Antenatal care in practice: an exploratory study in antenatal care clinics in the Kilombero Valley, south-eastern Tanzania

BACKGROUND: The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. Yet there are worrying gaps in knowledge of the quality of antenatal care provided in Tanzania. In particular, determinants of health workers' performance have not yet been fully understood. This paper uses ethnographic methods to document health workers' antenatal care practices with reference to the national Focused Antenatal Care guidelines and identifies factors influencing health workers' performance. Potential implications for improving antenatal care provision in Tanzania are discussed. METHODS: Combining different qualitative techniques, we studied health workers' antenatal care practices in four public antenatal care clinics in the Kilombero Valley, south-eastern Tanzania. A total of 36 antenatal care consultations were observed and compared with the Focused Antenatal Care guidelines. Participant observation, informal discussions and in-depth interviews with the staff helped to identify and explain health workers' practices and contextual factors influencing antenatal care provision. RESULTS: The delivery of antenatal care services to pregnant women at the selected antenatal care clinics varied widely. Some services that are recommended by the Focused Antenatal Care guidelines were given to all women while other services were not delivered at all. Factors influencing health workers' practices were poor implementation of the Focused Antenatal Care guidelines, lack of trained staff and absenteeism, supply shortages and use of working tools that are not consistent with the Focused Antenatal Care guidelines. Health workers react to difficult working conditions by developing informal practices as coping strategies or "street-level bureaucracy". CONCLUSIONS: Efforts to improve antenatal care should address shortages of trained staff through expanding training opportunities, including health worker cadres with little pre-service training. Attention should be paid to the identification of informal practices resulting from individual coping strategies and "street-level bureaucracy" in order to tackle problems before they become part of the organizational culture

Understanding the determinants and preventative strategies for high school violence in South Africa: The stakeholders’ targeted model

School violence is a serious public health issue in South Africa. Akinsola and Ramakuela (2009) conducted a study on teachers’ perceived prevalence, determinants and preventive strategies for violence-related behaviours among South African high school children in rural Vhembe district. Based on the results of this study, a model was developed. One of the assumptions underlying this model is that any form of school violence is not just a school’s problem. It involves schools, families and the communities. Hence the objective of developing this model is to provide a broad-based explanation about the determinants of violence in schools and the preventive measures. The diagram depicting the model is a rectangle which consists of two disproportional layers. The narrow external layer presents the main theme being addressed, i.e. school violence in South Africa and the various forms of violent behaviour being perpetuated by the students. The second layer presents the two sub-themes, the determinants and preventive measures. The inner layer is divided into two parts which show the relationship between the determinants and preventive measures. This analysis shows that since the determinants of school violence in South Africa are multi-faceted, the strategies to address the problem must also be designed and implemented at variety of levels.Key words: Determinants, preventive strategies, violence, stakeholders’  targeted model

People’s perception regarding HIV/AIDS prevention: A case study of a rural community in South Africa

This study explores the cultural beliefs, behaviours and pract ices related to HIV/AIDS in a rural communi ty in South Africa. The study was carriedout in Khutsong, a rural community in the Gauteng Province of South Africa. An interview guide wa s used to conduct brainstorming sessions. For the purpose of data collect ion, three heterogeneous groups were formed and each group was interviewed separately over a period of three days.The discussion focused on the perception of the groups re garding the prevent ion of HIV/AIDS with specific reference to socio-cultural factors. Data collected were analyzed descriptively by using the Tesch’s method of descript ive analysis. Regarding the prevention of HIV/AIDS, the respondent s perceived that the fol lowing factors should be considered: gender inequality, denial, stereotype, initiation rites, multiple sex partners, polygamous marriage, confidential ity, prostitution, poverty, unemployment, migra nt labour, education about condom use and the role of traditional healers in HIV/AIDS manageme nt. Based on the results, the study concludes that se veral factors should be taken into c onsideration for the success of any programme designed for the prevention of HIV/AIDS

Rural women’s understanding of the concept of menopause in Limpopo Province, South Africa

The word ‘menopause’ is derived from men and pausis and is a direct description of the psychological and physical events in women where menstruation ceases to occur. It is the time in a woman‘s life when she has experienced the last menstrual bleed. Menopause is not a disease per se but a condition associated with hormonal changes where estrogen diminishes to a low level causing health related symptoms. The purpose of this study was to explore and describe the knowledge of rural women concerning menopause in Mutale Municipality, South Africa. A qualitative, explorative, descriptive and contextual design was used. Purposive sampling was used to select the four villages and the focus groups. Sample size was determined by data saturation. The findings of the study indicated that the rural women in Mutale community had the common traditional understanding of the concept menopause, that blood is gone, old age, it was God’ nature of doing things and that cessation of menstruation was a normal and natural transition. They could not attach cessation of menstruation to menopausal conditions but to old age and physical as well as psychological health related problems. There is need for health care providers to conduct workshops in order to enlighten rural women in this community regarding phenomenal issues of menopause