Browsing by Author "Steyn, Petrus S"

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    Open Access
    Effects of a short interpregnancy interval on pregnancy outcomes
    (2017) Kisuule, Castro; van der Spuy, Zephne Margaret; Steyn, Petrus S; Petro, Gregory
    The interval between one pregnancy and the next may affect the outcome of pregnancy. Both short and long interpregnancy intervals (IPI) have been associated with adverse pregnancy outcomes and most of these occur with a short IPI. Our primary objective was to determine the effects of a short IPI (< 24 months) compared with a long IPI (≥ 24 months) on the subsequent potentially viable pregnancy in women who received antenatal care (ANC) in the secondary level hospitals in the Metro-West area of Cape Town. The secondary objective was to review possible determinants of a short IPI. Methods: This was a pilot descriptive cross-sectional study conducted between 1st September 2016 and 28th November 2016. One hundred and thirty women who were Para 2 were recruited to the study in the early postnatal period. Sixty women were recruited into the short IPI group (<24 months) and 70 to the long IPI group (≥24months). Questionnaire-based interviews were conducted and data were entered using Microsoft Excel 2012 spread sheets. Statistical analysis was done using Stata® Edition 13. Results: We analysed the data for both short and long IPI and found that there were no significant differences in preterm birth, abruptio placentae, preterm prelabour rupture of membranes (PPROM) and low birth weight. There was however a significant difference in the number of small-for-gestational- age (SGA) babies. In the short IPI group, 19 women (31.7%) had SGA babies in comparison to the long IPI group where 7 women (10%) had SGA babies( p = 0.015). Of the 130 respondents, 79 women (60.8%) had unintended pregnancies, 44 (73%) with a short IPI vs 35 (50%) with a long IPI (p = 0.017). Women with a long IPI were more likely to have a different partner for the subsequent pregnancy (p= 0.002). Women in relationships longer than 5 years were more likely to have a long IPI (p = 0.049). Thirty-eight women (63.3%) with a short IPI would have preferred the pregnancy later compared to 11 women (15.7%) with a long IPI (p<0.001). There were 27 (38%) women who supported themselves financially in the long IPI group compared with 8 (13%) with a short IPI (p=0.001). A long IPI was associated with more formal employment and professional careers compared to a short IPI (p= 0.002). In the long IPI group 10 women (7%) had professional positions compared with none in the short IPI group (p=0.002). There were no significant differences in breastfeeding duration, contraception use and knowledge, social habits, previous obstetric history, educational status or emotional support between the two groups. Conclusion: In our study, of all the pregnancy outcomes investigated, small-for-gestational age was the only clinical outcome significantly associated with a short IPI. There were differences in pregnancy intendedness, duration of relationships, financial support and employment between the two groups. The majority of women with a short IPI (63.3%) would have preferred the index pregnancy to have occurred later.
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    Trends of utilisation of reproductive health services by lesbian women in Cape Town
    (2014) Archary, Paverson; Steyn, Petrus S
    Background: The Lesbian, Gay, Bisexual and Transgender (LGBT) community has historically been marginalised. Increased international awareness of the LGBT profile has led to the recognition that the medical profession has overlooked the health needs of lesbian women, with a resultant paucity of data regarding lesbian women’s health risks. International literature has shown that lesbians remain at risk of sexually transmitted infections and HIV; are at significant risk of mental health disorders; exhibit a high-risk profile for cardiovascular disease, diabetes, as well as cancer, and underutilise health care services due to experiences of homophobia. South African data is almost non-existent. Objective: To explore Cape Town wsw’s (women who have sex with women) experiences with, and trends of utilisation of Reproductive Healthcare Services. Study Design: Cross Sectional Survey. Methods: A sample of self-identified wsw was recruited using a snowball sampling method to complete an anonymous, self-administered online questionnaire during February 2013. Outcome Measures: Predominantly descriptive, with an aim to validate the study questionnaire for the South African context. Results: A total of 116 responses were analysed. The mean age of the population was 37 years of age, with the majority identifying as lesbian. The population comprised predominantly of Caucasian, middle class suburban residents, with most having medical aid, and accessing private health care. A significant proportion of respondents reported previous intercourse with a male sexual partner. Barrier contraception was not always used during intercourse with men and almost never during sex with women. There were a significant number of sexually transmitted infections in women with no previous male sexual partners. Most respondents considered themselves to be at low risk of contracting HIV, and at intermediate risk of cervical and breast cancer, and showed higher than average utilization of cervical screening practices for 4 this population, despite a general perception that screening is unnecessary in lesbian women. A general trend towards disclosure of sexual orientation was noted; however users of private healthcare were significantly more likely to have disclosed their orientation to their physician than users of public and NGO services. Respondents held a preference for practitioners that were themselves gay/lesbian.The study tool was validated for use in the South African context; however redundancy could not be formally excluded from the questionnaire. Conclusions: Wsw from Cape Town experience internationally comparable exposures and risks of gynaecological problems. Further research is required to fully understand the healthcare needs of lesbian women living in lower socio-economic conditions.
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    Validation of the polycystic ovary syndrome health-related quality of life questionnaire (PCOSQ) in the clinical community in our gynaecological endocrine clinic
    (2016) Ncube, Nkosinathi; Van der Spuy, Zephne Margaret; Steyn, Petrus S
    Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and impacts negatively on their health related quality of life (HRQoL). The Polycystic Ovary Syndrome Questionnaire (PCOSQ) is a disease specific questionnaire used to measure HRQOL in affected women. This questionnaire has not been validated for use in the clinical population of South Africa. This study aimed to assess the psychometric properties of the PCOSQ in our population and to compare findings with those from the WHOQOL-BREF, a generic questionnaire that measures HRQoL. Methods: This was a cross sectional analytical study of women with PCOS as defined by the Rotterdam criteria attending the Gynaecological Endocrine Clinic at Groote Schuur Hospital in Cape Town. The PCOSQ and WHOQOL-BREF were administered at the first interview and a repeat PCOSQ interview was conducted telephonically within a period of 2 to 7 days. The clinical data of the participants at initial diagnosis were obtained from the clinical records. Results: A total of 105 consenting women were recruited over a period of 8 months from November 2013 to July 2014. Sixty-seven participants responded to the second follow up interview for test-retest reliability. The test-retest reliability was good with intra-class correlation coefficients from all domains being above 0.8 (0.820-0.929, P<0.001). The Cronbach's alpha coefficients of internal consistency were above 0.7 in all domains with the exception of the menstrual domain, which scored 0.65. Construct validity was demonstrated by a statistically significant correlation between the corresponding domains of the WHOQOLBREF (P<0.05). Secondary factor analysis confirmed the domain structure of the PCOSQ. The scores from all domains were reflective of an impaired quality of life. Weight had the most impact on the HRQoL. The WHOQOL-BREF demonstrated a poor internal consistency in the study population. Conclusions: The PCOSQ is a valid questionnaire for measuring the HRQoL in our clinical population and is preferred above the WHOQOL-BREF. The incorporation of the domain on acne and further exploration of the domain of menstrual problems could be undertaken to strengthen its factor structure. PCOS has an adverse effect on the HRQoL. Weight has the biggest impact on the HRQoL. The WHOQOL-BREF is suboptimal in measuring HRQoL in women with PCOS, as it is not specific to the condition.
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    Validation of the Utian quality of life scale in peri- and postmenopausal women in the metro west region of Cape Town
    (2016) Spence,Trevi A O; Patel, Malika; van der Spuy, Zephne Margaret; Steyn, Petrus S
    Background: Menopause is a universal event and today most women are reaching the age when menopause occurs. Very little research has been done in South Africa about the perimenopausal period, particularly with regard to quality of life (QoL). The Utian Quality of Life Scale (UQOL) was designed to determine the QoL in peri- and postmenopausal women, and not just to measure their symptoms. The aim of this study was to validate the UQOL in a local urban population in State sector hospitals in Cape Town. Methods: This was a prospective, cross-sectional study. Participants were recruited from the Mature Women's Clinic at Groote Schuur Hospital (GSH), and Gynaecology Out Patient Departments (GOPD) at GSH and New Somerset Hospital (NSH). Four questionnaires were administered- a demographics questionnaire, the UQOL, the WHOQOL-BREF and the Greene Climacteric Scale. Women were contacted telephonically after 3-14 days for retest of the questionnaires to establish reliability. Results: Fifty two participants were initially recruited and 49 were retested. Results showed that the UQOL is a valid instrument with which to measure QoL in our study population. The test-retest reliability was good, with only 2 questions having significantly different answers (p-value < 0.05). Internal consistency (Cronbach's alpha) was >0.7 for the occupational domain of the UQOL only. The health, emotional, and sexual domains had alpha values of 0.673 and 0.691 and 0.634 respectively, which are acceptable. The Cronbach's alpha for the health domain improved to 0.739 when question 8 was removed from the health domain. Construct validity was demonstrated by a statistically significant correlation between the domains of the UQOL and the WHOQOL-BREF. Secondary factor analysis confirmed the domain structure of the UQOL. The scores from the domains seem to indicate that perceived QoL in our study population is not significantly impaired, with the sexual domain showing the most negative impact on QoL. The WHOQOL-BREF demonstrated good internal consistency in our study population. Conclusions: The UQOL is a valid instrument to measure QoL related to the menopause in our patients. No questions were deleted from the original scale. Further research is needed in Afrikaans and Black African languages. The sexual experiences of peri- and post-menopausal women should also be explored. Menopause did not seem to adversely affect QoL in the women who participated in this study. The WHOQOL-BREF is a good tool to measure general QoL in our study population.