MPH / Department of Public Health

Thesis (MPH.) -- University of Limpopo, 2021 / Background: Late antenatal care (ANC) booking delays treatment and management of high-risk pregnancies, which may result to maternal deaths. Early ANC booking has been found to be effective in most of the pregnancy related risk factors that can be detected and managed at early stages of pregnancy. Aim: The aim of the study was to investigate the prevalence and factors contributing to late ANC booking amongst pregnant women in primary health care facilities at Dikgale-Mamabolo local area. Methods: Quantitative cross-sectional research approach was used. The study was conducted at Dikgale-Mamabolo local area, which consists of seven clinics at Polokwane, Limpopo province in South Africa. Only three clinics were purposefully selected for the study. The population of the study included pregnant women who were 18 years and above. The sample size consisted of 238 pregnant women who came for ANC services in primary health care facilities during the period of the study. Convenience sampling method was used to select pregnant women from the population. Data was collected using an adapted questionnaire. Data was analysed using Statistical Package for Social Sciences (SPPS) version 25. Results: The results indicated that 86% of pregnant women booked antenatal care before five months gestational age and 14% booked after five months gestational age. Factors contributing to late ANC booking amongst pregnant women were marital status, educational level, employment status, mode of transport to clinic, lack of information, cultural beliefs, long distance to the clinic, long waiting time in the clinic and clinic operating hours. Conclusion: Late ANC booking remains a major public health issue. The study showed that lack of information and cultural beliefs are major contributing factors to late ANC booking. It is recommended that awareness campaigns should be conducted in the community and schools to empower women with knowledge about ANC services.

Thesis (M. A. (Nursing)) -- University of Limpopo, 2021 / Indigenous practices are performances that occur naturally in a region or a growing living environment. Most women believe in indigenous practices because of their cultures and social structure. In South Africa regardless of the availability and accessibility of maternal and child health services, 50% of women were found that they still consult traditional birth attendants as their first choice during pregnancy, labour, delivery, and postnatal care. The purpose of the study was to determine the indigenous practices of women during pregnancy, labour and puerperium amongst cultural groupings at selected hospitals in Limpopo Province, South Africa. A Convergent parallel mixed method design was used in the study to collect both qualitative and quantitative data at the same time. Non-probability purposive sampling was used to select 15 participants and Probability simple random sampling was used to select 125 women who were pregnant, in labour and puerperium using slovin’s formula. Data were collected through a semi-structured interview with a guide for qualitative strand and a self-administered structured questionnaire for quantitative srtand. Data were analysed qualitatively using tech’s open coding method and quantitatively using Statistical Package for the Social Sciences (SPSS) Version 25 with the assistance of the University of Limpopo’s Bio-statistician. The results of the study showed that most women use indigeneous practices for protection against witchcraft, fear of giving birth in caesarian section and many other reasons.THPs and church leaders are regarded as the most principled people in their community. Indigenous women are aware of the sign and symptoms during pregnancy, labour, and puerperium which may determine consultation to healthcare practitioners, but they choose THPs and church leaders. Most women still rely on their religious beliefs to assist during their labour. Pregnant women, those in labour and puerperium should be supported to practice their religious beliefs and practices. THPs and church leaders are obliged to teach their clients and ensure that they know the names and components of the traditional medicines and church rituals they use.The nursing education should include indigenous practices in the curriculum so, that healthcare practitioners know about the indigenous practices and can serve as assistance in the training and development of health practitioners who continuously care for women during pregnancy, labour, and puerperium and as a result, may reduce maternal and child morbidity and mortality in Limpopo Province, South Africa.

Thesis (MPH.) -- University of Limpopo, 2022 / Background: Termination of pregnancy among young women is a public health issue, particularly in South Africa where high prevalence of pregnany terminations has lately been reported. It is estimated that 260000 terminations of pregnancy take place in South Africa every year. Studies in South Africa have reported that risk factors associated with termination of pregnancy such as financial problems, being poorly educated, being young, unemployed, dependent on parents, widowed or single and other relationship problems were most common. Approximately 1200 pregnancies were terminated in the District Hospital of Limpopo Province between 2017 and 2018. There is also an increased rate of unintended pregnancy among HIV positive women which suggest that women with HIV may be more likely to terminate pregnancy but chooses not to terminate due to fear of being judged. Therefore, the primary objective of this study was to investigate the risk factors associated with termination of pregnancy at a District Hospital in Limpopo Province. Methodology: A cross-sectional descriptive retrospective review study in which convenience sampling of the records of women who terminated pregnancies was used in this study. A self-constructed data extraction tool was used to extract the data from patients records. The tool covered variables such as the age of the women, educational status, marital status, year and month of termination of pregnancy, gestational age, parity, and gravidity, HIV status and circumstances leading to termination of pregnancy. Data analysis was done using the STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). The independent t-test was used for variables having two categories as it assesses whether the difference between means of two groups are statistically significant. This test was performed at the 95% confidence level. The p-value of less than 0.05 in the study results was used for statistical significant difference in means between the categories which were investigated. vi Results: The mean age was 27.9 years (standard error [Std. Err.] =0.37) and majority of women who terminated pregnancies were in the age group 20 – 24 years, single and had a secondary educational level. There was a statistical significance difference between age groups and the gestational age, parity and gravidity at p=0.004 and p<0.001 respectively. The proportion of women who were at gestational age of 1 to 8 weeks decreased with increasing maternal age from 22.4% in age ≤20 years to 13% in age group 30 – 34 years. There was again a statistical significance difference (p<0.001) in relation to number of pregnancies that have each resulted in the birth of an infant capable of survival (parity) and similarly to gravida. The prevalence of HIV amongst women who terminated pregnancy in the current study was found to be 21.3% and the risk of women who terminated pregnancies being HIV positive increased significantly with age as older women (age 20 years and above) were 6.5 times more likely to be HIV positive as compared to younger ones (p<001). Low educational level, gestational age of more than 13 weeks and parity of 1 – 2 were significantly associated with termination of pregnancy. The association of gravida of women who terminated pregnancies and HIV revealed that women who were in their second or third pregnancies (gravida) while HIV positive were 3.9 times more likely to terminate pregnancies as compared to those who were first pregnancy (p<0.001). Marital status was not significantly associated with termination of pregnancy. Conclusion: Termination of pregnancies among adolescents and youth is a major public health issue and the findings of this study highlight the need to address the structural socio-economic drivers of family planning which results in high number of termination of pregnancy amongst the youth. Structural interventions, such as increasing contraceptive use which may be useful for reducing the burden of unplanned pregnancies. These findings suggest the need for targeted interventions for women of child-bearing age to access reproductive health interventions to prevent unintended pregnancies and the associated risk of termination.

Submitted in fulfillment of the requirements for the Degree in Master of Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Introduction and Background According to the Declaration of Alma-Ata, maternal and child health care forms an integral component of primary health care. In line with this, the South African national government legislated free maternal and child healthcare services in the public sectors to ensure accessibility and availability of basic health care services to the community of South Africa. However, poor access and utilization of antenatal care services in rural areas continues and contributes to high maternal mortality and morbidity rates and untoward pregnancy outcomes. Aim The aim of this study was to explore the experiences of pregnant women from the KwaMkhizwana rural area regarding antenatal care services in order to identify the factors affecting effective provision of and access to the antenatal care services. Method A qualitative, explorative, descriptive research design, which was guided by Rosenstock’s Health Belief Model, was used to conduct the study. Data were collected by conducting semi-structured interviews with 15 participants who were purposively sampled between February and March 2016 and was analysed using Tesch’s method of data analysis. The sample size was determined by data saturation that was reached after ten interviews were conducted. A total of five additional interviews were conducted to confirm saturation of data. Findings There were five major themes and several sub-themes that emerged from the interviews. The major themes included: 1) availability and accessibility of antenatal care services; 2) established practices by the health post staff to reduce the number of clients; management and administration of the health posts; 3) access to health information by pregnant women; 4) communication between the pregnant women and the health post staff; and 5) socio-cultural taboos and beliefs of the community in the area. Conclusion and Recommendations The information gathered from the participants with regard to their experiences affirms that challenges still exist in this rural community regarding access to health care services, particularly antenatal care services. Recommendations pertaining to policy development, institutional management, practice, and research were made. Some of these recommendations included that several policies that are currently non-existent should be developed in order to promote accessibility of antenatal care service at primary health care level, more primary health care training schools should be established to increase the number of primary health care trained nurses, short courses for training of clinic supervisors should be conducted and that further research studies looking at ANC service accessibility especially in rural areas, focusing on health care workers and management experiences be conducted. / M

Disclosure of a Human Immunodeficiency Virus (HIV) positive status is vital for prevention and promotion of the couple‟s health. The study aimed to investigate the perceived barriers of pregnant women diagnosed as HIV positive towards disclosure of their HIV status to their partners in the Capricorn District, Limpopo Province. Recommendations were formulated to enhance the self-efficacy. A quantitative, explorative, descriptive cross-sectional design and the Health Belief Model theory was used. Non-probability, convenience sampling utilised and 170 respondents aged 18-40 years participated in the study. A questionnaire was used to collect data and the SSPS version 24.0 was utilised to analyse data. Overall, 87.64% respondents received disclosure education and 80% disclosed their status to their partners. Reasons for non-disclosure included fear of rejection, violent behaviour, blame and stigmatisation by partners. Health care workers should provide pregnant women with information on preventive strategies to enhance disclosure of HIV status. / Health Studies / M.A. (Nursing Science)

MSCPNT / Department of Nutrition

MPM / Oliver Tambo Institute of Governance and Policy Studies

Thesis (M. (Nursing)) -- University of Limpopo, 2022 / Background: The referral system is an essential component of the health system. The system meant to complement the Primary Health Care (PHC) principle of treating patients close to their homes at the lowest level of care with the needed expertise. Aim of the study: The aim of the study is to develop the strategies that will facilitate the referral system of high-risk pregnant women in between public sectors in the Bojanala district, North West Province, South Africa. Objectives of the study: To explore the referral system of high-risk pregnant women between public sectors within the Bojanala District, North West Province, South Africa. To develop strategies that will facilitate the referral system of high risk pregnant women in the Bojanala District, North West Province, South Africa. Methods: The researcher first obtained permission from the University of Limpopo Turfloop Research Ethics Committee (TREC), and further requested permission from the North West Department of Health, Bojanala District to conduct the study and was granted the permission. Qualitative, exploratory and descriptive designs were used to explore the referral system of high-risk pregnant women and to describe the strategies to facilitate the referral system of high-risk pregnant women in between public sectors in the Bojanala District, North West, South Africa. Non-Probability Purposive sampling method was used to select the midwives and obstetricians to participate in the study until data saturation was reached. Data were collected through one-on-one interviews using semi structured Interview Guide. The data were analysed using Tesch‘s eight steps of data analysis. Results: The results of this study revealed that the participants are knowledgeable about the referral system though they are many challenges that they encounter when managing high-risk women and having to refer them. They are aware of the current state of referral system and made their own suggestions on how to improve the referral system. Recommendations: Recommendations were made to facilitate the referral system of high-risk pregnant women in the North West Province, Bojanala District. The Department of Health must prioritise the provision of human and material resources to the district in order to achieve a better referral system and reducing the maternal and neonatal mortality as one of the millennium developmental goals. Conclusion: The referral system of high-risk pregnant women in the Bojanala District still has some challenges that need the intervention of the North West Department of Health to provide enough material and human resources to the Maternity Section in order to improve current status and to have an effective referral system

Department of Public Health / MPH