Thesis (Ph. D.)--University of Missouri-Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 175-188). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 175-188). Also available on the Internet.

Thesis (M.DS)--University of the Free State, 2006. / "January 2006." Includes bibliographical references (leaves 95-99)

Dissertation (D.P.H.)--University of Michigan, 2004. / Includes bibliographical references.

Submitted in partial fulfillment of the requirements for the Degree in Masters of Technology in Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Introduction: Evidence suggests that pregnant women who lead sedentary lifestyles and have a poor knowledge of exercise during pregnancy are at risk of developing diseases like gestational diabetes, pre-eclampsia and low back pain along with many other chronic conditions. An exercise program during pregnancy has benefits for both the mother and the child. No studies have ascertained the knowledge and practices of exercise in pregnant women in South Africa, furthermore, there was a need to conduct research regarding exercise amongst South African pregnant women, particularly to determine whether any barriers to physical activity exist. Aim: To compare the knowledge and practices of pregnant women regarding exercise during pregnancy between a selected private practice and public clinic. Methodology: A quantitative, descriptive, cross sectional survey was used in this research study. The population consisted of pregnant women (n = 400) attending both public and private sector antenatal care in the Ethekwini municipal area of KwaZulu-Natal, South Africa. Public sector participants were drawn from the Addington Hospital public antenatal clinic and private sector participants were drawn from the gynaecological practice of Dr D Sankar. Purposive, stratified sampling was used. Following the signing of an informed consent form, data was collected by means of a self-administered questionnaire. A minimum sample size of 324 patients was calculated by the statistician. Descriptive statistics, such as frequencies and percentages were used to describe the demographic profile of respondents and their physical activities. Inferential statistics, including Chi-Square tests of association and student t-tests were used to determine differences in proportions and means respectively between the two categories of participants. Odds ratios (OR) were calculated to ascertain the measure of association between a risk factor and an outcome. Results: There were 198 (57.6%) participants from the private gynaecological practice and 146 (42.4%) from the public clinic at Addington Hospital. The mean age of the study population was 27.65 ± 5.3 years. Almost half of the study population were Indians (46.2%). Blacks made up the second largest proportion of the study population (39.2%). More than half of the study participants were involved in exercise during their pregnancy (57.1%). However, only 37% of the study population met the international criteria of physical activity, which is 30 minutes of moderate -intensity aerobic exercise, per day, for 5 days a week, during pregnancy as set out by the American College of Obstetrics and Gynecologists (2002). However, there was evidence of unstructured physical activity which increased the level of acceptable physical activity in the majority of participants 82.1%. Walking was the most common activity that the women engaged in from both the private sector (88.8%) and public clinic (89.3%). The average time spent on walking was more than 30 minutes a day. Household chores and climbing stairs also increased the levels of physical activity within the participants. Only a minority of participants (35.4%) stated that they were diagnosed with an adverse health condition, which prevented them from exercising. Some participants who did not exercise reported that fatigue was the reason for not being physically active (51.6%). Conclusion: Interventions need to be implemented to increase the knowledge of physical activity amongst pregnant women and the benefits that are associated with it. An attempt needs to be made by health practitioners to try and increase the level of physical activity among pregnant women, so that they may benefit from its effects. / M

There is a growing body of research aimed at understanding social support during pregnancy in South Africa. Pregnancy is constantly referred to as one of the challenging and stressful periods affecting women’s physical and psychological well-being. Various research studies on social support argue that social support is paramount at this stage. Research on social support indicates that having adequate and quality social support impacts on how pregnant women experience pregnancy. My interest in social support comes in the wake of absent fathers in South Africa and with the emerging trend of “new” fathers. Although there is a volume of research on social support, it tends to be realist. Using a social constructionist framework, I explore other ways of talking about social support in an attempt to expand the discourse around social support. I explore how pregnant women talk about social support during pregnancy from their intimate partners in the small rural municipality of Elundini, Eastern Cape, South Africa. Intimate partner support was limited to heterosexual partners regardless of their marital status. The sampling procedure followed a non-probability sampling method. Participants of the study were between 24 and 32 years old. Their gestational age ranged between five and eight months. Fourteen in-depth interviews using photo-elicitation were conducted with seven participants and were analysed using a social constructionist informed thematic analysis. The major theme that emerged from the analysis was partner involvement and absence during pregnancy. The analysis of results suggests that expectant father presence translates to social support. Participants constructed his presence as reassurance in the context of possible abandonment. Absence was constructed in different ways: participants constructed absence as unjust and unfair, absence and marriage, temporary absence in the form of cultural phenomenon of ukwaliswa/ukubukubazana, absence as normal but burdening to the pregnant women’s social network. Participants reported that social support from the expectant father affected pregnancy wantedness.

No description available.

No description available.

STUDY OBJECTIVES: We sought to evaluate the construct validity and factor structure of the Spanish-language version of the Pittsburgh Sleep Quality Index (PSQI) among pregnant Peruvian women. METHODS: A cohort of 642 women were interviewed at ≤ 16 weeks of gestation. During interview, we ascertained information about lifestyles, demographics, sleep characteristics, and mood symptoms. Stress induced sleep disturbance, depressive symptoms, and anxiety symptoms were evaluated using the Ford Insomnia Response to Stress Test (FIRST), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) assessment scales, respectively. Consistency indices, exploratory and confirmatory factor analyses, correlations, and logistic regressions were used. RESULTS: Both exploratory and confirmatory factor analyses indicated a three-factor solution: sleep quality, sleep efficiency, and sleep medication. We observed significantly positive correlations of the PSQI with the FIRST (0.42), the PHQ-9 (0.49), and the GAD-7 (0.46). Poor sleepers (PSQI global score > 5) had significantly increased odds of experiencing stress-induced sleep disturbance (odds ratio, OR = 3.57; 95% CI: 2.40, 5.31), depression (OR = 5.48; 95% CI: 3.58, 8.37), and generalized anxiety disorder (OR = 4.57; 95% CI: 3.08, 6.76). CONCLUSION: The Spanish-language version of the PSQI instrument was found to have good construct validity among pregnant Peruvian women. Consistent with some other studies, the PSQI was found to have a three-factor structure. Further assessment and validation studies are needed to determine whether the three, factor-specific scoring of the PSQI is favored over the PSQI global score in diverse populations.

MPH, Maternal and Child Health, Faculty of Health Sciences, University of the Witwatersrand / Due to the high prevalence of HIV in South Africa, all pregnant women are offered an HIV test as part of the package of services offered during ante natal care (ANC). All women who present to an ANC clinic for the first time for that given pregnancy are given group talks about HIV and the availability of services to protect their children from HIV through Prevention of Mother to Child Transmission (PMTCT) services. Following these group discussions, all the women are then counselled on a one on one basis and are offered an HIV test. Women who decide not to take the test can opt out of testing at this stage, those who do go ahead and test are also offered post test counselling after which their test result is given to them. All HIV tests are conducted using rapid HIV test kits which make results known within 15 minutes, the results are given to the women on the same day of testing. Women whose CD4 count is below the antiretroviral treatment(ART) initiation threshold† are fast tracked onto ART , those whose CD4 is above the threshold should then be referred to other services which can help them maintain their health.1 These services are part of the Comprehensive Care, Management and Treatment (CCMT) approach. They include: CD4 count monitoring; treatment for opportunist infections; social workers, and support groups for psychosocial support.2 For purposes of this study, these services are collectively referred to as Wellness services. Thus PMTCT should serve as a gateway to either ART or Wellness services. This study therefore sought to describe the linkages between PMTCT, ART and Wellness by reviewing service utilisation levels and referral systems at sampled health facilities in Soweto. Data for this study were collected via a cross sectional record review of PMTCT registers and an ART initiation register at sampled health facilities. PMTCT registers were reviewed for the period January to March 2008 to determine what service had been given to pregnant women who accessed PMTCT services for the first time during that period † In his speech on World AIDS Day (December 1st 2009) President Jacob Zuma announced that CD4 count threshold for treatment initiation will be raised from 200 to 350 as of April 2010. 0707048E 2 and which follow on services they had been referred to. ART registers were reviewed for the period January to August 2008 to determine which of the pregnant women who had been referred to ART from the PMTCT service points at the sampled clinics accessed the service. Key informant interviews were also conducted with staff at PMTCT, ANC, ART and voluntary counselling and testing (VCT) service points at the sampled facilities. Descriptive statistics were run using SPSS version 17.0, comparisons were done using OpenEpi and key informant interview data were thematically analysed using Atlas TI version 5.2.0. Records at the PMTCT clinics showed that of the 1350 women who attended ANC clinics at the sampled facilities between January and March 2008, all but one agreed to test for HIV. Twenty-nice percent (388) tested positive for HIV. Of these 388 HIV positive women, 20% (77 women) had CD4 counts below 200 and were therefore eligible for initiation of ART. Review of records at the ART clinic showed that only 23% (n = 18, N = 77) of all ART eligible women had accessed the service. Review of the PMTCT register also showed that a significant proportion, 37% (n = 144, N =388), of women who tested HIV positive did not return to the clinics for their CD4 count results. These women therefore missed opportunities to access other follow on services to which they could have been referred and possibly ART as 31% (24 women) of these women were also eligible for ART. Review of records at Wellness services was not possible as no indications were made in the PMTCT registers of follow on services other than ART to which HIV positive women were referred. Thus the greater majority of women who were eligible for ART (77% of the 77 eligible women) did not access ART which they required to help them maintain their physical wellbeing. These women missed the opportunity to access holistic health care services, it is not known if they accessed ART services at other health facilities. Without the required antiretroviral therapy, it is highly likely that their women’s health status deteriorated such that they faced higher chances of morbidity and ultimately mortality. 0707048E 3 The review of records at both PMTCT and ART service points showed poor data management systems as referrals from PMTCT to ART were not always documented against client names in the PMTCT registers. Communication systems between the service points were also found to be poorly structured as there were no systematic feedback mechanisms on clients referred and seen. Linkages to Wellness services were even more poorly structured as no referrals to services which fall under Wellness were documented in the PMTCT registers. Key informants interviewed suggested several possible reasons why PMTCT and ART services were not being fully utilised as was evidenced by the of 37% of women who were not retained in care as they did not return for CD4 results and the low ART utilisation rate of 23%. Possible reasons suggestions were: ignorance of the need to access ANC services, preference for traditional medicine, fear of stigmatisation within their communities and poor staff attitudes towards patients. The key informants also suggested measures they thought could improve utilisation, these include hire of more staff, improved staff wages, improved interdepartmental communication and a bottom up approach to service improvement. A suggestion was also made to include PMTCT messaging in general HIV/AIDS information education communication material so as to raise awareness of the availability of PMTCT interventions. Although there were linkages between PMTCT, ART and Wellness services, these linkages were poorly developed and drop out from services was high. Efforts to follow up on patients or to retain them in care were not well developed as the data management systems employed by the service points were not consistently used nor did they facilitate patient monitoring and follow-up. Furthermore, the structural and managerial separation of the ART service point from PMTCT as well as the lack of standard protocols for referral to Wellness introduced barriers to service utilisation for women who required these services.