Mothers who are experiencing psychopathology are often unable to provide sensitivity to their infants, which is critical for the development of a secure attachment. The objective of the current study was to provide a statistical, quantitative consensus on the relationship between maternal psychopathology and infant attachment, by performing a number of meta-analyses. Prevalence rates of non-secure attachment in infants of mothers with overall and specific psychopathologies were calculated. Infants of mothers with psychopathology were also found to be at increased risk for developing a non-secure attachment, displayed significantly greater levels of attachment non-security, and there was a significant relationship between symptomology and non-security. Moderator analyses were also run to determine if any variables moderated this relationship. The results of this study indicate that it may be beneficial for clinicians to identify mother-infant dyads who may benefit from early interventions that focus on improving maternal mental health and enhancing infant attachment. / October 2016

In the beginning of my thesis there is an overview of the mother and woman role from the Middle Age till the present. In the first chapter I introduce four mothers from two novels by Elfriede Jelinek. I'm trying to display the way they are portrayed in a political system and a concrete period. The Next chapter explains the terms "sex" and "gender". Elfriede Jelinek shows the feminine and masculine principles as stereotypical. Disequilibrium between these two principles concludes to the lability of an individuum and the society. The author reduces females to their bodies. The body is being considered a product of a capitalist market. In the fascist-regime the body is an object which is aimed for liquidation. The dirtiness-motive appears as a metaphor for the way of thinking of petty bourgeois, for the complicity and guilt for Nazi crimes and also as a metaphor for feminine physiological procedures. The next chapter is dedicated to the mother and father-children-relation. The children deprecate their parents but at the same time they repeat their behavior. The border-motive is typical for both chosen novels. The children try to cross the social and also the geographical border (Anna's studies in the USA, Erika's world wide popularity). The last chapter treats Jelinek's linguistic method. I mentioned...

Introduction: Prevention of mother-to-child-transmission of HIV is a priority public health problem in Africa as pregnant women and their children are the most vulnerable. In South Africa, a prevention of mother to child transmission of HIV (PMTCT) programme has been implemented in antenatal clinics to reduce paediatric HIV/AIDS. It is necessary to assess the uptake of this programme by pregnant women. Objectives The purpose of this study was to determine the uptake of the PMTCT programme in the antenatal clinics of Sedibeng district. Using data coming from all the antenatal clinics (ANC) at a primary health care levelin Sedibeng for 2005 and 2006, we determined the proportion of ANC attendees who accepted to be counselled, the proportion of these who accepted to be tested for HIV, the proportion of these who came back for results and the proportion who were HIV positive. Nevirapine (NVP)uptake was determined as well among HIV positive women and babies born to HIV positive women. Methods Data collection was by a record review of PMTCT records from all antenatal clinics in the district. To determine maternal uptake of PMTCT, data were extracted from antenatal clinics monthly collation sheets for 2005 and 2006. Nevirapine uptake for the babies born to HIV positive mothers was determined in one facility: data were v - collected in the midwife obstetric unit of the community health centre from both the Nevirapine register and the mothers’ delivery records. Results A total of 8010 women attended in Sedibeng antenatal clinics in 2005 and 10217 in 2006. In 2005 95 % of attendee women accepted to be counselled among whom 91% accepted to be tested for HIV. In 2006 93% women accepted to be counselled among whom 91% accepted to be tested. Almost all tested women came back for results: 99% came back for results in 2005 and 98% in 2006. The proportion of HIV positive women in the attendees population was 23% in 2005 and 24% in 2006. Nevirapine was dispensed to only 600 per 1000 HIV positive women in 2005 and 539 per 1000 HIV positive women in 2006. From June 2005 to May 2006 only 59% of babies born to an HIV positive mother received NVP. Discussion and conclusion The study showed a good uptake of voluntary counselling and HIV testing in Sedibeng district antenatal clinics. But a low proportion of HIV positive women and HIV-exposed babies received NVP. There was probably a loss of follow up of women between ANC visits and delivery. Nevirapine uptake must be improved in Sedibeng antenatal clinics and further investigations need to be done to understand the factors influencing uptake.

MMed (Paediatrics), Faculty of health Sciences, University of the Witwatersrand / AIM: To evaluate aspects of the PMTCT programmes at selected hospitals and clinics in Gauteng. METHOD: A cross sectional survey of post partum women in Gauteng was undertaken during April- June 2006. Data was collected at four hospitals and eight Midwife Obstetric Units (MOUs) in four regions in Gauteng. Mothers, irrespective of HIV status, who delivered in the previous 48 hours were interviewed. This was followed by a review of the mother’s and infant’s records as well as relevant registers. RESULTS: Interviews with, and record reviews, of 182 mother-infant pairs were conducted/obtained; 69 (38%) at MOUs and 113 (62%) at hospitals. The majority (172 [95%]) of mothers were “booked” of whom 155 (85%) had undergone an antenatal HIV test. Forty-two mothers (23%) were HIV positive. Nevirapine was issued antenatally to 37/42 (89%) of eligible mothers; 30/42 (71%) took it during labour. Three women (8%) received the drug for the first time during labour; thus 33/42 (79%) of eligible mothers received nevirapine. Thirtytwo (76%) of babies born to HIV positive mothers received nevirapine. However, in only 24/42 of mother-infant pairs (57%) was receipt of nevirapine by both parties, recorded. There was no significant difference in nevirapine administration rates to mothers at clinics compared to hospitals (76% vs. 81%, p=0.71). Infants were more likely to receive nevirapine at clinics compared to hospitals (90% vs. 62%, p= 0.03). CONCLUSION: Four years after introduction of a PMTCT programme in Gauteng, nevirapine uptake and administration rates remained sub-optimal, with at least a quarter of eligible (identified) women and infants not receiving the intervention. The findings highlight the need to prioritise and consolidate PMTCT activities in the province.

ABSTRACT The purpose of this study was to understand the mothers lived experience and perception towards 24-hour Kangaroo Mother Care (KMC) during hospitalization of their preterm babies. A qualitative design was used and phenomenological methods used to collect data. Nine in-depth unstructured interviews were with purposely-selected participants. The meaning of their experience was analyzed using Collaizzi’s (1978) steps to phenomenological data analysis. Data analysis revealed major three themes: (a) “it is a bond between me and my child” (b) nurse-parent interaction, and (c) “it is tiring and exhaustive”. However, the study found that all the mothers in spite of exhaustion, reported some high level of satisfaction with KMC because it allowed them to be closer to their babies. hence giving them the opportunity to observe their growth and become fully involved in the care. KMC was additionally noted have provided a comforting and warm environment for the babies, thus enabling them to grow faster and this in turn increased maternal satisfaction. Recommendation was made regarding further research preferably quantitative study to establish relationship between production of breast milk and the use of KMC. The principle of 24-hour KMC should also be incorporated and emphasized in all levels of educational training as this practice has been found to have numerous benefits both to the mothers and to their preterm babies.

MFamMed, Faculty of Health Sciences, University of the Witwatersrand, 2009 / BACKGROUND Until recent years, uptake of voluntary counselling and testing for HIV (VCT) and enrolment into the programme of prevention of mother-to-child transmission of HIV (PMTCT) was very poor among pregnant women. This study aims to identify factors influencing enrolment into the programme of PMTCT among post-partum women. METHODS Cross sectional interview of 200 consecutive post-partum women was conducted using an interviewer-administered questionnaire. Forms of those who declined to participate were kept and marked “refusal”. Data was analysed using Epi info software. RESULTS The response rate was 84.5%. VCT uptake was 96.9% among participants and PMTCT uptake among HIV+ve mothers was 90.9%. The mean age of participants was 25 years, ranged from 14 to 41 years. Women in the age-group 20-29 were more likely to accept VCT and enroll for PMTCT than women in the other age-groups (p=0.0114). CONCLUSIONS AND RECOMMENDATIONS Provision of clear and well-defined policy guidelines and strong commitment to implementation of these guidelines have been largely responsible for impressive uptake of VCT among participants and high rates of satisfaction with PMTCT programme among HIV-infected women. Training of more lay-counsellors is recommended for its cost-effectiveness.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Public Health. Johannesburg, April 2012 / Introduction Routine PMTCT programmes are highly effective in reducing the mother-to-child transmission (MTCT) rate of HIV, but generally fail in follow-up of HIV-exposed children. Loss to follow-up in the PMTCT programme translates into failure in primary prevention of new infections in HIV-exposed infants, failure to identify HIV disease early in children, and a missed opportunity for early referral of HIV-positive children to ARV sites. An assessment of what happens to babies born of HIV-positive mothers in the West Rand district of Gauteng province, South Africa has never been done, and neither has the extent to which these babies are followed up for the first 12 months, and the extent of loss to follow-up been documented. Aim The purpose of this study is to describe the referral and follow-up of babies born to HIV-positive women during July to December 2005 in the PMTCT programme in the West Rand district of Gauteng. Method This was a descriptive study involving a retrospective review of records for a cohort of babies born to HIV-positive mothers in the PMTCT programme in the West Rand during July 2005 to December 2005. All records of HIV-positive mothers seen over the six-month period at Leratong hospital and the two midwife obstetric units (MOUs) that refer patients to Leratong hospital were reviewed, as were records of their babies. A total of 887 Mother-infant pairs were consecutively enrolled in the study. Results Referral linkages within the PMTCT programme were found to be weak. Only 34% of babies enrolled in the PMTCT programme were successfully registered with PMTCT follow-up services. HIV PCR testing of babies enrolled in the PMTCT programme was relatively low. Overall only 41% of enrolled babies were tested for HIV infection. Of those babies who had a HIV PCR test, 16% were tested before or at six weeks with the majority of babies (84%) having a HIV PCR after six weeks. HIV PCR testing coverage at six weeks was 8.4%. Referral of confirmed HIV-positive babies to ARV sites was poor. Only 25% of all HIV PCR-positive infants were successfully referred to ARV sites. There was a high loss to follow-up in the PMTCT follow-up programme. The probability of an infant remaining in the PMTCT programme decreased from 0.5 at six weeks to 0.04 beyond 20 weeks. Conclusion Despite a high enrolment of babies in the PMTCT programme in the West Rand, referral linkages within the PMTCT programme are weak and there is a high loss to follow-up of infants in the PMTCT follow-up programme. HIV PCR coverage at six weeks is significantly low, and referral of confirmed HIV PCR-positive babies to ARV sites is also significantly low. Further research is needed to assess whether there has been an improvement in the follow-up of babies in the PMTCT programme in the West Rand since the time of this study.

The facility under study has had a traditional postpartum and nursery, with different nurses for the mother and baby. A decision was made to change the care model to couplet-care (CC). CC is an evidence-based care model that promotes newborn care at the mother's bedside. Establishing an education and implementation plan is important to the success of the transition. The purpose of this project was to develop an evidence-based education and implementation plan for CC implementation and to provide for staff barriers and pushback to change. The goals of the study were to identify an approach to implement evidence-based practice education that is efficient and sustainable. There is a paucity of literature available that describes how to plan and implement CC. However, Mercer's maternal role attainment provides ample evidence to support the nursing care model of CC. A survey was developed to determine the gaps in current knowledge of couplet-care. The survey was returned by 54% of the 67 staff nurses from the mother-baby unit. and revealed the need for definitions of CC, Family Centered Care, and the need to integrate role-playing into the education plan. Transformation theory is used to identify attitudes and biases to practice change that interfere with implementation. Reflective discussion was built into the education plan to assist with overcoming barriers to practice change. Using an evidence-based program plan for a nursing care model change may ease the transition of other mother-baby units to CC. CC provides an environment that supports healthy newborn attachment and subsequent healthy lifestyle.

Pain is influenced by biological, social, emotional and cognitive factors. Emotions are not simply a consequence of pain but rather a fundamental part of the pain experience. In addition, the social context cannot be isolated when constructing the meaning of the child’s pain, and in understanding the influence of mother-child interactions on children’s physiology. This research consists of two studies, study one investigated the relationship between anxiety, depression and physical functioning in children and adolescents experiencing chronic pain. The participants were 73 childen and adolescents who were referred to either the Children’s Pain Management Clinic at the Royal Children’s Hospital or the Sydney Westmead Children’s Hospital aged between 7-18 years old. The results indicated that these young people were reporting anxiety and depression within the normal range with significant anxiety and depression levels both below prevalent rates found in the normal population. Furthermore, depression but not anxiety was associated with increasing leves of physical disablity in children and adolescents. This led to the investigation of the relationship between maternal emotions on children and adolescents’ anxiety, depression, somatic symptoms and physical functioing in children and adolescents experiencing chronic pain. Study two investigated the association of maternal and child emotions in children and adolescents with chronic pain. Participants included 62 mothers and 62 children and adolescents between the ages of 7-18 years (M=13). Mothers’ emotional distress (empathy, emotional involvement, and distress) was examined as a significant factor to be associated with children’s pain sensitive temperament and functional outcomes (anxiety, depression, somatisation, and physical functioning). Children’s perceptual sensitivity and avoidance of sensation, which are components of children’s pain sensitive temperament, were investigated in relation to children’s ability to regulate emotions. The association between maternal and child emotional regulation and children’s functional outcomes was also explored. Mothers completed questionnaires assessing children’s somatisation, their own difficulties with having a child with persisting pain and an empathy scale. Mothers also completed a semi-structured interview by Katz and Gottman (1991) the Meta-Emotion Interview which discusses mothers’ awareness of their own and their child’s emotions, mothers acceptance of their own and their child’s emotions, the regulation of their own and their child’s emotions and coaching of their child’s emotions. Children and adolescents completed quesionnaires measuring anxiety, depression, emotional involvement, somatisation and pain sensitive temperament. The results indicated low maternal emotional regulation was significantly associated with children's depression, anxiety and somatisation scores, whilst children’s emotional regulation was associated with children’s anxiety and depression, but not with somatisation scores. Maternal emotional distress was associated with children's pain sensitive temperament, emotional distress and reduced physical functioning. Furthermore, emotional regulation in children was associated with children's pain sensitive temperaments. It is proposed that young people with chronic pain may have a biological vulnerability to respond to stress and traumatic events as pain, and pain related symptoms. This biological sensitivity may be associated with children’s threshold of pain, whereby children’s perceptual sensitivity may be associated with reporting of somatic complaints. Thus, maternal emotions and social factors may be associated with children’s somatosensory processing and the chronic pain experience.

The purposes of this study were to find out about the associations between hostile attributional bias and aggressive behaviors among preschool-aged children and to identify possible sources of their hostile attributional bias. Seventy-two preschoolers with an average age of 4.76 and their mothers acted as participants. Children's hostile attributional bias was examined using videotaped vignettes developed for this study. Children's aggressive behaviors were assessed by teachers and parents separately. As possible sources of children's hostile attributional bias, mothers' attributional styles, parenting behavior, affect, and some demographic information were collected via questionnaires. The relationships between children's aggressive behavior, mothers' attributional styles, parenting behavior, and affect were also investigated. Consistent with previous studies on school-aged children, results indicated that aggressive preschoolers, as assessed by teachers, were more likely to have a hostile attributional bias than nonaggressive ones. On the other hand, children's aggressiveness, as assessed by their mothers, was significantly related to their mothers' parenting behaviors, but not to their hostile attributional bias. Mothers of aggressive preschoolers reported less positive parenting behaviors than those of less aggressive ones. Mothers' affect did not show such an effect. Although mothers' specific attributional styles did not have a direct effect on their parenting behavior and affect, their general attributional style had a moderating effect on their affect, suggesting a reciprocal relationship between mothers' affect and their children's aggressive behavior. Mothers' specific attributional style, parenting behavior, and affect were not identified as sources of children's hostile attributional bias, but family SES was. Children from lower SES families were more likely to have a hostile attributional bias than those from higher SES families. Findings were discussed relative to previous theory and research, and suggestions for future research and implications for preschool teachers were made. / Graduation date: 1996