Effectiveness of the basic antenatal care package in primary health care clinics

Pregnancy challenges the health care system in a unique way in that it involves at least two individuals – the woman and the fetus. The death rates of both pregnant women (maternal mortality) and newborns (perinatal mortality) are often used to indicate the quality of care the health system is providing. In terms of maternal and perinatal outcomes South Africa scores poorly compared to other upper-middle income countries (Penn-Kekana & Blaauw, 2002:14). The high stillbirth rate compared to the neonatal death rate reflects poor quality of antenatal care. Maternal and perinatal mortality is recognised as a problem and as a priority for action in the Millennium Development Goals (Thieren & Beusenberg, 2005:11). The Saving Mothers (Pattinson, 2002: 37-135) and Saving Babies (Pattinson, 2004:4-35) reports describe the causes and avoidable factors of these deaths with recommendations on how to improve care. The quality of care during the antenatal period may impact on the health of the pregnant woman and the outcome of the pregnancy, in particular on the still birth rate. In primary health care services there are many factors which may impact on and influence the quality of antenatal care. For example with the implementation of the comprehensive primary health care services package (Department of Health, 2001a:21-35) changes at clinic level resulted in a large number of primary health care professional nurses having to provide antenatal care, who previously may only have worked with one aspect of the primary health care package such as minor ailments or childcare. Because skills of midwifery or antenatal care, had not been practiced by some of these professional nurses, perhaps since completion of basic training, their level of competence has declined, and they have not been exposed to new developments in the field of midwifery. The practice of primary health care nurses is also influenced by the impact of diseases not specifically related to pregnancy like HIV/AIDS and tuberculosis. The principles of quality antenatal care are known (Chalmers et al. 2001:203) but despite the knowledge about these principles the maternal and perinatal mortality remains high. The Basic Antenatal Care quality improvement package is designed to assist clinical management and decision making in antenatal care. The implementation of the BANC package may influence the quality of antenatal care positively, which in turn may impact on the outcome of pregnancy for the mother and her baby. The aim of this study was to evaluate the effectiveness of the Basic antenatal care (BANC) package to improve the quality of antenatal care at primary health care clinics

Hierarchical Models for Independence Structures of Networks

We introduce a new family of network models, called hierarchical network models, that allow us to represent in an explicit manner the stochastic dependence among the dyads (random ties) of the network. In particular, each member of this family can be associated with a graphical model defining conditional independence clauses among the dyads of the network, called the dependency graph. Every network model with dyadic independence assumption can be generalized to construct members of this new family. Using this new framework, we generalize the Erd\"os-R\'enyi and beta-models to create hierarchical Erd\"os-R\'enyi and beta-models. We describe various methods for parameter estimation as well as simulation studies for models with sparse dependency graphs.Comment: 19 pages, 7 figure

Help-seeking by substance dependants presenting to healthcare professionals in the Free State Province

Introduction. Current data regarding treatment needs in South Africa for substance dependence are based on admissions to specialised treatment centres. The data therefore do not include patients presenting to independent healthcare workers and state hospitals. Aim. The aim of this study was to investigate help-seeking behaviour for substance dependence disorders from the perspective of healthcare professionals at various levels of the referral chain in Free State Province. Design. A descriptive study was performed. Setting. Treatment environments in Free State Province accessible to substance-dependent persons. Participants. General practitioners, private psychiatrists, prescribing healthcare professionals at state hospitals and treatment centres, and non-prescribing therapists responsible for management of substance-dependent persons. Measurements. A questionnaire was used to determine the level of help-seeking experienced by the participants regarding various classes of psycho-active substances. Findings. The presentation of alcohol, cannabis, opioid, benzodiazepine, ecstasy, cocaine and inhalant dependency at general practitioners, private psychiatrists, treatment centres and non-prescribing therapists was compared. Different patterns of help-seeking for substance dependence from the various professional groups were detected. Regarding alcohol dependence, 40.3% of private general medical practitioners reported being confronted with alcohol dependence at least once per month, compared with 100% of treatment centre representatives and private psychiatrists, 70.6% of state hospitals and 53.8% of non-prescribers. State hospitals reported the highest frequency for contact with cases of cannabis dependence, compared with the other professional groups, while psychiatrists reported the highest contact with cases involving benzodiazepine, cocaine and ecstasy. Therapists reported a higher level of contact with inhalant dependence, while this group virtually never presented at general practitioners and private psychiatrists. Conclusion. Help-seeking data can be used in conjunction with other data, such as treatment demand data, to inform and adapt policies and practice. Variations in the manifestation of help-seeking behaviour at various groups may be important pointers to conditions that influence help-seeking, and therefore should be investigated further

Moving from atheoretical to theoretical approaches to interprofessional client-centred collaborative practice

In this chapter we revisit the importance of theory in the development of interprofessional client centred education and practice (IPCEP). We focus specifically on the theoretical underpinnings and development of a workshop model aimed at moving practitioners from atheoretical to theoretical collaborative practice

Thickness control in a new flexible hybrid incremental sheet forming process

Incremental sheet forming is a cost-effective process for rapid manufacturing of sheet metal products. However, incremental sheet forming also has some limitations such as severe sheet thinning and long processing time. These limitations hamper the forming part quality and production efficiency, thus restricting the incremental sheet forming application in industrial practice. To overcome the problem of sheet thinning, a variety of processes, such as multi-step incremental sheet forming, have been proposed to improve the material flow and thickness distribution. In this work, a new process has been developed by introducing multi-point forming as preforming step before conducting incremental sheet forming processing. Employing an established hybrid sheet forming system and the corresponding thickness prediction model, the preform shape can be optimized by employing a two-step optimization approach to improve the sheet thickness distribution. In total, two case study examples, including a hemisphere part and an aerospace cowling part, are fabricated using the developed hybrid flexible process in this study. The experimental results show that the hybrid flexible forming process with the optimal preform design could achieve sheet parts with more uniform thickness distribution and reduced forming time

Evidence for strong f -d hybridization in intermetallic ferromagnet CePdIn2

Abstract: Please refer to full text to view abstract