Dissertations / Theses on the topic 'Newborn infants Victoria Mortality'

Multivariate statistical methods, including recent computing-intensive techniques, are explained and applied in a medical sociology context to study infant death in relation to socioeconomic risk factors of households in Sri Lankan villages. The data analyzed were collected by a team of social scientists who interviewed households in Sri Lanka during 1980-81. Researchers would like to identify characteristics (risk factors) distinguishing those households at relatively high or low risk of experiencing an infant death. Furthermore, they would like to model temporal and structural relationships among important risk factors. Similar statistical issues and analyses are relevant to many sociological and epidemiological studies. Results from such studies may be useful to health promotion or preventive medicine program planning. With respect to an outcome such as infant death, risk groups and discriminating factors or variables can be identified using a variety of statistical discriminant methods, including Fisher's parametric (normal) linear discriminant, logistic linear discrimination, and recursive partitioning (CART). The usefulness of a particular discriminant methodology may depend on distributional properties of the data (whether the variables are dichotomous, ordinal, normal, etc.,) and also on the context and objectives of the analysis. There are at least three conceptual approaches to statistical studies of risk factors. An epidemiological perspective uses the notion of relative risk. A second approach, generally referred to as classification or discriminant analysis, is to predict a dichotomous outcome, or class membership. A third approach is to estimate the probability of each outcome, or of belonging to each class. These three approaches are discussed and compared; and appropriate methods are applied to the Sri Lankan household data. Path analysis is a standard method used to investigate causal relationships among variables in the social sciences. However, the normal multiple regression assumptions under which this method is developed are very restrictive. In this thesis, limitations of path analysis are explored, and alternative loglinear techniques are considered.
Science, Faculty of
Statistics, Department of
Graduate

The issue of child mortality is currently under international spotlight, as the rates of neonatal and under five mortality are sobering. „About 29,000 children under the age of five [approximately] 21 each minute die every day, mainly from preventable causes‟. Although there has been a decline in global child mortality rates since 1990, sub-Saharan Africa still has the highest rates, where one child in eight dies before age five. As contained in the Millennium Development Goals (MDGs) 2010 report, in 2008, sub-Saharan Africa bore half of the 8.8 million deaths in children under five.
Thesis (LLM (Human Rights and Democratisation in Africa))--University of Pretoria, 2012.
http://www.chr.up.ac.za/
nf2012
Centre for Human Rights
LLM

Undernutrition in prevalent in Aboriginal communities, in utero, infancy and childhood. It influences childhood morbidity and mortality and growth patterns. Undernutrition and poor socio-economic status also contribute to endemic and epidemic infectious disease, including scabies and streptococcal infection. It has been suggested that early undernutrition, and streptococcal and scabies infection are risk factors for renal disease, which is at epidemic levels and increasing. This thesis examines the prevalence of undernutrition in newborns and infants in an Aboriginal community over time, and its impact on childhood growth and child and adult renal markers. The association between skin lesions, streptococcal serology, post-streptococcal glomerulonephritis (PSGN) and renal markers as evaluated through a community wide screening program in 1992-1995 is also examined. Birthweights have increased since the 1960s, but they are still much lower than the non-Aboriginal values. Weights in infancy have decreased since the 1960s. At screening in childhood stunting was common, reflecting the presence of long-term poor nutrition in infancy. In both adults and children, birth weight and infant weights were negatively associated with albuminuria measured by the albumin to creatine ratio (ACR).

Thesis (MMed)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Objective: The aim of the study was to determine the outcome of critically ill neonates and children admitted to a general intensive care unit in a large regional hospital (Worcester) in the Western Cape. A secondary aim of the study was to determine the risk factors for death in these neonates and children. Methodology: This was a retrospective descriptive survey of all paediatric admissions (under 13 years of age; July 2008 till June 2009) to an intensive care unit at a large regional hospital in Worcester, South Africa. Data collected included: demography, admission time, length of stay, diagnoses, interventions and outcome. Outcome was defined as successful discharge, death or transfer to a central hospital. Results: There were 194 admissions including children and neonates. The files of 185 children and neonates were analysed, while 8 children were excluded due to incomplete data set and one patient was a surgical admission. The male: female ratio was 1.3: 1 and the majority of patients (83%) admitted, were younger than 12 months of age at admission with a mean age of 8.5 months (median age 3.7 months; range 0 to 151 months). The majority (70%) of admissions were successfully discharged, nearly a quarter (24%) transferred to central hospitals in Cape Town and only 6% died (all younger than 5 years of age). Causes of death included acute lower respiratory tract infections (33%), acute gastroenteritis (25%), birth asphyxia complicated by pulmonary hypertension (16%) and prematurity (16%). Patients requiring airway assistance, were more likely to experience an adverse event (p=0.0001) and invasive ventilation was associated with an increased risk for a poor outcome (p=0.00). Conclusion: The majority of children requiring access to a paediatric ICU are younger than one year of age. The common causes of death are acute lower respiratory tract infections, acute gastroenteritis, prematurity and neonatal asphyxia. A regional hospital in South Africa should offer intensive care to children as the majority of their admissions can be successfully cared for without transfer to tertiary hospitals. To our knowledge, this is the first study reporting admissions and outcome of neonates and children cared for in a mixed intensive care unit in a large regional hospital in South Africa. This study suggests that large regional hospitals in South Africa should have mixed intensive care units to improve child survival.

Thesis (PhD)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: When estimating the covariance matrices of two or more populations, the covariance matrices are often assumed to be either equal or completely unrelated. The common principal components (CPC) model provides an alternative which is situated between these two extreme assumptions: The assumption is made that the population covariance matrices share the same set of eigenvectors, but have di erent sets of eigenvalues. An important question in the application of the CPC model is to determine whether it is appropriate for the data under consideration. Flury (1988) proposed two methods, based on likelihood estimation, to address this question. However, the assumption of multivariate normality is untenable for many real data sets, making the application of these parametric methods questionable. A number of non-parametric methods, based on bootstrap replications of eigenvectors, is proposed to select an appropriate common eigenvector model for two population covariance matrices. Using simulation experiments, it is shown that the proposed selection methods outperform the existing parametric selection methods. If appropriate, the CPC model can provide covariance matrix estimators that are less biased than when assuming equality of the covariance matrices, and of which the elements have smaller standard errors than the elements of the ordinary unbiased covariance matrix estimators. A regularised covariance matrix estimator under the CPC model is proposed, and Monte Carlo simulation results show that it provides more accurate estimates of the population covariance matrices than the competing covariance matrix estimators. Covariance matrix estimation forms an integral part of many multivariate statistical methods. Applications of the CPC model in discriminant analysis, biplots and regression analysis are investigated. It is shown that, in cases where the CPC model is appropriate, CPC discriminant analysis provides signi cantly smaller misclassi cation error rates than both ordinary quadratic discriminant analysis and linear discriminant analysis. A framework for the comparison of di erent types of biplots for data with distinct groups is developed, and CPC biplots constructed from common eigenvectors are compared to other types of principal component biplots using this framework. A subset of data from the Vermont Oxford Network (VON), of infants admitted to participating neonatal intensive care units in South Africa and Namibia during 2009, is analysed using the CPC model. It is shown that the proposed non-parametric methodology o ers an improvement over the known parametric methods in the analysis of this data set which originated from a non-normally distributed multivariate population. CPC regression is compared to principal component regression and partial least squares regression in the tting of models to predict neonatal mortality and length of stay for infants in the VON data set. The tted regression models, using readily available day-of-admission data, can be used by medical sta and hospital administrators to counsel parents and improve the allocation of medical care resources. Predicted values from these models can also be used in benchmarking exercises to assess the performance of neonatal intensive care units in the Southern African context, as part of larger quality improvement programmes.
AFRIKAANSE OPSOMMING: Wanneer die kovariansiematrikse van twee of meer populasies beraam word, word dikwels aanvaar dat die kovariansiematrikse of gelyk, of heeltemal onverwant is. Die gemeenskaplike hoofkomponente (GHK) model verskaf 'n alternatief wat tussen hierdie twee ekstreme aannames gele e is: Die aanname word gemaak dat die populasie kovariansiematrikse dieselfde versameling eievektore deel, maar verskillende versamelings eiewaardes het. 'n Belangrike vraag in die toepassing van die GHK model is om te bepaal of dit geskik is vir die data wat beskou word. Flury (1988) het twee metodes, gebaseer op aanneemlikheidsberaming, voorgestel om hierdie vraag aan te spreek. Die aanname van meerveranderlike normaliteit is egter ongeldig vir baie werklike datastelle, wat die toepassing van hierdie metodes bevraagteken. 'n Aantal nie-parametriese metodes, gebaseer op skoenlus-herhalings van eievektore, word voorgestel om 'n geskikte gemeenskaplike eievektor model te kies vir twee populasie kovariansiematrikse. Met die gebruik van simulasie eksperimente word aangetoon dat die voorgestelde seleksiemetodes beter vaar as die bestaande parametriese seleksiemetodes. Indien toepaslik, kan die GHK model kovariansiematriks beramers verskaf wat minder sydig is as wanneer aanvaar word dat die kovariansiematrikse gelyk is, en waarvan die elemente kleiner standaardfoute het as die elemente van die gewone onsydige kovariansiematriks beramers. 'n Geregulariseerde kovariansiematriks beramer onder die GHK model word voorgestel, en Monte Carlo simulasie resultate toon dat dit meer akkurate beramings van die populasie kovariansiematrikse verskaf as ander mededingende kovariansiematriks beramers. Kovariansiematriks beraming vorm 'n integrale deel van baie meerveranderlike statistiese metodes. Toepassings van die GHK model in diskriminantanalise, bi-stippings en regressie-analise word ondersoek. Daar word aangetoon dat, in gevalle waar die GHK model toepaslik is, GHK diskriminantanalise betekenisvol kleiner misklassi kasie foutkoerse lewer as beide gewone kwadratiese diskriminantanalise en line^ere diskriminantanalise. 'n Raamwerk vir die vergelyking van verskillende tipes bi-stippings vir data met verskeie groepe word ontwikkel, en word gebruik om GHK bi-stippings gekonstrueer vanaf gemeenskaplike eievektore met ander tipe hoofkomponent bi-stippings te vergelyk. 'n Deelversameling van data vanaf die Vermont Oxford Network (VON), van babas opgeneem in deelnemende neonatale intensiewe sorg eenhede in Suid-Afrika en Namibi e gedurende 2009, word met behulp van die GHK model ontleed. Daar word getoon dat die voorgestelde nie-parametriese metodiek 'n verbetering op die bekende parametriese metodes bied in die ontleding van hierdie datastel wat afkomstig is uit 'n nie-normaal verdeelde meerveranderlike populasie. GHK regressie word vergelyk met hoofkomponent regressie en parsi ele kleinste kwadrate regressie in die passing van modelle om neonatale mortaliteit en lengte van verblyf te voorspel vir babas in die VON datastel. Die gepasde regressiemodelle, wat maklik bekombare dag-van-toelating data gebruik, kan deur mediese personeel en hospitaaladministrateurs gebruik word om ouers te adviseer en die toewysing van mediese sorg hulpbronne te verbeter. Voorspelde waardes vanaf hierdie modelle kan ook gebruik word in normwaarde oefeninge om die prestasie van neonatale intensiewe sorg eenhede in die Suider-Afrikaanse konteks, as deel van groter gehalteverbeteringprogramme, te evalueer.

Thesis (MScMedSc)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Background: Sudden infant death syndrome (SIDS) is considered the second most frequent cause of infant mortality worldwide. Research specifically pertaining to SIDS is limited in the South African setting. Identifiable causes for sudden infant death remain challenging despite full medico-legal investigations inclusive of autopsy, scene visit and ancillary studies. Viral infections could contribute to some sudden unexpected death in infancy (SUDI) cases, especially since a multitude of respiratory viruses have been detected from autopsy specimens. The specific contribution of viruses in the events preceding death, including the subsequent involvement of the immature immune response in infants, still warrants deciphering. Infancy is characterised by marked vulnerability to infections due to immaturities of their immune systems that may only resolve as infants grow older when these sudden deaths rarely still occur. In South Africa there is a lack of a standard protocol for investigations into the causes of SIDS, including the lack of standard guidelines as to which specimens should be taken, which viruses should be investigated and which laboratory assays should be utilised. Objectives: In this prospective descriptive study we aimed to investigate the prevalence of viruses in SUDI and SIDS cases at Tygerberg Forensic Pathology Service (FPS) Mortuary over a one year period. The primary aim was to explore possible respiratory viral infections in SUDI and SIDS cases and to determine the usefulness of molecular techniques to detect viruses from SUDI cases. To determine the significance of viruses, we assessed signs of infection from lung histology. The secondary objectives included collecting demographic data to investigate possible risk factors for SUDI and to look for possible similarities between viruses confirmed in living hospitalised infants at Tygerberg, during the study period compared to viruses detected from SUDI cases. Methods: Between May 2012 and May 2013 samples were collected from 148 SUDI cases presenting at Tygerberg FPS Mortuary. As part of the mandatory routine investigations into SUDI, shell vial culture (SVC) results were collected from lung and liver tissue specimens and bacterial culture results were collected from left and right lung and heart swabs at autopsy. To investigate the possibility of viruses implicated in some of the infant deaths we used the Seeplex® RV15 Ace detection multiplex polymerase chain reaction (PCR) assay to establish the frequency of 13 ribonucleic acid (RNA) respiratory viruses (influenza A and B, human parainfluenza 1-4, human coronavirus [OC43, 229E/NL63], human rhinovirus A, B and C, respiratory syncytial virus A and B, human enterovirus and human metapneumovirus) from RNA extracted from tracheal and lower left and right lung lobe swabs. Tissue from the lower left and right lung lobes were also assessed for histology signs of infection. Results: During our study we confirmed multiple known demographic risk factors for SIDS, such as the age peak around 1-3 months, the male predominance, bed-sharing, sleeping in the prone position, heavy wrapping in warm blankets, prenatal smoke exposure, and socio-economic factors. With the Seeplex® RV15 Ace detection assay between one and three viruses were detected in 59.5% (88/148) of cases. Of the 88 cases that had viruses detected, 75% (66/88) had one virus and 25% (22/88) had co-detections of two to three viruses. The most common viruses detected were HRV in 77% (68/88) of cases, RSV in 18% (16/88) of cases and HCoV in 14% (12/88) of cases. Many of the viruses we detected from our cases are included in the SVC test that forms part of the medico-legal laboratory investigation for all SUDI cases at Tygerberg FPS Mortuary. SVCs were positive in 9.5% (14/148) of all cases only. We showed that the SVC method is potentially missing most of the 13 respiratory viruses we investigated that could contribute to death in some of the SUDI cases. Conclusion: In some cases that had a Cause of Death Classification - SIDS, the PCR viruses detected cannot be ignored, especially when it is supported by histological evidence of infection. We thus propose that the use of PCR could alter a Cause of Death Classification from SIDS to Infection in some of these cases. Further research is needed to determine the significance of detecting viruses from SUDI cases wherein no significant histological evidence of infection was observed. This questions whether PCR may be too sensitive and is detecting past and latent viral infections that do not play any role in the cause of death. The histological picture also requires further characterisation to determine if it accurately predicts infections or lethal events and can truly support virology findings, especially in young infants whose immune systems are still maturing. Without determining the true prevalence of viruses in SUDI cases and the viral-specific immune response, the contribution of virus-specific infections to this syndrome will remain largely undetermined.
AFRIKAANSE OPSOMMING: Agtergrond: Wiegiedood (“SIDS/SUDI”) word beskou as die tweede mees algemene oorsaak van sterftes in kinders jonger as een jaar wêreldwyd. Toegewyde SIDS-spesifieke navorsing in die Suid-Afrikaanse samelewing is beperk. Dit bly steeds „n uitdaging om oorsake te probeer identifiseer vir hierdie onverwagte sterftes in kinders (SUDI) ten spyte van volledige medies-geregtelike ondersoeke, insluitende die lykskouing, ondersoek van die doodstoneel en aanvullende ondersoeke. Virusinfeksies kan aansienlik bydra tot sommige onverwagte sterftes in kinders, aangesien verskeie respiratoriese virusse alreeds aangetoon is in monsters verkry tydens outopsies. Die spesifieke rol wat virusse speel in die prosesse wat die dood voorafgaan, asook die bydraende rol van „n onder-ontwikkelde immuunrespons in babas, regverdig verdere ondersoek. Die eerste jaar van lewe word gekenmerk deur verhoogde vatbaarheid vir infeksies weens die ontwikkelende immuunstelsels soos wat babas ouer word, en die voorkoms van SUDI neem stelselmatig af met „n toename in ouderdom. In Suid-Afrika bestaan daar tans geen standaard protokol vir die ondersoek van wiegiedood nie en daar is ook nie standaard riglyne oor die tipe monsters wat geneem moet word, watter virusse ondersoek moet word en watter laboratorium toetse uitgevoer moet word nie. Doelstellings: In hierdie prospektiewe beskrywende studie is gepoog om die virusse wat in gevalle van wiegiedood of SUDI voorkom te ondersoek. Die studie is uitgevoer by die Tygerberg Geregtelike Patologie Dienste lykshuis oor 'n tydperk van een jaar. Molekulêre tegnieke om virusse aan te toon in hierdie gevalle is gebruik om spesifieke virusinfeksies te ondersoek. Die resultate is met histologiese tekens van infeksie in longweefsel gekorreleer. Demografiese data is verder versamel om moontlike risikofaktore vir wiegiedood te ondersoek. Dit is verder vergelyk met virusse wat met dieselfde diagnostiese tegnieke in babas geïdentifiseer is wat tydens die studieperiode in Tygerberg Hospitaal opgeneem was met lugweginfeksies. Metodes: Monsters van 148 SUDI gevalle wat by die Tygerberg lykshuis opgeneem is, is versamel tussen Mei 2012 en Mei 2013. As deel van die roetine ondersoeke in SUDI gevalle, was selkultuur resultate verkry van long en lewer weefsel, asook bakteriële kulture van deppers wat van beide longe en hart geneem was tydens die lykskouings. „n Seeplex® RV15 Ace polimerase kettingreaksie (PKR) toets is gebruik om die teenwoordigheid van virusse te ondersoek wat moontlik by die babasterftes betrokke kon wees. Trageale- en longdeppers wat tydens die lykskouings versamel was, was getoets vir 13 ribonukleïensure (RNS) respiratoriese virusse (influenza A and B, human parainfluenza 1-4, human coronavirus [OC43, 229E/NL63], human rhinovirus A, B and C, respiratory syncytial virus A and B, human enterovirus and human metapneumovirus). Resultate: Ons studie het verskeie bekende demografiese risikofaktore vir SUDI bevestig, byvoorbeeld „n ouderdomspiek tussen een en drie maande ouderdom, manlike predominansie, deel van „n bed met ander persone, slaap posisie op die maag, styf toedraai in warm komberse, blootstelling aan sigaretrook voor geboorte en sosio-ekonomiese faktore. Die Seeplex® RV15 Ace toets het tussen een en drie virusse geïdentifiseer in 59.5% (88/148) van die gevalle. Uit die 88 gevalle waarin virusse opgespoor was, was selgs een virus in 75% (66/88) van gevalle gevind en twee en drie virusse in 25% (22/88). Die mees algemene virusse was HRV in 77% (68/88) van gevalle, RSV in 18% (16/88) van gevalle en HCoV in 14% (12/88) van gevalle. Baie van die virusse wat tydens hierdie studie ondersoek was, was ingesluit in die roetine selkultuur toets wat deel vorm van die standaard medies-geregtelike laboratoriumondersoeke in alle SUDI gevalle by die Tygerberg lykshuis, alhoewel die selkulture positief was in slegs 9.5% (14/148) van gevalle. Ons het gevind dat baie respiratoriese virusse potensieel gemisdiagnoseer word wat „n rol kon speel in of bydra tot die dood van sommige SUDI gevalle. Gevolgtrekking: In sommige gevalle waarin SIDS geklassifiseer is as die oorsaak van dood, kan die virusse wat met PKR toetse opgespoor is nie geïgnoreer word nie, veral waar die bevinding ondersteun word deur histologiese bewyse van infeksie. Ons stel dus voor dat die gebruik van PKR toetse die oorsaak van dood klassifikasie kan verander van SIDS na Infeksie in sommige van hierdie gevalle. Verdere navorsing is nodig om die waarde van gelyktydige opsporing van virusse in SUDI gevalle te bepaal wanneer daar geen noemenswaardige histologiese bewyse van infeksie gevind word nie. Dit bevraagteken of die PKR toets dalk te sensitief is en gevolglik vorige en latente virusinfeksies identifiseer wat nie noodwendig 'n rol in die oorsaak van dood speel nie. Die diagnostiese en kliniese waarde van die histologiese beeld in terme van die rol van virusinfeksies as bydraende oorsaak van dood moet verder ondersoek word, veral in jong kinders wie se immuunstelsels nog nie volledig ontwikkel is nie. Indien die werklike voorkoms van virusse in SUDI gevalle en die virus-spesifieke immuunrespons nie bepaal word nie, sal die rol van virus-spesifieke infeksies in hierdie sindroom grootliks onbekend bly.
Harry Crossley Foundation
Poliomyelitis Research Foundation (PRF)
National Health Laboratory Services Research Trust

Du fait de son impact sur la morbidité et la mortalité infantile, ainsi que de ses implications sur la santé à l’âge adulte, le petit poids de naissance constitue un problème majeur de santé publique. Le Burkina Faso, pays sahélien enclavé au cœur de l’Afrique occidentale est classé dans le groupe des pays pauvres très endettés et présente une forte prévalence de petit poids de naissance, imputable dans la majorité des cas au retard de croissance intra-utérine. Le contexte de ce travail, réalisé en milieu rural, se caractérise par une situation socioéconomique précaire se traduisant par un faible niveau des indicateurs de l’état de santé et une faible accessibilité aux services sociaux de base.

Objectifs, hypothèses

Ce travail repose sur les hypothèses que les facteurs socioéconomiques influencent la survenue du petit poids de naissance et que le petit poids de naissance a un impact négatif sur la croissance et la survie au cours de la première année de vie.

Ce travail s’est fixé pour objectifs de :

•connaître l’importance du petit poids de naissance à terme ;

•analyser les déterminants du petit poids de naissance ;

•proposer un score pour l’identification des femmes enceintes à risque de mise au monde d’un enfant de petit poids ;

•identifier les facteurs influençant la croissance des enfants nés de petit poids ;

•étudier l'impact du déficit pondéral à la naissance sur la morbidité et la mortalité infantile ;

•formuler des recommandations pour la prévention et la prise en charge du petit poids de naissance en milieu défavorisé dans le but d’orienter les stratégies de réduction de la mortalité infantile.

Méthodologie

Trois types d’études ont été réalisés:

•une étude de cohorte rétrospective portant sur 435 enfants dans le but d’explorer les facteurs de risque, la croissance, le statut nutritionnel et la mortalité des enfants nés de petit poids de naissance à terme.

•Une étude transversale portant sur 1013 naissances vivantes à terme qui a permis de déterminer la fréquence du petit poids de naissance et d’analyser les facteurs associés qui lui étaient associés.

•Une étude de cohorte prospective au cours de laquelle les 1013 enfants enrôlés dans l’étude transversale ont été suivis afin d’analyser leur croissance et leur survie au cours des 12 premiers mois de vie.

Principaux résultats

•Le petit poids de naissance représente 15,8% des naissances à terme.

•Le sexe féminin est prédominant chez les enfants de petit poids.

•Les facteurs sociodémographiques associés au petit poids de naissance sont essentiellement des caractéristiques sociodémographiques maternelles :le jeune âge de la mère (moins de 20 ans), le faible niveau d’instruction, le mauvais état nutritionnel et la faible accessibilité géographique aux structures de santé.

•Les facteurs obstétricaux associés au petit poids sont :la primiparité, la survenue de vomissements gravidiques, l’exécution de travaux champêtres et une charge de travail plus importante en cours de grossesse.

•Le score proposé pour l’identification des femmes à risque a un pouvoir de discrimination acceptable et présente une bonne stabilité et une faible marge d’erreur de prédiction.

•Indépendamment de la catégorie de poids à la naissance, tous les enfants demeurent en dessous des médianes des courbes de référence internationales pour l’ensemble des indices nutritionnels entre 0 et 12 mois.

•Malgré des gains plus importants mais de façon non significative, les enfants de PPN montrent une incapacité à combler leur retard en taille et en poids.

•Le PPN est associé à un risque significativement plus élevé de retard de croissance et d’insuffisance pondérale au cours de la première année de vie.

•Le petit poids de naissance et la non-complétude de la consultation prénatale étaient associés à un risque deux fois plus important de décès.

•L’état nutritionnel à l’âge de 3 mois ainsi qu’à l’âge de 6 mois joue un rôle plus important dans la survie chez les enfants de PPN que chez les enfants nés de poids normal.

Conclusions

Les solutions au problème du petit poids de naissance impliquent un paquet d’interventions intégrant des stratégies avant, pendant et après la grossesse et des programmes de prise en charge ciblant les enfants de petit poids après leur naissance. Il s’agit prioritairement de :

•l’information et de la sensibilisation des populations pour un meilleur suivi de la grossesse et une complétude de la consultation prénatale ;

•l’adoption de pratiques et d’habitudes en faveur d’une alimentation équilibrée des femmes enceintes ;

•un plaidoyer pour un allègement de la charge de travail des femmes enceintes ;

•l’utilisation de méthodes opérationnelles pour l’identification des femmes à risque ;

•l’amélioration de la qualité des prestations de surveillance de la grossesse ;

•la redéfinition du contenu et des protocoles des programmes de suivi et de promotion de la croissance des jeunes enfants avec une attention particulière pour les enfants nés de petit poids ;

•la lutte contre certaines pratiques sociales comme les mariages précoces et les grossesses chez les adolescentes et les femmes de moins de 20 ans ;

•la promotion de la scolarisation des jeunes filles et l’alphabétisation des mères ;

•l’amélioration de l’état nutritionnel de la population ;

•la réalisation d’études pour évaluer l’impact de certains déterminants et interventions sur l’incidence du petit poids et le devenir des enfants nés avec un handicap pondéral :rôle de l’infection palustre, interventions nutritionnelles ciblant les enfants de petit poids, apports nutritionnels pendant la grossesse.

Summary

Due to its impact on infant morbidity and mortality, and its effects on adult’s health, low birth weight (LBW) is a major issue in the public health sector. Burkina Faso, a Sahelian country land-locked in the heart of West Africa is listed among the heavily indebted poor countries, with a high prevalence of Low Birth Weight, caused in most cases by intra uterine growth retardation. The context of the current study, conducted in urban area, is characterised by a poor socio-economic situation resulting in weak health indicators and difficult access to the basic social services.

Objectives, assumptions

The study is based o the assumptions that socio-economic factors have an influence on the occurrence of Low Birth Weight and that Low Birth Weight has a negative impact on growth and survival during the first year of the infant.

The study has the following objectives:

•To assess the importance of low birth weight a term;

•To analyse the determinant factors of low birth weight;

•To suggest a classification for the identification of pregnant women at risk of giving birth to low birth weight infants ;

•To identify factors which have an impact on the growth of low birth weight children ;

•To look at the impact of body weight deficiency at birth on infant morbidity and mortality ;

•To give recommendations on the prevention and treatment of low birth weight children from underprivileged background with the aim to orientate strategies for infant mortality reduction.

Methodology

Three types of studies were conducted:

•A retrospective cohort study of 435 children aiming at exploring risk factors, growth, nutritional status, and mortality of low birth weight infants in the long run.

•A cross-sectional study of 1013 live full-term births, which led to determining the frequency of low birth weight and at analysing associated factors which are linked to low birth weight.

•A prospective cohort study during which the 1013 children taken into consideration for the cross-sectional study were followed up so as to analyse their growth and survival all along the first 12 months of their life.

Main results

•Low birth weight represents 15.8% of full-term births.

•Female babies are predominant among low birth weight babies.

•Socio-demographic factors linked to low birth weight are mainly maternal socio-demographic characteristics: young mother (below 20 years old), low educational level, poor nutritional status and limited geographical access to health infrastructures.

•Obstetrical factors linked to low birth weight are the following: primiparity, occurrence of vomiting during pregnancy, field work and a heavier workload during pregnancy.

•The suggested classification for the identification of women at risk proves to have an acceptable power of discrimination and shows good stability and limited margin of error for prediction.

•Regardless of weight categories at birth, all children remain below medians of international reference curves for all nutritional indicators between 0 and 12 months.

•In spite of more important but not significant weight gains, LBW children prove not to be able to catch up on height and weight.

•LBW is linked to a significantly higher risk in growth retardation and weight deficiency during the newborn’s first year of life.

•LBW and non-complete antenatal visits are linked to a death risk multiplied by two.

•The nutritional status at the age of 3 months and 6 months old plays a more important role in the survival in LBW children than in children born with normal weight.

Conclusions

Solutions to LBW imply a package of interventions which should integrate strategies before, during and after pregnancy, together with treatment programmes targeting LBW children after their birth. In priority, these are:

•Information and awareness given to population for a better follow-up of pregnancies and complete cycles antenatal visits ;

•New practices and habits to be taken on favouring a balanced diet of pregnant women ;

•Advocacy actions aiming at reducing the workload of pregnant women ;

•The use of operational methods to identify women at risk ;

•Improving the quality of monitoring of pregnancy;

•Redefined content and procedures of monitoring programs and promoting young children growth, with particular focus on LBW children ;

•The fight against some social practices such as early marriages and pregnancies of teenagers and women below 20 years;

•The promotion of school education for young girls and literacy for mothers ;

•Improving the nutritional status of the population;

•The realisation of studies to assess the impact of some determinant factors and interventions on the occurrence of low birth weight and on the future of children born with weight deficiency: role of malaria, nutritional interventions targeting LBW children, nutritional intakes during pregnancy

Doctorat en Sciences médicales
info:eu-repo/semantics/nonPublished

Background: Neonatal mortality is a major burden in developing countries. Most neonatal deaths in Bangladesh can be prevented by simple interventions or by preventive measures before birth, better delivery practices or basic treatments after birth. Researchers over the years have focused on upgrading health care options to combat particular causes of disease but simple preventive measures before birth are often ignored. The outcome of neonatal illnesses depends on how it is managed and when. An illness that is addressed before the actual occurrence will have a better outcome especially when it involves newly-born neonates who have limited immunity. Thus, understanding the neonatal causes of deaths is an effective way to improve neonatal outcomes at low cost. Study Design: This study used primary data from two ICDDR,B surveillance sites, Abhoynagar and Mirsarai from the period 1997-2006 and analysed the major 'preventable causes' that can be prevented before the birth of the baby. It also identified the 'treatable causes' that are not amenable to prevention before the birth of the baby. This categorization is based on context of a developing country as Bangladesh where advanced techniques to treat severe conditions is unavailable or expensive. A particular cause of death can potentially be prevented or treated but consideration needs to be given to what is feasible in terms of available resources. The study compares deaths between the two surveillance sites and observes some of the biological, social and health care variables associated with preventable and treatable causes of deaths. Result of Neonatal death causes: Preventable causes of neonatal deaths comprised 75 percent of all neonatal deaths signifying the importance of targeted interventions before birth .Major identified preventable causes were prematurity (48.9%), birth asphyxia(30.2%), maternal and pregnancy-related complications (16.5%)),and neonatal tetanus (4.4%). Pneumonia (66.4%) and sepsis (33.6%) were the two treatable causes identified. Preventable deaths comprised 79.5% (163/205) of deaths in Abhoynagar and 69.2% (144/208) of deaths in Mirsarai. Result of Post-neonatal causes of death: The study grouped preventable (Diarrhoea and malnutrition, composed 30%) and treatable (Pneumonia, sepsis and SIDS, comprise 70%) causes of post-neonatal deaths. Except for sepsis, all causes of deaths were found in greater proportion in Mirsarai. Conclusion: The study found that preventable causes constitute the majority of neonatal deaths in Bangladesh. To address the majority of causes of neonatal deaths, interventions are needed to focus on the period before birth of the baby.

Ethiopia is one of the five nations that bear the global burden of nearly 50% maternal mortalities and newborn deaths. Cause-specific maternal mortality and newborn death information are vitally important for prevention, but little is known about the causes of deaths. Many maternal mortalities and newborn deaths occur at home, outside the formal health sector, and few are attended by qualified medical professionals. Despite the fact that, non-medical factors are often more important in determining whether a woman/newborn lives or dies than the medical cause of death itself. This study determines and explores factors contributing to maternal mortalities and newborn deaths in Ethiopia with the aim of developing a community-based model for averting maternal mortalities and newborn deaths in Ethiopia. The study was organised in three phases. In Phase 1, a community-based-retrospective approach using explorative, descriptive and contextual study design, combining both qualitative and quantitative methods (mixed methods) were used to make an in-depth investigation and analysis of the circumstances and events surrounding individual cases of maternal mortality and newborn deaths. The result of the study revealed various direct and indirect as well as possible contributing factors to maternal mortalities and newborn deaths which outlined bases for forwarding Phase 2 of the study called concept analysis. In Phase 3, a prototype model was developed according to Chinn and Kramer’s approach to theory generation: initially, based on the empirical perspectives of the study, concept analysis was conducted. The structure and process of a model to avert maternal mortality and newborn death were described; and, six survey list; namely, agent, recipient, context, procedure, dynamic and terminus of Dickoff, James and Wiedenbach (1968) form the basis for development and description of a model for averting maternal mortality and newborn deaths in Ethiopia. Impediment in receiving prompt, adequate and appropriate care were common problems encountered even after reaching an appropriate medical facility. For any attempt to attain a significant reduction in maternal mortality and newborn death, the health care system in Ethiopia must assume its tasks to institute critical changes in both the structure and process of health care delivery services.
Health Studies
D. Litt. et Phil. (Health Studies)

A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout.
Health Studies
M.A. (Health Studies)

The purpose of this study was to investigate the determinants of high neonatal mortality rates in Migori County, Kenya. The neonatal mortality cases were utilised as the target population to the study. A quantitative, descriptive, cross-sectional, non-experimental research design was used. A systematic sampling technique was employed to draw a sample of 201 archived neonatal cases out of 420 neonatal mortality medical records, which constituted the study population. Data were collected by means of a developed questionnaire. The Statistical Package for Social Sciences (SPSS) Version 21 was used to analyse data. The main findings revealed the leading determinants of neonatal mortality were early neonatal period, prematurity, poor 1st Apgar score, low birth weight and neonates with intrapartum complications. Obstetrical haemorrhage and HIV were the main maternal complications associated to neonatal mortalities, while the leading direct causes of death in this study were birth asphyxia and sepsis. Other determinants were gender, rural residence, lowly educated and informally employed mothers. To reduce mortalities, a multifaceted approach is needed to establish quality improvement in neonatal intensive care, reduce preterm birth incidences, and empower mothers socio-economically.
Health Studies
M.A. (Nursing Science)

Background: Although the prevalence of pneumonia in pregnancy is reported to be less than 1%, the pregnant state and risk factors associated with the development of pneumonia adversely influence the outcome of pregnancy. KwaZulu-Natal is at the epicenter of the dual epidemics of tuberculosis and HIV-1 and the impact of these diseases occurring concurrently in pregnant women at King Edward VIII hospital (KEH), South Africa have been described previously. The impact of antenatal pneumonia in HIV-1 infected and uninfected women however has not been described in the study population and was investigated. Methods: Pregnant women with clinical and radiological evidence of pneumonia were recruited from the antenatal clinic and labour ward at KEH. The study was conducted prospectively between January and December 2000. The clinical profile of these women and the causative organisms were determined. In addition the impact of HIV-1 infection, maternal immunosuppression and maternal pneumonia on obstetric and perinatal outcomes were evaluated. Mothers diagnosed with tuberculosis and multi drug resistant tuberculosis were hospitalised at King George V hospital until delivery. Results: Twenty nine women were diagnosed with antenatal pneumonia (study arm) with Mycobacterium tuberculosis the only causative organism isolated. A control arm of 112 pregnant women was also studied. Maternal and perinatal mortality was restricted to the study arm with a maternal mortality ratio of 99 per 100 000 live births and a perinatal mortality rate of 240 per 1000 births. Pneumonia was significantly associated with a negative overall obstetric outcome in the presence of HIV- l infection, antenatal care, anaemia and second trimester booking status. In addition, the presence of pneumonia was significantly associated with maternal mortality. There was a highly significant association between exposure to pneumonia and poor neonatal outcome. Maternal pneumonia, maternal HIV infection and the presence of medical and obstetric conditions were significantly associated with low birth weight and neonatal pneumonia. Further, maternal pneumonia (p <0.001) and concurrent HIV infection (p=0.002) was significantly associated with neonatal death. Conclusion: The presence of pneumonia in the antenatal period impacts negatively on maternal and neonatal morbidity and mortality. Health care providers must maintain a high degree of suspicion when managing a pregnant woman with unresolving upper respiratory tract symptoms and refer timeously for further investigation. Pneumonia and in particular pulmonary tuberculosis associated with HIV co- infection in pregnancy is a threat to mother and baby. Therefore in areas endemic for TB and HIV infection, it may be prudent to screen HIV positive pregnant women for symptoms suggestive of pneumonia and thereby identify women requiring further investigations such as sputummicroscopy and cultures, and a screening chest radiograph.
Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2007.

Thesis (M.Med. (Paediatrics and Child Health)) -- University of Limpopo, 2019
Objectives To determine the prevalence and survival rate; and to assess the maternal risk factors as well as complications of prematurity, associated with the mortality of very low and extremely low birth weight infants in the Neonatal Intensive Care Unit (NICU) of Mankweng Hospital. Materials and Methods A retrospective descriptive study was conducted at the NICU of Mankweng Hospital for a 7-month period from 1st January to 31st July 2015. The patient medical records and the Perinatal Problem Identification Programme (PPIP) data were used for the study. Results Prevalence of prematurity was 23%, Infants weighing between 500g-1499g represented 6.3% of the total live births and 25% of the admissions to the NICU; of which 4.9% were classified as extremely low birth weight (ELBW). Overall 77% of the study population survived until discharge. From the medical records, the survival to discharge of infants with weight 500g - 999g was 52%; and 84% for those with weight 1000g-1499g. Multivariable analysis found that improved survival was associated with an increase in gestational age (p <0.001), as well as birth weight (p <0.001) and prolonged length of stay. Variables associated with poor survival were spontaneous preterm labour (p = 0.031), low Apgar score at 1 and 5 minutes (p <0.001), sepsis (p = 0.001), respiratory distress syndrome (p <0.001), pulmonary hemorrhage (p <0.001), hypothermia (P = 0.005), resuscitation at birth (p = 0.002) and necrotising enterocolitis (p =0.044). Antenatal steroids were not associated with survival (p =0.111), however this was not documented in 53%(134/252) of the records, so the non-significance to outcome in this study may not be a true reflection. The use of NCPAP or SiPAP only was associated with improved survival of up to 69% and high mortality rates were recorded in babies who required invasive ventilator support. Multi-organ immaturity was found to be the most common cause of death, followed by sepsis. Conclusion: The prevalence and survival rates of very low and extremely low birth weight, found in this study are comparable to those found in other tertiary hospitals in South Africa. The survival rate of ELBW babies is low and must be improved. Reliable data and further research should address effective steps to prevent preterm labour, extreme prematurity and hypothermia. The documentation and provision of antenatal steroids is encouraged. KEY CONCEPTS: Prematurity, Extremely low and Very low birth weight, Risk factors, Prevalence, Survival, Neonatal mortality rate.

The purpose of the research was to determine the underlying contributory factors in an obstetric unit at the district hospital in Mpumalanga province, South Africa, regarding neonatal deaths and to propose strategies for midwifery practice. Quantitative, nonexperimental, descriptive, exploratory and retrospective (ex-post facto) design was used to explore and describe the factors contributing to neonatal deaths. Data collection was done using an audit tool. The conclusions drawn from this study supported the assumptions that there are factors related to antenatal, intrapartum, postnatal and neonatal care that contribute to neonatal deaths, thus emphasizing the urgency of improving the care of pregnant mothers and their babies through effective implementation of programmes and protocols
Health Studies
M.A. (Health Studies)

Background Pregnancy and childbirth are normal physiological processes but the internal and external circumstances in which the child is conceived and born affect the life of the mother and child. Every pregnancy is associated with unpredictable risks and complications. Therefore, having a birth preparedness and complication prevention plan including safe motherhood are paramount to reduce maternal and infant mortality rates. Purpose of the study This study aimed to establish the pregnant women’s knowledge, perceptions and practices regarding birth preparedness planning, complication readiness and safe motherhood at Raleigh Fitkin Memorial Hospital to help reduce some of the avoidable causes of maternal and infant mortality rates. Research design and methods An exploratory, descriptive and qualitative research design was used for the study. Women who had delivered within a period of one week were purposively selected from the research site and interviewed using a structured interview guide until saturation of data. Ethical considerations were adhered to and measures of trustworthiness were applied. Giorgi’s analytic method was used for data analysis. Findings The findings revealed that most participants were not well informed about birth preparedness although some had managed to save for baby requirements and hospital fees. Transportation to the hospital for ANC and delivery was a problem to those who ended up delivering their babies at home or on the way to hospital. Knowledge about complications of birth was poor and only a few participants could name bleeding and prolonged labour. Most participants were not sure about safe motherhood, whilst some mentioned contraception and post-natal care. Conclusion Evidence from the study reveal that as much as pregnant women prepare baby’s clothes and money for labour and delivery, psychological preparation and transport preparation seemed poor. Complication readiness was not known by most participants.
Health Studies
M.A. (Health Sciences)

The purpose of the study was to determine the causes, of the increased perinatal mortality, identify and describe other factors contributing to the increased perinatal mortality rate in a rural healthcare facility situated in Sekhukhune district in Limpopo province, and to formulate the recommendations that will reduce the perinatal mortality rate based on the results. A quantitative, descriptive, cross-sectional and retrospective design was conducted. The study population was one hundred and sixty two (162) records of babies who died in the perinatal facility from the 1st January 2015 to the 31st December 2015 with a gestational age of about 28 weeks or more. No sampling was done, but a census was used. The sample comprised of one hundred and sixty two (162) of all the records related to perinatal mortality. Data were collected from patients’ records by using a checklist. Analysis of the data was performed by the IBM Statistical Package for Social Sciences (SPSS) version 14 computer software. Frequency tables and pie graphs were used to present the data. The results indicated that 75.3% (n=122) of the records were associated with health personnel as a factor contributing to perinatal mortality. Furthermore, preterm cases accounted for 45.1% (n=73) and prematurity accounted for 37.0% (n=60) of the cases of perinatal mortality. Therefore, preterm births and prematurity are risk factors that should be managed immediately after birth, and all babies should be managed prior to being transferred to the other healthcare institutions. The recommendations are that the education of patients about early antenatal visit, signs of labour and danger signs during pregnancy and training of healthcare workers on record-keeping have to be done on a continuous basis. Managers should conduct quality improvement programmes, benchmarking and implement maternal and neonatal guidelines in the clinical area throughout pregnancy.
Health Studies
M. P. H. (Health Studies)

Thesis (M. A. (Nursing Science)) -- University of Limpopo, 2016.
Perinatal morbidity is a public health indicator of the level of equality in a country. Its prevention has major medical, social and economic costs. The aim of this study was to describe factors contributing to high perinatal morbidity rates in Mankweng-Polokwane Complex of the Capricorn district, Limpopo Province, South Africa. A quantitative, descriptive cross-sectional research method was used to describe factors contributing to high perinatal morbidity. The study population comprised 80 registered midwives. Simple random sampling was used to select the 66 respondents. Data were collected using a self-developed questionnaire. Questionnaires were completed and returned, and only one questionnaire was not returned, and two were spoiled as they were incomplete, then 63 questionnaires were analysed. Ethical clearance was obtained from Medunsa Research and Ethics Committee, Limpopo Province Department of Health Ethics Committee and Hospital management. The Statistical Package for Social Sciences (SPSS, version 22) was used for data analysis. Descriptive statistics were used to analyse and describe and summarise data whereby the findings were presented in the form of distribution tables and graphs. Inferential statistics were used based on probability and allowed judgement to be made about the variables. The study revealed that shortage of staff, absenteeism, resignation, bad staff-patient ratio and overcrowding of patients, long waiting periods for caesarean sections, long waiting period for babies operation, work overload of staff, lack of equipment and supplies, congenital anomalies, perinatal asphyxia, prematurity and neonatal sepsis were contributory factors to high perinatal morbidity rates. The study recommended that all staff should be able to resuscitate newborn babies, be able to use Partograph effectively, further research on factors contributing to high perinatal morbidity and education training on speciality qualifications. Key-words: Factors, High, Perinatal, Morbidity rates

PhDH
Department of Advanced Nursing Science
Background: The National Committee for the Confidential Enquiries into Maternal Deaths recommend the implementation of “Saving Mothers’ recommendations” as a measure to reduce maternal deaths. However, this objective has not been achieved because the Maternal Mortality Rate in South Africa was standing at 134.33/100 000 live births and Limpopo Province at 165.16/100 000 live births. The national target for reduction of maternal mortality was 20% for all provinces for 2016. Limpopo Province’s reduction was below 12.5% for 2016. Purpose: The purpose of the study was to develop a strategy to enhance the implementation of the Saving Mothers’ recommendations in the maternity units of Limpopo Province. Methods: The convergent parallel design was used in this study. The study was conducted in phases, namely: Phase 1(a) was a qualitative research approach and a non-experimental, descriptive and exploratory design. The population consisted of district managers who were managing the Maternal Health Services and registered midwives who were working in the maternity units of Limpopo Province. Non-probability purposive sampling was used for both the district managers and the registered midwives. Data were collected using a central question for the managers managing Maternal Health services which was “What support are you giving to facilitate the implementation of the recommendations by the Saving Mothers Report?” and the question for the registered midwives was “What challenges are you experiencing when implementing the Saving Mothers’ recommendations.” Tesch’s open-coding technique was used to analyse qualitative data. Trustworthiness was ensured through credibility, confirmability, dependability, transferability and authenticity. Phase 1(b) was a quantitative and a non-experimental descriptive design. The population comprised of 200 patients who were included in the study. Questionnaires were developed and used to collect ABSTRACT vi data. Data was analysed using the Statistical Package for Social Sciences (SPSS, version 24.0) with the assistance of the statistician. Discussion of data were done in an explanatory sequential way where data from Phase 1a was discussed and supported by data from Phase 1b. Findings: The themes that emerged were: Challenges related to implementation of the recommendations of the Saving Mothers Report in maternity units, Description of existing training programmes and in-service education for health care professionals, Knowledge on implementing recommendations for the Saving Mothers Report when providing care in maternity units and Suggestions related to improvement of adherence to recommendations for the Saving Mothers Report in maternity units. Some of the themes were supported by the quantitative results whilst some not supported. Validity and reliability were ensured by giving the questionnaires to experts on the subject, colleagues and promoters to analyse and determine if items adequately represent content in the correct proportion. Ethical considerations were ensured by obtaining ethical approval from the University of Venda Ethics Committee and permission to access the facilities from the Limpopo Province Department of Health. The participants signed informed written consent. Phase 2 entailed strategy development and validation of the developed strategy. Recommendations: The recommendations included that the Department of Health should employ more staff and put operational managers in permanent positions. Sufficient equipment and supplies essential for maternal health care and maternal health infrastructure should be procured and a good plan for the managing thereof implemented. It is also recommended that health care workers should work hand in hand with the community structures and the ‘mosate’.
NRF

PhD (Health Sciences)
Department of Advanced Nursing Science
Preterm birth is an unresolved health issue; globally it is the largest contributor to mortality among children under 5 years of age. Worldwide, approximately 9.6% of all births are preterm which the World Health Organization (WHO) recognizes as one of the top ten causes of neonatal deaths. The alarming rates of preterm births and deaths may be directly linked to the shortage of resources and an inadequate database of midwifery care guidelines for midwives in South Africa resulting in poor maternal care in public health. This study sought to develop midwifery practice guidelines to promote quality care of preterm babies in resource-limited obstetric units of the Limpopo Province of South Africa. The convergent parallel mixed method was used, explorative, descriptive and contextual qualitative design were run concurrently with the descriptive quantitative approach. For the qualitative design, non-probability purposive sampling was used to select midwives and managers from Limpopo Province. In-depth one-to-one interviews were conducted with 11 midwives and 4 managers. Tesch’s eight steps of open-coding was used to analyze qualitative data. Trustworthiness was ensured through credibility, confirmability, dependability and transferability. For the quantitative approach, 31 midwives and 24 managers completed the Likert scale questionnaire. The non-probability method was employed to select midwives and managers to make up a sample size of 55 participants. Reliability and validity of the instrument was ensured through extensive literature review and a pilot study. Data were analyzed with the IBM Statistical Package for the Social Sciences (SPSS) version 23.0. Both quantitative and qualitative data analysis yielded three themes as follows: the role of midwives in reduction of preterm births and deaths in obstetric units; challenges faced by midwives whilst executing their role during preconception, antenatal, labour and v puerperium period; support needed by midwives during provision of maternal and neonatal care to reduce preterm births and deaths. In the discussion of the findings, qualitative findings were supported by quantitative findings. The WHO model (PICOS & GRADES) was adapted in the development of the guidelines. The group then validated the guidelines using a closed-ended checklist to verify whether the guidelines were congruent with practice. The results were analyzed through simple descriptive statistics where the data were summarized using frequency
NRF