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)

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))

Dissertation submitted in fulfillment of the requirements for the Degree of Master in Technology: Emergency Medical Care, Durban University of Technology, 2011. / Background Information regarding pre-hospital emergency medical services is limited and it is therefore challenging to determine if there is delay in emergency transport of patients. This study aimed to provide such information specifically regarding the emergency transportation of obstetric patients. Purpose The purpose of the study was to describe the transport of obstetric patients within the Ugu Health District of KwaZulu Natal, in terms of patient profiles, the response time intervals and factors that affected response times. Objectives The objectives of the study were to:  determine response time intervals from the initial call to delivery of the patient to a public sector hospital;  describe the types of obstetric cases being transported;  describe factors that affect response times and;  make recommendations on policies and procedures governing emergency obstetric patient transportation Methodology All obstetric patients transported by Emergency Medical Rescue Service (EMRS) within a 2 month time frame within the Ugu District made up the study population. The study was conducted through prospective quantitative data collection using hospital records, the EMRS information system (communications centre data base records) and the EMRS patient return forms. The data was triangulated which established reliability before descriptive analysis was conducted. vi Findings The EMRS predominantly transports obstetric patients in labour with a gravidity of 1. The mean response interval (from receipt of the call to arrival at the patient) of 1h41minutes was a result of delays in the pre-response interval (pre-response waiting time). The mean pre-response interval of 1h07 minutes was a result of delays caused by ambulance unavailability. Pearson‟s correlation showed a significant relationship between the pre-response interval and response interval i.e. delays in the pre-response interval caused delays in the response interval. The EMRS lacks Standard operating procedures governing emergency transport and this was one of the main factors that contributed to some of the causes of ambulance unavailability. The lack of standard operating procedures is therefore also partly responsible for a delayed response interval. 64.5% of the incidents achieved response time intervals of more than 1hour and has therefore failed to achieve the predetermined Department of Health target for 70% of ambulances reaching the site of the patient within 1 hour. Other factors that affect the response time intervals were the poor road conditions, shift change delays and re-routing of ambulances. Conclusion EMRS predominantly transports obstetric patients in labour, including high risk patient groups that are arguably beyond the scope of care of the Basic and Intermediate qualified Emergency Care Practitioners. Standard operating procedures for governing emergency transport are lacking and have contributed to a number of factors affecting response time intervals. Standard operating procedures therefore need to be developed taking into consideration the findings of this study as well as previous recommendations by the National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD).

Thesis (MA (Psychology))--University of Stellenbosch, 2006. / This study aimed to determine whether low-income women residing in a rural community in South Africa experienced any significant difference in the prevalence rates of depressive symptoms postpartum as compared to depressive symptoms prepartum. Thirty women between the ages of 16 and 38 were recruited during pregnancy from the local community clinic in Kylemore, South Africa. The women where assessed for elevated levels of depressive symptomatology using the Beck Depression Inventory (BDI) during pregnancy and again at three and six months postpartum. It was found that 18 (60%) of the women reported elevated levels of depressive symptomatology during the prepartum assessment, with 11 (37.9%) and 12 (48%) women reporting elevated levels of depressive symptomatology at the three months and six month postpartum assessment respectively. It was further found that the sample from the current study did not experience any significant difference in the rate of depressive symptomatology from the prepartum assessment to either of the postpartum assessments. The results also suggests that a relationship exists between the levels of depressive symptomatology prepartum and the levels of depressive symptomatology postpartum, as those women who experienced high levels of depressive symptomatology during pregnancy continued to show high levels of depressive symptomatology at the postpartum assessments. The findings from the current study thus suggest that the classification of postpartum depression as a unique and separate entity, that differs from depression occurring in women at other times and from depression as experienced by men, may be misleading. The term suggests a depression that develops following childbirth, while in the current study it seemed that when depressive symptoms were reported postpartum, they were also already apparent during pregnancy. The findings from the current study therefore suggest that the existence of postpartum depression as a distinct diagnosis or illness is problematic – a suggestion that has frequently been suggested in the literature (Aderibigbe, Gureje, & Omigbodun, 1993; Chandran, Tharyan, Muliyil & Abraham, 2002; Cooper, Campbell, Day, Kennerly & Bond, 1988; Cox, Murray & Chapman, 1993; O’Hara, Zekoski, Phillips & Wright, 1990; Patel, Rodrigues, & DeSouza, 2002).

Thesis (MMed)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: The vast majority of new Human Immunodeficiency Virus (HIV) infections in infants and young children occur through mother-to-child-transmission (MTCT), either during pregnancy, labour or delivery or by breastfeeding. Without access to perinatal MTCT (PMTCT) programmes approximately 30% of all babies born annually will be infected with HIV. OBJECTIVES The aim was to implement and audit a quality improvement cycle at the Worcester Obstetric Unit, which comprises of Worcester Hospital, a regional hospital in the Western Cape Province and its level one midwife obstetric Unit (MOU), in order to improve the quality of the PMTCT programme. The intervention included the implementation of easy changes and tools in the Antenatal Clinic, Infectious Diseases Clinic and Labour ward. METHODS The files and antenatal records of all HIV positive patients and patients with an unknown HIV status, who delivered at the Worcester Obstetric Unit during January, February and March of 2010 and 2011, were reviewed. All HIV negative patients and patients that had stillbirths and miscarriages were excluded. The pre-interventional findings of 2010 were compared with the post-interventional findings of 2011. RESULTS At the Worcester Obstetric Unit, for the study time period, there were 907 deliveries in 2010, of which 102 (11.2%) patients were HIV positive and 4 (0.4%) had an unknown HIV status compared to 2011, with 865 deliveries of which 108(12.5%) patients were HIV positive and no patients had an unknown HIV status. Significantly more patients were diagnosed with HIV before they fell pregnant than during pregnancy in the 2011 group, when compared with the 2010 group. A CD4 count was done on 94% of patients who were newly diagnosed with HIV and those with an unknown CD4 count result in the 2010 group, compared to 92% in 2011. There was a significant improvement after the intervention in the time it took from when blood was drawn for a CD4 count until the result was followed up, the median time decreased from 34 to 8 days (p=0.000001). Significantly more patients qualified for highly active antiretroviral therapy (HAART) after the guidelines were changed and the CD4 cut off was increased to 350 cells/l (p=0.001). Prior the intervention 18 patients did not receive the correct management before delivery due to preventable reasons, compared to one at the MOU. After the intervention this decreased significantly to only one patient at Worcester Hospital and none at the MOU (p=0.000001). Before the intervention adherence to the PMTCT protocol at the MOU was significantly better than at the hospital (p=0.0005) and after the intervention there was no significant difference (p=1.0). CONCLUSION Although the audit and quality improvement cycle was performed at a single hospital, with specific changes geared towards their needs, the basic principles can be applied to any Unit in the country providing a PMTCT service. Educating staff, creating awareness and reminding staff of the basic principles of PMTCT, implementing small changes and streamlining processes and setting specific goals or timelines, can lead to significant improvements in care, which ultimately will lead to a decrease in PMTCT of HIV and HIV related maternal and infant morbidity and mortality. / AFRIKAANSE OPSOMMING: Die oorgrote meerderheid (>90%) van nuwe Menslike Immuniteitsgebreksvirus (MIV) infeksies in babas en jong kinders vind plaas deur middel van moeder-na-kind-oordrag, hetsy gedurende swangerskap, die kraamproses of borsvoeding. Sonder toegang tot perinatale voorkomingsprogramme (PMTCT) sal ongeveer 30% van alle babas jaarliks met MIV geïnfekteer word. DOELWITTE Die doel van die studie was om ‘n gehalteverbeteringsiklus by die Worcester Verloskunde Eenheid, wat bestaan uit Worcester Hospitaal, 'n streekshospitaal in die Wes-Kaapprovinsie en sy vlak een vroedvrou verlossingseenheid (VVE), te implementer en daarna te oudit, om sodoende die gehalte van die PMTCT-program te verbeter. Die intervensie het bestaan uit die implementering van eenvoudige veranderinge en prosesse in die voorgeboortekliniek, infeksiesiekte-kliniek en kraamsaal. METODES Die lêers en voorgeboorte rekords van alle MIV-positiewe pasiënte en pasiënte met 'n onbekende MIV-status, wat gedurende Januarie, Februarie en Maart van 2010 en 2011 verlos het by die Worcester Verloskunde Eenheid, is nagegaan. Alle MIV-negatiewe pasiënte en pasiënte met doodgebore babas en miskrame is uitgesluit. Die pre-intervensie bevindings van 2010 is vergelyk met die post-intervensie bevindings van 2011. RESULTATE By die Worcester Verloskunde Eenheid was daar 907 geboortes gedurende die studietydperk in 2010, waarvan 102 (11,2%) pasiënte MIV-positief was en 4 (0,4%) met ‘n onbekende MIV-status. In 2011 was daar 865 geboortes waarvan 108 (12,5%) pasiënte MIV-positief was en geen met 'n onbekende MIV-status. In die 2011-groep is beduidend meer pasiënte gediagnoseer met MIV voor as tydens swangerskap. In die 2010-groep is daar 'n CD4-telling gedoen vir 94% van nuut gediagnoseerde pasiënte en diegene met 'n onbekende CD4-telling, in vergelyking met 92% in 2011. Daar was 'n beduidende verbetering na die intervensie in die tyd wat dit geneem het vandat bloed getrek is vir 'n CD4-telling totdat die resultaat opgevolg is. Die mediane tyd het verminder vanaf 34 na 8 dae (p = 0.000001). Nadat die riglyne vir kwalifisering vir hoogs aktiewe antiretrovirale terapie (HAART) verander is na ‘n CD4 telling 350 selle/l het daar beduidend meer pasiënte gekwalifiseer vir HAART. By Worcester Hospitaal het 18 pasiënte voor die intervensie nie die korrekte behandeling intrapartum ontvang nie weens voorkombare redes, in vergelyking met slegs een pasiënt by die VVE. Na die intervensie was daar ‘n beduidende afname na slegs een pasiënt by Worcester Hospitaal en geen by die MOU (p = 0.000001). Voor die intervensie was die korrekte uitvoering van die PMTCT-protokol by die MOU beduidend beter as by die hospitaal (p = 0,0005) en na die intervensie was daar geen beduidende verskil (p = 1.0). GEVOLGTREKKING Alhoewel die oudit en gehalteverbeteringsiklus uitgevoer is by 'n enkele hospitaal, met spesifieke veranderinge gerig tot hul behoeftes, kan die basiese beginsels toegepas word in enige eenheid in die land wat ‘n PMTCT diens verskaf. Opvoeding van personeel en bewusmaking rakende die basiese beginsels van PMTCT, klein veranderinge en die vaartbelyning van prosesse by die voorgeboorte klinieke en die stel van spesifieke doelwitte of tydlyne, kan lei tot aansienlike verbeteringe in pasiënte sorg. Dit sal uiteindelik lei tot 'n afname in die MIV oordrag van moeder na kind, asook MIV-verwante morbiditeit en mortaliteit in moeders en kinders.

Thesis (MA)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The topic of perinatal depression (i.e. depression during and after pregnancy) remains a subject of continued research interest, as a broad literature body reports that a large proportion of women suffering from this mental disorder do not receive appropriate treatment. This is worrisome, firstly, because mental health treatment is often readily available to the public and at no cost. Secondly, untreated perinatal depression not only holds dangerous consequences for the mother but also for the infant and the rest of the family. It is therefore important to identify those factors that act as barriers to mental health care utilization for perinatal depression. Although this is a persistent problem within the South African context, to date, little is known about the barriers to the utilization of available mental health services experienced among pregnant South African women. For this reason, the Perinatal Mental Health Project (PMHP) aims to provide mental health services at the same location where women receive obstetric services. However, despite their efforts, the number of women who decline available treatment is still of great concern. The present study offers a unique perspective on counselling for perinatal depression appointment-keeping barriers as it provides a holistic view of these barriers that exist not only within the women but also in their multi-levelled environments. Secondly, it addresses the problem of nonattendance to mental health care treatment offered by the PMHP and consequently also addresses the gap in South African research on the topic. The sample for this study was selected from PMHP files of those patients who failed to attend scheduled counselling appointments. The participants included in this study were selected by means of purposeful sampling to participate in face-to-face and telephonic semi-structured interviews. Participants were assured of confidentiality and anonymity. The semi-structured interviews were audio-recorded and transcribed after which transcriptions were entered into MS Word for textual analysis. Transcriptions were thematically analysed. The main themes that emerged from the present study included individual-related barriers, social-related barriers, institution-related barriers, community-related barriers and poverty-related barriers. The results of the present study reflect the motivations for depressive pregnant women to decline available and free mental health services provided by the PMHP, according to five main themes. These themes were then discussed according to Bronfenbrenner’s (1977; 1979) Ecological Systems Theory, which categorised the main themes identified according to the different systems operating within the patient’s environment, i.e. the individual-, micro-, meso-, exo-, and macrosystem. The individual system comprised the individual-related barriers, which included poor mental health, and ambivalent feelings toward the pregnancy. The microsystem comprised the social-related barriers, which included low social support and self-help strategies. Community-related barriers were considered within the mesosystem of the patient’s ecological environment, with stigma and pity as sub-barrier. The exosystem comprised the institution-related barriers, including referral protocol barriers, lack of information provided by the nurses, and nurses’ attitudes as experienced by participants. Lastly, poverty-related barriers were considered within the macrosystem, with financial life hardship, constant child-care demands, and transportation barriers as sub-barriers. The significance of this study lies in the original perspective offered on mental health care appointment-keeping behaviour within the South African context. Future research could, in addition to conducting interviews with hospital patients, include health care professionals and focus groups as this will allow for triangulation of the perspectives of all significant players. Also, having identified the problems and concerns with regards to attending counselling appointments, future research direction may be aimed at creating interventions designed to reduce the identified barriers to mental health care service use. / AFRIKAANSE OPSOMMING: Perinatale depressie (d.w.s. depressie voor en na swangerskap) bly ʼn onderwerp van voortdurende navorsings belang, aangesien ʼn breë navorsingsveld aandui dat ʼn groot proporsie van vroue wat aan hierdie geestesversteuring lei, nie die gepaste behandeling ontvang nie. Dit is kommerwekkend, eerstens, aangesien behandeling vir geestesgesondheid meestal openlik verkrygbaar is aan almal sonder enige koste. Tweedens, onbehandelde perinatale depressie hou nie slegs gevaarlike gevolge vir die moeder in nie, maar ook vir die baba en die res van die gesin. Dit is daarom belangrik om daardie faktore te identifiseer wat as hindernisse optree tot geestesgesondheid sorg diensgebruik vir perinatale depressie. Alhoewel dit ʼn voortdurende probleem binne die Suid-Afrikaanse konteks is, is daar tot op hede geen navorsing wat hindernisse tot gebruik van beskikbare geestesgesondheidsdienste bekend gemaak nie, veral wat ervaar word onder swanger Suid-Afrikaanse vroue nie. Vir hierdie rede, beoog die Perinatal Geestesgesondheid Projek (Perinatal Mental Health Project - PMHP) om geestesgesondheidsdienste te lewer by dieselfde plek waar vroue verloskundige dienste kan ontvang. Nietemin, ten spyte van hul pogings, is die getal vroue wat beskikbare behandeling van die hand wys steeds van groot kommer. Dié studie bied ʼn unieke perspektief op hindernisse tot berading vir perinatale depressie afspraak-ooreenkoms gedrag, aangesien dit ʼn algehele uitkyk bied op hindernisse wat nie slegs binne die vroue bestaan nie, maar ook in hul veelvlakkige omgewings bestaan. Tweedens, spreek dit die probleem van nie-bywoning van geestesgesondheidsbehandelingsdienste wat aangebied word deur die PMHP aan en gevolglik ook die gaping wat binne Suid-Afrikaanse navorsing rakende dié onderwerp bestaan. Die steekproef vir die studie was gekies van PMHP lêers van daardie pasiënte wat nie hul geskeduleerde terapie afsprake bygewoon het nie. Die deelnemers ingesluit in die studie is deur middel van doelgerigte-steekproefneming geselekteer om aan aangesig-tot-aangesig of telefoniese semi-gestruktureerde onderhoude deel te neem. Deelnemers is van hul vertroulikheid en anonimiteit van die proses verseker. Die semi-gestruktureerde onderhoude was oudio-opgeneem en transkripsies is daarvan gemaak, waarna die transkripsies in MS Word gelaai is vir tekstuele analise. Transkripsies is tematies geanaliseer. Die hooftemas wat na vore gekom het, sluit in individuele-verwante hindernisse, sosiale-verwante hindernisse, institusie-verwante hindernisse, gemeenskapsverwante hindernisse en armoede-verwante hindernisse. Resultate van dié studie reflekteer die motiverings van depressiewe swanger vroue om beskikbare en gratis geestesgesondheidsdienste wat verskaf is deur die PMHP van die hand te wys, volgens die vyf hooftemas. Hierdie temas is toe volgens Bronfenbrenner (1972) se Ekologiese Sisteemteorie verdeel in die verskillende sisteme teenwoording in die pasiënt se omgewing, naamlik die individuele-, mikro-, meso-, ekso-, en makrosisteem. Die individuele sisteem het die individuele-verwante hindernisse ingesluit, wat swak geestesgesondheid, en teenstrydige gevoelens teenoor die swangerskap omvat het. Die mikrosisteem het die sosiale-verwante hindernisse ingesluit, wat swak sosiale ondersteuning, en self-help strategieë omvat het. Gemeenskapsverwante hindernisse is binne die mesosisteem van die pasiënt se ekologiese omgewing beskou, en het stigma en jammerte as sub-hindernisse ingesluit. Die eksosisteem het die institusie-verwante hindernisse ingesluit, wat verwysing protokol hindernisse, gebrek aan inligting verskaf deur die verpleegsters, en verpleegsters se houdings soos ervaar deur die deelnemers omvat het. Laastens is die armoede-verwante hindernisse binne die makrosisteem beskou, en het finansiële lewens swaarkry, konstante kindersorg eise, en vervoer-verwante struikelblokke as sub-hindernisse ingesluit het. Die belang van dié studie lê in die oorspronklike perspektief van geestesgesondheidsbehandeling dienste afspraak-ooreenkoms gedrag binne die Suid-Afrikaanse konteks, wat aangebied is. Toekomstige navorsing kan, bykomend tot die voer van onderhoude met hospitaal pasiënte, fokus daarop om gesondheidsorg kenners en fokus groepe in te sluit, aangesien dit die triangulasie van perspektiewe moontlik maak van al die belangrike rolspelers. Ook, aangesien die probleem en bekommernisse rakende bywoning van terapie afsprake reeds geïdentifiseer is, mag toekomstige navorsing in die rigting beweeg met die doel om intervensies te omskep wat beoog om die geïdentifiseerde hindernisse tot geestesgesondheidsorg diensgebruik te verminder.

Thesis (MEdPsych (Educational Psychology)--University of Stellenbosch, 2007. / Fetal Alcohol Syndrome (FAS) is an ongoing problem in the Western Cape. Marginalised and poverty-stricken communities use alcohol as a method of entertainment because it is freely available and relatively inexpensive. Due to a cycle of ongoing poverty and lack of education, many women drink large quantities of alcohol when they are pregnant or before they know they are pregnant. This causes the unborn baby to be severely at risk for FAS. There has been much research done in academic and social environments on the presentation and symptoms of FAS and of behaviour. Less research has been done surrounding the mother's experience of her FAS child, it is therefore my aim to research this gap in the research. This research study investigated the experience of mothers who raised children with FAS. Many mothers of children with prenatal exposure to alcohol feel conflict and guilt regarding their children and I attempted to find out what their general experience surrounding this was. Within this research topic I aimed to investigate the mothers' attitudes, their behaviour towards and their general perceptions of their developing child with FAS. This was viewed from an eco-systemic framework in which the mother is an integral part of different systems impacting and working together, that influence her maternal functioning. Finally, the aim of this research study was to ascertain how best mothers of FAS children could be supported. In this same process, I hoped, the mothers could learn to feel empowered to help and support their child, and in the process attempt to shift ongoing cycles of negative behaviour patterns to more positive outcomes.

<p>Obesity is a major health problem in the Western world. Mean birth weight has increased during the last 25 years. One explanation is that the proportion of large for gestational age (LGA) infants has increased. Such infants risk developing obesity, cardiovascular disease and diabetes later in life. Despite the risk of neonatal hypoglycemia, their postnatal metabolic adaptation has not been investigated. Our data, obtained with stable isotope labeled compounds, demonstrate that newborn LGA infants have increased lipolysis and decreased insulin sensitivity. After administration of glucagon, the plasma levels of glucose and the rate of glucose production increased. The simultaneous increase in insulin correlated with the decrease in lipolysis, indicating an antilipolytic effect of insulin in these infants.</p><p>We also demonstrated an intergenerational effect of being born LGA, since women born LGA, were at higher risk of giving birth to LGA infants than women not born LGA. Further, the LGA infants formed three subgroups: born long only, born heavy only, and born both long and heavy. Infants born LGA of women with high birth weight or adult obesity were at higher risk of being LGA concerning weight alone, predisposing to overweight and obesity at childbearing age. In addition we found that pregnant women with gestational diabetes were at increased risk of giving birth to infants that were heavy alone. This could explain the risk of both perinatal complications and later metabolic disease in infants of this group of women.</p><p>To identify determinants of fetal growth, 20 pregnant women with a wide range of fetal weights were investigated at 36 weeks of gestation. Maternal fat mass was strongly associated with insulin resistance. Insulin resistance was related to glucose production, which correlated positively with fetal size. The variation in resting energy expenditure, which was closely related to fetal weight, was largely explained by BMI, insulin resistance, and glucose production. Lipolysis was not rate limiting for fetal growth in this group of women. Consequently, high maternal glucose production due to a high fat mass may result in excessive fetal growth.</p>

Dissertation submitted in compliance with the requirements for the Masters Degree in Technology: Nursing, Durban University of Technology, 2016. / Introduction Although the South African Government adopted a primary health care approach to health care service provision in order to ensure equitable access to and utilization of health care services to all communities, the country continues to face challenges regarding access and utilisation of health care services especially in the rural communities. Antenatal care which is mostly provided at primary health care level is regarded as the cornerstone for the success of the maternal and child health care programme. Therefore, poor access to and under-utilisation of health care services could potentially influence the success of this programme and pregnancy outcomes. Aim of the study The aim of the study was to determine whether pregnant women from KwaMkhizwana rural community had access to and were utilising antenatal care services. Methodology A qualitative, exploratory, descriptive and contextual study was conducted guided by Thaddeus and Maine’s three delays model. Purposive sampling of the pregnant women and all categories of nurses who were employed in the three health care facilities in the area was done. Data was collected in two phases through in-depth semi-structured interviews with both the pregnant women and the nurses respectively between February and March 2016. The sample size was guided by data saturation. All data were analysed using the Tesch’s method of data analysis. Study findings Six major themes and several sub-themes emerged from the interviews with both Phase 1 and Phase 2 participants. The major themes included: 1) access to health care and emergency services, 2) availability of human and material resources, 3) social and cultural beliefs, 4) past pregnancy experiences, 5) communication and transparency regarding health care service delivery and 6) quality of antenatal care services. Summary of the findings The pregnant women encountered several challenges which led to delays in seeking, reaching and receiving antenatal care. Most of the pregnant women participants related limited access to health care, with under-utilisation of antenatal services. They were unhappy about the antenatal care services they received in the three available health care facilities in the area, which made these facilities to be inaccessible and underutilised. The nurse participants recognised the challenges facing the pregnant women regarding the access and utilisation of antenatal care services, together with the challenges faced by the nurses while working in the three available health care facilities in the area. Recommendations The recommendations that were made included: to consider building a centrally located fixed primary health care clinic that would ensure equal access to health care services, strengthening the implementation of policies regarding the referral system and ambulance services, ensuring sustainable availability of human and material resources, developing strategies to ensure that the antenatal care services are delivered in line with the South African Department of Health policies and guidelines and strengthening community education. A further study on provision of antenatal care services in the area is also recommended. / M