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 For identification of unpublished studies in journals indexed in electronic databases, Google Scholar will be used.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.

Mentorship during transition period: a challenge for newly qualified midwives in Limpopo province of South Africa.

Background: Mentorship is a process in which structured support is provided to new graduates of the profession to facilitate theireffective transitional journey to professional autonomy. Objectives: To explore and describe the mentoring process as experienced by newly qualified midwives and experienced midwives during thetransition period. Methods: Aqualitative approach was used. Five hospitals were selected from Limpopo province. The study was conducted in a maternity unit of each selected hospital. Population comprised of all newly qualified midwives as well as all experienced midwives working at institutions under study. Non-probability, purposive sampling method was used to select twenty-five newly qualified and twenty-five experienced midwives working in maternity wards of selected hospitals. In-depth face-to-face interviews were conducted for data collection. Results: Ineffective mentoring processes were reported, where only a few experienced midwives seemed ready to provide informal and unstructured support to graduates. Experienced midwives recognised their mentoring role however, felt they did not have sufficient knowledge and skills regarding mentoring process. Shortage of staff and increased workload were reported as challenges which negatively affected the mentoring process. Conclusion: Mentoring is an effective process for facilitation of graduates' transition process to become registered autonomous midwifery practitioners. However, they were not effectively mentored; consequently, negatively affecting their development to professional maturity.

Managers' support on implementation of maternal guidelines, Limpopo province, South Africa.

BACKGROUND: The report of Saving Mothers indicated a decline of maternal mortality from 12.8% to 12.5% last triennium of 2017. This shows that regardless of availability of national maternal health guidelines, midwives and managers, 25% of maternal deaths were caused by preventable and avoidable factors. As such, support provided by managers is vital in promoting the utilisation of maternal guidelines. OBJECTIVES: The objective was to determine the support offered by managers to midwives during the implementation of maternal health guidelines. METHOD: The study design was cross-sectional descriptive in a quantitative domain. Simple random sampling was used to select 58 operational managers and two maternal managers. Data were collected using self-administered questionnaires and analysed using Statistical Package for Social Sciences version 23. Descriptive statistics provided by Microsoft Excel in the form of charts was used to describe data. Pearson's correlation test was used to describe relationships amongst variables. RESULTS: The results revealed that 83.3% respondents indicated a shortage of staff to attend pregnant women. Fifty-six per cent of managers indicated that shortage of material resources contributed to substandard implementation of maternal guidelines. Supervision and monitoring of implementation of maternal guidelines was difficult as indicated by 53.3%, and 63.3% indicated lack of supervision. CONCLUSION: Limited support in terms of monitoring and supervision by managers was strongly indicated as having a negative effect on implementation of maternal guidelines. Capacity building was offered; however, shortage of resources led to poor implementation of maternal guidelines by midwives.

Cultural Factors Contributing to Maternal Mortality Rate in Rural Villages of Limpopo Province, South Africa.

INTRODUCTION: The understanding of the link between cultural affairs and maternal health is critical to save the lives of women. The South African maternal mortality rate (MMR) target for 2015 was 38/100,000 live births. In 2017, South Africa had 1,222 maternal deaths. The purpose was to determine the perceived cultural factors contributing to MMR in rural villages in Mopani District. METHODS: This qualitative research and non-probability purposive sampling was used to select participants who met the inclusion criteria. Thirty women, age 40 years and above childbearing age, who had given birth in their lifetime, were sampled. Data were collected through in-depth individual interviews at the women's homes. Probing to elicit more information was conducted focusing on hemorrhage, hypertension and risk of contracting human immunodeficiency virus (HIV). Data were analyzed through open coding methods. Trustworthiness was ensured by Guba and Lincoln's criteria, credibility, dependability, confirmability, and transferability. RESULTS: From the study three themes emerged from the data as cultural factors relating to heavy, red post-delivery bleeding perceived as cleaning-out of the womb. With hypertension, gaining weight rapidly before the 20th week of gestation not reported as a pregnancy was still culturally concealed. Contracting HIV, women were exposed to unsafe sex practices due to cultural expectations of having children as a sign of femininity. DISCUSSION: The formulation of culture congruent interventions to promote good and acceptable cultural practices that cannot harm the physical and mental status of women was recommended to reduce unplanned deaths among them.

Managing hypertensive disorders during pregnancy in low resource settings.

Background: Maternal deaths caused by hypertensive disorders are preventable. The purpose was to assess midwives' perceived knowledge and skills on the implementation of maternal health guidelines when managing hypertensive disorders during pregnancy. Methods: Quantitative, cross-sectional method was used. Population comprised of 200 midwives. Data was collected through self-report questionnaires and analysed through Statistical Package for Social Sciences 24. Results: Midwives (63.5%) possessed knowledge and skills of implementing maternal guidelines. While 77.5% experienced shortage of human and material resources. Non-compliance to ambulance services led to delayed initiation of treatment. Recommendations: Continuous in-service training and education must be conducted. More resources to be provided to implement guidelines accurately.

Challenges of primary healthcare nurses regarding the integration of HIV and AIDS services into primary healthcare in Vhembe district of Limpopo province, South Africa.

BACKGROUND:  Integration of human immunodeficiency virus and acquired immune deficiency syndrome (HIV and AIDS) services into primary healthcare (PHC) is a key public health approach to achieving universal access to antiretroviral therapy (ART). Despite the government's efforts of integrating HIV services into PHC, an insufficient number of PHC staff and inadequate infrastructure are challenging when integrating HIV and AIDS services into PHC. This study explored the challenges of PHC nurses regarding the integration of HIV and AIDS services into PHC. OBJECTIVES:  The aim of the study was to explore the challenges of PHC nurses regarding the integration of HIV and AIDS services into PHC. METHOD:  An exploratory, descriptive and contextual qualitative research design utilising face-to-face semi-structured interviews was conducted with 12 PHC nurses from selected clinics and health centres in the Vhembe district of Limpopo province. RESULTS:  Two main themes emerged from data analysis which included challenges related to healthcare recipients and challenges related to healthcare providers. CONCLUSION:  Clear policies on the integration of HIV and AIDS services into PHC should be available and should include strategies to promote HIV testing and counselling, adherence to ART and scheduled appointments, disclosure of HIV status as well as revising the human resource policy to reduce workload.

Beliefs and practices of diabetic patients in Vhembe district of Limpopo Province.

BACKGROUND: Diabetes mellitus (DM) is a chronic condition affecting over 18 million people worldwide. It can lead to debilitating complications and premature death if not effectively controlled. South Africa, like any sub-Saharan countries and the world at large, is no exception. The prevalence of diabetes among South African adults has increased by 50% from 2009 to date, and an increase of some 11 million new diabetes diagnoses is expected by the year 2020. PURPOSE: The purpose of this study was to describe the beliefs and management practices of patients with DM in Vhembe district, Limpopo province. SETTING: The study was conducted at Vhembe district clinics. METHODS: A probability, purposive sampling was used to sample 100 diabetic patients. Data were collected using a pre-tested questionnaire. Data were analysed using the Statistical Package for Social Sciences version 19.0. Descriptive statistics, frequencies, and percentages were used to summarise the data from the study. RESULTS: The majority of the respondents had poor management practice of feet care and annual eye examinations. Twenty four (24.0%) of the respondents believed that DM can be cured and 22 (22.0%) did not believe that diet helps in the management of DM. CONCLUSION: The belief that DM is curable can have a negative effect as patients can quit taking treatment once the disease is under control. This happens irrespective of the national guidelines for the management of DM. Therefore, some strategies should be sought that could enhance the implementation of the guidelines in order to combat the disease.

Factors influencing weight control practices amongst the adolescent girls in Vhembe District of Limpopo Province, South Africa.

BACKGROUND: The incidence of overweight is increasing amongst adolescents in many countries around the world. Healthy and unhealthy weight control practices are common amongst overweight and non-overweight adolescents. AIM: The aim of this study was to explore factors influencing weight control practices amongst adolescent girls. SETTING: The study was conducted at selected secondary schools of Vhembe District of Limpopo Province, South Africa. METHODS: A qualitative, exploratory, descriptive and contextual design was used. Nonprobability, purposive sampling was used to select adolescents who are practicing weight control. In-depth interviews were conducted with 30 participants. Data were analysed according to Tesch's open-coding method. RESULTS: This study revealed that adolescent girls are influenced by a variety of factors to control their weights. These included individual factors, such as body image dissatisfaction; family factors, caused by parental criticism about adolescent weight; and environmental factors, which contain peer group endorsement of dieting. CONCLUSION: Adolescents are exposed to many unhealthy weight control practices, as a way of controlling excess weight. So it is of importance for healthcare providers to make them aware of healthy practices.