8.2.1 --- Dosage and grouping --- p.37 / Chapter 3.8.2.2 --- Result --- p.38 / Chapter 3.9 --- Part II: Efficacy and dose-response effects of serum from Maidong extract-treated rat serum --- p.40 / Chapter 3.9.1 --- Preparation of Maidong treated non-diabetic full rat serum --- p.41 / Chapter 3.9.1.1 --- Rats --- p.41 / Chapter 3.9.1.2 --- Dosage for feeding --- p.41 / Chapter 3.9.1.3 --- Administration --- p.42 / Chapter 3.9.1.4 --- Termination of rats and preparation of rat serum --- p.42 / Chapter 3.9.2 --- Safety dose of Maidong treated non-diabetic full rat serum non-diabetic mouse embryos --- p.43 / Chapter 3.9.2.1 --- Dosage --- p.43 / Chapter 3.9.2.2 --- Result --- p.44 / Chapter 3.9.3 --- Protective Effect of Maidong extract-treated full rat serum --- p.46 / Chapter 3.9.3.1 --- Dosage and grouping --- p.46 / Chapter 3.9.3.2 --- Result --- p.47 / Chapter 3.10 --- "Part III: Efficacy and dose-response effects of Ophiopogonin D, a major chemical component of Maidong in preventing hyperglycemia-induced cranial neural tube defect" --- p.49 / Chapter 3.10.1 --- Safety dose of Ophiopogonin D --- p.50 / Chapter 3.10.1.1 --- Preparation of Ophiopogonin D --- p.50 / Chapter 3.10.1.2 --- Dosage --- p.50 / Chapter 3.10.1.3 --- Results --- p.52 / Chapter 3.10.2 --- Efficacy and dose-response effects of Ophiopogonin D --- p.53 / Chapter 3.10.2.1 --- Dosage and grouping --- p.53 / Chapter 3.10.2.2 --- Results --- p.55 / Chapter Chapter IV --- Discussion --- p.58 / Chapter 4.1 --- Whole embryo culture system --- p.58 / Chapter 4.2 --- Quality control of Maidong extract --- p.58 / Chapter 4.3 --- "Therapeutic effect of single herb, formula and chemical components" --- p.59 / Chapter 4.4 --- Dosage of D-glucose to induce cranial NTD --- p.60 / Chapter 4.5 --- Dosage and efficacy of Maidong extract and Ophiopogonin D --- p.60 / Chapter 4.6 --- Administration of Maidong extract to non-diabetic female rats --- p.61 / Chapter Chapter V --- Conclusions --- p.63 / Chapter Chapter VI --- Future Study --- p.64 / References --- p.66

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.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The availability and provision of good antenatal care services ensure early detection and prompt management of any complication or disease that may adversely affect pregnancy outcome. To ensure high quality care, an ongoing health education and empowerment of pregnant women with pregnancy related information, need to be provided by midwives throughout pregnancy. The purpose of this study, therefore, was to explore the pregnant women`s experiences and perceptions regarding health education given during the antenatal period. The objectives set were to - explore the content of the health education given to pregnant women by midwives during the antenatal period - determine whether the health education offered by midwives is understood by pregnant women - determine whether information regarding Health Education during antenatal period is applicable and is used by pregnant women. A qualitative approach with an explorative descriptive design was applied for the purpose of this study. The population included pregnant women who attended an antenatal clinic for the second time in 2012. Ten pregnant women were selected purposively who consented to participate in the study. The trustworthiness of this study was assured by using Lincoln and Guba`s criteria of credibility, transferability, dependability and confirmability. A pretest was done with one participant not included in the actual study. Ethics approval was obtained from the Ethics Committee of the Faculty of Medicine and Health Sciences at Stellenbosch University, reference: S12/05/136. Informed written consent was obtained from each participant which included a recording of the interview. Data was collected through semi-structured interviews using an interview guide and a tape recorder. The researcher approached two women per day for five days. A total of ten (10) pregnant women were interviewed until data saturation reached. The use of Tesch's eight steps of data analysis was used to analyse the transcribed data as described in De Vos et al. (2004:331). Findings revealed that health education was given to pregnant women at the institution under study but with minimum explanations. The midwives were perceived as supportive and regarded as a source of information and self-care agents. Antenatal attendance was regarded as important by participants. Participants indicated that their unborn babies were monitored by the midwives in order to detect abnormalities early. However, midwives emphasised non-pregnancy related complications specifically HIV/AIDS and neglected to give basic antenatal care, such as antenatal exercises, personal hygiene and diet. Language was found to be a barrier and contributed to a lack of information. Recommendations include basic antenatal aspects to be covered in the health education, such as emphasis on personal hygiene, exercises, diet and avoidance of harmful sociocultural practices. With the implementation of appropriate teaching principles language, age and involvement of influential people during health education should be considered. In conclusion, to reduce maternal morbidity and mortality rates and promoting self-care reliance, antenatal care services should be accessible to facilitate ongoing health education by midwives throughout pregnancy. / AFRIKAANSE OPSOMMING: Die beskikbaarheid en voorsiening van goeie voorgeboortesorgdienste verseker die vroeë en vinnige bestuur van enige komplikasie of siekte wat swangerskap-uitkomste nadelig mag beïnvloed. Om hoë gehalte sorg te verseker, moet gesondheidsvoorligting en bemagtiging van swangervroue rakende swangerskap inligting deurlopend deur vroedvroue verskaf word. Die doel van hierdie studie was om vervolgens die swangervrou se ervaringe en persepsies ten opsigte van gesondheidsopvoeding gedurende die voorgeboortelike stadium te ondersoek. .Die doelwitte soos gestel was om: - die inhoud van die gesondheidsvoorligting wat deur vroedvroue gedurende die voorgeboorte periode aan swangervroue verskaf word, te ondersoek - te bepaal of die gesondheidsvoorligting wat verskaf word deur vroedvroue deur swangervroue verstaan word - vas te stel of die ligting aan swangervroue gepas is en te bepaal of dit toegepas word deur swangervroue. ’n Kwalitatiewe benadering met ’n beskrywende ontwerp is vir die doel van hierdie studie toegepas. Die populasie het swangervroue ingesluit wat ’n voorgeboortekliniek vir die tweede keer gedurende 2012 besoek het. Tien vrouens is doelgerig geselekteer wat daartoe ingestem het om aan die navorsing deel te neem. Die betroubaarheid van hierdie studie was verseker deur van Lincoln en Guba se kriteria van geloofwaardigheid, oordraagbaarheid, betroubaarheid en bevestigbaarheid gebruik te maak. ’n Loodsondersoek was met een deelnemer wat nie in die werklike studie ingesluit was nie, gedoen. Etiese goedkeuring is verkry van die Etiese Komitee van die Fakulteit van Geneeskunde en Gesondheidswetenskappe aan die Universiteit van Stellenbosch, verwysing: S12/05/136. Ingeligte skriftelike toestemming is verkry van elke deelnemer wat ook ’n opname van die onderhoud ingesluit het. Data is ingesamel deur van semi-gestruktureerde onderhoude gebruik te maak met behulp van ’n onderhoudsgids en ’n bandopnemer. Die gebruik van Tesch se ag stappe van data-analise is gebruik om die getranskribeerde data te analiseer (De Vos et al., 2004:331). Bevindinge het getoon dat gesondheidsvoorligting wel aan swangervroue by die inrigting onder die soeklig met die minimum verduidelikings verskaf is. Die vroedvroue is as ondersteunend en as ’n bron van inligting, asook as selfsorgagente waargeneem. Voorgeboorte bywoning is as belangrik deur deelnemers gesien. Deelnemers het aangedui dat hulle ongebore babas gemonitor is deur vroedvroue om abnormaliteite vroeg op te spoor. Nietemin, vroedvroue het nie-verwante swangerskap komplikasies, spesifiek MIV/VIGS beklemtoon en het nagelaat om aandag te gee aan basiese voorgeboortesorg soos voorgeboorte oefeninge, persoonlike higiëne en dieet. Daar is bevind dat taal ’n hindernis is en dat dit bygedra het tot ’n gebrek aan inligting. Aanbevelings sluit in basiese voorgeboorte aspekte wat gedek moet word in gesondheidsvoorligting, soos die beklemtoning van persoonlike higiëne, oefeninge, dieet en die vermyding van nadelige sosio-kulturele praktyke. Met die implimentering van doeltreffende onderrigbeginsels moet taal, ouderdom en die betrokkenheid van invloedryke mense gedurende gesondheidsvoorligting in ag geneem word. Ten slotte, om moeder-morbiditeit en-mortaliteitsyfers te verminder en selfsorgvertroue te bevorder, behoort voorgeboortesorgdienste toeganklik te wees, sodat vroedvroue volgehoue gesondheidsvoorligting tydens swangerskap kan fasiliteer.

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)