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
July, 2014 / BACKGROUND: The World Health Organization (WHO) has acknowledged the
importance of maternal care and listed it as part of its Millennium Development
Goals (MDGs). The 5th goal is focused on improving maternal health by reducing
the maternal mortality rate by 75% by 2015. South Africa has aligned itself with
the MDGs. The Gauteng Department of Health and Social Development has also
embraced the MDGs and decided to improve its maternal health services. It has
decided to target Intra-partum period for interventions to improve maternal health
because intra-partum period is associated with a high rate of perinatal death from
intra-partum hypoxia (4.8 per 1000 births) (National Department of Health, 2000),
as well as a significant number of maternal death (8.7%) (NCCEMD, 2007). This
study was planned to systematically study the clinical procedure performed
during the intra-partum period at the Heidelberg Hospital (a semi - rural district
hospital in the Lesedi Sub – district of Sedibeng District in Gauteng Province).
AIM: To describe the clinical procedures and factors related to these procedures
and maternal and neonatal health outcomes for the mothers admitted and
delivered in the Maternity unit at Heidelberg hospital during one year period (1st
April 2010 to 31st March 2011)
METHODOLOGY: The setting of this study was the Maternity unit of the
Heidelberg Hospital. A cross sectional study design was used based on
retrospective review of routinely collected data for 12 months (2010 April 1st to
2011 March 31st). No intervention was done as a part of this study. The study
variables included different clinical procedures (such as normal vaginal delivery,
assisted vaginal delivery, caesarean section, evacuation of uterus, caesarean
hysterectomy), socio-demographic profile of patients (such as age, gender,
ethnicity, medical aid), clinical profile (such antenatal diseases, booking status,
intra-partum complications, postpartum complications) and maternal and
perinatal outcomes.
RESULTS: The study found highest number of deliveries (78.6%) were normal
vertex deliveries and a very few (1%) assisted and breech deliveries. The
caesarean section rate was high (20.4%) as compared to the normal national
target (12, 5%). Fetal distress and CPD was the main indications for caesarean
section. The majority of women who delivered at Heidelberg Hospital maternity
came from poor socio-economic class, mostly single, teenagers, and
unemployed. They were the most vulnerable group in the Society.
The majority of women were booked and referred from PHC clinic where they
were booked for antenatal check-up. Pregnancy induced hypertension was the
commonest obstetric problem encountered during antenatal period. Most women
who delivered at Heidelberg hospital during the period were discharged without
complications, no maternal deaths were reported. There were 8.1% preterm
deliveries but a relatively high still birth rate which is of concern.
CONCLUSION: The study was the first of its kind to be done at Heidelberg
Hospital and the Sedibeng Health District. The study systematically analysed
routinely collected data and identified high risk patients, who would require
special attention. This study would hopefully assist the Hospital Management to
realise the high rate of CS and to develop appropriate measures to reduce
unnecessary C/S being done, and to strengthen referral systems. In addition,
further study is necessary at clinic level in the sub-district to identify work-loads in
the feeder clinics.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/17337 |
| Date | 26 March 2015 |
| Creators | Msiza, Lydia Lebohang Perseverance |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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