MPM / Oliver Tambo Institute of Governance and Policy Studies

MPH / Department of Public Health / The high maternal mortality ratio is caused by various factors, including avoidable complications which can be reduced by attendance to antenatal care visits. The utilisation of antenatal care has been low in rural areas, especially in Africa. The purpose of this study was to explore the utilisation of antenatal care in Mutasa District of Zimbabwe. This study used a qualitative study approach, adopting the descriptive, explorative design that presented an active image of the research participants’ reality and capture live experiences. Participants of the study were pregnant women and women with children under the age of one. The participant were sampled using purposive and snow-ball sampling techniques. In-depth interviews were conducted. The participants were interviewed in their native language, Shona. The main question was: Can you explain in your own words how you use antenatal care services from the primary health care facility? The researcher clarified questions which the participant failed to understand. The researcher wrote down all responses and used a tape recorder to capture the responses. The researcher analysed data using thematic content analysis where themes and sub-themes were discussed. The main theme was low uptake of antenatal care in rural primary health care facilities. From the main theme there were factors influencing and perceptions of women on uptake of antenatal care services in primary health care facilities. Trustworthiness was ensured through credibility, dependability, transferability and conformability. Permission from the relevant authorities, such as the University of Venda Higher Degrees Committee, the Provincial Medical Director and the District Administrator was sought before conducting this study. Informed consent was also sought before interviewing the participants. The study concluded that socio-demography of participants affected antenatal care attendance. These are age, level of education, low income, high parity and distance to facility. Other hindering factors to utilization of antenatal care were lack of knowledge, religion and acceptability of antenatal care by the women in rural primary health care facilities. Findings will be disseminated through a research report and published in relevant accredited journals with the help of the supervisors. The study recommended that the Ministry of Health and Child Care of Zimbabwe review Antenatal Care policies to ensure friendliness and to increase awareness through health education and continuous dissemination of antenatal care information. / NRF

The aim of this study was to identify factors affecting facility-based delivery with the purpose of developing a framework for the promotion of facility-based delivery among women living in rural Ethiopia. Explanatory mixed methods design, comprising of four phases-the descriptive (quantitative), explorative (qualitative), meta-inference and development phases was employed. The quantitative phase was conducted first using a structured questionnaire to identify the variables influencing facility-based delivery care seeking behaviour. A sample of 389 responses were used for data analysis using Structural Equation Modeling. The quantitative phase conducted next to explain the determinants that contributed to influencing facility-based delivery care seeking behaviour. Sixteen participants who were involved the first phase were involved in the follow-up second phase. As illustrated by the results of the study, the majority of women in the study areas continued to deliver at home, putting themselves at risk of dying from pregnancy related causes. As highlighted by the key findings from the quantitative and qualitative data of this study, the most influential factors in predicting and explaining delivery care seeking behaviour are response efficacy, attitude, subjective norm, and perceived behavioural control which are shaped by mothers’ confidence in the outcome, quality of care, interpersonal relations with family members, willingness to conform, access to services, and their decision making power. The way these findings emphasized the factors attitude, subjective norm and perceived behavioural control were consistent with the Theory of Planned Behaviour, while the significance of response efficacy was in line with Protection Motivation Theory. The study developed a framework to help promote facility-based delivery among mothers living in rural Ethiopia. / Health Studies / D. Litt. et Phil. (Health Studies)

L’objectif de la thèse était de développer un indicateur mesurant l’accessibilité spatiale des premiers soins (nommé Index of Spatial Accessibility : ISA) pour les femmes enceintes, à partir de sources de données collectant des informations en routine. Ce travail a pour vocation de mettre en évidence les limites des indicateurs existants tout en apportant des améliorations. Une attention particulière a consisté à étudier l’impact de l’effet des contours administratifs (ou effet de bord), la limite pointée dans de nombreuses études portant sur l’accès aux soins. L’indicateur d’accessibilité aux professionnels de santé que nous avons développé a pour objectif de mettre en évidence les disparités spatiales à une échelle géographique fine afin d’identifier les zones géographiques dans lesquelles il faudrait intervenir en priorité. Ce travail s’est concentré tout d’abord sur les professionnels de santé intervenant dans le suivi de la grossesse : médecins généralistes, sages-femmes et gynécologues. Les résultats mettent en évidence qu’en combinant la disponibilité avec la proximité des soins, les besoins en matière de santé et la mobilité, l’ISA permet de fournir une meilleure mesure d’accessibilité. L’ISA a été construit afin de pouvoir interroger l’accès aux soins pour d’autres pathologies ou d’autres populations. L’analyse de l’impact de l’effet de bord met en évidence que : 1) la moyenne et l'écart-type sont légèrement inférieurs avec effet de bord que sans, quel que soit le type des professionnels de santé ; 2) La variation d’ISA est plus marquée pour les sages-femmes et les gynécologues, et pour les zones rurales. Nous avons également menée une étude pilote sur le recours aux soins des femmes enceinte, à partir des données SNIIRAM afin d’étudier la relation entre le recours aux soins et l’indicateur ISA. / This paper developed an improved indicator: the Index of Spatial Accessibility (ISA) to measure geographical healthcare accessibility at the census blocks level, and seeks to assess the effect of edge on the accuracy of defining healthcare provider access by comparing healthcare provider accessibility accounting or not for the edge effect, in a real-world application. The indicator of accessibility to health professionals developed aims to highlight spatial disparities measured at a fine geographical scale and to identify area where actions are needed in priority. This work focused first of all on the health professionals involved in the follow-up of the pregnancy: general practitioners, midwives and gynecologists. The main finding is that by combining availability with proximity to services, health needs and mobility, and by calculating at the smallest feasible geographical scale, ISA provides a better measure of accessibility. ISA was conceived so that we could question the access to care for other pathologies and other populations. When we compare the variation of ISA with and without edge effect, we found that (1) mean and standard deviation are slightly below when offer and demand outside are taken in to account, whichever health professionals considered; 2) the variation of ISA is higher for midwives and gynecologists, and for rural areas. In addition, we also conducted a pilot study on the health use of pregnant women, using SNIIRAM data to examine the relationship between use of care and the ISA indicator.

Introducción: Al tener una disfunción del suelo pélvico aumentan las probabilidades de desarrollar incontinencia urinaria o prolapso genital. Estas condiciones, a su vez, podrían generar una infección del tracto urinario (ITU). En la población de mujeres embarazadas, la disfunción del suelo pélvico ocurre principalmente por la carga de peso del vientre, el cual podría ser una causa de la ITU. Objetivo: Determinar la asociación entre la disfunción del suelo pélvico y la ocurrencia de la ITU en gestantes. Métodos: Estudio observacional de tipo transversal analítico. La población fueron gestantes entre 18 a 35 años de 5 centros de salud en Lima. La disfunción del suelo pélvico se evaluó con el cuestionario The Pelvic Floor Inventories Leiden (PeLFIs) dividiéndose en 3 componentes: sensación de flacidez, patrón de orina e incontinencia urinaria. La ITU se midió incluyendo una sección en el cuestionario abarcando 3 preguntas. Las variables edad, actividad física, ocupación y peso fueron incluidas en la sección de preguntas generales dentro del cuestionario. Resultados: En total fueron 146 gestantes encuestadas que cumplieron criterios de selección. La prevalencia de ITU durante el embarazo fue de 42.5%. Las gestantes con ITU durante el embarazo tienen un puntaje mayor en los componentes de sensación de flacidez (p=0.036), patrón de orina (p=0.001) e incontinencia urinaria (p=0.011). Conclusión: Luego de ajustar las variables confusoras se determinó que existe asociación entre los 3 componentes de disfunción del suelo pélvico y la ITU, ya que la mayoría de las gestantes tuvieron tratamientos contra la ITU para no perjudicar su embarazo. / Introduction: Upon occurrence of a pelvic floor dysfunction, the chances of developing urinary incontinence or vaginal prolapse increase. Such conditions, in turn, may lead to a urinary tract infection (UTI). In pregnant women, the pelvic floor dysfunction mainly occurs due to the weight of the womb, which could be a cause of the UTI. Objective: To determine the association between the pelvic floor dysfunction and the occurrence of UTI in pregnant women. Methods: Observational research of analytical cross-sectional type. The population included pregnant women between 18 to 35 years old from 5 health centers of Lima. The pelvic floor dysfunction was assessed through the questionnaire “The Pelvic Floor Inventories Leiden” (PelFIs), and it was divided into three components: vaginal swelling, urination pattern, and urinary incontinence. The UTI was measured based on three questions in a section of the questionnaire. Variables such as age, physical activity, occupation, and weight were included in the section of general questions within the questionnaire. Results: A total of 146 pregnant women surveyed met the selection criteria. The prevalence of UTI during pregnancy was 42.5 %. The pregnant women suffering from UTI during the pregnancy period show a higher score in the components of vaginal swelling (p=0.036), urination pattern (p=0.001), and urinary incontinence (p=0.011). Conclusion: After adjusting the confounding variables, it was determined that there is no association between the three components of the pelvic floor dysfunction and the UTI since most of the pregnant women followed treatments against UTI to avoid any harm during pregnancy. / Tesis

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

No description available.

In 2011, African Americans in Tarrant County, Texas experienced an infant mortality rate of 14.3 per 1,000 live births. The leading cause of infant mortality in Tarrant County is prematurity and maternal nutritional status. Both maternal under-nutrition and over-nutrition are known risk factors for premature birth. Improving maternal nutrition, by reducing rates of gestational diabetes and preeclampsia, and by increasing consumption of essential prenatal vitamins and nutrients, is a road to decreasing preterm birth in African Americans. This qualitative study, based on both anthropology and public health theory, of the nutrition behavior of a group of African American expectant mothers and the experience of their health care providers and co-facilitators had a goal to provide a foundation for future development of nutrition behavior research and education for this specific population. The main finding of this study was the substantial gap of lived experience and education between the patients and their providers and co-facilitators, which hinders delivery of care and the patients’ acquiescence to nutrition recommendations. The discrepancies between the authoritative knowledge of the providers and the bodily knowledge of expectant mothers were responsible for the ineffectiveness of nutrition recommendations.

Community participation has been hailed as the panacea for most community programmes. Community participation at high levels empowers communities, increases self-reliance, selfawareness and confidence in self-examination of problems and seeking solutions for them Behavioural changes are promoted and utilisation and support of services is facilitated, which is of great importance in antenatal care and generally in this present day of HIV/AIDS. The purpose of this study was to determine the extent to which women were participating in the provision of antenatal care. Secondly, the study sought the pregnant women's perceptions and expectations regarding their participation in the provision of antenatal care and to find out at what level if any, the women wanted to be involved in the provision of antenatal care. The theoretical model guiding this study was Rifkin' s model for evaluating community participation. A guided interview was conducted with 30 conveniently selected pregnant mothers residing in the area of the Chinamhora clinic. The results indicated limited participation in the five process indicators of community participation. However, all the women regarded community participation as being important. The majority of the women wished to be involved at high levels of participation. The results of this study should be valuable to health care professionais in formulating strategies and modifying existing programmes to enhance community participation, with the decentralisation of health services in Zimbabwe. / Health Studies / M.A. (Advanced Nursing Sciences)

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)