4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
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Item Comparing health inequalities in maternal health: An analysis of the South African Demographic and Health Surveys (SADHS) 1998 and 2016(University of the Witwatersrand, Johannesburg, 2023-09) Holden, Celeste Claire; Blaauw, DuaneBackground: Inadequate access to maternal health services (MHS) is directly linked to maternal and neonatal mortality and morbidity. South Africa (SA) is known to be an unequal society. Researching and documenting the utilisation and access to MHS can assist in the appropriate redirection of services to ensure equitable service delivery. The study identifies differences in MHS access between ethnicity groups, residence, province, maternal education level and household wealth quintile. The study quantifies the inequalities in access to MHS in SA in 1998 and 2016, and then evaluates the change in inequalities between the two periods. Methods: Data was analysed from the 1998 and 2016 South African Demographic and Health Surveys. First. the study identifies differences in MHS access between ethnic groups, residence, province, maternal education level and household wealth quintile using regression analyses. Then, the inequalities related to access of MHS in 1998 and 2016 are calculated using the relative (RII) and slope (SII) index of inequality and the concentration index (CI). Lastly, the inequalities between 1998 and 2016 were compared using generalised linear models, indicating whether inequalities increased, decreased, or remained the same. All analyses were done in Stata and adjusted for the multistage-stratified sampling of the surveys. Results: Utilisation of MHS in SA varies between different groups based on ethnicity, residence, province, mothers’ education level, and wealth quintile. In 1998 and 2016, Black/African women have the least utilisation of all MHS. A clear pattern is seen where women with higher education and high wealth quintile, have increased MHS utilisation. In most cases, the inequalities narrowed between 1998 and 2016 for all MHS. However, inequalities are still present in 2016 for many MHS. For example, using simple inequality measures, the largest inequalities in 2016 are seen between women of different ethnicities accessing four or more antenatal visits (ANC4), where there is a 11.1 percentage point difference between the highest group (White & Indian/Asian) and the lowest group (Black/African). For complex inequality measures, there are still significant relative and absolute inequalities in antenatal visits in 2016 for maternal education (RII: 1.25; SII: 1.14) and household wealth quintile (RII: 1.23; SII: 1.11). Conclusions: Between 1998 and 2016, population-level utilisation to MHS increased in all MHS and the majority of within group inequalities narrowed over time. However, inequalities still exist in all maternal health outcomes. SA has implemented multiple programmes and policies to address inequalities in MHS and decrease maternal mortality and morbidity. However, these need to be continuously monitored and evaluated based on the latest data to ensure that efforts are going towards addressing the specific groups where inequalities are still present.Item Maternal and fetal outcomes in women with prolonged ‘latent phase of labour’ at Chris Hani Baragwanath Academic Hospital(2024) Rubushe, BongiBackground The recommended management of pronged latent phase of labour in South Africa is augmentation or delivery by caesarean section. A retrospective cohort study conducted at Chris Hani Baragwanath Academic Hospital in 2002 showed that prolonged latent phase of labour compared to normal labour was associated with an increase in caesarean sections (29% vs. 6%), and poor neonatal outcome compared to women without a prolonged latent labour. However they were unable to state whether the poor outcome was due to a prolonged latent labour. Recently larger studies have shown that the latent phase of labour may be a long as 24 hours with good maternal and neonatal outcomes. Objectives: The main objective of this study was to describe the maternal and neonatal outcomes as well as the labour performance in women with prolonged latent phase of labour at CHBAH. Methods The study was a descriptive, retrospective cohort study of pregnant women conducted at CHBAH from June 2016 – May 2017. These were women who were referred to CHBAH with prolonged latent phase of labour. They were term, must have had at least 2 per vaginal exams, <6 cm dilated at admission with a neonatal weight of more than 2000g, a normal foetus and an unscarred uterus. Results There were 89 women that were included in the study. The median time to reach full dilatation was 14.4 hours (IQR 9.5 – 23.9). The median time between one cm of dilatation to the next was more than 1 hour. A total of 60 (68.2%) women had a normal vaginal delivery and 28 (31.8%) were delivered by caesarean section, with 75.8% being for foetal distress. Two women had pyrexia and 12 had a tachycardia in the postpartum period. One woman sustained a 4th degree perineal tear and had a PPH requiring admission to ICU. There were no neonates born with an APGAR less than 7 at 5min. Neonatal resuscitation was performed in 6.7% of the neonates and 7.9% of the total neonates were admitted. There were no neonatal deaths. Conclusion This study should be considered as a pilot in the study of labour patterns. The caesarean section rate is lower than what is expected at this institution and no neonates were born with an APGAR of less than 7 at 5 minutes. This may be because of better fetal monitoring with better resources in 2016. However, women who have prolonged latent phase of labour should be monitored adequately.