Thesis (MTech (Radiography))--Cape Peninsula University of Technology, 2006 / A prospective cohort study was done on Human Immunodeficiency Virus (HIV) infected and uninfected women attending Khayelitsha Midwifery Obstetric Unit (MOU) and Gugulethu MOU from June 2003 to December 2004, primarily to establish whether there is an association between HIV infection and Intra-uterine growth restriction (lUGR). B-Mode real time ultrasound imaging was used to monitor fetal growth from ±22 weeks to 36 weeks gestational age. Birth weight, gestational age at delivery, gender, placental weight, and maternal complications were also included. Maternal factors considered included age, weight parity, singleton versus multiple pregnancy, previous IUGR or preterm delivery, previous fetal abnormality, social habits viz. cigarette smoking, alcohol and drug use, and vascular disease viz. Diabetes, hypertension, renal disease, cardiac disease and collagen disease. A secondary objective was to establish whether the CD4 T-lymphocyte count possibly modulated the presence of IUGR. All HIV infected women were given antiretroviral therapy according to the standard Protocol of the Provincial Government of Western Cape (2002). The research questions were: • Does maternal HIV infection increase the risk of intrauterine growth restriction and associated preterm delivery? • Does the immune status of (CD4 T-lymphocyte count) of HIV infected pregnant women modulate fetal growth? The primary objective of this study was to establish whether there is an association between HIV infection and IUGR, and hence that HIV infection leads to an adverse perinatal outcome. Ultrasound was used as a diagnostic tool to establish normal or abnormal fetal growth patterns. Anecdotal reports from health workers in the obstetric field suggested that IUGR and preterm delivery may be associated with low birth weight infants in HIV infected pregnant women. However, preterm delivery is associated with various other factors including low socio-economic status (poor nutrition), cigarette smoking, drug and alcohol abuse, previous history of preterm delivery, over distention of the uterus (hydramnios, multiple gestation), premature rupture of membranes, cervical incompetence, vaginal infections (bacterial vaginosis) and maternal disease e.g. hypertension, heart disease (Lizzi, 1993: Symmonds, 1992; Odendaal et aI, 2002). HIV is now thought to be an added factor. Afier doing a systematic review and meta-analysis of 31 studies, Brocklehurst and French (1998) reported that there is an association (although not strong) between HIV infection and adverse perinatal outcome in developed countries; but in developing countries, there is an increased risk of infant death. By excluding or controlling for confounding variables that could affect fetal growth, this study aimed to determine whether there is a significant association between HIV and fetal growth by comparing fetal growth in HIV infected and uninfected women from midsecond trimester to the time of delivery. A secondary objective was to establish whether there is an association between the immune status (CD4 T-lymphocyte count) of the mother and IUGR. The immune status of the mother is probably one of the most important factors affecting the fetus and perinatal outcome. As the mother's viral load increases, her immune system is increasingly compromised, resulting in the occurrence of HIV-related diseases, and a concurrent increase in fetal complications. In this study a CD4 T-lymphocyte count was used to assess the level of immunodeficiency of all the HIV infected participants. Ideally the test should have been done each time the participant was scanned so that the CD4 T-lymphoc)1e count could be monitored simultaneously with the fetal growth parameters, however due to financial constraints and ethical considerations, one test was done on each HIV infected women. This study was based at two MOU's where different antiretroviral therapy (ARVT) regimens were used. The one MOU offered Zidovudine (ZDV) to mothers from 34 weeks gestation to the onset of labour, and the other MOU offered Nevirapine (NVP) as a single dose to the mother at the onset of labour and to the neonate within 72 hours of birth (Provincial Government Western Cape, 2002). This presented an opportunity to compare two groups of HIV infected women on different regimes. The intention was to establish whether ZDV had an adverse effect on fetal growth and resulted in low birth weight. However, 6 months after the study started a revised Prevention of Mother to Child Transmission (PMTCT) Protocol was implemented where women at both MOU's received the same ARVT i.e. ZDV and NVP. This objective was therefore abandoned due to a change in the PMTCT Protocol in the Western Cape. The study was based at two Midwife Obstetric Units (MOU) in the Western Cape where the prevalence of HIV in pregnant women is relatively high i.e. 20 - 24 % (Mother-to-child transmission Monitoring Team, 2001), viz. Gugulethu MOU and Khayelitsha MOU. A prospective cohort study was done with the intention of recruiting a sample of 400 pregnant women, 200 HIV infected and 200 uninfected. The actual sample size was 415. The study group was 194 HIV infected women and the control group was 221 uninfected women. Confounding variables such as cigarette smoking, alcohol and drug abuse. multiple gestation. grand multipara pregnancy, history of IUGR or preterm delivery. fetal abnormality detected at the time of the first scan in the current pregnancy, and maternal vascular disease - were excluded. Confounding variables such as maternal age, maternal weight and gestational age were controlled. Ultrasound imaging was used as a diagnostic tool to establish normal and abnormal fetal growth patterns. A B-mode real time ultrasound unit was used to confirm the gestation age and rule out any obvious fetal abnormalities at 20-24 weeks gestation. Fetal growth scans were done at 28 weeks, 32 weeks and 36 weeks gestation to compare fetal growth patterns in the study and control groups. Fetal biometry used to monitor fetal growth included biparietal diameter (BPD), head circumference (HC), femur length (FL), abdominal circumference (AC) and estimated fetal weight (EFW). Amniotic fluid index (AFI), placental thickness & placental grading were also included. The following variables were analyzed post delivery: • Gestation age at delivery: Normal term delivery is considered to be at 37 - 42 weeks and premature delivery is considered to be less than 37 weeks gestation. The HIV infected and uninfected groups were compared to assess if there \vas a significant difference in the number of preterm deliveries. • Birth weight: The HIV infected and uninfected groups were compared to assess if there was a significant difference in the number of infants with low birth weight. • Perinatal complications: The HIV infected and uninfected groups were compared to assess if there was a significant difference in the number of perinatal complications and to assess if there was an association between the immune status (CD4 T-lymphocyte count) of HIV infected women and perinatal complications. Appropriate ethical principles in medical research were applied. The participant's autonomy, rights and best interests were always considered a priority. Informed consent was obtained from all the participants. Strict confidentiality was adhered to regarding any data collected throughout the study. The Research Ethics Committees at Cape Peninsula University of Technology and University of Cape Town granted ethics approval for the study. Statistical analysis was performed using the statistical package SPSS 12.0.

The phenomenon of teenage pregnancy among school-going youth is on the increase in South Africa, despite the existence of a number of intervention programmes. Although both curricular and co-curricular awareness programmes targeting this phenomenon are currently employed within South African schools, these programmes have patently not met with much success, since the problem remains acute. It was the question why these programmes are not succeeding in alleviating the problem that prompted my interest in undertaking this study. Based on literature that suggests that those programmes that are successful in reaching the youth are designed through participatory processes, rather than being designed by outside experts, my thesis proposes that prevention programmes that are designed and implemented by the youth for the youth may be more successful in helping them to make healthy decisions in terms of their sexual behaviour. This study attempted to engage youth in a participatory way in identifying and exploring their perceptions of teenage pregnancy and using the knowledge thus gained to design, implement and evaluate prevention strategies in their school. The study is informed by social learning theory and adopted a participatory action research (PAR) design, which is located in a critical paradigm. I purposefully recruited twenty-four youths (14 females and 10 males) to participate. The primary research question that guided this study was: “How can peer educators be engaged to create prevention strategies to reduce teenage pregnancy and its impacts?” The following sub-questions were identified from the primary research question: What do learners themselves know feel and experience with regard to the causes and effects of teenage pregnancy How might a participatory methodology help learners to create relevant and contextualised strategies for addressing teenage pregnancy? How can such strategies be implemented in a school system? What recommendations could be made for addressing teenage pregnancy in a contextualised way? The research was conducted in two cycles. In Cycle One, data was generated through two focus group discussions, led by a young researcher from the community to encourage openness and honesty. In addition through snowball sampling, six teenage mothers and two teenage fathers agreed to be interviewed individually. The same questions were asked in the two discussions and the individual interviews, namely: “What do you know, feel and think about teenage pregnancy?” In the first cycle, I responded to my first sub-research question. Interviews, drawings and focus group discussions were used to generate data. Three themes emerged from the data to provide insight into how the youth at the school perceived the phenomenon of teenage pregnancy. The findings from this cycle revealed certain tensions between what youth said they needed and what adults, such as teachers and parents, thought they needed to know. The participating teenagers regarded themselves as sexual beings, while the adults in their sphere of influence preached abstinence, moralised or merely cited the facts, without entering into any discussion of how young people could deal with social pressures and better protect themselves against unplanned pregnancy. The participating youth were clearly aware of how to prevent pregnancy, but the social barriers to using condoms or contraceptive pills were a stumbling block. They possessed knowledge of the potential consequences of risky behaviour, but this did not stop them from engaging in such behaviour. In the second cycle of the research, the participants used the findings of the first cycle to develop prevention messages and strategies to convey these messages to their peers. They used participatory visual methods to accomplish this. The findings from this cycle revealed that a peer education approach helped participants to increase maturity in sexual decision-making, had a positive effect on the learning and acquisition of new skills, and improved critical thinking relating to sexuality. The study also had a positive impact on other learners’ knowledge and the attitudes displayed by both learners and teachers, and also led to improvements in school policies related to sexuality education. It is contended that the study contributed important theoretical and methodological insights. Knowledge generated from the study could make a contribution to the field of sexuality education and how it should be approached in schools, particularly in communities facing social and economic adversity. The methodological contribution of this study provided guidelines and theory on how participatory action research and participatory methods can be implemented in schools to enable youth to influence change in their schools, not only regarding teenage pregnancy, but also other social issues.

M.Cur. / Please refer to full text to view abstract

Teenage pregnancy is an international phenomenon with girls falling pregnant from as early as 14 years of age. In South Africa teenage pregnancies are also on the increase (Kaiser, 2000:18; Statistica SA, 2006:5;). Teenage pregnancy may have negative effects for the teenager in that it can force the teenager to drop out of school prematurely as well as shortening her educational career which might limit future career possibilities. It also predisposes both the mother and the child to health risks. Finally, teenage pregnancy also leads to family destabilisation. Within the Xhosa communities family destabilisation becomes even more severe as it is culturally and traditionally related. Traditionally, teenage pregnancy in the Xhosa communities is stigmatized. The family suffers from embarrassment and disappointment and the effects of these experiences can manifest in outrage on the part of the parents towards the pregnant teenager resulting in non-communication with her and ultimately rejection (Boult & Cunningham, 1991:36). This results in no or minimal support from the family (Nxumalo, 1997:16). The research design and method to achieve the objective of the study was a theory-generative design based on a qualitative, phenomenological, explorative, descriptive and contextual research approach utilizing the four steps of theory generation. During the step of concept analysis, which is the first step of the process of theory generation, data was collected by means of individual interviews with the pregnant Xhosa teenagers, parents and grandparents. The interviews were audio-taped and transcribed verbatim. The sample for the study was selected purposively to ensure indepth information.

Adissertation submitted to the Faculty of Education in fufillment or partial fufilment of the requirement for the degree of Master of Education (Research Methodology) in the Department of Educational Psychology and Special Education at the University of Zululand, 2006. / The purpose of this study was to investigate the nature of educators' attitudes towards teenage pregnancy in Secondary Schools of the Lower Tugela Circuit of KwaZuIu-Natal. Subjects were educators (N=97) from twenty secondary schools. These educators were of different ages; races: religious affiliation, educational levels teaching experience and gender. The study, further, investigated the relationship (if any) that exist between their attitudes towards teenage pregnancy and various educators' characteristics such as age, gender, race, religious affiliation, educational level and their teaching experience. The study was conducted in response to the KZN Circular Number 116 of 2000 which seem to give more rights to pregnant learners . The findings indicated that educators have positive attitudes and are sympathetic towards pregnant teenagers, but displayed reservations about the level of skills they have with regard to helping teenagers in the times of emergency (like delivery) in the classroom. The study formulated some recommendations that the researcher hope (believe) will strengthen the relationship between educators and pregnant teenagers in schools.

The purpose of this study was to explore the life experiences of multiparous teenage mothers at selected communities in the Eastern Cape Province. The population for this study was pregnant teenage mothers aged 12-18 years having at least one previous pregnancy, living in the catchment areas of the provincial hospital of Bizana in the Alfred Nzo District of the Eastern Cape Province. Data were collected through 12 semi-structured individual interviews using a selfdeveloped interview schedule. The transcribed interviews were analysed by means of thematic analysis, using the five stages according to Terre Blanche, et al. (2006), namely familiarisation, inducing themes, coding, elaboration, and checking. Subcategories were grouped into 12 categories and five main themes. Findings on the life experiences of the multiparous teenage mothers are described according to the main themes, namely the everyday life of the teenage mothers, cultural practices leading to pregnancies, factors contributing to pregnancies, challenges experienced by teenage mothers, and messages from the teenage mothers. Recommendations focus on the role of social services to engage the multidisciplinary team and the community to assist in the empowerment of young mothers to break the cycle of multiparous teenage pregnancies and the negative impact thereof on the lives of young mothers. / Health Studies / M. P. H.

This study was undertaken in order to determine how black teenage primigravidae in the Umlazi area of KwaZulu perceived their pregnancies. This was an exploratory study. An interview schedule was used to elicit information from the primigravida teenagers concerned. One hundred and sixteen primigravida teenagers were interviewed. The sampling frame stretched over 6 antenatal clinics at Umlazi. This study revealed that most primigravida teenagers stand in need of consideration from health professionals of the comprehensive health services. / Health Studies / M.A. (Nursing Science)

This research report is submitted to the School of Social Sciences at the University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Arts in the field of Demography and Population Studies for the year 2016, September 2017 / Background: South Africa has some of the most progressive legislation when it comes to sexual and reproductive health rights. However, contraceptive use amongst this segment of the population group remains distorted. From a public health perspective, investing in the sexual and reproductive health needs of young people translates into an improvement in the sexual health status of the population at large. As such this paper makes use of the Health Belief Model to investigate the factors associated with the choice of type of contraceptive methods used by sexually active young women to prevent a pregnancy. Methodology: Data for this study was obtained from Wave 2 of the Transitions to Adulthood survey. The weighted sample size is 464. Analysis on the weighted data was conducted in STATA 13.1 in survey mode in order to achieve the objectives of this study. Descriptive statistics were used to analyse the data at the univariate level. The Chi-squared test was conducted to examine the relationship between the variables under investigation and the outcome, contraceptive use. The multinomial logistic regression model was used to analyse the data at the multivariate level. The results of which were provided in terms of relative risk ratios. Findings: Approximately 41% of sexually active young women in KwaZulu Natal did not use contraception to prevent a pregnancy with their most recent sexual partner. Results from the multinomial logistic regression model revealed that sexually active young women who were single were 77% less likely to make use of hormonal and other contraceptive methods to prevent a pregnancy compared to their who were counterparts in a relationship (p-value= 0.00001). Young women who have been pregnant at least once were approximately 60% less likely to utilise hormonal and other contraceptive methods to prevent a pregnancy with their most recent sexual partner. Conclusion: By using the Health Belief Model as a theoretical basis this study highlighted the complex non-linear relationships between the variables selected to constitute the health beliefs as well as the health-related behaviour of contraceptive use. The findings of this study demonstrate two key realities related to contraceptive use of sexually active young women in KwaZulu Natal. Firstly, relatively low rates of contraceptive uptake. Secondly, amongst sexually active young women who utilised contraception, there are even lower usage rates of long-acting reversible contraceptive methods. As such, it is important for healthcare facilities in KwaZulu Natal and South Africa at large to support young women in their decision to protect themselves from unintended pregnancies and from infections of HIV and others STIs. / XL2018

The issue of adolescent health has steadily grown momentum with people realizing the vulnerability ofthis sector ofthe world's population. Within the South African context, the tide had also turned. However, most initiatives aimed at the prevention of problems, one of which was adolescent pregnancy. Extant literature revealed that despite efforts to reduce adolescent pregnancy, adolescent fertility rate in SubSaharan Africa remained on the rise. As such, the need for appropriate maternity services for this group became a concern, as extant literature also revealed the costly long term effects to pregnant and parenting adolescents, as well as society as a whole. Within KwaZulu-Natal pregnant and parenting adolescents use the same maternity services as their adult counterparts. It was not clear if these services were appropriate to the needs of these clients. As such, a Glaser Grounded Theory approach was used to explore the maternity services from the points of view of the various stakeholder groups. Data was collected, using theoretical sampling, by means of semi-structured interviews and focus group interviews. Constructs of adolescent-friendly maternity care were identified from the findings. The components of the constructs included aspects of (1) Structures and Resources, (2) Attitudes to AMCs, and (3) Services. The resources or structures that either need to exist and/or be improved included policies, the quality and quantity of HCps, formalized support for AMCs, a sensitized administration, community involvement and the educational preparation of HCps. The attitudes that service providers were expected to demonstrate in their interaction with AMCs included those of equality, empathy and respect. They were also expected to show understanding towards AMCs and provide them with reassurance and support. The third component identified specific services to be provided to AMCs during the antenatal, labour and delivery, and postnatal period. These constructs can be used by health care planners and providers to strengthen and improve service provision to and utilization by pregnant and parenting adolescents and form the foundation on which a theory of adolescent-friendly maternity care can be based. Recommendations were made with regards to future service and research endeavours. / Thesis (Ph.D.)-University of KwaZulu-Natal, 2005.

Using South African and Zimbabwean Demographic and Health Surveys of 1998 and 1999 respectively, findings show that about 35% and 42% women between the ages 15-24 years had given birth at least once in South Africa and Zimbabwe respectively. Of these births, 26% and 32.2% occurred to South African and Zimbabwean women before they reached their 20th birthday respectively. In addition, these births among women between ages 15-24 account for 17% and 27% of the total births in South Africa and Zimbabwe. These are indeed high levels of early childbearing. It is because of these high levels of early childbearing that this dissertation aims to examine determinants contributing to early childbearing. To achieve this, two comparable data sources are analyzed, namely South African Demographic and Health Surveys (SADHS) of 1998 and Zimbabwean Demographic and Health Surveys (ZDHS) of 1999. The results from this dissertation show that major significant determinants contributing to early childbearing are the age of sexual debut; childhood place of residence; highest level of education attained; socio-economic status; and ethnicity and sex of household head. The results of this dissertation make an important contribution to the growing knowledge base of Sub-Saharan African early childbearing research. Its recommendations are based on the findings of the determinants contributing to high levels of childbearing, which can be used for planning and policy development towards adolescent fertility prevention. / Thesis (M.A.)-University of KwaZulu-Natal, Durban.