Assessing South African Medical Interns’ Experience and Confidence in Managing Obstetric Emergencies
- Authors: Miller, Andrew
- Date: 2021-02
- Subjects: Obstetrical emergencies
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/6882 , vital:52352
- Description: Background: Medical doctors in South Africa are required to complete a two-year internship at training hospitals, including a four-month rotation in obstetrics and gynaecology. Following this, doctors are allocated to community service posts; many of which are at district and primary level facilities where supervision is limited. The latest triennial Saving Mothers Report identified district hospitals as the second leading site for maternal deaths of all causes. District hospital were also the leading site for maternal deaths secondary to obstetric haemorrhage and the most likely site for the lack of a skilled doctor to be identified as a factor in deaths associated with caesarean delivery. Methods: This cross-sectional descriptive study aimed to describe the self-perceived readiness of medical interns completing their training to independently manage obstetric emergencies, based on the ESMOE modules in the HPCSA internship logbook. The research assessed medical interns in the last three months of their training, using a self-administered online questionnaire, with data collection between October and December 2019. Cluster sampling of interns at training facilities throughout the country resulted in a total of 182 respondents from 17 hospitals in seven provinces in the country, with an overall response rate of 34.1%. Results: Most interns had experience with, and confidence in, the management of miscarriage and hypertension in pregnancy. However, gaps in labour ward management, pregnancy related sepsis and surgical skills were identified. Only 42.3% of respondents were confident in their ability to diagnose obstructed labour, 26.3% had performed an assisted delivery, 39.0% were confident in their knowledge of the indications and contraindications of assisted deliveries and 35.7% had been involved in the delivery of a baby with shoulder dystocia. Regarding pregnancy related sepsis, 54.4% had experience with managing a wound abscess and 29.7% were confident managing puerperal endometritis. While 78.0% felt confident to perform a caesarean section, only 28.6% had performed uterine compression sutures for uterine atony at caesarean section. Additionally, there was a statistically significant variation in scores between training hospitals. Conclusion: A gap exists between the shortcomings in district hospital obstetric services, the prioritisation of placement of community service doctors at primary care and district hospitals, and the self-perceived readiness of medical interns completing their training to safely manage obstetric emergencies. This highlights the importance of clinical support for junior doctors at district hospitals and standardisation of intern training at accredited facilities across the country. , Thesis (Masters) -- Faculty of Health Sciences, 2021
- Full Text:
- Date Issued: 2021-02
Assessing South African Medical Interns’ Experience and Confidence in Managing Obstetric Emergencies
- Authors: Miller, Andrew
- Date: 2021-02
- Subjects: Obstetrical emergencies
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/6882 , vital:52352
- Description: Background: Medical doctors in South Africa are required to complete a two-year internship at training hospitals, including a four-month rotation in obstetrics and gynaecology. Following this, doctors are allocated to community service posts; many of which are at district and primary level facilities where supervision is limited. The latest triennial Saving Mothers Report identified district hospitals as the second leading site for maternal deaths of all causes. District hospital were also the leading site for maternal deaths secondary to obstetric haemorrhage and the most likely site for the lack of a skilled doctor to be identified as a factor in deaths associated with caesarean delivery. Methods: This cross-sectional descriptive study aimed to describe the self-perceived readiness of medical interns completing their training to independently manage obstetric emergencies, based on the ESMOE modules in the HPCSA internship logbook. The research assessed medical interns in the last three months of their training, using a self-administered online questionnaire, with data collection between October and December 2019. Cluster sampling of interns at training facilities throughout the country resulted in a total of 182 respondents from 17 hospitals in seven provinces in the country, with an overall response rate of 34.1%. Results: Most interns had experience with, and confidence in, the management of miscarriage and hypertension in pregnancy. However, gaps in labour ward management, pregnancy related sepsis and surgical skills were identified. Only 42.3% of respondents were confident in their ability to diagnose obstructed labour, 26.3% had performed an assisted delivery, 39.0% were confident in their knowledge of the indications and contraindications of assisted deliveries and 35.7% had been involved in the delivery of a baby with shoulder dystocia. Regarding pregnancy related sepsis, 54.4% had experience with managing a wound abscess and 29.7% were confident managing puerperal endometritis. While 78.0% felt confident to perform a caesarean section, only 28.6% had performed uterine compression sutures for uterine atony at caesarean section. Additionally, there was a statistically significant variation in scores between training hospitals. Conclusion: A gap exists between the shortcomings in district hospital obstetric services, the prioritisation of placement of community service doctors at primary care and district hospitals, and the self-perceived readiness of medical interns completing their training to safely manage obstetric emergencies. This highlights the importance of clinical support for junior doctors at district hospitals and standardisation of intern training at accredited facilities across the country. , Thesis (Masters) -- Faculty of Health Sciences, 2021
- Full Text:
- Date Issued: 2021-02
Women’s perceptions, beliefs and lived experiences of postpartum intrauterine contraception at a District Hospital in the Eastern Cape Province of South Africa – a qualitative study
- Authors: Gibson, Dylan
- Date: 2021-00
- Subjects: Postpartum contraception
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/6833 , vital:51015
- Description: Background There is a significant unmet need for family planning in South Africa where long acting reversible contraceptives (LARC), including intrauterine contraceptive devices (IUCD) are underutilised. The situation is no different in the Amathole District in the Eastern Cape where high rates of unintended pregnancies continue to be a problem. The postpartum period presents a unique opportunity for providing effective contraception. It has been established that immediate post-placental insertion of a copper IUCD is a safe, effective method that has the potential to reduce unintended pregnancy rates. A Post placental intrauterine contraceptive device (PPIUCD) refers to an IUCD that is placed into the uterine fundus immediately after delivery of the placenta after caesarean or vaginal delivery. The understanding of women’s perceptions, beliefs and lived experiences of the PPIUCD in this community has the potential to improve uptake of this method. The aim of the study was to fully explore the phenomenon of postpartum intrauterine contraception as a means of family planning at Madwaleni District Hospital in the Amathole District within the Eastern Cape, South Africa. Methods A qualitative, phenomenological study design was used in gathering data through a combination of three focus group discussions and in-depth individual interviews with three different groups of peripartum women. Data was collected from perinatal women at three snapshots in time, namely prior to labour, during the postpartum admission and at 12 weeks postpartum with the aim to fully explore the phenomenon of post-placental IUCD use in the study population. III Results The data was analysed using the framework method and five themes were derived iteratively from the text. These themes included the perceptions of perinatal women towards a PPIUCD, the origins of these perceptions, the reasons why women would or would not choose the method for themselves and lastly, the experiences of those women who chose the method. The findings of this study showed that PPIUCD was a novel method in this community and that misinformation, largely driven by deficiencies in antenatal counselling, led to hesitancy to adopt the method. These deficiencies extended to those women who consented to a PPIUCD insertion at caesarean section who did not fully understand what they had consented to. Despite this, women were open to a more effective, convenient contraceptive and the overall experiences of those women who chose to use a PPIUCD was positive. Conclusions Post-placental IUCD insertion was a relatively new method in the study population. Deficiencies in antenatal contraceptive counselling created uncertainty and scepticism which in turn contributed to low uptake of the method among perinatal women. Despite this, there was a strong desire amongst perinatal women to access effective, convenient family planning and prevent future unwanted pregnancies. The overall experiences of women who did choose the method was positive. This suggested that with the right counselling and support, there would be an increase in uptake of PPIUCD in the population. Recommendations from this study include the need to explore healthcare workers perspectives on this topic, to further explore the lived experience of PPIUCD users over a longer period of time and to explore the effectiveness of various antenatal counselling strategies to equip women to make peripartum contraceptive choices. , Thesis (Masters) -- Faculty of Health Sciences, 2021
- Full Text:
- Date Issued: 2021-00
- Authors: Gibson, Dylan
- Date: 2021-00
- Subjects: Postpartum contraception
- Language: English
- Type: Masters theses , text
- Identifier: http://hdl.handle.net/11260/6833 , vital:51015
- Description: Background There is a significant unmet need for family planning in South Africa where long acting reversible contraceptives (LARC), including intrauterine contraceptive devices (IUCD) are underutilised. The situation is no different in the Amathole District in the Eastern Cape where high rates of unintended pregnancies continue to be a problem. The postpartum period presents a unique opportunity for providing effective contraception. It has been established that immediate post-placental insertion of a copper IUCD is a safe, effective method that has the potential to reduce unintended pregnancy rates. A Post placental intrauterine contraceptive device (PPIUCD) refers to an IUCD that is placed into the uterine fundus immediately after delivery of the placenta after caesarean or vaginal delivery. The understanding of women’s perceptions, beliefs and lived experiences of the PPIUCD in this community has the potential to improve uptake of this method. The aim of the study was to fully explore the phenomenon of postpartum intrauterine contraception as a means of family planning at Madwaleni District Hospital in the Amathole District within the Eastern Cape, South Africa. Methods A qualitative, phenomenological study design was used in gathering data through a combination of three focus group discussions and in-depth individual interviews with three different groups of peripartum women. Data was collected from perinatal women at three snapshots in time, namely prior to labour, during the postpartum admission and at 12 weeks postpartum with the aim to fully explore the phenomenon of post-placental IUCD use in the study population. III Results The data was analysed using the framework method and five themes were derived iteratively from the text. These themes included the perceptions of perinatal women towards a PPIUCD, the origins of these perceptions, the reasons why women would or would not choose the method for themselves and lastly, the experiences of those women who chose the method. The findings of this study showed that PPIUCD was a novel method in this community and that misinformation, largely driven by deficiencies in antenatal counselling, led to hesitancy to adopt the method. These deficiencies extended to those women who consented to a PPIUCD insertion at caesarean section who did not fully understand what they had consented to. Despite this, women were open to a more effective, convenient contraceptive and the overall experiences of those women who chose to use a PPIUCD was positive. Conclusions Post-placental IUCD insertion was a relatively new method in the study population. Deficiencies in antenatal contraceptive counselling created uncertainty and scepticism which in turn contributed to low uptake of the method among perinatal women. Despite this, there was a strong desire amongst perinatal women to access effective, convenient family planning and prevent future unwanted pregnancies. The overall experiences of women who did choose the method was positive. This suggested that with the right counselling and support, there would be an increase in uptake of PPIUCD in the population. Recommendations from this study include the need to explore healthcare workers perspectives on this topic, to further explore the lived experience of PPIUCD users over a longer period of time and to explore the effectiveness of various antenatal counselling strategies to equip women to make peripartum contraceptive choices. , Thesis (Masters) -- Faculty of Health Sciences, 2021
- Full Text:
- Date Issued: 2021-00
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