Master of Public Health - MPH / Background- Sexual and Reproductive Health (SRH) problems continue to affect adolescents’ health and well-being even into their adulthood. Globally and especially within sub-Saharan Africa with a heavy burden of adolescent SRH problems, increased attention is being paid to these issues. This study looks at adolescents’ awareness, utilisation of and experiences of the available SRH services in Omaruru District, Namibia. Methodology- This analytical cross-sectional study used a two-stage cluster sampling method. Data from students aged 15-19 years in secondary schools were collected and analysed using a structured self-administered questionnaire and STATA statistical software respectively. Ethical approval was obtained from the Biomedical Research and Ethics Committee (University of the Western Cape) and the Namibian Health Ministry. Written parental/caregiver informed consent and written participant assent, as per the Namibian law were obtained. Results- While 87% of respondents had heard of SRH, 46% had ever used SRH services. Of these 44% were contraceptive services. Fifty-one percent had ever had sex (of which 17% had given birth to or fathered their first child), 56% of their first sexual experiences were between ages 15-17 years. Twelve percent had used illegal drugs three months prior to the survey. In multivariate analyses female sex, urban residence and reported sexual debut had significant independent relationships with contraception use. Use of SRH services was independently significantly associated with having had sexual debut. Among SRH services users: 71% would recommend these services to their friends, 51% and 56% found health providers welcoming, with good attitudes, and guaranteeing their privacy and confidentiality. Conclusion Greater effort is needed to curb teenage pregnancy in school-going adolescents by promoting the use of all SRH services especially contraception among sexually active adolescents. It is encouraging that respondents who had used SRH service reported that their privacy and, confidentiality were respected and that healthcare providers’ attitudes generally satisfactory. Lower SRH knowledge, service use and use of contraception and condoms needs further investigation in rural youth and then programmatic and service changes tailored to their needs. Gender norms that underpin adolescent females disadvantage in a number of SRH areas needs to be addressed

Abstract Aim: To map first-time mothers experiences of breastfeeding support provided by maternal health care, birth center and BB. Method: A quantitative survey with a cross-sectional design. The criterias to be included was first-time mothers who breastfed or wished to breastfeed and gave birth to a full-term child in the last two years. Data were collected through a web survey published on Facebook. A comfort selection was chosen and data were analyzed with descriptive statistics. Comparisons were made between two age groups Results: A total of 197 first time mothers were answered in the survey. Group 1 consisted of first-time mothers aged 21-30 years and Group 2 consisted of first-time mothers aged 31-42 years. The breastfeeding support included written, verbal and practical guidance. Positive and negative factors in breastfeeding support were identified. Both differences but mainly similarities were identified among first-time mothers’ experiences of breastfeeding support. It was 70,3% of the entire population who wanted more information about breastfeeding. A difference was that Group 2 generally estimated lower breastfeeding support compared with Group 1. Conclusion: The breastfeeding support was estimated quite low by both age groups. Almost half of the first-time mothers considered themselves to receive the best breastfeeding support from sources other than maternal health care, childbirth and BB. This indicates that the breastfeeding support that first-time mothers received was insufficient. First-time mothers requested more information about breastfeeding. High attendance of the midwife and individual guidance were positive factors.   Keywords: breastfeeding, experiences, midwives, mothers, support.

A series of 4 observational studies was performed on a Bovelder herd at Johannesburg Water’s Northern Farm. The heifer and cow breeding seasons started on 15 October and 1 November every year, and consisted of 50 d and 60 d of oestrus observation respectively, with once daily artificial insemination (AI). Five to 7 days after the AI period bulls were added in multi-sire groups for a period of 42 d. Pregnancy diagnoses were performed between 23 March and 26 April every year. The farming system had been in place for >25 years, with few deviations. In the first study, reproductive tract scoring (RTS) by transrectal palpation on a 5- point scale was performed 1 day before the start of breeding on a group of heifers (n = 272) born in 2002. Heifers with RTS 1 or 2 were estimated to be pre-pubertal, those with RTS 3 pubertal and those with RTS 4 or 5 post-pubertal. Pre-breeding body weight (BW) and body condition score (BCS) were recorded, and Kleiber ratio (KR) was calculated (average daily gain/end weight0.75). Heifers were followed until they weaned their first calves. The objectives of this study were to determine if RTS is a valid tool to predict reproduction and production performance in limited bred beef heifers, and to compare its predictive value with that of BW, BCS, age and KR. After adjustment for BW and age, RTS was positively associated with pregnancy rate to the 50 day AI season (P < 0.01), calf weaning weight (P < 0.01) and pregnancy rate to the subsequent breeding season (P < 0.01), and negatively associated with days to calving (P < 0.01). RTS was a better predictor of fertility than was vi KR, and similar in its prediction of calf weaning weight. It was concluded that RTS is a predictor of heifer fertility and compares well with other traits used as a predictor of production outcomes. It was further hypothesised that RTS may predict long-term reproductive performance due to its association with pregnancy outcome and days to calving after first breeding, combined with reports that heifers calving early tend to calve early in subsequent seasons and have increased lifetime production. In study 2, a 7-year longitudinal study, 292 beef cows in two age cohorts were observed from 1-2 d before their first breeding season (day of RTS), until they had weaned up to 5 calves. Years to reproductive failure was defined as the number of years until a cow failed to become pregnant during the AI season. Animals with RTS 1 or 2 were at increased risk of early reproductive failure compared to those with RTS 4 or 5 (HR = 1.4, 95% CI 1.0, 1.9) despite the fact that RTS was not associated with calving rate or days to calving after the second calving season. The predictive value of RTS was lower in the age cohort with a higher prevalence of anoestrus. Most animals with RTS 1 or 2 that were subsequently detected in oestrus were in early to mid di-oestrus at the time of scoring. It was concluded that RTS is a valid culling tool to improve long-term reproductive success in a seasonal breeding system, by excluding poor performing animals. It was further concluded that the predictive value of RTS decreases with increasing prevalence of anoestrus and at certain stages of the oestrous cycle. Apart from failure to calve, dystocia as a result of foeto-maternal disproportion is the cause of significant production loss in beef heifers. Internal pelvis area (PA) can be calculated as the product of vertical and horizontal diameter of the pelvis measured transrectally using a calliper device. In study 3, the effects of five culling strategies using prebreeding PA data on calving and dystocia rates and on pre-breeding and calf birth weight (BWT) were compared in 484 heifers. Multiple regression analyses were used to determine independent predictors of PA, calf BWT and dystocia. Hypothetical culling of 10 or 20% of heifers was applied within age cohort after ranking by each of the following: unadjusted PA (PA); PA adjusted to 365 d of age (APA); PA:BW ratio (PA:BW); PA adjusted to the median BW of the group by the regression coefficient of PA on BW(BWPA) and PA similarly adjusted to the median lean BW (LBWPA). Dam parity, calf BWT and either BWPA or LBWPA were the only independent predictors of dystocia (P < 0.05), whereas the effect of PA tended to be significant only after adjusting for calf BWT (P = 0.08). After culling by PA or APA, retained heifers were heavier, had a higher calving rate and calves tended to be heavier at birth compared to culled heifers, but dystocia rates were not different. Although culling by PA:BW resulted in lower dystocia rate, it resulted in lower pre-breeding BW in retained than in culled heifers. Culling by BWPA and LBWPA had better sensitivity and specificity for dystocia than PA, and resulted in higher calving- and lower dystocia rates in the retained heifers, without affecting the pre-breeding BW or calf BWT. It was concluded that pelvimetry is a useful culling tool to aid in the management of dystocia in yearling heifers, and that adjustment of PA to median BW within age group improves its accuracy and avoids the undesirable side-effects of using unadjusted PA. The strong association of PA with calving rate resulted in the hypothesis for study 4, namely that PA can add prognostic value to RTS as a predictor of reproductive failure in beef heifers. Transrectal ultrasound (US) examination of the reproductive tract was also investigated in this study (n = 488) with the objective of identifying which ultrasonographic measures taken at a single point in time before the onset of breeding were independently associated with reproductive outcomes. In this study pregnancy failure was defined as the failure to become pregnant after the AI and bull breeding periods while anoestrus was defined as the failure to be detected in oestrus during the entire 50 d AI period. BCS, uterus horn diameter, absence of a CL, largest follicle of less than 13mm and PA were the pre-breeding examination variables that remained in prognostic models (P < 0.1). Combining either the model based on the three remaining US measures or RTS with PA provided more accurate prognostic models for pregnancy failure and anoestrus than using RTS alone (P < 0.05). It was concluded that US measures have prognostic value for pregnancy failure in restricted bred yearling heifers as a result of their association with anoestrus, and that smaller PA has additional value to identify poor performing heifers. In conclusion, pre-breeding examination is useful to identify beef cows with lower potential to reproduce successfully over the long term in a restricted breeding system. It is recommended that PA should always be included in such examination, either unadjusted or adjusted by BW, in herds with a low and high incidence of dystocia respectively, in combination with ultrasonography of the reproductive tract. When ultrasonography is not available, the accuracy of RTS by transrectal palpation can likely be improved by repeating it in low scoring animals after 7 days. / Thesis (PhD)--University of Pretoria, 2013. / gm2014 / Production Animal Studies / unrestricted

Thesis (M. Law. (Development and Management)) --University of Limpopo, 2019 / Like many other countries, South Africa has its own socio-economic challenges. For the past two decades, the country has been experiencing rapid population growth, yet in the same period, there has been a pervasive decline in social and economic stability, and in the end, stagnant human wellbeing. This has been as a result of diminishing access to basic services such as health care, quality housing, quality education and safe clean drinking water. Among other factors, unregulated and rapid population growth contribute to these socio-economic challenges. This study seeks to illustrate that overpopulation undermines and threatens social development, societal stability and survival of humanity. Therefore, the examines the possibility of enacting a legislation or policy that will regulate or limit procreation or the right to give birth. It also reflects on the Chinese experience to obtain some lessons from China’s One-Child Policy. It is submitted that South Africa must draft its own policy or legislation that will regulate population growth with the primary objective of aligning population with available state resources. Keywords: overpopulation, right to reproductive health, socio-economic rights, human wellbeing, social transformation.

The study sought to describe the factors contributing to termination of pregnancies among teenagers in Vhembe District of Limpopo Province, by studying the responses given by teenage girls aged 19 years and younger. The study also sought to determine the socio economic characteristics of teenagers who terminate pregnancies, the role of parental care in avoiding unwanted teenage pregnancies, the teenagers’ general knowledge of reproductive health issues as well as their sources of information regarding reproductive health issues. The major inferences drawn from this study included that teenagers’ knowledge of reproductive health issues was inadequate and that they have nothing tangible because of their low educational and economic status that put them at risk of being involved in sexual activities at an early age leading to unwanted pregnancies that end up in termination. Based on the findings of the study, recommendations were made for imparting knowledge regarding sexual issues to teenage girls in Vhembe District of Limpopo Province.

DNUR / Sexual and reproductive health services include family-planning or contraception, pre-natal care, safe births and post-natal care, safe and accessible post-abortion care and where legal, access to safe abortion services, prevention and treatment of sexually transmitted infections and cervical cancers, sexual health information, and counselling. Adolescents face many sexual and reproductive health risks, ranging from teenage pregnancy, early unprotected sex, and sexually transmitted infections. Every year one in twenty young people worldwide contracts sexually transmitted infections, and currently, fifty percent of HIV infections occur in young people aged 15-24 years. Teenage pregnancy is at alarming rate among school girls. The overall aim of this study was to develop a comprehensive sexual and reproductive health programme for secondary school learners in Capricorn and Mopani Districts of Limpopo Province, South Africa. Three objectives which guided programme development were: 1. to assess the knowledge of secondary school learners about SRH issues, 2. to assess teachers’ views about the impact of the existing SRH programmes for adolescents and 3. to explore the perceptions of parents towards the provision of SRH services in schools. Sequential mixed methods approach was used where the initial quantitative phase was followed by qualitative phase. Three steps were used as the basis for developing the programme. Step 1 used quantitative descriptive survey to assess the knowledge of learners about sexual and reproductive health issues. Step 2 also used quantitative descriptive survey to assess teachers’ views about the impact of the existing sexual and reproductive health programmes provided in schools. An exploratory qualitative method was used in step 3 to explore the perceptions of parents towards the provision of sexual and reproductive health services in schools. The study population comprised of learners, teachers and parents. Probability and non-probability sampling methods were used. Self-administered questionnaires were used to collect quantitative data from learners and teachers, while in-depth face-to-face interviews were used to collect qualitative data from parents. Quantitative data was analysed using Statistical Package for the Social Sciences version 23. Qualitative data was analysed using Techs’ technique. Reliability and validity as well as trustworthiness were ensured. Ethical principles were adhered to throughout the study. Results indicated that (63%; n=69) learners were sexually active lacked knowledge about contraception (80%; n=40), STIs (38%; n=32) and (33%; n=37) had been pregnant and the mean age was 17. Eighty six (86%; n= 97) reported inaccessibility to sexual and reproductive health services. About (55%, n= 19) teachers were found to be inadequately trained and lacked training manuals. Most teachers reflected ineffectiveness of the existing programmes as evidenced by high pregnancy rates. Parents reflected difficulty in communicating sexual and reproductive health issues with teenagers and lack of knowledge, thus indicating the importance of the programme in schools. Parents also indicated the relevancy of teachers in facilitating the programme and collaboration between the Department of Education and the Department of Health. Dickoff’s six elements of the survey list was used to develop the programme. Programme validation was done by involving participants to evaluate it by completing questionnaires. The programme will empower learners to deal with sexual and reproductive health issues, resulting in decreased teenage pregnancy and other sexual risks. Collaboration and support were the recommendations directed to both the Department of Education and the Department of Health. Further research was also recommended. / NRF

Polycystic Ovarian Syndrome is the one of the leading causes of infertility among women who are of child-bearing age. The syndrome’s vast range of phenotypes has made it challenging for researchers to not only consistently diagnose but also discover a cure. Currently, there are several proposed treatments being looked into, however, much of the research focuses on employing promising biomarkers, micro ribonucleic acids (miRNAs), that can potentially aid in diagnosis. The four prominent locations of research for these biomarkers include: ovarian tissues specifically looking into granulosa cells (GC), adipose tissue, follicular fluid, and the serum. My goal is to determine which of these areas holds the most promise to diagnose this syndrome in the years to come. This study reviewed a large collection of the current polycystic ovarian syndrome literature evaluating both reported miRNAs and how viable those would be as potential biomarkers to use for the future. The data showed that a majority of these promising biomarkers were found in granulosa cells, adipose tissue, and follicular fluid. Although there were miRNAs that were deemed promising in the serum, research is still far from conclusive in using these miRNAs as biomarkers for diagnosis of polycystic ovarian syndrome. By comparing the miRNAs selected from each type of location, I was able to conclude that miR-21, miR-93, miR-223, and miR-let-7b hold the most promise for the potential to become biomarkers for polycystic ovarian syndrome in the near future. Currently, there is a lot of research particularly surrounding these miRNAs and how they were shown to have been expressed in statistically significant levels among women with the syndrome. However, because of their complexity, miRNAs do not regulate one single pathway, it is hard to describe a mechanism that explains the pathophysiology of the syndrome. I believe we are still far away from successfully zooming in on one biomarker. By determining the most potential biomarker(s), we can focus resources and efforts towards finding a better diagnostic tool for this syndrome.

At the Quillen College of Medicine, first year medical students are taught how to perform the female pelvic exam as part of the “Introduction to Physical Exam” course. Our previous research has found that students feel more confident and report a higher level of perceived transferability to live patients when learning the pelvic exam on soft-embalmed donors in comparison to low-fidelity mannequins. Our goal in this project was to incorporate soft-embalmed donors into the curriculum of first year medical students, making this teaching method available to all students, and objectively assess their skills as well as their retention. During the “Introduction to Physical Exam” course, high fidelity soft embalmed donors were available for students to practice the female pelvic exam with instruction from attending physicians. After learning exam techniques, all 67 students were given a survey to assess their confidence, perceived transferability, and preference for either soft embalmed donors or mannequins. They were also invited back the following week to assess their short term retention and ability to accurately perform the pelvic exam, with the option of using communication skills learned elsewhere in the ETSU curriculum. Thirteen students returned for this follow-up session and completed surveys to reassess their experience. We plan to follow this cohort of students throughout their medical school career to assess long term retention. All return participants felt they retained the pelvic exam knowledge learned the week prior, with 61.54% agreeing, and 38.46% strongly agreeing. Most felt prepared to now do a pelvic exam on a live patient (53.85% agreed, 38.46% strongly agreed). Students also reported that feedback on their communication and procedural skills was beneficial to the learning process. The use of high fidelity soft embalmed donors in medical education provides students with a realistic model to learn and become confident in performing pelvic exams. We have seen that this education model helps them retain their knowledge on pelvic exam technique. We look forward to following this cohort of students to see if this retention of knowledge persists into their third year of medical school.

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Collecting and aggregating timely and rigorous data for sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) services and outcomes evaluation in humanitarian settings is essential for accountability and transparency. However, reliable SRMCNAH data are scarce in such settings, and the quality of available data often varies across different humanitarian settings. Establishing a core set of SRMNCAH indicators that are feasible to collect in all humanitarian settings is the first step in developing and implementing a common core framework for monitoring SRMNCAH programs in such settings. Led by the World Health Organization, in 2018 a group of global experts in the SRMNCAH field proposed a core list of indicators for inclusion in routine data collection systems. In 2019-2022, a team at the University of Ottawa in partnership with local investigators led multi-method feasibility assessments in Afghanistan, Bangladesh, the Democratic Republic of Congo, and Jordan to understand the feasibility, relevance, and acceptability of the proposed core indictors. In this thesis I report on the results from the multi-methods assessment in Afghanistan. Based on a desk review, key informant interviews, facility assessments, facility observation sessions, and focus group discussions in three provinces, we explored national stakeholders’ perspectives on SRMNCAH data collection, in general, and the proposed indicator list, in particular. The findings of this assessment and the results from the other three countries will help stakeholders reach a consensus on the final list of SRMNCAH indicators that are feasible for collection in all humanitarian settings.