A research report submitted to Faculty of Health Sciences in partial fulfilment of the requirements for the degree of Master of Science in Epidemiology in the field of Implementation Science, School of Public Health University of The Witwatersrand. Johannesburg June 2018. / Background Intermittent Preventive Therapy using sulfadoxine pyrimethamine (IPTp-SP) is a malaria control strategy to reduce cases of malaria in malaria endemic countries. However, the administration of the recommended three doses of IPTp throughout the stages of pregnancy still remains low in Nigeria even though, Nigeria is a malaria endemic country. Quality improvement approach has been demonstrated to improve practice among healthcare providers. This study therefore used a quality improvement approach to train and coach healthcare providers in order to improve the administration of the recommended doses of IPTp to pregnant women receiving antenatal care (ANC) services. Methods A quasi-experimental study design was carried out to evaluate the effect of quality improvement approach consisting of training and coaching of healthcare providers to improve the administration of IPTp during ANC service. Primary Healthcare Centre (PHC) Samaru was purposively selected and twelve healthcare providers participated in the study. ANC daily register was reviewed pre-intervention, intervention and post-intervention period of the study. Data were analysed using line graphs and run charts. Results A total of 36 ANC visit weeks were observed between 21st November 2016 and 27th July 2017. The mean level for IPTp1 administration pre-intervention was 105.85% (SD: 29.28) and 75.20% (SD: 16.89) for IPTp2+. The levels of IPTp1 administration were relatively stable from Week 1 to Week 10 although, there was overestimation of IPTp1 as 8 of the 16 Weeks in the pre-intervention period i.e. Weeks 3, 5, 7, 8, 11, 13, 15 and 16 all had more than 100% of eligible women administered IPTp1. The patterns of IPTp2+ administrations shows the levels of IPTp2+ administration were erratic. There was evidence indicating the process of IPTp1 was relatively stable post-intervention as the data crosses the median line only six times i.e. 7 runs. This indicates that the process of IPTp1 was within normal variation over the post-intervention period. There was an upward shift showing immediate improvement of the administration of IPTp2+ post-intervention although, there was a non-random variation in the administration of IPTp2+. The iv improvements of IPTp were not sustainable due to stock-outs. The quality of the ANC daily register was poor. Conclusion The integrated training and coaching intervention approach improved the administration of the recommended three doses of IPTp within the context of a PHC. These findings should be interpreted with caution as the impact of the intervention may not have reached its full impact due to the short post-intervention assessment. Stock-outs remains a huge barrier to the administration of IPTp under DOT during ANC services. The data quality of the ANC daily register improved post-intervention however, there were still slight errors thus, indicating that healthcare providers need constant coaching. It is important to integrate training and coaching of healthcare providers in order to have desired and sustained outcomes. Keywords: Malaria in pregnancy, IPTp, IPTp-SP, SP, ANC, Pregnant women, Healthcare providers, administration, QI, integrated training and coaching. / LG2018

Background Expectations and knowledge of pregnant women prior to fetal ultrasound are well documented in developed countries. Women have generally been shown to have appropriate and reasonable expectations and knowledge. The main objective of this study was to examine whether the views of women in our setting are similar to findings from studies in developed countries. Methods This was a descriptive study done on pregnant women attending the ultrasound department and antenatal clinic at Rahima Moosa Mother and Child Hospital. An interview questionnaire was administered before the ultrasound scan. Results Two hundred and fifty women were recruited. The most frequently expressed expectation was to determine sex of baby (n=154). This was followed by wanting to know the baby’s wellbeing and health (n=136). All the women interviewed had expectations. The majority of women did not know that fetal anomalies could be detected at fetal ultrasound (n=235), this was statistically significant (p=0.003) and was correlated to educational level. Almost half the women did not know the purpose of the ultrasound for which they were referred for (n=124). Conclusion Most women had appropriate expectations in keeping with studies from developed countries. Lack of education was directly linked to poor knowledge of fetal ultrasound. This study has identified areas where patient education is needed regarding fetal ultrasounds. / LG2018

Only a small amount of research on yoga during pregnancy has been done. Yoga is a cost effective tool that expectant mothers can utilize to improve their unborn child's health. There is strong evidence that yoga is useful in having healthier babies. The absence of research on yoga during pregnancy is the impetus for the present study. The independent variable in. the proposed study is yoga participation (yes or no). It was hypothesized that women who participated in Prenatal Yoga would deliver babies with higher APGAR scores. Participants consisted of 18 mothers. The findings did not support the hypothesis, the difference in APGAR scores between the two conditions was not significant, F(l, 16) = 0.312,p = .584.

El quiste de colédoco es una patología poco común, diagnosticada generalmente después del nacimiento; pero en los últimos tiempos el diagnóstico prenatal ha tomado mayor importancia, pues permite una intervención precoz y brinda un mejor pronóstico a los pacientes. Se presenta el caso de una lactante que fue diagnosticada mediante ecografía obstétrica, a las 21 semanas de vida intrauterina; confirmándose luego el diagnóstico por medio de resonancia magnética. La paciente fue operada a los tres meses de vida, realizándosele una quistectomía, colecistectomía y derivación biliodigestiva en Y de Roux, con evolución posoperatoria favorable.

Bakgrund: Hur mödrar knyter an till sitt väntade barn, vad det påverkas av och vad det kan få för konsekvenser samt hur de lär känna sitt barn under graviditeten innefattas av prenatal anknytning. Prenatal anknytning har stor plats inom mödrahälsovården men som begrepp är det relativt odefinierat. Syfte: Syftet var att beskriva begreppet prenatal anknytning genom en begreppsanalys. Metod: En begreppsanalys med kvalitativ design. Först utfördes en litteratursökning, den teoretiska fasen, och sedan blev fem barnmorskor identifierade genom ett bekvämlighetsurval och intervjuades i fältstudiefasen. Resultatet från fältstudiefasen sammanställdes med resultatet från den teoretiska fasen. Resultat: Begreppet prenatal anknytning resulterar i flera definierade attribut där fosterrörelser har stor del. Andra attribut är interaktion, dela med sig, fantasier och känslor. Referensramen för begreppet bestäms av dess förutsättningar och konsekvenser. Slutsats: Prenatal anknytning kan ses som ett komplext begrepp som anpassas till varje graviditet utifrån de definierade attributen. / Background: Mothers prenatal attachment, what it is influenced by and what the consequences might be and how the mothers experience their child during pregnancy are included in prenatal attachment. The concept is lacking clear definitions. Prenatal attachment has a great part within maternal health care but as a concept it's relatively undefined. Aim: The aim was to describe the concept of prenatal attachment through a concept analysis. Methods: A concept analysis with qualitative design. Five midwives were selected trough a convenience sampling and were interviewed, earlier a literature review was conducted. The result from the field study phase was brought together with the result from the theoretical phase. Results: The concept of prenatal attachment results in defined attributes. Fetal movement was a significant attribute. Other attributes were interaction, sharing, fantasies and emotions. The frame around the concept is set due to its conditions and consequences. Conclusion: Prenatal attachment can be identified as a complex concept adapted to each pregnancy based on the defined attributes.

Studies have reported that the most trusted health care relationship is that of the prenatal healthcare professionals (PHPs) and the prenatal patient. Yet many of the patient’s environmental health questions go unanswered for a variety of reasons. To better understand the situation, this research examines environmental health education practices of PHPs – obstetricians, prenatal nurses, family physicians, midwives and doulas - offered during the preconception and prenatal period. Specifically, this thesis discusses some of the PHP self-reported opportunities and barriers surrounding the provision of environmental health education (EHE). In person (n=17) and telephone (n=4) interviews were conducted with PHPs in the Ottawa Region. Additionally, a key informant within the Society of Obstetricians and Gynaecologists of Canada (SOGC) was asked specific questions about the association’s role in the development of standardized educational care guidelines. The results show that most PHPs have a limited knowledge of EHE and are reluctant to discuss it without access to more professional research. PHPs feel that there is little professional association support and that guidelines for adding EHE to their current prenatal care plans are non-existent. This study is one of the first studies that uniquely examined EHE in the prenatal period from perspective of prenatal healthcare professionals.

Qin, Yun. / "April 2002." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (p. 229-254). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Circulating RNA offers a new detection approach for non-invasive diagnosis. Over the past few years, much effort has been spent on the investigation of possible detection of circulating RNA in plasma. In this thesis, we aim to quantify and characterize cell-free RNA in plasma, and investigate the possibility of using circulating fetal RNA in maternal plasma for non-invasive prenatal diagnosis or monitoring. / In the first part of the thesis, the particle-associated nature of circulating RNA was investigated. Quantitative real-time reverse-transcriptase polymerase chain reaction was developed to measure circulating RNA in healthy individuals and hepatocellular carcinoma (HCC) patients. By subjecting plasma samples to filtration and ultracentrifugation, the presence of both particle-associated and non-particle-associated mRNA species was demonstrated in human plasma. In HCC patents, both the circulating particle- and non-particle-associated plasma RNA concentrations were increased. / The discovery of circulating nucleic acids in plasma and serum has led to the development of numerous promising non-invasive diagnostic tests. The initial non-invasive tests mainly target circulating DNA species. For prenatal diagnosis, circulating fetal DNA in maternal plasma has been utilized for the non-invasive determination of a number of fetal genetic traits. However, as fetal and maternal DNA species co-exist in maternal plasma, these DNA based diagnostic applications depend largely on the use of genetic markers that could discriminate between fetal and maternal DNA, such as the Y chromosome of a male fetus. Thus, a particular DNA marker could only be used in a proportion of pregnancies. This limitation has prompted a quest to develop new fetal nucleic acid markers that are independent of sex or polymorphism and that can be used in all pregnancies. / The existence of circulating RNA is an extraordinary finding because RNA is more labile than DNA and ribonuclease is known to be present in blood. The second study of the thesis reveals that circulating RNA is surprisingly stable under different preanalytical situations. This information has made the study of circulating RNA simpler and more practical for clinical uses. / The third part of this thesis aims at detecting circulating fetal RNA in the plasma of pregnant women. We showed that two placental-derived mRNA species, namely those transcribed from the genes coding for human placental lactogen (hPL) and the beta-subunit of human chorionic gonadotropin (betahCG), are readily detectable in maternal plasma. (Abstract shortened by UMI.) / Tsui Bo Yin. / "May 2005." / Adviser: Y. M. Dennis Lo. / Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0074. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 166-189). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

The current state of preimplantation genetic diagnosis technology is presented, as are the biological principles and medical procedures that make it possible. The arguments of both proponents and those with social and ethical reservations about the broader implications of the technique are carefully reviewed, and the limitations of the dominant medical model approach to the technique are exposed. A discussion of reproductive autonomy in light of emerging testing applications of PGD not directly related to the avoidance of serious genetic abnormalities in the resulting child demonstrates the complexity of both clinical decision-making and public policy formulation with regard to PGD. Recently proposed legislation in Canada reflects such complexities, and highlights the lack of social consensus on the appropriate uses of, and restrictions on, PGD. A variety of "soft law" instruments, notably professional codes of practice and research guidelines implemented by institutional ethics committees, may mitigate some of the uncertainty surrounding PGD in Canada, but their limited applicability and espousal of the medical model approach render questionable their capacity to reconcile tolerance of pluralism with respect for human life, diversity, and reproductive autonomy.

The present study investigated the use of the Maternal Perinatal Scale (MPS) as an instrument for predicting group membership among normal versus emotionally handicapped children. An examination of neurological symptoms as they relate to specific behavioral factors within the Child Behavior Checklist (CBCL) was conducted, as well as an investigation of the relationship between factors within the MPS as predictors of specific behaviors within the CBCL. Subjects included 119 EH students and 211 normal subjects with a mean age of 10 years, 3 months. Samples were collected from a suburban midwestern area of approximately 800,000 population.Results of discriminant analyses indicated that the MPS items were able to predict group membership with 85.5% accuracy when the mother's history was included and 88.2% when the Childhood Checklist was added as additional data. Out of 66 possible factors, 22 yielded correlations which were significant at the .01 level.A significant relationship between the total number of neurological symptoms observed in a child and the degree of behavioral deviance as reported with the CBCL was an outstanding feature of this study. Nine of ten factors on the CBCL were correlated with the total NSI score at the .01 level of significance, with Attention Problems demonstrating the greatest degree of relationship. Canonical analysis of the MPS factors as predictors of specific CBCL subscales yielded vague results. Although several correlations were significant, the pattern of variance provided a minimal degree of interpretive utility.Future research stemming from these results would include further examination of the nature of relationships between perinatal factors and mother's history, as well as the incorporation of strategies to provide early intervention to infants and children at risk for future placement in the EH category. The MPS appears to offer promise as a tool for bringing consistency and replicability into the area of perinatal research, as well as serving to assist in the early identification of at-risk children. The prospect of predicting specific behavioral factors from perinatal variables continues to be a viable direction for future study. / Department of Educational Psychology