A systematic review and document analysis on the prevention of mother-to-child programmes to prevent vertical transmission of human immuno-deficiency virus
- Authors: Sobetwa, Nwabisa Nokuzola
- Date: 2017
- Subjects: AIDS (Disease) in pregnancy , Maternal health services , HIV infections -- Children -- Transmission -- Prevention
- Language: English
- Type: Thesis , Masters , MSoc
- Identifier: http://hdl.handle.net/10353/7957 , vital:31282
- Description: Background: The National Strategic Plan 2012-2016 is advocating for zero new infections due to vertical transmission. This goal has not yet been achieved. This study evaluated whether the prevention of mother-to-child vertical transmission (PMTCT) of Human Immuno-deficiency Virus (HIV) programmes in South Africa are based on evidence. Aim: The aim of this study was to conduct a systematic review of the available literature comparing PMTCT antiretroviral regimens published between the years 2000 to 2015 and to do a document analysis of the current implemented PMTCT programme to evaluate if it is based on best evidence. Rational: The rational of the systematic review and the document analysis were to assess whether the latest PMTCT policy was based on evidence and to critically analyse published articles that addressed aspects related to efficacy and efficiency of PMTCT programmes to reduce transmission of HIV from mothers to their infants. Methods: Overall 25 randomised controlled trials and primary studies that assessed efficacy of ARV regimens to prevent mother-to-child transmission of the HIV during pregnancy, labour and the postnatal periods were systematically reviewed. In 1997 the first trial began and the last one ended in 2012. Twelve guidelines referring to PMTCT were sampled and they were published by WHO and Department of Health South Africa from 2001 to 2015. The document analysis was only based on National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults April, 2015. Findings: The systematic review illustrated that significantly fewer infants tested HIV-positive when exposed to a longer ARV regime although there was no significant difference once the infants reached six months of age. Different ARVs have a similar Preamble effect on maternal deaths; however, a double or triple combination of ARVs is superior to monotherapy to decrease infant deaths. Common maternal adverse reactions to ARVs include anaemia, bronchopneumonia, and maculopapular rash. Infant adverse events included septicaemia, pneumonia, gastroenteritis, fever and maculopapular rash. The document analysis has shown that the PMTCT policy is mainly based on evidence from randomised controlled trials and systematic reviews. Occasionally some statements are still based on lower categories of evidence such as non-experimental descriptive studies. Conclusion: The systematic review showed that double and triple ARV therapy is superior to monotherapy and that the longer the mother and her infant are exposed to ARV therapy the better the results are to prevent MTCT. Adverse events are always posing a challenge and as with any other medication, caregivers must be aware of potential adverse reactions. The National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults April 2015 is based on evidence, but the policy itself does not include any reference to evidence.
- Full Text:
- Date Issued: 2017
Mothers' experiences with regards to caring for their neotates following a caesarean section delivery
- Authors: Jikijela, Thobeka Pretty
- Date: 2016
- Subjects: Cesarean section , Maternal health services , Newborn infants -- Care
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10948/7493 , vital:21788
- Description: The rate of caesarean section deliveries is increasing globally despite the World Health Organisation (WHO) recommendations not to exceed 15% of deliveries per year in each country. Furthermore, the commitment to baby-friendly hospital initiative puts a strain on mothers who must still take care of their neonates following a caesarean section delivery despite the pain experienced after surgery. It has been observed that pain management becomes a critical factor in the assistance of caesarean-section-delivered mothers in caring of their neonates otherwise mothers stay away from nursery or struggle with the neonate who is with her. The study aimed at exploring and describing the experiences of mothers with regard to caring for their neonates following a caesarean section delivery and developing objectives to: To explore experiences of mothers with regard to caring for their neonates following a caesarean section delivery and: To make recommendations to midwifery operational managers to assist mothers to cope better with caring of their neonates following a caesarean section delivery. The study used a qualitative, explorative, descriptive and contextual research design. Data was collected from eleven purposively selected mothers who had had a caesarean section delivery who were caring for their neonates in the post-natal wards in a public hospital in the Nelson Mandela Bay Municipal area. One-on-one, semi-structured interviews were conducted using a tape- recorder to capture them and writing of field notes to justify some of the themes or sub-themes identified. Data was analysed using data analysis method suggested by Creswell (2009:186). Trustworthiness was maintained through the standards of truth value, applicability, consistency and neutrality while ethical considerations were autonomy, beneficence and justice. From the findings it emerged that mothers had diverse experiences of pain following a caesarean section delivery. The mothers had also experienced physical limitations that hindered their ability to care for their neonates and themselves. Furthermore uncaring attitudes, shortage of staff and non-supportive services were experienced as contributing to mothers’ inability to breastfeed and taking care of themselves. Recommendations were for clinical nursing practice, nursing education and further research. Caesarean section delivery is painful and limiting to the mothers following surgery and demands extensive pain management and breastfeeding support. Managers need to address the contributing factors and develop strategies to assist the mothers cope better with pain.
- Full Text:
- Date Issued: 2016
Perceptions of private sector midwives and obstetricians regarding collaborative maternity
- Authors: Wibbelink, Margreet
- Date: 2014
- Subjects: Maternal health services , Maternal health care teams
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10067 , http://hdl.handle.net/10948/d1020979
- Description: The World Health Organization (WHO) states that no region in the world is justified in having a caesarean section rate greater than 10-15 percent, calculated as the number of caesarean deliveries over the total number of live births. There is however, an international increase in the rate of caesarean section deliveries and this is a concern to midwives. The increase is evident in South Africa as well. Currently the rate of caesarean section deliveries in the private sector can be as high as 70 percent per total number of live births per year. As a result, the public often perceives giving birth surgically in South Africa as ‘normal’ and ‘safer’ than vaginal delivery, even for low-risk pregnancies. The lack of involvement of midwives in the care of pregnant women in the private sector is indicated as one of the reasons related to the high caesarean section delivery rates. This motivated the researcher to undertake a study to explore and describe the perceptions of private sector midwives and obstetricians regarding the feasibility of collaboration in maternity care. A literature review to support the study identified research done previously regarding collaborative maternity care. The study followed a qualitative, exploratory, descriptive, contextual design. The research population included midwives and obstetricians in the private sector in the Eastern Cape. Non-probability, purposive sampling was used. The researcher conducted semi-structured one-to-one interviews to collect information rich data. The researcher ensured that the study was conducted in an ethical manner by adhering to ethical principles such as autonomy, non-maleficence, beneficence and justice. The interviews were transcribed and Creswell’s’ data analysis spiral was used as a guide for the data analysis. Themes and sub-themes were identified and grouped together to form new categories. An independent coder assisted with the coding process. Data analysis results revealed the following results Participants perceived a collaborative working relationship as being beneficial to maternity care. Participants identified that there might be critical impediments that need to be faced in order to realize collaborative maternity care. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness, which consists of the following four criteria namely credibility, transferability, dependability and conformability. The information obtained from this study assisted in developing guidelines to facilitate the implementation of collaborative maternity care between midwives and obstetricians in private practice in South Africa. The objective of the study was thus met.
- Full Text:
- Date Issued: 2014
The impact of HIV/AIDS on the delivery of maternal health care services of selected primary health care clinics of Peddie in the Eastern Cape Province
- Authors: Mangi, Nozuko Glenrose https://orcid.org/0000-0001-9158-8820
- Date: 2011
- Subjects: Maternal health services , Primary health care , HIV infections -- Africa
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/24576 , vital:63209
- Description: The aim of this descriptive study was to explore the impact of HIV/AIDS on the maternal health programme at selected Primary Health Care (PHC) clinics in the Peddie sub-district, in the Eastern Cape, South Africa. This study showed that the HIV/AIDS epidemic has had major influences on the rendering of maternal health services in this sub-district. An understanding of the impact of HIV/AIDS on the delivery of the maternal health programme in the Peddie Primary Health Clinics will potentially help the District Health Service office, as well as the clinic managers and professional nurses to formulate strategies to strengthen the maternal health programme. This data will also be helpful when developing plans to cope with the heavy work-load of the clinics offering maternal health services, and to address the attitudes and concerns of the professional nurses working in the PHC clinics in this area. Thirty professional nurses working at 10 clinics responded to the questionnaires which elicited questions pertaining to the impact of HIV/AIDS on the rendering of their services. As part of the data gathering procedures, standardised notice boards at the PHC clinics were used to document the services rendered. The numbers of ANC clients attended to each of the clinics per week were collected in routine attendance tick registers used in the clinics for recording and monitoring statistics in the maternal health programme. The data was analysed to examine the possible impact of HIV/AIDS on maternal health services rendered by registered nurses/midwives working in the PHC clinics. The registered nurses who responded to the questionnaires (Annexure H) made several suggestions. These included the following: (i) encouraged more training (11 nurses), (ii) addition of more staff members, (iii) to have specialized staff for management of maternal HIV. Because of the study limitations such as the sample size of 10 clinics with a total of 30 nurses who were studied, the study may not be generalised to the whole of the Eastern Cape Province. The study however did provide baseline information on the impact of HIV/AIDS on the maternal health programme. The study findings were that HIV/AIDS has had an impact on the delivery of the maternal health programme due to the extra services brought about by the response to the HIV/AIDS pandemic. This study will contribute to a better understanding of the impact of HIV/AIDS on the maternal health programme at the PHC level in Peddie. The research provided insight into issues that are crucial to the delivery of maternal health programmes in rural areas. , Thesis (MCur) -- Faculty of Science and Agriculture, 2011
- Full Text:
- Date Issued: 2011
Effectiveness of the basic antenatal care package in primary health care clinics
- Authors: Snyman, J S
- Date: 2007
- Subjects: Pregnant women -- Health and hygiene , Hospitals -- Maternity services -- South Africa -- Port Elizabeth -- Evaluation , Maternal health services
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10037 , http://hdl.handle.net/10948/728 , Pregnant women -- Health and hygiene , Hospitals -- Maternity services -- South Africa -- Port Elizabeth -- Evaluation , Maternal health services
- Description: Pregnancy challenges the health care system in a unique way in that it involves at least two individuals – the woman and the fetus. The death rates of both pregnant women (maternal mortality) and newborns (perinatal mortality) are often used to indicate the quality of care the health system is providing. In terms of maternal and perinatal outcomes South Africa scores poorly compared to other upper-middle income countries (Penn-Kekana & Blaauw, 2002:14). The high stillbirth rate compared to the neonatal death rate reflects poor quality of antenatal care. Maternal and perinatal mortality is recognised as a problem and as a priority for action in the Millennium Development Goals (Thieren & Beusenberg, 2005:11). The Saving Mothers (Pattinson, 2002: 37-135) and Saving Babies (Pattinson, 2004:4-35) reports describe the causes and avoidable factors of these deaths with recommendations on how to improve care. The quality of care during the antenatal period may impact on the health of the pregnant woman and the outcome of the pregnancy, in particular on the still birth rate. In primary health care services there are many factors which may impact on and influence the quality of antenatal care. For example with the implementation of the comprehensive primary health care services package (Department of Health, 2001a:21-35) changes at clinic level resulted in a large number of primary health care professional nurses having to provide antenatal care, who previously may only have worked with one aspect of the primary health care package such as minor ailments or childcare. Because skills of midwifery or antenatal care, had not been practiced by some of these professional nurses, perhaps since completion of basic training, their level of competence has declined, and they have not been exposed to new developments in the field of midwifery. The practice of primary health care nurses is also influenced by the impact of diseases not specifically related to pregnancy like HIV/AIDS and tuberculosis. The principles of quality antenatal care are known (Chalmers et al. 2001:203) but despite the knowledge about these principles the maternal and perinatal mortality remains high. The Basic Antenatal Care quality improvement package is designed to assist clinical management and decision making in antenatal care. The implementation of the BANC package may influence the quality of antenatal care positively, which in turn may impact on the outcome of pregnancy for the mother and her baby. The aim of this study was to evaluate the effectiveness of the Basic antenatal care (BANC) package to improve the quality of antenatal care at primary health care clinics.
- Full Text:
- Date Issued: 2007
Postnatal women's experiences of the prevention of mother-to-child transmittion of HIV programme
- Authors: Links, Nomvuyiseko
- Date: 2007
- Subjects: AIDS (Disease) in pregnancy -- South Africa , HIV infections -- Children -- Transmission -- Prevention , Children -- Diseases -- Prevention , HIV infections -- Transmission , Maternal health services
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10042 , http://hdl.handle.net/10948/545 , http://hdl.handle.net/10948/d1011704 , AIDS (Disease) in pregnancy -- South Africa , HIV infections -- Children -- Transmission -- Prevention , Children -- Diseases -- Prevention , HIV infections -- Transmission , Maternal health services
- Description: This research study endeavoured to explore and describe the experiences of women who participated in the Prevention of Mother-To-Child Transmission (PMTCT) of HIV Programme. Data relating to evaluation of the PMTCT Programme in the piloted sites compiled by other researchers in the Department of Health focus on the process, progress and extent of service implementation. There appears to be a dearth of information available from women participants in the PMTCT Programme. The objectives of the study were to: · Explore and describe postnatal women’s experiences of the PMTCT Programme offered in the East London Hospital Complex. · Propose recommendations into the existing guidelines for midwives who implement the PMTCT Programme in the health services to ensure optimal implementation of this programme. The research population included postnatal women who participated in the PMTCT of HIV Programme at the East London Hospital Complex (Frere site). Permission to conduct the research was obtained from the Eastern Cape Department of Health Ethics Committee, Chief Executive Officer of the hospital complex and the Advanced Degrees Committee and Human Ethics Committee at the Nelson Mandela Metropolitan University. The research study was qualitative, exploratory, descriptive and contextual in design. Data collection was carried out by face-to-face semi-structured interviews with postnatal women at the East London Hospital Complex (Frere site). The tape-recorded interviews were transcribed verbatim with the aid of field notes. Data analysis was done according to Tesch’s method of data analysis (in De Vos et al, 2000:343). Themes were identified from the transcriptions and finalised after consensus discussions with an independent coder who was experienced in qualitative research. Literature control, guided by the themes identified in the interviews, was carried out to compare and verify the findings of the study. Three major themes with sub-themes were identified during data analysis. The major themes were identified as follows: · The participants expressed feelings of being devastated by the results that confirmed their HIV positive status. · The participants expressed a thirst for knowledge on how to live with the diagnosis and on how to continue with the PMTCT Programme. · The physical environment where counselling and testing were done, as well as the practical arrangements, were not conducive to the full implementation of the PMTCT Programme at the antenatal clinic. Conclusions were drawn and recommendations were made in the form of additional guidelines for midwives implementing the PMTCT Programme in the antenatal clinic health services. Guidelines for further midwifery-related research were formulated.
- Full Text:
- Date Issued: 2007