Academic literature on the topic 'Pregnant women – South Africa – Limpopo'

Thesis (PhD)--University of Stellenbosch, 2011.
ENGLISH ABSTRACT: Pregnancy is a vulnerable time in settings such as sub-Saharan Africa, and is associated with exposure to a multitude of physiological, social and psychological risks. High HIV prevalence, and the fact that many women will test for HIV for the first time during their pregnancy, has raised concern about women‘s psychological health during pregnancy. Depression during the antenatal period is of public health concern as it has been shown to be associated with poorer foetal and delivery outcomes, risky behaviours, and poorer uptake of antenatal care. Antenatal depression is a predictor of postnatal depression, and postnatal depression has been associated with poor maternal sensitivity and attachment in mothers which is known to result in increased behavioural and developmental difficulties in children. The aim of this research was to provide a clear, in depth and culturally sensitive understanding of the manifestation of depression in pregnant women in a rural area with high HIV prevalence in South Africa. The research method included a diagnostic assessment of depression in 109 women in their third trimester of pregnancy, and an in-depth qualitative examination of the contextual framework within which HIV testing and depression are experienced with a sub-sample of 56 women. The quantitative results demonstrated that the prevalence of antenatal depression was high (46.7%), with close to half of the women being diagnosed with depression. Presentations of depression most frequently included disturbances in mood, loss of interest and suicide ideation. Symptoms which overlap with common side effects of pregnancy such as loss of energy and weight change did not result in an overestimation of depression. Likewise, very little evidence of the somatisation of depression, or particular cultural barriers to the diagnosis of depression based on DSM-IV criteria was found. Rates of suicide ideation were high and equally common among HIV positive as HIV negative women. Factors significantly associated with depression included living within a family homestead, access to a regular source of income and practical support from a partner. Both income and partner support had a negative association with depression. Living away from a family or parental home had a positive association with depression. The results showed that the Edinburgh Postnatal Depression Scale (EPDS) was effective in identifying depression and that a shorter three item version was as effective as longer versions. A positive score for depressed mood on the EPDS was significantly associated with HIV, suggesting that the EPDS is a good screening tool for elevated psychological risks among HIV positive women post HIV testing. Qualitative results showed that having an unsupportive partner and the occurrence of relationship or familial conflict played an important role in the development of emotional distress during pregnancy and resulted in a high number of unwanted pregnancies. Partner and familial conflict was intertwined with cultural practices which govern the acceptability of childbearing among unmarried women and the social recognition of partnerships and paternal responsibilities. Testing for HIV was considered a stressful life event for all women regardless of their HIV status and was a particularly negative life event for women who tested HIV positive or for women who had concerns over partner infidelity. Disclosure among HIV positive women frequently lead to increased partnership conflict. Qualitative findings suggested that depression and emotional distress after HIV testing did interfere with women‘s ability to engage with prevention messages. Women who were coping well with learning their HIV positive status had high levels of family disclosure and subsequent family support in common. The implication of this research is that it is important that public health programmes screen for depression among childbearing women. These data suggests that a shorter three item version of the EPDS along with screening for partner and family support or conflict would effectively detect most women at high risk for depression. Likewise, public health interventions for women with depression which are implemented in primary health care facilities and in isolation of the partnership and familial context within which depression occurs are not likely to be effective. Further research is needed to establish the precise prevalence of antenatal and postnatal depression in women at high risk for HIV; to validate the effectiveness of a shorter screening tool in resource limited settings; and to establish risk and protective factors, and trimester specific risks which could inform the design of cost effective interventions in poorly resourced settings.
AFRIKAANSE OPSOMMING: Swangerskap in Afrika, suid van die Sahara, is ʼn kwesbare tydperk met blootstelling aan ʼn menigte fisiologiese, sosiale en sielkundige risiko‘s. Die hoë voorkoms van HIV en die feit dat baie vrouens gedurende swangerskap vir die eerste keer vir HIV wil toets, het ‗n besorgdheid oor vrouens se sielkundige gesondheid gedurende swangerskap laat ontstaan. Depressie gedurende die voorgeboortelike periode is van belang vir publieke gesondheid, want daar is bewyse wat dui op ‗n verband tussen depressie en swakker fetale en geboorte resultate, riskante gedrag en verminderde gebruik van voorgeboortelike sorg . Voorgeboortelike depressie is ʼn indikasie van moontlike nageboortelike depressie en nageboortelike depressie word geassosieer met swak moederlike sensitiwiteit en die gebrekkige vorming van ‗n band tussen moeder en kind; wat reeds bewys is om te lei tot verhoogde gedrags- en ontwikkelingsprobleme in kinders. Die doel van hierdie navorsing was om ʼn duidelike, indiepte en kulturele-sensitiewe begrip van die manifestasie van depressie in swanger vroue in ʼn landelike omgewing met hoë HIV voorkoms in Suid Afrika te verkry. Die navorsingsmetode sluit in ʼn simptomatiese beraming van depressie by 109 vroue in hul derde trimester van swangerskap en ʼn indiepte kwalitatiewe ondersoek na die kontekstuele raamwerk waarbinne HIV toetse en depressie ondervind word met ʼn sub-steekproef van 56 vrouens. Die bevinding was dat die voorkoms van voorgeboortelike depressie hoog was, 46.7 %, met feitlik die helfte van die vrouens wat met depressie gediagnoseer is. In die meeste gevalle het die voorkoms van depressie gepaard gegaan met ʼn verandering in gemoedstoestand, ʼn verlies aan belangstelling en selfmoordgedagtes. Simptome wat ooreenstem met algemene newe-effekte van swangerskap, soos verlies aan energie en verandering in gewig, het nie bygedra tot ʼn oorberekening van depressie nie. Soortgelyk is baie min bewyse gevind dat somatosasie van depressie, of spesifieke kulturele grense, tot die diagnose van depressie gebaseer op DSM-IVkriteria bydra. Die oorweging van selfmoord was hoog en algemeen tussen beide HIV-positiewe en HIV-negatiewe vouens. Faktore wat aansienlik met depressie geassosieer word, sluit in om in ʼn familiegroep te bly, toegang tot ʼn vaste bron van inkomste en die praktiese ondersteuning van ʼn lewensmaat. Beide inkomste en die ondersteuning van ʼn lewensmaat het ʼn negatiewe verbintenis met depressive. Om nie by familie of in ʼn ouerhuis te bly nie het ʼn positiewe assosiasie met depressive. Alhoewel HIV-status verband hou met depressie, was dit nie uitermate die geval nie, alhoewel daar ʼn gebrek aan statistiese kragdoeltreffendheid was om die effek van HIV vas te stel, gegee die beperkte grootte van die steekproef. Die resultate het getoon dat die EPDS graderingsinstrument effektief was om depressie te identifiseer en dat ʼn korter driepunt weergawe daarvan net so effektief was soos die langer weergawe. ʼn Positiewe telling vir ʼn depressiewe gemoedstoestand op die EPDS het ʼn betekenisvolle assosiasie met HIV en dui daarop dat die EPDS ʼn goeie graderingsinstrument is vir verhoogde sielkundige risiko by HIV-positiewe vrouens, selfs al is HIV-positiewe vrouens in dié steekproef statistieksgewys nie meer geneig tot depressie as HIV-negatiewe vrouens nie. Kwalitatiewe resultate toon dat ʼn lewensmaat wat nie ondersteunend is nie en die voorkoms van verhoudings- of familiekonflik ʼn belangrike rol speel in die ontwikkeling van emosionele angs gedurende swangerskap en dit het gelei tot ʼn groot aantal ongewenste swangerskappe. Konflik met ʼn lewensmaat en met familie was verweefd met kulturele gebruike wat die aanvaarbaarheid van geboortes onder ongetroude vrouens beheer en die sosiale erkenning van verhoudings en die vader se verantwoordelikhede. ʼn HIV-toets is as ʼn stresvolle lewensgebeurtenis beskou deur alle vroue, ongeag van hulle HIV-status en was ʼn besondere negatiewe lewensgebeurtenis vir vroue wat HIV-positief getoets het of vir vroue wat bekommerd was oor hulle lewensmaats se getrouheid. Onthulling van die HIV-status van positiewe vrouens het gereeld tot verhoogde konflik in verhoudings gelei. Kwalitatiewe bevindings dui daarop dat depressie en emosionele angs na ʼn HIV-toets inmeng met ʼn vrou se vermoë om ag te slaan op voorkomingsboodskappe. Vroue wat die kennis van hulle HIV-positiewe status goed hanteer het, het hoë vlakke van bekendmaking van hulle status en die ondersteuning van hulle familie in gemeen. Die implikasie van die navorsing is dat dit belangrik is vir publieke gesondheidsorgprogramme om te toets vir depressie onder swanger vroue. Die resultate dui daarop dat ʼn korter driepunt weergawe van die EPDS, saam met ʼn ondersoek na die ondersteuning van of konflik met ʼn lewensmaat en familie, effektief kan wees om vroue met ʼn hoë risiko vir depressie te identifiseer. Soortgelyk, publieke gesondheidsingryping in primêre gesondheidsorg fasiliteite vir vroue met depressie wat in isolasie van die lewensmaat en familie konteks, waar depressie voorkom geadministreer word, is onwaarskynlik om te slaag. Bevindings onderskryf die belangrikheid van ondersteuning vir die familie om effektief te kan reageer en herstel van stresvolle faktore soos onbeplande swangerskappe en HIV-diagnose, in ʼn konteks wat swaar deur HIV geaffekteer word, aangesien dit ʼn voorkomende effek op depressie kan hê. Verdere navorsing is nodig om die presiese voorkoms van voorgeboortelike en nageboortelike depressie in vrouens met ʼn hoë blootstelling aan HIV vas te stel; om die sukses van ʼn korter graderingsinstrument in arm omgewings te staaf; en om die risiko en beskermende faktore vas te stel en trimester spesifieke risiko‘s wat die ontwerp van ʼn koste-effektiewe ingryping in gebiede met ontoereikende hulpbronne kan beïnvloed.

Vythilingum, B. et.al. 2012. Risk factors for substance use in pregnant women in South Africa. South African medical journal, 102(11):851-854
ENGLISH ABSTRACT: Objectives. To study the prevalence of alcohol and substance use in a South African antenatal population and its correlates with sociodemographic factors, depression and perceived stress. Methods. A prospective self-report study on all women presenting for their first antenatal visit who consented to the study at a midwife obstetric unit (MOU) in the East Metropole district, Cape Town, using the Alcohol Use Disorders Identification Test (AUDIT), Drug Use Disorders Identification Test (DUDIT), Edinburgh Depression Scale (EDS) and Perceived Stress Scale (PSS). Statistical analyses using the chi-square test, separate one-way analyses of variance (ANOVA) and logistic regression analyses were performed as appropriate. Outcome measures were depression, alcohol use and substance use. Results. The questionnaire was completed by 323 women. During pregnancy 36.8% of women smoked, 20.2% used alcohol and 4% used substances. Using EDS cut-off scores of 12 and 15, respectively, 48.9% and 33.6% of the sample had scores consistent with major depression. An EDS cut-off score of 12 was significantly associated with both alcohol use (25.9% v. 15.2%, p=0.019) and risky drinking (76.9% v. 36.8%, p=0.04), while an EDS cut-off score of 15 was significantly associated with substance use (8.2% v. 1.4%, p=0.004) as well as alcohol dependence (23.1% v. 3.1%). Conclusions. We found high rates of both alcohol abuse and antenatal depression, and a significant association between depression, substance use and alcohol abuse; EDS scores greater than 12 could be used to identify women at risk of alcohol dependence and/or substance abuse.
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Thesis (MPH)--University of Limpopo (Medunsa Campus), 2011.
Background: South Africa hosts the largest number of pregnant HIV-positive women, accounting for almost 15% of the global total. Many amongst these HIV-positive pregnancies are unplanned and may be related to reproductive unmet needs, sexual risky behaviours, and/or community, contextual and individual factors that may determine and/or make these HIV-infected women to fall pregnant. The occurrence of an HIV-positive pregnancy in our region implies however the practice of unprotected sex, and is associated with the risk of reinfection with a different strain of HIV as well as with the risk of HIV transmission to an uninfected male partner and to the offspring. Knowing the demographic profile of HIV-infected women who become pregnant and experience parenthood as well as the circumstances of occurrence of their pregnancies is necessary for developing policies and interventions aimed at addressing the reproductive needs of this subpopulation, thus preventing HIV-positive unintended pregnancies as well as the horizontal and vertical transmission of HIV. Objectives: This study had three objectives. The first objective was to describe the demographic profile of pregnant HIV-positive women attending antenatal care (ANC) in public sector clinics in Postmasburg, South Africa. The second study objective was to determine the proportion of these pregnant HIV-infected women who were aware of their HIV-positive status prior to the occurrence of their current pregnancy. Lastly, the third objective sought to describe the circumstances of occurrence of their current pregnancy. Methodology: We used a quantitative descriptive design to collect data on 41 consecutive pregnant HIV-positive women who attended ANC at three public sector clinics in Postmasburg, from September to December 2010. Participants were administered a structured pre-tested questionnaire in their home language by trained interviewers. The study instrument was designed to collect data related to participants‘ socio-demographic characteristics, the time-period of HIV- v positive diagnosis relative to their current pregnancy, and the circumstances of occurrence of their current pregnancy. Results: The analyses of the study results showed that pregnant HIV-positive women attending ANC in Postmasburg were likely to be young (mean age, 27.71 ± 5.72 years), never married (56.10%), Afrikans (65.9%) and Setswana speakers (58.52%) of low socioeconomic status, with no or one child (65.85%). The majority of participants (63.4%) were from a predominantly informal settlement; 78% were unemployed while 61% were either devoid of any income or were living with Rands 500 or less. Sex mixing was common in the 15-19 years-old, involving 80% of respondents of this age category. Most of respondents (78.05%) became aware of their HIV-positive diagnosis during their current pregnancy that was unplanned in 73.17%. The study findings also revealed low levels of pregnancy intendedness (31.71%), hormonal contraceptives use (24.9%) and condoms uptake (34.15%), with high rates of condoms failure among users (87.12%). Respondents also reported other circumstances of occurrence of their current pregnancy, including, irregular condoms use (14.29% of condom users), partner refusal to use condom (10%), stopping contraceptives use because of side effects (50% of users), partner‘s pressure (12% of participants), coerced sex (2.4%) and having had sex under the influence of alcohol (2.4%). Conclusion: These results highlight the need for improving the reproductive health services that are offered to HIV-positive individuals. Integrating PMTCT and Family planning services, training health workers in issues related to the reproductive rights and reproductive health of HIV-infected individuals, systematically offering HIV counseling and testing to women of childbearing age who come into contact with health facilities for any reason and adequately informing HIV-positive women of childbearing age about available reproductive options, planned conception and safer motherhood, are necessary for preventing unintended HIV-positive pregnancies as well as the horizontal and vertical transmission of HIV.

The rural women in EMLM hew the wood, carry water, satisfy the men, produce and take care of the children to continue the family tree, and manage all the household chores. Their contribution is central to the effective functioning of families and communities. Yet, in terms of decision-making and local governance structures, they are absent. Indeed, there is truly a large constituency of women out there who are largely unrepresented; and therefore, they have no idea how governance is conducted – even around them. This is unfair, especially in jurisdictions where women are clearly in the majority. It is inconceivable that local governance structures have over a decade recorded only a single elected female member. With this in mind, this study seeks to explore the extent of rural women’s participation in local governance in Elias Motsoaledi Local Municipality. It is a comparison of traditional and democratic local governance structures; and the methods the researcher has used are qualitative and quantitative data on women councillors from 2013, in order to assess the factors that may be accountable for their small numbers, as compared to their male counterparts. The conclusion drawn was that the social structure, its traditions and cultural was identified in the study as the main obstacle to the advancement of women in the political arena. This study has not exhausted all the facets of the challenges; but it has brought a few to the fore, in an attempt to help stimulate debate, and inform policy and practice in the future.

Background: Intimate Partner Violence (IPV) is recognized globally as a major public health concern linked to numerous adverse physical, mental, sexual and reproductive health outcomes. IPV is associated with both pregnancy and HIV-infection independently, but there are few data on IPV in populations of HIV-infected pregnant women. We examined the prevalence and predicators of IPV among pregnant women initiating lifelong antiretroviral therapy (ART) in a large primary care clinic in Cape Town, South Africa. Methods: Consecutive pregnant women seeking antenatal care in Gugulethu, Cape Town were recruited into the MCH-ART study examining service models for postpartum ART care. IPV, depression, alcohol and drug use, and emotional distress were assessed using the 13-item WHO Violence Against Women questionnaire, the Edinburgh Postnatal Depression Scale (EPDS), alcohol and drug use disorders identification test (AUDIT/DUDIT) and the Kessler-10 (K-10) scale, respectively. Questionnaires were administered privately by trained interviewers. Women identified with specific IPV or mental health concerns were referred to appropriate services. Logistic regression was used to examine factors independently associated with experiences of IPV after adjusting for age and socioeconomic status. Results: From April 2013-May 2014, 623 women were enrolled (median age, 28 years):97% reported being in a relationship, 38% were married and/or cohabiting and 70% reported not having discussed or agreed on pregnancy intentions prior to conception . Overall, 21%(n=132) reported experiencing ≥ 1 act of IPV in the past 12 months, including emotional violence(15%), physical violence(15%) and sexual violence(2%). Of those reporting any IPV, 48% reported experiencing multiple types. Emotional and physical violence were most prevalent among women 18-24 years old, while sexual violence was most commonly reported among women 25-29 years old. Women who reported not discussing or disagreeing on pregnancy intentions with their partners prior to conception were significantly more likely to experience violence(p=0.030), and women who experienced IPV reported higher levels of substance abuse, depression and emotional distress(p<0.001 for all associations). Discussion: These data demonstrate high levels of IPV in this population. While the potential impact of HIV-infection, pregnancy and pregnancy intention on the risk of IPV and related factors require further research, IPV-related screening and support services should be considered as part of the package of care for ART in pregnancy.

Birthweight is powerful predictor of infant growth and survival. Premature birth and intrauterine growth retardation of birthweight. Maternal environment is important underlying determinant of birthweight. Common lifestyle risk factors include maternal under-nutrition, smoking, alcohol and social factors and stress. The Winelands/West Coast region has high rates of low birthweight. In addition, alcohol abuse and smoking are major problems in this area. The aim of this quantitative case-control study was to determine the epidemiology of low birthweight, related to lifestyle behaviours in pregnant women, with particular attention to lifestyle factors such as alcohol, smoking, and stress-related factors.

Thesis (MBA)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Scientific research that focuses on South African females’ success in engineering is limited. The South African engineering workforce and universities have been encountering challenges in attracting and retaining as many females as possible in these fields. This research assignment seeks to advance the understanding of challenges and reasons that contribute to most female learners shying away from engineering studies at tertiary level. To achieve this, Grade 11 and Grade 12 Mathematics and Physical Science female learners from six different schools, which are in a single educational circuit, were observed and interviewed. Mathematics and Physical Science are the two subjects which are prerequisites for engineering studies at any South African higher education institution. For this reason the research focused on female learners who were studying both these subjects. This study also includes a literature review of factors affecting South African women engineers in the labour market. This includes the factors that females around the world consider before choosing a career and the reasons why females stay in their chosen careers. The findings highlight a number of variables that contribute to females’ underrepresentation in engineering. These variables include societal expectations, perceptions of females in careers that are historically male dominated, the quality of education that female learners receive at school, female learners’ performance in Mathematics and Physical Science, guardians’ support of careers chosen by female learners, learners’ knowledge of the various career streams, the use of home language in teaching subjects assessed in English, family responsibilities, and university admission requirements for engineering. Suggestions on how some of these challenges can be mitigated have been highlighted in this research assignment. The main points are:  The need for career guidance workshops and companies’ exhibitions to be taken to the students’ schools where attention can be given to the students of one school at a time and companies can facilitate discussions with learners about the types of work that their companies offer.  Encouraging and advocating for greater parental involvement in the students’ studies as this can reduce the number of students who do not study on a regular basis.  Offering of teaching employment to candidates who fully meet the requirements for the positions they are applying for especially for core subjects like English, Maths, and Science.  Adding engineering faculties to the two universities in the Limpopo Province and giving bursaries or financial aid to help school girls who want to study engineering at university  Teaching school girls time management skills from an early age so as to help them know how to balance the time they spend on each subject. Further details on how some of these suggestions can be achieved are discussed in the last chapter of this research report.

Thesis (M.A.(Media studies ))--University of Limpopo, 2007
There is gross uneven access and utilization of Information and Communication Technology (ICT) between developed and underdeveloped communities in South Africa. As a result the majority of the underdeveloped communities which are mainly found in rural areas fail to participate in the global ICT arena. Rural communities’ especially rural women are subjected to deprivation, poverty and isolation. Government sought to reverse the situation through the provision of Telecentres and Multi-purpose Community Centres (MPCCs). To understand the plight of the rural women, different theories ranging from capitalism to socialism were reviewed in an attempt to trace the mode of South African production which caused the problem and some understanding of the solution possible. The theory of oppression by Paul Freire (1970) serves as the main point of focus on how rural women fail to utilize Telecentres and MPCCs. Qualitative and quantitative approaches were adopted in order to present the perceptual views of these women. Various methods of collecting data were used in order to have a wider perspective of how Telecentres and MPCCs are utilized by rural women. This includes a profound investigation through which a pilot study, participant observation, focus group, interviews and questionnaires became instrumental to the whole research. The findings of the pilot study conducted in Mogalakwena Hewlett Packard inclusive of community (HPi-community) reflected that there are discrepancies and deficiencies which exit between Mogalakwena HPi-community and the three Telecentres Botlokwa, Mankweng and Mohodi. The tripartite marriage between Government Hewlett Packard and the municipality enable the Mogalakwena HPi-community to provide better ICT facilities. The other three Telecentres fail to meet the standard of the Mogalakwena HPi- community due to the fact that they lack financial support. Participant observation assisted in discovering that ICT access created a good relationship between Botlokwa Telecentre and its neighbouring institutions. It was also discovered that most youths come for computer-skill acquisition. Focus groups interviews were conducted using English and the local language (Sepedi) in order to meet the rural women’s level of understanding. Through in depth analysis, the study indicates that poverty, unemployment, limited funding, illiteracy, and unavailability of ICT facilities for the disabled are the main issues that contribute to the low impact of Telecentre and MPCC utilization. Apart from this analysis, ICT access has a significant impact on the lives of rural communities especially women. However, there is still a need for an accelerated growth in ICT utilization. It is recommended that effective mechanisms be put in place to assist improve the situation in ICT provision. This must involve the people themselves taking initiatives, of course with the active support of government.