Barriers to Obstetric Care among Maternal Near Misses

Background. There are several factors in the healthcare system that may influence a woman's ability to access appropriate obstetric care.Objective. To determine the delays/barriers in providing obstetric care to women who classified as a maternal near-miss. Methods. This was a descriptive observational study at Steve Biko Academic Hospital; a tertiary referral hospital in Pretoria; South Africa. One hundred maternal near-misses were prospectively identified using the World Health Organization criteria. The 'three-delays model' was used to identify the phases of delay in the health system and recorded by the doctor caring for the patient.Results. One or more factors causing a delay in accessing care were identified in 83% of near-miss cases. Phase I and III delays were the most important causes of barriers. Lack of knowledge of the problem (40%) and inadequate antenatal care (37%) were important first-phase delays. Delay in patient admission; referral and treatment (37%) and substandard care (36%) were problems encountered within the health system. The above causes were also the most important factors causing delays for the leading causes of maternal near-misses - obstetric haemorrhage; hypertension/pre-eclampsia; and medical and surgical conditions.Conclusions. Maternal morbidity and mortality rates may be reduced by educating the community about symptoms and complications related to pregnancy. Training healthcare workers to identify and manage obstetric emergencies is also important. The frequency of antenatal visits should be revised; with additional visits in the third trimester allowing more opportunities for blood pressure to be checked and for identifying hypertension

Kwazulu-Natal Minibus Taxi Drivers' Perceptions on HIV and AIDS: Transmission; Prevention; Support and Effects on the Industry

In South Africa; the minibus taxi drivers are largely becoming another high-risk category in the HIV and AIDS epidemic. Although previous studies have shown that knowledge of HIV and AIDS is relatively high among the taxi drivers it is still not clear how this sub-population perceive the support rendered to them with regard to HIV and AIDS prevention strategies. This study aimed to focus on this atypical workplace and explore the KwaZulu-Natal; minibus taxi drivers' perceptions on HIV and AIDS. In this study; qualitative methods were utilized to determine the minibus taxi drivers' understanding of HIV and AIDS infection; HIV prevention strategies; existing support strategies and effects of HIV and AIDS on the taxi industry. Focus-group discussions were conducted; to collect data. The results showed that even though the taxi drivers had some understanding on HIV and AIDS there was still a dire need for interventions that were geared towards addressing HIV-related needs of the drivers in this industry

Cervical Cancer Screening in Urban Clinics in eThekwini Municipal Area

Cancer of the cervix is a significant burden on women's health throughout the world despite it being a largely preventable disease. In South Africa; the launch of the National Guideline on Cervical Cancer Screening in 2000 aimed to reduce the incidence of cervical cancer in the country. The aim of this research is to review the status of cervical screening in clinics of eThekwini municipal area in Durban; KwaZulu- Natal; South Africa. A cross-sectional; descriptive study of clinics involving 22 nurses working in fixed clinics offering cervical screening in the eThekwini municipal area was carried out. Interviews were conducted with professional nurses from the clinics using a semi-structured questionnaire. Questions focused on the availability of resources to implement cervical screening; nurses' knowledge; attitudes and beliefs towards cervical screening. Interview data were verified and complemented by direct observation of screening facilities. The equipment in the clinics was always adequate for taking cervical smears. No patient education material was available to promote cervical screening or provide information about cervical cancer. The median number of women screened was 20 per month in accordance with a quota system currently in place. When given a hypothetical cytology result to interpret; 27of nurses identified the correct management regimen; 64recognised that they needed more training in the interpretation of cytology results. Most cervical screening in the clinics was done for diagnostic reasons rather than as population-based screening. Barriers to effective cervical screening included: insufficient nursing staff; a quota system limiting the number of smears that could be taken and inadequate patient educational material on cervical cancer