Mariette Nel

Knowledge of and attitude towards pain relief during labour of women attending the antenatal clinic of Cecilia Makiwane Hospital, South Africa

Abstract Background This study determined womens knowledge of and attitudes to pain relief during labour. Methods This descriptive study included 151 women, 18 years or older, attending the antenatal clinic of Cecilia Makiwane Hospital. Women were interviewed using a questionnaire that determined their knowledge of and attitudes regarding pain relief. Results The median age of the women was 29 years and most was pregnant for a second or third time. More than half the women (56.3%) indicated that they knew about pain relief and most had received their information from a previous labour experience (56.5%) or from friends and relatives (55.3%). Of the women who had knowledge of pain relief (n=85), 65.9% indicated injections. Half the women (51.7%) believed that they should experience mild pain, however, while 55.7% had experienced severe pain during previous labour and 65.3% of these had found the experience to be unacceptable. Most women (59.8%) who had been pregnant were not told what to expect when in labour. Of those who had been told (n=41), 75.6% found the information useful. The women who had previously delivered in a health facility rated the service received in relieving labour pain as fair (47.3%) and good (31.2%). Most of the women (99.3%) believed that the staff had an important role to play in helping to relieve labour pain. Most of the women (78%) expressed no concern about problems associated with pain relief methods, while a large number (83.4%) expressed little or no confidence in labour pain relief. Conclusion Most of the women gained knowledge regarding pain relief from past experiences or from friends and relatives. Even though the few women who received information about what to expect during labour found the information useful, most expressed little confidence in labour pain relief.

Body weight, eating practices and nutritional knowledge amongst university nursing students, Eastern Cape, South Africa

Abstract Background Health care workers need to be equipped to deal with the increasing obesity and obesity-related morbidity occurring in developing countries. Objectives To assess weight status, eating practices and nutritional knowledge amongst nursing students at the University of Fort Hare, Eastern Cape. Method A cross-sectional descriptive survey was conducted on 161 undergraduate (51 male and 110 female) students of the Department of Nursing Sciences at the University of Fort Hare. Body mass index, waist and hip circumferences and waist hip ratio were determined. Nutritional knowledge and eating practices were investigated by structured interviewer-administered questionnaires. Results Statically, 49.7% were overweight or obese (58.2% of the females; 31.4% of the males) and 65.2% had waist circumferences putting them at risk for non-communicable diseases. Most did not meet the recommendations for intakes from the vegetable group (97.5% ate <3 servings per day), the fruit group (42.2% ate <2 servings per day), and the dairy group (92.6% ate <2 servings per day); whilst 78.3% ate ≥4 serving per day of sugar or sweets. Most consumed margarine, oil or fat (68.3%), sugar (59.0%) and bread (55.9%) daily, but few reported daily intakes of vegetables (12.4%), fruit (23.6%), fruit juice (21.2%) and milk (15.6%). Fewer than 50% knew the recommended intakes for vegetables, fruit, dairy, starchy foods and meat or meat alternatives. Conclusions These nursing students had a high prevalence of overweight and obesity, poor eating habits and inadequate knowledge on key nutrition issues, which may impact negatively on their efficacy as future health ambassadors to the public.

Transformation: are nurse leaders in critical care ready?

Aim  The aim was to determine whether nursing leaders met the criteria for transformational and/or transactional leadership. Background  Many changes have occurred in South Africa and are reflected in the health-care systems. As a result, it has become crucial to source leaders who are able to manage the change process effectively so as to ensure the success and survival of our health-care organizations. Methods  The 45-item Multifactor Leadership Questionnaire (Rater) was completed by 41 respondents out of a population of 121. A proportional stratified simple random sampling technique was used to select the raters of seven leaders. Results  Most nursing leaders role-modelled the culture of the organisation but did not stimulate their followers intellectually and did not demonstrate innovative motivation or individual consideration. Consequently, their followers may exhibit a lack of commitment to collective goals, with detrimental effects on the health-care organisation as a whole. Conclusions and implications for nursing managers  Nursing leaders should be trained to become transformational leaders so as to encourage their followers to become innovative and motivated to render high quality nursing care.AIM The aim was to determine whether nursing leaders met the criteria for transformational and/or transactional leadership. BACKGROUND Many changes have occurred in South Africa and are reflected in the health-care systems. As a result, it has become crucial to source leaders who are able to manage the change process effectively so as to ensure the success and survival of our health-care organizations. METHODS The 45-item multifactor leadership questionnaire (Rater) was completed by 41 respondents out of a population of 121. A proportional stratified simple random sampling technique was used to select the raters of seven leaders. RESULTS Most nursing leaders role-modelled the culture of the organisation but did not stimulate their followers intellectually and did not demonstrate innovative motivation or individual consideration. Consequently, their followers may exhibit a lack of commitment to collective goals, with detrimental effects on the health-care organisation as a whole. CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGERS: Nursing leaders should be trained to become transformational leaders so as to encourage their followers to become innovative and motivated to render high quality nursing care.

Childhood disability population-based surveillance: Assessment of the Ages and Stages Questionnaire Third Edition and Washington Group on Disability Statistics/UNICEF module on child functioning in a rural setting in South Africa

Background Epidemiological information on childhood disability provides the basis for a country to plan, implement and manage the provision of health, educational and social services for these vulnerable children. There is, however, currently no population-based surveillance instrument that is compatible with the International Classification of Functioning, Disability and Health (ICF), internationally comparable, methodologically sound and comprehensively researched, to identify children under 5 years of age who are living with disability in South Africa and internationally. We conducted a descriptive pilot study to investigate the sensitivity and specificity of translated versions of the Ages and Stages Questionnaire Third Edition (ASQ-III) and the Washington Group on Disability Statistics/UNICEF module on child functioning (WG/UNICEF module) as parent-reported measures. The aim of our study was to identify early childhood disabilities in children aged 24–48 months in a rural area of South Africa, to determine the appropriateness of these instruments for population-based surveillance in similar contexts internationally. Methods This study was conducted in the Xhariep District of the Free State Province in central South Africa, with 50 carers whose children were registered on the South African Social Security Agency (SASSA) database as recipients of a grant for one of the following: Care Dependency, Child Support or Foster Care. The researchers, assisted by community healthcare workers and SASSA staff members, conducted structured interviews using forward–backward translated versions of the ASQ-III and the WG/UNICEF module. Results Both measurement instruments had a clinically meaningful sensitivity of 60.0%, high specificity of 95.6% for the ASQ-III and 84.4% for the WG/UNICEF module, and the two instruments agreed moderately (Kappa = 0.6). Conclusion Since the WG/UNICEF module is quicker to administer, easier to understand and based on the ICF, it can be considered as an appropriate parent-reported measure for large-scale, population-based as well as smaller, community-specific contexts. It is, however, recommended that future research and development continues with the WG/UNICEF module to enhance its conceptual equivalence for larger-scale, population-based studies in South Africa and internationally.

Nutritional status of undergraduate healthcare students at the University of the Free State

Abstract Objectives: This study aimed to evaluate the lifestyle habits of South African students preparing for careers in health care that could influence the efficacy of their counselling practices on risk factors for noncommunicable diseases (NCDs) as future healthcare professionals. Design: Cross-sectional descriptive study. Setting and subjects: One hundred and sixty-one students (median age 21.5 years, 75.8% women) enrolled in the Faculty of Health Sciences at the University of the Free State. Outcome measures: Anthropometry was measured and structured questionnaires administered to assess dietary and lifestyle habits. Results: Many students were at risk of NCDs, with 19.8% being overweight or obese (body mass index > 25 kg/m2), 11.8% had a waist circumferences above gender-specific cut-off points, 98.1% consumed < 3 servings of vegetables/day, 58.4% consumed < 2 servings of fruit/day, 83% consumed < 2 servings of dairy products/day, 60% did not eat a beta-carotenerich fruit or vegetable daily, 31% did not eat a vitamin C-rich fruit or vegetable daily, 62% never consumed legumes, 43% reported a high intake of fats and sweets, 11% smoked a median of 3.5 cigarettes/day and 63% consumed a median of three drinks of alcohol/day on a median of four days (95% weekend days) per month. Fifty-nine per cent were active and 39% were very active owing to busy class schedules, but only 32% participated in formal exercise and sports. Conclusion: The poor dietary and lifestyle habits of most participants highlight the need to not just educate, but better empower these students to deal with the growing public health problem of obesity and related NCDs in the country.

Nutritional status of disabled schoolchildren in Bloemfontein (2002-2003)

Objectives: To assess the nutritional status of disabled schoolchildren using anthropometric measures and dietary intake, and to compare estimated energy expenditure with energy intake and body weight.

Rotational conjunctival flap surgery reduces recurrence of pterygium

We aimed to compare the recurrence rate following primary pterygium surgery using two different techniques, i.e. simple conjunctival closure (SCC) and rotational conjunctival flap (RCF). Postoperative discomfort and complications were also investigated in these patients.

Assessment of the physical activity, body mass index and energy intake of HIV-uninfected and HIV-infected women in Mangaung, Free State province

Background: Declining levels of physical activity at workplaces, during leisure time and when travelling, accompanied by increasing exposure to the mass media, are major determinants of the global obesity epidemic. This study aimed to assess physical activity, the body mass index (BMI) and energy intake of human immunodeficiency virus (HIV)-uninfected and HIV-infected black women in Mangaung. Method: A random sample of 500 black women was selected in Mangaung. Physical activity levels, dietary intake and BMI were determined in younger and older women, aged 25–34 and 35–44 years, respectively. Results: Of the 488 women who qualified for participation, 61% of the younger women and 38% of the older women were HIV-infected. Low physical activity levels were reported in most women, and more than 50% were overweight or obese. The BMI of HIV-infected younger women with low physical activity levels (24.9 kg/m2) was significantly lower than that of the HIV-uninfected younger women (27.2 kg/m2) (p-value 0.02). The energy intake of older HIV-infected women with low physical activity levels was significantly lower (10 090 kJ) than that of the older HIV-infected women in the normal to high physical activity category (14 519 kJ) (p-value 0.03). Conclusion: A more active lifestyle and energy-reduced diet that focuses on food quality could partially address BMI parameters in HIV-uninfected women. Safeguarding a lean BMI in HIV-infected women, by increasing physical activity levels while maintaining current energy intake, with an emphasis on healthy eating practices, could support quality of life.

Agreement between measured height, and height predicted from ulna length, in adult patients in Bloemfontein, South Africa

Objective: To assess the agreement between measured height, and height predicted from ulna length using the Malnutrition Universal Screening Tool (MUST) equations, in adult patients admitted to government hospitals in Bloemfontein, South Africa. Design: Descriptive cross-sectional survey. Setting: Medical, surgical, pulmonary, orthopaedic, cardiovascular and general wards at Pelonomi, Universitas and National Hospitals in Bloemfontein. Subjects: All patients between 19 and 60 years, admitted during a two-week period in March 2015, who gave written informed consent, and were able to stand upright and unassisted, were included. Outcome measures: Standing height (via stadiometer; referred to as reference height), weight and ulna length were measured. Predicted height and body mass index (BMI) were calculated from ulna length using MUST equations, and compared with reference height and BMI by 95% confidence intervals (CI) and Bland–Altman analysis. Results: The sample comprised n = 200 participants (48% female; median age: 42 years: 32–51 years). The median height estimated from ulna length (170.2 cm; range: 154.2–213.0 cm) was statistically significantly (95% CI [7.1; 7.7]) longer than the median reference height (163.9 cm; range: 145.1–188.4 cm). The Bland–Altman analysis indicated that the 95% limits of agreement between the two methods ranged from –19.8 to 5.7 cm. Median BMI based on estimated height (20.1 kg/m2) was significantly (95% CI [–1.9; –1.6]) lower than median BMI calculated from reference height (21.8 kg/m2). Conclusion: Height predicted from ulna length with the MUST equations overestimated height in this population. This may be related to high prevalence of stunting in the South African population. The discrepancy may have clinical implications particularly for critically ill patients. Strong message: Estimations of height based on upper body long-bone measurements may not be reliable in populations with a high prevalence of stunting.

Nutritional environment at secondary schools in Bloemfontein, South Africa

References Objective: The objective was to determine the nutritional environment at secondary schools in Bloemfontein, Free State province. Design: This was a cross-sectional, descriptive study. Subjects and setting: The subjects were secondary school principals in Bloemfontein, Free State province, in 2006. Method: Principals of 10 secondary schools who were already participating in a larger study on 26 schools completed structured questionnaires on nutrition practices. Results: Four schools utilised nutrition education programmes. None had vending machines. Two schools sold dairy products. Biscuits and chocolates were sold at eight schools, and sweets, crisps and fast food at all of the schools. Conclusion: The nutrition environment at Bloemfontein secondary schools does not support healthy eating habits. Nutrition policies need to be introduced to improve the nutritional environment at schools as the available food for learners at the tuck shops and/or via the vendors was mostly unhealthy.