Morbidity from falciparum malaria in Natal/KwaZulu

Plasmodium falciparummalaria is endemic in the northern KwaZulu areas of South Africa. The clinical morbidity produced by this parasite has not been studied since the institution of the present malaria control programme. Fifty-nine patients were prospectively studied at a peripheral clinic during the peak malaria season; Symptoms and signs of the infection, parasite loads, haemoglobin values and leucocyte counts were recorded in all patients. Haemoglobin and leucocyte counts were also measured in 37 control subjects without malaria. The commonest symptoms were persistent headache (100%), rigors (98%) and myalgia (93%). None of the patients presented with coma, pulmonary oedema, hypoglycaemia or algid malaria. Splenomegaly was found in 49%, hepatomegaly in 20% and mental confusion in 5% of patients. Mean parasite load was 1,71% and 57% of patients had parasite loads of <1%. Anaemia of < 10 g/dl was significantly more frequent (P < 0,0001) in the patient group than in the control group. Leucopenia (white cell count < 4,0 x 109/l) was present in 12 of 50 patients in whom it was measured compared with 2 controls (P =0,0175). The results show a wide range of morbidity, with- out severe complications as presenting manifestations. Symptomatic infection in the presence of low parasite loads suggests that there may be little or no immunity in this population

Implementation of basic antenatal care approach in Ethekwini district, KwaZulu-Natal, South Africa

The purpose of the study was to assess implementation of the Basic Antenatal Care (BANC) approach in eThekwini district in KwaZulu-Natal. A descriptive quantitative research design guided by Oakland’s Total Quality Management model was used to conduct the study. The study was conducted in the two health authorities that are responsible for providing the public health care services in eThekwini district. Data were collected from 12 primary health care (PHC) clinics. Several variations were noted with regards to how the two health authorities implemented the BANC approach. These included staffing in the PHC clinics, operation days and hours, performance of staff, professionalism and courteousness of staff towards clients. The study highlights the need for standardised policies on allocation, training and in-service education of staff and operation days and hours in the PHC clinics in order to ensure a standardised approach to service delivery. Implementation of the BANC approach in the district could be improved and or strengthened by the two health authorities complementing each other by sharing good practices and benchmarking from each other.Keywords: Antenatal care, basic antenatal care, health authority, primary health care, South Afric

Towards a rural information system

In IDL-1495

Timing of first antenatal care attendance and associated factors among pregnant women in an obstetric health facility in eThekwini district, KwaZulu-Natal Province, South Africa

The purpose of the study was to determine timing of first antenatal care attendance and associated factors among pregnant women in an obstetric health facility in eThekwini district, KwaZulu-Natal Province, South Africa. A Midwives’ Obstetric Unit forms a section of the Cato Manor Primary Health Care clinic that is responsible for providing maternal and childcare services, which include antenatal, intrapartum and postnatal care to women from socioeconomically disadvantaged community living in informal settlements. In South Africa, despite the widespread availability of free antenatal care (ANC) services, most women in underprivilleged settings present late for their first antenatal care and fail to return for ANC follow-up, potentially leading to perinatal and maternal complications. Using a crosssectional survey design, data was collected from 329 pregnant women attending ANC in a Midwives’ obstetric unit at Cato Manor Primary Health Care Clinic in eThekwini District, KwaZulu-Natal. Late booking was a challenge in the primary health care clinic. There was no evidence of association between late ANC booking and most demographic variables except one (planning of pregnancy). This highlights the importance of assisting all women to have their pregnancies planned. The number of pregnant women that initiate ANC before 12 weeks (40-50%) and the few women that still initiate ANC after 24 weeks (less than 10%) suggest an improvement in the trends of timing of ANC bookings for the rural women. There is a need to intensify community awareness programmes and social mobilisation in order to educate pregnant women about the importance of early booking at the ANC (10-12 visits) as stipulated in the guidelines of the Basic Antenatal Care approach (BANC).Keywords: Antenatal care, timing of first attendence, accessibility, primary health car