A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public
Health in the field of Hospital Management
APRIL 2014 / Background: The South African Department of Health stipulated that district hospitals
must provide comprehensive package of preventive, promotive, curative and
rehabilitative reproductive health services for women that requires medical and special
resources, not found in the health centres and clinics (Department of Health, 2002).
The Evander District (ED) Hospital, a district hospital situated in the Govan Mbeki Subdistrict
in the Mpumalanga Province provides both in-patient (36 beds in maternity unit
and four nursery beds) and outpatient services. The Hospital Maternity Unit has
recently been criticised by the Mpumalanga Department of Health for high rate of CS
(30%), and perinatal mortality rate (40 per 1000). But, the Hospital never analysed the
data collected routinely to develop an understanding of the challenges faced by the
Unit. The Unit staff complained about inadequate resources as one of the reasons. The
Hospital has introduced a Cost centre in the Maternity Unit for efficient management of
resource allocation for the Unit. This study analysed the routinely collected data from
the Hospital Information System and Maternity Unit Cost centre for assessing the
maternity services currently rendered by the Evander District Hospital.
Aim: To described the deliveries at the Evander Hospital over a period of 6 months from
01st January 2011 to 30th June 2011.
Methodology: It was a cross sectional study that reviewed the records from Hospital
Information System (all antenatal cards and Obstetric files of the women who delivered
at the labour ward during the study period) and Maternity Unit cost center. The variables
used for the study included number and type of deliveries, socio-demographic and
clinical profiles of patients, maternal and perinatal complications and outcomes. In
addition, costing information collected during the same period. Descriptive and
inferential statistics were used for analysis. Permissions were obtained from the
Mpumalanga Department of Health and University of the Witwatersrand ‘Human
Research Ethics Committee (Medical) before commencement of the study.
Results: A total of 1,081 deliveries were performed at the Evander Hospital over sixmonth
period. The highest number of deliveries was NVD (67.44%), followed by
caesarean sections (31.82%).
The majority of the women who delivered came from poor socio-economic class and
mostly single and black, which is a reflection of the characteristics of the catchment
population of the Evander Hospital. Teenage pregnancy rate was quite high (20%). The
majority of the subjects were primipara (41%). Although most of them (91.3%) of them
were booked, only 14% had stipulated number of antenatal visits (4 or more visits) and
7.4% of booked mothers, did not have booking blood results, which was a missed
opportunity. HIV was the most prevalent (33, 31.3%) medical conditions, which is
similar to the HIV prevalence reported in antenatal sero-prevalence survey in South
Africa. Only 17% had planned and scheduled CS. Very few patients had post-partum
complications indicating well managed third stage of labour. There was no maternal
death during this period. All patients were discharged home.
More than 17% (n=185) subjects had low birth weight babies (less than 2500 g), which
is just above national average of 16%. The median Apgar score among children
delivered at Evander Hospital was 9. Interestingly, the Apgar scores of babies of
subjects who had operative deliveries were significantly lower than those who had nonoperative
deliveries. Most of the babies were born alive. Stillbirth rate (7 per 1000 live
births) was significantly lower than South African national average 17.8 per 1000 live
births.
The total medical cost for the maternity ward for the six months studied amounted to R
4,584,466, the average monthly cost being R 76,407.67. The most expensive items
were drugs and pharmaceuticals and least expensive being the medical consumables.
Conclusion: This study was the first of its kind to be done in this Hospital and the
Health District. The study identified gaps where management of pregnant women in the
Evander Hospital could be further improved through improved booking, planned
deliveries and thereby reducing low birth weight rates and still birth rate. This would
assist the Hospital Management to develop appropriate measures to reduce
unnecessary CS being done, NVD being delivered in the hospital rather than using
CHC, and strengthening referral system and strategies to reduce HIV and AIDS
incidence. In addition, further study is necessary at the PHC facilities in the Sub-district
to identify determinants for high rate of teenage pregnancy.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/15275 |
| Date | January 2014 |
| Creators | Hlatywayo, Nanana Glory |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf, application/pdf |
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