The Challenges of Implementing a Health Referral System in South Africa: A Qualitative Study

Introduction

Health system strengthening efforts also entails streamlining an existing referral system in a particular context to improve quality of health care offered to people. Conceptually, the referral system in South Africa, is seemingly sound. Nevertheless, gaps exist in its implementation. The aim of this study was to explore health care professionals' perceptions of referral system implementation in the Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape Province of South Africa.

Methods

This qualitative study included 12 health care professionals as participants. Each participant was interviewed using a semi-structured interview guide; with their consent, the interviews were audio recorded and transcribed verbatim. For data analysis, a thematic content analysis was used.

Results

The participants identified many impediments to the effective implementation of the referral system in BCCM. The main obstacles were deteriorating infrastructure, inadequate staffing, lack of transportation, and inadequate medical supplies and medications.

Conclusion

In mitigation, the participants proposed suggestions such as increasing the capacity of the health workforce, allocating personnel appropriately, increasing the availability of transportation, and providing essential medications to all levels of care. They also suggested involving all stakeholders in the referral process, providing education and training to health professionals on the referral system, and enhancing communication and feedback between the various levels of care. These challenges emphasised in this study highlight the need for targeted interventions to improve the referral system in this setting.

Pharmacological labour pain interventions: South African midwives' perspective

BACKGROUND

Women of childbearing age feel great about giving birth, but the pain could be excruciating depending on their pain tolerances. Midwives requires obstetrical knowledge and skills such as pain management during labour and safety. We explored midwives' perspectives on the utilisation of pharmacological pain alleviation interventions during labour in selected hospitals in Matjhabeng Municipality, Free State province, South Africa. A qualitative study was undertaken, involving a sample of ten midwives, using a semi-structured interview guide. The interviews were audio-recorded and transcribed verbatim. Tesch's open coding data analysis method was applied to analyse the data. The midwives were restricted to use Pethidine and Phenergan prescribed by doctors for labour pain relief, which disrupted labour pain management and obliged them either to wait for a physician or follow telephone instructions. According to the midwives, women taking Pethidine and Phenergan encountered adverse effects and discomfort. Midwives identified high workload, inadequate personnel, lack of skill and knowledge, lack of medication availability, and lack of infrastructure as the primary challenges of administering pharmacological methods to women in labour. The lack of standing orders, which delays the administration of medications pending a physician's prescription, constituted an additional difficulty. In the instance that Pethidine and Phenergan were unavailable or ineffective for some women, the midwives recommended that women be administered alternative pharmacological pain relievers. They also advocated for institutionalization of pharmacological guidelines allowing them to use their discretion when treating labour pain. Midwives can only utilise a few standardised and regulated pharmacological medications for labour pain management. The midwives' ability to administer pharmacological pain relief during labour was hampered by a high workload burden, insufficient staff, lack of skill and understanding, drug unavailability, and inadequate infrastructure. Midwives advocated for supported guidelines that would allow them to treat labour pain at their discretion. Intersectoral stakeholders are required to improve midwife skills and attitudes. Health facilities need to train and supply analgesics to midwives. Midwives ought to be familiar with pharmacological pain relievers.

Barriers to Exclusive Breastfeeding for Mothers in Tswelopele Municipality, Free State Province, South Africa: A Qualitative Study

Despite the numerous advantages of exclusive breastfeeding (EBF), the practice remains infrequently adopted in certain countries and is also associated with context-specific obstacles. Consequently, this study explores the experiences and opinions of mothers about the barriers and support systems of exclusive breastfeeding (EBF), in a bid to promote this practice in the Tswelopele Municipality of the Free State Province of South Africa. In-depth individual, semi-structured interviews were conducted with 16 mothers, using an audio recorder after receiving their permission to record the interviews. The analysis of the collected data revealed that opinions clustered around four topics: mother-related barriers to EBF, baby-related barriers to EBF, support systems to enhance EBF, and complications caused by barriers to EBF. The findings from these themes and sub-themes imply that the maternal factor is strongly influenced by other factors regarding the success or failure of this practice. These include extreme breast discomfort, maternal illness, the fear that the mother's milk supply is insufficient, a lack of understanding about EBF, and the influence of different cultural factors. When mothers encounter difficulties with breastfeeding, these challenges may impede their ability to practice EBF. In addition, while some participants were eager to breastfeed their babies and continued EBF for a period of six months, their infant's health and behavioral issues prevented them from doing so. Some of these problems included infant sickness and crying. From the prenatal to the postnatal period, mothers and their families should have access to breastfeeding education and counseling, along with sufficient time to make informed infant nutrition decisions. During counseling sessions, conversations with these stakeholders should focus on fostering a realistic understanding regarding what to expect when breastfeeding for the very first time, debunking breastfeeding-related misconceptions, and addressing inaccurate information and concerns. In addition, health professionals must be empathic and respectful of the mother's traditions and cultures and must also educate mothers and their families on the importance of EBF. Our list of themes and sub-themes could be utilized to enlighten exclusive breastfeeding challenges and potential mitigation efforts, not only in Tswelopele Municipality, South Africa but also in a number of other geographical contexts.

Perception of Women's Knowledge of and Attitudes towards Cervical Cancer and Papanicolaou Smear Screenings: A Qualitative Study in South Africa

BACKGROUND

Cervical cancer is the most common form of cancer worldwide. Consequently, it is crucial that women are encouraged to undergo interventions early via Papanicolaou (Pap) smear screenings to improve their health. In light of this, this study explored the knowledge of and attitudes towards cervical cancer and Papanicolaou (Pap) smear screenings among women in the Caleb Motshabi district, South Africa. Four focus group discussions were carried out among 19 women. The interviews/discussion were audio-recorded and transcribed verbatim and then analysed thematically. In this regard, seven main themes emerged that provided insight into the perceptions of the participants regarding their knowledge of and attitudes towards cervical cancer and Papanicolaou (Pap) smear screenings. While the majority of participants were aware of cervical cancer and Pap smears, they lacked more specific knowledge of what this cancer is or its related causes. Although some participants had had a Pap smear done, they neither knew how the procedure was done nor the reasons for it. In addition, most mentioned receiving information about this procedure from their peers rather than healthcare workers. Notably, those with previous experience indicated that they had regular screenings. Furthermore, they better understood exactly how it is done. The findings emphasised women's limited knowledge of cervical cancer and Pap smears. It further highlighted the need for sustainable education programmes and mobile clinics to encourage an awareness of and accessibility to this particular type of screening within South African communities. Therefore, intervention strategies that make people aware of this specific cancer and encourage the uptake of Papanicolaou (Pap) smear screenings are crucial, as is the continued advocacy for sustained educational programmes and accessible healthcare services.

Efficacy and positive outcome of physical activity in pregnant women

Background & Objective: Evidence has shown the innumerable benefits of prenatal physical activity practice; therefore, the knowledge pregnant women have, and efforts to sustain the knowledge and encourage them to engage in prenatal physical activity, are desirable. The objective of the study was to assess the knowledge and attitudes concerning prenatal physical activity of pregnant women attending primary health antenatal care clinics. Methods: A cross-sectional study of 1082 pregnant in Buffalo City Municipality, Eastern Cape province, South Africa were sampled from July to October 2019. Socio-demographic and maternal characteristics, and knowledge, attitude and practices towards prenatal activity were obtained. Results: Overall, 62.4% women had high knowledge regarding prenatal physical activity; and half of the women showed a positive attitude toward it (50.1%). The majority of the participants affirmed prenatal physical activity is safe (88.2%) and beneficial for the baby (79.6%). Whilst participants had knowledge of other types of antenatal exercises, 80.9% of the women had no knowledge of swimming exercise. Negative attitudes towards physical activity included the feeling of tiredness (67.7%), lack of interest (64.8%), and inadequate information on physical activity (59.5%). Conclusions: The women had high knowledge of prenatal physical activity, and relatively positive attitudes toward prenatal physical activity. The feeling of tiredness, lack of motivation and inadequate information on physical activity constituted negative attitudes towards physical activity. There is need to provide education and advocacy in the clinical settings; also, interventions to encourage and promote prenatal physical activity in the community and at home are desirable to address the weaknesses identified in this study regarding the women’s knowledge and attitudes concerning prenatal physical activity. doi: https://doi.org/10.12669/pjms.38.8.4911 How to cite this:Okafor UB, Goon DT. Efficacy and positive outcome of physical activity in pregnant women. Pak J Med Sci. 2022;38(8):---------.  doi: https://doi.org/10.12669/pjms.38.8.4911 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Uncovering Barriers to Prenatal Physical Activity and Exercise Among South African Pregnant Women: A Cross-Sectional, Mixed-Method Analysis

Background

The barriers to prenatal physical activity and exercise have been widely reported in the literature, highlighting context-specific challenges. However, generally, research on prenatal physical activity and exercise among pregnant women in South Africa is rare; and particularly concerning the barriers to their prenatal physical activity practice. This study assessed the barriers to physical activity participation among pregnant women in the Eastern Cape, South Africa.

Methods

This was a sequential explanatory mixed method, predominantly quantitative study involving 1,082 pregnant women. A structured self-administered questionnaire on perceived barriers to physical participation was applied to collect quantitative data; while a subset of 15 pregnant women participated in individual in-depth semi-structured interviews to augment quantitative data. Quantitative and qualitative data were analyzed using descriptive statistics and thematic analysis, respectively.

Results

The results of the quantitative analysis presented major barriers: lack of advice on prenatal physical activity and inadequate or conflicting information about prenatal physical activity; tiredness; work commitments; discomfort; lack of time; low energy; non-accessibility to physical activity; lack of financial resources, and safety concerns for the mother and the baby. Qualitatively, the barriers identified relate to four main themes: individual, lack of information, lack of resources, and environmental barriers.

Conclusion

The major barriers cited by the women were tiredness, lack of time, discomfort, and low energy. They also include lack of support, advice and information about prenatal physical activity. The multiple constraining factors responsible for low or non-prenatal physical activity of pregnant women in this setting highlight the need to tailor interventions to address their individual uniquely perceived barriers.

Development and Validation of Prenatal Physical Activity Intervention Strategy for Women in Buffalo City Municipality, South Africa

Women rarely participate in physical activity during pregnancy, despite scientific evidence emphasising its importance. This study sought to develop an intervention strategy to promote prenatal physical activity in Buffalo City Municipality, Eastern Cape Province, South Africa. A multi-stage approach was utilised. The Strength, Weakness, Opportunity and Threat (SWOT) approach was applied to the interfaced empirical findings on prenatal physical activity in the setting. Subsequently, the Build, Overcome, Explore and Minimise model was then used to develop strategies based on the SWOT findings. A checklist was administered to key stakeholders to validate the developed strategies. Key strategies to promote prenatal physical activity include the application of the Mom-Connect (a technological device already in use in South Africa to promote maternal health-related information for pregnant women) in collaboration with cellphone and network companies; the South African government to integrate prenatal physical activity and exercise training in the medical and health curricula to empower the healthcare providers with relevant knowledge and skills to support pregnant women in prenatal physical activity counselling; provision of increased workforce and the infrastructure necessary in antenatal sessions and antenatal physical exercise classes and counselling; the government, in partnership with various stakeholders, to provide periodical prenatal physical activity campaigns based in local, community town halls and clinics to address the lack of awareness, misrepresentations and concerns regarding the safety and benefits of physical activity during pregnancy. The effective implementation of this developed prenatal physical activity by policymakers and health professionals may help in the promotion of physical activity practices in the context of women in the setting.

Perceptions of women of reproductive age towards maternal death in Qaukeni sub-District, Eastern Cape Province, South Africa: A qualitative study

Maternal mortality is a global problem, particularly in developing countries. This study explored perceptions, knowledge and attitudes of women of reproductive age concerning maternal deaths in Qaukeni Sub-District, Eastern Cape Province, South Africa. This was a community-based qualitative study using using in-depth interviews among women of reproductive age. Data was analyzed using thematic analysis. The study found some of the mothers knew the causes, signs and symptoms of pregnancy as well as danger signs during pregnancy such as haemorrhage, sepsis, high blood pressure and complications of unsupervised home deliveries, while others had little knowledge about these signs and symptoms. The participants indicated that using herbal medications during pregnancy could result to serious complications and even maternal death. Women do not attend antenatal care because of the long distances, absence of clinics, shortage of nurses and doctors; thus, predisposing women to deliver at homes with the assistance of traditional birth attendants, who had limited knowledge related to health issues and the Prevention of Mother- to-Child-Transmission programme. The findings indicated that some women are knowledgeable about the causes of maternal deaths during pregnancy as well as the signs and symptoms of pregnancy. Health education during pregnancy and provision of better resources would help improve the maternal health of women in this rural setting.

A comparative analysis of teenagers and older pregnant women concerning maternal and neonatal adverse outcomes in Raymond Mhlaba sub-District, South Africa

Teenage pregnancy has become a common global public health issue, associated with increased risk of obstetric complications and adverse neonatal outcomes. Teenagers are more prone to obstetric complications compared to older women. This study examined the maternal and neonatal adverse outcomes among teenagers, and compared them with older pregnant women. This study extracted maternal and neonatal adverse outcomes from 196 medical records of women delivered at Fort Beaufort Hospital from April 2017 to March 2018. Teenagers developed anaemia (13%) and pre-eclampsia (2.1%) during pregnancy as compared to older pregnant women. Most of the women delivered through normal vertex, although the teenagers had the highest percentage of caesarean section (27%) compared to the older women. Few proportions of women developed complications during delivery, however, obstructed labour (14.7%), prolonged labour (11.5%), foetal distress (14.8%) was more prevalent in teenagers. Most neonates were delivered at preterm birth and were alive across all age groups. However, few of the preterm births (23.2%) and very premature neonates (7.4%) occurred among the teenager mothers compared to older women. Few neonates had an Apgar score of less than 7 in 1 minute across all age groups. The risk of obstructed labour, prolonged labour, and foetal distress was predominant among teenagers compared to the older women. There was high incidence of vaginal deliveries, preterm babies and low Apgar score among teenagers compared to the older women. The findings of this study revealed that the teenagers start booking at the second trimester, which may impose the risk of complications if not observed at an early stage. There was high incidence of vaginal deliveries, preterm babies and low Apgar score among teenagers compared to the older women. Programmes to support early antenatal bookings for teenagers are important to address adverse maternal complications associated with late antenatal bookings.

Providing physical activity education and counseling during pregnancy: A qualitative study of midwives' perspectives

Background

Midwives have a strategic role to inform, educate, and encourage pregnant women to maintain an active lifestyle during pregnancy.

Aim

This study explored a cohort of midwives' perspectives on providing prenatal physical activity education and counseling during pregnancy.

Subjects and Methods

Seventeen midwives participated in semistructured interviews which were audio-recorded and transcribed verbatim. A thematic analysis approach was applied to the transcribed qualitative data.

Results

Midwives rarely provide physical activity education and counseling to pregnant women, citing lack of knowledge on which physical activity to recommend, and the duration and intensity of the physical activity as reasons. Walking is the only physical activity recommended during antenatal sessions. Barriers to providing physical activity education and counseling include shortage of midwives, busy work responsibilities, nonavailability of exercise equipment, and nonprioritization of antenatal physical activity. The midwives also cited overwhelming work responsibilities resulting in extreme fatigue rendering them hardly able to counsel the women. They advocated for the introduction of exercise classes in antenatal health care and the training of midwives on exercises to improve the uptake of midwives' knowledge regarding prenatal exercise and their engagement with pregnant women during antenatal consultations.

Conclusions

The midwives lacked knowledge of physical activity during pregnancy and rarely provided such education and counseling. They advocated the need for training and workshops on maternal physical activity. Our findings suggest that physical activity should be integrated into the midwifery/nursing curriculum to empower midwives and other health providers to offer evidence-based physical activity education and counseling to women during antenatal health care as part of the primary health-care service.

Physical Activity Advice and Counselling by Healthcare Providers: A Scoping Review

Background: Despite scientific evidence on prenatal physical activity and exercise, synthesized evidence is lacking on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers. The scoping review seeks to fill this gap by synthesizing available literature on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers to women during antenatal visits. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) search framework for scoping reviews was applied to retrieve original research articles on the prenatal physical activity and exercise practices of healthcare providers with pregnant women, published between 2010-2020, and available in English. The search databases included Google Scholar, PubMed, Science Direct, Scopus, EMBASE, The Cumulative Index for Nursing and Allied Health Literature (CINAHL), BIOMED Central, Medline and African Journal Online. Studies that fulfilled the eligibility criteria were retrieved for analysis. Results: Out of the 82 articles that were retrieved for review, 13 met the eligibility criteria. Seven of the articles were quantitative, four qualitative, one mixed-method and one controlled, non-randomised study, respectively. Three themes emerged as major findings. Healthcare providers affirmed their responsibility in providing prenatal physical activity advice and counselling to pregnant women; however, they seldom or rarely performed this role. Major barriers to prenatal physical activity and exercise included insufficient time, lack of knowledge and skills, inadequate or insufficient training, and lack of resources. Conclusion: This review highlights salient features constraining the uptake of prenatal physical activity and exercise advice/counselling by prenatal healthcare providers in both community and clinical settings. Prenatal physical activity advice and counselling are key components to the promotion of physical activity adherence during and post-partum pregnancy; this requires adequate knowledge of physical activity prescriptions and recommendations, which are personalised and contextual to environment. Research is needed to examine the prenatal physical activity advice and counselling from prenatal healthcare providers on issues hindering effective delivery of the aforementioned in the context of promoting prenatal physical activity in clinical or community settings.

Physical Activity in Pregnancy: Beliefs, Benefits, and Information-Seeking Practices of Pregnant Women in South Africa

Background

Notwithstanding the benefits of physical activity (PA) during pregnancy, anecdotal evidence suggests ignorance, unscientific beliefs, and lack of awareness about PA among pregnant South African women.

Aim

This study examined the beliefs, perceived benefits, and sources of information on PA during pregnancy.

Methods

A cross-sectional descriptive study was employed between June and September 2019 using an interviewer-administered questionnaire with 1,082 pregnant women. These women were attending antenatal primary health–care clinics in Buffalo City, Eastern Cape, South Africa. A self-designed questionnaire solicited information on beliefs, benefits, and sources of information regarding PA during pregnancy.

Results

A majority of the participants held positive beliefs concerning PA during pregnancy. They maintained that PA was safe for mother and fetus, improved labor and delivery (93.1%), promoted energy (89.0%), and should be discontinued when tired (76.6%). Most held negative convictions that PA during pregnancy increased body temperature (64.5%) and that pregnancy was a time to rest and refrain from PA (56.5%). Predominantl sources of information received about PA during pregnancy were television, the radio, and other media (70.2%). Most participants were aware of the benefits of PA during pregnancy —— reduction in infant weight (61.4%), lessening of moodiness (90.4), and decreased risk of gestational diabetes mellitus (92.9%), pregnancy-induced hypertension (92.5%), and complications at birth (97.8%), while common negative perceptions included musculoskeletal discomfort (82.7%), and back pain (85.7%). An overwhelming majority affirmed that PA improved self-image (95.7%), sleep patterns (94.2%), and respiratory function (95.8%).

Conclusion

Our findings suggested that women hold positive beliefs and perceive PA as beneficial to their health and the baby; however, they received most of their information from the Internet. Most women regarded pregnancy as a period to relax and rest. Interventions to promote PA during pregnancy are needed.

Applying the Ecological Model to understand pregnant women's perspectives on the modifiable constraints to physical activity during pregnancy: A qualitative research study

The benefits of physical activity (PA) during pregnancy are widely reported; however, PA practice is seemingly not a valued habit among pregnant women attending public antenatal health centres in the Eastern Cape of South Africa. Guided by the ecological model, we sought to explore modifiable barriers to PA among pregnant women.Semi-structured interviews involved a purposive sample of 15 pregnant women. Interview questions were guided by the ecological model constructs at intrapersonal, interpersonal, and environmental level. Thematic analysis was applied to summarise the modifiable barriers to PA during pregnancy.Three main themes emerged, based on the modifiable barriers to PA during pregnancy that belong to the varying Ecological Model constructs. On the intrapersonal level, 5 themes emerged, namely, time-constraint beliefs, feeling of tiredness, low energy, lack of motivation, and a lack of knowledge on benefits and types of PA. Two themes emerged for the interpersonal level, lack of PA advice and lack of information on PA recommendations and guidelines. Another theme defined the environmental level lacking resources. Most themes related to individual factors, which prevent PA-promoting behaviour.Overall, intrapersonal factors relating to tiredness and exhaustion, lack of time beliefs, work and household commitments, and lack of motivation were key modifiable barriers to PA by the women. The findings provide insights into possible interventional strategies to optimise PA during pregnancy among women in this setting. Appropriate knowledge, education and advice on the benefits, types, and intensity of PA in pregnancy are needed.

Physical activity and exercise during pregnancy in Africa: a review of the literature

BACKGROUND

Pregnancy is an important phase in a woman's life, with health status at this stage affecting both the woman and her child's life. Global evidence suggests that many women engage in low levels of physical activity (PA) and exercise during pregnancy despite its beneficial effects. This is particularly the case in Africa.

METHODS

This article reviews the literature on levels of PA and exercise among pregnant women in Africa, highlighting the level of PA or exercise participation during pregnancy in Africa, including types of PA, factors affecting PA, beliefs about and benefits of prenatal activity, advice or counselling on PA during pregnancy in Africa, and PA interventions proposed to promote the uptake of prenatal PA. Electronic search databases used were Google Scholar, Science Direct, Scopus, EMBASE, ERIC, Medline, Web of Science, EBSCOhost, PubMed, BIOMED Central, and African Journal Online. The basic search terms were: 'Physical activity', 'Exercise', 'Pregnancy', 'Pregnant women' and 'Africa'. A total of 40 references were found. On the basis of an analysis of titles, abstracts and the language of publication (other than English), 11 articles were rejected, and 29 articles were fully read, although two had to be rejected due to a lack of access to the full version. Finally, 27 references were included in the review.

RESULTS

Few studies exist on PA during pregnancy in Africa. The limited data available suggests that, compared to the Western world, pregnant women in Africa do not adhere to the recommendations for PA during pregnancy. Levels of participation in PA during pregnancy are low and decline as the pregnancy progresses. The majority of the studies used direct, objective measures to assess PA during pregnancy. Personal and environmental factors such as lack of time, lack of knowledge, inadequate information from healthcare providers, feelings of tiredness and an absence of social support constituted the main barriers to PA during pregnancy. The types of PA participation among pregnant women varied across studies and geographical settings.

CONCLUSIONS

While published data is limited, it seems clear that the participation of pregnant women in PA during pregnancy in Africa is low and declines with advancing pregnancy. There is a need for more studies to examine the dynamics of PA during pregnancy in Africa to guide contextual interventions to improve and promote maternal health on the continent.

Physical Activity Level during Pregnancy in South Africa: A Facility-Based Cross-Sectional Study

Physical activity participation during pregnancy confers many maternal and foetal health benefits to the woman and her infant and is recommended by various health bodies and institutions. However, in South Africa, scant information exists about the physical activity status and its determinants among pregnant women. The aim of this study was to assess the physical activity level and associated factors among pregnant women. This cross-sectional study enrolled 1082 pregnant women attending public health facilities in Buffalo City Municipality, Eastern Cape, South Africa. Information on socio-demographic and maternal characteristics were obtained, and the Pregnancy Physical Activity Questionnaire was used to assess physical activity during pregnancy. Multiple logistic regression analyses were used to assess associations between physical activity and the predictor variables during pregnancy. Adjusted odds ratios with 95% confidence interval were applied to estimate factors associated with physical activity levels. Statistical significance was set at p < 0.05. Only 278 of the women (25.7%) met recommendations for prenatal activity (≥150 min moderate intensity exercise per week). The average time spent in moderate-vigorous physical activity was 151.6 min (95% CI: 147.2-156.0). Most of the women participated in light exercises with a mean of 65.9% (95% CI: 64.8-67.0), and 47.6% (95% CI: 46.3-48.9) participated in household activities. The majority of the women did not receive physical activity advice during prenatal care sessions (64.7%). Factors negatively associated with prenatal physical activity were lower age (<19 years) (adjusted odd ratio (AOR) = 0.3; CI: 0.16-0.76), semi-urban residence (AOR = 0.8; CI: 0.55-1.03), lower educational level (AOR = 0.5; CI: 0.20-0.71), unemployment (AOR = 0.5; CI: 0.29-0.77) and nulliparity (AOR = 0.6; CI: 0.28-1.31). However, prenatal physical activity was positively associated with starting physical activity in the first trimester (AOR = 1.9; CI: 1.06-3.31) compared to other trimesters. The findings of this study demonstrated low levels of physical activity during pregnancy in South Africa. The majority of women did not meet the recommendation of 150 min of moderate intensity activity per week. Light intensity and household activities were the most preferred form of activity. The factors affecting physical activity of women in this present study include lower age, semi-urban setting, low educational level, unemployment and nulliparity. In order to increase activity levels, future work should seek to improve knowledge, access and support for physical activity in pregnant women in South Africa. This should include education and advocacy regarding physical activity for professionals involved in maternal health provision.

Developing a Physical Activity Intervention Strategy for Pregnant Women in Buffalo City Municipality, South Africa: A Study Protocol

Despite global awareness about the importance and health benefits of physical activity (PA) during pregnancy, several studies have reported a low prevalence of PA participation among pregnant women in both developed and developing countries. This means that most pregnant women do not meet the current PA recommended guideline of 150 min of moderate intensity PA per week. The global call to prioritise PA participation levels in the general population necessitates evaluating the factors affecting PA practice. Seemingly, pregnant women mostly from low-to-middle income countries like South Africa are often predisposed to adverse pregnancy outcomes, possibly because of limited access to, and knowledge of, improved pregnancy and health outcomes as a result of PA participation. Physical activity has been sparsely studied among pregnant South African women, and specifically, there is no known study that assesses the PA levels, patterns, beliefs, sources of information, perceived benefits, barriers, attitudes of pregnant women concerning PA and exercise participation; nor one that explores the perspectives of healthcare providers regarding prenatal PA in the Eastern Cape Province. In addition, no PA intervention strategy exists to promote PA participation in the region. This study, in attempting to fill these gaps in knowledge, adopts two phases. In Phase I, a concurrent mixed-method (quantitative and qualitative) approach assesses the following factors related to PA participation in pregnant women: participation levels, beliefs, attitudes, perceived benefits, barriers to uptake and sources of information. It further ascertains if healthcare professionals are sufficiently informed about PA and if they are advising pregnant women about the need for PA participation during pregnancy. Data will be collected through a structured questionnaire, interviews and focus group discussions. Information on socio-demographic and maternal characteristics will be obtained, and the Pregnancy Physical Activity Questionnaire (PPAQ) will assess PA during pregnancy. A sample size of 384 pregnant women is the required minimum sample for an infinite population at a confidence level of 95%, a precision level of ± 5% and at a prevalence of PA or exercise during pregnancy of 50% (p < 0.05); however, a sample size larger than the minimum number necessary will be recruited to account for possible attrition and to protect against possible data loss. Data will be analysed using a multiple logistic regression to determine the factors that predict sedentary or moderate PA levels and chi-squared analysis to determine the associations between the PA levels of the participants and socio-demographic and clinical variables. The study will assess the data collected on the above-mentioned variables and draw conclusions based on patterns and themes that emerge during analysis. Phase II of the study focuses on strategy development and validation to facilitate the promotion of PA during pregnancy. The developed strategy will be validated through the application of the Delphi technique and the administration of a checklist to selected key stakeholders through organised workshops. Understanding the level and correlates of PA participation among this special population is fundamental to designing intervention strategies to enhance their understanding of, and participation in, PA and exercise. Furthermore, this study's findings will inform facility-based healthcare providers about the need to integrate health education on PA and pregnancy into antenatal and postnatal care visits in the setting.

Screening for Cardio-Metabolic Risk Factors Among Student Nurses: A Cross-Sectional Study

Non-communicable diseases are a growing public health phenomenon in both developed and developing countries. This study examines the prevalence and correlates of cardio-metabolic risk factors among student nurses at a nursing college in East London, South Africa. The WHO STEPwise standardized questionnaire was used to collect information on socio-demographic data and behavioural characteristics (smoking, alcohol consumption, physical inactivity, and dietary intake) of 228 nursing students. Height, weight, waist circumference, blood pressure and fasting blood glucose were measured. The prevalence of overweight, obesity pre-diabetes and diabetes was 33%, 44%, 6% and 7%, respectively. Pre-hypertension and hypertension occurred in 44% and 11%, respectively. Female gender and increasing age were independent predictors of obesity. In the logistic regression model analysis, participants who were above 35 years [AOR=9.12, CI 3.37-24.68, p&lt;0.000], female [AOR=4.10, CI 1.94-8.64, p=0.000], and do not meet the WHO sport criteria of physical activity participation [AOR=2.11, CI=1.10-4.07, p=0.025] had the likely odds of obesity. Interventions targeting physical activity and healthy lifestyle behavioural programmes to promote the health and wellness of the nursing students would improve the metabolic health of the nurses in the setting.

Elevated Blood Pressure of High Altitude Dwelling Andibila Adults in Oju, Nigeria

OBJECTIVE: To examine the blood pressure of high altitude dwelling Andibila adults in Oju, Nigeria. METHODS: A cross-sectional survey of 121 Andibila adults living at a high altitude in Oju, Benue state, Nigeria. Body mass, stature, girths (waist and hip circumferences) were taken using standard procedures. Blood pressure (BP) measurement was assessed twice, and the average recorded. Participants with a systolic blood pressure (SBP) of &ge; 140 and diastolic blood pressure (DBP) of &ge; 90 were diagnosed as hypertensive. RESULTS: The participants mean age was 49.9 years (SD=16.5. The prevalence rate of elevated pressure was 55.9%. Traditional alcohol use was significantly common in males (49.1%; OR=31.8; 95% CI 7.1 &ndash;143.3; p&lt;0.0001) than females (2.9%). Increase in SBP was significantly associated with increasing age (r=0.198; p=0.0301), WC (r=0.215; p=0.018) and BMI (r=0.242; p=0.008). CONCLUSION: There is need for health education and awareness campaign concerning the risk of elevated blood pressure of lean Andibila adults living in a geographically secluded setting.