Euphemia Mbali Mhlongo

Background: The high maternal and neonatal deaths recorded in low- and middle-income countries, particularly in Africa, present a serious challenge. Sub-Saharan countries still record the highest mortality ratio and even the highest in the developing world. It is reported that five major complications such as obstructed labor, unsafe abortion, high blood pressure during pregnancy, hemorrhage, and infection are responsible for this high mortality rate, which could be prevented through birth preparedness program, adequate health education, and information sharing, including the use of social media in attempt to educate every expectant woman regarding birth preparedness. Objective: This study aimed to assess birth preparedness among women in early labor at selected hospitals. Design: A qualitative descriptive approach. Methods: This was a descriptive qualitative research study, conducted among expectant women in early labor and three focus group discussions. Data were collected and analyzed from participants using face-to-face interviews and focus group discussions. The interviews were transcribed verbatim and analyzed using thematic content analysis. Participants for this study were pregnant women in early labor with gestational ages between 36 and 41 weeks, as the study excluded the mothers who were in preterm labor. Results: Nine themes emerged from the data: understanding of birth preparedness, perceived benefits of birth preparedness, women’s responsibilities in birth preparedness, roles of healthcare workers in birth preparedness, timing of birth preparedness activities, women’s choices regarding delivery location, pregnancy complication readiness, sources of information on motherhood and birth preparedness, and barriers to birth preparedness. Several categories emerged under each theme, and the results revealed that understanding of birth preparedness was associated with mental, emotional, financial, and physical preparedness. Participants reported barriers associated with budget limitations, lack of information, healthcare workers’ attitudes, unplanned pregnancies, and cultural beliefs. Healthcare workers were abusive and displayed negative attitudes toward expectant women. Conclusion: Challenges affecting the status of birth preparedness among expectant mothers can be understood and therefore preventable. Interventions need to enforce already existing maternity health protocols and leverage innovation and technology to reduce the morbidity and mortality of pregnant women and neonates.

Background: Given the central role of antenatal competencies in midwifery practice and the critical importance of accurate symphysis-fundal height (SFH) measurement for monitoring foetal growth, it is essential to explore the factors that influence student midwives’ competence and confidence in performing this key clinical skill. Evidence showed inconsistency in SFH measurement among the midwives. Objectives: This study aimed to investigate factors influencing student midwives’ competence and confidence in the measurement, plotting and interpretation of SFH in selected public health institutions in KwaZulu-Natal. Method: A quantitative, descriptive cross-sectional design was employed. A convenience sampling technique was used to select participants. Data were collected from 184 student midwives of 250 student midwives using a structured questionnaire, yielding a response rate of 73.6%. Results: The study identified several factors influencing competence and confidence in SFH measurement, plotting and interpretation, including regular communication (74.4%), constructive feedback from clinical lecturers (76.1%), student–preceptor relationships (64.9%), role modelling (78.2%) and the overall learning environment (69.2%). Conclusion: Although many students reported receiving constructive feedback and positive role modelling, variability across units underscored the need for a more structured and standardised approach to clinical teaching and mentorship. Strengthening the clinical learning environment is essential to complement existing teaching strategies and ensure consistent, high-quality preparation of midwives. Contribution: The findings will guide curriculum developers to consider SFH skills as stand-alone procedures, so students can practise them and become competent at the point of registration as a midwife.

Objectives: Electronic health register's (eRegisters) use have recently gained popularity in Africa. eRegisters are used to capture real-time patient information on several encounters with a healthcare provider. Given poor maternal and child health outcomes in Lesotho, eRegisters provide a promising innovative means of enhancing health outcomes, especially those related to midwifery. eRegisters capture maternal and newborn care services provided at healthcare facilities. Such data are important for informing evidence-based midwifery practice. Lesotho, a landlocked, sub-Saharan African country, piloted use of an eRegister in 2018. However, factors promoting eRegister and data use have not been fully documented. Therefore, this study explored factors promoting eRegister and data use for midwifery practice in Lesotho. Design: The study used a descriptive qualitative approach with interviews and focus group discussions used to collect data. Descriptive content analysis as outlined by Erlingsson and Brysiewicz (2017) was followed during data analysis. Setting: The study was conducted at three of the eRegister piloting facilities in Lesotho to examine eRegister implementation across different levels of care. Data collection occurred between December 2023 and March 2024. Participants: Purposive sampling was used to recruit healthcare workers across the three facilities. Participants were selected to capture the range of relevant roles and experience with eRegister across each facility, and 7, 6 and 5 participants were recruited. Results: Five categories emerged as factors promoting eRegister and data use: system readiness, organisational environment, data value and utility in practice, human resource competency and digital literacy and governance and stakeholder engagement. Conclusion: This study identified critical factors that promote the use of the eRegister and data in Lesotho. The findings suggest that while external funding and partner responsiveness have been pivotal in sustaining eRegister operations, long-term sustainability will require stronger national ownership, including domestic investment in infrastructure, technical support and digital health governance. Future studies should explore the effect of eRegister use on clinical outcomes and examine strategies for scaling up digital health interventions in resource-limited settings.

Background: Performing midwifery care requires competence and confidence because of the profession’s emphasis on independent functioning and professional responsibility. The student midwives generally can manage to plot the symphysis fundal height measurements on charts correctly, but their real learning need is to accurately interpret what the measurements meant in relation to their patients’ due dates and overall pregnancy health. This interpretation is essential for the early detection of potential complications. Aim: To explore and describe lecturers’ perceptions of student midwives’ competence and confidence in performing symphysis fundal height measurements, plotting, and interpreting the results. Setting: The study took place in KwaZulu-Natal College of Nursing, South Africa. Methods: A descriptive, qualitative design was used. Data were collected using focus group discussions from August 2023 to September 2023. Thematic analysis method was used to analyse data. Results: Four main themes emerged namely, perceived significance of symphysis fundal height measurement, the perceived prerequisites enabling competence and confidence, the perceived challenges and barriers to competence and confidence, and the recommendations made to improve the competence and confidence of student midwives. Conclusion: It was the perception of the lecturers that improved competence and confidence of student midwives in the measurement, plotting, and interpretation of symphysis fundal height could lead to the correct interpretation and identification of high-risk pregnancies. Contribution: The findings will guide the curriculum developers and policy makers in the formulation of symphysis fundal height measurement protocols and standard operating procedures, to improve and standardise midwifery skills in this regard.

Background: Final-year nursing students are actively involved in the delivery of public immunisation programmes as part of workplace-based learning, and require adequate knowledge, clinical skills, and attitudes regarding vaccines. This study investigated the knowledge, attitudes and perceptions regarding vaccines of final year nursing students at a South African University. Methods: This cross-sectional study, through the use of an online survey questionnaire, assessed the knowledge, attitudes and perceptions regarding vaccines and the Expanded Programme of Immunization of final-year nursing students registered at a South African University during the 2021–2022 academic year. Results: There were 68 participants enrolled in the study (85% response rate). Participants displayed good knowledge regarding vaccines (average score of 52.54/70 ± 5.01 standard deviation [s.d.]), and overall positive perceptions of their training on vaccines and its safety. Knowledge gaps were identified in the mechanisms through which vaccines confer immunity in the human body and the cold chain requirements for the storage of vaccines. Of concern was the prevalent misconception among 78% of participants that vaccines are not effective. Conclusion: The findings of this study indicate that final year nursing students at the University of KwaZulu-Natal, South Africa have good knowledge regarding vaccines. However, an improved understanding of the mechanism of vaccines will aid nursing students to confront and address misperceptions by clients thereby reducing improving vaccine uptake. Curriculum planners should also consider the inclusion of communication strategies to address vaccine hesitancy. Contribution: The study contributes to data on nurse education regarding vaccines in the African context, and identifies areas to improve vaccine uptake.

Introduction: Evidence from many countries suggests that provision of home and community-based health services, linked to care at fixed primary health care facilities, is critical to good health outcomes. In South Africa, the Ward-Based Primary Health Care Outreach Teams are well placed to provide these services. The teams report to a primary health care facility through their outreach team leader. The facility manager/operational manager provides guidance and support to the outreach team leader. Aim: The aim of the study was to explore and describe the perceptions of facility managers regarding support and supervision of ward-based outreach teams in the National Health Insurance pilot sites in Kwa Zulu-Natal. Setting: The study was carried out in three National Health Insurance pilot districts in KwaZulu- Natal. Methods: An exploratory qualitative design was used to interview 12 primary health care facility managers at a sub-district (municipal) level. The researchers conducted thematic analysis of data. Findings: Some gaps in the supervisory and managerial relationships between ward based primary health care outreach teams and primary health care facility managers were identified. High workload at clinics may undermine the capacity of PHC facility managers to support and supervise the teams. Field supervision seems to take place only rarely and for those teams living far away from the clinic, communication with the clinic manager may be difficult. The study further highlights issues around the training and preparation of the teams. Conclusions: Ward based primary health care outreach teams have a positive impact in preventive and promotive health in rural communities. Furthermore, these teams have also made impact in improving facility indicators. However, their work does not happen without challenges.

There is a rampant increase in diabetes prevalence globally. Sub-Saharan Africa (SSA) is projected to carry the largest burden of diabetes (34.2 million) by 2030. This will inevitably cause a parallel increase in diabetes-associated complications; with the predominant complications being blindness due to diabetic retinopathy and diabetic cataracts. Eye programs in developing countries remain inadequate, existing as stand-alone programs, focused on the provision of acute symptomatic care at secondary and tertiary health levels. Over 60% of people with undiagnosed diabetes report to eye care facilities with already advanced retinopathy. While vision loss due to cataracts is reversible, loss of vision from diabetic retinopathy is irreversible. Developing countries have in the last two decades been significantly impacted by infectious pandemics; with SSA countries committing over 80% of their health budgets towards infectious diseases. Consequently, non-communicable diseases and eye health have been neglected. This paper aimed to highlight the importance of strengthening primary health care services to prevent diabetes-related blindness. In SSA, where economies are strained by infectious disease, the projected rise in diabetes prevalence calls for an urgent need to reorganize health systems to focus on life-long preventative and integrated measures. However, research is critical in determining how best to integrate these without further weakening health systems.

Nigeria contributes the highest to the global burden of HIV/AIDS and also accounts for the largest proportion of new vertically transmitted HIV infections among children. The Mentor Mothers program in the Nigerian Department of Defense was introduced in accordance with the World Health Organization and its implementing partner guidelines to curb the high incidence of vertically acquired HIV infections. Understanding the experiences of participants could serve as a gateway to evaluating the effectiveness of the program to better provide quality services within targeted health facilities. This qualitative study employed key informant interviews with six healthcare workers as well as two focus group discussions with six mentor mothers and six prevention of mother-to-child transmission (PMTCT) patients in four selected hospitals in the Nigerian Department of Defense to explore their experiences of the Mentor Mothers program. A thematic analysis technique was used to analyze the collated data. As a result, four main themes emerged, with the program perceived by most participants as providing psychosocial support to the patients, a valuable educational resource for raising HIV awareness, a valuable resource for promoting exclusive breastfeeding and mitigating vertical transmission of the virus, and functioning as a link between patients and the healthcare system. The participants reported that the program had effectively decreased HIV infections in children, reduced child and maternal mortality, and supported the livelihood and development of women, families, and communities in and around the Nigerian Department of Defense health facilities.