1,721,055 research outputs found
Attitudes and intentions of future health care providers regarding termination of pregnancy (TOP) services in South Africa
No full textIncludes bibliographical references (leaves 79-84).Voluntary or induced termination of pregnancy (TOP) is a common reproductive health phenomenon worldwide, whether legal or illegal (WHO, 2004; Schenker and Cain, 1999). Although some countries, including South Africa, have liberalized TOP laws to allow legal and safe provision of abortion, many barriers continue to impede successful rollout of services. Key among these are the following: * recruiting and retaining staff to provide such services, * incorporating TOP observation and training into medical training curricula, preventing burnout, * addressing negative attitudes and stigma of health providers, * diminishing professional discrimination and harassment, and * offering more TOP training modules, counselling workshops, and values clarification workshops over a spread of geographic areas (Adamo, 2003). Identifying future health professionals who may be interested in training and eventually providing TOP care has thus been prioritized by the South African Department of Health. Examining the knowledge, attitudes, beliefs, and intentions of medical students in training could make an important contribution to policy initiatives with respect to abortion provision. The current study measured these parameters among medical students in one of the eight medical training institutions in South Africa. With the liberalization of TOP legislation in South Africa, future health professionals' attitudes and intentions towards abortion services is a critical determinant to equity, access, and availability of women's reproductive care and to the successful implementation of TOP law
Expanding contraceptive options in South Africa : knowledge, attitudes, and practices surrounding the intrauterine device (IUD)
Full text linkThe intrauterine device (IUD) is a safe, effective, convenient, reliable, inexpensive, and cost-effective form of reversible contraception. It rivals female sterilization, injectables, and implants with respect to effectiveness in pregnancy prevention. Once inserted, IUDs are nearly maintenance free; some IUDs can even be used for over a decade. In many settings however, the utilization of this form of contraception is poor and a number of barriers to usage exist. These barriers often relate to lack of knowledge and misperceptions among both potential users and healthcare providers. The IUD is a reliable option that may be an ideal form of contraception for many women in South Africa. In order to make this method available on a wider scale, it is necessary to provide correct information to women and health care professionals and to increase the availability and use of this highly effective method. We conducted a cross-sectional descriptive study designed to assess the current knowledge, attitudes, and practices of potential users and health care providers with respect to the IUD. We recruited 205 women between 15 to 49 years of age who were attending family planning and ST! care services at four primary level public clinics (two in the more urban Western Cape Province and two in the rural Eastern Cape Province in South Africa). In addition, we interviewed 32 providers from 12 clinics (six clinics per province). Ethical approval for this research was obtained from both the University of Cape Town and Walter Sisulu University (formerly the University of the Transkei). Permission was also given by the local and provincial health services. Among clients, knowledge of the IUD was poor. About 26% of women had heard of the IUD. After the method was explained to them, 89.7% of women believed that there were advantages to using the IUD and 72.7% of women said that they would consider using the JUD in the future. Also, women thought the IUD was an easier contraceptive method to use than oral contraceptive pills, injectables, male and female condoms, and female sterilization. Logistic regression modelling showed that, after adjusting for level of education, being from the Western Cape, older age, and having heard of emergency contraception all independently predicted awareness of the IUD method. For the most part, providers knew how the IUD worked to prevent pregnancy; however, providers were lacking in more detailed knowledge about the method and had misinformation about the IUD. Almost all (93 .6%) of providers recognized their need for more information and training about the IUD. Providers reported that barriers to IUD usage in South Africa were lack of knowledge of the method on the part of providers (84.4%), a lack of trained providers to insert or remove the IUD (62.5%), limited availability of the device at health facilities (56.3%), and a lack of knowledge on the part of potential users (46.9%). Despite these barriers, 81 % of providers believed women would be interested in the IUD if they knew about it and 73.3% believed the IUD should be promoted in South Africa. Our results suggest that the IUD would be a welcome addition to the contraceptive method mix in South Africa and that both clients and providers would be interested in this method. It is clear that awareness campaigns among women seeking contraception would be necessary for building support and publicizing the IUD. It will also be necessary to train and educate providers, focusing on up to date information, dispelling myths, and proper insertion and removal techniques. South Africa could re-introduce the IUD into the contraceptive method mix and increase women's choice by adding this valuable, viable, and sustainable option to the contraceptive method mix. The findings of this study, which was requested by the provincial health services, will be used to inform policy and as a starting point for assessing the feasibility and acceptability of a greater role for the IUD in the contraceptive method mix in South Africa
Independent Midwifery practices in Cape Town: birth outcomes and predictors for medical interventions from 2003-2009
No full textIncludes bibliographical references.The midwifery model of care is a safe, effective, inexpensive, holistic, woman and baby centered-approach to maternal and infant health. It is widely used in developing and developed world contexts and has proven to have birth outcomes that are comparable to hospital-based, obstetric models. In many settings however, application of the independent midwifery model of care has become increasingly difficult to maintain. Tensions surrounding perceived skills and competencies of midwives, the increasing acceptance of hospital-based, obstetric models of childbirth, controversy over necessity and use of medical interventions, rising insurance premiums, and competition over clients in private sector scenarios are all factors contributing to both low availability and utilization in many countries, including South Africa. In order to consider the role of this model in maternity services in South Africa and to potentially make this model available on a wider scale, it is necessary to understand the demographics of current utilization of existing independent midwifery services, as well their as birth outcomes. This retrospective cohort study documents the total number of deliveries attended by independent midwives, the socio-demographic and reproductive characteristics of women using independent midwives and the birth outcomes and delivery types in the greater Cape Town region among the 16 independent midwives who have practiced during the six and a half year period of January 2003 - end of June 2009. It identifies factors associated with normal vaginal deliveries, instrumental deliveries and caesarean sections, as well as documents the socio-demographic and professional characteristics of the 16 independent midwives. Ethical approval for this research was granted by the University of Cape Town. Anonymous client data was collected from midwifery practices' Maternity Registers and transferred onto a data abstraction sheet. Midwife data was collected via an interviewer-administered questionnaire. All data was entered into Microsoft Excel and analyzed using Stata. The findings of this study will be used to inform maternal and infant health care policy, as well as provide statistics for independent midwives' quality assurance and auditing of services
Independent midwifery practices in Cape Town: birth outcomes and predictors for medical interventions from 2003-2009
Full text linkThe midwifery model of care is a safe, effective, inexpensive, holistic, woman and baby cantered approach to maternal and infant health. It is widely used in developing and developed world contexts and has proven to have birth outcomes that are comparable to hospital-based, obstetric models. In many settings however, application of the independent midwifery model of care has become increasingly difficult to maintain. Tensions surrounding perceived skills and competencies of midwives, the increasing acceptance of hospital-based, obstetric models of childbirth, controversy over necessity and use of medical interventions, rising insurance premiums, and competition over clients in private sector scenarios are all factors contributing to both low availability and utilization in many countries, including South Africa. In order to consider the role of this model in maternity services in South Africa and to potentially make this model available on a wider scale, it is necessary to understand the demographics of current utilization of existing independent midwifery services, as well their as birth outcomes. This retrospective cohort study documents the total number of deliveries attended by independent midwives, the socio-demographic and reproductive characteristics of women using independent midwives and the birth outcomes and delivery types in the greater Cape Town region among the 16 independent midwives who have practiced during the six-and-a-half-year period of January 2003 - end of June 2009. It identifies factors associated with normal vaginal deliveries, instrumental deliveries and caesarean sections, as well as documents the socio-demographic and professional characteristics of the 16 independent midwives. Ethical approval for this research was granted by the University of Cape Town. Anonymous client data was collected from midwifery practices‟ Maternity Registers and transferred onto a data abstraction sheet. Midwife data was collected via an interviewer-administered questionnaire. All data was entered into Microsoft Excel and analyzed using Stata. The findings of this study will be used to inform maternal and infant health care policy, as well as provide statistics for independent midwives‟ quality assurance and auditing of services
Perspectives on etonogestrel implant use in HIV-infected women in Cape Town, South Africa: a qualitative study among providers and stakeholders
No full textAccess to a range of safe and effective modern contraceptive methods enables women to make free and informed choices about their reproductive lives and broadly improves maternal and child health outcomes. Successful avoidance of unintended pregnancy and the corresponding ability to plan for pregnancy are especially valuable in the context of Human Immunodeficiency Virus (HIV) infection. Revised South African national guidelines seeking to expand overall contraceptive access were released in 2012 and, in response to the severity of the domestic HIV epidemic, specifically detailed the sexual and reproductive health rights and needs of HIV-positive women. Six years later, evaluation of the implementation and impact of these guidelines, as well as of more recent policy responses in this area, is necessary. This need for evaluation is outlined in Part A of this mini-dissertation in the form of a research proposal. A literature review (Part B) assesses what is currently known about considerations surrounding contraceptive decision-making in the context of HIV and antiretroviral therapy (ART). The use of the subdermal Long Acting Reversible Contraceptive (LARC) implant in HIV-positive women is explored in depth, given that the 2012 guidelines introduced the method as an entirely new option for South African women, as well as in light of recent controversy surrounding the implant’s provision to women taking the first-line ART drug, efavirenz (EFV). A journal-style article structured for submission to BMC Public Health (Part C) then uses thematic qualitative methodology to explore primary family planning provider and other relevant stakeholder perspectives on the provision of implants to HIV-positive women clients attending Cape Town primary care facilities. The study adds to existing literature regarding implant provision in the context of HIV and ART, and offers new insight into the impact of a 2014 South African Department of Health decision to recommend against the then-newly introduced implant as an option for women taking EFV-based ART. This research finds that several converging factors may have lead primary providers to view the implant as broadly contraindicated in all HIV-positive clients regardless of their iii exposure to EFV, namely: insufficient provider training; provider and community unfamiliarity with and scepticism about the new method; structural pressures on providers to keep up to date with and provide wide-ranging integrated services in busy clinical environments; and inadequate stakeholder consultation surrounding the wording and overall appropriateness of the implant/EFV guidance itself. Recommendations are provided in the article, including the need for: the retraining of primary healthcare providers in rights and choice-based family planning (particularly in implant provision and counselling); simplified counselling messages and user-friendly decision-making tools to help providers facilitate informed contraceptive choice for HIV-positive women; generalized beneficiary and community sensitization/education about implants including in the context of HIV and ART; and more comprehensive stakeholder/beneficiary consultation in future contraceptive policy-related endeavors
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Randomized trial comparing bleeding patterns after immediate and conventional oral contraceptive initiation
No full textBibliography: leaves 89-94.Starting oral contraceptives immediately, under direct observation, increase OC initiation rates and may increase effective use and continuation However, if adverse bleeding pattern occur, then such an approach may paradoxically decrease continuation rates. The purpose of this study is comapare 90-day bleeding patterns following immediate ("Quickstart) versus conventional OC initiation
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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