This research study endeavoured to explore and describe the experiences of women who participated in the Prevention of Mother-To-Child Transmission (PMTCT) of HIV Programme. Data relating to evaluation of the PMTCT Programme in the piloted sites compiled by other researchers in the Department of Health focus on the process, progress and extent of service implementation. There appears to be a dearth of information available from women participants in the PMTCT Programme. The objectives of the study were to: · Explore and describe postnatal women’s experiences of the PMTCT Programme offered in the East London Hospital Complex. · Propose recommendations into the existing guidelines for midwives who implement the PMTCT Programme in the health services to ensure optimal implementation of this programme. The research population included postnatal women who participated in the PMTCT of HIV Programme at the East London Hospital Complex (Frere site). Permission to conduct the research was obtained from the Eastern Cape Department of Health Ethics Committee, Chief Executive Officer of the hospital complex and the Advanced Degrees Committee and Human Ethics Committee at the Nelson Mandela Metropolitan University. The research study was qualitative, exploratory, descriptive and contextual in design. Data collection was carried out by face-to-face semi-structured interviews with postnatal women at the East London Hospital Complex (Frere site). The tape-recorded interviews were transcribed verbatim with the aid of field notes. Data analysis was done according to Tesch’s method of data analysis (in De Vos et al, 2000:343). Themes were identified from the transcriptions and finalised after consensus discussions with an independent coder who was experienced in qualitative research. Literature control, guided by the themes identified in the interviews, was carried out to compare and verify the findings of the study. Three major themes with sub-themes were identified during data analysis. The major themes were identified as follows: · The participants expressed feelings of being devastated by the results that confirmed their HIV positive status. · The participants expressed a thirst for knowledge on how to live with the diagnosis and on how to continue with the PMTCT Programme. · The physical environment where counselling and testing were done, as well as the practical arrangements, were not conducive to the full implementation of the PMTCT Programme at the antenatal clinic. Conclusions were drawn and recommendations were made in the form of additional guidelines for midwives implementing the PMTCT Programme in the antenatal clinic health services. Guidelines for further midwifery-related research were formulated.

The intent of this research project was to discover the barriers that exist in this community when a woman attempts to access prenatal care. A concern for the well being of the children in the community and a belief in the importance of early intervention to enhance outcomes inspired the idea for this project.

Thesis (M. A. (Nursing Science)) -- University of Limpopo, 2016. / Perinatal morbidity is a public health indicator of the level of equality in a country. Its prevention has major medical, social and economic costs. The aim of this study was to describe factors contributing to high perinatal morbidity rates in Mankweng-Polokwane Complex of the Capricorn district, Limpopo Province, South Africa. A quantitative, descriptive cross-sectional research method was used to describe factors contributing to high perinatal morbidity. The study population comprised 80 registered midwives. Simple random sampling was used to select the 66 respondents. Data were collected using a self-developed questionnaire. Questionnaires were completed and returned, and only one questionnaire was not returned, and two were spoiled as they were incomplete, then 63 questionnaires were analysed. Ethical clearance was obtained from Medunsa Research and Ethics Committee, Limpopo Province Department of Health Ethics Committee and Hospital management. The Statistical Package for Social Sciences (SPSS, version 22) was used for data analysis. Descriptive statistics were used to analyse and describe and summarise data whereby the findings were presented in the form of distribution tables and graphs. Inferential statistics were used based on probability and allowed judgement to be made about the variables. The study revealed that shortage of staff, absenteeism, resignation, bad staff-patient ratio and overcrowding of patients, long waiting periods for caesarean sections, long waiting period for babies operation, work overload of staff, lack of equipment and supplies, congenital anomalies, perinatal asphyxia, prematurity and neonatal sepsis were contributory factors to high perinatal morbidity rates. The study recommended that all staff should be able to resuscitate newborn babies, be able to use Partograph effectively, further research on factors contributing to high perinatal morbidity and education training on speciality qualifications. Key-words: Factors, High, Perinatal, Morbidity rates

The problem that this study addressed was the high rate of maternal mortality for Black women in the United States, which has been rising, including before the COVID-19 pandemic. The goal was to identify significant predictors of medical mistrust. The study recruited a convenience sample via an online social media campaign. The resultant sample was 100% Black and female (N=192) with a mean age of 33.23 (SD= 4.980, min=24, max=61), while 94.8% were born in the United States (n=182). Using background stepwise regression, the following were found to be significant predictors of a higher level of medical mistrust: older age (B = .033, p = .001); higher levels of education (B = 0.205, p = .000); lower annual household income (B = -.055, p = .026); higher level of perceived racism, discrimination, and inequity in treatment from medical staff (B = 0.137, p = .046); lower levels of cultural sensitivity/ competence/ humility ratings for medical staff (B = -.155, p = .002); higher past year mental distress (i.e., Depression, Anxiety, Insomnia and Trauma) (B = .369, p = .000); and lower levels of social support post-partum (B = -0.162, p = .004)—with 46.5% of the variance predicted by the model (R2 = 0.698, Adjusted R2 = 0.465). The study findings highlight a crisis of Black maternal mortality in the United States, as well as a crisis in healthcare service delivery to Black women, as uncovered via this study. The data betrays a dimension of the crisis in healthcare service delivery to Black women who report experiencing discrimination for being Black at 75.5%, for their appearance (skin tone, hair, etc.) at 62.0%, and for being overweight or obese at 28.6%. Implications of the findings are discussed, while recommendations for future research are offered. In terms of those implications, perhaps most importantly, this data effectively identifies the year after a high-risk birth hospitalization as an essential time for ensuring Black women enter counseling with licensed and certified mental health professionals.

Thesis (MPH.) -- University of Limpopo, 2021 / Background: South Africa’s poor maternal health indicators have resulted from weak maternal health services delivery, including access to quality family planning, skilled birth attendance, emergency obstetric care, and postnatal care for mothers and new-borns. Maternal deaths and disabilities remain a major public health problem in developing countries and maternal mortality is the health indicator which shows the greatest gap between the rich and poor countries. There are global achievements which are substantial reduction in global maternal mortality and an increase in the proportion of childbirths occurring in health facilities. On annual basis there are maternal health outcomes which occurs and these include an estimated 139 million births, an estimated 289 000 women die during pregnancy, childbirth or soon after and lastly an estimate 2.6 million will have stillbirths and 2.9 million infants will die in the first month of life. The purpose of the study was to determine the factors driving maternal health services utilization in rural areas of Limpopo Province. Methodology: The current study was done at Hlogotlou area in Sekhukhune district of Limpopo province and it used a quantitative research approach, that was descriptive cross-sectional study to determine the factors driving maternal health services utilization. The structured questionnaire was used to describe the knowledge levels of pregnant women on utilizing the antenatal services and to describe the utilization of prenatal services by pregnant women. The sampling method was random. The total number of 450 pregnant women participated in the study and all of them were analysed. Data were analysed using STATA version 12 and descriptive statistics were used to describe the data wherein categorical variables, frequencies and percentages were reported. Differences between groups (teenagers, adolescents, adults) were analysed using univariate logistic regression. Results: A total of 450 pregnant women were interviewed majority of women were in the age group 21-25 years, single, unemployed had a secondary educational level. Socio-economic status was assessed using a household wealth index and majority of the pregnant women in the current study were in the medium socio-economic status at 66.4% and majority of the women were using social grants 67.8%. Majority of women get information pertaining to antenatal care from televisions followed by those who v received information from leaflets, radio and those who did not receive information from anywhere at 37.1%, 23.1%, 22.7% and 16.9% respectively. There was a statistical significance difference between those who initiated first antenatal care visit before 12 weeks and after 12 weeks at p-value=0.007. Majority of pregnant women who used televisions as source of information for maternal health care, majority of them were found to be initiating antenatal care after 12 weeks at as compared to those who used radio and leaflets or newspapers as they initiated antenatal care before 12 weeks. Majority of pregnant women in the current study were aware of the antenatal care services rendered at the clinics and they were aware of the fact that antenatal care services rendered at the clinics could assist in detecting the complications related to pregnancies and also reported that these services could reduce the maternal and neonatal morbidity including maternal mortality. There was an understanding of the importance of antenatal care amongst the pregnant women. The predictors of utilization of maternal health services were young age, lower educational level pregnant women who were not married were pregnant women who were in the low socio-economic status. The young pregnant women were 2.2 times more likely to plan their pregnancies and 1.8 times more likely to discuss their pregnancies with their partners or spouses. Pregnant women who were married at a young age were 0.4 times less likely to lack the knowledge about existing for antenatal care at the clinics. Pregnant women with lower educational level were 6.8 times more likely to lack the knowledge about existing for antenatal care at the clinics. Pregnant women who were not married were 2.1 times more likely to go for the first antenatal care booking in the first trimester (1-12 weeks). Pregnant women who were in the low socio-economic status were 1.4 times more likely to lack the knowledge about existing for antenatal care at the clinics and 1.3 times more likely to report that barriers to accessing antenatal care services was either culture, religion or language barrier. Conclusion: The findings of this study highlight the need to address the structural socio-economic drivers of maternal health care utilizations in rural areas of Limpopo Province, South Africa. Timely entry to antenatal care was low in the study area. In order to improve the situation, it is important to provide community-based information, education and vi communication on antenatal care and its right time of commencement. In addition, empowering women and implementing the proclamation designed for the age at marriage should be mandatory up to the local level. Our findings suggested that policies enhancing improved education could benefit health awareness. Key concepts Antenatal care, maternal health care services, pregnant women, utilization.

Mistreatment experienced by women delivering in healthcare institutions is a concerning pattern reproduced and normalized in health systems globally, causing widespread harm. Women’s reports and observations of childbirth practices in institutions have revealed that disturbing proportions of deliveries are characterized by indignity, humiliation, and neglect. The enormity of the problem constitutes a social catastrophe, as potentially hundreds of thousands are affected daily at a profoundly important moment of personal, family, and social life. Growing global concern has elicited research on mistreatment’s prevalence and characteristics, with limited attention to developing explanatory theory. The observed patterns indicate that mistreatment is systemic; therefore, social theory is required to understand why mistreatment persists, despite official norms that prohibit mistreatment and promulgate respectful care. Diane Vaughan’s normalization of organizational deviance theory from organizational sociology, emerged from studies of how things go wrong in organizations. The theory posits that organizational structures and processes are distorted due to resource scarcity combined with production pressures resulting in normalized organizational deviance in daily micro-level transactions. Furthermore, regulatory systems are unable to capture and mitigate the problem. Vaughan’s multi-level framework provided an opportunity for analogical cross-case comparison to elaborate theory on mistreatment as normalized organizational deviance.To elaborate the theory, the Tanzanian public health system in the period of 2010-2015 was selected as a case because it was the site of a seminal study to measure the prevalence of mistreatment, explore its causes, and develop and test interventions to reduce its occurrence. My participation in designing and conducting this study provided understanding of the phenomenon which formed the foundation of this dissertation. Novel theory was first elaborated through a systematic review of literature on maternal health care and the government health system in Tanzania. A broad Scopus search identified 4,068 articles published on the health system and maternal health in Tanzania of which 122 were selected. Data was extracted using a framework based on the theory and reviews of mistreatment in healthcare. Relationships and patterns emerged through comparative analysis across concepts and system levels and then were compared with Vaughan’s theory and additional organizational theories, resulting in a nascent theory. A qualitative theory-driven approach was then applied to verify and expand the nascent theory using qualitative exploratory data from the study in Tanzania described above. The data included eight focus group discussions and 37 in-depth interviews involving 91 individuals representing community and health system stakeholders. Data were analyzed deductively and inductively using the theory’s framework while allowing for emergent constructs. Analysis based on the literature review revealed that normalized scarcity at the macro-level combined with production pressures that emphasized biomedical care and imbalanced power-dependence on limited financial sources altered values, structures, and processes in the health system. Meso-level actors strove to achieve production goals with limited autonomy and insufficient resources, resulting in workarounds and informal rationing. Biomedical care was prioritized, and emotion work was rationed in provider interactions with women, which many women experienced as disrespect. The nascent theory developed through literature review was largely supported by the qualitative data, while providing further nuance and elucidating new components. Moral distress, which occurs when one knows the right thing to do but is prevented from taking the right action due to institutional constraints, emerged as an important systems effect of organizational dysfunction. In addition, the qualitative data revealed that managers coped with dual roles as both managers and providers and that the service interaction includes families, not solely providers, women, and newborns. The challenges in the regulatory environment also were clarified, highlighting that monitoring and observing mistreatment was hindered due to structural secrecy and the nature of mistreatment. The nascent theory revealed the importance of emotional labor and emotion work in understanding mistreatment. Emotional labor has been widely acknowledged as an important aspect of healthcare provision, especially for a positive patient experience; yet there has been limited attention to emotion work as the underlying effort required to provide respectful maternity care and prevent mistreatment. Qualitative data from the exploratory formative research were further analyzed to explore the characteristics of emotion work. 22 interviews and 3 focus groups with 44 maternity providers from different levels of care provision in two districts were analyzed using thematic analysis combined with affinity diagramming. Six key themes were identified that provide a deeper understanding of the emotion work required of maternity providers, including 1) expected to love and care for patients; 2) controlling emotions; 3) managing patient expectations in the face of system shortages; 4) providers are human beings too; 5) nurses are perceived as harsh; and 6) limited system support for emotion work. The themes and corresponding sub-themes highlight that the nature of childbirth care, the context, and gender norms influence the ability to exert emotion work and thus provide respectful care. Emotion work was expected but good performance was unacknowledged by the system. Additional resources are required, not only to ensure the most basic of resources to provide quality of care, but to ensure sufficient organizational support to address the emotional demands of providers. Systems need to acknowledge the extra effort required for emotion work and support and train providers to provide this care, as well as help them to manage difficult emotions that they experience due to the nature of their work. Analogical comparison with another case of organizational deviance enabled a novel approach to elaborate theory. Normalization of organizational deviance proved useful for understanding mistreatment. This theory and others from organizational sociology that explore why things go wrong in organizations may be relevant for other areas of persistent systems failure and underperformance. Further theory testing in different contexts and types of health systems is needed to understand the generalizability of the nascent theory and advance its development. In addition, many of the constructs, such as emotional labor and moral distress, have not been widely applied in low- and middle-income settings and require deeper study. This theory reveals the systemic factors driving mistreatment and can guide the identification of system leverage points to transform health systems towards ensuring a respectful experience during childbirth for women and their newborns. Ensuring that adequate resources are provided to achieve targets is essential, but organizational support to address the emotional demands of providers must also be provided. These changes will ease the burden among providers and managers struggling to provide care in under-resourced health systems. The extra effort required for emotion work should be acknowledged and appropriate training provided, as well as support for providers to manage the difficult emotions that they experience due to the nature of their work. The findings may also have implications beyond childbirth, as the theory highlights the conditions that may lead to burnout and poor mental health among providers, an ongoing problem worldwide that was exacerbated by the COVID-19 pandemic.

The purpose of this study was to describe the utilisation of maternal and child health (MCH) care services by mothers from four selected health facilities in the Balaka District of Malawi. A non- experimental quantitative descriptive research was conducted to determine the knowledge of mothers with regard to MCH services and to identify factors that impact on the utilisation of the MCH care, based on the Andersen’s behavioral model of health services utilization. A combination of proportionate stratified sampling and convenience sampling was used and data was collected by means of self-administered questionnaires. It was found that mothers know the available services and that a number of factors have an impact on the utilisation of health care services. These relate amongst others to educational level, finances and cultural beliefs. / Health Studies / M.A. (Public Health)

Mozambique is in the process of setting up maternity waiting homes (MWHs) in an attempt to improve access of women living in remote areas. It is expected that MWHs will increase institutional deliveries and consequently, decrease maternal mortality caused by the delay in reaching obstetric care. However, no evidence for this assumption has been found in the literature. The objective of this research was, using Geographical Information Systems (GIS), to assess the impact of MWHs in increasing institutional deliveries coverage. GIS technology is a valuable methodology to analyse access, especially in contexts where official records are weak. An ecological study, using a sample of 28 health facilities, was conducted in six districts in northern Mozambique. The findings suggest that MWHs could contribute to increasing institutional deliveries coverage in a range of 4% to 2 %. However, they do not appear to increase access of women living in remote areas. / M.A. (Public Health)

A descriptive quantitative study was undertaken in the Leribe and Butha-buthe northern districts of Lesotho. Thirty-six trained, twenty-four untrained TBAs and nine nurses involved in training TBAs were recruited. In line with research by Clarke and Lephoto (1989:3) the TBAs were elderly females who had children of their own. In contrast with the MOH (1993: 10) where TBAs were found to be illiterate, most (93%) of the TBAs in this study had at least a primary education. The art of primary midwifery was learned through assisting with a delivery and being taught by mothers or mothers-in-law. The public health nurses conduct formal training ofTBAs in Lesotho over a period of two weeks, where subjects like ante-natal care, delivery of the baby and post- natal care are addressed. The majority (78.8%) provide antenatal care at their homes or the home of the mother. This includes palpation, history taking, and abdominal massage and health education. An important role is identifying women at risk. During labour the progress of labour is monitored and care is given to the mother and baby post-natally. Trained TBAs could identify women at risk more readily than untrained TBAs. Cases referred most frequently were prolonged labour and retained placenta. Trained TBAs practiced hygiene more often and gave less herbs than untrained TBAs. The health care system is providing support to the TBAs through training and supervision, but was found to be inadequate. Community leaders are involved in the selection of TBAs for training. Regular meetings are held with the TB As to discuss problems. Communication is one of the problems the TB As have to face, because of the long distances from health care centres. A lack of infrastructure and supplies is also of concern. It can be concluded that TBAs play an important role in maternal health care in Lesotho and are supported to a lesser degree by the health care system, which causes problems for the TBAs in their practices. It is recommended that the ministry of health becomes more aware of the need for training TBAs and that a programme for training should be more appropriate, taking cultural practices into account. / Advanced Nursing Science / D.Lit. et Phil.

The purpose of this study was to describe and evaluate the strategies used to reduce maternal mortality of the Fezile Dabi District in the Free State Province, South Africa. A quantitative descriptive study was conducted at three hospitals to describe and evaluate the strategies. Data collection was done by using the Maternal and Neonatal Programme Effort Index (MNPI) self-administered questionnaire. The study population comprised of 71 (midwives (52), doctors (13), management-operational managers (6). The overall response rate for the three hospitals was (43.5%). The study indicated that programme efforts for maternal health are similar across the three hospitals, however, there are particular areas in each hospital that need more attention. The ratings of all the strategies generally showed weak to partial effort. The findings revealed general poor performance under the following strategies: postpartum care, training arrangements, information, education, communication and hospital protocols. Based on the study results, the quality of maternal health care need to be improved / Health Studies / M.A. (Public Health)