Thesis (M.P.H.)--University of Hong Kong, 2006.

Thesis (M.S.)--University of Michigan, 1981.

published_or_final_version / Community Medicine / Master / Master of Public Health

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 Medicine in the branch of Anaesthesiology April 2017 / Background: More than 166 000 women die annually from obstetric haemorrhage, with uterine atony being the most common causative factor (3). More than 50% of these deaths occur in Sub-Saharan Africa (4, 5). Synthetic oxytocin is integral in the prevention and management of postoperative post partum haemorrhage (PPH) and therefore it is essential for anaesthesiologists to have an adequate knowledge of this drug. Aim: The aim of the study was to describe the current knowledge and practise of the anaesthetists in the department of Anaesthesiology at the University of Witwatersrand (Wits), regarding Syntocinon® during caesarean section under spinal anaesthesia. Method: A validated questionnaire was distributed to anaesthetists working at Wits during departmental academic meetings in April 2015. Results: The results of the study showed that 60% of the participating anaesthetists had inadequate knowledge of IV Syntocinon® and that practice varied widely and was based on individual participants’ preference and was not consistent with international guidelines or protocols. Conclusion: Urgent staff education and implementation of a standardised practice guideline and protocol regarding usage and dosing of IV Syntocinon® is needed to prevent poor maternal outcomes and poor service delivery. / MT2017

Thesis (M.P.H.)--University of the Witwatersrand, Faculty of Health Sciences, 2013. / BACKGROUND – District hospitals provides level of care services that are part of the basic service package for district hospitals. Services applicable to district hospitals’ operating theatres include performance of elective and emergency surgical procedures. A study was conducted at Sekororo district hospital to evaluate the functioning of the operating theatre system. AIM: To describe the profile of patients, theatre down time and theatre throughput efficiencies at the district hospital for the period 1 April 2009 – 31 March 2011. METHODOLOGY: This was a cross sectional study based on a retrospective record review. The study setting was Sekororo District Hospital Operating Theatre. The population included records of all operations performed in the theatre during the study period. Theatre utilization was calculated as well as patient throughput to assess the internal operational efficiencies. The throughput of elective and emergency cases were compared. RESULTS: A total of 702 cases were performed during the study period. The majority of cases performed in the operating theatre were maternity cases (caesarean sections). Maternity cases accounted for 602 cases. The most common indication for caesarean sections (CS) is Cephalo-pelvic Disproportion (CPD) (49.2%). For the maternity cases, the majority were emergency cases (84.33%), and 15.67% elective cases. Theatre utilization for this period was 3% (3.6% for 2009/10 and 3.2% for 2010/11). There was a statistically significant difference (p<0.01) between the average throughput for emergency and elective cases – 25 minutes for emergency cases (confidence interval 20-35 minutes) versus 62.5 minutes for elective cases (confidence interval 38.75 – 78.75 minutes). CONCLUSION: The theatre utilization rate is extremely low for this study period. Patient throughput is much more efficient for emergency cases. Further studies are required to determine resource allocation to the operating theatre that resulted in the low theatre utilization.

Thesis (M. P. H.)--University of Hong Kong, 2005. / Also available in print.

Thesis (MHSc--Health Science) -- Auckland University of Technology, 2003. / Appendices D, E, F and G not included in e-thesis. Also held in print (87 leaves, 30cm.) in Akoranga Theses Collection (T 618.86 ART)

Thesis (M.P.H.)--University of Hong Kong, 2005.

Introduction Maternal volume depletion at the time of caesarean section plays a role in ma- ternal and fetal outcome. Measuring uid volume status currently requires invasive monitors. It would be useful to determine biochemical measurements which would accurately determine uid volume status in these patients. We investigated the di erence in biochemical parameters of participants presenting for elective and urgent caesarean section at Chris Hani Baragwanath Hospital and made inferences about their uid volume status. We also sought to de- termine whether this difference in biochemical parameters if present could be linked to a potential difference in the intra-operative haemodynamic course as well as fetal outcome between the two groups. Method This was a prospective open-label observational cross-sectional pilot study. The sample was 54 participants, 27 elective and 27 urgent cases. Blood and urine samples were taken at the red line. Parameters from the blood samples were haematocrit, haemoglobin, sodium, urea, creatinine and plasma osmolality. Parameters from the urine samples were sodium, creatinine, osmolality and specific gravity. Intra-operatively, all participants received a standard spinal anaesthetic. Vari- ables measured intra-operatively were systolic, diastolic and mean arterial blood pressure, heart rate, highest level of block achieved as well as 1 and 5 minute Apgar scores of the newborn. The primary outcome variable was hypotension (mean arterial drop of more than 15% from the baseline). The secondary outcome variable were the Apgar scores of the infants. Results Urine specific gravity showed a trend towards statistical significance (mean, median, standard deviation for elective, urgent): 1.01, 1.010, 0.01 and 1.02, 1.015, 0.01 p = 0:06. The other biochemical parameteres displayed higher p- values. The average relative blood pressure change was -11,7% (median, standard de- viation) (-12.4, 11.1) for the elective group and -15.1% (-14.9, 15.1) for the urgent group p = 0:36. The relative blood pressure change to end point of study was -9.6% (-9, 12.7) for the elective group and -15.4% (-17, 17.6) for the urgent group p = 0:17. When comparing baseline blood pressure and heart rate measurements to the 10 minute end point measurements; 15 participants expe- rienced hypotension in the urgent group compared to 9 in the elective group p = 0:17. When comparing baseline blood pressure measurements to the av- erage at 2, 4, 6, 8, and 10 minute intervals; 13 participants from the urgent group experienced hypotension compared to 9 participants in the elective group p = 0:40. The average Apgar scores at 1 min were 8.89 (9,0.32) for the elective group and 8.37 (9,0.93) for the urgent group p = 0:01. Conclusion This was a pilot study and as such statistical signi cance between variables was not expected. However possible trends were identified to guide future investiga- tions. The higher incidence rate of hypotension in the urgent group showed such a trend towards signi cance as well as the higher urine specific gravity in the urgent group. We also noted that Apgar scores differed significantly between elective and urgent cases.

M.Cur. (Midwifery and Neonatal Nursing) / The purpose of this study is to determine the experiences of parents prior to, during and following an unplanned caesarean section. Parents who experience this event have mixed emotions. The related occurrences may influence their behaviour and consequently their relationships with their spouses, themselves and their environment. These interact with each other continually and thus need to be looked at in context. The "Nursing of the Whole Person Theory' ensures a wholistic approach to the parents. Unstructured, in-depth interviews held with five mothers and five fathers, respectively, on day three post-delivery, were transcribed and analyzed. At six weeks a follow-up semistructured questionnaire was answered by these same respondents and analyzed. The experiences of the parents were then compared. A literature control was undertaken in order to determine what the conclusions of other researchers in this field are. The results of the literature search were compared to that of the present study and conclusions reached. Recommendations concerning nursing practice, education and further study were made at the end of the study, including a listing of the limitations affecting the study.