Midwives' experiences regarding the utilization of partographs in a Namibian Regional Hospital
- Authors: Fernandes, Diina
- Date: 2015
- Subjects: Midwifery -- Namibia , Labor (Obstetrics) -- Namibia
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10071 , http://hdl.handle.net/10948/d1021158
- Description: Labour has been characterized as the most dangerous journey a woman undertakes. The reason being, that although it is a natural process, many labouring women suffer complications during labour and childbirth including prolonged or obstructed labour. These complications can result in maternal and infant morbidity and mortality. The partograph is a monitoring tool that can provide a continuous pictorial overview and is essential to monitor and manage labour. It is recommended by the WHO for use universally by midwives while monitoring labour. However partographs are poorly utilized and most parameters on the partograph are not monitored and findings after reviewing a labouring woman are not documented on the partograph. It is unclear how midwives working in Namibian Health services experience and utilize the partograph during the monitoring of a woman in labour. These may be the factors that hinder the effective utilization of the partograph. The objective of this study was to explore and describe the experiences of midwives regarding the utilization of the partograph for monitoring a labouring woman in a Namibian regional hospital in order to develop guidelines based on the findings to improve the use of the partograph by midwives in order to improve the management of labour. The research design was qualitative, descriptive, explorative and contextual in nature. The research population consisted of midwives working in a regional hospital in Namibia. A purposive and convenient sampling method was used to select participants. Specific inclusion criteria were met and consent was obtained from the participants and from the Regional Health Directorate Management of the hospital where the research was conducted. Interviews were conducted by an independent interviewer within the Department of Health to ensure an unbiased viewpoint. Data were collected by means of semi-structured in depth interviews with a guide, using an audio tape recorder. Field notes were used to record non- verbal communication. As soon as data were saturated, the interviews were stopped. They were then transcribed, verbatim and analysed using the Tesch’s approach as described in (Creswell, 2009:186). The service of an independent coder was utilized to ensure trustworthiness. Trustworthiness was further ensured by using the strategies suggested by Lincoln and Guba’s model, namely credibility, transferability, dependability and confirmability. Ethical considerations were honoured throughout by adhering to ethical principles during the study. These included ensuring that the participants` rights were respected, they were not harmed and fairness were ensured. On completion of the data analysis a literature control was conducted and existing literature was compared to the findings in order to identify similarities and differences and to verify whether the literature supported the findings. Four main themes that emerged during data analysis are: Theme 1.Midwives found it a positive experience to use the partograph when caring for a woman in labour. Theme 2. When a midwife experienced problems in using the partograph, it may lead to detrimental outcomes. Theme 3. Utilizing the partograph evoked differing emotions in midwives. Theme 4. Midwives` knowledge and skills in the utilization of the partograph should be updated regularly. By describing the lived experienced of midwives in the maternity ward on the use of the partograph, the midwives had a positive attitude to using the partograph, but they also found it difficult to utilize the instrument as was directed by the (WHO) due to challenges experienced such as: unrealistic staff/patient ratio, shortage of staff, time consuming, insufficient knowledge and skills among midwives and lack of appropriate equipment. There is a specific need to prevent further negative emotions by addressing the challenges experienced. Based on the findings, guidelines for partograph utilization which aimed at improving the midwifery care were developed. Recommendations were made regarding midwifery education, clinical midwifery care and midwifery research.
- Full Text:
- Date Issued: 2015
- Authors: Fernandes, Diina
- Date: 2015
- Subjects: Midwifery -- Namibia , Labor (Obstetrics) -- Namibia
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10071 , http://hdl.handle.net/10948/d1021158
- Description: Labour has been characterized as the most dangerous journey a woman undertakes. The reason being, that although it is a natural process, many labouring women suffer complications during labour and childbirth including prolonged or obstructed labour. These complications can result in maternal and infant morbidity and mortality. The partograph is a monitoring tool that can provide a continuous pictorial overview and is essential to monitor and manage labour. It is recommended by the WHO for use universally by midwives while monitoring labour. However partographs are poorly utilized and most parameters on the partograph are not monitored and findings after reviewing a labouring woman are not documented on the partograph. It is unclear how midwives working in Namibian Health services experience and utilize the partograph during the monitoring of a woman in labour. These may be the factors that hinder the effective utilization of the partograph. The objective of this study was to explore and describe the experiences of midwives regarding the utilization of the partograph for monitoring a labouring woman in a Namibian regional hospital in order to develop guidelines based on the findings to improve the use of the partograph by midwives in order to improve the management of labour. The research design was qualitative, descriptive, explorative and contextual in nature. The research population consisted of midwives working in a regional hospital in Namibia. A purposive and convenient sampling method was used to select participants. Specific inclusion criteria were met and consent was obtained from the participants and from the Regional Health Directorate Management of the hospital where the research was conducted. Interviews were conducted by an independent interviewer within the Department of Health to ensure an unbiased viewpoint. Data were collected by means of semi-structured in depth interviews with a guide, using an audio tape recorder. Field notes were used to record non- verbal communication. As soon as data were saturated, the interviews were stopped. They were then transcribed, verbatim and analysed using the Tesch’s approach as described in (Creswell, 2009:186). The service of an independent coder was utilized to ensure trustworthiness. Trustworthiness was further ensured by using the strategies suggested by Lincoln and Guba’s model, namely credibility, transferability, dependability and confirmability. Ethical considerations were honoured throughout by adhering to ethical principles during the study. These included ensuring that the participants` rights were respected, they were not harmed and fairness were ensured. On completion of the data analysis a literature control was conducted and existing literature was compared to the findings in order to identify similarities and differences and to verify whether the literature supported the findings. Four main themes that emerged during data analysis are: Theme 1.Midwives found it a positive experience to use the partograph when caring for a woman in labour. Theme 2. When a midwife experienced problems in using the partograph, it may lead to detrimental outcomes. Theme 3. Utilizing the partograph evoked differing emotions in midwives. Theme 4. Midwives` knowledge and skills in the utilization of the partograph should be updated regularly. By describing the lived experienced of midwives in the maternity ward on the use of the partograph, the midwives had a positive attitude to using the partograph, but they also found it difficult to utilize the instrument as was directed by the (WHO) due to challenges experienced such as: unrealistic staff/patient ratio, shortage of staff, time consuming, insufficient knowledge and skills among midwives and lack of appropriate equipment. There is a specific need to prevent further negative emotions by addressing the challenges experienced. Based on the findings, guidelines for partograph utilization which aimed at improving the midwifery care were developed. Recommendations were made regarding midwifery education, clinical midwifery care and midwifery research.
- Full Text:
- Date Issued: 2015
The effects of salinity and inundation on salt marsh plants in the context of climate change
- Authors: Tabot, Pascal Tabi
- Date: 2012
- Subjects: Salt marsh plants -- Climatic factors , Plant ecophysiology
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:10637 , http://hdl.handle.net/10948/d1019919
- Description: Ecophysiology studies are needed to predict plant responses in relation to climate change. Variations in salinity and inundation are expected to influence the survival and distribution of salt marsh. The following species were chosen to study as they occur in most South African salt marshes and are representative of different tidal ranges; namely Triglochin buchenaui (lower intertidal), Bassia diffusa (upper intertidal succulent) and Limonium linifolium (upper intertidal non-succulent). To simulate climate change conditions as predicted for South Africa, a 3 x 5 controlled experiment of three inundation levels (tidal, submerged and drought) and five salinity levels (0, 8, 18, 35, 45 ppt) was conducted for each species. This resulted in 15 treatments per species. Plant responses were measured over a three month period. Triglochin buchenaui showed significant variation in height (7.57 ± 0.5 to 29 ± 1.55 cm, p < 0.005, DF = 55) with optimum growth at 0 ppt under tidal conditions; leaf area increments and relative growth rates which decreased with increasing salinity under all inundation states. There was almost a cessation of growth under submergence which reduces the plant’s regeneration potential under these conditions. Proline accumulation (1.84 ± 0.23 to 3.36 ± 0.38 mg l-1), response of photosynthetic pigments and electrolyte leakage (8.17 ± 0.80 to 38.36 ± 7.42 percent) were fundamental to osmotic and membrane response regulation. Plants survived in all inundation states at salinity up to 45 ppt, but the optimum range was 0 to 18 ppt, and best water state was the tidal condition. Viable rhizomes were produced under drought conditions. Bassia diffusa (Thunb.) Kuntze plants under submergence died within one month, irrespective of the salinity. Optimum growth occurred in plants of the tidal treatment at 18 ppt, and reduced with increased salinity and drought conditions. Plants in the tidal treatments were more succulent than the drought-treated plants. There was reduced leaf mass and high anthocyanin concentrations in drought-treated plants and these effects increased with salinity. Soil and leaf water potential were positively correlated with anthocyanin concentration in leaves and stems, suggesting anthocyanin accumulated in response to drought and could be an adaptation to lower the plant’s water potential under drought conditions. A shift of anthocyanin from leaves to stems was found in drought-treated plants, and this possibly enables the maximization of photosynthesis in leaves, to complement its role in osmotic balance and photo-protection. Growth of Limonium linifolium showed that the plant was tolerant to a wide range of salinity under both tidal and drought conditions, but was susceptible to complete submergence, with high membrane damage even in tidal-treated plants. Plants died within 2 weeks of complete submergence. Results further indicated that L. linifolium tolerates extreme drought by accumulating large quantities of proline and oxalic acid, which consequently lowers its water potential for uptake of soil water of high salinity. Excess salts were excreted through salt glands. This is an important adaptation for a plant that thrives in a highly variable saline habitat Further investigation of submergence effects on upper intertidal species using B. diffusa showed three key stages in the response. A drop in chlorophyll a+b within 6 hours (4.2 ± 0.2 to 2.4 ± 0.3 mg l-1) with a corresponding increase in carotenoid concentration (0.6 ± 0.1 mg l-1) indicated an immediate response to submergence. Oxalic acid concentration was highest on Day 4 (13.6 mM) as opposed to control levels, indicative of its role in submergence tolerance, thus Day 4 may be the peak of positive acclimation. The third phase was marked by a sharp increase in electrolyte leakage to 47.5 ± 2.6 percent on Day 10, from 9.4 ± 1.4 percent on Day 7, with a corresponding decrease in total dissolved solutes between Days 7 and 10. Results suggest that oxalic acid accumulates under submergence possibly as a stabilizing osmolyte. The threshold for tolerance of the species under submergence is 7 days with membrane damage thereafter. Bassia diffusa would not survive prolonged submergence (> 7 days) but could survive submergence of short duration (< 7 days) through continuous underwater photosynthesis, accumulation of osmolytes such as oxalic acid and carotenoid, and maintenance of relative water content and succulence within control levels. When considered together, results showed that the two upper intertidal species were sensitive to waterlogging and would not survive complete submergence, whereas the lower intertidal species could in addition to its natural range, thrive in conditions typical of the upper intertidal range, namely prolonged dry conditions and high sediment salinity. These results have important implications for the future management of salt marshes under predicted climate change conditions. In permanently open South African estuaries, a landward migration of salt marsh will be possible if coastal squeeze is limited and the rate of landward recruitment is on par with sea level rise. In this case salt marsh species would retain their current zonation while shifting inland. Increased sea storms and saltwater intrusion could lead to high salinity concentration in the sediment and significantly reduce growth of salt-sensitive plants. In estuaries that are temporarily open to the sea, reduced freshwater inflow will result in an increase in mouth closure, high water levels, prolonged submergence, and consequently die back of salt marsh vegetation. On the other hand increased abstraction and drought would result in low water levels and high sediment salinity which would decrease growth and survival of salt marsh. This research has provided new knowledge on the ecophysiology of salt marsh plants which can be used to predict the responses of plants to climate change.
- Full Text:
- Date Issued: 2012
- Authors: Tabot, Pascal Tabi
- Date: 2012
- Subjects: Salt marsh plants -- Climatic factors , Plant ecophysiology
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:10637 , http://hdl.handle.net/10948/d1019919
- Description: Ecophysiology studies are needed to predict plant responses in relation to climate change. Variations in salinity and inundation are expected to influence the survival and distribution of salt marsh. The following species were chosen to study as they occur in most South African salt marshes and are representative of different tidal ranges; namely Triglochin buchenaui (lower intertidal), Bassia diffusa (upper intertidal succulent) and Limonium linifolium (upper intertidal non-succulent). To simulate climate change conditions as predicted for South Africa, a 3 x 5 controlled experiment of three inundation levels (tidal, submerged and drought) and five salinity levels (0, 8, 18, 35, 45 ppt) was conducted for each species. This resulted in 15 treatments per species. Plant responses were measured over a three month period. Triglochin buchenaui showed significant variation in height (7.57 ± 0.5 to 29 ± 1.55 cm, p < 0.005, DF = 55) with optimum growth at 0 ppt under tidal conditions; leaf area increments and relative growth rates which decreased with increasing salinity under all inundation states. There was almost a cessation of growth under submergence which reduces the plant’s regeneration potential under these conditions. Proline accumulation (1.84 ± 0.23 to 3.36 ± 0.38 mg l-1), response of photosynthetic pigments and electrolyte leakage (8.17 ± 0.80 to 38.36 ± 7.42 percent) were fundamental to osmotic and membrane response regulation. Plants survived in all inundation states at salinity up to 45 ppt, but the optimum range was 0 to 18 ppt, and best water state was the tidal condition. Viable rhizomes were produced under drought conditions. Bassia diffusa (Thunb.) Kuntze plants under submergence died within one month, irrespective of the salinity. Optimum growth occurred in plants of the tidal treatment at 18 ppt, and reduced with increased salinity and drought conditions. Plants in the tidal treatments were more succulent than the drought-treated plants. There was reduced leaf mass and high anthocyanin concentrations in drought-treated plants and these effects increased with salinity. Soil and leaf water potential were positively correlated with anthocyanin concentration in leaves and stems, suggesting anthocyanin accumulated in response to drought and could be an adaptation to lower the plant’s water potential under drought conditions. A shift of anthocyanin from leaves to stems was found in drought-treated plants, and this possibly enables the maximization of photosynthesis in leaves, to complement its role in osmotic balance and photo-protection. Growth of Limonium linifolium showed that the plant was tolerant to a wide range of salinity under both tidal and drought conditions, but was susceptible to complete submergence, with high membrane damage even in tidal-treated plants. Plants died within 2 weeks of complete submergence. Results further indicated that L. linifolium tolerates extreme drought by accumulating large quantities of proline and oxalic acid, which consequently lowers its water potential for uptake of soil water of high salinity. Excess salts were excreted through salt glands. This is an important adaptation for a plant that thrives in a highly variable saline habitat Further investigation of submergence effects on upper intertidal species using B. diffusa showed three key stages in the response. A drop in chlorophyll a+b within 6 hours (4.2 ± 0.2 to 2.4 ± 0.3 mg l-1) with a corresponding increase in carotenoid concentration (0.6 ± 0.1 mg l-1) indicated an immediate response to submergence. Oxalic acid concentration was highest on Day 4 (13.6 mM) as opposed to control levels, indicative of its role in submergence tolerance, thus Day 4 may be the peak of positive acclimation. The third phase was marked by a sharp increase in electrolyte leakage to 47.5 ± 2.6 percent on Day 10, from 9.4 ± 1.4 percent on Day 7, with a corresponding decrease in total dissolved solutes between Days 7 and 10. Results suggest that oxalic acid accumulates under submergence possibly as a stabilizing osmolyte. The threshold for tolerance of the species under submergence is 7 days with membrane damage thereafter. Bassia diffusa would not survive prolonged submergence (> 7 days) but could survive submergence of short duration (< 7 days) through continuous underwater photosynthesis, accumulation of osmolytes such as oxalic acid and carotenoid, and maintenance of relative water content and succulence within control levels. When considered together, results showed that the two upper intertidal species were sensitive to waterlogging and would not survive complete submergence, whereas the lower intertidal species could in addition to its natural range, thrive in conditions typical of the upper intertidal range, namely prolonged dry conditions and high sediment salinity. These results have important implications for the future management of salt marshes under predicted climate change conditions. In permanently open South African estuaries, a landward migration of salt marsh will be possible if coastal squeeze is limited and the rate of landward recruitment is on par with sea level rise. In this case salt marsh species would retain their current zonation while shifting inland. Increased sea storms and saltwater intrusion could lead to high salinity concentration in the sediment and significantly reduce growth of salt-sensitive plants. In estuaries that are temporarily open to the sea, reduced freshwater inflow will result in an increase in mouth closure, high water levels, prolonged submergence, and consequently die back of salt marsh vegetation. On the other hand increased abstraction and drought would result in low water levels and high sediment salinity which would decrease growth and survival of salt marsh. This research has provided new knowledge on the ecophysiology of salt marsh plants which can be used to predict the responses of plants to climate change.
- Full Text:
- Date Issued: 2012
A study of current and potential future commuter transportation requirements in Kagiso township
- Authors: Lefutso, David
- Date: 2005
- Subjects: Commuters -- South Africa -- Gauteng Urban transportation -- South Africa -- Gauteng Urban transportation -- South Africa -- Gauteng -- Planning
- Language: English
- Type: Thesis , Masters , MBA
- Identifier: vital:765 , http://hdl.handle.net/10962/d1003886
- Description: This study is intended to unpack the current and potential future commuter transport requirements in Kagiso Township within the context of transport planning and the ongoing transformation of the transport sector in South Africa. In order to meet the above challenges, it was felt that an investigation of the socio-economic profile of transport users in Kagiso Township was required, which would be indicative of potential needs and requirements in terms of current and future travel infrastructure. This study is significant, as it considers the impact of socio-economic factors and transport interactions by fully examining the impact of accessibility, urban development patterns, local mobility and planning. Mogale City’s Kagiso Township was selected for in-depth study because it has seen one of the highest urbanization rates in Gauteng Province, with people from all over Gauteng relocating to this suburb, either buying relatively moderately priced housing via mortgaging or, alternatively, trying to gain access to government low-cost housing. The study investigates the connection between socio-economic characteristics of a local population (inter alia, age, gender, household size, and vehicles per household, employment status and income) and their transport requirements (travel demand forecasting), within an urban transport context. Socio-economic characteristics of a population are important in transport demand forecasting because there is a general belief in transport planning that the predisposition to travel and trip generation vary with the characteristics of the traveller. A travel demand forecasting model by Bussière and Rice (1999) is used for the purposes of simulating existing and future travel patterns. The forecasted household mobility and needs of commuters in Kagiso Township are compared with current municipal plans to see whether such plans are realistic and can address existing needs. The evaluation of the current municipal plans is included to test the responsiveness of public policy and practice towards the needs of the affected local community. This evaluation extracted information on whether the relevant municipality has identified the problems and issues affecting the local community of Kagiso Township. In addition, it assessed whether the municipality has identified possible solutions to these problems and issues and whether it has prioritised any projects to improve transportation in Kagiso Township.
- Full Text:
- Date Issued: 2005
- Authors: Lefutso, David
- Date: 2005
- Subjects: Commuters -- South Africa -- Gauteng Urban transportation -- South Africa -- Gauteng Urban transportation -- South Africa -- Gauteng -- Planning
- Language: English
- Type: Thesis , Masters , MBA
- Identifier: vital:765 , http://hdl.handle.net/10962/d1003886
- Description: This study is intended to unpack the current and potential future commuter transport requirements in Kagiso Township within the context of transport planning and the ongoing transformation of the transport sector in South Africa. In order to meet the above challenges, it was felt that an investigation of the socio-economic profile of transport users in Kagiso Township was required, which would be indicative of potential needs and requirements in terms of current and future travel infrastructure. This study is significant, as it considers the impact of socio-economic factors and transport interactions by fully examining the impact of accessibility, urban development patterns, local mobility and planning. Mogale City’s Kagiso Township was selected for in-depth study because it has seen one of the highest urbanization rates in Gauteng Province, with people from all over Gauteng relocating to this suburb, either buying relatively moderately priced housing via mortgaging or, alternatively, trying to gain access to government low-cost housing. The study investigates the connection between socio-economic characteristics of a local population (inter alia, age, gender, household size, and vehicles per household, employment status and income) and their transport requirements (travel demand forecasting), within an urban transport context. Socio-economic characteristics of a population are important in transport demand forecasting because there is a general belief in transport planning that the predisposition to travel and trip generation vary with the characteristics of the traveller. A travel demand forecasting model by Bussière and Rice (1999) is used for the purposes of simulating existing and future travel patterns. The forecasted household mobility and needs of commuters in Kagiso Township are compared with current municipal plans to see whether such plans are realistic and can address existing needs. The evaluation of the current municipal plans is included to test the responsiveness of public policy and practice towards the needs of the affected local community. This evaluation extracted information on whether the relevant municipality has identified the problems and issues affecting the local community of Kagiso Township. In addition, it assessed whether the municipality has identified possible solutions to these problems and issues and whether it has prioritised any projects to improve transportation in Kagiso Township.
- Full Text:
- Date Issued: 2005
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