An audit of caesarean sections performed for suspected fetal distress at Mowbray Maternity Hospital in 2018

Background The cardiotocograph (CTG) is used for fetal monitoring antenatally and in labour, to detect potential fetal hypoxia and thus prevent perinatal morbidity and mortality. An abnormal CTG influences decisions clinicians make in terms of timing and mode of delivery, as the type of abnormality may warrant immediate delivery by caesarean section (CS). However caesarean section rates are increasing worldwide and in South Africa, and ‘fetal distress' is one of the common indications. The increased CS rate also increases the risk of maternal morbidity and mortality. At Mowbray Maternity Hospital, weekly review meetings show that ‘pathological CTG' and ‘non reassuring CTG' accounted for the majority of emergency CS. Therefore, this study was undertaken to see if ‘fetal distress' is being over-diagnosed leading to unnecessary CS, or to affirm that the CS are correctly indicated for this diagnosis. Hence an investigation of caesarean sections done for ‘fetal distress in 2018 was performed in order to audit emergency CS performed at MMH for abnormal CTG tracings. Methods A retrospective observational study with a comparative component was performed. The PASS 2022 software was used to calculate the sample size. The calculation was made for proportions of agreement using a kappa statistic which was calculated to be 114 cases. The study population was derived from the institutional theatre register, in which patients, who had an emergency CS for an abnormal CTG or ‘fetal distress', between 01 January 2018 and 31 March 2018 were included. The CTGs were interpreted by the two obstetric specialistts (experts) and this was compared with the original interpretation made by the attending doctor. In addition, the independent experts assessed the appropriateness of the decision for CS. Data was also obtained on co-existing obstetric conditions, and perinatal and maternal outcomes. Ethics approval for the study was attained from the University of Cape Town Human Research Ethics Committee (UCT HREC) and facility approval from MMH. Results Ninety cases were identified from the study period and analysed. The attending doctor assessed 22 (24.4%) CTGs as suspicious and 68 (75.6%) as pathological, whereas the experts assessed 7 (7.8%) as normal, 22 (24.4%) as suspicious and 61 (67.8%) as pathological. There was overall agreement in CTG interpretation between the experts and the attendant doctor for 61 cases (67.8%). The reliability of this agreement was measured using Cohen's Kappa and was 0.247 (CI 0.153-0.341). This is a ‘fair' level of agreement. A further analysis showed that there was a higher proportion of agreement with pathological CTGs and a lower proportion of agreement for suspicious CTGs which accounted for 52 (57.8%) and 9 (10%) cases, respectively. A review of the medical records showed that 69 (77%) of patients had one or more co-existing obstetric condition such as prolonged pregnancy, hypertensive disorders, prolonged rupture of membranes and meconium-stained liquor etc. When considering these obstetric factors as well as the CTG, the experts assessed 16 women (17.8%) to have had unnecessary caesarean sections. In terms of neonatal outcomes, the mean five-minute APGAR was 8, and only 3 babies had a five-minute APGAR which was less than 7. Twelve babies (13.3%) babies were admitted to the neonatal unit and of those, 4 (4.4%) were admitted for low Apgar scores. The commonest maternal complication was PPH which affected 8.9% of the patients. Conclusion The inter-observer agreement in CTG interpretation at MMH was fair, which is comparable to other studies done in the world, with agreement on the indication for CS of 82.2%. The agreement in CTG interpretation was high with pathological CTGs and poor with suspicious CTGs. A second opinion for CS for abnormal CTG may reduce the number of unnecessary CS especially for suspicious CTGs. A normal CTG tends to affirm good fetal wellbeing, however an abnormal CTG does not always mean that there is fetal compromise, therefore the clinical condition must be evaluated together with the CTG to make an appropriate decision with regards to timing and mode of delivery

Factors that enhance and detract line managers as delivery channels of effective human resource management

Human Resource Management is at the peak of discussion in most companies. This is after realising the importance on Human resource today’s competitive landscape. Human resource gives the organisation, competitive advantages as advanced technology and systems are easily copied. With focus on Human Resource Management, came the devolution of line managers. Line managers are not trained, nor experts on HRM, and as they take on the human resource role, the success of HRM depends on how well they can carry out their HR responsibilities. This research looks at factors that are detractors and enhancers of the effective Human Resource Management. Four factors are identified as having an impact on the HRM and these are Workload Pressures, Competency, Recognition and Management and HR staff support. The research methodology employed is a survey technique, which consisted of a survey questionnaire to identify, which ones are detractors and enhancers. The research identified some of these factors to fall as a detractor or enhancer depending on their positivist or negativity.Dissertation (MBA)--University of Pretoria, 2010.Gordon Institute of Business Science (GIBS)unrestricte

Land restitution, traditional leadership and belonging: defining Barokologadi identity

How do government policies and practices affect struggles over collective identity and struggles over land? Examining the interconnections among collective identity struggles, land struggles and state policies and practices in post-apartheid South Africa, this paper argues that the government\u27s contradictory policies and ambivalent practices have aggravated collective struggles over the boundaries of belonging. Specifically, the differing definitions of community set forth in traditional leadership, land tenure and land restitution policies exacerbate existing divisions among ‘communities’ concurrently subject to these policies and create practical policy dilemmas for decision-makers. This paper illustrates the interplay between public policies and collective identity struggles through close examination of struggles among the Barokologadi ba ga Maotwe, a so-called traditional community. The Barokologadi case underscores the necessity of attending to these interactions

Skill requirements and levels within the supply chain management field in South Africa

Supply chain integration (SCI) has received attention within the supply chain/logistics community because of its positive influence on financial performance. Studies have confirmed that organisations which implement external supply chain integration need to ensure that internal integration is implemented successfully because it promotes external integration. Organisations need to ensure that they acquire and appoint the correct set of skills in order to achieve successful supply chain integration. This research study explores the skill requirements and current skill levels within the South African context. The researcher collected data through 20 in-depth, semi-structured interviews with supply chain experts across various industries. The research results show that the current skill requirements are aligned with the American production and inventory control society (APICS) supply chain manager competency model. Also, the research results showed that, through training and development, organisations are actively improving their supply chain skill levels; as a result, most organisations confirmed that the majority of their employees meet the skill requirements in place. This study contributes to the supply chain/logistics literature in that it identifies current skill requirements within supply chain/logistics in the South African context. It also contributes to the supply chain literature, focusing on the involvement of human resources. This study confirms the active involvement of human resources within South African organisations.Mini Dissertation (MBA)--University of Pretoria, 2018.dm2019Gordon Institute of Business Science (GIBS)MB

Language variation in the Botswana speech community and its impact on children's education

Bibliography: pages 133-141.This study seeks to investigate Language variation in the Botswana speech community and its impact on children's education. The study is premised on the assumption that the learner's non-standard language from the home environment is not accommodated in the learning environment. The language used in the classroom is the standard language. This study deals with aspects such as language change, language contact, language interference as well as standardisation and the differences that exist in the spoken and written Setswana. Sociolinguistic factors such as language use are also dealt with. The problem of the use of non-standard varieties, as compared to the use of standard forms in the broad educational field is investigated