LL.D. / This thesis critically evaluates the position of pregnant women (and women who have recently given birth) in the context of South African Labour Law and social security law, from both a comparative and a South African perspective. The fact that women fall pregnant and give birth to children, while men do not, raises issues of theoretical and practical importance in regard to equality issues. Pregnancy has historically been both the cause of and the occasion for the exclusion of many women from the workplace because of the practical difficulties many women face in reconciling the demands of paid work with family responsibilities – although there is no logical reason why women’s giving birth to children necessarily means that they should have primary responsibility for childcare. The underlying premise which underpins the subject matter of this thesis is that pregnant women are unfairly discriminated against in the workplace. While it cannot be denied that men and women are different and that the biological fact of pregnancy is a state unique to women, this “difference” has resulted in gender discrimination, and, more germane to this thesis, in pregnancy discrimination in the jurisdictions to be considered, namely, the United Kingdom, the European Union, SADC and South Africa. This thesis concentrates on various issues pertaining to pregnancy and maternity protection and emphasises the seemingly irreconcilable dichotomy between the desire to recognise and accommodate women’s unique role as child-bearers and the desire to achieve parity between the sexes in regard to conditions of employment, remuneration and general benefits. The central dilemma is whether women can be treated as equal to men in regard to opportunities, entry to the workplace and remuneration, on the one hand, and yet be treated in a special way when it concerns childbearing and childrearing, on the other. In this thesis it is argued that men and women are different and that social justice cannot therefore be achieved by equal treatment. In facing this challenge, legislatures and courts have become ensnared in the dichotomy of equality and distinction, and the question considered here is whether South Africa is fulfilling its constitutional and international obligations regarding the equal treatment, and the granting to them of equal opportunities and reasonable accommodation. This thesis develops an appropriate and relevant paradigm for pregnant women in the workplace. It identifies and highlights the existing deficiencies and lacunae in the South African legal system inherent in both labour law and social security law, and develops proposals for the possible amendment of the existing legislative framework by drawing largely on international, supranational, foreign and regional jurisdictions and by critically evaluating the current South African maternity terrain, particularly in the light of South Africa’s developing constitutional jurisprudence.

Magister Public Health - MPH / Many of the known risk factors associated with low birth weight, such as socio-economic status, ethnicity, genetic makeup, and obstetric history, are not within a women's immediate control. However, there are many things that a woman can do to improve her chances of having a normal healthy child. Lifestyle behaviours, such as cigarette smoking, nutrition and the use of alcohol, play an important role in determining the growth of the fetus. The aim of this study was to establish the knowledge, attitudes and practices related to lifestyle factors such as alcohol use, smoking and nutrition among childbearing women and health care workers on the farms in Stellenbosch and Vredendal. / South Africa

Magister Artium - MA / This study aimed to explore the attitudes to HIV testing among a group of black, low socio-economic status pregnant women from Gugulethu, South Africa. The key research interest was to evaluate the attitudes and understandings of HIV/AIDS that underpin the decision to comply or not comply with prenatal HIV testing. Theories of health behaviour concur that the extent to which an individual will engage in a given health behaviour, such as HIV test compliance, will be a function of the extent to which a person believes she is personally susceptible to the particular illness and her evaluation of the severity of the consequences of contracting the disease. / South Africa

Magister Public Health - MPH / The study aimed to assess the level of adherence and to identify the barriers to adherence and the motivations for good adherence to antiretroviral therapy, amongst women who commenced treatment while pregnant at research clinics in Molepolole, Mochudi, Lobatse and Gaborone. / South Africa

Masters of Public Health - see Magister Public Health / Background: Malaria is the leading cause of death of Uganda's children under 5 years of age and the number-one cause of illness in adults in Uganda. The success of malaria treatment strategies is closely linked to the behavior of patients and caretakers of young children. In the case of malaria this includes accessing appropriate treatment for suspected malaria in time. In Bungokho Sub County, in spite of the efforts by district health workers and the Ministry of Health to implement the malaria control, prevention and treatment strategies, pregnant women and caretakers of children under 5 years of age continue to present late for treatment in the health units resulting in possible avoidable death or disability. Aim and objectives: The aim of this study was to explore the factors that lead to late presentation of children and pregnant women with malaria for treatment at health units. This was done by exploring the perceptions of caregivers of children under five years and pregnant women on the community knowledge and understanding of the symptoms and treatment of malaria; and describing perceptions of caregivers and pregnant women on health care provision at the health units and alternative treatment for malaria. Methods :The study was conducted in Bungokho Health sub-district, in Mbale district, Eastern Uganda over a two month period in 2009. It was a descriptive exploratory study using qualitative research methods. Four focus groups were carried out, two with caregivers of children under 5 years and two with pregnant women, with each focus group consisting of eight participants. Two caregivers and two pregnant women were identified from the focus groups for further indepth interviews. Four in-depth interviews were conducted with health unit staff from Bungokho HCVI. Notes were taken and observations made during the focus groups and interviews. The proceedings were audio-taped and recordings used to expand and clarify notes. Thematic content analysis was used to analyze the data and identify recurrent themes from the focus group discussions and  interviews of the reasons for late presentation for malaria treatment. Results: All caregivers were women, a significant majority of whom were peasants who had not gone beyond the primary education. Caregivers were aware of the general symptoms of malaria but associated more serious or dangerous symptoms with other causes including witchcraft. Pregnant women, on the other hand, seemed to have sound knowledge of both the general and dangerous symptoms of malaria and were likely to attend the health units timeously for reatment. Religious beliefs and practices, particularly belief in the healing ability of prayers prevented early reporting of malaria cases to health units leading to late presentation. Alternative treatment of malaria from traditional herbalists was also sought by the communities particularly when the intensity of malaria was at its peak during the rainy season. Poverty in the community seemed to play a big role in shaping community preference for treatment sources, as well as early presentation to the health units. It was found that the anticipated cost of laboratory tests and sundries at the health units deterred caregivers from taking children under five to health units. There was therefore a strong reliance (and preference for) community medicine distributor's (CMDs) because of free services and easy access. Lack of support from spouses (in particular husbands) coupled with the rude behavior of health workers towards caregivers and pregnant women discouraged visits to health units. The long waiting time and intermittent drug stock-outs also created a negative perception of service at the health units. Conclusions and recommendations: There is need for further sensitization of communities on the need to seek prompt treatment for children under five years of age at the health units (that is, within 24 hours of the onset of fever). Training and supervision of CMDs should be strengthened to ensure consistent supply of drugs, correct dosage of anti-malarial medication and improvements in the referrals to the health units. In order to improve service delivery at the health units, there is need to review and strengthen human resource management of the health units, including staffing requirements and management practices, such as support and supervision, patient care standards and client feedback mechanisms. It is also important that there are adequate stocks of anti-malarial drugs  and laboratory supplies at health units. / South Africa

Magister Public Health - MPH / Since the advent of the HIV pandemic, efforts have been made to find and implement interventions to reduce the risk of transmission of the infection in various risk groups. Mother to child transmission is responsible for a great majority of childhood HIV infections. Interventions have been developed which reduce considerably the risk of mother to child transmission to babies born to women who are infected. To be able to access these interventions, pregnant women first have to know their status by being tested at antenatal clinics. Initial testing protocols in most countries were based on the opt-in, client-initiated approach. However, in many countries, this did not result in many women getting tested and being able to access interventions. Accordingly, many countries have now adopted the routine opt-out approach as a way of increasing testing rates among women attending antenatal clinics. Ghana has had a PMTCT programme since 2004 initially based on opt-in testing. In 2007, there was a change in this testing regimen to the opt-out approach. The aim of this study was to assess the quality, acceptability and factors influencing the acceptability of the use of routine verbal opt-out strategy for HIV testing during pregnancy for women attending antenatal clinics in the Kassena-Nankana district of northern Ghana. A cross-sectional analytical study design was used in this study. The study was conducted in the Kassena-Nankana district of northern Ghana using a structured questionnaire in face to face exit interviews with pregnant women after they had completed their first antenatal clinic visit. A total of 251 women aged between 15-49 years were interviewed after informed consent had been obtained from them. Data was captured with Epidata and analysed with EpiInfo. Cross-tabulations and logistic regression analyses were done. Of the 251 respondents who were interviewed in this survey, 85% of them were aware of MTCT, 82% knew at least one PMTCT strategy, 92% felt they had experienced good quality counselling that day at the ANC and 81% thought that the opt-out testing was acceptable. The perception of the women in the study about the quality of counselling they were given, their exposure to radio and their ethnicity were significantly associated with their acceptability of opt-out testing for HIV. While majority of the respondents felt that the quality of the counselling they received was good and a majority also felt that the opt-out strategy was acceptable, there were concerns about the quality of counselling provided. Recommendations include the need to improve counselling practices in the antenatal clinics by providing more structured information to the women. The District Health Management Team also needs to provide more information to people in the communities about PMTCT using radio as a medium.

The focus of the study was to evaluate the attitudes of midwives towards the implementation of the Choice on Termination of Pregnancy Act in the O.R. Tambo District hospitals in the Eastern Cape. There was no provision for termination of pregnancy (TOP) for unplanned pregnancy until 1994 when the Choice on Termination of Pregnancy (CTOP) Act was introduced. This act allowed any pregnant woman to request TOP when she wished for TOP. The midwives could voluntarily undergo training in TOP services and the designated institutions started offering TOP services, but stopped at a later stage. This resulted in overcrowding in health institutions which continued rendering TOP services. The researcher posed one question to be answered as: What are the attitudes of the midwives who are employed by health institutions in the O.R. Tambo District in the Eastern Cape Province towards the implementation of the Choice on Termination of Pregnancy Act? The aim of the study was to evaluate the attitude of midwives towards the implementation of the CTOP Act in the O.R. Tambo District hospitals. The objective of this study was to determine the attitudes of these midwives towards the implementation of these services in the O.R. Tambo District in the Eastern Cape Province. A quantitative descriptive design was used in this study. The population consisted of 150 midwives from two hospitals in the O.R. Tambo District. The sample consisted of 75 midwives; 30 midwives from Hospital 1 and 45 midwives from Hospital 2. Random systemic sampling was used in selecting the participants. Data were collected using a questionnaire developed by the researcher and approved by the supervisor and the University of Fort Hare Ethics Committee. In the study, using a sample of (n = 75), the attitude on the implementation of CTOP scale had high reliability of 0.81. Data were analysed with the help of a statistician using Statistix 8.1 software for Windows. Approval to conduct the study was obtained from the University of Fort Hare Ethics Committee, Eastern Cape Department of Health and Hospital 1 and Hospital 2 before the study was conducted. The dignity of the participants was maintained by explaining v the topic of the research study, the aim and objectives of the study, the method to be used for data collection and the significance of the study. The participants were allowed to ask questions and the name and telephone of the supervisor were provided in case they needed some clarity. Voluntary, written informed consent was obtained before the interviews were conducted. Privacy, anonymity and confidentiality were ensured and maintained through all the stages of the research process. The finding of this study was that the midwives employed by the health institutions in O. R. Tambo District Municipality displayed positive responses in the majority (n=11/61.1%) of 18 items in the questionnaire. Since the midwives in this study demonstrated a positive attitude towards TOP, it was recommended that the reason for stopping the TOP services in the concerned institutions should be investigated. The following are also recommended: Compulsory training of midwives should include aspects of reproductive epidemiology, in particular, the epidemiology of unsafe abortions. Training in TOP services should continue, so that there will be adequate number of midwives to provide the TOP services, and consideration of special remuneration for TOP providers. Employment of managers trained in TOP and voluntary training of managers working in TOP sections should be considered so that they may provide effective support to TOP providers. Formation of support centres for TOP providers at Provincial and National levels. Education of the community in prevention of unwanted pregnancies by means of contraceptives and indications for a need to provide TOP services, to prevent victimisation of the TOP providers. Availability of a toll free number for reporting victimisation of the TOP providers.

Chlamydia trachomatis est une bactérie à développement intracellulaire obligatoire, divisée en 19 sérovars parmi lesquels les sérovars D-K sont responsables d’infections oculo-génitales et les sérovars L de la lymphogranulomatose vénérienne (LGV). En France, C. trachomatis est le principal agent bactérien responsable d’infections sexuellement transmissibles (IST). Les méthodes moléculaires occupent une place de choix dans le dépistage et l’épidémiologie des infections à C. trachomatis. Grâce à leur utilisation à partir de prélèvements non invasifs, nous disposons de chiffres de prévalence qui s’élèvent à 1,5% dans la population générale, 3,6% chez les femmes âgées de 18 à 24 ans sexuellement actives et 10 à 15% dans les centres à vocation de dépistage des IST. N’ayant aucune donnée chez la femme enceinte, le programme hospitalier de recherche clinique (MATIST) que nous avons mis en place chez les femmes enceintes suivies au CHU de Bordeaux a montré une prévalence de l’infection à C. trachomatis de 2,5%, à M. genitalium de 0,8% et à N. gonorrhoeae de 0%. Chez les femmes de moins de 24 ans, la prévalence était respectivement de 7,9% et 2,4%. La compréhension de l’épidémiologie et de la dissémination des infections à C. trachomatis nécessite la mise au point de techniques de typage performantes d’autant qu’un seul sérovar, le sérovar E, est rencontré dans près de la moitié des cas. Nous avons développé une méthode de typage moléculaire, la MLVA (MultiLocus Variable Number of Tandem Repeat Analysis), qui analyse le polymorphisme associé aux répétitions en tandem et permet un typage intra-sérovar. Cinq VNTRs ont été identifiés. La méthode a été automatisée puis appliquée à 220 souches et échantillons cliniques de C. trachomatis de génovar E, permettant d’identifier 25 types MLVA. Les souches d’origine ano-rectale isolées de patients homosexuels et les souches suédoises appartenant au nouveau variant ont été individualisées au sein de deux types MLVA uniques et distincts, suggérant une origine clonale. L’ensemble des résultats obtenus ont montré que la MLVA est un outil de typage moléculaire performant, plus discriminant que les autres méthodes auxquelles nous l’avons comparée. De plus, dans le cadre de la surveillance épidémiologique de la LGV ano-rectale due au variant L2b qui sévit en Europe depuis 2003 presque exclusivement chez les homosexuels, nous avons identifié le premier cas de LGV ano-rectale chez une femme. Enfin, nous avons développé une technique de PCR en temps réel permettant une détermination objective de la concentration minimale inhibitrice d’un antibiotique donné vis-vis de C. trachomatis. Cette technique a également montré que les antibiotiques étudiés n’avaient qu’une activité bactériostatique sur C. trachomatis. / Chlamydia trachomatis is an obligate intracellular bacterium, divided into 19 serovars, among which serovars D-K are responsible for oculo-genital infections and serovars L of lymphogranuloma venereum (LGV). In France, C. trachomatis is the main bacterial cause of sexually transmitted diseases (STI). Molecular methods are the methods of choice for the C. trachomatis detection and epidemiology. Through their use, it has been shown that the prevalence of C. trachomatis infection rise up to 1.5% in the general population, to 3.6% for sexually experienced women aged 18-24 and to 10-15% in STI medical settings. As no data were available for pregnant women, we conducted a clinical research study (MATIST) in pregnant women at the Bordeaux University hospital. The prevalence of C. trachomatis, M. genitalium and N. gonorrhoeae infections was 2.5%, 0.8% and 0%, respectively. In women under 24 years, the prevalence of C. trachomatis, and M. genitalium infections was 7.9% and 2.4%, respectively. Understanding the epidemiology and the spread of C. trachomatis infection requires the development of efficient typing techniques knowing that a single serovar, serovar E, is found in nearly half the cases. We developed a MLVA (MultiLocus Variable-Number of Tandem Repeat Analysis) method which analyzes the genome polymorphism associated to tandem repeats and allowed intra-serovar subtyping. Five VNTRs were identified. The automated method was applied on 220 C. trachomatis genovar E clinical specimens and isolates, yielding 25 MLVA types. All anorectal isolates from men who have sex with men exhibited the same MLVA type, suggesting clonal spread. In the same way, we confirmed the clonal origin of the Swedish new variant of C. trachomatis. MLVA appears to be a good tool for molecular typing, with a higher discriminatory power than those of other methods used for comparison. Since 2003, a LGV proctitis outbreak caused by the new variant L2b has been reported in Europe in men who have had sex with HIV-positive men. We reported the first case of C. trachomatis L2b proctitis diagnosed in a woman. Finally, we developed a real-time PCR method allowing an objective determination of minimum inhibitory concentration of antibiotics for C. trachomatis. Our results also showed that all antibiotics studied only had bacteriostatic activity on C. trachomatis.

The health of pregnant women is a major concern to health care providers. This grounded theory study of 40 women examined the health of pregnant women and the special threat that poverty and violence posed to their capacity for health. Pregnant women experienced their health as an integrated part of their daily lives; that is, they reported that their health was affected by 'everybody and everything." Women's main concern during pregnancy was to have a healthy newborn and, to this end, they engaged in the process of creating a healthy pregnancy by engaging in health-enhancing behaviours. In this process, the woman focused primarily on ensuring the birth of a healthy baby. Three conditions were essential to a woman's capacity to create a healthy pregnancy: (1) the acceptance of the pregnancy, (2) adequate financial resources, and (3) supportive relationships (especially having a supportive partner). Pregnancies invariably carried with them some uncertainty, and this caused the 40 women in this study to experience a state of vulnerability which, in turn, triggered attempts to create healthy pregnancies. This led to a cycle of improving health: the more energy women had to carry out health-enhancing behaviours the better they felt physically and mentally; the more able they were to conduct their daily activities; and, consequently, the better their health. However, living within a context of poverty and/or violence increased pregnant women's vulnerability and decreased their capacity for creating a healthy pregnancy, leading to extreme stress and the experience of threat. Male violence threatened the women's ability to be connected to those who were important sources of emotional, financial, task-oriented, and knowledge-oriented support, and, thus jeopardized their ability to meet their fundamental needs. Furthermore, the lack of sufficient financial resources limited women's abilities to leave their abusive partners. In order to survive, women in these circumstances sometimes reverted to previous, often harmful, ways of coping in an attempt to reduce their high levels of stress. These coping strategies usually took the form of behaviours that required little energy, such as smoking, not eating properly, and consuming alcohol. Having financial support and a safe place to go were crucial with regard to enabling women to decide to leave abusive partners. Regaining control of their lives in this way allowed women to refocus their energy on health-enhancing behaviours. The women in this study showed incredible strength as they met the challenges imposed by poverty and abuse. They did not remain victims but took hold of their lives with courage and conviction. In order to promote the adoption of health-enhancing behaviours by childbearing women, health care providers must recognize poverty and violence as factors that significantly threaten women's capacity for health. Further to this, special efforts must be made to render culturally sensitive care to First Nations women (i.e., recognizing their cultural identity and heritage, their connection to nature, and the importance of the elders of their community). To this end, we must recognize the connections between racism, colonization, poverty, and violence. For until we have eradicated poverty, and the cycle of violence and degradation that is its legacy, we will not have succeeded in doing all we can to ensure the health and well being of our citizens. / Applied Science, Faculty of / Nursing, School of / Graduate

Orientador: Fernanda Garanhani de Castro Surita / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T11:53:37Z (GMT). No. of bitstreams: 1 Godoy_AnaCarolina_M.pdf: 6315489 bytes, checksum: 17704d401caec449a4069f23091baa1e (MD5) Previous issue date: 2015 / Resumo: Objetivos: Verificar o ganho de peso gestacional das mulheres de Campinas ¿ SP, as recomendações utilizadas no Brasil para o ganho ponderal na gravidez e a proporção de mulheres que aderem essas recomendações. Métodos: foi realizado um estudo do tipo corte transversal na cidade de Campinas ¿ SP que incluiu 1052 mulheres no puerpério imediato, internadas em três maternidades selecionadas, com recém-nascido vivo e gestação única. As participantes foram entrevistadas e responderam às questões sobre dados sociodemográficos e os dados da gestação, do parto, do recém-nascido foram extraídos dos prontuários. O peso pré-gestacional, peso na última consulta e altura da mulher foram extraídos do cartão de pré-natal. Também foi realizada uma revisão sistemática dos artigos que avaliaram as recomendações sobre ganho de peso na gestação em mulheres brasileiras e a adequação do ganho poderal nessas mulheres. Resultados: Nos dados originais da cidade de Campinas encontramos que 13,6% das mulheres eram obesas e 24,6% apresentavm sobrepeso, e que nesses grupos o ganho de peso excessivo foi de 55,9% e 53,7% respectivamente. O sobrepeso e a obesidade se associaram com maior risco para ganho de peso excessivo e parto cesariana. A prematuridade foi mais prevalente nas obesas e em mulheres com baixo IMC pré-gestacional. Na revisão sistemática foram incluídos 17 estudos, verificou-se que não existe padronização das recomendações brasileiras para ganho de peso, as recomendações utilizadas foram as do Institue of Medicine, curva de Atalah e recomendações do Ministério da Saúde. Uma grande parte das mulheres brasileiras inicia a gestação com sobrepeso e obesidade e tende a ganhar peso excessivo na gestação. A metanálise avaliou quatro estudos e verificou que gestantes com sobrepeso apresentaram mais ganho de peso excessivo do que gestantes eutróficas (OR=2,80, IC95%=2,22-3,53). Conclusão: não existe padronização nas recomendações brasileiras para o ganho de peso gestacional e as gestantes com sobrepeso e obesidade são as de maior risco para ganho de peso gestacional excessivo e parto por cesariana. Há necessidade de padronizar as orientações de ganho ponderal na gestação para a população brasileira, os profissionais de saúde e as mulheres, auxiliando dessa forma o conhecimento e melhor adequação do ganho de peso pelas gestantes, melhorando os resultados maternos e neonatais / Abstract: Objectives: To determine the gestational weight gain women of Campinas - SP, the recommendations used in Brazil for weight gain during pregnancy and the proportion of women who join these recommendations. Methods: We performed a study of transversal in the city of Campinas - SP which included 1052 women postpartum, admitted to three hospitals selected with a live newborn and single pregnancy. Participants were interviewed and answered questions about sociodemographic data and the data of pregnancy, childbirth, newborn were extracted from medical records. The pre-pregnancy weight, weight at last visit and height of women were taken from the prenatal card. It was also performed a systematic review of articles assessing the recommendations on weight gain during pregnancy in Brazilian women and the adequacy of ponderal gain in these women. Results: In the original data from Campinas found that 13.6% of women were obese and 24.6% apresentavm overweight, and that these groups gain excessive weight was 55.9% and 53.7% respectively. Overweight and obesity were associated with increased risk for excessive weight gain and cesarean birth. Prematurity was more prevalent in obese and in women with low pre-pregnancy BMI. In the systematic review were included 17 studies, it was found that there is no standardization of Brazilian recommendations for weight gain, the recommendations used were the Institue of Medicine, Atallah curve and the Ministry of Health's recommendations. A large part of Brazilian women start pregnancy overweight and obesity and tends to gain excessive weight during pregnancy. The meta-analysis evaluated 4 studies and found that overweight pregnant women had more excessive weight gain than normal weight pregnant women (OR = 2.80, 95% CI 2.22 to 3.53 =). Conclusion: there is no standardization in Brazilian recommendations for weight gain during pregnancy and pregnant women with overweight and obesity are the most at risk for excessive gestational weight gain and cesarean delivery. There is a need to standardize pondeal gain guidelines during pregnancy for the Brazilian population, health professionals and women, helping in this way the knowledge and best adequacy of weight gain for pregnant women, improving maternal and neonatal outcomes / Mestrado / Saúde Materna e Perinatal / Mestra em Ciências da Saúde