Community-based postnatal care model: Catalyst for management of mothers and neonates.

BACKGROUND:  Early postnatal discharge is perceived as a factor that contributes to the possibilities of the maternal, neonatal complications and deaths. The implementation of the community-based postnatal care model is crucial to mitigate the morbidity and mortality of postnatal women and neonates during the first weeks of delivery. A community-based postnatal care model was developed for the management of neonates during the postnatal care period in the community. OBJECTIVES:  The study aims to share the developed community-based postnatal care model that could assist postnatal women in the management of neonates. METHOD:  Empirical findings from the main study formed the basis for model development. The model development in this study was informed by the work of Walker and Avant; Chinn and Kramer Dickoff, James and Wiedenbach; and Chinn and Jacobs. RESULTS:  The results indicated that there was no community-based postnatal care model developed to manage neonates. The model is described using the practice theory of Dickoff, James and Wiedenbach elements of agents, recipients, context, process, dynamics and outcomes within the community context of the postnatal care period. The model was further described by Chinn and Krammer following the assumptions of the model, concept definition, relation statement and nature of structure. CONCLUSION:  The utilisation of the model is critical and facilitates the provision of an enabling and supportive community-based context by primary caregivers for the effective management of neonates.Contribution: This study provides a reference guide in the provision of community-based postnatal care by postnatal women after discharge from healthcare facilities.

The impact of DNA methylation as a factor of Adverse Pregnancy and Birth Outcomes (APBOs): a systematic review protocol.

BACKGROUND: Deoxyribonucleic acid (DNA) methylation is one of the epigenetic modifications that has gained a lot of interest as a factor influencing fetal programming and as a biomarker for adverse pregnancy and birth outcomes (APBOs). Epidemiological studies have demonstrated that DNA methylation can result in adverse pregnancy and birth outcomes (APBOs) including miscarriage, intrauterine growth restriction (IUGR), low birth weight (LBW), sepsis, and preterm birth (PTB), which may later result in diseases in adulthood. However, the mechanism by which DNA methylation influences these APBOs remains unclear. The systematic review will assess the association between global and gene-specific DNA methylation with adverse pregnancy outcomes. METHOD: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 checklist will be followed when conducting this systematic review. To develop the search strategy the PI(E)COS (population, intervention/exposure, comparator/control, outcome, and study designs) framework will be followed. Thus far, the research team has retrieved 4721 from Cochrane Library, PubMed, Web of Sciences, and MEDLINE. Out of these, 584 studies have been screened for eligibility, and approximately 124 studies meet the inclusion criteria. Pending the search results identified from the grey literature. For identification of unpublished studies in journals indexed in electronic databases, Google Scholar will be used. I.M and A.S will separately extract data from the articles and screen them, if there are any disagreements between I.M and A.S, then the L.M will resolve them. The methodological quality and bias risk of the included studies will be evaluated using the Critical Appraisal Skill Programme CASP) checklist. [Formula: see text] and [Formula: see text] alpha = 0.10 statistic will be used for assessing statistical heterogeneity between studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will be used to assess and grade the overall quality of extracted data. ETHICS AND DISSEMINATION: Ethical approval is not required. The systematic review will assess available literature on possible associations between DNA methylation with adverse pregnancy and birth outcomes (APBOs) including LBW, IUGR, miscarriage, sepsis, and PTB. The findings could help guide future research assessing DNA methylation and other APBOs. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRCRD42022370647.

Concept analysis: Community-based postnatal care.

BACKGROUND:  Community-based postnatal care is a valuable resource in the provision of maternal and neonatal care, specifically outside the hospital environment. However, its application in maternal and neonatal care is not clearly documented in relation to the rendering of services by primary caregivers. OBJECTIVES:  This study clarifies the concept of 'community-based postnatal care' by using the concept analysis method. METHOD:  To analyse the concept, relevant literatures were reviewed and analysed using the Walker and Avant method, namely, selecting a concept, determining the purpose of analysis, identifying all uses of the concept, defining attributes, identifying a model case, identifying borderline, related and contrary cases, identifying antecedents and consequences and identifying the empirical referents. Characteristics that repeatedly appeared throughout the literature were noted and categorised. RESULTS:  It was established from the concept analysis that 'community-based postnatal care' was complex and experienced ethnically. The analysis included that primary caregiver participation was based on home-levelled-skilled care, community participation and mobilisation, linkages of health services and community stakeholders. The attributes were influenced by antecedents and consequences. CONCLUSION:  The empirical referents of community based can be integrated within the midwifery guidelines to measure the concept. When concepts are understood, self-care on early detection, early management and referral during early postnatal care will be enhanced.Contribution: The results of this study will foster independence, confidence and a respectful relationship between primary caregivers and the health care facility staff. The results are expected to guide future research and enhance community-based postnatal care in midwifery practice.

Support needs of parents with preterm infants at resource-limited neonatal units in Limpopo province: A qualitative study.

BACKGROUND:  Preterm birth is often unexpected and life-threatening for the baby and/or the mother. When admitted to the hospital, midwives need to provide informational, instrumental, psycho-cultural and emotional support to enhance post-discharge care. OBJECTIVES:  This study aimed to explore and describe the support provided to parents of preterm infants in preparing for post-discharge care. The study was conducted in three district hospitals in the Mopani district, South Africa. METHOD:  A qualitative approach wherein explorative, descriptive and contextual designs were used. A non-probability, convenience sampling was used to select 23 midwives who were working in the maternity unit for at least 2 years. Data were collected through in-depth individual semi-structured interviews until data saturation was reached. The data were analysed through Tesch's open coding method. Trustworthiness was ensured through credibility, transferability and confirmability. Ethical principles adhered to were: informed consent, beneficence, right to self-determination, confidentiality and anonymity. RESULTS:  The findings revealed that parents need informational, instrumental direct supervision, and psycho-cultural and emotional support during preparation for discharge. CONCLUSION:  Parents were unsure of their ability to care for the preterm infants after discharge and manage their own needs. The provision of informational, instrumental, psycho-cultural and emotional support needs would play a vital role in their ability to cope with their parental roles and the relationship with their infant.Contribution: The support provided to parents could build parental confidence and act as an integral part of neonatal follow-up programmes.

Perceived Consequences of COVID-19 Restrictive Visitation Policy on Family Members at Rural Hospitals in Vhembe District: A Qualitative Study.

From a public health standpoint, a stringent visitation policy was necessary during the COVID-19 pandemic, but it had unforeseen communicative and emotional health consequences for family members. This study explored family members' experiences regarding implementing a restricted visitation policy when a patient was admitted with COVID-19 at public hospitals in the Vhembe district. Researchers used an exploratory, descriptive, and contextual qualitative technique. Twelve family members made up the population. Unstructured telephone interviews were used to obtain the data, and open coding was used to analyse data. Ethics were consistently followed. Before taking part, participants provided verbal informed consent, acknowledging that they could withdraw from the study if necessary. Three themes emerged: inadequate measures for temporary communication channels and techniques, the mental health effects of COVID-19 admission, and poor/lack of standardised visitation policy during the COVID 19-pandemic. There was a need to balance safety from contracting COVID-19 infection and promoting family-centred care. Virtual visits through telecommunication solutions could reduce fear and anxiety as the family could be updated on the progress of the hospitalised relative. Alternatively, hospital managers must allocate a dedicated person in the unit to update families when they call and enquire about the conditions.

Factors Related to the Implementation of Preconception Care Recommendations in Selected Districts of Limpopo Province: A Qualitative Study.

Preconception care (PCC) is the provision of biomedical, behavioural, and social health interventions to women and couples before they fall pregnant. The World Health Organization (WHO) developed PCC recommendations in 2013, which were included in the South African maternity care guidelines in 2016. The purpose of PCC is to lessen behaviours and environmental factors leading to maternal ill-health, thus reducing maternal and perinatal mortality rates. OBJECTIVE: To determine the implementation of PCC recommendations at health facilities in the selected districts of Limpopo Province and the associated factors. METHODS: A qualitative exploratory design was used. Nonprobability, purposive sampling was used to sample 29 professional nurses (PNs), and 51 women of childbearing age (WCBA) (19-35 years) from clinics and community health centres (CHCs). Data were collected through in-depth interviews with the professional nurses and focus group discussions with the WCBA. Data analysis was performed through open coding. Measures of trustworthiness were adhered to. Permission to conduct the study was obtained from relevant stakeholders, participation was voluntary and participants signed a consent form prior to data collection. RESULTS: The findings of the study revealed that there was partial implementation of the PCC recommendations in the selected districts of Limpopo Province, PCC provision was dependent on clients' initiation, a knowledge gap regarding PCC recommendations was identified from the professional nurses, and a lack of awareness regarding PCC from the WCBA. CONCLUSION: The preconception period is an important determinant of the pregnancy outcome; therefore, focus should be redirected to the pre-pregnancy period and not only to when the woman is already pregnant. However, to achieve this, professional nurses and WCBA should be empowered regarding PCC and its benefits.

Midwives' Voices on Early Initiation of Antenatal Care Following a Positive Gravindex Test: A Qualitative Study.

Background: Early Antenatal Care (ANC) initiation is aimed at improving maternal and perinatal health outcomes through the identification of complications and determining the level of care needed. This study aimed to determine the voices of midwives on the provision of early initiation of ANC following positive gravindex. Materials and Methods: The phenomenology approach underpinned the study. The participants included midwives providing ANC at health facilities under Tshino-Mutsha local area in May-December 2020. Nonprobability, purposive sampling was used to select four clinics and to sample 20 midwives. Semistructured face-to-face, in-depth interviews were conducted using an interview guide. Data saturation was reached at Participant 15; however, the researcher continued until Participant 20. Trustworthiness was ensured and ethical principles were adhered to. Data analysis was done using Tesch's open coding approach. Results: Two themes and seven subthemes emerged, as challenges related to the provision of midwifery practice and to pregnant women. The seven subthemes were the shortage of resources, poor support of midwives, poor adherence to the available protocol for the provision of ANC, blaming of midwives by management and community, late ANC booking by pregnant women, denial of pregnancy by young women ignorance leading to a general resistance to ANC instructions, hence late booking. Conclusions: It was concluded that shortage of human and material resources hindered the initiation of early ANC to detect, prevent, and manage the existing and potential causes of maternal and newborn mortality and morbidity.

Early Postnatal Care: Exploring Primary Caregivers' Experiences of Continuity of Care After Discharge at Selected Districts in Limpopo Province South Africa.

Background: Early postnatal discharge is perceived as a factor that contributes to possible maternal, neonatal complications and deaths during the first week of delivery. Continuing with provision of home-based postnatal care by the primary caregivers is crucial to prevent morbidity and mortality. Purpose: The purpose was to explore the experiences of primary caregivers of continuing with the provision of early postnatal care at home. Method: A qualitative research approach, which was explorative, descriptive, and contextual was conducted in the three selected districts of different ethnic groups at Limpopo Province in October 2019. A non-probability, purposive sampling was used to conveniently sample 20 primary caregivers of postnatal women. Data were collected during the first 2 weeks of delivery through in-depth individual semi-structured interviews until data saturation was reached. Data were analysed through a thematic analysis framework applying Tesch's open coding method. The study was done in Limpopo district, South Africa. Findings: The findings revealed a theme, namely, knowledge and skills of providing community-based postnatal care and three sub-themes; early postnatal care to detect and prevent possible complications to the mother; general postnatal care, and early neonatal care to detect and prevent possible complications. Conclusion: Primary caregivers displayed acceptable indigenous skills and knowledge of providing early postnatal care. However, the skills of detecting potential danger signs were not adequately displayed. It was recommended that midwives need to create awareness to primary caregivers from the antenatal through postnatal care period. Community Health Workers to assist during immediate postnatal check-ups (mother and neonate) which is done within 72hours of delivery. The health education, counseling, and community-based awareness campaigns are to be done with a focus on the detection and prevention of possible complications to mother and baby.

Health literacy of mothers on factors associated to pre-rupture of membranes on perinatal outcomes in Vhembe district, South Africa.

Pre-rupture of membranes prior labour initiation could complicate approximately 5% of pregnancies and could be associated with a high incidence of perinatal morbidity and mortality complications. The major complications could be chorioamnionitis and cord compression resulting in hypoxia. This study aimed to assess the health literacy of mothers on perinatal outcomes following pre-rupture of membranes at Thulamela B clinics of Vhembe district. A quantitative research approach with a cross-sectional descriptive design was used. The study population comprised a total of 210 lactating mothers within 6 weeks following delivery, irrespective of the mode of delivery were purposively selected. Data were collected by the researchers through self-administered questionnaires. The Statistical Package for Social Sciences (SPSS) version 25 was used for data analysis. The results are presented in the form of tables and graphs based on probability allowing judgment to be made on variables. Validity and reliability were ensured. Ethical clearance was obtained from the University of Venda Research Ethics Committee and permission to access health facilities from the Limpopo Province Department of Health. Findings revealed that limited and inadequate health literacy towards pre-rupture of membranes contributes to perinatal morbidity and mortality, with associated factors like poor antenatal care attendance, delayed health seeking, defaulting, and loss of follow-up. Recommendations to emphasise the provision of preconception and antenatal care where health information on risks and danger signs of PROM to perinatal outcomes are given were made.

Provision of Care to Preterm Infants at Resource Limited Health Facilities of Mopani District, South Africa.

Background: Inadequate neonatal facilities in rural areas is one of the challenges affecting the management of preterm infants. In low income countries with limited resources, over 90% of preterm babies die within few days of life. Purpose: The purpose of this study was to describe the challenges encountered by midwives when providing care to preterm infants at resource limited health facilities in Limpopo Province, South Africa. Methods: Qualitative research approach, using exploratory and descriptive design was used. Non-probability purposive sampling was used to select twenty three midwives who had an experience of two or more years in maternity. Data was collected using unstructured individual interviews, which were voice recorded and transcribed and data analysed qualitatively through the open-coding method. Findings: Revealed one theme, preterm condition and expected care; with sub-themes namely; perceived causes of preterm complications and deaths, preterm babies experience several difficulties which need specialised care, the need for constant individualised care and monitoring of preterm infants by midwives, functional relevant equipment needed for care of preterm infants, a need for constant training for midwives regarding care of preterm infants, and importance for a proper structure to house preterm infants which will lead to quality care provision. Conclusion: Preterm babies need simple essential care such as warmth, feeding support, safe oxygen use and prevention of infection. Lack of adequate resources and limited skills from midwives could contribute to morbidity and mortality. Health facility managers need to create opportunities for basic and advanced preterm care to equip the skills of midwives by sending them to special trainings such as Limpopo Initiative Neonatal Care (LINC), Helping Baby Breath (HHB) and Neonatal Intensive Care Unit (NICU). Operational managers should be involved in the identification, procurement and supply of required equipment. Continuous health education should be provided on the mothers about kangaroo mother care (KMC) and measures to prevent infections in the neonatal unit.

Factors affecting integration of midwifery nursing science theory with clinical practice in Vhembe District, Limpopo Province as perceived by professional midwives.

BACKGROUND: Professional midwives have an important role to play in midwifery training to produce a competent midwife. According to the social learning theory, professional midwives act as role models for students. When allocated for clinical learning experiences in the training hospitals, students will have the opportunity to observe the well-trained, skilled, and experienced professional midwives. The whole process will enable students to integrate theory with practice and they will become competent. AIM: The aim of this study was to determine the factors affecting integration of midwifery nursing science theory with clinical practice as perceived by midwives. SETTING: The study was conducted at the training hospitals in Vhembe district of the Limpopo Province, South Africa. These hospitals were: Donald Fraser, Siloam, and Tshidzini. METHODS: A qualitative explorative, descriptive and contextual design was used. A Nonprobability, convenient sampling method was used to select 11 midwives from the following hospitals: Donald Fraser, Siloam, and Tshidzini, in Vhembe district. In-depth individual interviews were conducted. Data were analysed through open coding method. RESULT: One theme and five sub-themes emerged from the analysed data, namely: shortage of midwives, attitudes towards student midwives, reluctance to perform teaching functions, language barriers, and declining midwifery practice standards. CONCLUSION: Shortage of midwives in the clinical areas led to fewer numbers of mentors whom the students could observe and imitate to acquire clinical skills. Some of the midwives were reluctant to teach students. Recommendations were made for both training institutions and hospitals to employ preceptors for students in the clinical practical.