A RESEARCH REPORT SUBMITTED TO THE FACULTY OF HEALTH SCIENCES, UNIVERSITY OF THE WITWATERSRAND, IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC HEALTH JANUARY 2012 / Background: Nkhensani Hospital is a level 1 district hospital which provides comprehensive and integrated health care for the Giyani sub–district population, which is estimated to be 270 000. The major services provided are casualty, medicine, paediatrics, maternity and surgery. The hospital is experiencing challenges in the maternity ward which is admitting more patients than the 47 allocated beds. Monthly, an average of 400 women are admitted for delivery from clinics. The causes are suspected to be due to a number of different factors like shortage of staff at the clinics, poor referral system, poor services at clinics and health centres, poor facilities, and pregnant woman not attending antenatal care and bypassing lower levels of care. Aim: To describe the pattern and appropriateness of referrals in patients attending the maternity ward at the Nkhensani Hospital. Methodology: A retrospective study was used to review and asses the patient records for the study (January to December 2009). Information was obtained from the Hospital Information System and secondary data from patients records will be used to assess the referral pattern in Nkhensani Hospital’s maternity ward. Results: The data showed that the patients admitted had a mean age of 26 years, with a range from 15 to 45 years. Patients were admitted for various reasons, which when categorised were found to have 57% of inappropriate referrals. Similarly 68% of referrals were found to have low risk pregnancies. About 85% of the deliveries were normal vaginal deliveries. Of the patients who attended the facility, 57% were referred from clinics, 19% from community health centres, 1% from general practitioners and 23% as self referrals. The source of referral was not found to be v associated with appropriate reasons for delivery, risk category, length of stay or mode of delivery. Conclusion: The research showed that the referral pattern in the maternity ward from clinics and health centres as well as self referrals indicated that policies were not being adhered to, which led to an over utilisation of the maternity ward in Nkhensani Hospital under Giyani sub-district

Mothers of neonates admitted to neonatal intensive care units appear to suffer stress which may be related to the illness and treatments the neonate is undergoing, separation from the neonate and social and relationship issues. Nursing professionals employed in the neonatal intensive care unit (NICU) need specific preparation in order to assist mothers to cope with the experience of their neonate being admitted to the NICU. Research is required in order to adequately describe the nature of the stress and whether it changes over a period of time and to provide nursing professionals with information relating to the subject of stress suffered by mothers in this situation. A quantitative, longitudinal study of stress experienced by mothers of the neonate NICU patient was undertaken using the Neonatal Unit Parental Stress (NUPS) Scale (Reid, Bramwell, Booth & Weindling, 2007) (Reid et al., 2007). Mothers who met inclusion criteria were recruited to participate in the study. They were asked to complete the NUPS questionnaire at two time points. Correlations were examined between data obtained on the NUPS questionnaire and the mother and infant demographic data. The results of this study have shown that mothers experience the greatest stress as a result of neonatal suffering and their inability to perform functions of the mother role as a result of separation from the neonate. These findings have been used to make recommendations for the preparation of nursing professionals who work in the NICU.

Thesis (M.S.N.)--Marshall University, 2003. / Title from document title page. Document formatted into pages; contains viii, 62 p. Includes vita. Includes bibliographical references (p. 43-47).

Thesis (M.P.H.)--University of Michigan, 1946.

Thesis (M.P.H.)--University of Michigan, 1946.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management APRIL 2014 / Background: The South African Department of Health stipulated that district hospitals must provide comprehensive package of preventive, promotive, curative and rehabilitative reproductive health services for women that requires medical and special resources, not found in the health centres and clinics (Department of Health, 2002). The Evander District (ED) Hospital, a district hospital situated in the Govan Mbeki Subdistrict in the Mpumalanga Province provides both in-patient (36 beds in maternity unit and four nursery beds) and outpatient services. The Hospital Maternity Unit has recently been criticised by the Mpumalanga Department of Health for high rate of CS (30%), and perinatal mortality rate (40 per 1000). But, the Hospital never analysed the data collected routinely to develop an understanding of the challenges faced by the Unit. The Unit staff complained about inadequate resources as one of the reasons. The Hospital has introduced a Cost centre in the Maternity Unit for efficient management of resource allocation for the Unit. This study analysed the routinely collected data from the Hospital Information System and Maternity Unit Cost centre for assessing the maternity services currently rendered by the Evander District Hospital. Aim: To described the deliveries at the Evander Hospital over a period of 6 months from 01st January 2011 to 30th June 2011. Methodology: It was a cross sectional study that reviewed the records from Hospital Information System (all antenatal cards and Obstetric files of the women who delivered at the labour ward during the study period) and Maternity Unit cost center. The variables used for the study included number and type of deliveries, socio-demographic and clinical profiles of patients, maternal and perinatal complications and outcomes. In addition, costing information collected during the same period. Descriptive and inferential statistics were used for analysis. Permissions were obtained from the Mpumalanga Department of Health and University of the Witwatersrand ‘Human Research Ethics Committee (Medical) before commencement of the study. Results: A total of 1,081 deliveries were performed at the Evander Hospital over sixmonth period. The highest number of deliveries was NVD (67.44%), followed by caesarean sections (31.82%). The majority of the women who delivered came from poor socio-economic class and mostly single and black, which is a reflection of the characteristics of the catchment population of the Evander Hospital. Teenage pregnancy rate was quite high (20%). The majority of the subjects were primipara (41%). Although most of them (91.3%) of them were booked, only 14% had stipulated number of antenatal visits (4 or more visits) and 7.4% of booked mothers, did not have booking blood results, which was a missed opportunity. HIV was the most prevalent (33, 31.3%) medical conditions, which is similar to the HIV prevalence reported in antenatal sero-prevalence survey in South Africa. Only 17% had planned and scheduled CS. Very few patients had post-partum complications indicating well managed third stage of labour. There was no maternal death during this period. All patients were discharged home. More than 17% (n=185) subjects had low birth weight babies (less than 2500 g), which is just above national average of 16%. The median Apgar score among children delivered at Evander Hospital was 9. Interestingly, the Apgar scores of babies of subjects who had operative deliveries were significantly lower than those who had nonoperative deliveries. Most of the babies were born alive. Stillbirth rate (7 per 1000 live births) was significantly lower than South African national average 17.8 per 1000 live births. The total medical cost for the maternity ward for the six months studied amounted to R 4,584,466, the average monthly cost being R 76,407.67. The most expensive items were drugs and pharmaceuticals and least expensive being the medical consumables. Conclusion: This study was the first of its kind to be done in this Hospital and the Health District. The study identified gaps where management of pregnant women in the Evander Hospital could be further improved through improved booking, planned deliveries and thereby reducing low birth weight rates and still birth rate. This would assist the Hospital Management to develop appropriate measures to reduce unnecessary CS being done, NVD being delivered in the hospital rather than using CHC, and strengthening referral system and strategies to reduce HIV and AIDS incidence. In addition, further study is necessary at the PHC facilities in the Sub-district to identify determinants for high rate of teenage pregnancy.

nÃo hà / Introduction. In Western society, traditionally, the pregnancy experience, education and health of children is part of the tasks that in the sexual division of labor, belongs to the woman. Also in the process of breastfeeding the father is not included. Objective. This study aimed to evaluate interventions in educational practices experienced by couples in the process of breastfeeding having the as a participant. Methodological path. For understanding and description of this phenomenon, the father as a participant in the process of breastfeeding, it was decided to go beyond a situational diagnosis. It was done a research-action considering that the intention has always been dedicated to discuss with the participants of this study, about values, concepts and beliefs culturally assimilated by the society in relation to the process of breastfeeding, and intending to reflect the possible shift in paradigms. Participated eight couples with their children, followed for eight and six months of life. Before the birth, took place four meetings, after the birth of the child, each family was visited daily for ten consecutive days, and, on average, were visited at their residences 20 times in the six months of childÂs life. Conclusions. In search of the literature, we found that publications are still incipient and probably actions involving the father in the process of breastfeeding. This experience shows that the father may be an important ally, true partner, is essential to credit and encouraging their participation. They demonstrate satisfaction in providing care to children, especially when they realize that their initiatives and attempts to hit are valued by the partner and by health professionals. It is realized that are shy and isolated the initiatives to include the father, especially in public services, where they are sometimes regarded visits. Recommendations. Facing these results, it is recommended that fathers should be invited to attend meetings and individual consultations of his partner during prenancy and childbirth. Relevance. It is believed that this study will guide motivations to activeness of the nurse to promote the involvement of fathers in the promotion of breastfeeding at the primary level, pre-natal, secondary and tertiary in maternity, continuing in homes of families through domiciliary visits / IntroduÃÃo. Na sociedade ocidental, tradicionalmente, vivenciar a gestaÃÃo, educaÃÃo e saÃde dos filhos faz parte das tarefas que, na divisÃo sexual do trabalho, cabe à mulher. TambÃm no processo da amamentaÃÃo o pai nÃo à incluÃdo. Objetivo. Esta pesquisa teve como objetivo avaliar intervenÃÃes de prÃticas educativas vivenciadas por casais no processo da amamentaÃÃo, tendo o pai como partÃcipe. Caminho metodolÃgico. Para compreensÃo e descriÃÃo desde fenÃmeno, o pai como partÃcipe no processo da amamentaÃÃo, decidiu-se ir alÃm de um diagnÃstico situacional. Realizou-se pesquisa-aÃÃo considerando que a pretensÃo sempre esteve voltada para discutir, juntamente com os participantes deste estudo, acerca de valores, conceitos e crenÃas culturalmente assimilados pela sociedade em relaÃÃo ao processo da amamentaÃÃo, pretendendo refletir na possÃvel mudanÃa de paradigmas. Participaram oito casais com seus filhos, acompanhados durante oito e seis meses de vida. Antes do parto, aconteceram quatro encontros; apÃs o nascimento da crianÃa, cada famÃlia foi visitada diariamente por dez dias consecutivos, sendo que, em mÃdia, foram visitadas em suas residÃncias 20 vezes nos seis meses de vida da crianÃa. ConclusÃes. Na busca da literatura, verificou-se que ainda sÃo incipientes publicaÃÃes e provavelmente aÃÃes que envolvam o pai no processo da amamentaÃÃo. Com esta experiÃncia evidencia-se que o pai pode ser um importante aliado, verdadeiro parceiro, sendo indispensÃvel o crÃdito e o estÃmulo a sua participaÃÃo. Eles demonstram satisfaÃÃo em prestar cuidados aos filhos, principalmente quando percebem que suas iniciativas e tentativas de acerto sÃo valorizadas pela companheira e pelos profissionais de saÃde. VÃ-se que sÃo tÃmidas e isoladas as iniciativas de inclusÃo do pai, principalmente nos serviÃos pÃblicos, em que estes sÃo por vezes considerados visitas. RecomendaÃÃes. Diante destes resultados, recomenda-se que os pais devam ser convidados a participar das reuniÃes e consultas individuais de sua companheira no perÃodo gravÃdico e puerperal. RelevÃncia. Acredita-se que este estudo possa nortear motivaÃÃes no sentido de atuaÃÃo efetiva da enfermeira para promover o envolvimento do pai na promoÃÃo da amamentaÃÃo no nÃvel primÃrio, no prÃ-natal, secundÃrio e terciÃrio nas maternidades, continuando nas residÃncias das famÃlias por meio de visitas domiciliÃrias

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Thesis (Ph. D.)--University of Virginia, 2007. / Includes bibliographical references. Also available online through Digital Dissertations.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 6 uppsatser.