Objective:This Eastern Cape study assessed the awareness, knowledge and perceptions of the healthcare professionals in Mthatha General Hospital on National Health Insurance Scheme (NHIS).Method:A descriptive cross-sectional study was conducted among health professionals at Mthatha General Hospital. A simple random sample of 100 participants drawn across the various categories of health professionals responded to a validated questionnaire on awareness, purpose and challenges of implementation of NHIS.Results:Of the total (N=100), 86 health professionals returned the questionnaire (response rate=87%); 54 female (63%) and 32 male (37%). The majority of the respondents were nurses (67%) and doctors (28%). Others were radiographers (n=2) and clinical associates (2). The majority of the respondents (89.5%) were aware of NHIS and their sources of information on NHIS were: seminars and meetings (n=32), television and radio (n=26), friends and family members (n=14), newspapers (n=10) and internet (n=4). Good understanding of the objectives of NHIS was demonstrated by 81.3% (n=70) of the respondents. The poor state of health facilities and inadequate staffing across the country were reported as the major impediments to the implementation of NHIS. However, the majority of the respondents (n=64) expected that the quality of healthcare service delivery would improve by increasing the staff strength in the various health facilities.Conclusion:The majority of the health professionals in this setting were aware of NHIS. Both the infrastructure and staff strength require the attention of the health authorities in order to effectively implement the scheme in the district.

Background: The use of spinal anaesthesia has increased in the last three decades, given that it is the recommended anaesthetic of choice for better foetal and maternal outcomes in Caesarean section. Failed spinal anaesthesia (FSA) exposes patients to unfavourable experience of pain and the potential complications of general anaesthesia that are being avoided in the first instance. This study determines the incidence and the predictors of failed spinal anaesthesia in pregnant women presenting for Caesarean section at Mthatha General Hospital, Eastern Cape. Methods: This descriptive cross-sectional study included 197 pregnant women scheduled for Caesarean section under spinal anaesthesia at Mthatha General Hospital from May 1 to August 30, 2013. A standard proforma was utilised for data collection on items of demographic, surgical and anaesthetic records of each parturient. The main outcome measure was the incidence of failed spinal anaesthesia (defined as partial or incomplete spinal block requiring conversion to general anaesthesia). Results: The incidence of failed spinal anaesthesia was 11.7%, which was slightly higher in emergency Caesarean sections. In univariate analysis, previous anaesthesia, obesity, dry tap of cerebrospinal fluid (CSF), bloody CSF and duration of work experience less than one year were significantly associated with FSA in the cohort. Conclusion: The study found a high incidence of failed spinal anaesthesia during Caesarean section in this setting. Upskilling of doctors in spinal anaesthesia is urgently needed in the study setting. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1292696

IntroductionBabies born before arrival at a health facility have a higher risk of neonatal death and their mothers a higher risk of maternal death compared with those born in-facility. The study explored the reasons for mothers giving birth before arrival (BBA) at health facilities and their experiences of BBA.MethodsA qualitative research design was used. Individual and focus group interviews of BBA mothers and of nurses were undertaken at a community health centre and a district hospital in King Sabata Dalindyebo Local Municipality.ResultsReasons for BBA included a lack of transport, a lack of security at night that deterred mothers from travelling, precipitate labour, failure to identify true labour, and a lack of waiting areas at health facilities. Traditional and cultural beliefs favouring childbirth at home and nurses’ negative attitudes during antenatal care and labour influenced mothers to go to health facilities when in advanced labour. Mothers were aware of possible complications associated with BBA.ConclusionSocio-economic, individual, cultural and health system factors influence the occurrence of BBA. Relevant parties need to address these factors to ensure that all babies in the King Sabata Dalindyebo Local Municipality are delivered within designated health facilities.

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