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An ideal maternal health program for a community in Venezuela a thesis submitted in partial fulfillment ... Master of Public Health ... /Meaño, Jesus Antonio. January 1944 (has links)
Thesis (M.P.H.)--University of Michigan, 1944.
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Descriptive evaluation of the Maternal Support Services in Washtenaw County a report submitted in partial fulfillment ... for the degree of Master of Science in Community Care ... /Greig, Ellen. January 1997 (has links)
Thesis (M.S.)--University of Michigan, 1997. / Includes bibliographical references.
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Midwifery and medicine : discourses in childbirth, c. 1945-1974Pitt, Susan January 1995 (has links)
No description available.
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Caesarean section deliveried in public sector hospitals in South Africa, 2001-2009.Monticelli, Fiorenza 05 April 2013 (has links)
Introduction
There is concern that C-section rates are increasing in the public health sector in South Africa
and wide variation has been reported between districts, provinces and hospitals. This study is
a comprehensive analysis of C-section rates in all public sector hospitals during 2000/01-
2008/09 by facility, district and province. It aims to inform decision makers in maternal
health services of the trends and patterns occurring in C-section rates in South African public
sector hospitals. Variation in C-section rates is described to highlight the differences in care
that pregnant women receive in different parts of the country and to illustrate where inequity
of resource allocation is occurring, as well as highlighting possible data quality problems.
Methodology
This is a descriptive study using quantitative methods of analysis on secondary data obtained
from the National Department of Health’s routinely collected data specific to Caesarean
sections in the DHIS. C-section averages are weighted by taking the number of deliveries per
facility and level into consideration.
Results
1. Wide variation is noted between individual facilities, between and within provinces
and districts and within the different levels of hospitals in 2008/09.
The mean weighted C-section rate ranges from 17.2% in District Hospitals to 40.7% in
Specialised Maternity Hospitals. A 3.7 fold difference between the highest and lowest
district average C-section rates is seen for District Hospitals. Within provinces, average
District Hospital C-section rates vary by as much as 3.5 fold between districts. Interdistrict
variation in Regional Hospitals shows a 3.3 fold difference between the lowest
and highest average district rates. Among the eight National Central Hospitals there is a
2.5 fold difference between the highest (79.7%) and lowest (31.7%) facility C-section
rates. Nationally a total of 23 District Hospitals had C-section rates below 5% and nine
hospitals of varying levels had rates of over 50%
2. Caesarean Section rate trends, 2000/01 – 2008/09 are increasing.
Nationally the average C-section rate in South Africa increased by 6.3 percentage points
from 18.1% in 2000/01 to 24.4% in 2008/09, with an average annual compounded growth
rate of 3.8%. Bivariate linear regression analysis confirms there is a positive linear
relationship between time (year) and C-section rate (p<0.001). All levels of hospitals
showed an increasing trend over the nine years, (p<0.001), with the rate in Provincial
Hospitals having increased by the highest amount (1.40%) year on year and District
Hospitals, the least (0.48%). Trends within certain districts and individual hospitals
however, show a decline.
3. A strong relationship between level of deprivation and C-section rate exists when
adjusting data for provincial variation
Bivariate linear regression analysis revealed no association between the level of
deprivation of the population at district level and the mean C-sections rate per district
(p=0.130). Multiple regression analysis adjusted for the effect of province, reveals a
significant association (p=0.044). A negative association between the DI (p=0.006) and Csection
rate is seen in eight out of nine provinces.
4. Data quality of C-sections and deliveries in the DHIS needs improving
Data quality in the DHIS leaves uncertainty in some instances whether C-section rate
trends are a true reflection or not. The C-section rate indicator on its own is unable to
inform on the full spectrum of emergency obstetric care. The definition of C-section rate
for primary health care currently only considers deliveries in District Hospitals. The
national C-section rate for primary health care in the country however, reduces from
17.2% to 13.2% when including the deliveries which take place in CHCs.
Conclusions
The quality of data relating to C-sections (number of births, C-sections and hospital
categorisation) in the DHIS needs to be improved in order to enable accurate monitoring and
should include deliveries and C-sections which take place in Community Health Centres to
allow for a more accurate reflection of C-section rate in primary health care.
The C-section rate indicator on its own is insufficient to adequately inform on the full
spectrum and quality of the provision of emergency obstetric care in South Africa. Including
additional indicators to the DHIS, such as the UN process indicators, could improve on the
current knowledge and monitoring of the provision of emergency obstetric care in South
Africa.
The wide variation in C-section rates seen among District Hospitals and the C-section rates
between and within districts and provinces, suggest inequity in resource allocation and
irregular service delivery patterns. Reasons and solutions for these wide differences need to
be found, which are likely to be unique to each district and province.
Further studies are needed to investigate the access of poorer women, especially those in
remote rural areas to emergency obstetric care services.
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Near-misses in maternal health services in South Africa: patients' perspectives from East London Hospital complex and referral areasMangesi, Lindeka 19 March 2013 (has links)
Background: South Africa has a high Maternal Mortality Ratio (MMR) and is not on track to
meet Millennium Development Goal (MDG) 5, target 5A (to reduce by three quarters between
1990 and 2015 the MMR). Along with gathering crucial information about maternal deaths, it is
also important to understand the experiences and opinions of those who have almost died during
their pregnancy or delivery - termed near-misses in maternal health services - to recommend
relevant interventions aimed at bringing down South Africa's MMR. Aim: The overall aim of the study was to explore patient experiences and perspectives of
maternal near-misses and their opinions of how these could have been prevented.
Methods: Using a case study design, where the case was women who had experienced severe
acute maternal morbidity (a near-miss event), in-depth interviews were conducted with nearmisses
until a point of saturation was reached after the ninth woman. Each woman was
interviewed twice on two separate occasions between 1st April and 30th September 2009 about
their experiences and opinions of the near-miss event, and access to reproductive health services
and the health system more broadly. Their social and economic circumstances were also
explored.MAXqda was used for data management and a thematic analysis was carried out on the
interview data.
Results: Bureaucracy in accessing reproductive health services, lengthy referral processes, lack of
transport and resources in clinics were seen as major health system barriers that contributed in
women being near-misses. Inadequate knowledge about reproductive health and warning signs of
serious morbidity; although seen as patient factors, were also be attributed to health system
factors. The desire to or not to fall pregnant was not the only factor that influenced contraceptive
use. Power relations between women and their partners affected most women who were in lower
positions of power. Cessation of menstruation as a side effect of contraception resulted in failure
to recognize absence of menstruation during pregnancy. Lack of service integration affected
women irrespective of their demographic characteristics. Patients are at risk of abuse in health
facilities although this is not the norm. Little attention was given to postnatal care of women.
Conclusion: Health systems' issue which according to the AAAQ framework were not
satisfactory contributed in women being near-misses. Women's limited knowledge on reproductive health issues which might be as a result of inadequate information offered at the
clinic affected use of reproductive health services. Educating women and their families about
obstetric emergencies may result in early recognition of warning signs of obstetric emergencies
and prevention of near-misses.
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Reducing maternal morbidity and mortality from caesarean section-related haemorrhage in Southern GautengMaswime, Tumishang Mmamalatsi Salome January 2017 (has links)
A thesis submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy
April 2017. / Introduction
The number of maternal deaths from bleeding during and after caesarean section (BDACS) has increased dramatically in South Africa in recent years. Four studies were conducted to gain insight on measures to reduce maternal deaths from BDACS. The aim was to identify clinical and health system factors associated with near-miss and maternal death from BDACS.
Methods
A systematic review was done on near-miss from postpartum haemorrhage, with a sub-analysis on BDACS. The field research, done in southern Gauteng, included: 1) a six-month prospective near-miss audit of women with BDACS in 13 hospitals; 2) a two-year retrospective maternal death audit in seven hospitals; and 3) a health systems audit in 15 hospitals.
Results
The systematic review on near-miss from PPH found two studies that described near-miss from BDACS, with a mortality index of 0-11%. In the near-miss and maternal death audits, the main risk factors for BDACS were pre-operative anaemia and previous caesarean section. Atonic uterus was the main cause of haemorrhage, with associated failure to use second line uterotonic drugs. Failure to diagnose and treat shock was the main reason why women died. Most maternal deaths from BDACS occurred in regional hospitals. The hospital systems audit identified shortages of second line uterotonic drugs and surgical skills availability as contributors to near-miss and maternal death from BDACS.
Conclusion
Although bleeding may be arrested through obstetric surgical techniques and easily available drugs, severe BDACS is a complex disease that requires a multi-disciplinary approach in a functional health system, especially regarding the detection and management of hypovolaemic shock. Measures to reduce maternal morbidity and mortality from BDACS include health system strengthening, with high care and critical care facilities, and improving the availability of drugs and surgical skills at district and regional hospitals / MT2017
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Patient-related adverse events in the maternity units at Tokollo/Mafube district Hospital complexNoge, Sesi Roslina 27 October 2011 (has links)
BACKGROUND: The Tokollo/Mafube District (TMD) Hospital Complex located in the
rural area of Fezile Dabi District within the Free State Province has reported a high
number of adverse events (AE) from the maternity units. Although the information linked
to AE occurring in the hospitals is routinely collected and reported to the hospital
management in accordance with the Provincial policy, no study has been done to
systematically analyse the available information and to explore the current situation.
AIM: To describe the patient-related AE in the maternity units of TMD Hospital Complex,
related individual and health system factors, and the functioning of the reporting system
used for these AE during the two year study period.
METHODOLOGY: A descriptive cross-sectional study design was used, based on a
retrospective review of routinely collected hospital data from the health records of
patients, the AE Committee meeting minutes, and other relevant hospital documents.
The study was conducted at the maternity units of TMD Hospital Complex which
consists of two hospitals in the Fezile Dabi District within the Free State Province. Data
was collected in the following categories of variables: the types of AE (in terms of levels
of seriousness), the profiles of patients who experienced such AE (e.g. age, gravidity,
marital status, residence, and socio-economic status), the related health system factors
identified during the adverse events committees meetings (such as personnel, transport,
equipment, environment and management) and reporting of these AE.
RESULTS: This study revealed that a total of 88 patients, comprising 0.8% of the total
number of admissions to the maternity units, experienced AE. Maternal AE occurred
more commonly than perinatal AE. The majority of women experiencing AE were
unemployed (93%), between the ages of 19-34 (81%), unmarried (79%) and resided in
towns (88.6%). In addition, most of these women belonged to the groups of primigravida
and multigravida (85%), attended between one and three antenatal visits (42%), and delivered via normal vaginal deliveries (76%) with a high number of stillborns (77.2%).
Overall, the majority of maternal AE occurred during the intrapartum stage. Another
significant finding was that majority of AE reported were classified as the most serious
being SAC 1, which accounted for 93% of the maternal AE and 84% of perinatal AE.
The early perinatal AE accounted for 100% of the reported perinatal AE.
Although majority of AE reported at the institution were within the prescribed period,
reporting time to the Complex AE Committee (CAEC) and District AE Committee
(DAEC) was exceeded in the majority of cases. In addition, all AE that required
investigation complied with the provincial policy but exceeded the required investigation
period.
The findings regarding health systems related factors as determined by root cause
analysis performed by the AE committee revealed that clinical governance issues
accounted for 43% of both maternal and perinatal AE, followed by patient transport
issues as provided by the Emergency Medical Services (EMS) which also accounted for
a significant percentage (33%).
CONCLUSION: This study has demonstrated that specific health system related factors
played a significant role on the occurrence of AE at the maternity units of TMD Hospital
Complex and that the majority of the reported AE were very serious (SAC 1). It is
important that these preventable, contributory factors are addressed by management at
both the complex and district levels. Furthermore the results suggest that patients’
profiles, to a certain extent, do have an influence on the occurrence of AE in maternity
units of TMD hospital Complex and it is important that patients’ profiles be taken into
consideration when adverse incidents are analysed.
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Maternal and foetal outcomes of deliveries attended to at Emkhuzweni Health Centre in SwazilandWoreta, Fikadu January 2010 (has links)
Thesis (M Med(Family Medicine)) -- University of Limpopo, 2010. / Abstract
AIM The aim of the study was to measure the maternal and foetal outcomes of the deliveries attended to at Emkhuzweni Health Centre, Swaziland.
Objectives The objectives of the study were:
.:. To determine maternal outcomes of the deliveries attended to at Emkhuzweni
Health Centre.
.:. To determine foetal outcomes of the deliveries attended to at Emkhuzweni Health
Centre.
.:. To identify risk factors that affect maternal and foetal outcomes at Emkhuzweni
Health Centre
Methods
A retrospective chart review was performed for all 520 deliveries at Emkhuzweni Health Centre between January 1,2007 and December 31 2007. Labouring mothers were eligible for the study if they met the inclusion criteria. The study was conducted after ethical approvals from the relevant authorities were obtained.
Data were obtained from records for the following variables: age, address, gravidity, parity, health service where ANC was attended, risk factor, mode of delivery, maternal condition after delivery and post-delivery maternal hospital stay.
For each foetus, the APGAR score at the first and fifth minute, weight and sex of the neonate and condition after delivery were recorded.
Results
The results revealed that the maternal outcomes after delivery were normal for 89.85% of the mothers; 3.4% of those who delivered at EHC had PPH, 5.4% developed puerperal sepsis, 1 % PIH and 0.2% cases resulted in maternal death. The majority of mothers (61.7%) were discharged from the maternity ward in less than 24 hrs.
As far as foetal outcomes were concerned, normal babies accounted for 68% of births, early onset neonatal sepsis for 1.9%, congenital malformation (0.6%), stillbirth (1.5%), low birth weight (9.2%), preterm babies (17.8 %) and neonatal death (0.4%0.
Conclusion
This study found that the maternal outcomes at Emkhuzweni Health Centre in 2007 were similar to those in Swaziland as a whole and in other developing countries, except that there was a higher rate of pre-term delivery among pregnant women assisted at Emkhuzweni Health Centre.
The foetal outcomes of Emkhuzweni Health Centre in 2007 were similar to the data from developing countries. Additionally, however; significant numbers of pre-term babies were delivered and a high incidence of neonatal sepsis was observed at the Health Centre.
Some of the risk factors for the observed maternal and foetal outcomes were poor antenatal care attendance, distance of the Health Centre from the home state of the pregnant woman, preterm labour, under age and teenage pregnancies.
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Maternity care into the 21st century :Carr, Patricia A. Unknown Date (has links)
Thesis (MNursing (Advanced Practice))--University of South Australia, 1996
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Enforcing maternal health rights in Nigeria : options and challenges.Agbakwa, Nkiru Felicitas. January 2004 (has links)
Thesis (LL. M.)--University of Toronto, 2004. / Adviser: R. Cook.
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