ABSTRACT Objectives: To determine what obstetric complications can be associated with end-stage AIDS and maternal death. Method: From 1990 to 2005 the maternal death files of patients with either AIDS-defining illnesses or CD4 counts of less than 200x106/ℓ were analyzed in a descriptive study. All patients died undelivered or within 42 days of delivery. Result: Sixty six percent (49/74) of pregnancies ended prematurely by preterm delivery or miscarriage. Twenty perinatal deaths occurred. The average birth weight was 1498g at an average gestational age of 30.5 weeks. The mean CD4 count was 45.5x106/ℓ. The majority of maternal deaths were caused by respiratory illnesses. Conclusion: Preterm ABSTRACT Objectives: To determine what obstetric complications can be associated with end-stage AIDS and maternal death. Method: From 1990 to 2005 the maternal death files of patients with either AIDS-defining illnesses or CD4 counts of less than 200x106/ℓ were analyzed in a descriptive study. All patients died undelivered or within 42 days of delivery. Result: Sixty six percent (49/74) of pregnancies ended prematurely by preterm delivery or miscarriage. Twenty perinatal deaths occurred. The average birth weight was 1498g at an average gestational age of 30.5 weeks. The mean CD4 count was 45.5x106/ℓ. The majority of maternal deaths were caused by respiratory illnesses. Conclusion: Preterm labour and early pregnancy loss are common among terminally ill pregnant women with AIDS. It is proposed that hypoxia in the presence of respiratory disease could lead to cytokine production in the uterine cavity, leading to preterm delivery, even in the absence of intrauterine infection.

Philosophiae Doctor - PhD / Globally, Employee Assistance Programme (EAP) has become the most effective workplace programme used to assist employees in the identification and resolution of performance and behavioural related problems. Employees, irrespective of the sector of employment are seen as the most valuable assets of any organization and therefore their wellness is as important as the organization itself. Employees' personal or work related problems may adversely affect their health as well as their productivity, thereby impeding the growth of an organization. It is for this reason that the EAP has increasingly become an important tool in addressing employees’ personal and work related challenges. Midwives as employees are prone to challenges such as maternal deaths at the workplace. They are more likely to undergo stressful situations for failing to meet the general goal of their profession, which, among others, include provision of adequate care for pregnant women until they safely deliver. These stressful conditions have negative effects on midwives' health, behaviour and productivity. However, there is no literature that has looked at how midwives in the Ashanti Region of Ghana are affected by maternal deaths and their coping mechanisms employed to address the effects of maternal deaths. Literature revealed that there is hardly any known work-related assistance programme designed to support Ghanaian midwives when faced with work-related challenges likely to affect their work-output. Hence, this study developed an appropriate EAP for midwives dealing with maternal deaths in Ghana based on the exploration and description of the effects of maternal death, coping mechanisms used and their experiences with the facility-based maternal death review (MDR). In order to meet the general aim of the study, a qualitative research approach, with a combination of exploratory, descriptive and contextual designs was used. Purposive sampling was employed to select participants; ward and unit managers (supervisors) (18) and midwives who met the inclusion criteria (39). A total of 57 participants were used in the study. Data were collected through semi-structured individual interviews and focus group discussions, as well as field notes. Thematic Content Analysis was used to manage data through transcribing, organizing, development of category and coding of data. Final data management was done with qualitative computer data analysis package (Atlas ti version 7.1.7). The full understanding of the effects of maternal deaths on midwives and the mechanisms of coping employed to address effects afforded the development of an EAP to support midwives dealing with maternal deaths. Five main themes emerged from the analysis of collected data, namely effect of death as a unique experience, multi-dimensional effects of MD on Midwives' personal life, effects of MD on the midwives’ associated environment, mechanisms of coping employed by Midwives and Perceived MDR process (Phase 1). Phase 2 considered the development of Employee Assistance Programme (EAP) for midwives dealing with maternal deaths in Ashanti Region of Ghana. The steps of developing occupational health service at the workplace by Acutt Hattingh and Bergh (2011) were applied to develop the EAP. Ethical practices pertaining to the study of human subjects as specified by the Research Ethics Committee of the University of the Western Cape and research guidelines of Ministry of Health- Ghana Health Service were observed. It is recommended that, all hospitals in Ashanti Region institute the EAP programme to assist midwives cope with challenges associated with maternal death.

Thesis (M.Sc. (Nursing)) -- University of Limpopo, 2016 / The aim of this study was to determine the adaptations of midwives to their work after maternal deaths at a tertiary hospital complex in Limpopo Province. Qualitative phenomenological, exploratory, descriptive and contextual research design was used. Snowball sampling was used to select 22 midwives who experienced maternal deaths. Semi-structured interviews with a guide and audiotape were used to collect data. Tesch’s eight steps of qualitative data analysis were adopted. The study revealed that the midwives had traumatic experiences after maternal deaths and were failing to adapt to their work. Strategies to enhance the adaptation of midwives to their work after maternal death were developed. The study recommends that support, debriefing session, group therapy and counselling should be provided to the affected midwives. There should be provision of adequate number of midwives and material resources in the maternity units to maintain acceptable midwifery care. Sufficient number of midwives should be trained for advanced midwifery to increase capacity in the maternity units. Keywords: Adaptations, midwives, maternal deaths, tertiary hospital

PhD (Health Sciences) / Department of Advanced Nursing Science / STRACT Background: The implementation of the World Health Organisation maternal health care guidelines in African countries has resulted in the reduction of maternal deaths by half since 1990. As a result, between 1990-2013, maternal mortality ratio declined by only 2.6% per year and this is far from the annual decline of 5.5% required to achieve the Sustainable Development Goals (SDGs). Ninety percent of women are dying from preventable maternal conditions and most of them are from the low and middle-income areas. The 2011-2013 Saving Mothers Report indicates that the Limpopo Province was ranked number three on the Maternal Mortality Rate in South Africa. Hence, this study sought to assess the implementation of maternal health care guidelines by professional nurses in Limpopo Province. Method: A convergent parallel mixed-methods design study was used. Phase 1 entailed parallel collection of qualitative and quantitative data. In this approach, self-administered questionnaires were used in the quantitative research method and an in-depth interview in qualitative research method. Data were collected from Maternal Health Care Managers, Professional Nurses and Operational Managers working in Primary Health Care Facilities of the Vhembe and Mopani Districts. Systematic methods to sample managers and midwives through the Slovan formula was used. Ethical clearance for the study was obtained from the University of Venda Research Ethics Committee and permission to conduct the study at the Primary Health Care facilities was obtained from the Limpopo Province Department of Health and Health District Offices. Data analyses were done separately using the Statistical Package for Social Sciences for quantitative data and Tesch’s open-coding methods for qualitative data. Validity, reliability and trustworthiness were ensured through a pilot study and by critical appraisal and peer review of the research instruments by experts in the field of maternal health. Results: The study revealed that midwives experienced difficulty when providing care to women presenting with postpartum haemorrhage and pre-eclampsia or eclampsia. Difficulty in the management was confirmed by 36% of respondents. Some participants lacked knowledge on the management of women with postpartum haemorrhage, Pre-eclampsia and eclampsia and this was also indicated by 30% of respondents. Shortage of staff led to work overload, especially if one midwife was left alone to provide care to patients in the facility. Furthermore, midwives experienced delayed ambulance services when in need of referring women who required urgent attention to the next level. Delayed ambulance was indicated also by 80,4% of respondents ad this contributed to the midwives’ frustrations hence poor maternal outcomes. High risk women failed to return to the hospital and others hide their previous history of complications and hence experienced abrupt postpartum haemorrhage leading to poor implementation of maternal health guidelines. Phase 2 dealt with the development of the strategy to facilitate implementation of maternal health guidelines in Limpopo Province using the Strengths, Weaknesses, Opportunities and Threats analysis, identified from the collected data. Phase 3 comprised the validation of the strategy, which was conducted using a quantitative research design. Meetings were held with Maternal Health Care Managers, Midwives and Operational Managers working at Primary Health Care Facilities of Vhembe and Mopani districts. Self-administered questionnaires were distributed for respondents to complete and data were analysed using descriptive analysis. Almost all respondents (95%) agreed that the developed strategy was suitable and applicable for midwifery practice. Maternal Health Care Managers, Midwives and Operational Managers made suggestions that will enhance the developed strategy. Recommendations: Continuous education and in-service training must be done in order to capacitate midwives with knowledge of the management of women with postpartum haemorrhage, pre-eclampsia and eclampsia. The curriculum for Midwifery training must be strengthened and must include enrolled nurses. Health education to women must be strengthened and they must be encouraged to give the correct history in order to reduce maternal mortality rate. / NRF

Magister Public Health - MPH / Sub Saharan Africa (SSA) single-handedly accounted for approximately two thirds (196 000) of the world maternal deaths. High maternal deaths have been attributed to high prevalence of HIV and low uptake of Antenatal Care (ANC). This made World Health Organization (WHO) to recommend integration of Prevention of Mother to Child Transmission of HIV (PMTCT) services into ANC to improve accessibility and utilization. According to Zambia Ministry of Health (MoH), every pregnant woman should have her ANC registration in the first trimester and achieve eight visits by delivery time. With the extra need of PMTCT services in the women living with HIV, early and regular ANC attendance is emphasized. However, in Zambia, there is limited information on ANC uptake and its associated factors among women living with HIV. / 2023

<p>Despite all measures taken by the South African government since 1994, there is a contiuous increase of maternal mortality in the country and the Northwest Province is amongst the highest. Studies to date combining the review of maternal deaths and severe acute maternal morbidity (SAMM) have been conducted primarily in urban areas. The aim of this study was to determine the causes of death and avoidable factors for maternal mortality and severe acute maternal morbidity in a rural regional hospital from 01/01/2005 to 30/04/2006.</p>

<p>Despite all measures taken by the South African government since 1994, there is a contiuous increase of maternal mortality in the country and the Northwest Province is amongst the highest. Studies to date combining the review of maternal deaths and severe acute maternal morbidity (SAMM) have been conducted primarily in urban areas. The aim of this study was to determine the causes of death and avoidable factors for maternal mortality and severe acute maternal morbidity in a rural regional hospital from 01/01/2005 to 30/04/2006.</p>

Magister Public Health - MPH / Despite all measures taken by the South African government since 1994, there is a contiuous increase of maternal mortality in the country and the Northwest Province is amongst the highest. Studies to date combining the review of maternal deaths and severe acute maternal morbidity (SAMM) have been conducted primarily in urban areas. The aim of this study was to determine the causes of death and avoidable factors for maternal mortality and severe acute maternal morbidity in a rural regional hospital from 01/01/2005 to 30/04/2006. / South Africa

Philosophiae Doctor - PhD / In this thesis, I use gender and human rights approaches to examine and analyse the major causes of maternal mortality, which result from delay in seeking maternity care and failure to attend maternity care during pregnancy. A gender approach was used to identify and analyse inequalities that arise from belonging to one sex or from unequal power relations between sexes and how these impact on women accessing maternity care. The Human Rights approach was used to identify and analyse health system related factors that led women to delay seeking care and also failing to attend maternity care. A qualitative multiple case study methodology was followed with data analysed thematically. Findings were interpreted in the context of the International Bill of Rights, the South African Bill of Rights and International Human Rights treatises. Maternity women are unable to access maternity care because of their unmet gender equity needs, and because of maternity services that are not respecting, protecting and fulfilling their human right to access health care. A Gender-Human rights model of accessibility to quality maternity care is developed to assist health care providers in promoting availability of maternity services to health consumers. The model propositions are based on the major concepts which are: Gender equity, Women empowerment, Human rights to quality health care, Evidence Based Health Care, and Support during labour.

Background: The interest in obstetrical complications that culminate with maternal death and the urgent need for improvement in these indexes led to the development of the concept of maternal near miss. From a normal situation, the patients are in a continuum that can evolve with the development of moderate and severe situations of health. Severe acute maternal morbidity (SAMM) (situation less severe) and near miss (NM) (situation more severe) are two degrees of situation immediately before maternal death. The main advantage of studying these cases is higher frequency when comparing with maternal deaths cases and that the determining factors are the same. This study aims to determine the ocurrence of SAMM and NM situations in two maternities of reference of the state of Sergipe, determine the prevalence of the event and describe the risk factors associated. Casuistic and methods: A cross sectional study with double controls was conducted in patients who were pregnant sometime and were hospitalized in two reference maternities of Sergipe state. The patients answered a survey about issues relevant to the subject. For categorical variables was used Fisher s exact test. For normal continuous variables was applied the Student t test and for the not normal, the U-Mann-Whitey test. Odds ratio and confidence interval were used whenever possible. Multivariate analysis was performed and p <0,05. Results: There were 16,243 live birth deliveries, and occurred 1102 SAMM, 77 NM and 17 maternal deaths cases. The prevalence of SAMM + NM founded were, respectively, 7.6 cases/1000 LB, the mortality index was 18% (4.5 cases for each death) The main causes of SAMM and NM were respectively: 67.5% by hypertensive causes and 87.1% by necessity of invasive procedures. High age, low income, absence of prenatal, high rates of cesarean section, previous abortion and low weight of the baby at birth with unfavorable perinatal prognosis were statistically significant for the study group. Multivariate analysis showed that the number of eligibility criteria for NM was related with the severity of the situation. Conclusions: The situations of SAMM and NM in the two maternities studied reached significant values. Study NM can be the most efficiently way of conducting internal audits for the improving of the quality of services. Protocols based on adverse situations like these, where the detection can be made on the exact point of failure, can recommend conducts and interventions able to save lives. / Introdução: O interesse por complicações em obstetrícia que culminassem com morte materna e a necessidade urgente da melhora desses índices resultou no desenvolvimento do conceito de near miss materno. A partir de uma situação normal, a paciente insere-se em um continuum que pode evoluir com o desenvolvimento de situações de gravidade moderada e intensa. Morbidade materna grave (MMG) e near miss (NM) são duas denominações dadas às situações imediatamente anteriores ao óbito materno. A grande vantagem em se estudar esses casos é justamente a sua frequência superior em relação aos casos de morte materna (MM) e que os fatores determinantes são os mesmos. Este estudo tem por objetivos: determinar a ocorrência de situações de MMG e NM em duas maternidades de referência do estado de Sergipe, determinar a prevalência do evento nesses locais e descrever os fatores de risco associados. Casuística e métodos: Foi realizado estudo do tipo transversal com duplo controle em pacientes que em algum momento estiveram gestantes e permaneceram internadas em situações de risco nas duas maternidades de referência do Estado de Sergipe no período de um ano. As pacientes responderam a um questionário que continham questões sobre o assunto. Para a análise estatística das variáveis categóricas foi utilizado o teste exato de Fisher. Para as variáveis contínuas normais e para tabelas 2x2 foi aplicado o teste t de Student e para tabelas maiores o teste do qui-quadrado. Para as tabelas não-normais foi aplicado o teste de U-Mann-Whitey. Cálculo do Odds ratio e intervalo de confiança foram utilizados sempre que possível. Neste estudo foi realizada análise multivariada e o valor de p< 0,05 foi considerado. Resultados: Dos 16.243 partos, ocorreram 1102 casos de MMG, 77 casos de NM e 17 MM. A prevalência de MMG + NM foi de 72,6 casos /1000 NV, o índice de mortalidade foi de 18% (4,5 casos para cada morte). As principais causas de MMG e NM foram respectivamente: 67,5% por causas hipertensivas e 87,1% devido à necessidade de realização de procedimentos invasivos. Idade elevada, baixa renda, a não realização de pré natal, maior índice de parto cesáreo, antecedentes obstétricos de aborto anterior e cesárea anterior, baixo peso do RN ao nascer com prognóstico perinatal desfavorável mostraram-se estatisticamente significantes para o grupo estudado. A análise multivariada demonstrou que a quantidade de critérios de elegibilidade de NM esteve relacionada à gravidade do quadro. Conclusões: As situações de NM + MMG nas duas maternidades estudadas atingiram valores expressivos. Estudar NM pode ser o modo mais eficiente de realização de auditorias internas na busca da melhora da qualidade dos serviços. Protocolos baseados em situações adversas como estas, onde pode ser feita a detecção exata do ponto de falha, podem recomendar condutas e intervenções possivelmente capazes de salvar vidas.