Antiretroviral therapy is an important public health strategy to reduce the risk of HIV vertical transmission. Implementation of such therapy depends on the identification of HIV-infected pregnant women. This study investigated how the biographical characteristics of the pregnant women (16-45 years) influenced their health decision-making in Bulawayo clinics. The study was guided by the theories of health behaviour. The study assumed that the respondents’ demographic characteristics will influence their attitudes towards PMTCT programme. Using a structured questionnaire, forty pregnant women who visited the Bulawayo clinics to have prenatal checkups were interviewed. The majority of respondents came from a poor, high-density township. Most of the respondents were married, but about a third were not married at the time data collection and 5% were separated. The survey items were demographic characteristics, knowledge of PMTCT, HIV risk perceptions and service utilisation. The levels of literacy among the respondents were high; more than 80% had completed primary education. Overall the respondents’ demographic characteristics influenced their attitudes towards PMTCT. Majority of the women knew that a mother with HIV can pass the virus to her child, during pregnancy, delivery and breastfeeding. The pregnant women’s health-seeking behaviour and their attitudes toward reproductive health services are influenced by their demographic situation. / Health Studies / (M.A. (Social Behavior Studies in HIV/AIDS))

Antiretroviral therapy is an important public health strategy to reduce the risk of HIV vertical transmission. Implementation of such therapy depends on the identification of HIV-infected pregnant women. This study investigated how the biographical characteristics of the pregnant women (16-45 years) influenced their health decision-making in Bulawayo clinics. The study was guided by the theories of health behaviour. The study assumed that the respondents’ demographic characteristics will influence their attitudes towards PMTCT programme. Using a structured questionnaire, forty pregnant women who visited the Bulawayo clinics to have prenatal checkups were interviewed. The majority of respondents came from a poor, high-density township. Most of the respondents were married, but about a third were not married at the time data collection and 5% were separated. The survey items were demographic characteristics, knowledge of PMTCT, HIV risk perceptions and service utilisation. The levels of literacy among the respondents were high; more than 80% had completed primary education. Overall the respondents’ demographic characteristics influenced their attitudes towards PMTCT. Majority of the women knew that a mother with HIV can pass the virus to her child, during pregnancy, delivery and breastfeeding. The pregnant women’s health-seeking behaviour and their attitudes toward reproductive health services are influenced by their demographic situation. / Health Studies / (M.A. (Social Behavior Studies in HIV/AIDS))

The purpose of this study was to analyse and describe the factors that influence the choice of site of delivery by pregnant women in Mukono district. By employing quantitative, non experimental research methods, 431 women were interviewed by using structured questionnaires. These women had either delivered at; home, TBA, private or public clinic and 72% had been delivered by skilled attendants. Choice of delivery site was influenced by the attitudes of health workers which were rather poor in public sites, proximity of site, attendance of antenatal clinic at a site, availability of supplies and drugs, plus level of care including emergency obstetric care. / Health Studies / M. A. (Public Health)

Introduction: Evidences indicate that human immuno-deficiency virus (HIV) and diabetes (DM) impact pregnancy outcomes but no experience on the integrated service delivery of HIV, DM and pregnancy care. This study explored the domains and levels of integration among DM, HIV and pregnancy care to prepare a service delivery model in Ethiopia. Methods: A sequential exploratory mixed method and the integration theoretical framework guided the study. An exploratory qualitative phase used focused group discussion, in-depth interview and observation to explore the level of integration and to refine a questionnaire for the quantitative phase. The data were transcribed and coded for theme-based analysis. The descriptive quantitative phase described HIV, DM and pregnancy care services, and determined the burden of DM among HIV patients and the prevalence of pregnancy and pregnancy outcomes. Data was analysed using Epi-info. The findings were triangulated, discussed and interpreted. Results: Seven themes were generated: joint plan, shared budget, monitoring system, structural location, the need of policy guide, the practice of integrated service delivery and suggested integration approaches. A coordinated HIV and pregnancy care services were noted. There was a linkage between diabetes and HIV, and diabetes and pregnancy care. The 1.5% of diabetes among HIV, the low number of pregnancies per a mother in diabetes (1.8) and HIV (1.3); the high adverse pregnancy outcomes among HIV (13.4% abortion, 12.4% low birth weight (LBW), 3.5% pre-term birth, 2.1% congenital malformation) and diabetes (3.2% big baby, 3.2% LBW, 3.1% Cesarean-section); the respective absent and low (16.2%) diabetes screening service at anti-natal and HIV clinics, the absent pregnancy care service for diabetic females justified the development of the tripartite integrated service delivery model of diabetes, HIV and pregnancy care. Conclusions: The model suggests active diabetes screening, evaluation and treatment at HIV and antenatal clinics. It considers the coordination between non-communicable diseases (NCD), HIV and maternal health units. Pregnancy care could be coordinated at HIV and NCD units. Full integration can be practiced between HIV and pregnancy care units. Preparing policy guide, building the capacity of health providers, advocating and piloting the model may be prioritized before the implementation of the model. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to analyse and describe the factors that influence the choice of site of delivery by pregnant women in Mukono district. By employing quantitative, non experimental research methods, 431 women were interviewed by using structured questionnaires. These women had either delivered at; home, TBA, private or public clinic and 72% had been delivered by skilled attendants. Choice of delivery site was influenced by the attitudes of health workers which were rather poor in public sites, proximity of site, attendance of antenatal clinic at a site, availability of supplies and drugs, plus level of care including emergency obstetric care. / Health Studies / M. A. (Public Health)

Basic Antenatal Care (BANC) is a way of training or upgrading the knowledge and skills of all nurses, midwives and doctors involved in antenatal care at the primary health care level so that the minimum care can be provided effectively. This study was conducted to investigate the implementation of the BANC program by midwives in the Mdantsane clinics during February 2009. Methods: A descriptive study design was undertaken targeting midwives providing antenatal care to pregnant women, in 14 clinics of Mdantsane. Data was collected from 25 midwives in the clinics, and from 140 ANC cards of women attending ANC on the day of their visit to the clinic. Results: The majority of midwives providing BANC in Mdantsane clinics were not trained in BANC. There were 10 trained midwives and 15 not yet trained. A total of twenty five midwives were involved in the study. The number of visits according to the BANC schedule was well known by the midwives in the study. The content of the visits was well known for the first visit, but for subsequent visits, the participating midwives could not state exactly what they do on these visits. They perceived BANC as something beneficial for both midwives and pregnant women with 24 of the participating midwives rating BANC as advantageous. In completing an ANC card, the midwives scored between 48 percent and 100 percent. Under examination, they scored between 52 percent and 100 percent. Lastly on interpretation and decision making, they scored between 0 percent and 92 percent. This could have troubling consequences for the health status of the mother and baby. Weaknesses in providing antenatal care identified in the study included participating midwives failing to fill in the last normal menstrual period (LNMP) and the estimated date of delivery (EDD), which was a worrying observation. Plotting of the gestational age at first visit was also not carried out well as only 47 percent of the midwives in the study did this, meaning that there would be a miscalculation of the gestational age thereafter throughout the pregnancies. The body mass index (BMI) was not calculated as the maternal height and weight were not written on the ANC card. This should be completed in order to check the nutritional status of the pregnant woman to help supplement, if malnourished, and educate on diet, if overweight. Only 17 percent of the midwives in the study plotted the foetal presentation. Failure to plot foetal presentation could lead to complications during delivery because women with abnormal presentations could end up delivering in a clinic instead of the hospital.Conclusion: This study showed that even though midwives are implementing BANC among pregnant women, it is not being carried out correctly. Therefore the programme will not be as beneficial as it would be if put into practice correctly. This is highlighted by the lack of knowledge from the untrained midwives regarding the content of care on subsequent visits. Thus there is an urgent need for BANC training to be conducted and monitored at various sites.

Background: Group B streptococcus (GBS) is regarded as one of the most important causes of maternal and neonatal morbidity and mortality in many parts of the world. GBS recto-vaginal colonization is important in the health of a mother and her neonate, especially in developing countries. Maternal vaginal colonization with GBS at the time of delivery can cause vertical transmission to the neonate. Multilocus sequence typing (MLST) is a technique used to characterize microbial isolates by means of sequencing internal fragments of housekeeping genes and has the advantage of reproducibility and has been shown to correlate with the other typing techniques and thus has emerged as the standard for delineating the clonal population of GBS. The study aimed to investigate the epidemiology of GBS colonization among pregnant women and their neonates, and to characterize the isolates by multilocus sequence typing technique at Dr George Mukhari Academic Hospital, Pretoria. Methodology: A total of 413 pregnant women who visited the antenatal clinic were recruited and screened. Participants were interviewed using a questionnaire to gather demographic and other relevant information such as history of current pregnancy, previous miscarriages and still births. Samples from maternal rectum and vagina as well as neonate ear and umbilical cord were taken for culture using colistin and nalidixic acid (CNA) blood agar and incubated for 24-48 hours. If negative after 48 hours, Todd-Hewitt broth was subcultured after 18-48 hours onto sheep blood agar. Multilocus sequence typing (MLST) was used to characterize seven group B streptococcus isolates collected at Dr George Mukhari academic hospital. Fragments of seven housekeeping genes were amplified by polymerase chain reaction (PCR) for each strain and sequenced. CLC bio software (Inqaba biotech, South Africa; Pretoria) was used to analyse sequenced loci and UPGMA dendrogram was constructed. Results: The colonization rate for GBS in pregnant women and their neonates was 30.9% and 0%, respectively. A higher proportion of GBS were isolated from the rectum (37.9%) as compared to the vagina (20.6%). Most socio-economic, demographic and obstetric factors analysed were not significantly associated with.GBS colonization. On 128 positive samples, the results of Todd-Hewitt enrichment broth and direct plating method using CNA were compared. A total of 45.3% of colonised were positive on direct selective agar (CNA); an additional 54.7% samples were recovered from Todd-Hewitt broth. Three genes (adhP, glnA and tkt) were sequenced successfully for six samples (1, 2. 4,6,12 and 65). The UPGMA tree with 1000 bootstrap showing the relationship between six samples was drawn.Conclusion: This study revealed that pregnant women of all ages are at risk of group B streptococcus colonization. Group B streptococcus was common among pregnant women at Dr George Mukhari Academic Hospital. No socio-economic risk factor was associated with group B streptococcus colonization. Results confirm that the combination of Todd-Hewitt broth and CNA agar plate is a time saving and sensitive method. The allelic profile, characteristics such as G+C (guanine+cytosine) content and dN/dS ratio were not analysed because of the smaller sample size used in this study, which shows that the MLST method was unsuccessful in this study. The UPGMA tree based on differences in consensus of the isolates showed that all group B streptococcus isolates are clustered and descend from a single node. / Life & Consumer Sciences / Life Sciences / M.Sc. (Life Sciences)

Human Immunodeficiency Virus is the leading cause of death among women of reproductive age worldwide. It is also a major contributor to infant mortality. The effective application of prevention of mother-to-child transmission strategies effectively reduces the risk of mother-to-child transmission. The intent of this study was to determine the availability and accessibility of the PMTCT programme in one district of the North West Province of South Africa. A qualitative, explorative, descriptive and contextual design was utilised to gain better understanding of the experiences of both the HIV positive pregnant women and the Health Care Workers regarding the availability and access to the PMTCT programme. The study population consisted of HIV positive pregnant women between 18 and 49 years of age and Health Care Workers aged between 21 to 60 years of age. The non-probability purposive sampling technique was utilised to identify potential research participants. Data were collected by means of individual semi-structured interviews with HIV positive pregnant women and focus group discussions with the Health Care Workers. Adherence to Tesch’s eight descriptive methods was utilised as the primary form of data analysis, organisation and interpretation. The findings of the study revealed that availability and accessibility of PMTCT services are still problematic. Distance, waiting periods, and long queues were among the few mentioned as problematic. There were also few positives such as communication, counseling and health education. Strategies for facilitation of the availability and accessibility of the PMTCT programme were developed based on the findings. Themes emerged from the HIV positive pregnant women’s data included: acceptance of one’s sero positive status, maternal concerns, stressors about HIV status, as well as lack and shortage of resources and support by health care professionals and family; while emerging themes from the Health Care Workers included: fear of disclosure by HIV positive pregnant women, child feeding, formal trainings and workshops on PMTCT programme, as well as lack and shortage of resources and loss to follow-up activities / Health Studies / D. Litt. et Phil. (Health Studies)

Human Immunodeficiency Virus is the leading cause of death among women of reproductive age worldwide. It is also a major contributor to infant mortality. The effective application of prevention of mother-to-child transmission strategies effectively reduces the risk of mother-to-child transmission. The intent of this study was to determine the availability and accessibility of the PMTCT programme in one district of the North West Province of South Africa. A qualitative, explorative, descriptive and contextual design was utilised to gain better understanding of the experiences of both the HIV positive pregnant women and the Health Care Workers regarding the availability and access to the PMTCT programme. The study population consisted of HIV positive pregnant women between 18 and 49 years of age and Health Care Workers aged between 21 to 60 years of age. The non-probability purposive sampling technique was utilised to identify potential research participants. Data were collected by means of individual semi-structured interviews with HIV positive pregnant women and focus group discussions with the Health Care Workers. Adherence to Tesch’s eight descriptive methods was utilised as the primary form of data analysis, organisation and interpretation. The findings of the study revealed that availability and accessibility of PMTCT services are still problematic. Distance, waiting periods, and long queues were among the few mentioned as problematic. There were also few positives such as communication, counseling and health education. Strategies for facilitation of the availability and accessibility of the PMTCT programme were developed based on the findings. Themes emerged from the HIV positive pregnant women’s data included: acceptance of one’s sero positive status, maternal concerns, stressors about HIV status, as well as lack and shortage of resources and support by health care professionals and family; while emerging themes from the Health Care Workers included: fear of disclosure by HIV positive pregnant women, child feeding, formal trainings and workshops on PMTCT programme, as well as lack and shortage of resources and loss to follow-up activities / Health Studies / D. Litt. et Phil. (Health Studies)

Text in English / Malaria is endemic throughout Uganda and the leading cause of morbidity and mortality. Malaria causes complications in 80.0% of all pregnancies in Uganda. This study attempted to identify factors that influence pregnant women’s utilisation of anti-malaria services in the Buikwe district of Uganda. These factors were contextualised within the Social Learning Theory’s major concepts. The target populations comprised pregnant women attending antenatal clinics (phase 1) and midwives providing antenatal services (phase 2) at 16 clinics in the Buikwe district of Uganda during the data collection phase of the study. Structured interviews were conducted with a sample of 400 randomly selected pregnant women and with the accessible population of 40 midwives. Pregnant women, who had progressed beyond primary school level education, were more likely to take intermittent preventive treatment (IPT) drugs and to use long lasting insecticide treated nets (LLINs) to prevent malaria. Pregnant women were more likely to implement malaria-preventive actions if they lived within five kilometres of clinics, were satisfied with available health services, were knowledgeable about the malaria preventive measures and had used IPT during previous pregnancies. Pregnant women who implemented one malaria-preventive action were likely to implement other actions as well (Pearson’s correlation coefficient was 0.65; p<0.05). Midwives’ provision of malaria-preventive services to pregnant women were influenced by the availability of IPT drugs, accessibility of safe drinking water, frequency of giving health education to pregnant women, cooperation with village health teams, malaria-related in-service training, midwives’ education level and experience. Although 97.9% of the pregnant women had taken IPT and 84.2% of those who had received LLINs, utilised these nets, malaria prevention during pregnancy could be improved. All pregnant women should attend antenatal clinics at least four times during each pregnancy, commencing during the first trimester of pregnancy to receive adequate health education and prenatal services, including IPT and LLINs. All midwives should receive malaria-related in-service training. Regular audits of midwives’ records should identify and address strengths and weaknesses related to the prevention and management of malaria during pregnancy. Such actions could enhance the prevention and management of malaria, estimated to affect 80% of pregnant women in Uganda. / Health Studies / D. Litt. et Phil. (Health Studies)