<p><font size="3"> <p>Namibia has recorded an ascending trend of maternal and neonatal mortality rate from 225 &ndash / 449 per 100 000 women from 1992 to 2006, and 38 &ndash / 46 per 1000 live births from 2000 to 2006 respectively. Kavango Region in Namibia is one among the top seven regions with high maternal and infant mortality rate. Most pregnant women in peri-urban areas of Rundu District in the Kavango region, where this study was conducted, attend ante-natal care services but do not use public health facilities for delivery. The health records from the public health facilities in Rundu, especially from Nkarapamwe clinic and Rundu Hospital maternity section, reveal that although the pregnant women comply with the required standard policy of a minimum of three visits per pregnancy or more, over 40% of women who attend public ante-natal care clinics do not deliver in the public health facility. The aim of this study was to explore the perceptions of women regarding obstetric care in public health facilities in Kehemu settlement, a peri-urban area of Rundu town. The objectives of the study were to explore the perceptions of women on accessibility and acceptability of maternity services in public health facilities. An explorative qualitative study design using focus group discussion as a data collection method was conducted with three groups of women. A purposeful sampling procedure was used to select participants. Ethical approval was obtained from the High Degree Committee of University of the Western Cape and permission to use data from local facilities was obtained from the Ministry of Health and Social Services. Participants were recruited on their own free will and they signed an agreement on confidentiality. A data reduction process was used for analysis. The study findings indicate that women wish to use public health facilities for deliveries due to perceived benefits, in particular, safety for the mother and the baby and that those services are<font size="3"> affordable. However a number of reasons hinder women to access services including the attitudes of health care providers, inability to afford transport at night and cultural influences. The study recommends that delivery services at the local clinic be expanded from eight to twenty-four hours / an information campaign on pregnancy and birth complications as well as the benefits of delivering in a public facility be implemented / refresher training for nurses to improve their caring practices during delivery should be considered and that a similar research be conducted with care providers to ascertain ways to improve maternity services in the public health facility in the area. </font></p> </font></p>

Pregnancy and childbirth complications are a leading cause of death and disability among women of reproductive age in developing countries. Worldwide data shows that, by choice or out of necessity, 60 percent of births in the developing world occur outside a health institution and 47 percent are assisted by Traditional Birth Attendants (TBAs), family members, or without any assistance at all. This thesis argues that TBAs in India have the capacity to disseminate knowledge of beneficial maternal practices to the community. Since the 1970s the training of TBAs has been one of the primary single interventions encouraged by World Health Organisation (WHO) to address maternal mortality. However, since the 1990s international funding for TBAs has been reduced and the emphasis has shifted to providing skilled birth attendants for all births due to evidence that the maternal mortality rate (MMR) in developing countries had not reduced. Researchers have observed that the shift in policy has taken place without adequate evidence of training (in)effectiveness and without an alternative policy in place. This thesis argues further that two main types of birthing knowledge co-exist in India; western biomedicine and traditional knowledge. Feminist, anthropological, and midwifery theorists contend that when two knowledge paradigms exist, western knowledge tends to dominate and claim authority over local ways of knowing. The thesis used such theories, and quantitative and qualitative methods, to assess whether the local TBA training programmes in Ahmednagar District in India have been successful in disseminating biomedical knowledge in relation to the birthing practices of local TBAs and in incorporating local knowledge into the training. The data revealed that some biomedical knowledge had been successfully disseminated and that some traditional practices continue to be practiced in the community. There is a top-down, one-sided imposition of biomedical knowledge on TBAs in the training programme but, at the local level, TBAs and mothers sometimes follow the training instructions and sometime do not, preferring to adapt to the local perceptions and preferences of their community. The thesis reveals the significance of TBA training in the district but queries the effectiveness of not including local TBA practices into the training programmes, arguing this demonstrates the hierarchical authority of biomedicine over local traditional practices. The thesis highlights the significance of community awareness that accompanies TBA training and makes recommendations in order to enhance training outcomes.

Background: Occupational stress is a global and complex phenomenon, and workers in developing countries can be affected by it (International Labour Organisation 2001). Staff within maternity settings have been identified as being at risk of suffering from stress, resulting in adverse health outcomes (Evenden and Sharpe, 2002). However, MWAs’ perceptions of stress have not been captured and are not reflected in the literature. Purpose: The aim of this study was to explore MWAs’ perceptions of occupational stress, possible cause(s), the impact and support available and the coping methods they adopted within maternity care settings (hospital) in Nigeria. Methodology: This study adopted a qualitative methodology. Husserl’s (1962) phenomenological approach was chosen as it enabled the researcher to collect rich, in-depth, descriptive accounts of the MWAs’ perceptions of the phenomenon under study through the use of semi-structured interviews. Findings: The major sources of stress for MWAs included work overload, long working hours, staff shortages, work exploitation and intensification and lack of support from senior staff. The stress levels MWAs experienced impacted on their health and well-being and resulted in related behavioural and physical reactions. Conclusion: This study confirmed that MWAs were exposed to similar stress factors experienced by other health workers and reported in the research literature. Additionally, it demonstrated the need for more qualitative studies to explore the perceptions of occupational stress among under-represented groups of healthcare workers. Importantly, this study created an opportunity to explore the experience of dedicated women facing challenging employment practices in hospital settings in Nigeria. Equally, it gave a voice to these unrecognised, almost invisible women, who were the MWAs that played a key role within the maternity services.

Made available in DSpace on 2015-05-14T13:16:23Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 3324327 bytes, checksum: b85304a7fe276b9b7697e2cdf5a23471 (MD5) Previous issue date: 2013-12-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This study aimed at verifying exposure levels for gasoline and ethanol vapors and their psychophysical, neurocognitive, and physiological consequences in a sample of Brazilian pump attendants. Gas chromatography and microclimate sensing were used to passive and active monitoring of environmental levels of vapors. The psychophysical evaluation comprised the chromatic tests Lanthony D15-d and Cambridge Color Test 2.0, the Contrast Sensitivity Function using vertical sinusoidal gratings and Metropsis at the frequencies 0.2, 0.5, 1.0, 2.0, 5.0, 10.0, and 16.0 cpd, and eye-tracking at 250 Hz. Except by the D15-d test, all vision tests were performed with the dominant eye. The neurocognitive evaluation included the Trial Making Tests (A and B) and the Rey's Complex Figure Test. After applying exclusion criteria, the physiological evaluation was carried out in 16 attendants, who had a blood test to assess hepatic-biliary functions by the following markers: Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Direct Bilirubin (DB), Total Bilirubin (TB), and Gamma-glutamyl transpeptidase (GAMMA GT). The screening phase also included a questionnaire of Psychological and Neurophysiological Symptoms (PNS), a sociodemographic questionnaire, the Ishihara and the Rasquin 'E' tests. Thirty-eight pump attendants (Exposed Group) were selected, all males, with mean age of 32.66 years (SD = 1.30) and average schooling of 9.68 years (SD = 0.34). Thirty-eight volunteers (Control Group) were selected, all males, with mean age of 30.0 years (SD = 1.54), average schooling of 9.84 years (SD = 0.34), without reporting exposure to solvents and considered healthy following the inclusion criteria. The groups did not differ in age (p = .224) or schooling (p = .52), and all participants had normal or corrected-to-normal visual acuity 20/20. The Mann-Whitney test showed significant differences between scores in the Index of Color Confusion of the D15-d (p < .01, with losses in the tritan axis 75%), the Area of ellipses (protan, deutran, and tritan, all at p < .05), the frequencies 5, 10, and 16 cpd (p < .01), the Trail Making A (p < .01) and B (p < .05), the copy and memory of the Rey's complex figure (both at p < .01), and the number of saccades and trajectory time in the visual labyrinth (both at p < .01) as measure by the eye-tracker. The physiological evaluation showed changes in the values of DB (100 % of the pump attendants) and TB (62,5 %). Two attendants had combined changes in hepatic enzymes and biliburin. The Spearman correlation showed a significant association between the time of service and the areas protan (ρ = .46, p < .01) and deutan (ρ = .64, p < .01), the spatial frequency 5 cpd (ρ = .36, p < .05), and the Trail Making A (ρ = .40, p < .05) and B (ρ = .37, p < .05). The weight showed a tendency to attenuate the visual deficits, having a negative correlation with the area deutan (ρ = - .45, p < .01) and a positive one with contrast sensitivity at 0.20 cpd (ρ = .37, p < .05). Correlations were also found between DB and the time to perform the eye-tracker task (ρ = .58, p < .05) and the GGT and complaints of psychoneurovegetative instability (ρ = .57, p < .05). The Kruskal Wallis, and Mann-Whitney as a post-hoc test with Bonferroni's correction, showed that from 8 years of exposure there are consequences to color vision (Protan and Deutan) and for neurocognitive processes related to attention (Trail Making). The questionnaire PNS showed that 52.6% of pump attendants had symptoms of neuropsychological aggressions. Furthermore, there was a convergence between memory and attention complaints, with lower scores in the memory for the Rey's complex figure (ρ = - .34, p < .05). This study brings additional and new evidences for the consequences on color vision and contrast sensitivity, shows a potential occupational etiology in hepatic-biliary changes, presents neurocognitive xviii deficits in Brazilian pump attendants, and concludes that such deficits are correlated with chronic exposure (significant from 8 years of service) with a level of exposure to gasoline and ethanol below the Brazilian tolerance limit, but within an intervention level to gasoline vapor (168 and 153,40 ppm > 150 ppm) according to the Brazilian Standards for Work Health and Safety. / O objetivo deste estudo foi determinar os níveis de exposição aos vapores da gasolina e do etanol e verificar as consequências psicofísicas, neurocognitivas e fisiológicas em uma amostra de frentistas brasileiros. Para avaliar o nível de exposição ambiental foram realizados monitoramentos passivos e ativos de vapor com cromatografia gasosa e sensoriamento microclimático. A avaliação psicofísica foi realizada com os testes cromáticos de Lanthony D15-d e o Cambridge Color Teste 2,0; com a Função de Sensibilidade ao Contraste utilizando grades senoidais verticais e o Metropsis nas frequências 0,2; 0,5; 1,0; 2,0; 5,0; 10,0 e 16,0 cpg e com o rastreamento ocular utilizando um eyetracker 250 Hz. Todos os testes de visão, exceto o D15-d, foram realizados monocularmente com o olho dominante. A avaliação neurocognitiva ocorreu com os testes Trail Making A, B e com a Figura Complexa de Rey. A avaliação fisiológica, após utilização de parâmetros de exclusão, foi realizada pela análise de sangue de 16 frentistas verificando funções hepatotóxicas pelos marcadores Alanina Aminotransferase (ALT), Aspartato Aminotransferase (AST), Bilirrubina Direta (BD), Bilirrubina Total (BT) e Gamaglutamiltraspeptidase (GGT). Utilizou-se ainda o questionário de sintomas Psicológicos e Neurofisiológicos (PNF) além de um questionário sóciodemográfico e os testes de Ishihara e o ―E‖ de Rasquin na triagem. Essa etapa selecionou 38 frentistas do sexo masculino (Grupo Exposto), com idade média de 32,66 anos (DP = 1,30), grau de escolaridade média igual a 9,68 anos de estudo (DP = 0,34) e 38 voluntários (Grupo Controle) também do sexo masculino, sem histórico de exposição a solventes, considerados saudáveis pelos parâmetros de exclusão, com idade média de 31,00 anos (DP = 1,54) e grau de escolaridade médio de 9,84 anos de estudo (DP = 0,34). Não existiu diferença significativa entre a idade (p = 0,224) e o grau de escolaridade (p = 0,52) dos grupos que apresentaram ainda acuidade visual de 20/20 ou corrigida. Pelo teste de Mann-Whitney foram encontradas diferenças significativas entre os escores para: o Índice de Confusão de Cores do teste D15-d (p < 0,01, prevalecendo perdas no eixo tritan 75%), as Áreas das elipses (protan, deutan e tritan, ambos p < 0,05), as frequências 5 cpg, 10 cpg e 16 cpg (ambos p < 0,01), o teste Trail Making A (p < 0,01) e B (p < 0,05), a cópia e a memória da Figura complexa de Rey (ambas p < 0,01) e o número de sacadas e tempo de percurso do labirinto no eyetracker (ambos p < 0,01). A avaliação biológica demonstrou principalmente alterações nos valores da BD (100 % dos frentistas) e BT (62,5 %). Dois frentistas tiveram alterações combinadas de enzimas hepáticas e bilirrubinas. A correlação de Spearman demonstrou a influência do tempo de serviço no acréscimo das áreas protan (ρ = 0,46; p < 0,01) e deutan (ρ = 0,64; p < 0,01), além de correlações com a frequência de 5 cpg (ρ = 0,36; p < 0,05) e com os testes Trail Making A (ρ = 0,40; p < 0,05) e B (ρ = 0,37; p < 0,05). O peso apresentou a tendência de atenuar os déficits nos testes de visão, correlacionando negativamente com a área deutan (ρ = - 0,45; p < 0,01) e positivamente com a sensibilidade ao contraste na frequência 0,20 cpg (ρ = 0,37; p < 0,05). Existiram ainda correlações entre a BD e o tempo para realizar a prova no eyetracker (ρ = 0,58; p < 0,05) e entre o GGT e as queixas de instabilidade psiconeurovegetativa (ρ = 0,57; p < 0,05). Os testes Kruskal Wallis, e Mann- Whitney como post hoc com correção Bonferroni, demonstraram que a partir de 8 anos de exposição existem consequências para a visão de cores (Protan e Deutan) e para processos neurocognitivos relacionados a atenção (Trail Making A). O questionário PNF apontou que 52,60 % dos frentistas possuem sintomas de agressões neuropsicológicas. Além disso, existiram convergências entre as queixas de falta de memória e concentração, com menores pontuações da memória na Figura Complexa de Rey (ρ = - 0,34; p < 0,05). Este estudo confirma e avança nas descobertas de consequências na visão de cores e sensibilidade ao contraste, aponta uma possível etiologia ocupacional nas alterações hepatotóxicas, apresenta as deficiências neurocognitivas nos frentistas brasileiros e conclui que essas deficiências e as da visão de cores estão correlacionadas a uma exposição crônica (significativa aos 8 anos de serviço) com um nível de exposição a gasolina e ao álcool etílico abaixo do Limite de Tolerância brasileiro, mas a um nível de intervenção para o vapor de gasolina (168,00 e 153,40 ppm > 150 ppm) conforme as Normas de Saúde e Segurança do Trabalho brasileiras.

Magister Public Health - MPH / This is a cross sectional survey study that explored determinant factors contributing to home child delivery and influence of traditional birth attendances on place of delivery in Rungwe District, Tanzania.The study focussed on three main aspects namely factors (socio-economic, cultural and knowledge) that influence women to deliver at health facilities and those who deliver ta home. Reasons/factors associated with the acceptability of health services and influence of traditional birth attendaces on place of delivery and whether accessibility to health services and traditional birth attendants influence women to decide the place of delivery. The study was descriptive cross-sectional in nature where a multistage random sampling procedure was used to select 8 wards and 16 villages. A systematic sampling was used to determine household interval in each village. Only one woman with at least one child was chosen in a household using a random sampling. In case of the absence of a woman with at least one child in a house falling in the interval, then the next house was considered. A total of 400 women with at least one child were selected at random from household cluster sample from all four divisions in Rungwe district. They were interviewed using semi-structured questionnaire. The participation rate was 100 % in both divisions. The age of the women ranged from 19-49 years with the mean age of 31 years (Std dev 7.5). Data entry and analysis were done using the quantitative statistics with Epi Info 2002 software. Results were presented using descriptive statistics, figures and tables, and analytical statistics, using Student’s t-test and chi-square. A total of 400 women were interviewed, among them, it showed that there were good attendance for antenatal care 395 (98.75%) and only 5 (1.25%) did not attend antenatal care. However, 243 (60.8%) of women interviewed had incidence of home delivery and 157 (39.3%) had incidence of health facility delivery. Home deliveries in a surveyed area are commonly assisted by unskilled persons, and consequently carry increased risks to the mother and to the new-born baby. Improvement of quality and accessibility of health care services by the health facility should involve harmonic balance between health service provider and beneficiaries in order to change the attitude towards minimizing the practice of home child delivery in Rungwe district, in Mbeya region, in Tanzania as awhole and elsewhere in the world.

Magister Public Health - MPH / Namibia has recorded an ascending trend of maternal and neonatal mortality rate from 225 – 449 per 100 000 women from 1992 to 2006, and 38 – 46 per 1000 live births from 2000 to 2006 respectively. Kavango Region in Namibia is one among the top seven regions with high maternal and infant mortality rate. Most pregnant women in peri-urban areas of Rundu District in the Kavango region, where this study was conducted, attend ante-natal care services but do not use public health facilities for delivery. The health records from the public health facilities in Rundu, especially from Nkarapamwe clinic and Rundu Hospital maternity section, reveal that although the pregnant women comply with the required standard policy of a minimum of three visits per pregnancy or more, over 40% of women who attend public ante-natal care clinics do not deliver in the public health facility.The aim of this study was to explore the perceptions of women regarding obstetric care in public health facilities in Kehemu settlement, a peri-urban area of Rundu town. The objectives of the study were to explore the perceptions of women on accessibility and acceptability of maternity services in public health facilities.An explorative qualitative study design using focus group discussion as a data collection method was conducted with three groups of women. A purposeful sampling procedure was used to select participants. Ethical approval was obtained from the High Degree Committee of University of the Western Cape and permission to use data from local facilities was obtained from the Ministry of Health and Social Services. Participants were recruited on their own free will and they signed an agreement on confidentiality. A data reduction process was used for analysis.The study findings indicate that women wish to use public health facilities for deliveries due to perceived benefits, in particular, safety for the mother and the baby and that those services are affordable. However a number of reasons hinder women to access services including the attitudes of health care providers, inability to afford transport at night and cultural influences.The study recommends that delivery services at the local clinic be expanded from eight to twenty-four hours; an information campaign on pregnancy and birth complications as well as the benefits of delivering in a public facility be implemented; refresher training for nurses to improve their caring practices during delivery should be considered and that a similar research be conducted with care providers to ascertain ways to improve maternity services in the public health facility in the area.

No description available.

Background: Occupational stress is a global and complex phenomenon, and workers in developing countries can be affected by it (International Labour Organisation 2001). Staff within maternity settings have been identified as being at risk of suffering from stress, resulting in adverse health outcomes (Evenden and Sharpe, 2002). However, MWAs’ perceptions of stress have not been captured and are not reflected in the literature. Purpose: The aim of this study was to explore MWAs’ perceptions of occupational stress, possible cause(s), the impact and support available and the coping methods they adopted within maternity care settings (hospital) in Nigeria. Methodology: This study adopted a qualitative methodology. Husserl’s (1962) phenomenological approach was chosen as it enabled the researcher to collect rich, in-depth, descriptive accounts of the MWAs’ perceptions of the phenomenon under study through the use of semi-structured interviews. Findings: The major sources of stress for MWAs included work overload, long working hours, staff shortages, work exploitation and intensification and lack of support from senior staff. The stress levels MWAs experienced impacted on their health and well-being and resulted in related behavioural and physical reactions. Conclusion: This study confirmed that MWAs were exposed to similar stress factors experienced by other health workers and reported in the research literature. Additionally, it demonstrated the need for more qualitative studies to explore the perceptions of occupational stress among under-represented groups of healthcare workers. Importantly, this study created an opportunity to explore the experience of dedicated women facing challenging employment practices in hospital settings in Nigeria. Equally, it gave a voice to these unrecognised, almost invisible women, who were the MWAs that played a key role within the maternity services.

Объект исследования – профессиональный стресс у бортпроводников и агентов по организации обслуживания пассажирских авиаперевозок, предмет исследования – синдром профессионального стресса у бортпроводников и агентов по организации обслуживания пассажирских авиаперевозок. Магистерская диссертация состоит из введения, двух глав, заключения, списка литературы (81 источник) и приложения, включающего в себя бланки применявшихся методик. Объем магистерской диссертации 118 страница, на которых размещены 11 рисунков и 22 таблицы. Во введении раскрывается актуальность проблемы исследования, разработанность проблематики, ставятся цель и задачи исследования, определяются объект и предмет исследования, формулируются основная и дополнительные гипотезы, указываются методы и эмпирическая база, а также этапы проведения исследования, теоретическая и практическая значимость работы. Первая глава включает в себя обзор теоретических представлений о профессиональном стрессе, эмоциональном выгорании и совладающем поведении в исследованиях отечественных и зарубежных авторов. Представлены разделы, посвященные исследованию показателей профессионального стресса, эмоционального выгорания, копинг стратегий и их взаимосвязей специалистов, обслуживающих пассажиров авиакомпаний. Выводы по первой главе представляют собой итоги по изучению теоретического материала. Вторая глава посвящена эмпирической части исследования. В ней представлено описание организации и методов проведенного исследования и результатов, полученных по всем использованным методикам: системы «Интегральная диагностика и коррекция профессионального стресса» А. Б. Леоновой (ИДИКС), опросника «Профессиональное (эмоциональное) выгорание» MBI К. Маслач адаптированный Н. Е. Водопьяновой, опросника «Стратегии преодоления стрессовых ситуаций» (Strategic Approach to Coping Scale, SACS) С. Хобфолла. Также в главе представлен сравнительны и корреляционный анализ результатов исследования. Выводы по главе 2 включают в себя основные результаты эмпирического исследования. В заключении в обобщенном виде изложены результаты теоретической и эмпирической частей работы, а также выводы по выдвинутым гипотезам, обоснована практическая значимость исследования. / The object of the study is professional stress among flight attendants and agents for the organization of passenger air transportation services, the subject of the study is the syndrome of professional stress among flight attendants and agents for the organization of passenger air transportation services. The master's thesis consists of an introduction, two chapters, a conclusion, a list of references (81 sources) and an appendix, which includes forms of the methods used. The volume of the master's thesis is 118 pages, which contain 11 figures and 22 tables. The introduction reveals the relevance of the research problem, the elaboration of the problem, sets the purpose and objectives of the study, defines the object and subject of the study, formulates the main and additional hypotheses, indicates the methods and empirical base, as well as the stages of research, the theoretical and practical significance of the work. The first chapter includes an overview of the theoretical concepts of occupational stress, emotional burnout and coping behavior in the research of domestic and foreign authors. The sections devoted to the study of indicators of professional stress, emotional burnout, coping strategies and their interrelationships of specialists serving airline passengers are presented. The conclusions of the first chapter represent the results of the study of theoretical material. 1. The second chapter is devoted to the empirical part of the study. It describes the organization and methods of the conducted research and the results obtained using all the methods used: the system "Integrated diagnosis and correction of occupational stress" by A. B. Leonova (IDIKS), the questionnaire "Professional (emotional) burnout" by MBI K. Maslach adapted by N. E. Vodopyanova, the questionnaire "Strategies for overcoming stressful situations" (Strategic Approach to Coping Scale, SACS) by S. Hobfall. The chapter also presents a comparative and correlation analysis of the research results. The chapter also presents a comparative and correlation analysis of the research results. The conclusions of Chapter 2 include the main results of an empirical study. In conclusion, the results of the theoretical and empirical parts of the work are summarized, as well as conclusions on the hypotheses put forward, the practical significance of the study is substantiated and possible prospects for further development of this issue are described.

The purpose of this study was to identify the need for a training programme and to develop the training programme to meet the needs of traditional birth attendants in the management of pregnancy, labour and puerperium. The study was conducted in the Flagstaff district which is one of the districts of the north eastern region (region E) of the Eastern Cape. The target group consisted of all the traditional birth attendants who availed themselves at the residential clinics of Flagstaff district and the number is not known as not all traditional birth attendants who presented themselves are recognized by their communities as traditional birth attendants. The study was a quantitative descriptive design and the data was collected by means of structured interviews using a questionnaire that was designed by the researcher. According to the findings the traditional birth attendants are functioning without being formally trained before. They lack knowledge and skill in the management of pregnancy, labour and puerperium. Some of their practices are reason for concern, for example cephalic versions and not using protective devices. There is a need for the development of the training programme in the Flagstaff district. This programme was developed from the information obtained from the data-analysis and is given as annexure F / Health Sciences / M.A. (Advanced Nursing Sciences)