La grossesse est une période importante dans la vie d’une femme. Celle-ci va subir différents changements (hormonaux et cliniques) et différentes adaptations (neuromécaniques) qui peuvent contribuer au développement de douleurs dans les régions lombaire et pelvienne, aussi appelées douleurs lombo-pelviennes. Cette thèse vise à déterminer quelle est la contribution des facteurs hormonaux, neuromécaniques et cliniques qui contribuent au développement et à l'évolution des douleurs lombo-pelviennes chez la femme enceinte pour éventuellement déterminer quelles sont les approches à adopter en matière de prise en charge de ces douleurs. À l’aide de quatre études (revue intégrative de la littérature, revue narrative, étude de cohorte et étude de faisabilité contrôlée et randomisée), cette thèse a permis de comparer la littérature actuelle avec de nouvelles études et de mettre en lumière les manques encore présents en lien avec ce sujet. La revue intégrative de la littérature a permis de constater que la relaxine (l’hormone la plus étudiée en comparaison à l’oestrogène et la progestérone) ne semble pas être associée au développement ni à l’évolution des douleurs lombo-pelviennes chez les femmes enceintes. La revue narrative présente les changements hormonaux et biomécaniques ainsi que les adaptations neuromusculaires liées à la grossesse qui pourraient jouer un rôle dans le développement des douleurs lombo-pelviennes pendant la grossesse. L’étude de cohorte a montré une augmentation de l'intensité des douleurs lombo-pelviennes et de l'incapacité physique, une augmentation du risque de mauvais pronostic pour la douleur ainsi qu’une diminution du catastrophisme lié à la douleur au fil de la grossesse. Les résultats ont aussi montré une corrélation entre l'incapacité physique et les niveaux d'oestrogènes (premier-deuxième trimestre), ainsi qu'une corrélation entre les niveaux d'oestrogènes et l'intensité de la douleur diurne (deuxième-troisième trimestre). L’étude de faisabilité contrôlée et randomisée a été réalisée auprès de 32 femmes enceintes recrutées sur une période de 14 mois. Parmi elles, 26 (11 dans le groupe d'intervention et 15 dans le groupe contrôle) ont participé à la visite post-intervention (taux de rétention de 81,3 %). Le taux d'observance était similaire pour les séances d'exercices supervisées et non supervisées, bien que l'acceptabilité fût meilleure pour les séances supervisées par rapport aux séances non supervisées. À la rencontre pré-intervention, les caractéristiques des participantes étaient similaires entre les deux groupes, sauf pour le niveau d'éducation (plus élevé dans le groupe contrôle). Les résultats préliminaires n'ont montré aucune différence significative dans la fréquence, l'intensité et l'incapacité physique associées aux DLP entre les groupes, bien que des tendances prometteuses aient été observées. Cette thèse examine les changements hormonaux, cliniques, biomécaniques et les adaptations neuromusculaires chez les femmes enceintes souffrant de douleurs lombo-pelviennes. Les résultats montrent qu’un programme d'exercices de contrôle moteur est sûr et faisable avec quelques ajustements, mais que la stabilité de la région lombo-pelvienne demeure complexe et incertaine en raison des variations hormonales et des adaptations neuromécaniques pendant la grossesse. Bien que l'efficacité de l'intervention n'ait pas été statistiquement démontrée, nos résultats ont montré la faisabilité d’une éventuelle étude contrôlée et randomisée à plus grande échelle. Cette thèse identifie également des aspects à considérer pour les futures études visant à améliorer la prise en charge des femmes enceintes souffrant de douleurs lombo-pelviennes pendant la grossesse. / Pregnancy is an important period in a woman's life. Pregnant women will undergo different changes (hormonal and clinical) and adaptations (neuromechanical) that can contribute to the development of pain in the lumbar and pelvic region, also known as lumbopelvic pain. This thesis aims to determine the contribution of hormonal, neuromechanical, and clinical factors that contribute to the development and evolution of lumbopelvic pain in pregnant women, to eventually determine which approaches should be adopted in terms of managing these pains. Through four studies (an integrative literature review, a narrative review, a cohort study, and a controlled and randomized feasibility study), it was possible to compare current literature with new studies and highlight the gaps still present in this field. The integrative literature review showed that relaxin (the hormone most studied in comparison to estrogen and progesterone) does not seem to be associated with the development or evolution of lumbopelvic pain in pregnant women. The narrative review presents the hormonal and biomechanical changes as well as the neuromuscular adaptations related to pregnancy that could play a role in the development of lumbopelvic pain during pregnancy. The cohort study showed an increase in the intensity of lumbopelvic pain and disability, an increase in the risk of poor prognosis for pain, as well as a decrease in pain catastrophizing over the course of pregnancy. The results also showed a correlation between disability and estrogen levels (first second trimester), as well as a correlation between estrogen levels and the diurnal lumbopelvic pain intensity (second third trimester). The controlled and randomized feasibility study was conducted on 32 pregnant women recruited over a period of 14 months. Among them, 26 (11 in the intervention group and 15 in the control group) participated in the post-intervention visit (retention rate of 81.3%). Adherence rates were similar for supervised and unsupervised exercise sessions, although acceptability was better for supervised sessions compared to unsupervised sessions. At the pre-intervention meeting, participant characteristics were similar between the two groups, except for education level (higher in the control group). Preliminary results showed no significant differences in frequency, intensity, and disability associated with lumbopelvic pain between the groups, although promising trends were observed. This thesis examines hormonal, clinical, biomechanical changes and neuromuscular adaptations in pregnant women with lumbopelvic pain. The results show that a motor control exercise program is safe and feasible with some adjustments, but the stability of the lumbo-pelvic region remains complex and uncertain due to hormonal variations and neuromechanical adaptations during pregnancy. Although the effectiveness of the intervention has not been statistically proven, results suggest that its efficacy could potentially be demonstrated through a larger randomized controlled trial. This thesis also identifies aspects to consider for future studies aimed at improving the management of pregnant women with lumbopelvic pain during pregnancy.

The aim of the study was to investigate the knowledge and utilisation of antenatal care (ANC) services by pregnant women at a clinic in Ekurhuleni. A quantitative, descriptive correlational study was carried out on 90 eligible pregnant women. Data were collected with a self-administered questionnaire and analysed with the help of a statistician using the Epi Info version 7 computer program. The results of the study indicate that most women initiated ANC later than the recommendations by the World Health Organization (WHO). Over half of the respondents had overall good knowledge of ANC, but lacked knowledge of medication and screening tests done during pregnancy, some danger signs during pregnancy and of exclusive breastfeeding. Factors that were identified as associated with late initiation of ANC were current employment status, number of children, transport costs to clinic and number of antenatal visits. / Department of Health Studies / M.A. (Public Health)

The aim of the study was to investigate the knowledge and utilisation of antenatal care (ANC) services by pregnant women at a clinic in Ekurhuleni. A quantitative, descriptive correlational study was carried out on 90 eligible pregnant women. Data were collected with a self-administered questionnaire and analysed with the help of a statistician using the Epi Info version 7 computer program. The results of the study indicate that most women initiated ANC later than the recommendations by the World Health Organization (WHO). Over half of the respondents had overall good knowledge of ANC, but lacked knowledge of medication and screening tests done during pregnancy, some danger signs during pregnancy and of exclusive breastfeeding. Factors that were identified as associated with late initiation of ANC were current employment status, number of children, transport costs to clinic and number of antenatal visits. / Department of Health Studies / M.A. (Public Health)

O presente estudo é um subprojeto do Instituto de Psiquiatria do Desenvolvimento intitulado \"Novas Ferramentas na Compreensão do Desenvolvimento Infantil: a Interação Gene-Ambiente e Conectividade Neuronal\", financiado pela FAPESP e aprovado pela CAPPESQ com o número de protocolo 0054/09. Os primeiros anos são particularmente importantes no ciclo vital, é rápido o crescimento e desenvolvimento do cérebro, tornando-se vulnerável à exposição a diferentes fatores de risco biológicos e psicossociais. Os fatores biológicos, em geral, são acompanhados por fatores psicossociais e ambientais que potencializam o seu efeito. Essas condições adversas são fatores de risco e ameaça ao desenvolvimento infantil. Devido à importância e ao impacto dos atrasos no desenvolvimento sobre o futuro da criança, quanto mais precocemente forem identificadas as crianças de maior risco, menor o agravamento futuro. O objetivo dessa dissertação foi caracterizar o desenvolvimento neuropsicomotor de crianças de 6 a 9 meses através da Escala Bayley de Desenvolvimento, em uma amostra de base populacional. Estimou-se a prevalência de atraso e a identificou os fatores de risco psicossociais e ambientais associados. É um estudo epidemiológico de coorte de nascimento longitudinal, com três seguimentos. A primeira entrevista com a gestante, para coleta de dados socioeconômicos e a entrevista para diagnósticos psiquiátricos, o segundo encontro para verificar diagnósticos psiquiátricos no puerpério, dados de nascimento e alimentação do lactente e por último aos 6 meses a aplicação da Escala Bayley. Avaliados 368 lactentes, encontramos 15,4% das crianças classificadas com atraso significativo em pelo menos um dos domínios, entre eles 10,87% tiveram atraso no desenvolvimento motor, com déficit de linguagem o total de 8,15% e 3,01% dos lactentes apresentaram atraso no desenvolvimento cognitivo aos 6 meses. Em analises constatou que o desenvolvimento cognitivo foi o fator com maior associação a fatores de estresse materno. Os transtornos, de humor durante a gestação, transtorno psicótico e transtorno de ansiedade no puerpério, a classe econômica, escolaridade materno, mãe adolescente e fumo durante a gestação, foram associados ao atraso no desenvolvimento mesmo após ajustes para fatores confundidores. Conclui-se que os transtornos psiquiátricos são preditores de atraso no desenvolvimento neuropsicomotor aos 6 meses de idade. Esse estudo mostra a importância da triagem para identificação de possíveis atrasos no desenvolvimento, para consequentes programas de intervenção a fim de evitar ou minimizar agravos futuros e possibilitar a criança desenvolver-se com todo seu potencial / This study is a subproject of Developmental Psychiatry Institute entitled \"New Tools in Child Development Understanding: Gene-Environment Interaction and Connectivity Neuronal\", funded by FAPESP and approved by CAPPESQ with protocol number 0054/09. It aims to characterize the neurological development of children aged 6 to 8 months by the Bayley scale in a population-based sample. It is expected, therefore, to estimate the prevalence of delay and the identification of psychosocial and environmental risk factors. The first years are particularly important in the life cycle, when is the rapid growth and development of the brain, making it vulnerable to exposure to different biological and psychosocial risk factors. Biological factors generally are accompanied by psychosocial and environmental factors that increase its effect. These adverse conditions are a risk factor and threat to child development. The importance and the impact of delays in the development of the child\'s future, the earlier identified the delay development, the risk could be smaller. The purpose of this thesis was to characterize the neurological development of children 6-9 months ago through the Bayley scale in a population-based sample, then estimate the prevalence of delay and identifying psychosocial and environmental risk factors. A longitudinal epidemiological study of birth cohort with three segments, the first interview with the pregnant woman, to collect socioeconomic data and the psychiatric diagnoses interview, the second meeting to check psychiatric diagnoses in the postpartum period, data of birth and infant feeding. At last, on six months, implementation the Bayley Scale of Development. Evaluated 368 infants, 15.4% children were classified as significant delay in at least one of the areas, among them 10.87% had delayed motor development, language delay total of 8.15% and 3.01 % of infants were delayed cognitive. In analysis, found that cognitive development was the factor with the largest association of maternal stress factors. Disorders, mood during pregnancy, psychotic disorder and anxiety disorder in the postpartum period, economic class, maternal education, teenage mother and smoking during pregnancy were associated with delayed development even after adjusting for confounding factors. It is concluded that, psychiatric disorders are predictors of delay in psychomotor development at 6 months of age. This study shows the importance of screening to identify possible developmental delays, for subsequent intervention programs to prevent or minimize future hazards and allow the child to develop to their full potential. Keywords: development; risk factors; infants

O presente estudo é um subprojeto do Instituto de Psiquiatria do Desenvolvimento intitulado \"Novas Ferramentas na Compreensão do Desenvolvimento Infantil: a Interação Gene-Ambiente e Conectividade Neuronal\", financiado pela FAPESP e aprovado pela CAPPESQ com o número de protocolo 0054/09. Os primeiros anos são particularmente importantes no ciclo vital, é rápido o crescimento e desenvolvimento do cérebro, tornando-se vulnerável à exposição a diferentes fatores de risco biológicos e psicossociais. Os fatores biológicos, em geral, são acompanhados por fatores psicossociais e ambientais que potencializam o seu efeito. Essas condições adversas são fatores de risco e ameaça ao desenvolvimento infantil. Devido à importância e ao impacto dos atrasos no desenvolvimento sobre o futuro da criança, quanto mais precocemente forem identificadas as crianças de maior risco, menor o agravamento futuro. O objetivo dessa dissertação foi caracterizar o desenvolvimento neuropsicomotor de crianças de 6 a 9 meses através da Escala Bayley de Desenvolvimento, em uma amostra de base populacional. Estimou-se a prevalência de atraso e a identificou os fatores de risco psicossociais e ambientais associados. É um estudo epidemiológico de coorte de nascimento longitudinal, com três seguimentos. A primeira entrevista com a gestante, para coleta de dados socioeconômicos e a entrevista para diagnósticos psiquiátricos, o segundo encontro para verificar diagnósticos psiquiátricos no puerpério, dados de nascimento e alimentação do lactente e por último aos 6 meses a aplicação da Escala Bayley. Avaliados 368 lactentes, encontramos 15,4% das crianças classificadas com atraso significativo em pelo menos um dos domínios, entre eles 10,87% tiveram atraso no desenvolvimento motor, com déficit de linguagem o total de 8,15% e 3,01% dos lactentes apresentaram atraso no desenvolvimento cognitivo aos 6 meses. Em analises constatou que o desenvolvimento cognitivo foi o fator com maior associação a fatores de estresse materno. Os transtornos, de humor durante a gestação, transtorno psicótico e transtorno de ansiedade no puerpério, a classe econômica, escolaridade materno, mãe adolescente e fumo durante a gestação, foram associados ao atraso no desenvolvimento mesmo após ajustes para fatores confundidores. Conclui-se que os transtornos psiquiátricos são preditores de atraso no desenvolvimento neuropsicomotor aos 6 meses de idade. Esse estudo mostra a importância da triagem para identificação de possíveis atrasos no desenvolvimento, para consequentes programas de intervenção a fim de evitar ou minimizar agravos futuros e possibilitar a criança desenvolver-se com todo seu potencial / This study is a subproject of Developmental Psychiatry Institute entitled \"New Tools in Child Development Understanding: Gene-Environment Interaction and Connectivity Neuronal\", funded by FAPESP and approved by CAPPESQ with protocol number 0054/09. It aims to characterize the neurological development of children aged 6 to 8 months by the Bayley scale in a population-based sample. It is expected, therefore, to estimate the prevalence of delay and the identification of psychosocial and environmental risk factors. The first years are particularly important in the life cycle, when is the rapid growth and development of the brain, making it vulnerable to exposure to different biological and psychosocial risk factors. Biological factors generally are accompanied by psychosocial and environmental factors that increase its effect. These adverse conditions are a risk factor and threat to child development. The importance and the impact of delays in the development of the child\'s future, the earlier identified the delay development, the risk could be smaller. The purpose of this thesis was to characterize the neurological development of children 6-9 months ago through the Bayley scale in a population-based sample, then estimate the prevalence of delay and identifying psychosocial and environmental risk factors. A longitudinal epidemiological study of birth cohort with three segments, the first interview with the pregnant woman, to collect socioeconomic data and the psychiatric diagnoses interview, the second meeting to check psychiatric diagnoses in the postpartum period, data of birth and infant feeding. At last, on six months, implementation the Bayley Scale of Development. Evaluated 368 infants, 15.4% children were classified as significant delay in at least one of the areas, among them 10.87% had delayed motor development, language delay total of 8.15% and 3.01 % of infants were delayed cognitive. In analysis, found that cognitive development was the factor with the largest association of maternal stress factors. Disorders, mood during pregnancy, psychotic disorder and anxiety disorder in the postpartum period, economic class, maternal education, teenage mother and smoking during pregnancy were associated with delayed development even after adjusting for confounding factors. It is concluded that, psychiatric disorders are predictors of delay in psychomotor development at 6 months of age. This study shows the importance of screening to identify possible developmental delays, for subsequent intervention programs to prevent or minimize future hazards and allow the child to develop to their full potential. Keywords: development; risk factors; infants

The aim of the study was to determine factors contributing to late booking amongst pregnant women at Ekurhuleni health district in order to offer recommendations for enhancing early booking. Interpretative phenomenological analysis design was used. Data were collected using semi-structured individual face-to-face interviews from 20 purposively selected pregnant women. Each interview was audio recorded and lasted between 45-60 minutes. Fields notes were taken to triangulate data collection method. Audio recorded interviews were transcribed verbatim. Data were thematically analysed using Interpretative Phenomenological Analysis framework for data analysis. Results indicate that healthcare service related factors such as human resources, infrastructure and the type of service rendered at the clinic contribute to late bookings. Client related factors such as socioeconomic status, cultural beliefs and knowledge deficit also contribute to late bookings. Recommendations are made addressing both healthcare service and client related factors in order to enhance early booking among pregnant woman at Ekurhuleni district. / Health Studies / M.A. (Nursing science)

The purpose of the study is to determine the barriers to utilisation of antenatal care services among pregnant women in Omaheke Region - Namibia. A quantitative, cross-sectional descriptive research was followed, and a structured questionnaire was used to obtain information from study participants. One hundred and ten (110) women of child-bearing age between 18 to 49 years who visited Gobabis District Hospital in Omaheke Region for deliveries (full-term) or kept for postnatal care purposes were selected. A questionnaire with open-ended and closed-ended questions was designed using a Likert scale to gather information. SPSS software was used to generate descriptive statistics. Results indicated that the majority of respondents (39%) who attended antenatal care services, fell within the age range of 18-21 years. Participants demonstrated higher knowledge of the recommended number of antenatal care visits and of the importance of antenatal care services. Transport money and cost, long distances to health facilities, desirability, unplanned or unwanted pregnancy, and limited transportation options are the barriers that contribute to low utilisation of antenatal care services among pregnant women in Omaheke Region. Recommendations for deployment of more qualified midwives at rural antenatal clinics, building more antenatal care clinics in the region and creation of community awareness campaigns on the importance of antenatal care may increase the utilisation of antenatal care services in the Region. It is anticipated that this research will contribute to the promotion and utilisation of antenatal care services among pregnant women in Omaheke Region. / Health Studies / M. P. H.

L’annonce des résultats du diagnostic d’une maladie grave est toujours un moment difficile à vivre pour le patient et, dans une moindre mesure, pour le médecin. Lorsqu’il s’agit du VIH/SIDA, la difficulté est d’autant plus importante que bien souvent, cette maladie véhicule honte et culpabilité avec risque de stigmatisation de la personne séropositive. Chez les femmes enceintes burundaises, cette situation est encore plus préoccupante. Des barrières liées au contexte socio-culturel les poussent à des conduites d’évitement du test du VIH, alors que le dépistage constitue une porte d’entrée pour les soins de prévention de la transmission du VIH de la mère à l’enfant. <p><p>L’objectif de cette thèse était de comprendre l’état psychologique des femmes enceintes lors du dépistage du VIH dans les services de Prévention de la Transmission Mère-Enfant (PTME) du VIH à Bujumbura. Cette compréhension permettrait d’optimiser la prise en charge psychologique de ces femmes enceintes au moment du dépistage du VIH et de mettre en place un accompagnement psychosocial dans leur milieu de vie. De façon spécifique, ce travail visait à :(1) analyser le contenu verbal des entretiens de conseils pré et post-test tels qu’ils sont faits dans les services de PTME, et de les comparer avec les normes proposées en la matière par l’OMS ;(2) évaluer l’anxiété chez les femmes enceintes à différents moments du dépistage du VIH; (3) analyser les raisons du refus du dépistage et du renoncement aux soins par les femmes enceintes séropositives à VIH. <p><p>La recherche a été réalisée principalement auprès des femmes enceintes rencontrées dans les services de consultation prénatale à Bujumbura, capitale du Burundi. Les outils de récolte des données étaient des entretiens conseillers-femmes enceintes au cours des activités de dépistage, les échelles d’évaluation de l’anxiété (HADS et STAI), des questionnaires de rétention/impact de l’information, des focus groups et un récit de vie. Ces outils nous ont permis de recueillir des données que nous avons traitées qualitativement par analyse de contenu et quantitativement par des analyses statistiques avec le logiciel SPSS.<p><p>Les résultats sont présentés dans cinq études. Notre première étude a montré que l’adaptation locale du schéma proposé par l’OMS pour les conseils pré et post-test en dépistage prénatal du VIH est une nécessité. Cela permettrait aux conseillers de mieux communiquer avec les femmes enceintes. Les trois autres études portant sur l’évaluation de l’anxiété ont montré que les besoins psychologiques des femmes enceintes au cours du dépistage du VIH devraient être reconnus et pris en compte. La détection de l’anxiété devrait être systématique afin de commencer une prise en charge psychologique dès le début du processus de dépistage et ainsi aller au devant des conduites d’évitement. La cinquième et dernière étude a montré que la stigmatisation et ses conséquences seraient à la base du refus du dépistage du VIH et du traitement en cas de séropositivité. Dès lors, le suivi médical doit être associé à un suivi psychologique pour réaliser une prise en charge intégrée des femmes enceintes dans les services de PTME. En continuité avec cette prise en charge au niveau des structures de santé, des stratégies d’accompagnement psychosocial adéquates devraient être planifiées au niveau des communautés. En outre, nous recommandons des études visant les problématiques psychologiques et sociales liées au VIH/SIDA chez la femme enceinte au Burundi. <p><p>Abstract:The announcement of the diagnosis of a serious illness is always a difficult experience for the patient and to a lesser extent, to the doctor. When it comes to HIV / AIDS, the challenge is even more important that in many cases, this disease vehicle with shame, guilt and risk of stigmatization of HIV-positive person. For pregnant women in Burundi, the situation is even more worrying. Socio-cultural barriers cause avoidance of HIV testing, while the screening is a gateway to care for the prevention of HIV transmission from mother to child.<p><p>The objective of this thesis was to understand the psychological state of pregnant women in HIV testing services in the Prevention of Mother to Child Transmission (PMTCT) of HIV in Bujumbura. This understanding would maximize the psychological care of pregnant women at the time of HIV testing and to develop psychosocial support in their living environment. Specifically, this work aimed to: (1) analyzing the verbal content of counseling interviews pre and post-test as they are made in PMTCT services, and compare them with the proposed standards in this area by WHO, (2) assess anxiety in pregnant women at different stages of HIV testing, (3) analyze the reasons for refusal of screening and seeking care for pregnant HIV-positive.<p><p>The research was conducted mainly among pregnant women encountered in antenatal clinics in Bujumbura, Burundi's capital. Tools for data collection were interviews between counselors and pregnant women during routine screening, rating scales of anxiety (HADS and STAI), questionnaires of retention / impact of information, focus groups and a life story. These tools have allowed us to collect data that we have treated qualitatively by content analysis and quantitatively by statistical analysis using SPSS.<p><p>The results are presented in five studies. Our first study showed that local adaptation of the scheme proposed by the WHO for counseling pre and post-test in antenatal HIV testing is a necessity. This would allow counselors to better communicate with pregnant women. The other three studies of anxiety assessment showed that the psychological needs of pregnant women in HIV testing should be recognized and taken into account. Anxiety screening should be systematic to begin psychological support early in the process of HIV testing. The fifth and final study showed that stigma and its consequences would be the causes for refusal of HIV testing and treatment in HIV positive cases. Therefore, medical care should be combined with psychological support to achieve an optimal management of pregnant women in PMTCT services. In continuity with this support in the structures of health, psychosocial support strategies should be planned at the community level. In addition, we recommend studies related to psychological and social issues of HIV / AIDS among pregnant women in Burundi.<p> / Doctorat en Sciences Psychologiques et de l'éducation / info:eu-repo/semantics/nonPublished