Browsing by Subject "Maternal "

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    Nurses' knowledge and perceptions of and attitudes towards aspects of the new health systems framework: a qualitative case-study of the nurses employed at three public health facilities in the West District, City of Tygerberg, Cape Town
    (1999) Marco, Colleen; Di , Cooper
    A qualitative case study was conducted amongst nurses employed at the Elsies River's Community Health Centre, Community Health Clinic and Midwife Obstetric Unit. The purpose of the study was to gain insight into the nurses' knowledge and perceptions of and attitudes, towards key aspects of the new health systems framework, namely, the concept of Primary Health Care, the structure of the District Health System and selected aspects of the Maternal, Child and Women's Health Policy framework. An additional purpose was to gain insight into the nurses' Scope of Practice and whether nurses felt they were adequately skilled to provide a quality Primary Health Care service at district level. The first phase of the study involved individual interviews with nineteen nurses from the three main nursing categories. The second phase consisted of a focus group discussion in which five Registered Nurses participated. The study findings indicate that the nurses lack the knowledge and understanding of the key aspects of the new health systems framework. There has not been adequate consultation between the health authorities and the nurses, with respect to the formulation of the new health policy framework and the implementation thereof at local and district level. This resulted in negative attitudes being adopted by these nurses towards their superiors, the community and towards the new health systems framework. The nurses were found to not have adequate clinical skills to implement the new health policies. Furthermore, in-service training was identified as important, in order to render an effective Primary Health Care service. The training programs of these nurses were mainly curative-based and did not equip them to function competently within the Primary Health Care-based health service. Changes in the nursing education curriculum are discussed in order for a re-orientation towards Primary Health Care to occur. Specific recommendations are presented regarding the reorientation and training of nurses and appropriate methods to involve them in the development of the District Health System at local level.
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    Simulation-based low-dose, high-frequency plus mobile mentoring versus traditional group-based training approaches on day of birth care among maternal and newborn healthcare providers in Ebonyi and Kogi States, Nigeria; a randomized controlled trial
    (BioMed Central, 2018-08-13) Ugwa, Emmanuel; Otolorin, Emmanuel; Kabue, Mark; Ishola, Gbenga; Evans, Cherrie; Oniyire, Adetiloye; Olisaekee, Gladys; Onwe, Boniface; LeFevre, Amnesty E; Bluestone, Julia; Orji, Bright; Yenokyan, Gayane; Okoli, Ugo
    Abstract Background There is limited information from low and middle-income countries on learning outcomes, provider satisfaction and cost-effectiveness on the day of birth care among maternal and newborn health workers trained using onsite simulation-based low-dose high frequency (LDHF) plus mentoring approach compared to the commonly employed offsite traditional group-based training (TRAD). The LDHF approach uses in-service learning updates to deliver information based on local needs during short, structured, onsite, interactive learning activities that involve the entire team and are spaced over time to optimize learning. The aim of this study will be to compare the effectiveness and cost of LDHF versus TRAD approaches in improving knowledge and skill in maternal and newborn care and to determine trainees’ satisfaction with the approaches in Ebonyi and Kogi states, Nigeria. Methods This will be a prospective cluster randomized control trial. Sixty health facilities will be randomly assigned for day of birth care health providers training through either LDHF plus mobile mentoring (intervention arm) or TRAD (control arm). There will be 150 trainees in each arm. Multiple choices questionnaires (MCQs), objective structured clinical examinations (OSCEs), cost and satisfaction surveys will be administered before and after the trainings. Quantitative data collection will be done at months 0 (baseline), 3 and 12. Qualitative data will also be collected at 12-month from the LDHF arm only. Descriptive and inferential statistics will be used as appropriate. Composite scores will be computed for selected variables to determine areas where service providers have good skills as against areas where their skills are poor and to compare skills and knowledge outcomes between the two groups at 0.05 level of statistical significance. Discussion There is some evidence that LDHF, simulation and practice-based training approach plus mobile mentoring results in improved skills and health outcomes and is cost-effective. By comparing intervention and control arms the authors hope to replicate similar results, evaluate the approach in Nigeria and provide evidence to Ministry of Health on how and which training approach, frequency and setting will result in the greatest return on investment. Trial registration The trial was retrospectively registered on 24th August, 2017 at ClinicalTrials.Gov: NCT03269240 .
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    The association between maternal HIV and stillbirths in an era of universal art in pregnancy in the Western Cape, South Africa
    (2025) Lubinda, Elizabeth; Kalk, Emma; Maswime, Salome
    BACKGROUND: Annually, approximately 1.9 million stillbirths occur globally, with a rate of 13.9 per 1000 births. The devastating aftermath affects around 4.2 million mothers, and 75% of stillbirths are concentrated in South Asia and sub-Saharan Africa (SSA) particularly, with a rate of 32.2 per 1000 births in SSA. South Africa reported a stillbirth rate of 16.3 per 1000 births in 2019, despite global efforts to reduce stillbirth rates. SSA also faces the highest global HIV prevalence at 20%. South Africa, home to 8.4 million people living with HIV, grapples with a 30% prevalence among pregnant individuals. Antiretroviral therapy (ART) coverage for pregnant individuals reached 97% in 2019, especially in the Western Cape with an HIV prevalence of 17.9% among antenatal individuals. Quality antenatal care (ANC) is crucial, with research showing a lower stillbirth rate for those receiving higher quality ANC. The COVID-19 pandemic in 2020 introduced new challenges, potentially influencing stillbirth rates through factors like lockdowns and limited healthcare access. Pregnant individuals contracting SARS-CoV-2 faced an increased likelihood of stillbirth. In this context, our cohort study in the Western Cape, South Africa, utilized routine health data to investigate the contemporary relationship between pregnant individuals with HIV and stillbirths in the era of universal ART during pregnancy. The study explores associations with demographic and clinical variables, including the quality of ANC. METHODS: Utilizing data from the Western Cape Pregnancy Exposure Registry (PER) between 2017 and 2021, this cohort study focused on pregnant women attending antenatal care (ANC) at the Gugulethu Midwife Obstetrics Unit (GMOU) and Worcester Midwife Obstetrics Unit (WMOU) in South Africa. Integrated information from the Provincial Health Data Centre (PHDC) was used to create a linked database for cohort generation. The cohort included women aged 18 or older, with known HIV status and a recorded pregnancy outcome after 20 weeks of gestation. The primary outcome was stillbirth, with maternal HIV status serving as the primary exposure. ANC quality, based on WHO guidelines, was assessed by considering variables such as ANC timing, the number of visits, and various healthcare parameters. ANC quality was categorized using both the old WHO guidelines (at least 4 visits) and the new WHO guidelines (at least 8 visits), with a good ANC quality score requiring 7 or more out of 11 quality ANC variables. Statistical analyses, including logistic regression, were conducted to explore associations between maternal HIV status, ANC quality, and stillbirth prevalence. The study also collected data on maternal characteristics to provide a comprehensive understanding of contributing factors. RESULTS: The study included 15,123 participants: 4,773 women living with HIV (WLHIV) and 10,350 women without HIV. WLHIV had a median age of 28 years, while women without HIV had a median age of 31 years. The overall stillbirth rate was 15 per 1,000 births (95% CI: 13.1-16.9). Stillbirth rates were higher among WLHIV at 17 per 1,000 births (95% CI: 13.34-20.66) compared to women without HIV at 14 per 1,000 births (95% CI: 11.75-16.25). Maternal HIV- positive status (AOR = 1.15, 95% CI: 0.87-1.52, p = 0.34) did not show a statistically significant association with stillbirths. Women with prior diabetes exhibited a significant increase in stillbirth odds (AOR = 2.63, 95% CI: 1.06-6.52, p = 0.04). Women without HIV but with a history of diabetes had a stillbirth prevalence of 4.08%, compared to 3.80% for WLHIV. WLHIV with good-quality ANC had fewer stillbirths (4 visits: 5.06%, 8 visits: 2.53%) than women without HIV (4 visits: 11.56%, 8 visits: 5.06%). ART for ≥100 weeks among WLHIV showed a protective effect, with 47% lower stillbirth odds than ART <20 weeks (AOR = 0.53, p = 0.01) and 45% lower stillbirth odds than ART <20 weeks (AOR = 0.55, 95% CI: 0.33-0.91, p = 0.02). Despite higher stillbirth odds for WLHIV, no significant association was found between maternal HIV status and stillbirths after adjustment (AOR = 1.15, 95% CI: 0.87-1.52, p = 0.34). CONCLUSION: This study, utilizing routine program data, revealed no statistically significant difference in the prevalence of stillbirths between women living with and without HIV. Despite the lack of a statistically significant association between the quality of antenatal care (ANC) and stillbirths, the study underscores the importance of adhering to WHO recommendations and utilizing databases such as the Pregnancy Exposure Registry for evidence-based decision-making. Although the overall stillbirth rate slightly exceeded global targets, there was noticeable improvement following the universal rollout of antiretroviral therapy (ART). Notably, among women living with HIV (WLHIV), a longer duration of ART was linked to a significant reduction in the odds of stillbirth, highlighting the critical role of sustained access to ART. Despite its limitations, these findings contribute to global health objectives, particularly those aimed at eliminating preventable newborn deaths by 2030. ART emerges as a pivotal factor in decreasing stillbirth rates among women living with HIV.