D.Cur / One of the most important factors relating to antenatal care provisions as One of the most important componentscomponents of P rimary Health Carecomponents of Prima ry Health C are (PHC ) is that the provisio forfor all pregnant women for whom these provisions afor all pregnant women for whom these provisions related to the a vailability, afforda bility, accepta bility, effectiveness, efficiency , equityrelated to the availability, utilization of the antenatal care clinics by pregnant women. TheThe White Paper on the Trans foThe White Paper on the Trans formation of The White Paper on services be madeservices be ma de accessib le for all the po pulation grou ps in South A frica. Thisservices thethe health services should be equally accessible in thethe health services should be equally accessible in WhiteWhite Paper states tha t all citizens shou ld have equ al access toWhite Paper states that all citizens should entitled. The right of access to health care means that: " Health professionals are obliged to facilitate access. The following constitute access to health care: " Functional services, of sufficient quality; " Physical, economic and information access; " Respect for ethics and culture, including language; " Scientifically appropriated and high quality care; and " Recognition of the needs of vulnerable groups. IfIf the curriculum for the training ofIf the curriculum for the training of primary health careIf the curriculum itit should reflect community needs more accura tely and the teaching sho uldit should reflect community moremore emphasis on community and oumore emphasis on community and outcome-bmore emphasis undertundertaundertakenundertaken to explore and describe the factors that influence the accessibility of carecare services in the then Central Region of the then Northern Prcare services in the then Central strategies to address such factors. TheThe aim of this study was to expThe aim of this study was to explore and desThe aim of this accessibilityaccessibility of antenatalaccessibility of antenatal care clinics in the rural areas. The researcher descrip tivedescriptive and contextualdescriptive and contextual design to approachdescriptive and contextual obtained th rough interview s withobtained through interviews with postpartum women, clinic and hospitalobtained withwith nurses fromwith nurses from thewith nurses from the Maternal and Child Health (MCH) Office in ofof Heaof Healof Health and Welfare. The second phase entailed the development of strategies addressingaddressing thoaddressing those factors addressing those factors that influence the accessibility data obtained in phase one of this study as well as from the literature. TheThe results of this research show that several personal anThe results of this research show that several byby both health care us ers and health care providersby both health c are users and h ealth care provid ers haveby thethe antenatal care clinics. The principal factors are: adolescent pregnancy,the antenatal care clinics. humanhuman and materialhuman and material resources, thehuman and material resources, the considerable thethe long waiting hours, paucity of community ithe long waiting hours, paucity of community involvemethe relatingrelating to the organization of health care activities at the clinic, andrelating to the organization of and safety at the clinics. RecommRecommendationsRecommendations evolving from this study are that the Health Department should moremore nurse s and mater ial resources, the clinicmore nurses and material resources, the clinic should be organised nnursesnurses shounurses should be given in-service education in primary health care (PHC), including antenatalantenatal care services, on a regular basis in order to equip themantenatal care services, on a clinics.clinics. Security of the clinic en vironment should be imp roved to ensu re the safety o f both personnel and patients on a twenty-four hourpersonnel and patients on a twenty-four hour basis. Antenatal more accessible to all the communities.

A comparative study of two groups of primiparas was conducted in Vancouver, British Columbia (Canada), during the summer of 1976. The first group was comprised of those women who attended 50 per cent or more of a series of prenatal classes (the attenders), and was compared to a group of non-attenders, those who had not attended prenatal classes during their pregnancy. The objective of the study was to examine those factors which are expected to influence utilization of prenatal educational programs. The long-term objective was to generate data which could be used to improve these programs; and, consequently, also to improve the health of the mother and child. From a total sample of 154 primiparas drawn from the mothers having given birth to a live baby in April, May or June 1976, 127 were interviewed: 54 non-attenders and 73 attenders. The comparison of the groups of attenders and non-attenders showed the following results: 1) There were differences between the two groups in regard to basic socio-economic and demographic characteristics. In general, the non-attenders tended to be younger, less educated, poorer, new immigrants, and less fluent in English than the attenders. 2) When tested on a set of knowledge questions, the two groups showed differences in the areas of pregnancy, childbirth and child care knowledge. In general, the attenders responded correctly to more of the questions than did the non-attenders. However, on some questions, the differences were not very large and it would be interesting to re-examine these differences when confounding factors are controlled (e.g., English fluency). The comparison of behavioural health practices revealed the following: The non-attenders were less likely to smoke during pregnancy than were the attenders. - The two groups were fairly comparable in terms of a positive change in their nutrition habits during pregnancy. - As expected, more attenders than non-attenders used controlled breathing techniques during the delivery. Seventy-six per cent of the non-attenders either partially or totally breastfed their babies compared with 55 per cent of the attenders. When asked about their reasons for not attending prenatal classes, the non-attenders most frequently mentioned a lack of awareness of the existence of the classes and a general feeling that it was unnecessary to attend. Difficulty in speaking and understanding English was also a factor in non-utilization of classes. In regard to wife-husband relationships, husbands were given as a source of support by more attenders than non-attenders, although the difference was not statistically significant. It could be worthwhile to investigate this area more thoroughly to determine whether the presence of support from a husband/partner is a reason for attendance or occurs as a result of the attendance. The data on knowledge and behavioural health practices could raise questions concerning the effectiveness of the prenatal programs. However, this study has not been designed to evaluate these programs. Most of the factors studied regarding knowledge and health practices are known to be associated with socio-economic and cultural factors. An analysis of the true effect of the program should take these factors into consideration. In conclusion, this study has shown ways of increasing utilization of prenatal educational programs. Emphasis should be placed on the following: The target population - More effort and resources should be devoted to reach lower socio-economic groups, new immigrants, and those less fluent in the English language. The method - New communication and information dissemination techniques, as well as diversified teaching methods, should be developed (e.g., more courses should be taught in a language other than English). The content - Given the differences in knowledge levels and health practices, the content should be geared more to meet the needs of specific sub-groups in the population. Publicity - The study demonstrates the need for making better known the existence of the program as well as its present objectives. This study has raised a number of questions regarding both utilization of prenatal care and outcome measures relating to this care. Therefore, a larger and well designed study to investigate these questions more extensively is recommended. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The importance of maintaining maternal wellbeing during the antenatal period is mandatory to the mother and the baby. Although asymptomatic maternal tachycardia could be seen as part of the physiological changes during pregnancy, it could also be a sign of a serious underlying condition. Previous studies have shown that maternal deaths could occur in women with pre-existing cardiac conditions (Naidoo, Desai & Moodley, 2002:17). The concern that many conditions associated with maternal tachycardia pass through the health care system without being noticed or investigated motivated the researcher to undertake this study. The study aimed to determine the prevalence of maternal tachycardia during late pregnancy and its association with anaemia, major cardiac diseases and/or complications and adverse maternal and perinatal outcomes. A case-control retrospective study design within a prospective study was employed with a quantitative approach. A total sample size of 204 participants, constituting 14.3% of the study population (N=1431) was purposefully selected from the Monica AN24™ recordings of the Safe Passage Study at Tygerberg Hospital to collect the data. Ethical approval was obtained from the Health Research Ethics Committee of the Faculty of Medicine and Health Sciences, Stellenbosch University and a waiver of consent had been granted. A group of 16 participants, who met the inclusion criteria, constituting 7.8% of the total sample, was selected for the pilot study. Reliability and validity was ensured by the pilot study and pre-testing the data collection instrument as it was tested under the exact circumstances as the actual study experts in the field of nursing and medical research and statistics were used. The data was analyzed by the use of the STATISTICA version 9 programme. The results show a 7.1% (n=102) prevalence of maternal tachycardia in late pregnancy. There were no pre-existing cardiac conditions in any of the groups and no maternal cardiac complications during pregnancy and delivery. The case group had a higher incidence (55.0%) of haemoglobin values lower than 11.0 g/dL than the control group (47.0%), however the Mann-Whitney U test revealed no statistically significant difference of the Hb values at 28 to 38 weeks between the case and the control groups. The participants presenting with anaemia (Hb < 11.0 g/dL) were classified as mild anaemia (Hb value of 7.0 – 10.9 g/dL). There were no participants that presented with severe anaemia (Hb value of < 7.0g/dL). There was an increased prevalence (9.1%) of infection in the participants presenting with maternal tachycardia, although this difference was not significant between the two groups. The infant outcome revealed an increased mean birth weight of 194g for the case group that presented with maternal tachycardia. Several recommendations were identified that were grounded in the study findings. The findings reveal that the current antenatal care practice in terms of not recording the maternal heart rate is sufficient. / AFRIKAANSE OPSOMMING: Die belangrikheid van die handhawing van moederlike welsyn gedurende die voorgeboorte tydperk is noodsaaklik vir die moeder en die baba. Alhoewel asimptomatiese moederlike tagikardie gesien kan word as deel van die fisiologiese veranderinge tydens swangerskap, kan dit ook 'n teken wees van 'n ernstige onderliggende toestand. Vorige studies het aangetoon dat moederlike sterftes kan voorkom in vroue met voorafgaande harttoestande (Naidoo, Desai & Moodley, 2002:17). Die kommer dat verskeie toestande wat verband hou met moederlike tagikardie, deur die gesondheidsorg stelsel kan deurglip sonder om opgemerk te word, het die navorser gemotiveer om hierdie studie te onderneem. Die studie is daarop gemik om die voorkoms van moederlike tagikardie tydens laat swangerskap en sy verbintenis met anemie, ernstige hartsiektes en/of komplikasies en ongunstige moederlike en perinatale uitkoms te bepaal. 'n Gevalkontrole retrospektiewe studie-ontwerp binne 'n voornemende studie is gebruik met 'n kwantitatiewe benadering. 'n Totale steekproefgrootte van 204 deelnemers, wat 14.3% van die populasie (N=1431) uitmaak is op ‘n doelgerigte manier uitgekies uit die Monica AN24™ opnames van die Veilige Geboorte Studie by Tygerberg Hospitaal om die data in te samel. Etiese goedkeuring is verkry van die Mensnavorsing Etiese komitee komitee van Fakulteit van Geneeskunde en Gesondheidswetenskappe van die Universiteit Stellenbosch en 'n kwytskelding van toestemming is verleen. 'n Groep van 16 deelnemers, wat voldoen aan die insluitingskriteria, wat 7,8% van die totale steekproef bestaan, is geselekteer vir die loodsstudie. Betroubaarheid en geldigheid is verseker deur die loodsstudie en die voorafgaande toets van die data-insamelingsinstrument onder presies dieselfde omstandighede as die werklike studie sowel as die gebruik van kenners in die gebied van verpleging en mediese navorsing en statistiek. Die data is ontleed deur die gebruik van die Statistica weergawe 9 program. Die resultate toon 'n 7,1% (n=102) voorkoms van moederlike tagikardie in laat swangerskap. Daar was geen onderliggende harttoestande in enige van die groepe en geen moederlike hartkomplikasies tydens swangerskap en geboorte nie. Die gevalgroep het 'n hoër voorkoms (55,0%) van Hb waardes laer as 11.0 g/dl as die kontrole groep (47.0%) gehad, maar die Mann-Whitney U-toets toon geen statisties beduidende verskil in die Hb waardes by 28-38 weke tussen die geval en die kontrolegroepe nie. Die deelnemers met anemie (Hb < 11.0 g/dl) is geklassifiseer met ligte bloedarmoede (Hb waarde van 7.0-10.9 g/dl). Daar was geen deelnemers wat erge bloedarmoede (Hb waarde van < 7.0g/dL) getoon het nie. Daar was verhoogde voorkoms (9,1%) van infeksie in die deelnemers met moederlike tagikardie, hoewel die verskil nie beduidend tussen die twee groepe was nie. Die baba uitkoms toon 'n toename in gemiddelde geboortegewig van 194g vir die gevalgroep wat met moederlike tagikardie gediagnoseer is. Verskeie aanbevelings is geïdentifiseer wat in die studie se bevindinge gegrond is. Die bevindinge dui daarop dat die huidige voorgeboortelike sorgpraktyk in terme van nie rekordering van die moederlike hartspoed voldoende is.

nÃo hà / A presente pesquisa teve por objetivo construir e validar um protocolo direcionado a consulta de Enfermagem no prÃ-natal a ser utilizado na Casa de Parto Natural LÃgia Barros Costa. Pesquisa tecnolÃgica desenvolvida de janeiro de 2012 a novembro de 2013 em quatro fases com 10 etapas. A primeira fase correspondeu à construÃÃo do protocolo onde foi realizada uma adaptaÃÃo as etapas propostas pela GerÃncia de Ensino e Pesquisa do Grupo Hospitalar ConceiÃÃo (GHC) para Diretrizes ClÃnicas/ Protocolos Assistenciais de Porto Alegre e foi composta por sete etapas. A primeira etapa correspondeu à escolha do tema, onde o protocolo foi dividido em capÃtulos em uma sequÃncia lÃgica para melhor direcionar o atendimento prÃ-natal. A etapa 2 foi referente a justificativa do tema escolhido. Na etapa 3 foram disponibilizadas as fontes bibliogrÃficas utilizadas no protocolo. A etapa 4 correspondeu as evidÃncias encontradas ao longo da elaboraÃÃo do protocolo. Na etapa 5 foi realizada a organizaÃÃo do protocolo em algoritmos visando ordenar e estabelecer os fluxos das aÃÃes. A etapa 6 foi caracterizada pela enumeraÃÃo das referÃncias utilizadas as quais foram disponibilizadas em formato Vancouver. Na etapa 7 ocorreu a diagramaÃÃo do protocolo desenvolvida atravÃs do programa CorelDraw x6. A fase 2 correspondeu a elaboraÃÃo textual do protocolo o qual foi escrito em fonte Times New Roman, tamanho 12 sendo composto por 94 pÃginas com 12 capÃtulos. A fase 3 foi referente a validaÃÃo de conteÃdo e aparÃncia do protocolo. Na etapa 8 foram escolhidos, atravÃs de critÃrios de inclusÃo prÃ-estabelecidos, 22 especialistas com experiÃncia na Ãrea de interesse (ObstetrÃcia, saÃde da mulher, prÃ-natal, saÃde da famÃlia, validaÃÃo de instrumentos), os quais avaliaram objetivos, estrutura, aparÃncia e relevÃncia do protocolo. Um item era considerado validado quando apresentasse Ãndice de Validade de ConteÃdo (IVC) &#8805;0,78. Ressalta-se que todos os itens apresentaram IVC superior a esse valor. Em relaÃÃo aos objetivos do protocolo houve variaÃÃo do IVC de 0.86 a 1.0. Na avaliaÃÃo alusiva a estrutura e aparÃncia o IVC tambÃm variou de 0.86 a 1.0. No tocante a avaliaÃÃo da relevÃncia do protocolo, houve variaÃÃo do IVC de 0.90 a 0.95. O protocolo foi validado de forma global com IVC=0.92. Na etapa 9 foi realizada adequaÃÃo do protocolo Ãs sugestÃes dos especialistas referente a reelaboraÃÃo de frases, acrÃscimo ou modificaÃÃes de informaÃÃes e ilustraÃÃes. A fase 4 foi equivalente a disponibilizaÃÃo do protocolo e foi composta pela etapa 10 que correspondeu ao encaminhamento do protocolo para impressÃo. Considerou-se o protocolo validado em conteÃdo e aparÃncia por especialistas, sendo importante a realizaÃÃo de estudo posterior para verificar o seu impacto na unidade de saÃde na qual serà utilizado.

Thesis (M.S.)--West Virginia University, 2002. / Title from document title page. Document formatted into pages; contains vi, 43 p. Vita. Includes abstract. Includes bibliographical references (p. 34-36).

Thesis (Ph. D.)--University of Chicago, Irving B. Harris Graduate School of Public Policy Studies, June 2001. / Includes bibliographical references. Also available on the Internet.

Not available / text

Background: The current practice in northern Canada is to transfer pregnant women residing in communities without hospital facilities to larger centres at 37 weeks gestation. Little research has been conducted on how the practice of transferring women for childbirth affects available prenatal care continuity and prenatal care options, and whether or not this in turn affects health outcomes. Objectives: The aim of this study is to examine whether differences exist in prenatal care, risk factor distribution, and neonatal morbidity, between women who are transferred for childbirth, and women who are able to remain in their home community to give birth. Methods: Secondary analysis of the Canadian Maternity Experiences Survey 2006-2007 data was conducted in order to examine the relationship between transfer for childbirth, prenatal care, maternal risk factors, and neonatal morbidity. Crude odds ratios and adjusted odds ratios were calculated to assess the relationships between variables using multiple logistic regression, with bootstrap weights applied. Results: Women who were transferred for childbirth were more likely to experience a negative neonatal morbidity outcome (OR=1.9, 95% CIs 1.3-2.8), though this relationship disappeared when the relationship was adjusted for potential confounders. When these results were adjusted for potential confounding, smoking during pregnancy was the only risk factor shown to be significantly associated with neonatal morbidity in this study (OR=1.8, 95% CIs 1.0-3.0). Conclusion: More detailed and widespread data collection is needed to be able to properly assess prenatal care, maternal risk factors and neonatal morbidity in northern Canada. A perinatal database, constructed for surveillance purposes, would assist in further exploring the effect of transfer policy on prenatal care practices and maternal risk factor distribution, and the effect this has on neonatal health outcomes. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-09-29 14:55:33.977

Prenatal care provides numerous maternal and infant health benefits, and it is more likely to be effective if women begin receiving care early and continue their care throughout pregnancy. Patient satisfaction is recognized as a predictor of adherence to medical recommendations and utilization of care. The purpose of this study was to identify the factors associated with pregnant women’s satisfaction with prenatal care in Winnipeg. A cross-sectional, descriptive, correlational design was used to examine the relationships between expectations, interpersonal processes of care, the quality of prenatal care, personal characteristics, and the type of provider with overall satisfaction, as well as with satisfaction with each of the following dimensions: information, provider care, staff interest, and system characteristics. Donabedian’s (2003) structure, process, and outcome framework guided the study. A convenience sample of 216 pregnant women from diverse socioeconomic backgrounds was surveyed using self-administered questionnaires in late third trimester; providers were obstetricians (58.2%), midwives (15.9%), family physicians (13.9%), nurse practitioners (4.8%), or mixed (7.2%). Multiple linear regression analyses were used to identify predictors of satisfaction. Perceived quality of care was a significant predictor of overall satisfaction and all the satisfaction subscales. The provider’s interpersonal style was a significant predictor in all but one of the satisfaction measures, satisfaction with information, where patient-centered decision-making was significant. The type of prenatal care provider (midwife) was a predictor of satisfaction with system characteristics. Expectations for prenatal care were unrelated to satisfaction. Although most of the participants in this study were satisfied with prenatal care, 5-20% reported dissatisfaction with various dimensions. The findings of this study have implications for future research, practice, education and policy. Important information on structure and process was generated, with the potential to improve the experience and satisfaction of women receiving prenatal care.

Thesis (Ph.D.)--Duquesne University, 2005. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 226-240) and index.