An appraisal of strategies to mitigate related to non-communicable diseases of the eye: a case study of Michael Mapongwane Health Clinic in Khayelitsha, Western Cape Metro District
- Authors: Ngcebetsha, Avela Ayanda
- Date: 2022-03
- Subjects: Chronically ill--Care , Ophthalmic nursing
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/22908 , vital:53186
- Description: Preventive and curative eye-care services are a critical component of care for patients diagnosed with chronic diseases. The South African constitution guarantees health as a fundamental human right of all citizens. While most chronically ill patients are managed at the primary health care centers, eye care services are currently contracted to private service providers. The extent to which people, especially the chronically ill patients, have access to eye-care service under the current structure is less understood. The study aims to establish the effectiveness and sustainability of the eye-care service delivery model at the Michael Mapongwane CHC, with specific reference to access to eye-care services. Specifically, the study examined the rate and determinants of eye-care service utilisation, assess user’s satisfaction and perspectives of primary health workers and private service providers regarding the current structure of eye-care services. The study adopted a descriptive and explanatory design, which involved a survey and semi-structured interviews. The survey was conducted among 423 patients attending the two primary health centers selected for this study. Patients with chronic illness were recruited over a period of one month. Overall, 365 patients with chronic illness and 58 patients without chronic illness took part in the study. Descriptive and inferential statistics were used to analyse the quantitative date. Purposive sampling was used to select nine health workers and 10 private eye-care service providers for the semi-structured interviews. The data obtained were transcribed and coded. Thematic content analysis was performed on the qualitative data. The results show that less than half of the respondents (n=168) had ever had an eye test, and an even lower proportion (n=115) had had an eye test in the past two years. Age, female sex, formal rural dwelling, marital status, and income were significantly associated with ever having an eye test done. The results reveal a gross inequality in access to eye care test. Only 19.2% of patients diagnosed with hypertension had had their eyes examined. Even fewer proportions of the patients (8.5%) had had their eyes examined during or after diagnosis for hypertension. Likewise, only one in three patients diagnosed with diabetes has had their eyes examined before or after they were diagnosed with diabetes. The majority of patients who had used the services affirmed that it was easy to access eye care services. While most respondents agreed that waiting time to make an appointment was not too long, over half of them affirmed that waiting to see an eye doctor was too long. Most users were reasonably satisfied with the eye care services received. Primary health care providers highlighted challenges such as work overload, poor infrastructure, and patient’s forgetfulness of the appointment dates as factors affecting access to eye care services in their clinic. The primary challenges the private eye-care service providers experienced were small rooms or inappropriate clinic rooms, language barrier and inadequate support from the clinics. In conclusion, this study has shown that access to preventive and curative health care services was among patients attending primary health care centres, and especially those with chronic illness. The current structure of eye care services makes it difficult for patients to access care and for providers to provide quality care. , Thesis (MPH) -- Faculty of Health Sciences, 2022
- Full Text:
- Authors: Ngcebetsha, Avela Ayanda
- Date: 2022-03
- Subjects: Chronically ill--Care , Ophthalmic nursing
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/22908 , vital:53186
- Description: Preventive and curative eye-care services are a critical component of care for patients diagnosed with chronic diseases. The South African constitution guarantees health as a fundamental human right of all citizens. While most chronically ill patients are managed at the primary health care centers, eye care services are currently contracted to private service providers. The extent to which people, especially the chronically ill patients, have access to eye-care service under the current structure is less understood. The study aims to establish the effectiveness and sustainability of the eye-care service delivery model at the Michael Mapongwane CHC, with specific reference to access to eye-care services. Specifically, the study examined the rate and determinants of eye-care service utilisation, assess user’s satisfaction and perspectives of primary health workers and private service providers regarding the current structure of eye-care services. The study adopted a descriptive and explanatory design, which involved a survey and semi-structured interviews. The survey was conducted among 423 patients attending the two primary health centers selected for this study. Patients with chronic illness were recruited over a period of one month. Overall, 365 patients with chronic illness and 58 patients without chronic illness took part in the study. Descriptive and inferential statistics were used to analyse the quantitative date. Purposive sampling was used to select nine health workers and 10 private eye-care service providers for the semi-structured interviews. The data obtained were transcribed and coded. Thematic content analysis was performed on the qualitative data. The results show that less than half of the respondents (n=168) had ever had an eye test, and an even lower proportion (n=115) had had an eye test in the past two years. Age, female sex, formal rural dwelling, marital status, and income were significantly associated with ever having an eye test done. The results reveal a gross inequality in access to eye care test. Only 19.2% of patients diagnosed with hypertension had had their eyes examined. Even fewer proportions of the patients (8.5%) had had their eyes examined during or after diagnosis for hypertension. Likewise, only one in three patients diagnosed with diabetes has had their eyes examined before or after they were diagnosed with diabetes. The majority of patients who had used the services affirmed that it was easy to access eye care services. While most respondents agreed that waiting time to make an appointment was not too long, over half of them affirmed that waiting to see an eye doctor was too long. Most users were reasonably satisfied with the eye care services received. Primary health care providers highlighted challenges such as work overload, poor infrastructure, and patient’s forgetfulness of the appointment dates as factors affecting access to eye care services in their clinic. The primary challenges the private eye-care service providers experienced were small rooms or inappropriate clinic rooms, language barrier and inadequate support from the clinics. In conclusion, this study has shown that access to preventive and curative health care services was among patients attending primary health care centres, and especially those with chronic illness. The current structure of eye care services makes it difficult for patients to access care and for providers to provide quality care. , Thesis (MPH) -- Faculty of Health Sciences, 2022
- Full Text:
Development of a strategy to promote prenatal physical activity participation among women in Buffalo City Municipality, South Africa
- Okafor, Uchenna Benedine https://orcid.org/0000-0002-0435-2041
- Authors: Okafor, Uchenna Benedine https://orcid.org/0000-0002-0435-2041
- Date: 2022-03
- Subjects: Prenatal care , Exercise for pregnant women
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10353/22919 , vital:53218
- Description: Research has proven that prenatal physical activity practice is associated with multiple health benefits; however, most women in South Africa rarely participate in prenatal physical activity. In contrast to more developed countries, there is dearth of research focusing specifically on prenatal physical activity and exercise among South African women. Nevertheless, in order to effectively, and strategically promote such prenatal activity, such information is important to plan for an intervention strategy. The main aim of this study was to assess the level, patterns, and associated factors of prenatal physical activity; beliefs, knowledge, attitudes, perceived benefits, and sources of information women received during pregnancy; and, furthermore, to develop an effective and relevant intervention strategy to facilitate the participation in this particular activity in Buffalo City Municipality, Eastern Cape, South Africa. Methods The study was a mixed-method, cross-sectional study design with both quantitative and qualitative data collection and analyses. The sequential explanatory design was adopted to merge and mix different datasets to be collected and analysed. The quantitative data involved a convenient sample of 1082 pregnant women in 12 randomly selected primary healthcare clinics offering antenatal health services in Buffalo City, Eastern Cape. The Pregnancy Physical Activity Questionnaire was interviewer-administered to women at each antenatal health clinic on pre-specified days, in a designated room allocated to the primary researcher by the health facility manager. The descriptive statistics were frequency distribution, percentages, mean and standard deviation. Furthermore, the bivariate and multivariate analyses were performed on two categories of participants, namely inactive or active, to determine the factors affecting prenatal physical activity behaviour. Furthermore, multiple logistic regression analyses were used to assess associations between physical activity and the predictor variables during pregnancy. Adjusted odds ratios with 95% confidence interval were applied to estimate factors associated with physical activity levels, and the associations between prenatal physical activity levels and socio-demographic, lifestyle, and obstetrics characteristics were determined using a chi-squared analyses. The significance level was set at p = 0.05. In addition, a qualitative descriptive approach was applied, using semi-structured face-to-face interviews with 15 purposively selected pregnant women, as well as 17 midwives offering antenatal health-care services to pregnant women in the 12 selected healthcare clinics. Qualitative data were analysed using a thematic content analysis. To develop the physical activity strategy for the promotion of prenatal physical activity practice, three frameworks were applied, namely the Strength, Weakness, Opportunity and Threat (SWOT), the Political, Economic Growth, Socio-Cultural, Technological, Laws and Environmental (PESTLE), and, lastly, the Build, Overcome, Explore and Minimise (BOEM) analytical frameworks. To facilitate the validation of the strategy, the findings were additionally analysed, after which, appropriate intervention strategies promoting prenatal physical activity were developed by again using the SWOT and PESTLE analytical strategic frameworks. This process involved a purposive sampling of seven experts with knowledge of and a proven academic and scholarly background in prenatal physical activity and maternal health. Next, the developed physical activity strategy was presented to various stakeholders, which included six primary healthcare managers, two midwives, and pregnant women purposively selected in each of the 12 chosen antenatal health clinics for the validation process. The stakeholders discussed, deliberated on, and provided comments and opinions of the feasibility and implementation of the developed prenatal physical activity for promotion of physical activity practices in the Eastern Cape Province. Results The findings of this particular study demonstrated low levels of prenatal physical activity among pregnant women, and, further indicated that the most preferred form of activity was light-intensity and household activities. Only 278 of the women (25.7%) met recommendations for prenatal activity (≥150 min moderate intensity exercise per week). The average time spent in moderate–vigorous physical activity was 151.6 min (95% CI: 147.2– 156.0). Most of the women participated in light exercises with a mean of 65.9% (95% CI: 64.8–67.0), and 47.6% (95% CI: 46.3–48.9) participated in household activities. The majority of the women did not receive physical activity advice during prenatal care sessions (64.7%). Lower age (<19 years) (adjusted odd ratio (AOR) = 0.3; CI: 0.16–0.76), semi-urban residence (AOR = 0.8; CI: 0.55–1.03), lower educational level (AOR = 0.5; CI: 0.20–0.71), unemployment (AOR = 0.5; CI: 0.29–0.77) and nulliparity (AOR = 0.6; CI: 0.28–1.31) were negatively associated with prenatal physical activity, while prenatal physical activity was positively associated with starting physical activity in the first trimester (AOR = 1.9; CI: 1.06–3.31) compared to other trimesters. In addition, the pregnant women were aware of the safety (88.2%) and benefits of physical activity for both mother and baby (79.6%), improved labour and delivery (93.1%), promote energy (89.0%), and should be discontinued when tired (76.6%). However, they also held the contradictory belief that pregnancy is “a time to rest” (56.5%). Furthermore, the most common sources of information about prenatal physical activity were the media, television, the radio and Internet-based websites (70.2%). Most women affirmed that prenatal physical activity reduced infant weight (61.4%), lessen moodiness (90.4), decreased risk of gestational diabetes mellitus (92.9%), pregnancy-induced hypertension (92.5%), and complications at birth (97.8%), while common negative perceptions included musculoskeletal discomfort (82.7%), and back pain (85.7%). The majority of women indicated that prenatal physical activity improved self-image (95.7%), sleep patterns (94.2%), and respiratory function (95.8%). The results from the quantitative data revealed that the major modifiable barriers to prenatal physical activity were tiredness (73.3%), lack of advice from healthcare professionals (nurses/midwives) (64.7%), low energy (64.5%), and non-accessibility to physical activity facilities (63.0%). The results were confirmed in the qualitative data, based on the Ecological Model, in which women also mentioned tiredness, work and household responsibilities, a lack of motivation, and the lack of physical activity advice and information on the relevant recommendations and guidelines. Overall, 62.4% women had high knowledge regarding prenatal physical activity; and half of the women showed a positive attitude toward it (50.1%). Whilst participants had knowledge of other types of antenatal exercises, 80.9% of the women had no knowledge of swimming exercise. Negative attitudes towards physical activity included the feeling of tiredness (67.7%), lack of interest (64.8%), and inadequate information on physical activity (59.5%). In addition, the study highlighted that midwives rarely educate and counsel pregnant women about prenatal physical activity during scheduled antenatal visits, which was attributed largely to the shortage of midwives handling many responsibilities at clinics. Nevertheless, the midwives did express a willingness to provide effective physical activity education and counselling on prenatal physical activity, if supported by relevant training and workshops. Furthermore, they further recommended the use of the Mom Connect application, which is a technological device designed by the National Department of Health, to distribute relevant information about maternal and child health. The prenatal physical activity strategies developed to address the above-mentioned and other barriers associated with prenatal physical activity include the use of scientific and technological innovations to provide basic information on prenatal physical activity to pregnant women by means of Mom Connect, and, by collaborating with the various cellphone and network companies in South Africa. Another strategy was to integrate prenatal physical activity training into the curricula of the existing higher institutions of learning that provide teaching of maternal health in the Eastern Cape Province. Additional strategies included the documentation and subsequent clarification of misconceptions about the safety concerns often associated with prenatal physical activity by making the documents accessible to all women at the clinics in the form of a small pamphlet or booklet. Lastly, stakeholders suggested that the government offer periodic prenatal physical activity campaigns, which should be presented in local community town halls and clinics and by other stakeholders to address the current lack of awareness and effectively eliminate misrepresentations and falsehoods around the safety of prenatal physical activity within geographical setting of the Eastern Cape Province. Conclusion Despite the advantages of prenatal physical activity practices, most pregnant women in South Africa do not participate in moderate-intensity physical activity. Notably, while women perceive prenatal physical activity as beneficial to both mother and baby, such theoretical knowledge is not easily translatable into practice. The predominant sources of information on prenatal physical activity are the television, the radio, and other media, which may be potentially misleading or contradictory to evidence-based physical activity practice. Furthermore, tiredness, a lack of time, work and household responsibilities, and a lack of motivation were major modifiable barriers to prenatal physical activity by the women. In addition, pregnant women rarely receive information on prenatal physical activity. Consequently, to address the needs of the pregnant women as highlighted in this study, a prenatal physical activity intervention strategy was developed and validated by key stakeholders to promote prenatal physical activity and exercise practice among women, taken in account the local context. , Thesis (PhD) -- Faculty of Health Sciences, 2022
- Full Text:
- Authors: Okafor, Uchenna Benedine https://orcid.org/0000-0002-0435-2041
- Date: 2022-03
- Subjects: Prenatal care , Exercise for pregnant women
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10353/22919 , vital:53218
- Description: Research has proven that prenatal physical activity practice is associated with multiple health benefits; however, most women in South Africa rarely participate in prenatal physical activity. In contrast to more developed countries, there is dearth of research focusing specifically on prenatal physical activity and exercise among South African women. Nevertheless, in order to effectively, and strategically promote such prenatal activity, such information is important to plan for an intervention strategy. The main aim of this study was to assess the level, patterns, and associated factors of prenatal physical activity; beliefs, knowledge, attitudes, perceived benefits, and sources of information women received during pregnancy; and, furthermore, to develop an effective and relevant intervention strategy to facilitate the participation in this particular activity in Buffalo City Municipality, Eastern Cape, South Africa. Methods The study was a mixed-method, cross-sectional study design with both quantitative and qualitative data collection and analyses. The sequential explanatory design was adopted to merge and mix different datasets to be collected and analysed. The quantitative data involved a convenient sample of 1082 pregnant women in 12 randomly selected primary healthcare clinics offering antenatal health services in Buffalo City, Eastern Cape. The Pregnancy Physical Activity Questionnaire was interviewer-administered to women at each antenatal health clinic on pre-specified days, in a designated room allocated to the primary researcher by the health facility manager. The descriptive statistics were frequency distribution, percentages, mean and standard deviation. Furthermore, the bivariate and multivariate analyses were performed on two categories of participants, namely inactive or active, to determine the factors affecting prenatal physical activity behaviour. Furthermore, multiple logistic regression analyses were used to assess associations between physical activity and the predictor variables during pregnancy. Adjusted odds ratios with 95% confidence interval were applied to estimate factors associated with physical activity levels, and the associations between prenatal physical activity levels and socio-demographic, lifestyle, and obstetrics characteristics were determined using a chi-squared analyses. The significance level was set at p = 0.05. In addition, a qualitative descriptive approach was applied, using semi-structured face-to-face interviews with 15 purposively selected pregnant women, as well as 17 midwives offering antenatal health-care services to pregnant women in the 12 selected healthcare clinics. Qualitative data were analysed using a thematic content analysis. To develop the physical activity strategy for the promotion of prenatal physical activity practice, three frameworks were applied, namely the Strength, Weakness, Opportunity and Threat (SWOT), the Political, Economic Growth, Socio-Cultural, Technological, Laws and Environmental (PESTLE), and, lastly, the Build, Overcome, Explore and Minimise (BOEM) analytical frameworks. To facilitate the validation of the strategy, the findings were additionally analysed, after which, appropriate intervention strategies promoting prenatal physical activity were developed by again using the SWOT and PESTLE analytical strategic frameworks. This process involved a purposive sampling of seven experts with knowledge of and a proven academic and scholarly background in prenatal physical activity and maternal health. Next, the developed physical activity strategy was presented to various stakeholders, which included six primary healthcare managers, two midwives, and pregnant women purposively selected in each of the 12 chosen antenatal health clinics for the validation process. The stakeholders discussed, deliberated on, and provided comments and opinions of the feasibility and implementation of the developed prenatal physical activity for promotion of physical activity practices in the Eastern Cape Province. Results The findings of this particular study demonstrated low levels of prenatal physical activity among pregnant women, and, further indicated that the most preferred form of activity was light-intensity and household activities. Only 278 of the women (25.7%) met recommendations for prenatal activity (≥150 min moderate intensity exercise per week). The average time spent in moderate–vigorous physical activity was 151.6 min (95% CI: 147.2– 156.0). Most of the women participated in light exercises with a mean of 65.9% (95% CI: 64.8–67.0), and 47.6% (95% CI: 46.3–48.9) participated in household activities. The majority of the women did not receive physical activity advice during prenatal care sessions (64.7%). Lower age (<19 years) (adjusted odd ratio (AOR) = 0.3; CI: 0.16–0.76), semi-urban residence (AOR = 0.8; CI: 0.55–1.03), lower educational level (AOR = 0.5; CI: 0.20–0.71), unemployment (AOR = 0.5; CI: 0.29–0.77) and nulliparity (AOR = 0.6; CI: 0.28–1.31) were negatively associated with prenatal physical activity, while prenatal physical activity was positively associated with starting physical activity in the first trimester (AOR = 1.9; CI: 1.06–3.31) compared to other trimesters. In addition, the pregnant women were aware of the safety (88.2%) and benefits of physical activity for both mother and baby (79.6%), improved labour and delivery (93.1%), promote energy (89.0%), and should be discontinued when tired (76.6%). However, they also held the contradictory belief that pregnancy is “a time to rest” (56.5%). Furthermore, the most common sources of information about prenatal physical activity were the media, television, the radio and Internet-based websites (70.2%). Most women affirmed that prenatal physical activity reduced infant weight (61.4%), lessen moodiness (90.4), decreased risk of gestational diabetes mellitus (92.9%), pregnancy-induced hypertension (92.5%), and complications at birth (97.8%), while common negative perceptions included musculoskeletal discomfort (82.7%), and back pain (85.7%). The majority of women indicated that prenatal physical activity improved self-image (95.7%), sleep patterns (94.2%), and respiratory function (95.8%). The results from the quantitative data revealed that the major modifiable barriers to prenatal physical activity were tiredness (73.3%), lack of advice from healthcare professionals (nurses/midwives) (64.7%), low energy (64.5%), and non-accessibility to physical activity facilities (63.0%). The results were confirmed in the qualitative data, based on the Ecological Model, in which women also mentioned tiredness, work and household responsibilities, a lack of motivation, and the lack of physical activity advice and information on the relevant recommendations and guidelines. Overall, 62.4% women had high knowledge regarding prenatal physical activity; and half of the women showed a positive attitude toward it (50.1%). Whilst participants had knowledge of other types of antenatal exercises, 80.9% of the women had no knowledge of swimming exercise. Negative attitudes towards physical activity included the feeling of tiredness (67.7%), lack of interest (64.8%), and inadequate information on physical activity (59.5%). In addition, the study highlighted that midwives rarely educate and counsel pregnant women about prenatal physical activity during scheduled antenatal visits, which was attributed largely to the shortage of midwives handling many responsibilities at clinics. Nevertheless, the midwives did express a willingness to provide effective physical activity education and counselling on prenatal physical activity, if supported by relevant training and workshops. Furthermore, they further recommended the use of the Mom Connect application, which is a technological device designed by the National Department of Health, to distribute relevant information about maternal and child health. The prenatal physical activity strategies developed to address the above-mentioned and other barriers associated with prenatal physical activity include the use of scientific and technological innovations to provide basic information on prenatal physical activity to pregnant women by means of Mom Connect, and, by collaborating with the various cellphone and network companies in South Africa. Another strategy was to integrate prenatal physical activity training into the curricula of the existing higher institutions of learning that provide teaching of maternal health in the Eastern Cape Province. Additional strategies included the documentation and subsequent clarification of misconceptions about the safety concerns often associated with prenatal physical activity by making the documents accessible to all women at the clinics in the form of a small pamphlet or booklet. Lastly, stakeholders suggested that the government offer periodic prenatal physical activity campaigns, which should be presented in local community town halls and clinics and by other stakeholders to address the current lack of awareness and effectively eliminate misrepresentations and falsehoods around the safety of prenatal physical activity within geographical setting of the Eastern Cape Province. Conclusion Despite the advantages of prenatal physical activity practices, most pregnant women in South Africa do not participate in moderate-intensity physical activity. Notably, while women perceive prenatal physical activity as beneficial to both mother and baby, such theoretical knowledge is not easily translatable into practice. The predominant sources of information on prenatal physical activity are the television, the radio, and other media, which may be potentially misleading or contradictory to evidence-based physical activity practice. Furthermore, tiredness, a lack of time, work and household responsibilities, and a lack of motivation were major modifiable barriers to prenatal physical activity by the women. In addition, pregnant women rarely receive information on prenatal physical activity. Consequently, to address the needs of the pregnant women as highlighted in this study, a prenatal physical activity intervention strategy was developed and validated by key stakeholders to promote prenatal physical activity and exercise practice among women, taken in account the local context. , Thesis (PhD) -- Faculty of Health Sciences, 2022
- Full Text:
Experiences of midwives regarding the use of pharmacological and non-pharmacological labour pain interventions in Lejweleputswa District in Free State
- Parkies, Limakatso Elizabeth
- Authors: Parkies, Limakatso Elizabeth
- Date: 2022-03
- Subjects: Pharmacology , Anesthesia in obstetrics
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/23567 , vital:58166
- Description: Due to the disabling effects of severe labour pains, labour pain management remains an important topic in midwifery and needs to be reviewed more often. According to studies, various pain relief options, both pharmacological and non-pharmacological, are available to help women cope with pain, but midwives did not employ these techniques adequately because of various experiences. Studies further indicate that, though the limited number of these techniques were employed they were not effective on some women. Thus, the purpose of this research study was to explore and describe midwives’ experiences on pharmacological and non-pharmacological labour pain management in the Lejweleputswa District of the Free State Province. This study employed a qualitative, descriptive, explorative, and contextual design. A purposive sampling technique was used to select the participants. The target population was midwives who work in the maternity wards of the institutions under study with three to five years’ experience in midwifery. Individual, face-face, semi-structured interviews were conducted; these were recorded for the researcher’s reference purposes, so as not to overlook important information. In addition, the researcher made use of field notes, recording in them what was heard, observed, felt, experienced, and thought during the interview. Ethical principles and trustworthiness were maintained throughout this study. Data analysis was done using Tesch’s approach to open coding in qualitative research. Confidentiality and anonymity were ensured throughout the interviews. The nine themes and 19 sub-themes that emerged during data analysis were discussed comprehensively. The findings indicate that midwives use both pharmacological and non-pharmacological methods in managing labour pain. Some methods are effective in relieving pain for certain mothers, while other methods proved ineffective. Midwives administer Pethidine and Phenergan as per doctors’ prescription; non-pharmacological methods, such as back massage, deep breathing exercises, mobilisation, and warm baths or showers are also employed. Midwives provide pharmacological methods to all women in labour, and routinely employ non- pharmacological methods. Although the midwives are willing to manage patients’ pain, they face certain challenges, such as shortage of staff, increased workload, as well as inadequate resources. This leads to inadequate provision of non-pharmacological care. In conclusion, the midwives’ experiences were that both pharmacological and non-pharmacological techniques were used for all labouring women and they had relaxing and calming effects on some women, resulting to them giving birth with ease, although for some they were not effective. In addition, the pharmacological interventions caused drowsiness to some women and babies. The findings will provide evidence-based information to the Free State Department of Health in order to assist policymakers and stakeholders in initiating and developing appropriate policies, guidelines, and interventions that can improve labour pain management. The Free State Department of Health should consider using other opioids and non-opioids in managing labour pain to broaden the scope of pain relief methods available to the midwives. , Thesis (MPH) -- Faculty of Health Sciences, 2022
- Full Text:
- Authors: Parkies, Limakatso Elizabeth
- Date: 2022-03
- Subjects: Pharmacology , Anesthesia in obstetrics
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/23567 , vital:58166
- Description: Due to the disabling effects of severe labour pains, labour pain management remains an important topic in midwifery and needs to be reviewed more often. According to studies, various pain relief options, both pharmacological and non-pharmacological, are available to help women cope with pain, but midwives did not employ these techniques adequately because of various experiences. Studies further indicate that, though the limited number of these techniques were employed they were not effective on some women. Thus, the purpose of this research study was to explore and describe midwives’ experiences on pharmacological and non-pharmacological labour pain management in the Lejweleputswa District of the Free State Province. This study employed a qualitative, descriptive, explorative, and contextual design. A purposive sampling technique was used to select the participants. The target population was midwives who work in the maternity wards of the institutions under study with three to five years’ experience in midwifery. Individual, face-face, semi-structured interviews were conducted; these were recorded for the researcher’s reference purposes, so as not to overlook important information. In addition, the researcher made use of field notes, recording in them what was heard, observed, felt, experienced, and thought during the interview. Ethical principles and trustworthiness were maintained throughout this study. Data analysis was done using Tesch’s approach to open coding in qualitative research. Confidentiality and anonymity were ensured throughout the interviews. The nine themes and 19 sub-themes that emerged during data analysis were discussed comprehensively. The findings indicate that midwives use both pharmacological and non-pharmacological methods in managing labour pain. Some methods are effective in relieving pain for certain mothers, while other methods proved ineffective. Midwives administer Pethidine and Phenergan as per doctors’ prescription; non-pharmacological methods, such as back massage, deep breathing exercises, mobilisation, and warm baths or showers are also employed. Midwives provide pharmacological methods to all women in labour, and routinely employ non- pharmacological methods. Although the midwives are willing to manage patients’ pain, they face certain challenges, such as shortage of staff, increased workload, as well as inadequate resources. This leads to inadequate provision of non-pharmacological care. In conclusion, the midwives’ experiences were that both pharmacological and non-pharmacological techniques were used for all labouring women and they had relaxing and calming effects on some women, resulting to them giving birth with ease, although for some they were not effective. In addition, the pharmacological interventions caused drowsiness to some women and babies. The findings will provide evidence-based information to the Free State Department of Health in order to assist policymakers and stakeholders in initiating and developing appropriate policies, guidelines, and interventions that can improve labour pain management. The Free State Department of Health should consider using other opioids and non-opioids in managing labour pain to broaden the scope of pain relief methods available to the midwives. , Thesis (MPH) -- Faculty of Health Sciences, 2022
- Full Text:
Exploration of the factors influencing the upscaling of medical male circumcision targets in selected hospitals in eThekwini District, South Africa
- Authors: Tshabalala, Sandile Clement
- Date: 2022-03
- Subjects: Circumcision
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/22005 , vital:51930
- Description: Medical male circumcision has been shown to reduce female to male HIV transmission. This study was designed to examine the underlying factors responsible for, or influencing, the inability of the health care system to achieve the MMC targets in selected hospitals in KZN. The objective of this study to was explore the challenges that lead to failure of the government to meet set targets, regarding the implementation of the MMC programme in the province of KZN, as perceived by the health care workers. Methodology A mixed quantitative and qualitative study where 150 questionnaires were used and in-depth open-ended interviews were conducted. Participants were from Clairwood and Wentworth hospitals in the district of eThekwini, KwaZulu-Natal. Eighteen healthcare workers (nurse managers, doctors, nurses and counsellors) were purposively selected from the two hospitals. Results Findings showed that poor marketing of MMC, in line with the cultural and religious inclination of the catchment populations, had an effect on the targets. The fear of pain by the male clients came out as the biggest factor followed by the fear of having an HIV test done. The six weeks healing period before indulgence in sexual intercourse had a part to play in the reluctance of clients to do MMC. Some clients feared losing the ability to have an erection post MMC and would therefore not come for MMC. Other contributory factors for failure to reach targets included shortage of staff, poor mobilisation by the staff due to lack of training on how to mobilise and how to market MMC, lack of availability of mobilisation and marketing resources, inadequate and inequitable allocated of resources. Other factors include, lack of incentives for staff to stay in the programme or even within the Department, lack of training, cultural and religious beliefs in the community. The staff also felt that the MMC targets were too high. Notwithstanding, the staff members were willing to learn how to market MMC and to mobilise clients. Clients and community education on the importance of MMC and the combination of this process with good sexual behaviour would improve MMC uptake and reduce HIV prevalence and the incidence. Conclusions The fear of pain, fear to do HIV test and the fear to loose erection were the most prominent reasons why the males would not come for MMC procedure. , Thesis (MPH) -- Faculty of Health Sciences, Public Health, 2022
- Full Text:
- Authors: Tshabalala, Sandile Clement
- Date: 2022-03
- Subjects: Circumcision
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/22005 , vital:51930
- Description: Medical male circumcision has been shown to reduce female to male HIV transmission. This study was designed to examine the underlying factors responsible for, or influencing, the inability of the health care system to achieve the MMC targets in selected hospitals in KZN. The objective of this study to was explore the challenges that lead to failure of the government to meet set targets, regarding the implementation of the MMC programme in the province of KZN, as perceived by the health care workers. Methodology A mixed quantitative and qualitative study where 150 questionnaires were used and in-depth open-ended interviews were conducted. Participants were from Clairwood and Wentworth hospitals in the district of eThekwini, KwaZulu-Natal. Eighteen healthcare workers (nurse managers, doctors, nurses and counsellors) were purposively selected from the two hospitals. Results Findings showed that poor marketing of MMC, in line with the cultural and religious inclination of the catchment populations, had an effect on the targets. The fear of pain by the male clients came out as the biggest factor followed by the fear of having an HIV test done. The six weeks healing period before indulgence in sexual intercourse had a part to play in the reluctance of clients to do MMC. Some clients feared losing the ability to have an erection post MMC and would therefore not come for MMC. Other contributory factors for failure to reach targets included shortage of staff, poor mobilisation by the staff due to lack of training on how to mobilise and how to market MMC, lack of availability of mobilisation and marketing resources, inadequate and inequitable allocated of resources. Other factors include, lack of incentives for staff to stay in the programme or even within the Department, lack of training, cultural and religious beliefs in the community. The staff also felt that the MMC targets were too high. Notwithstanding, the staff members were willing to learn how to market MMC and to mobilise clients. Clients and community education on the importance of MMC and the combination of this process with good sexual behaviour would improve MMC uptake and reduce HIV prevalence and the incidence. Conclusions The fear of pain, fear to do HIV test and the fear to loose erection were the most prominent reasons why the males would not come for MMC procedure. , Thesis (MPH) -- Faculty of Health Sciences, Public Health, 2022
- Full Text:
The contribution of efficient financial management on public health service delivery at King Cetshwayo District in KwaZulu Natal
- Authors: Msane, Sihlesabambo Londiwe
- Date: 2022-03
- Subjects: Public health -- Finance
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/21882 , vital:51839
- Description: The aim of this research is to develop strategies that the DOH could put into place to improve its internal controls in financial management in order to contribute towards service delivery at Ngwelezane, Queen Nandi and Eshowe hospitals within King Cetshwayo District. The study used a mix of qualitative and quantitative study methods, however using one research instrument to collect both qualitative and quantitative data from 37 financial managers in these three hospitals. Data analysis using content analysis (of qualitative data) and percentage frequency analysis (of quantitative date) yielded study findings. This study found that financial managers are fairly competent regarding ‘effective communication’, ‘team work’, and ‘financial leadership’; the study results did not show respondents’ clear comprehension of Auditor General findings and processes followed to implement the recommendations in order to assess internal controls; and findings also indicate that financial managers meet objectives of financial management through cash flow, budget forecasts and expenditure. Developing a framework that will guide and monitor the application of financial strategies with the aim of improving service delivery will involve enhancing financial managers’ knowledge of District and Institution Service Delivery Plans, allocating resources properly and efficiently during the budgeting exercise, establishing internal strategies to maximise accountability and transparency, having fraud prevention strategies in these institution, and putting measures in place to be able to forecast budgetary adverse. It is recommended that the Executive Management facilitates strategic break-away sessions for the financial managers to workshop them on practical ways to improve the efficiency of financial management on public health service delivery, as outlined in this study. , Thesis (MPH) -- Faculty of Health Sciences, 2022
- Full Text:
- Authors: Msane, Sihlesabambo Londiwe
- Date: 2022-03
- Subjects: Public health -- Finance
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/21882 , vital:51839
- Description: The aim of this research is to develop strategies that the DOH could put into place to improve its internal controls in financial management in order to contribute towards service delivery at Ngwelezane, Queen Nandi and Eshowe hospitals within King Cetshwayo District. The study used a mix of qualitative and quantitative study methods, however using one research instrument to collect both qualitative and quantitative data from 37 financial managers in these three hospitals. Data analysis using content analysis (of qualitative data) and percentage frequency analysis (of quantitative date) yielded study findings. This study found that financial managers are fairly competent regarding ‘effective communication’, ‘team work’, and ‘financial leadership’; the study results did not show respondents’ clear comprehension of Auditor General findings and processes followed to implement the recommendations in order to assess internal controls; and findings also indicate that financial managers meet objectives of financial management through cash flow, budget forecasts and expenditure. Developing a framework that will guide and monitor the application of financial strategies with the aim of improving service delivery will involve enhancing financial managers’ knowledge of District and Institution Service Delivery Plans, allocating resources properly and efficiently during the budgeting exercise, establishing internal strategies to maximise accountability and transparency, having fraud prevention strategies in these institution, and putting measures in place to be able to forecast budgetary adverse. It is recommended that the Executive Management facilitates strategic break-away sessions for the financial managers to workshop them on practical ways to improve the efficiency of financial management on public health service delivery, as outlined in this study. , Thesis (MPH) -- Faculty of Health Sciences, 2022
- Full Text:
- «
- ‹
- 1
- ›
- »